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 .

Panelists  Nick Banatvala, Sean Maguire, Barbara Hoffmann, and Kjeld Hansen at the Lung Health Matters side event.

NEW YORK – Although chronic respiratory diseases (CRDs) are the third leading cause of death globally, there remains a ‘mismatch’ between impact and action, said a group of global health leaders and experts on the sidelines of the 80th UN General Assembly.

“There is a mismatch between the disease [impact] from CRD and the action against it. CRD lags behind in awareness and attention, and so far, we don’t have any specific targets,” said Barbara Hoffmann, Chair of the European Respiratory Society (ERS) Advocacy Council, at the event Wednesday, Lung Health Matters – Accelerating Progress towards UN NCD targets.”  

The high-level side event, sponsored by the Permanent Mission of Malaysia and the Government of Romania, focused on the enormous societal costs of CRDs and their main risk factors, and actions that can be taken to prioritize lung health and preventative measures, through political commitment, resource mobilization, and greater integration of lung health issues into environmental policies. 

Some of the most common CRDs are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.

“Lung health is absolutely essential to personal well being. It’s essential for our economies and for our ability to thrive as societies,” said Hoffmann.  In the WHO European Region, which includes some 53 nations extending from the British Isles to Central Asia and Russia, CRDs are the sixth leading cause of death.

Unveiling the Political Declaration on NCDs 

The event came on the eve of the Fourth UN High-Level Meeting on Noncommunicable Diseases (NCDs), where the United States blocked the consensus approval of a new Political Declaration for the Prevention and Control of NCDs, despite overwhelming approval by almost all other UN member states. The  declaration will now be brought for a vote in the UN General Assembly in October. See related story:

BREAKING: UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus

Taking the long view, the lung health experts who gathered also noted the ‘missed opportunities’ within the declaration, especially in regards to respiratory health and air pollution. 

“While there are things to celebrate in the declaration, there’s also actually quite a lot of missed opportunities in that document. It’s not as strong as it could be, or it should be, around the challenges that air pollution presents to health and in particular, particular to respiratory health,” said Sean Maguire, Executive Director of Strategic Partnerships of the Clean Air Fund. 

In particular, Maguire called out the absence in the declaration of any reference to fossil fuels as a leading air pollution source. Nearly one-half of all deaths from COPD and 19% of deaths from lung cancer are attributable to air pollution exposures,  according to the latest Global Burden of Disease data from the Seattle-based Institute of Health Metrics and Evaluation. 

Deaths from lung diseases attributable to environmental risks (including but not only air pollution) as compared to behavioural and metabolic risks.

“Burning fossil fuels is really at the heart of what causes so much air pollution. So unless we’re honest about the challenges, we’re not going to succeed. We’re not going to meet our SDG targets, and we’re not going to reduce the health work of air pollution.” 

Lack of Defined Targets for CRDs Despite Being Preventable and Manageable 

Barbara Hoffmann speaking on results from the WHO Europe-ERS Report into CRDs in the WHO European Region

In addition, unlike other major NCDs, CRDs lack robust global targets, both in the new political declaration as well as in WHO global action plans, which are essential to supporting country prioritization, measuring progress, and benchmarking. This includes the recent landmark resolution, “Promoting and prioritizing an integrated lung health approach,” which was formally adopted at the 78th World Health Assembly this past May.

The lack of defined targets for CRDs also means that governments may not assign it sufficient priority in national health planning. 

In comparison, there are five global diabetes targets, three global targets on hypertension control, targets for reducing the burden of several types of cancers and three targets tackling HIV/AIDS, through increased access to prevention, diagnostics, and treatment. 

“These CRDs are largely preventable and manageable, yet no specific targets have been formulated, and the action to prevent and match them remains weak,” she says, citing a recently released WHO European Region report on CRDs, co-developed with the Respiratory Society.  

The report recommends that countries consider adoption of national-level targets for COPD and asthma to ensure advocacy, implementation and progress monitoring at country, regional, and global level.

“There is a need for setting targets and for starting disease surveillance, and we need further actions, national plans, awareness raising and education. CRD is largely preventable and manageable, and we know how to do it, and can do something about it,” said Hoffmann. 

Bringing Lung Health to the Forefront in Malaysia 

Muhammed Radzi Jamuludin, the representative of Malaysia and Ambassador to Cuba

Malaysia is one such country that has been making concerted effort in the fight for better lung health, both locally and globally.

“Lung health must be a shared priority,” said Muhammed Radzi Jamaludin, the representative of Malaysia and Ambassador to Cuba, in his opening remarks. 

He highlighted the recent WHA resolution, “Promoting and prioritizing an integrated lung health approach,” which was co-sponsored by Malaysia, together with 15 other WHO member states, which calls for a comprehensive and forward-looking agenda to strengthen prevention, early diagnosis, treatment and control of lung diseases.

Malaysia has also launched the roadmap for the Lung Health Initiative 2025 – 2030, a holistic plan that covers various aspects of lung health, from prevention to treatment, and including palliative care and research. Other efforts to address lung health issues in the country also included nationwide awareness campaigns, stricter tobacco and vaping regulations, multi-sectoral collaboration to improve air quality, workplace safety, and enhancing screening/early detection.

Air pollution has multiple, cascading health impacts on children.

Jamaludin called on governments for even stronger commitments in order to accelerate progress and achieve UN NCD targets.  

“By firmly placing lung health within the global NCD and sustainable development agenda, we can reduce premature mortality, improve population health and build healthier and more resilient societies.” 

Stronger Governance for Multi-sectoral Action

Nick Banatvala, Head of the Secretariat for the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, also emphasized the need for lung health to be articulated at a national level, especially in development strategies, where multi-sectoral plans can be made. 

“[Lung health] now needs to be well articulated in national health and development strategies. I’m always pushing for development strategies, because that’s where I think we have a big opportunity, because so much of what we’re discussing requires action across a number of different sectors.”

However, this is easier said than done, and as it ‘becomes notoriously difficult to get action’ once other sectors are involved, says Banatvala, using the example of tobacco industry interference. 

The solution lies in stronger governance, he argues. 

“We need to take this political declaration back not to the Minister of Health, because they’ve heard it, but to parliamentarians and say, these are your communities. These are your people. You should be elected or fail to be elected, dependent on whether or not you are sorting out tobacco and air and health services and universal health coverage.” 

Investing in civil society and patient advocacy

Patients, those impacted by CRDs themselves, also need to become more involved in advocacy and policy debates in order to integrate lung health better into the NCD agenda, the experts agreed.

“Some of the best investment is investing in civil society organizations, in grassroots who can make their voice known, to try and get the voice of the patients,” Banatvala said.

Kjeld Hansen, Chair of the European Lung Foundation, spoke about his experiences working and advocating for patients with asthma and other CRDs as a person who himself has lived experience with lung disease. “I understood at that point that if I meet the right people with the right solutions, anything is actually possible,” he said. 

“Civil society actors will come together with the government to help set priorities on different issues. And once you hear it from your constituency, then it’s much harder to strike down the message afterwards. So I would say, bring them into the process.” 

Now the Real Work Begins 

José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases

While final UN approval of the political declaration will now be delayed for a few more weeks, it’s important to focus on the next stages in the process, ”when the resl will begin,” said José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases. 

“What matters now is implementation and advocacy at the national level, turning global commitments into cleaner air, into early diagnosis, into stronger primary care, into treatments for patients, for 650 million people affected by [CRDs].”

Patients impacted by CRDs must be at the heart of this work, “if we are to keep the momentum to ensure that patients see the change,” he emphasized. 

“Let us measure our progress not by the declarations adopted, but by the lives that will be extended and the dignity restored to patients everywhere.”

Image Credits: National Cancer Institute/Unsplash, Raisa Santos, Our World in Data, IHME.

People running
The World Health Organization sees physical activity as a “missed opportunity” in combatting non-communicable diseases.

The statistics are stark. Non-communicable diseases (NCDs), like heart disease, cancer, and diabetes, are responsible for a staggering 75% of non-pandemic deaths worldwide.

This isn’t just a challenge for high-income nations; it’s a crisis that hits low- and middle-income countries the hardest, where 85% of premature NCD deaths occur. It’s clear the traditional approach to healthcare isn’t enough. We need a new strategy, one that empowers individuals and strengthens health systems from the ground up.

This is the promise of self-care, a concept that is now rightfully at the center of the global health conversation. The World Health Organization (WHO) defines self-care as the ability of individuals, families, and communities to promote health, prevent disease, and manage illness. It’s a simple but powerful idea that focuses on empowering people to take an active role in their own health, from managing chronic conditions to getting vaccinated or using digital health tools to monitor blood pressure.

A smarter approach to health

United for Self-Care Coalition team at the sidelines of 80th UNGA.

At first glance, self-care might sound like an individual responsibility, but it’s a powerful public health strategy with benefits that ripple across entire societies. The “Health for All, by All” self-care manifesto launched by the United for Self-Care Coalition on the sidelines of United Nations General Assembly this week champions this very idea, aligning with the new 2025 UN Political Declaration on NCDs. The manifesto argues that by investing in self-care, we can make healthcare more accessible, more efficient, and more equitable.

Consider the potential impact. Self-care interventions can help 150 million more people gain control over their hypertension and help another 150 million more quit tobacco. The numbers aren’t just about saving lives; they’re also about saving healthcare systems from breaking under the strain. By empowering individuals to manage routine health needs, we can free up doctors and nurses to focus on more critical cases. This isn’t bypassing health systems; it’s strengthening them.

And the economic benefits are immense. We’re talking about billions of dollars in annual savings. By 2030, self-care interventions across the board could generate $179 billion in healthcare savings and free up 2.8 billion physician hours per year. In low- and middle-income countries, this could lead to $230 billion in potential gains, fundamentally changing the healthcare landscape.

Our call to action

Self-care isn’t a replacement for professional medical care. It’s an essential partner. It’s about creating a health ecosystem where people have the tools and knowledge to stay healthy, and where healthcare providers can use their expertise most effectively. The manifesto calls on policymakers and Member States to make this a reality by:

  • Providing dedicated investment in self-care infrastructure, including digital health tools, education campaigns, and equitable access to self-care products and tools, with a particular focus on women, youth, marginalized communities, and vulnerable populations.
  • Incentivizing self-care within financing models such as through value-based care, universal coverage schemes, and public-private partnerships.
  • Embedding self-care in health workforce planning allowing care teams to focus their expertise where it’s most needed, while individuals take more control over routine management.
  • Integrating self-care into primary care strategies enabling earlier intervention, better health outcomes, and reduced system strain.
  • Systematically involving patients and people with lived experience in designing, implementing, and evaluating self-care infrastructure, policies, products and tools.

The solutions are ready and realizable. Now is the time to embrace a new approach to global health – one that empowers us all to turn the tide on NCDs, together.

The United for Self-Care Coalition is a global alliance of like-minded organizations dedicated to the common goal: to achieve universal health coverage through codifying self-care as a critical component of the self-care continuum, particularly in the context of managing NCDs.

Image Credits: Gabin Vallet, United for Self-Care Coalition .

WHO Director General Dr Tedros Adhanom Ghebreyesus at the launch of the hypertension report.

World leaders are expected to commit to 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 at the United Nations on Thursday.

These targets are in the final draft of the political declaration set for adoption at the UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health in New York.

Earlier in the week, the World Health Organization (WHO) released its global hypertension report, which showed that 1.4 billion people lived with hypertension in 2024 – yet only around 20% (320 million) had their high blood pressure under control.

“Hypertension is a leading cause of heart attack, stroke, chronic kidney disease, and dementia. It is both preventable and treatable – but without urgent action, millions of people will continue to die prematurely, and countries will face mounting economic losses,” according to the report, released on the sidelines of the UN General Assembly.

WHO Director General Dr Tedros Adhanom Ghebreyesus told the launch that he lived with hypertension, which is controlled by medication: “And that is the great paradox of hypertension. It can be controlled by relatively inexpensive medication.”

However, access to affordable medicine and blood pressure devices were the biggest barrier to controlling high blood pressure, added Tedros.

The report, which draws on data from 194 countries, also shows that only 28% of low-income countries had all five WHO-recommended hypertension medicines readily available in their clinics.

“Barriers span the pharmaceutical value chain, from regulatory systems and medicine selection, to pricing, procurement, prescribing, and dispensing,” according to the report.

Major gaps

Other major gaps in addressing hypertension include weak communication about risks – such as the consumption of alcohol, tobacco, salt and transfat, and physical inactivity.

Some countries had limited access to blood pressure devices, a lack of trained primary care teams, unreliable supply chains and costly medicines.

“Every hour, over 1,000 lives are lost to strokes and heart attacks from high blood pressure, and most of these deaths are preventable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Countries have the tools to change this narrative. With political will, ongoing investment, and reforms to embed hypertension control in health services, we can save millions and ensure universal health coverage for all.”

Dr Kelly Henning, head of Bloomberg Philanthropies Public Health Program.

Dr Kelly Henning, who leads the Bloomberg Philanthropies Public Health Program, told the report’s launch that countries that “integrate hypertension care into universal health coverage (UHC) and primary care are making real progress, but too many low- and middle-income countries are still left behind.” 

Dr Tom Frieden, CEO of Resolve to Save Lives, said that the lives of 50 million people can be saved if the global control of high blood pressure was increased from the current 20% to 50%. He also highlighted that uncontrolled high blood pressure is the cause of one-in-six patients’ dementia.

“It only costs $5 a year to treat a patient with the best medications in the world,” said Frieden. “Twenty-five years ago, South Korea’s hypertension control was 15%. They have increased this to 62% this year … and seen a decline of over 80% in cardiovascular deaths.”

Resolve to Save Lives CEO Dr Tom Frieden.

The report also gives credit to Bangladesh and the Philippines for making significant progress – largely by “integrating hypertension care into UHC, investing in primary care, and engaging communities”.

Low-cost anti-hypertensive medication and limited patient fees in South Korea have enabled the country to improve blood pressure control nationally.

Between 2019 and 2025, Bangladesh increased hypertension control from 15% to 56% in some regions by embedding hypertension treatment services in its essential health service package and strengthening screening and follow-up care.

The Philippines has effectively incorporated the WHO’s HEARTS technical package into community-level services nationwide.

The draft declaration commits countries to scaling up “early screening, monitoring and diagnosis, affordable and effective treatment, and regular follow-up for people at risk of cardiovascular disease or living with high blood pressure”.

Impact of mental health

Social isolation is a risk factor for mental illness and Alzheimer’s.

Meanwhile, over one billion people across the world are living with mental health disorders, according to two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’, released earlier this month.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros. “Investing in mental health means investing in people, communities, and economies — an investment no country can afford to neglect. Every government and every leader has a responsibility to act with urgency and to ensure that mental health care is treated not as a privilege, but as a basic right for all.”

The draft declaration commits to several measures to address mental health, including scaling up “psychosocial and psychological support, and pharmacological treatment for depression, anxiety and psychosis”, particularly at the primary health care level and within general health care services.

It also commits to addressing the stigma associated with mental illness, and the “health risks related to digital technology, including social media, such as excessive screen time, exposure to harmful content, social disconnection, social isolation, and loneliness.”

Weakened declaration

While NCD advocates have welcomed the three “150 million” targets, they have lamented the weakening of language on taxing unhealthy products since the zero draft in May.

As previously reported by Health Policy Watch, the text no longer refers to taxing sugar-sweetened beverages, and describes higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

The zero draft target of “at least 80% of countries” implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages to levels recommended by the WHO by 2030 is completely absent from the final draft.

The declaration has also removed virtually all references to WHO recommendations. This is apparently at the insistence of the United States, which withdrew from the WHO when Donald Trump became president in January, sources close to the talks told Health Policy Watch.

Image Credits: Bruno Martins/ Unsplash.

Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections.

Two Indian manufacturers will be able to mass-produce cheap generic versions of the HIV ‘miracle’ drug, lenacapavir, which almost eliminates HIV transmission via an injection given twice a year – thanks to support from donors.

The Gates Foundation will support Hetero Labs, while Unitaid, the Clinton Health Access Initiative (CHAI), and Wits RHI will support Dr Reddy’s Laboratories. This will reduce the annual price per patient for the two injections to $40, according to simultaneous announcements in New York on Wednesday.

Gates is offering Hetero “upfront funding and volume guarantees”, and Unitaid-CHAI-Wits RHI will provide Dr Reddy’s with “financial, technical, and regulatory support to deliver affordable, quality-assured generic versions of lenacapavir to low- and middle-income countries (LMICs) by 2027, following regulatory approval.”

In clinical trials, lenacapvir eliminated 99% of HIV transmission, making it the closest product to an HIV vaccine.

One study shows that scaling up access to lenacapavir to just 4% of the population in high-burden countries could prevent up to 20% of new infections, according to the Gates Foundation.

It has made more than $80 million available in “catalytic investments” to accelerate market readiness, scale delivery, and shorten the timeline for generic entry of lenacapavir.

End HIV

“Scientific advances like lenacapavir can help us end the HIV epidemic—if they are made accessible to people who can benefit from them the most,” said Trevor Mundel, president of global health at the Gates Foundation. “We are committed to ensuring that those at highest risk, who can least afford it, aren’t left behind.”

“Securing a US$40 price for the twice-yearly lenacapavir injection for PrEP is a historic breakthrough that proves the most advanced tools can be made affordable from the very start,” said Unitaid’s executive director, Dr Philippe Duneton.

In 2024, Gilead Sciences granted royalty-free licenses for lenacapavir production to six generic manufacturers for 120 low- and middle-income countries. Following regulatory approvals, generic lenacapavir will flow through national HIV programs and public procurement channels such as the Global Fund.

On 4 September, the US government announced that lenacapavir’s US manufacturer, Gilead, had made the drug available to the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund at cost.

PEPFAR plans a “market-shaping initiative” to get the drug to some two million people in countries with high burdens of HIV, according to the US announcement.

PEPFAR will focus on using lenacapavir to prevent mother-to-child HIV transmission.

Still ‘far away’

“The deals announced today on generics are a major step forward in ending the HIV epidemic,” said Kate Hampton, CEO of the Children’s Investment Fund Foundation (CIFF), which is also supporting the rollout of lenacapavir via the Global Fund. 

“They build on full value-chain investments by CIFF and others to foster a competitive market so that access to lenacapavir is affordable and reliable for all those who need it.”

“This is a watershed moment. A price of $40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines,” said Winnie Byanyima, executive director of UNAIDS.

Describing lenacapavir as “revolutionary”, UNAIDS pointed out that its current annual price in the US is $28,000 per person.

UNAIDS estimates that 1.3 million people were infected with HIV in last year.

Beatriz Grinsztejn, president of the International AIDS Society, welcomed lenacapavir generics being made affordable, but said “availability in 2027 still feels far away.”

“With the HIV response in a funding crisis, countries are already making difficult trade-offs. To realize the full potential of this innovation, [pre-exposure prophylaxis] options like lenacapavir must reach the most vulnerable people, which requires urgent, additional investment to avoid delays or denied access.”

Meanwhile, a global HIV activist coalition noted that the $40 price will be “restricted to the 115 LMICs and five territories covered by Gilead’s voluntary license” announced  earlier this year.

They called for global access tongenerics, particularly as “over a quarter of new HIV acquisitions occur in the 26 countries and territories that are excluded by Gilead from its license, including Argentina, Brazil, Mexico”.

Image Credits: Gilead, Gilead.

The Elders panel: Pandemic Action Network head Eloise Todd (moderator),  Juan Manuel Santos, former President of Colombia; Mary Robinson, ex-President of Ireland; Zeid Ra’ad Al Hussein, former UN High Commissioner for Human Rights; Helen Clark, former Prime Minister of New Zeland, and Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General.

Despite the massive challenges of climate change, disease outbreaks and conflict, there is a glaring lack of leadership committed to long-term, science-based solutions, former world leaders told a meeting on the sidelines of the UN General Assembly (UNGA) in New York.

“We need leaders who have a long-term view and take decisions that, many times, are unpopular or difficult,” said Juan Manuel Santos, former President of Colombia and chair of The Elders.

“The UN has never met in more difficult times since its creation after the Second World War,” added Santos, calling for reform of the UN to “recover the world order from this present world disorder”.

Mary Robinson, Ireland’s former President, said that leaders need to be in “crisis mode” to tackle climate change and health.

“Some [leaders] are saying extraordinary things, but the science is clear, and it’s vital on climate and health. Somehow leaders are not actually grounding their way forward on science,” said Robinson.

Ireland’s former President, Mary Robinson

Her sentiment was echoed by Helen Clark, the former Prime Minister of New Zealand, who reminded the audience that the world had faced darker times – but conceded that at present “leadership is a missing component”.

Clark stressed that the UN High-Level Meeting on Pandemic Preparedness in a year’s time needs to be a rallying point for countries, who need to address the crises of health and climate together.

“It’s amazing how bereft we are of profound ideas,” said Zeid Ra’ad Al Hussein, former UN High Commissioner for Human Rights.

“Just look at Gaza. It’s emblematic of where the world is today: the enforced starvation of children, and we just sit there and sit there and we denounce and we condemn. Something has to snap, and we have to regain a sense of responsibility.”

Dr Gro Harlem Brundtland, former Prime Minister of Norway and former Director-General of the World Health Organization (WHO) added that world leaders cannot only think about their countries but about the world.

Shortly after The Elders spoke, US President Donald Trump told the UNGA that climate change is the ”greatest con job ever perpetrated in the world”, and that UN climate change predictions ”were wrong” and made by ”stupid people”.

Wellcome CEO John-Arne Røttingen

In a panel after the Elders, Wellcome CEO John-Arne Røttingen said that countries formerly dependent on aid, particularly in Africa, were determined to assume more responsibility for their own systems and capabilities, and this was a positive move.

However, he warned that a focus on national sovereignty ran the risk of undermining the collective action and mechanisms needed to tackle common problems of climate, outbreaks and pandemics.

“Without the mechanisms to look at the leadership, the evidence and the financing we need for the collective problems, we will have big problems coming,” warned Røttingen.

The Gates Foundation’s Dr Chris Elias warned that the current era of “crisis and scarcity” is “incredibly dangerous” as people tend to “focus on what’s in front of you” rather than take a long-term view.

Since the massive withdrawal of donor aid by the US earlier this year, the Gates Foundation has assisted several governments, and most want data and analytics to empower them to determine what they should priotitise.

“The role of philanthropy in a time of both crisis and scarcity is to work closely with countries as they weather this storm and, at the other side, to invest in some of those global public goods that are unlikely to get prioritised by individual countries or even regional bodies at a time of crisis,” said Elias, highlighting the Gates Foundation’s announcement on Monday to invest $912 million in the Global Fund over three years.

US ‘science denial’ is an ‘attack on global health’

Brazil’s Health and Environmental Surveillance Secretary Dr Mariângela Simão.

While several speakers avoided naming the US when lamenting how global priorities have been abandoned and undermined, Brazil’s Health and Environmental Surveillance Secretary, Dr Mariângela Simão, did not mince her words.

“We have attacks on multilateralism. We have attacks on specific countries. And my country is being attacked,” she said.

‘The US government is saying to Brazil that you shouldn’t put in jail in the ex-president [Jair Bolsanero] who tried to do a coup d’etat,” said Simão. 

The US “denial of science” is also an attack on global health, she added. “When denial is becomes a public policy, it affects the world. [There is] an attack on vaccines, and what we see in the Americas is a surge of measles.

“Brazil and our neighbours are all trying to stave off [outbreaks] by boosting up our vaccine coverage. But it doesn’t help when the US says you don’t need to vaccinate newborns against Hepatitis B unless the mother is positive.”

However, Simão said that Brazil, which hosts the next climate COP in Belém later this year, is working on a health action plan that will address how climate impacts on health.

Simão is leading Brazil’s health delegation to the UN after the US restricted Health Minister Alexandre Padilha’s visa to within “five blocks of the UN”. The US has also refused to give visas to the leaders of the Palestinian Authority to attend UNGA.

Preparing for pandemics

Priya Basu, who heads the Pandemic Fund, said there is “huge demand” from countries for support – with demand exceeding available funds five-to seven-fold every time the fund called for proposals.

“We have distributed $7 billion of pandemic prevention, preparedness and response investments across 75 countries in six regions,” said Basu.

These focus on surveillance, laboratory, strengthening workforce, and surge capacity that can be ramped up in crises.

Meanwhile, Felicitas Riedl, director of Innovation and Competitiveness at the European Investment Bank (EIB), said her bank invested in projects that had a “systemic approach” to addressing “health, climate and biosecurity”.

Intergovernmental Working Group (IGWG) vice-chair Madeleine Heywood of Australia and WHO Director General Dr Tedros Adhanom Ghebreyesus at the close of IGWG’s second meeting.

Text-based negotiations on the final piece missing from the World Health Organization’s (WHO) Pandemic Agreement will begin in November – and “relevant stakeholders’ will be allowed to observe them for the first time as a “pilot”.

This was resolved at the second meeting of the WHO Intergovernmental Working Group (IGWG), which concluded last Friday evening.

The Group of Equity proposed to the IGWG that the negotiations be opened up to “relevant stakeholders’, groups that have been formally recognised by the WHO. Several stakeholders have also made this call throughout the Pandemic Agreement negotiations.

Countering misinformation

In its submission to IGWG last week, Knowledge Ecology International (KEI) said: “The secrecy that surrounds negotiations on the WHO pandemic treaty undermines trust in the WHO, and enables misinformation to have more impact.”

It called on the WHO to follow the lead of the World Intellectual Property Organization (WIPO) and webcast all plenary sessions.

“The WHO could do better and allow the sharing of information from informals under the Chatham House rule, so that the public has information about what issues divide negotiators, and why,” KEI added.

There are over 200 stakeholders, according to a WHO list. These include intergovernmental agencies, such as the United Nations, African Union, Pan-American Health Organization and the South Centre. 

Groups with observer status, including the vaccine alliance, Gavi, and the Global Fund, non-state actors in official relations with the WHO and other stakeholders recognised by the WHO can also attend. This opens the door to groups such as the Coalition for Epidemic Preparedness Innovations (CEPI), Drugs for Neglected Diseases initiative (DNDi), KEI, Medicines Patent Pool, Médecins Sans Frontières (MSF) and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

Many of these groups have followed the pandemic agreement negotiations since the start and have frequently asked to observe the actual negotiations, rather than simply being allowed to attend and address plenaries.

WHO Director General Dr Tedros Adhanom Ghebreyesus welcomed the decision, saying that this would “give ownership to all stakeholders” when he addressed the end of the meeting.

Describing last week’s discussions as “substantive and positive”, Tedros said this gave him hope that the talks will be concluded by the deadline of next May.

The meeting discussed the draft outline of elements that need to be addressed by the outstanding annex on a Pathogen Access and Benefit-Sharing (PABS) System, including operation, access, benefit-sharing and governance, scope and use of terms, according to its report.

After a series of informal meetings in the week of 6 October, the IGWG Bureau will prepare a draft of the annex, “taking into account all elements, building on the draft outline of elements and taking into consideration written submissions by IGWG Members, inputs received during the second meeting of the IGWG, and informal discussions”, according to the report.

The actual negotiations will begin later at the third IGWG meeting from 3-7 November and continue at the final meeting of the year from 1-5 December.