ACIP committee vaccine Hep B
The influential Advisory Committee on Immunization Practices (ACIP) recommended delaying initial Hep B vaccine in newborns – reversing 35 years of policy.

A United States vaccine advisory panel, recently reformed to include known vaccine skeptics, voted to eliminate a three-decade-long recommendation that all newborns in the US receive a vaccine to protect against hepatitis B (Hep B) at birth –  a change that was denounced immediately by medical groups like the American Academy of Pediatrics and the American College of Physicians. The recommendation must be approved by the acting director of the Centers for Disease Control and Prevention (CDC). 

The Advisory Committee on Immunization Practices (ACIP), voted 8-3 to revise the US’s childhood immunization schedule for Hep B for the first time since 1991, saying that the shot is no longer necessary for babies born to mothers who test negative for the virus. 

Instead, ACIP recommended that parents delay the first dose to no earlier than two months – and consult with their doctors about whether and when to receive the vaccine.

ACIP vice-chair Robert Malone cited the “cumulative risk” of combined vaccines at birth as a reason for delaying vaccinations. 

But Malone has been criticized for vaccine misinformation. He is one of the new board members appointed by Health and Human Services Secretary Robert F. Kennedy Jr, a vaccine skeptic, following a “purge” of prior board members.

Medical experts urged the panel not to change the schedule 

vaccine Hep B cdc
A screenshot of the CDC’s website as of December 5, showing current evidence in support of Hep B vaccinations.

A long lineup of medical experts who provided feedback to the panel in two days of testimony strongly urged against changing the vaccination schedule, which has been credited with reducing Hep B infections by 99% in the US – preventing maternal to infant transmission of mostly-asymptomatic Hep B. Globally, the vaccine has prevented millions of infections, per Health Policy Watch’s related coverage.

“This vote is an unnecessary solution looking to find a problem to solve. It will only endanger children and increase risk of death for millions,” said Dr Jason Goldman, the President of the American College of Physicians in remarks to the Committee, whose proceedings were livestreamed.

“I would urge that we go back to our true experts who do this all the time, our CDC colleagues. They could have vetted this misinformation before it was presented to the public,” said hepatitis researcher Dr Amy Middleman pointing to discrepancies in remarks made by the Committee. 

The ACIP panel further recommended that instead of sticking to a set three-dose schedule, medical providers should test the antibody levels in infants to determine whether they should receive additional doses – when and if an initial Hep B dose is administered.

The problem with this approach, according to physicians, is that there is no implementation research or cost analysis of doing additional blood draws to back it up.  Without the jab, deadly and debilitating Hep B disease can be transmitted from asymptomatic mothers to newborns at birth who are not routinely screened under the patchwork of health insurance policies and systems that exist in the US today.  Moreover, toddlers and children can also become infected from more contact with infected blood or other bodily fluids at home or in school.

“We should do the studies first to determine if fewer doses are actually effective,” said Dr Judith Shlay, a family medicine specialist, in remarks to the committee. 

Republican senator speaks out against recommendation

It’s now up to the CDC Director Jim O’Neil to decide on whether to formally adopt the ACIP recommendation – and pressure on him is already building.

In a post on X, Senator Bill Cassidy (R-LA), a medical doctor and chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP), urged the acting CDC director to reject the ACIP’s recommendations. Cassidy was a critical vote in confirming Kennedy’s appointment as Secretary of Health and Human Services. 

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake. The hepatitis B vaccine is safe and effective,” he said in a post on X.

“Before the birth dose was recommended, 20,000 newborns a year were infected with hepatitis B. Now, it’s fewer than 20. Ending the recommendation for newborns makes it more likely the number of cases will begin to increase again. This makes America sicker,” he commented. 

Cassidy referred to the drop in US Hep B infections over the past three decades. Now, most cases of Hep B in the US occur in the Appalachian region, which suffers from a higher poverty rate compared to the rest of the country, according to CDC surveillance.

“Acting CDC Director O’Neill should not sign these new recommendations and instead retain the current, evidence-based approach,” Cassidy said. 

Image Credits: CDC.

Clinical trials
The African continent only accounts for 4% of clinical trials globally, jeopardizing the development of new medicines, and demonstrating the chronic underinvestment in the continent’s healthcare ecosystem.

In Kenya, toxicologists and epidemiologists face a difficult choice: to pursue better-paid work to support their families, or volunteer as reviewers for vaccine clinical trials, often without the compensation needed to cover even their children’s school fees.

Their dilemma underscores a broader challenge in Africa’s clinical research ecosystem. Slow, duplicative approval processes and limited regulatory capacity continue to deter sponsors from bringing trials to the continent. The continent accounts for 25% of the global disease burden, but just 4% of clinical trials. 

This “stark disparity” means that access to vaccines, diagnostics, and medicines is “not always guaranteed,” said Caxton Murira, a clinical research expert with the Science for Africa Foundation. 

Yet the continent also represents “enormous untapped potential” for the creation of effective and ethical medicines and vaccines, said Angelika Joos, science and regulatory policy executive at  Merck, and a panelist at the fourth and final event in a series at the annual Africa Regulatory Conference. 

“Africa is critical for advancing science and for ensuring that medicines work for everyone,” she said, addressing the recent webinar, hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). The four-part online conference focused on patient and community engagement, under-represented populations, innovative designs, and lastly, streamlining regulatory processes. 

Creating incentives for reviewers is one of the many ways experts have proposed to improve the continent’s regulatory system for clinical trials. To draw more clinical trials to Africa, panelists urged countries to  harmonize, simplify, and accelerate approvals for regulatory and ethics approvals across the continent. 

A ‘mismatch’ in the R&D pipeline

Africa continent clinical trials
Capacity fragmentation, poor visibility of resources, and a time-consuming regulatory process all hinder Africa’s clinical trial capabilities.

At the heart of the problem is chronic underinvestment. Funding for clinical research and development does not reflect Africa’s burden of disease, Murira noted. This gap spans both infectious diseases, such as malaria and tuberculosis, and noncommunicable diseases (NCDs) like diabetes and heart disease, which are rising as Africa’s population ages.

And while many countries have made significant progress in reducing infectious diseases, NCDs are often neglected in clinical research and trials, Murira argued. 

Globally, clinical trials exceeded $84 billion in market size in 2024, with every dollar invested in clinical research yielding a $405 return. Yet only 4% of the roughly 25,000 trials that occur each year take place on the African continent. 

This mismatch, driven by global market and industry strategies rather than local disease burden, jeopardizes the future of new medicines and demonstrates the chronic underinvestment in the continent’s healthcare ecosystem.  

Experts pointed to capacity fragmentation, poor visibility of resources, and a time-consuming regulatory process as worsening Africa’s clinical trial under-representation. Many countries can host clinical trials – beyond the usual hubs where funding is typically concentrated to such as South Africa, Egypt, Nigeria, Kenya, Ghana, and Tanzania. However, lesser-known sites struggle to compete with established centers.

Networks for collaboration

Clinical trial research Africa
Researchers across the continent, like those at Cape Town’s H3D Foundation, benefit from online platforms that raise the visibility of potential clinical trial sites.

To enhance this visibility, the South African-based start-up, nuvoteQ, has set up an interactive online platform called the Clinical Trials Community (CTC) Africa. 

CTC aims to attract investment in African clinical trials by showcasing the continent’s clinical trialists and research sites, said CEO Adriaan Kruger. 

It is an “interactive platform” that provides a registry of sites, data on site feasibility, and access to country-specific regulatory and ethics information to make it easier for sponsors to find and partner with African research locations. 

“We actively work on providing and building a financially sustainable model so that we can keep these platforms running in the long term,” said Kruger, noting that past initiatives have failed to gain traction.

Efforts to enhance visibility and partnerships are already underway regionally. The Science for Africa Foundation, headquartered in Nairobi, has mapped over 3,500 clinical trial centers, regulatory boards in 55 countries, and 196 ethics committees. The goal, Murira said, is to improve visibility while highlighting gaps that need investment.

“We’ve shifted from asking, ‘What’s your research capacity?’ to ‘How can we use what you have to position you to be a leader on the African continent?’” said Murira, who heads the foundation’s clinical trials and research portfolio. 

Standardizing the process 

Clinical trials IFPMA regulatory conference
Panelists at the final Africa Regulatory Conference discuss potential solutions to optimize clinical trial approvals.

Aside from finding suitable sites for trials, researchers or pharmaceutical companies looking to recruit patients into clinical trials find that the approval process can be duplicative, ineffective, and expensive, said Joos. 

These delays hinder patient access to innovative treatments, and deter researchers from attempting more trials.

Bioethicist Keymanthri Moodley, an emeritus professor at Stellenbosch University, highlighted the lack of standardization – and trust – between research approval boards as impeding the process. 

“One research committee does not trust the competency of another,” Moodley argued. So if malaria vaccine researchers wanted to recruit participants across a national border, they could run into months-long delays for approvals from both countries. Furthermore, both researchers and reviewers are in need of training. 

“We have the tools but we need standardization,” said Moodley, pointing to World Health Organization’s (WHO) Global Benchmarking Tool (GBT) as a helpful metric for evaluating national regulatory authorities (NRAs). 

“There has been so much development at the theoretical level. But the area where we experience challenges is implementation. The continent is heterogeneous. Every country is different, but in general, very few resources are allocated to regulatory authorities and research ethics committees. And so we were always complaining about delays in regulatory approval,” said Moodley, who also served as founding director of a WHO Collaborating Centre in Bioethics.

David Mukanga, deputy director for Africa regulatory systems at the Gates Foundation, echoed these concerns, saying that as research ethics committee members are not paid to review trials, they are placed in a difficult position. 

“If you review 30 protocols in five years, it doesn’t count towards your promotion,” he said. But supervising a PhD student does.” 

This leaves academics juggling teaching loads, exams, and financial pressures while trying to support essential ethical reviews. 

“There needs to be creative incentives for people to be able to commit time and be recognized for their good work in supporting reviews,” he said.

Reducing duplication through regulatory reliance

One solution gaining attention is regulatory reliance – the concept that one country’s drug regulator uses the scientific assessments of another trusted authority. This, in turn, could reduce redundant reviews and shorten approval timelines.

“Leveraging trusted national regulatory assessments reduces duplication, speeds approvals, and fosters collaboration,” said Lada Leyens, a senior director at the pharmaceutical company Takeda. 

The UK’s medicines regulator recently introduced a clinical trial reliance pathway allowing approvals within two weeks when a trusted authority has already assessed the application, Leyens noted. For under-resourced African regulators facing staff shortages and high turnover, reliance could significantly shorten timelines.

Africa’s future

For those working to improve the clinical research and trials ecosystem in Africa, enhancing the visibility of capacity, fostering trust between researchers, regulators, sponsors, and the community, and increasing investments in ethical clinical trials in Africa all remain critical goals. 

“We need to build the capabilities now and the capacities now to position Africa as a key player in the next decade of this global health innovation. It’s about equity, it’s about scientific progress, and it’s about preparing Africa for the future,” remarked Joos. 

 

The webinar, Streamlining regulatory and ethics approvals, was the fourth of a four-part online African Regulatory Conference hosted by IFPMA. All four sessions were recorded and available for viewing.

Image Credits: Eugene Kabambi/ WHO, IFPMA.

San Francisco City Attorney David Chiu briefs the media about the case on Tuesday.

The City of San Francisco has filed a historic lawsuit against 10 ultra-processed food (UPF) manufacturers, seeking “restitution and civil penalties” to help local governments to “offset astronomical health care costs associated with UPF consumption”.

The 10 companies are Kraft Heinz Company, Mondelez International, Post Holdings, The Coca-Cola Company, PepsiCo, General Mills, Nestle USA, Kellogg, Mars Incorporated, and ConAgra Brands, which make the bulk of UPF in the US.

The first-of-its-kind lawsuit, filed on Tuesday on behalf of the people of the State of California, alleges that the companies used “unfair and deceptive acts” to sell and market their products, violating California’s Unfair Competition Law and public nuisance statute. 

Aside from restitution, the City wants the companies to stop using “deceptive marketing” and “take action to correct or lessen the effects of their behavior”. 

“This case is about food products whose ingredients and manufacturing processes interrupt our bodies’ abilities to function. It is about the Defendants – gigantic food conglomerates, all – who designed, manufactured, marketed, and sold these foods knowing they were dangerous for human consumption,” the City argues.

San Francisco City Attorney David Chiu told a media briefing: “They took food and made it unrecognisable and harmful to the human body.”

Comparing the UPF companies’ tactics to those used by tobacco companies, Chui said: “We must be clear that this is not about consumers making better choices. Recent surveys show Americans want to avoid ultra-processed foods, but we are inundated by them. These companies engineered a public health crisis, they profited handsomely, and now they need to take responsibility for the harm they have caused.”

Some of the UPF targeted by the City of San Francisco.

UPF stimulates cravings

San Francisco Mayor Daniel Lurie added: “San Francisco families deserve to know what’s in their food. We’re not going to let our residents be misled about the products in our grocery stores. We are going to stand up for public health and give parents the information they need to keep themselves and their kids safe and healthy.”

The court papers define UPF as “former whole foods that have been broken down, chemically modified, combined with additives, and then reassembled using industrial techniques such as molding, extrusion, and pressurization. 

Some contain additives unique to UPF, including “colors, flavor enhancers, emulsifiers, artificial sweeteners, thickeners, and foaming, anti-foaming, bulking, and gelling agents”. 

These foods are a “combination of chemicals designed to stimulate cravings and encourage overconsumption”. UPF makes up some 70% of food consumed in the US.

The consumption of UPF has been linked to Type 2 diabetes, fatty liver disease, cardiovascular disease, colorectal cancer, and depression.

Protecting communities

“This lawsuit is a critical step toward protecting the health of our communities,” said San Francisco Director of Health Daniel Tsai. “For decades, ultra-processed foods have reshaped our diets. 

“These products are not just unhealthy, they are engineered to be addictive, disproportionately harm low-income communities and communities of color, and contribute to rising rates of chronic illness like diabetes, heart disease, and cancer,”  said San Francisco Director of Health Daniel Tsai.

The City’s court papers also argue that UPF marketing campaigns “disproportionately targeted Black and Latino children, who have been targeted with 70% more ads for ultra-processed foods than their white counterparts”.

The prevalence of diabetes among Black Americans has quadrupled in the past 30 years, and Black Americans are 70% more likely to develop diabetes than White Americans, according to the court papers.

Largest review of UPF

The aggressive marketing of ultra-processed food is one of the drivers of children’s rising obesity.

The court case, the first such action by a municipality, comes a few weeks after the world’s largest review of UPF was published in The Lancet.

The three-part review argues that the rise in UPF “is driven by powerful global corporations who employ sophisticated political tactics to protect and maximise profits”. 

The review stresses that education aimed at individual behaviour change is not enough: “Deteriorating diets are an urgent public health threat that requires coordinated policies and advocacy to regulate and reduce ultra-processed foods and improve access to fresh and minimally processed foods.”

The series provides hundreds of studies to prove its thesis that UPF is displacing long-established dietary patterns centred on whole foods, and this is “a key driver of the escalating global burden of multiple diet-related chronic diseases”.

Using evidence from national food intake surveys, large cohorts, and interventional studies, the review highlights global patterns of “gross nutrient imbalances”. It shows that overeating is driven by the “high energy density, hyper-palatability, soft texture, and disrupted food matrices” of UPFs, and the rise of UPF has led to the consumption of “toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives”.

The Lancet editorial published alongside the review notes that “the rise of UPFs in human diets is damaging public health, fuelling chronic diseases worldwide, and deepening health inequalities”.

“Addressing this challenge requires a unified global response that confronts corporate power and transforms food systems to promote healthier, more sustainable diets.”

The series advocates for a food system based on local food producers, preserving cultural foods and ensuring economic benefits for communities.

Image Credits: City of San Francisco.

Ozempic injection obesity
The widely popular weight loss drugs were recommended for obesity treatment by the WHO, a first for the global agency.

First-ever WHO guidelines recommending the use of glucagon-like peptide-1 (GLP-1) therapies for the treatment of obesity in adults has been issued by the World Health Organization – in what the global health agency said is a “conditional” sign of approval for the cutting edge medications that have become widely popular. 

The new WHO recommendations go well beyond those of its Essential Medicines List (EML) issued in September, which recommended the drugs only for diabetes. 

And the guidelines should have widespread ramifications for policy decisions in countries where the drugs have not yet been approved. Worldwide, more than one billion people are obese, leaving individuals susceptible to a host of health conditions like diabetes, heart disease, and some cancers. 

The highly-sought after drugs, sold under brand names like Wegovy®, Ozempic®, and Zepbound® in the United States, were initially only recommended by WHO for the treatment of Type II diabetes in the EML. In September, the active ingredients of these drugs – not the brand names – were added to the WHO’s Essential Medicines List – which guides national health systems in making medicine procurement decisions. 

Recognizes obesity is a chronic disease

 “The new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, in a statement. “While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”

The WHO did qualify its recommendations, saying endorsement “is conditional due to limited data on their long-term efficacy and safety, maintenance and discontinuation, their current costs, inadequate health-system preparedness, and potential equity implications.”

The drugs should not be used by pregnant women, and should be paired with evidence-based interventions like healthy diets and physical activity, the guidelines also stress. 

Need to assure equitable access

Obesity GLP-1 drugs US
The US comprises the lionshare of GLP-1 drug consumption, with states debating whether to shoulder the costs for Medicare recipients.

With US consumers comprising nearly 75% of current GLP-1 demand worldwide, the “greatest concern is equitable access” to the new treatments, said Tedros, speaking with journalists earlier this week. 

“Without concerted action, these medicines could contribute to widening the gap between the rich and poor, both between and within countries,” he added. 

And even with ramped up production, these drugs would likely only reach 10% of adults who could benefit from GLP medications in the next five years, the WHO said in a press release. Their guidelines recommended that countries and pharma companies implement several strategies to try to expand access, such as pooled procurement, tiered pricing, and voluntary licensing of what are now patented formulations to local manufacturers. 

Writing in the Journal of the American Medical Association (JAMA), this week, a team of WHO directors and advisors argued that “the availability of GLP-1 therapies should galvanize the global community to build a fair, integrated, and sustainable obesity ecosystem.”

Nearly one in five Americans have used a GLP-1 therapy at least once. And nearly one in eight are currently on the medication. Thirteen states already cover the drugs under Medicaid programmes, despite the enormous up-front cost – with others considering coverage.

While the US currently dominates GLP-1 sales, EU countries, China, and India are expected to make up more of the demand for these drugs in the coming years.

So the question remains whether lower-and-middle income countries, which are facing their own accelerating obesity rates, will have the same level of access. These countries still face barriers to basic diabetes care, the initial intent of use of GLP-1 drugs. 

‘Medication alone won’t solve the obesity crisis’

UNICEF and other international agencies singled out the aggressive marketing of ultra-processed food as a driver of rising obesity, especially in children.

Despite the excitement and potential of these drugs, the WHO cautioned that obesity treatment still must be paired with healthy diets and physical activity. 

“Medication alone will not solve the obesity crisis,” said Tedros. “Obesity is a complex disease that requires comprehensive, lifelong care. And it has many social, commercial and environmental determinants, requiring action in many sectors – not only in the clinic.”

These other determinants of obesity, such as a food environment rich in high sugar, fat, and salt foods, mean that the global overweight or obese population is expected to reach 60% by 2050.

Countries in Sub-Saharan Africa, the Middle East, and Latin America will be particularly affected by this surge. 

“Obesity is largely preventable,” said the WHO’s assistant director-general for health promotion and disease prevention, Jeremy Farr. “Yet millions of people around the world face environments that make it easier to gain weight and harder to stay healthy.”

Image Credits: David Trinks, KFF.

The IQ of Indian children exposed to high levels of air pollution was lower than children in areas with low air pollution.

Air pollution not only affects lung health but also brain development in children, according to two studies presented at the World Conference on Lung Health (WCLH) held in Denmark recently.

One study from India found that children living in highly polluted areas scored nearly 20 points lower on the intelligence quotient (IQ) than their peers in cleaner environments, immediately limiting their educational potential and life opportunities.

These findings highlight air pollution as not merely an environmental issue but a global health emergency that threatens children’s futures and severely worsens existing lung disease.

Air quality lowers IQ in children

Zeroing in on the link between airborne particulate matter and cognitive ability, new findings from the Kalinga Institute of Industrial Technology (KIIT) in India suggest a significant and close association between children’s IQ development and long-term exposure to ambient air pollution.

The KIIT study, published in the WCLH abstract book, examined the impact of particulate matter PM2.5 and PM10 (particulate matter with a diameter of 2.5 and 10 micrometres) on the cognitive development of children aged 6-8 in the state of Odisha in India. While the effects of air pollution on lung and cardiovascular health are well documented, this research represents a pioneeringl look into its potential to disrupt cognitive development in children.

Setting up a comparative analytical study, researchers assessed two sites between July and December 2022: one with high pollution levels (PM10 above 60 micrograms per cubic metre and PM2.5 above 40 micrograms) and one with low pollution. Children who had lived within a 1.5 km radius of air quality monitoring stations for six years were tested, using Malin’s Intelligence Scale for Indian Children, which measures full-scale, verbal, and performance IQ.

The results were stark. Mean Full-Scale IQ in high-pollution areas was 80.33 compared to 98.12 in low-pollution areas. Children from high-pollution areas had a verbal IQ of 81.60 compared to 99.68 in low-pollution areas, and a performance IQ of 79.02 compared to 96.55 in cleaner areas.

The authors conclude that long-term exposure to air pollution is closely linked to poorer cognitive development in children. The report further suggested that the child’s age and weight, poor kitchen ventilation, maternal education, and family income also made an impact on full-scale IQ, painting a picture of multiple interacting risk factors.

Air pollution affects the poorest the most

“The burden of air pollution and climate change on health is one which sadly continues to grow. And, as with many other determinants of health, it is the world’s poorest who are the most affected,” said Professor Guy Marks, president of the International Union Against Tuberculosis and Lung Disease (The Union).

“New strategies are urgently needed globally to ensure no one’s future is limited simply because of the air they breathe.”

The Union was established in 1920 as the world’s first global health organisation and works towards a world free of tuberculosis and lung disease. Its members, staff, and consultants work in more than 140 countries globally. 

Asthma attacks increase in West Africa

Separately, a direct link between air pollution and the severity of asthmatic conditions in adolescents has been reported in a new study by the Centre Hospitalier et Universitaire de Pneumo-Phtisiologie (CNHUPPC) in Cotonou, Benin, in West Africa.

In Cotonou, where air pollution systematically exceeds World Health Organisation (WHO) thresholds for all pollutants, researchers followed a cohort of 730 asthmatic adolescents over 36 months. The study reported that over one-third 37% of the adolescents experienced at least one respiratory event or asthma attack.

Measuring individual exposure via portable air quality sensors carried in backpacks and fixed sensors in schools and homes, the researchers determined that the adolescents with frequent respiratory events had higher levels of exposure to several pollutants, including nitrogen dioxide, PM1, PM2.5 and PM10. 

The study also noted that asthma symptoms occurred 2.5 times more during the seasonal harmattan period when a cool, dry and dusty wind blows, usually between December and March. This highlights the compounding effect of climate-related atmospheric changes. 

“Fine particulate air pollution remains very high in West Africa and poses a serious risk to the respiratory health of adolescents with asthma who are chronically exposed,” said Dr Attannon Arnauld Fiogbé, chest physician and clinical researcher at CNHUPPC. He suggested that strengthening responses by combining air quality alerts with therapeutic education could significantly improve respiratory health.

Air purifiers in schools 

Proposing a tangible solution to mitigate some of the exposure, Professor Anant Sudarshan from the University of Warwick in the UK, advocates for targeted intervention in schools, especially for low-income communities. 

“Introducing appropriately sized air purifiers in all government schools may be a good policy. Children spend a significant share of their day in classrooms, and any reduction in pollution exposure can have large health benefits,” Sudarshan told Health Policy Watch. 

“This is most important for the poor who cannot afford to purify air at home or who live close to traffic or industry,” Sudarshan added.

Sudarshan explained that children spend roughly one-third of their day at school for two-thirds of the year – around 17% of their lives – so cleaning up the air just in schools could cut a child’s annual pollution exposure by approximately 17%.

This reduction is considered vital because PM2.5 has been shown to have similar effects on cognitive behaviour and productivity as CO2 buildup, impacting both short-term alertness and long-term development. 

For policymakers grappling with this crisis, the evidence is now clear: the fight for lung health must integrate immediate, robust action to protect the cognitive and life-long potential of the world’s children.

Image Credits: Akshar Dave/ Unsplash.

A technician at the Biomedical Research Institute in South Africa, which is training African scientists. Investing in regional health systems is essential to ensure global development.

As the world navigates a pivotal moment in global health and development, one of the most critical pathways to sustainable development is through regional public health. Investing in regional health systems and production capacity of public health goods isn’t just a moral responsibility; it is an economic imperative. 

A 2020 McKinsey & Company report revealed that every $1 spent on health in developing countries can yield a return of $2 to $4, underlining the impact of strategic investments in health. 

When the COVID-19 pandemic brought the world to a standstill, it not only revealed critical failures and fragilities in the global response to public health crises but also highlighted the inextricable link between health and development. 

It caused the first rise in global poverty in a generation, triggered the deepest global recession since the end of World War II, and widened inequalities within and across countries, particularly for the most vulnerable. 

The unequal access and distribution of medical countermeasures between wealthy nations and low- and middle-income countries left millions around the world without life-saving vaccines, overwhelmed healthcare systems, and led to the loss of lives. 

Over-centralized, top-down response

Beyond the human and economic costs, the pandemic exposed a troubling reality: An overly centralized, top-down global response is inadequate when crises arise. The failure of initiatives like the COVID-19 Vaccines Global Access (COVAX) to ensure equitable vaccine access for poorer nations exemplified these weaknesses. 

In response, regional institutions stepped up. The Caribbean Public Health Agency (CARPHA) mobilized resources to support member states in their COVAX participation. Similarly, the Association of Southeast Asian Nations (ASEAN) launched the Vaccine Security and Self-Reliance initiative to boost regional procurement and stockpiling. 

In Africa, the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) created the African Vaccine Acquisition Task Team, securing enough doses to cover a third of the continent’s population. 

Historically, public health outbreaks like HIV, TB, malaria, Ebola, SARS, dengue, Zika, mpox, and COVID-19 have demonstrated that public health threats do not respect borders. When a nation or region cannot adequately prepare for, prevent, or respond to these threats, it poses significant risks for the rest of the global community. 

Around the world, regional agencies like the Africa CDC, CARPHA, the European Centre for Disease Prevention and Control (ECDC), the Gulf CDC and the, yet to be established, ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), are emerging as powerful models for tackling cross-border health challenges and fostering regional countries’ cooperation and a platform for future south-south collaboration – through shared responsibilities, knowledge exchange, data-sharing, and pooled resources. 

In the face of recent disruptions, regional bodies continue to show their indispensable role in shaping a more resilient and coordinated global response. 

The Africa CDC’s declaration of the 2024 mpox outbreak as a Public Health Emergency of Continental Security before the World Health Organisation (WHO) – making it the first of its kind in the agency’s history – illustrates the power of regional leadership. 

This catalyzed the rapid mobilization of resources, collective will, and interventions to contain the outbreak and protect vulnerable populations.

 Likewise, ASEAN convened and activated regional action quickly during its 2024 mpox outbreak, while in 2021, the European Union (EU) established the Health Emergency Preparedness and Response Authority, bolstering regional capacity to respond to health emergencies and ensuring access to vaccines, diagnostics, and therapeutics. 

Together, these highlight the transformative potential of regionally anchored strategies, and the crucial need for them as central players – not just in crisis response, but in ongoing efforts to coordinate, respond, and sustain recovery – not as mere beneficiaries but as essential actors. 

Equity and resilience

Strong regional public health mechanisms should be the key engines for equity and resilience. Although the world has taken a significant step forward with the adoption of the Pandemic Agreement to improve coordination, transparency, and equity, it is not enough. 

Challenges persist, especially the power dynamics that favor wealthier countries in decision-making and in controlling vaccine rights and distribution. By contrast, empowering regional health systems to produce vaccines, therapeutics, and diagnostics locally can help address these inequities. Such efforts can create ripple effects – enhancing human capital, creating jobs, and stimulating economic growth.

The African Vaccine Manufacturing Accelerator (AVMA) financing initiative, designed to unlock up to $1.2 billion over the next decade, reinforces this shift toward self-reliance. 

Moreover, regional institutions are vital for advancing equity by increasing the negotiating leverage of marginalized or less powerful states in global health governance. 

For instance, the Pandemic Agreement’s provision and voting rights for regional organisations such as ASEAN, the AU and the EU illustrate the importance of regional voices. 

The Africa CDC’s role in galvanizing a unified African position during the negotiations emphasizes how regional bodies strengthen collective influence. 

The lesson is clear: Robust regional public health systems not only promote equitable representation on the global stage but also serve as mediums for self-sufficiency and health sovereignty. 

These qualities are key to building resilient health systems capable of weathering overlapping global shocks and shifting geopolitical priorities. Given these promising developments, there is a compelling argument for establishing a Latin American CDC to enhance the region’s capacity to coordinate and respond to outbreaks effectively – a proposal worth exploring. 

Public health is a public good, and it must be viewed not as charity but as a strategic investment in our shared future. Building resilient, equitable, and well-resourced regional health systems, backed by strong political will, is essential for stability and shared prosperity. 

By prioritizing this approach, we take a step toward transforming the global health architecture and creating a more equitable and healthier future.  

Michael Weinstein is the president and co-founder of the AIDS Healthcare Foundation (AHF), the largest AIDS health organization in the world, whose mission is to provide cutting-edge medicine and advocacy regardless of ability to pay.

Mehdi Jomaa is the former Prime Minister of Tunisia (2014-2015) and a member of Club de Madrid, a forum of former democratic presidents and prime ministers who leverage their experience and global reach to strengthen inclusive democratic practice and improve the well-being of people around the world.

Image Credits: Kerry Cullinan.

Dr Gitau Mburu, first author of the new WHO guidance on infertility.

One in six people of reproductive age will be affected by infertility, yet health services to address this are “severely limited” and largely funded out-of-pocket, according to the first ever global guideline  on the issue by the World Health Organization (WHO).

“In some settings, even a single round of in vitro fertilization (IVF) can cost double the average annual household income,” WHO notes.

“Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Millions face this journey alone — priced out of care, pushed toward cheaper but unproven treatments, or forced to choose between their hopes of having children and their financial security. “

Tedros encouraged countries to adopt the guideline, giving “more people the possibility to access affordable, respectful, and science-based care”.

Basic prevention

The guideline includes 40 recommendations, starting with “basic prevention first” then advancing to more expensive options, scientist Dr Gitau Mburu, first author of the report, told a media briefing.

The starting point is basic education sessions at the primary health care level about issues that can affect fertility, including age, untreated sexually transmitted infections, alcohol and tobacco consumption.

“Informing people about fertility and infertility early can assist them in making reproductive plans,” the WHO notes in a media release.

Much of the guideline outlines the clinical pathways to diagnose and treat common biological causes of male and female infertility. 

“It provides guidance about how to progressively advance treatment options from simpler management strategies – where clinicians first provide advice on fertile periods and fertility promotion without active treatment – to more complex treatment courses such as intrauterine insemination or IVF,” according to the WHO media release.

The guidance also recognises that infertility can lead to depression, anxiety and social isolation, recommending ongoing psychosocial support for all those affected.

The report is based on information from 95 countries, only half of which have policies on infertility, Mburu said.

The recommendations address male and female infertility, Mburu said, adding that men are responsible for 45.1% of infertility. 

However, in many cultures, women are blamed if they don’t fall pregnant – and 36% of women with infertility face intimate partner violence. 

Dr Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing.

“The prevention and treatment of infertility must be grounded in gender equality and reproductive rights,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing.

“Empowering people to make informed choices about their reproductive lives is a health imperative and a matter of social justice.”

She stressed that people delaying having children should not be equated with infertility, which the WHO defines as the “failure to achieve pregnancy” after 12 months or more of regular, unprotected sex.

A health worker vaccinates a young child against measles

Although global immunisation efforts have led to an 88% drop in measles deaths in the past 25 years, measles cases are surging worldwide, according to a new report from the World Health Organization (WHO).

Last year, 59 countries reported large or disruptive measles outbreaks – almost triple that in  2021 and the highest since the onset of the COVID-19 pandemic.

There were an estimated 11 million infections in 2024, which is nearly 800,000 more than pre-pandemic levels in 2019.

The measles cases increased by 86% in the WHO Eastern Mediterranean region, 47% in the European Region, and 42% in the South-East Asian Region in 2024, when compared with 2019. 

However, the African Region experienced a 40% decline in cases and 50% decline in deaths over this period, partly due to increased immunisation.

“All regions except the Americas had at least one country experiencing a large outbreak in 2024. The situation changed in 2025 with numerous countries in the Americas battling outbreaks,” according to the WHO media release.

The WHO also highlighted that “deep funding cuts” to country immunisation programmes and the Global Measles and Rubella Laboratory Network (GMRLN), which tests samples, may “drive further outbreaks in the coming year”.

More than 30 million children were under-protected against measles in 2024 – three-quarters of them in the African and Eastern Mediterranean regions, often in fragile, conflict-affected or vulnerable settings.

Around 84% of children received their first dose of the measles vaccine last year, and only 76% received the second, according to estimates by the WHO and UNICEF.

At least 95% coverage with two measles vaccine doses is required to stop transmission and protect communities from outbreaks.

“Measles has resurged in recent years, even in high-income countries that once eliminated it, because immunization rates have dropped below the 95% threshold,” according to the WHO.

“Even when overall coverage is high nationally, pockets of unvaccinated communities with lower coverage rates can leave people at risk and result in outbreaks and ongoing transmission.

“To achieve measles elimination, strong political commitment and sustained investment is

needed to ensure all children receive two doses of the measles vaccine and surveillance systems.”

The Immunization Agenda 2030 (IA2030) Mid-Term Review, also released on Friday, stresses that measles is often the first disease to resurge when vaccination coverage drops.

Growing measles outbreaks are exposing weaknesses in immunization programmes and health systems globally, and threatening progress towards IA2030 targets, including measles elimination.

By the end of 2024, 81 countries (42%) had eliminated measles. In 2025, 96 countries had eleiminated measles with the addition of Pacific island countries, Cabo Verde, Mauritius and Seychelles. 

While the Region of the Americas regained measles elimination status in 2024, it lost this status again in November 2025 due to ongoing transmission in Canada.

Image Credits: WHO/John Kisimir.

Ambassadors Caroline Bwanali-Mussa of Malawi, Leslie Ramsammy of Guyana and Matthew Wilson of Barbados.

Millions of girls miss school each month when they menstruate, as their families cannot afford sanitary pads or tampons – something that a Geneva-based diplomatic effort is seeking to address.

Ambassador Matthew Wilson of Barbados described improving access to menstrual as a “global moral imperative” at a meeting of diplomats this week. 

“[Caribbean] surveys show that one in four girls have missed school due to lot of menstrual products, and over 30% of low-income households struggle to purchase them regularly,” Wilson told the meeting, hosted by the Permanent Missions of Barbados, Canada, and Malawi to the United Nations in Geneva, the Sanitation and Hygiene Fund (SHF), and the Global Center for Health Diplomacy and Inclusion (CeHDI).

“The unmet need for menstrual hygiene products in Africa is very high,“ said Zimbabwe’s  Ambassador Ever Mlilo, quoting recent research which showed that almost 75% of women and girls lacked access to these products in Burkina Faso, 70% in Ethiopia, and 65% in Uganda. 

Tax codes

Demonstration against taxes on period products in Ghana.

One of the first steps towards ensuring affordable and accessible menstrual hygiene products is getting a separate tax code for these products.

Currently, menstrual products are lumped with disposable nappies and other products deemed luxury items, which has made it difficult to implement tax breaks, speakers told the meeting.

The World Customs Organization (WCO) assigns Harmonized System (HS) codes to goods, enabling tracking of their use as well as any taxes and tariffs levied.

“Menstrual products don’t have a dedicated HS category. Single-use products are grouped together with diapers, wipes and other tissues, making it very difficult to even understand the types of tarriffs that these products are subject to, because they’re not classified,” said the  Sanitation and Hygiene Fund’s Adrian Douglas.

The WCO meets every five years to revise the HS classification, with a meeting planned for next year, and the Canadian government has been leading efforts to get an HS code for menstrual products.

International standards

Distributing free period products to teens.

Another avenue for diplomatic pressure is ensuring that the International Organization for Standardization (ISO) sets standards for menstrual products. 

“Menstrual products do not have an ISO standard yet, and it’s caused all kinds of challenges  in importation, challenges in ensuring quality, and it’s been one of the barriers that has prevented new innovations from reaching users,” said Douglas.

“There are heavy metals present in nearly all the menstrual products that are on the market today,” he added, pointing out that getting ISO standards on these products was expected by 2027.

“Today, in low and middle income countries alone, the annual value of the menstrual product market is $28 billion. So there’s a lot of convincing arguments to be made to include private sector to attract the additional investment.”

Afripads, a social enterprise based in Uganda that is making and distributing sanitary products, has reached seven million women and girls across 40 countries in the last 15 years, Afripads CEO Michelle Tjeenk Willink told the meeting.

“One of our main focuses is that if you tackle menstrual health, girls miss far less school and are more likely to graduate, more likely to continue to be financially active, economically active in work. So we always track [impact] in terms of school days, and we’ve given back more than 20 million school days to girls,” said Tjeenk Willink.

Import tariffs

Demonstration in Malawi- elimination of taxes on menstrual products ‘didn’t immediately translate into lower prices.’

“The Caribbean is extremely import dependent, particularly for menstrual hygiene products,” Wilson said. 

“Any shifts in global trade dynamics, production costs, and supply chain disruptions have immediate and significant consequences on the affordability and access of these products in our region. 

“So when import costs rise due to tariffs elsewhere, due to factors entirely outside of our control, prices increase at the community level, potentially undermining years of progress that have been made to reduce period poverty.”

While Barbados, Guyana, St Lucia and Trinidad and Tobago have removed VAT or reduced taxes on menstrual products, this has not been enough to guarantee lower prices.

“While VAT is being removed in many countries, not all taxes are removed. There are other kinds of taxes, like excise taxes, that are still applied,” said Ambassador Leslie Ramsammy of Guyana.

Earlier this year, Guyana removed all taxes on feminine hygiene products, but the country is still affected by tariffs and import taxes.

Wilson urged his diplomatic colleagues to engage WCO, the World Trade Organization (WTO) and other multilateral forums “to ensure that menstrual products are clearly delineated, have clear HS codes ascribed to them, are included as essential goods and that they’re considered for exemption from escalating tariffs.

“This is critical, not just for our region, but for millions of women and girls cannot afford to bear the burden of trade policies beyond their control.”

Malawi’s Ambassador Caroline Bwanali-Mussa agreed that “some tax reforms alone have not been enough”. 

In 2022, Malawi eliminated import duties and excise taxes (VAT) on pads and menstrual cups but this “did not immediately translate into lower prices”, she said.

Instead, Bwanali-Mussa said that “harmonised trade systems can unlock dignified, affordable access to menstrual products for all who need them”.

She also reminded the meeting of a 2024 United Nations Human Rights Council resolution which called on member states to ensure universal access to affordable menstrual products, including by “eliminating or reducine all taxes on menstrual products” and supporting those “living in economic vulnerability with free or affordable options”.

Image Credits: Teenn4Teens, CeHDI, Teens4Teens, Teens4teens, Afripads.com.

G20 leaders met in South Africa over he past weekend.

For the first time, the G20 Leaders’ Declaration explicitly references the Lusaka Agenda  – a significant milestone for developing countries that have long called for a fairer global health architecture. This acknowledgement gives political weight to an agenda that places integrated health systems, universal health coverage, and national leadership at the center of global health reform.

But a reference alone is not enough. Commitments must translate into action. With donor funding in decline and health needs growing more complex, G20 countries – and other nations – must deliver on the Lusaka Agenda: strengthen primary health care, secure sustainable domestic financing, and build resilient systems that protect the most vulnerable. Health is not a cost – it is the smartest investment. G20 countries have both the responsibility and the capacity to act together.

We stand at a pivotal moment in global health. The era of fragmented, disease-specific programs has shown its limitations. People live with multiple conditions, and health needs are increasingly interconnected.

Most low- and middle-income countries are ready and capable of taking greater responsibility for their populations’ health. But fragile states and those affected by conflict face unique challenges that demand global solidarity. These countries must remain a priority in efforts to strengthen health systems and ensure access for all.

We cannot afford to repeat the mistakes of the past. Fragmentation has left millions underserved. Today,  countries must act together to protect the most vulnerable and champion integration over division.

The Lusaka Agenda: A blueprint for change

The Lusaka Agenda is the result of a country-led process initiated in Africa and endorsed globally. It was developed through consultations with governments, regional bodies such as the African Union and Africa CDC, and global health partners, and was formally launched at the Conference on Public Health in Africa (CPHIA) in Lusaka in November 2023. Since then, it has been recognized by WHO, supported by Gavi and the Global Fund, and now referenced in the G20 Leaders’ Declaration—a milestone that gives it political weight and global legitimacy.

The Agenda calls for a fundamental shift in how global health is organized. 

First, it urges countries and partners to prioritize primary health care as the foundation of health systems, ensuring that essential services are accessible to all and integrated across disease areas. 

Second, it emphasizes the need to strengthen resilient and integrated health systems, moving away from fragmented, vertical programs toward approaches that respond to people’s real needs rather than donor-driven priorities. 

Third, it calls for sustainable domestic financing, encouraging countries to increase public health spending and embed health as a core investment in national budgets. 

Finally, it seeks to foster coherence across global health initiatives, reducing duplication and aligning efforts under a unified vision for universal health coverage.

The essence of the Lusake Agenda

At its core, the Lusaka Agenda is a call for equity, self-reliance in the production of medical products, and nationally led health systems—both in Africa and globally. Countries in the Global South are already leading this transformation, supported by regional institutions like the African Union and Africa CDC. 

They bring ownership, political will, and a young, dynamic population ready for change. But leadership must be matched with investment.

Examples from around the world show this is possible: the Philippines funds universal health coverage through health taxes on tobacco and alcohol; Rwanda has embedded cancer screening into primary care; and Jordan integrates non-communicable disease care with infectious disease treatment for refugees. These points demonstrate that integration works – and that reform cannot wait.

Why reform cannot wait

Global health has achieved extraordinary gains. Child mortality has halved since 2000. Millions of lives have been saved through vaccines, infectious disease treatment, and stronger health systems. Norway has been proud to contribute, through Gavi, the Global Fund, the Global Financing Facility, and other funds and initiatives.

But success has come at a cost. Vertical programs have created fragmentation. While HIV, TB, and malaria patients often receive quality care, millions with chronic diseases die undiagnosed. Every year, hundreds of thousands of children die from preventable conditions like asthma, pneumonia, diarrhoea and diabetes. 

Air pollution alone claims eight million deaths annually, more than half a million of them children. These are not inevitable tragedies; they are failures of access. The treatments exist. They are affordable. Yet they do not reach those who need them most. This is not inefficiency – it is injustice.

Shared leadership: Norway and South Africa

South Africa, through its G20 Presidency under the theme “Solidarity, Equality, Sustainability”, has elevated priorities that matter: universal health coverage, primary health care, and non-communicable diseases. 

Norway, as a G20 guest country this year, stands firmly alongside South Africa in these efforts. Both nations share a commitment to sexual and reproductive health and rights (SRHR), a cornerstone of equity and resilience. Together, we champion integrated health systems that protect the most vulnerable and deliver care for all.

South Africa’s leadership also extends to health sovereignty. The Johannesburg Process – supported by Norway, the World Health Organization (WHO), Gavi, and others – is strengthening local production of vaccines and medicines, including the mRNA technology transfer hub in Cape Town. 

For Norway, this is about more than technology; it is about resilience, preparedness, fairness and economic growth. By investing in regional manufacturing capacity, we help ensure that lifesaving tools reach those who need them most, when they need them. Investment in production creates jobs and revenues for States to build their own sustainable societies.

Driving reform and building resilience

Norway contributed to building the global health system we have today, investing billions in vaccines, disease control, and maternal and child health. But we also helped shape a system that became too vertical and fragmented. Now it’s time to reform this system towards the future. 

As Minister of International Development Åsmund Aukrust stated at the Oslo seminar in September: “Norway will continue delivering on our promise of 1% of GNI to official development assistance. Public health and strengthening health systems remain a priority. We will work to ensure universal health coverage in low-income countries, where we protect the vulnerable and marginalized—especially children and youth.”

Norway’s leadership is not only financial. It is political and strategic. We will champion integration and equity, support WHO’s coordination role, fund country-led priorities, and ensure that children and vulnerable populations come first.

As the world moves from negotiation to implementation of the Pandemic Agreement, Norway is proud to have helped secure this landmark deal. Together with partners, we are now focused on turning commitments into action, strengthening preparedness, building surge capacity, and ensuring equitable access to countermeasures. 

The Pandemic Fund, which came out of G20 and Norway supports, is a critical instrument for financing readiness and response. These efforts are not separate from health systems. They are part of making them stronger, more resilient, and better able to protect future generations.

 Smarter, fairer health financing

We need systems that make smarter, transparent and evidence-based decisions about resource allocation. It is unsustainable to overspend on one disease while ignoring others that kill just as many – or more. Inequality in spending must be addressed. Children and youth must come first. The most vulnerable must be shielded, not only from illness but from financial ruin caused by health costs. Universal Health Coverage (UHC) is not just a moral imperative. It is an economic one.

For many countries, the costs of strengthening health systems are rising as chronic, non-communicable diseases become more prevalent. These illnesses not only strain health budgets but also impose heavy social and economic burdens: parents unable to work because they care for chronically ill children, and adults sidelined from the workforce due to long-term conditions. This is a drag on productivity and national development.

Strengthening domestic resource mobilization, through good budgeting practices, improved tax systems and a broader tax base, is essential for sustainable health financing. 

Fiscal measures such as taxes on tobacco, alcohol, sugary drinks, and pollution are powerful tools to fund health and promote healthier societies. At the same time, initiatives like the Johannesburg Process contribute directly to strengthening local production and pandemic preparedness. These are investments in sovereignty and resilience.

WHO should coordinate

The WHO is uniquely positioned to play a central coordinating role in this transformation. As the only global health body with a constitutional mandate to coordinate international health work, WHO should guide the implementation of the Lusaka Agenda. 

This includes helping align global health initiatives with country priorities, developing practical tools for integration, and supporting national systems to deliver care based on real needs. WHO should act as a convener and facilitator—championing equity, integration, and country ownership across all levels of the global health architecture.

Call to action

The G20 has a unique role in shaping global health priorities and mobilizing resources. Its collective influence can drive reforms and keep health at the center of sustainable development.

However, words alone are not enough. At the G20 Health Ministers’ meeting in Polokwane earlier this month, a joint declaration could not be agreed on because two countries opposed the text. 

Yet all other G20 members and invited countries supported it—a strong indication of consensus and momentum. Now, that momentum must translate into action.

As the Norwegian Minister of Health and Care Services stated in Polokwane: “We need bold action: we must move from a Lusaka Agenda to Lusaka Deliverables, Lusaka Timeline, Lusaka KPIs—and most important: Lusaka Results.”

Acting together is essential. We must put the health of the most vulnerable first. The tools exist. Resources exist. What is needed now is political will—and the courage to act.

Stine Håheim is Norway’s State Secretary for International Development. She has also served as Deputy Minister in the Ministry of Foreign Affairs, and as a Member of Parliament (2013-2017). She trained as a teacher.

Usman Mushtaq is Norway’s State Secretary for Health and Care Services. A medical doctor by training, Mushtaq was preciously the Vice Mayor for Labour, Integration, and Social Services in Oslo.