Delegates at World Health Assembly’s Committee A after it adopted the pandemic agreement by vote in May.

Regulating pharmaceutical companies that manufacture essential health products during a public health emergency is a key flashpoint between developed and developing countries ahead of the final round of talks on the pandemic agreement.

This is evident in some of the 17 submissions made to the Intergovernmental Negotiating Working Group (IGWG), which is coordinating the final phase of the talks. These talks begin on 15 September and focus on an annex to the pandemic agreement adopted at the World Health Assembly (WHA) in May. 

The annex deals with a pathogen access and benefit-sharing (PABS) system. It will outline how information about pathogens with pandemic potential is shared in a safe, transparent, and accountable manner, and how those who share information will benefit from products that are developed as a result.

Many countries in the global South want any sharing that they do to be on condition that they get benefits from products made as a result. It stems from the bitter experience of these countries during the COVID-19 pandemic, when countries like South Africa shared details of the Omicron variant only to face travel sanctions rather than access to vaccines.

Hours and hours of negotiations failed to secure agreement on PABS, which was then kicked down the road in an annex, enabling the WHA to adopt the deal. However, with less than nine months until the next WHA, it remains unclear whether member states will be able to reach a compromise.

The IGWG only has about seven months of negotiating time as the PABS annex has to be completed by 17 April 2026 to meet the deadline of submission to the World Health Assembly in May 2026, according to WHO legal officer Steven Solomon.

Group of Equity submission

The recent submission by the Group for Equity, a powerhouse interest group of 33 developing countries, wants manufacturers that are part of the PABS system to grant the World Health Organization (WHO) “non-exclusive licenses that can be sub-licensed to manufacturers in developing countries” during a public health emergency of international concern (PHEIC) and a pandemic. This would enable them to make vaccines, diagnostics and therapeutic products.

The Group believes that manufacturers in developing countries that provide pathogen materials and sequencing information should be the primary beneficiaries of such licenses.

They also want such a license to “include provision of the full regulatory dossier, technical know-how, and any necessary materials”. 

Two diseases – polio and mpox – are currently designated as PHEICs by the World Health Organization (WHO). 

If the Group’s proposal were adopted, it would mean that manufacturers in mpox hotspot countries that share information – such as the sequencing of the new mpox clades – could obtain licenses to produce any vaccines and therapeutics that develop as a result.

The Group of Equity includes countries with significant capacity to produce pharmaceutical products, including Bangladesh, Brazil, China, India, Indonesia, Malaysia, Thailand, Mexico, South Africa, Ethiopia and Egypt.

Voluntary contracts

Wealthier countries, primarily in Europe, now that the US is no longer part of the WHO, have sought to protect the intellectual property rights of their pharmaceutical companies and provide wide access to affordable medical products.

However, the European Union’s submission to the IGWG, a mere three pages, mainly summarises what the annex should cover, rather than proposals. But it does state that the key instrument for benefit-sharing should be “contracts with participating manufacturers (which are both legally-binding and voluntarily concluded)”.

Meanwhile, China has suggested that the access pharmaceutical manufacturers get to the PABS system should be “contingent” on their home country being a party to the Pandemic Agreement, as previously reported by Health Policy Watch. 

This would exclude US manufacturers, as the US withdrew from the WHO when the Trump administration assumed office on 20 January.

According to China,  the annex should “specify qualification criteria, boundaries of liability, and both financial and technical benchmarks” for manufacturers, and “make these contingent on whether their home state is a party to the Pandemic Agreement”.

Aside from deciding on PABS, the IGWG will prepare the ground for the Conference of the Parties that will govern the pandemic agreement, and the terms of reference for a coordinating financial mechanism, which will help defend countries against outbreaks and pandemics.

Image Credits: WHO.

The number of people living with mental health disorders around the world is on the rise, according to the World Health Organization (WHO).

Over a billion people across the world are living with mental health disorders, a slight but significant increase over the numbers from the last time the data was collected in 2000, with anxiety and depression being the most prevalent conditions.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations, according to the latest data released Tuesday by the World Health Organization (WHO).

These key findings are contained in two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’.

Mental health disorders are prevalent across all countries and communities, affecting people across age and income groups, the reports found. The prevalence of mental health disorders is also rising. While there are some signs of progress, greater investment and action is needed globally to scale up mental health services, experts said during the report’s release.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “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.”

Globally, one in every seven people lives with a mental health disorder.

Apart from being the second biggest cause of long-term disability, after back pain, and contributing to loss of healthy life, mental health disorders are also driving up healthcare costs for affected people and families.

Women are disproportionately affected

Mental health disorders are more common among women than they are among men, according to the latest data.

While the prevalence of mental health disorders can vary by sex, women are disproportionately impacted.

“Since depression and anxiety are by far the most common mental health conditions, and since these are more common among women, the overall picture is that women have more mental health conditions,” said Dr Mark Van Ommeren, head of WHO’s Department of NCDs and Mental Health.

Anxiety, depression and eating disorders are the most common mental health disorders among women. ADHD and substance use is more common among men.

One extreme outcome of mental health disorders is death by suicide. There were an estimated 727,000 deaths by suicide in 2021 alone, making it a leading cause of death in young people across all countries and socioeconomic contexts.

Reduction in suicide rates is still far from the target.

While the United Nations Sustainable Development Goals (SDGs) aimed to cut down these deaths by a third before 2030, on the current trajectory, only a 12% reduction is likely to be achieved by that deadline.

The number one billion too has made an appearance for the first time. Ommeren said that the last time the data was reported was in 2000 when the number of people affected by mental health disorders was less than a billion.

“One would expect an increase, but there’s actually a bigger increase than the increase in the world population,” Ommeren said.

The reports also made it clear that the economic impacts of mental health disorders are staggering. Much of this is indirect cost in the form of lost productivity. For instance, depression and anxiety alone cost the global economy an estimated US$1 trillion each year, according to WHO data.

Investment continues to lag, workforce gap remains

WHO wants countries to focus on community-based models of care though that is not yet widespread.

While many countries did improve their mental health services post-pandemic, including taking actions like strengthening their mental health policies, laws and planning, it has not been not enough.

Investment has also stagnated. Median government spending on mental health remains at only  2% of total health budgets — unchanged since 2017. There is a huge spending of disparity between low-income countries and high-income countries.

While high-income countries spend up to $65 per person on mental health, low-income countries spend as little as $0.04.

“We see, for example, high-income countries spending a little less than 5% of their health budgets on mental health, whereas in low lower-income countries, it’s more like 1% so a threefold difference. And if you start looking at the actual dollar amounts, then the differences become much starker,” said Dr Daniel Chisholm, mental health specialist at WHO’s Department of NCDs and Mental Health.

There is no ideal amount to spend, experts said, but if low-income countries too spend about 5% of their overall health budget on mental health disorders, that is likely to go a long way.

Reform in how mental health services are being provided is also progressing very slowly.

Less than 10% of countries have fully transitioned to community-based care models recommended by WHO and other experts, with most countries still in the early stages of transition. Most of the inpatient care continues to rely heavily on psychiatric hospitals, with nearly half of admissions occurring involuntarily and over 20% lasting longer than a year.

Silver lining

WHO has called for an equitable financing of mental health resources.

WHO has been pushing countries to expand primary healthcare and integrate mental health services into primary care. Latest data suggests that 71% of countries are now meeting at least three of the five WHO criteria for doing so. However, data gaps remain; only 22 countries provided sufficient data to estimate service coverage for psychosis.

Most of the countries now report having functional mental health promotion initiatives such as early childhood development, school-based mental health and suicide prevention programmes. Over 80% of countries offer mental health and psychosocial support as part of emergency responses, up from 39% in 2020.

Outpatient mental health services and telehealth are also becoming more available, though access remains uneven.

While there is an extreme shortage of mental health workforce in low-and middle-income countries with the global median number of mental health workers at 13 per 100 000 people, small improvements have been registered.

“We see pretty modest but definitely some positive signs of increased availability of specialized mental health workers, like psychiatrists, of course, psychologists, nurses who work in mental health space, social workers,” Chisholm said. “So that’s a slightly more encouraging sign, rather than the stagnation in the estimated expenditure levels,” he added.

Dr Daniel Chisholm, mental health specialist at WHO’s Department of NCDs and Mental Health speaking at a press conference to mark the release of the two reports.

The latest data thus shows that countries remain far off track to achieve the targets set in WHO’s Comprehensive Mental Health Action Plan for the years 2013-2030.

“We need urgent systemic transformation of mental health systems worldwide, and this includes sustained investment in mental health workforce and services, a decisive shift toward community-based, person-centered care as part of universal health coverage, legal and policy reforms that uphold rights and dignity,” said Dr Dévora Kestel, director at WHO’s Department of NCDs and Mental Health.

The reports include data from 144 countries, are an attempt to provide policy makers with the most up-to-date global data on the prevalence, burden, and economic cost of mental health conditions. They are meant to inform national strategies and shape global dialogue ahead of the United Nations High-Level meeting on NCDs and promotion of mental health set to take place in New York on 25 September.

Image Credits: Joice Kelly/ Unsplash, WHO.

A healthworker takes a sample from a person suspected of having mpox.

Ghana has seen an “exponential” increase in mpox cases over the past week, while there have been smaller increases in the Democratic Republic of the Congo (DRC), Guinea, Burundi, and Kenya, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Ghana now has 313 confirmed cases, an 87% increase over the previous week when it had 167 cases, said Professor Yap Boum, the institution’s deputy lead on mpox at a media briefing on Thursday. Ghana and Guinea have both applied for vaccines to Africa CDC.

The DRC, Uganda, Sierra Leone, Burundi, Guinea, Liberia account for 86% of cases on the continent. While there was a small 7% uptick in cases over the past week, overall cases are down 76% since the peak of the epidemic.

Increase in Western Pacific

Globally, 47 countries in five of the six World Health Organization (WHO) regions had reported mpox cases by the end of July, according to the latest WHO surveillance report.

The Western Pacific reported a 160% increase in cases between June and July driven by the increase in cases in Philippines (from zero cases to 126 confirmed cases in July) and China (from 108 to 152 confirmed cases), according to the WHO report.

China, Germany, Türkiye, and the United Kingdom reported additional mpox cases last month of clade Ib MPXV linked to travel. Community transmission of this more serious clade is only happening in central and eastern Africa.

Overall, however, mpox cases are decreasing – particularly in African countries with a 28% reduction in cases between June and July, although 21 still have active cases.

Cases in the WHO regions of the Americas and Europe both reported a 31% reduction in cases. The Eastern Mediterranean Region did not report any mpox case in July 2025 .

Global mpox cases, 31 July 2025

Cholera task force

​​Cholera cases are also declining in Africa, aside from in the DRC and Chad.

African leaders have resolved to establish a Continental Task Force on Cholera Control and a Presidential Task Forces in the 23 affected countries, which is largely caused by inadequate access to clean water and sanitation.

Africa has already recorded 231,738 cholera cases so far this year – which is close to the total number of cases for 2024.

Image Credits: Katson Maliro/ WHO, Africa CDC , WHO.

CDC officials accuse US Health Secretary Robert F Kennedy Jr of politicising science.

Details from the resignation letters of top officials from the United States’ Centers for Disease Control and Prevention (CDC) show that the government’s top health experts have been ignored and sidelined by Health and Human Services (HHS) Secretary Robert F Kennedy Jr.

Kennedy has never been briefed by any experts from the CDC’s National Center for Immunization and Respiratory Diseases (NCIRP), which deals with immunisation, viral and bacterial diseases, influenza and coronaviruses, according to Dr Demetre Daskalakis, NCIRP director until his resignation on Wednesday.

“We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary. I am not sure who the Secretary is listening to, but it is quite certainly not to us,” said Daskalakis in his letter, which he published on X.

“Unvetted and conflicted outside organisations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources,” he added.

The resignations came during a day of chaos at the CDC as Kennedy sought to remove director Dr Susan Monarez, the Republican pick for the post confirmed by the US Senate a month ago. 

Reports indicate that Kennedy attempted to pressure Monarez into supporting new restrictions on COVID-19 vaccines and instructed her to dismiss senior staff. Late Wednesday, Monarez’s legal counsel said that she refused to resign, but her appointment was later “terminated” by the White House.

During the COVID-19 pandemic, Kennedy was one of the foremost spreaders of anti-vaccine misinformation and conspiracies, while the organisation he founded, Children’s Health Defense, has campaigned against several vaccines for years.

Surging measles cases

Former CDC Chief Medical Officer Dr Debra Houry

Chief Medical Officer Dr Debra Houry, the institution’s most senior career leader, resigned on Wednesday after 10 years at the CDC, serving under both Republican and Democratic administrations.

“The science at CDC should never be censored or subject to political pauses or interpretations,” Houry wrote in her letter, published by Inside Medicine.

Asserting that vaccines save lives, Houry said that, while it is important to question research, this should be done “by experts with the right skills and experience, without bias, and considering the full weight of scientific evidence”. 

“Recently, the overstating of risks and the rise of misinformation have cost lives, as demonstrated by the highest number of US measles cases in 30 years and the violent attack on our agency,” she added.

Dr Daniel Jernigan, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, has worked at the CDC since 1994.

“I believe strongly in the mission of public health and the leadership that CDC has given for almost 80 years; however, given the current context in the department, I feel it is best for me to offer my resignation,” said Jerigan.

CDC data manipulation?

Dr Jennifer Layden, director of the CDC’s Office of Public Health Data, Surveillance, and Technology, has also resigned, although her reasons have not been made public. 

There have been indications for months that the CDC’s database is under political pressure.

The CDC has removed 146 datasets since March, according to Stat. Meanwhile, on numerous datasets, the word “gender” was replaced by “sex”, according to a study published in The Lancet in July.

Axios reported on 8 August that the CDC had changed the wastewater viral activity for COVID-19 from “low” to “moderate”. However, when Health Policy Watch checked the CDC site, it indicated that wastewater data for COVID-19 has not been updated since 9 August due to a “technical issue”, but the COVID risk was now classified as “low”. This suggests it had been downgraded since the Axios report – despite no new data being available.

CDC database on wastewater and COVID-19, accessed on 27 August 2025.

The CDC apparently also took down its public database showing that Republican-governed states have higher homicide rates than Democratic states.

‘Eugenics’ at play?

Daskalakis makes several damaging allegations in his letter, one being that “eugenics plays prominently in the rhetoric being generated” about vaccines.

“The intentional eroding of trust in low-risk vaccines, favoring natural infection and unproven remedies, will bring us to a pre-vaccine era where only the strong will survive and many, if not all, will suffer,” he argues.

“The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest,” he says, adding that he has “never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people”.

Daskalakis also says that recent restrictions on access to COVID-19 vaccines threaten the lives of young children and pregnant women, and criticises Kennedy’s preference for communicating via social media rather than office channels.

“I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision. Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world,” he concludes.

Kennedy’s response

Kennedy was dismissive of the resignations during an interview on Fox News, suggesting the institution is “in trouble” and that “some people should not be working there anymore”.

Republican Senator Bill Cassidy, chair of the Senate health committee, simply said on X that the CDC’s “high-profile departures will require oversight” by his committee.

However, Senator Patty Murray (D-Wash.), the top Democrat on the Senate health committee, called for Kennedy to be fired: “We cannot let RFK Jr. burn what’s left of the CDC and our other critical health agencies to the ground – he must be fired. I hope my Republican colleagues who have come to regret their vote to confirm RFK Jr. will join me in calling for his immediate termination from office.”

Image Credits: HHS.

Wildfires in Canada and the US have substantially worsened their air pollution levels.

The eighth AQLI report released on Thursday, establishes a global warming link to air pollution – surprisingly in the United States and Canada. However, the global air pollution hotspot remains in South Asia. 

NEW DELHI – The latest data is out on how much air pollution is estimated to shorten lives, and New Delhi tops the global list for the eighth year running. 

The Indian megacity’s pollution level in 2023 was high enough to shave off 8.2 years of a person breathing its polluted air over the long term.

South Asia remains the most polluted region in the world. In countries here, the impact of particulate pollution on life expectancy is nearly twice that of childhood and maternal malnutrition and more than five times that of unsafe water, sanitation and handwashing. The report has been produced by the Energy Policy Institute at the University of Chicago (EPIC).

The 2025 Air Quality Life Index report shows South Asia to have the highest air pollution.

Within South Asia, Bangladesh is more polluted than India, averaging 60.8 micrograms/cubic metre (µg/m³) of the fine pollutant, PM 2.5, compared to 41 µg/m³ of it’s larger neighbour. But its capital Dhaka (76.4 µg/m³) is less polluted than Delhi, which – with 88.4 micrograms – is the highest of the global cities analysed. 

Air pollution poses the greatest threat to life expectancy in South Asian countries, in comparison to other major risks.

While India’s capital has topped the AQLI list for each of the eight reports so far, the data shared with Health Policy Watch shows a declining trend. It’s down from almost 10 years of life expectancy potentially lost in the 2018 report to 8.2 years in the latest report. 

Explaining what the declining numbers mean for a Delhi resident’s life span, Tanushree Ganguly, AQLI’s Director, told HPW, that, “our annual reports do not estimate the number of years of life already lost. Instead, they estimate the number of years that could be lost on average if people were exposed to the pollution levels of a given year over the long term.”

Government action in last eight years

While India and its cities continue to dominate rankings such as AQLI and those by IQAir, the government points to a series of measures it has implemented in the past decade, which it says are paying off.

It informed Parliament last month that the National Clean Air Programme (NCAP)  launched in January 2019, has shown “positive results” with pollution reducing in 103 cities. As many as 22 cities have met the national standards, which aren’t as stringent as WHO’s recommendations.

The government’s Delhi-centred action includes the creation of an empowered agency, CAQM, and an emergency response plan, GRAP, to shut down sources of pollution on days when air pollution spikes. 

Across India, a network of real-time, high-quality monitors has been installed, from a handful in 2014 to almost 600 now. It ‘leap-frogged’ fuel standards, jumping from Bharat Stage 4 to BS 6 (BS being at par with Euro standards). The most significant programme was NCAP which aimed to cut pollution in about a hundred cities. Since then it expanded the cities covered to about 130, and the raised the target to cut pollution levels by 40% by 2026.

Is air quality action reducing pollution?

AQLI’s data, too, shows a decline for both Delhi and India. However, Ganguly says it is “difficult to conclusively determine” with current evidence if these changes are due to meteorological changes or on-ground action. The year-to-year differences in these estimates reflect actual measured changes in pollution levels. To a lesser extent, they may also be influenced by improvements in the underlying satellite-derived models.  

AQLI Report Year AQLI India (years) AQLI Delhi (years)
2018 4.2 9.75
2019 4.07 9.23
2020 4.09 9.24
2021 3.73 7.89
2022 3.87 8.6
2023 3.92 8.61
2024 3.5 7.81
2025 3.5 8.2

Source: AQLI, EPIC, New Delhi. 

Each report is based on data from two years prior; so 2025’s report is based on 2023 data, and 2018’s report on 2016’s data.

Despite the progress in government policy there have been gaps, some literally. Obstacles include a 46% vacancy rate in pollution control agencies, government’s inability to enforce a ban on burning crop residue and fireworks, recent setbacks over targeting sources of high pollution from old vehicles and coal-fired power plants, and the fact that the NCAP prioritises PM 10 pollution (large particles like dust) rather than PM 2.5, which is far deadlier for human health and harder to contain. 

Huge jump in US, Canada air pollution

Globally, the United States and Canada sprang a surprise. Wildfires in Canada significantly worsened air quality in 2023, with PM2.5 levels rising by over 50% in Canada. Air quality in the US, which has recorded huge wildfires in California and is also affected by the Canadian fires, worsened by 20% compared to 2022. Both countries recorded their largest year-on-year increases in PM2.5 concentrations since 1998. 

Canada’s wildfire season was the worst in its history. The AQLI report points to growing evidence of a link between climate change and air pollution. Canada’s most polluted provinces were Northwest Territories, British Columbia, and Alberta. Here, particulate pollution levels in 2023 were comparable to polluted Latin American countries like Bolivia and Honduras, cutting people’s lives short by more than two years. 

The AQLI team wants the ‘life index’ to resonate with people by communicating the health consequences of air pollution shortening their lifespans. They reason that when communities have access to data on the air they breathe – and

understand its impact on their health – they are more likely to take protective action and push governments toward accountability.

Image Credits: Mike Newbry/ Unsplash, AQLI 2025 Report.

The headquarters of the US Centers for Disease Control and Prevention.

The White House “terminated” Dr Susan Monarez as director of the Centers for Disease Control and Prevention (CDC) late Wednesday night after she refused to resign.

On Wednesday evening, Monarez’s legal counsel said that she would not resign as CDC director despite an earlier announcement on X  by the US Department of Health and Human Services (HHS) that she was no longer in her post.

“When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving an agenda,” said her legal counsel, Mark Zaid, in a statement.

Zaid also accused Kennedy and HHS of “[setting] their sites on weaponising public health for political gain”, adding that his client had not been informed of her dismissal, which comes barely a month after she was confirmed in her position by the US Senate.

However, four top CDC officials did resign on Wednesday. They are CDC chief medical officer Dr Debra Houry; Dr Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases; Dr Daniel Jernigan from the National Center for Emerging and Zoonotic Infectious Disease, and Dr Jennifer Layden, head of the office public health data.

Daskalis said in a statement on X that he was resigning because he is “unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health”.

Daskalis added that the recent change in the adult and children’s immunization schedule “threaten the lives of the youngest Americans and pregnant people” and that “the data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership”.

FDA restricts access to vaccines

The CDC turmoil comes a day after the US Food and Drug Administration (FDA) restricted  COVID-19 vaccines to Americans aged over 64. Access to younger people is restricted to those with at least one underlying medical condition that exposes them to severe risk. Children may only receive the vaccine if they consult a medical provider. 

The FDA has also removed the emergency use listing for vaccines for children. This means that the BioNTech-Pfizer COVID-19 vaccine, Comirnaty, is only available for children over the age of five, according to Pfizer. 

The Novavax vaccine has been licensed for those aged 12 and over. Moderna’s COVID-19 vaccine, Spikevax, is now the only vaccine available to children from the age of six months – but only if they have underlying conditions.

Newer COVID-19 formulations from Pfizer, Moderna and Novavax to address the latest variants have only been approved for those over the age of 11 years who have at least one underlying condition.

In reaction, the Infectious Diseases Society of America (IDSA) has urged physicians to continue to recommend COVID-19 vaccines based on “the best available science” after the US Food and Drug Administration (FDA) restricted  COVID-19 vaccines to Americans aged over 64.

“By narrowing its approval, FDA has made a decision that completely contradicts the evidence base, severely undermines trust in science-driven policy and dangerously limits vaccine access, removing millions of Americans’ choice to be protected and increasing the risk of severe outcomes from COVID,” said IDSA president Dr Tina Tan in a statement.

Off-label use

Tan added that “scientific evidence continues to strongly support broad vaccination far beyond the limited populations outlined in the FDA’s new label”.

“Physicians can still provide COVID vaccines off-label, and IDSA strongly urges doctors to continue recommending and administering vaccination to their patients based on the best available science,” said Tan.

She warned that “pharmacists’ ability to provide off-label vaccines may be severely constrained, underscoring the vital role of physicians and other clinicians in maintaining access”. 

IDSA also called on insurers to “continue covering COVID vaccines consistent with multiple medical society recommendations and scientific evidence”, and urged the US Congress to “conduct strong oversight of the administration’s decision to restrict Americans’ freedom to choose vaccination as we approach the upcoming respiratory virus season”. 

Dr Tom Frieden, CEO of Resolve to Save Lives and a former CDC director, said that “the change to the vaccine label, which has been driven by falsehoods, may put vaccines out of reach of many Americans who want to protect themselves and their loved ones from illness”.

Earlier this month, the American Academy of Pediatrics recommended COVID-19 vaccines for children between the ages of six months and two years, who are most vulnerable to severe disease.

Research shows that long COVID may have affected up to six million children in the US. 

Although Axios reported on 8 August that the CDC had changed the wastewater viral activity for COVID-19 from “low” to “moderate”, data from the CDC has not been available since 9 August due to a “technical issue” and the risk is now classified as “low”.

CDC advisory committee still to weigh in

Meanwhile, Health Secretary Robert F Kennedy Jr welcomed the FDA’s decisions on X, saying that he has delivered on his promises to “end covid vaccine mandates; keep vaccines available to people who want them, especially the vulnerable; demand placebo-controlled trials from companies, and end the emergency”.  

The CDC has yet to make its recommendations about this year’s COVID-19 vaccines. However, in June Kennedy Jr fired all 17 members of the CDC’s Advisory Committee for Immunization Practices (ACIP). At least half of the eight people he replaced them with have spoken out against the handling of COVID-19 and vaccines.

The new appointees are Dr Joseph Hibbeln, Martin Kulldorff, Retsef Levi, Dr Robert Malone, Dr Cody Meissner, Dr Michael Ross, Dr James Pagano and Vicky Pebsworth.

Malone has promoted several false and alarmist claims about COVID-19 vaccines, and said they did not work. 

Pebsworth is a director and board member at the National Vaccine Information Center, which has questioned the safety of COVID-19 vaccines and encouraged people to seek alternatives.

Kulldorff was co-author of the Great Barrington Declaration with Dr Jay Battacharya, new director of the National Institutes of Health, which favoured herd immunity to address COVID-19 for all but the most vulnerable.

Meissner, is in favour of children and pregnant children being excluded from the COVID-19 vaccine schedule.

Levi, who has questioned the safety of COVID-19 vaccines, has also been appointed to chair a new review committee to review COVID-19 science.

In his resignation statement, the CDC’s Daskalakis said that the “recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader.   Their desire to please a political base will result in death and disability of vulnerable children and adults.  Their base should be the people they serve not a political voting bloc.”

This story was updated with news of the disruptions in the CDC leadership.

Image Credits: Photo by Mat Napo on Unsplash.

Representatives from Gavi and Unicef at the Mwalumina Rural Health Centre in Zambia, the first clinic in the country to receive solar power as part of Gavi’s Health Facility Solar Electrification (HFSE) programme.

Zambia has become the first country to inaugurate a solar clinic as part of Gavi’s $28 million Health Facility Solar Electrification (HFSE) programme, which aims to power 1,277 clinics across four countries by June 2026 – improving services for 25 million people.

The weekend event, at Mwalumina Rural Health Centre in Zambia’s Chongwe District, is the first step towards bringing reliable solar power to 250 Zambian health facilities across the country, improving health services for 1,3 million Zambians.

“By bringing sustainable power to our rural health facilities and ensuring vaccines and essential medicines reach every child, we are investing in healthier communities and a stronger health system,” Zambian Health Minister Dr Elijah Muchima told the inauguration on Sunday.

The initiative prioritises health facilities that provide maternity services and serve remote communities. It aims to ensure the safe storage of vaccines and medicines, enable the use of critical diagnostic and medical equipment, improve working conditions for health professionals and strengthen resilience and equity in primary health care services.

Several vaccines – including some of those to combat COVID-19 – need to be refrigerated, which is a challenge for many rural clinics that don’t have reliable electricity.

“These efforts will light up maternity wards, keep vaccines safe, and deliver care to the hardest-to-reach communities,” said Gavi CEO Dr Sania Nishtar.

“In places where one in four health facilities have no electricity, solarisation is more than a technical fix, it is a lifeline.”

Rollout to Ethiopia, Pakistan and Uganda

The HFSE initiative will deploy solar photovoltaic systems and cold chain equipment to health facilities in Ethiopia, Pakistan and Uganda, as well as Zambia.

The initiative will also improve the climate resilience of health facilities, reducing reliance on coal- and hydro-electric power, and reduce carbon emissions.

By the end of the rollout in June 2026, an estimated 25 million people will benefit from an increased range of services such as expanded access to immunisation services and availability of clean water.

The Ethiopia launch of HFSE took place in October 2024, and aims to reach 300 health facilities, improving services for an estimated 6.7 million Ethiopians.

“Climate change is increasing the burden of diseases in the most vulnerable communities, and access to electricity is a core determinant of a country’s ability and readiness to provide quality health services,” Thabani Maphosa, Gavi’s Chief Country Delivery Officer, told the Ethiopia launch.

“Establishing and scaling health facility solar electrification represents an unprecedented opportunity to strengthen primary health care systems, contribute to a greener planet, and drive improved health outcomes.”

Gavi has also contributed significantly to the roll-out of solar-powered cold chain equipment through its Cold Chain Equipment Optimisation Platform (CCEOP), established in 2016 to assist countries to buy cold storage equipment they need. 

“However, fridges alone aren’t enough,” according to Gavi. “This pilot tests whether that model can be scaled to fully solarize health facilities by powering lights, equipment, and digital tools. If successful, it could unlock co-investment and long-term government support for maintenance, ensuring sustainability.”

New initiative to improve vaccine delivery

Zambia also launched an initiative called DRIVE – the Direct Delivery of Routine Immunisation Vaccines and other Essential health commodities for Equity – alongside the solar project.

DRIVE “works like a social enterprise, involving community volunteers, young people, and others at the local level to help deliver vaccines and health supplies directly to clinics and outreach sites”, according to a media release from the Zambian government. 

“These delivery partners will work up to 10 days a month transporting vaccines, and for the rest of the month, they can use the same transport to earn income through other activities, helping them support themselves and maintain the vehicles.”

DRIVE is being launched in 41 districts and will create 200 jobs as well as improving immunisation.

“The two initiatives we are launching today work hand in hand to strengthen our health system. By bringing vaccines and supplies directly to health centres and providing clean, reliable energy, we are making healthcare more accessible and consistent. These efforts support health workers, create jobs, build community ownership, and help us adapt to climate challenges,” explained Dr. Nejmudin Kedir Bilal, UNICEF’s Zambia Representative.

The HFSE initiative is supported by UNICEF and the World Health Organization.

Image Credits: Gavi.

Construction workers are particularly vulnerable to heat stress.

Hundreds of migrant construction workers are likely to have died of heat stress while building soccer stadiums in the Qatari desert for the recent Fifa World Cup.

But people’s exposure to extreme heat – temperatures of 38°C and higher – is becoming widespread as climate-related temperatures soar.

“Billions of people are already exposed to dangerous heat at work, elevating their risk of heat stroke, dehydration, kidney disease and other serious illnesses,” Dr Rüdiger Krech, World Health Organization (WHO) director of Environment, Climate Change and Health, told a media briefing on Thursday.

“In agriculture, construction and other physically demanding sectors, we’re seeing a clear rise in heat stroke, dehydration and long-term kidney and cardiovascular damage due to dangerous working conditions,” added Krech during the launch of a new report on heat stress, published by the WHO and the World Meteorological Organization (WMO).  

“The workers keeping our societies running are paying the highest price. These impacts are especially severe in vulnerable communities with limited access to cooling health care and protective labour policies.”

WMO director Johan Stander told the media briefing that the past 10 years are the hottest on record and 2024 was the hottest year ever.

Extreme heat has “accelerated” in Europe, Africa, North America and Asia, where new record temperatures were recorded, he added.

“In the Middle East, we’ve seen temperatures in the region of 50°C, and areas in Europe have topped around 40°C.”

The report defines workplace heat stress as “increased heat storage in the body of a worker as a result of excessive heat exposure in the workplace”. This can be due to hot environmental conditions, increased metabolic heat from performing physically demanding tasks; and/ or the requirement to wear heavy protective clothing, which limits the body’s ability to dissipate heat (for example, health workers wearing PPE in hot climates during disease outbreaks).

It describes heat stroke as “a life-threatening condition defined by profound central nervous system dysfunction”, including severe disorientation, seizures, coma.

Outdoor construction and agricultural work during the hot season are considered the highest-risk occupations for experiencing morbidity and mortality associated with workplace heat stress.

The WMO’s Johan Stander, WHO’s Rudiger Krech and Joy Shumake-Guillemot, lead of the WHO/WMO Joint Office for Climate and Health

Safe working environments

The International Labour Organization (ILO)’s Joaquim Pintado Nunes told the briefing that it is mandatory for the 187 countries that are ILO members “to promote safe and healthy working environments”.

“More than 2.4 billion workers are exposed to excessive heat, and this represents 71% of the world’s total working population,” said Nunes, the ILO’s head of Occupational Safety and Health and the Working Environment.

Heat exposure causes more than 22 million occupational injuries and almost 19,000 deaths each year, according to an ILO report published last year. In 2020, there were an estimated 26.2 million persons living with chronic kidney disease attributable to workplace heat stress.

The ILO report found that workers in Africa (92.9%) and the Arab states (83.6%) had the worst heat exposure, but the fastest changing working conditions are in Europe and Central Asia, with the proportion of workers affected rising by 17.3%, almost double the global average increase.

“Heat exhaustion and sometimes fatal heatstroke have been repeatedly reported among coal miners, surface miner workers and gold miners, as well as workers in agriculture and construction workers in the United States of America,” according to the WHO-WMO report.

“Climate change is reshaping the world of work,” said Nunes. “Without bold, coordinated action, heat stress will become one of the most devastating occupational hazards of our time, leading to a significant loss of life, significant loss of productivity and with catastrophic effects in the future of work.”

Joaquim Pintado Nunes, chief of Occupational Safety and Health and the Working Environment, International Labour Organization (ILO)

Data about workers’ conditions is often hard to come by. To establish the cause of death of the migrant workers in Qatar, researchers triangulated the mortality data of Nepalese migrants in Qatar, interviews with returning migrants about their working conditions, and temperatures.

Most of the migrant workers were young men aged 25 to 35. Globally, this group usually only records a 15% death rate from cardiovascular disease (CVD). But 22% of the Nepalese migrants who died while working in Qatar died of CVD in the cool season and 58% died in the hot season – which the researchers concluded to be likely due to “extreme heat stress”.

Clear recommendations

The report, the first on the subject since 1969, offers guidance to governments, workers, employers, local authorities and health experts to mitigate heat stress.

Recommendations include occupational heat-health policies with “tailored plans and advisories that consider local weather patterns, specific jobs, and worker vulnerabilities”.

Those most vulnerable to heat include middle-aged and older workers, people with chronic health conditions and lower physical fitness.

The report also recommends educating all stakeholders on how to recognise and treat the symptoms of heat stress – particularly essential for subsistence farmers, who are not part of organised workplaces and may not understand what is happening to them.

Krech told reporters that the threshold for the human body is 38°C, over which it is dangerous to work.

Professor Andreas Flouris from the University of Thessaly in Greece said that there is “ongoing discussion” in Europe on “moving towards thresholds of environmental limits where workers can safely work”.

Cyprus, Spain, Belgium already have such thresholds defined in legislation, added Flouris, who was the report’s editor.

“The report provides the evidence that policy makers can use to convince both the employers and the workers that it’s in their best interest for both in terms of health but also productivity, to move to such solutions,” said Flouris.

Image Credits: Shraga Kopstein/ Unsplash, WHO-WMO.

The US Centers for Disease Control and Prevention in Atlanta, which a gunman recently attacked.

US Health and Human Services Secretary Robert F Kennedy Jr has been given until 2 September to stop spreading anti-vaccine information by hundreds of current and former staff members from the Center for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the HHS.

In a letter released by “Save HHS” on Wednesday, over 750 staff – about half of whom opted to remain anonymous – say that they are gravely concerned about “America’s health and safety” following an attack on the CDC early this month, when a man opposed to COVID-19 vaccines fired hundreds of bullets at the institution. A police officer was killed in the attack.

“The attack came amid growing mistrust in public institutions, driven by politicised rhetoric that has turned public health professionals from trusted experts into targets of villainization – and now, violence,” according to the letter, which has been sent to Kennedy and Members of the US Congress.

Lukewarm response to CDC gunman

In a media release accompanying the letter, the staff described Kennedy’s response to the shooting as “delayed and cursory”. He also “failed to take accountability for his role in the denigration of HHS employees and his decades of anti-vaccine rhetoric that reportedly contributed to the shooter’s motives”.

In an interview shortly after the attack, Kennedy criticised the CDC’s response to the COVID-19 pandemic.

The staff accuse Kennedy of being “complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information”.

They say he has sown public mistrust, including by calling the CDC a “cesspool of corruption”, falsely claiming mRNA vaccines “failed to protect effectively” during the COVID-19 pandemic and subsequently cancelling $500 million in contracts for mRNA vaccine development, “possibly our best line of defence against another respiratory virus pandemic”.

They also cite his disbanding of the US Advisory Committee on Immunization Practices (ACIP) as part of his anti-vaccine activity.

They also accuse the health secretary of falsely claiming the measles vaccine has not been “safety tested” and that protection “wanes very quickly” while “promoting inappropriate prevention measures like vitamin A even as US measles case numbers are at their highest in more than 30 years”.

Finally, they say Kennedy has misused data to “falsely claim childhood vaccines are the cause of autism despite decades of research demonstrating otherwise”.

‘Dangerous and deceitful’

Describing these Kennedy statements as “dangerous and deceitful”, the letter gives the HHS Secretary until 2 September to “cease and publicly disavow the ongoing dissemination of false and misleading claims about vaccines, infectious disease transmission, and America’s public health institutions”.

It also asks him “acknowledge and affirm that CDC’s work is rooted in scientific, non-partisan evidence focused on improving the health of every American” and “guarantee the safety of the HHS workforce”.

Dr Anne Schuchat, former Principal Deputy Director of CDC, said that “an attack on a U.S. government agency should be a moment in time when we come together”. 

“Instead, Secretary Kennedy continues to spread misinformation at the risk of American lives,” she added.

Dr Ian Morgan, an NIH scientist and steward of NIH Fellows United, said that the attack on the CDC  on the death of the police officer should have been a “wake-up call” for Kennedy and NIH Director Jay Bhattacharya.

“Yet, we’ve seen them persist in the same antivaccine and anti-science rhetoric that led to the shooting, endangering the lives of HHS workers and the American public. This dangerous rhetoric from HHS leaders must stop,” said Morgan.

Neither Kennedy nor the HHS had responded to the letter by the time of publication.

An examination of 51 studies has assembled more evidence that exposure to air pollution is linked to a higher risk of dementia.

Air pollution, specifically the tiny particles known as PM2.5, is linked to higher rates of dementia, according to a recently published study in The Lancet.

Nitrogen dioxide (NO2) and black carbon, which is the black soot left behind when combustion is incomplete, have also been linked to higher risk of dementia in the study, which is headed by researchers at UK’s Cambridge University.

“What this means is that cleaner air policies, including those targeting diesel, could help protect brain health, not just lung and heart health. Dementia is a devastating disease, and while we wait for a cure, we need to act on modifiable risk factors. Air pollution is one of the biggest,” Haneen Khreis, one of the authors of the study, told Health Policy Watch.

Researchers reviewed 51 existing studies across several countries up to October 2023 to arrive at this conclusion.

PM2.5 is 1/28 of the width of a human air and much of it is released during the burning of gasoline, oil, diesel or wood. PM10 particles are relatively larger, though still invisible to the naked eye.

“PM2.5, or fine particulate matter, can cross the blood-brain barrier, resulting in inflammation and disruption of brain function. There is also evidence to suggest that fine particles can travel through the olfactory nerve into the brain,” Pallavi Pant, who is the head of global initiatives at Health Effects Institute told HPW.

“Exposure to air pollution may also have impacts on brain development and functioning in children, including an increased risk for neurodevelopmental disorders like autism and psychological disorders like anxiety and depression,” Pant pointed out.

The dangers of PM2.5

A comparison of the sizes of PM2.5, PM10, human hair and fine beach sand.

Air pollutants are categorized by their sizes. There is PM2.5 and there is PM10. Evidence does not yet link PM10 with higher rates of dementia, but the number of studies looking closely at PM10 were small, the researchers concluded.

Gases like NO2, and particles the size of PM2.5 or less, are dangerous because they are small enough to enter the bloodstream from the lungs after being inhaled.

Once inside the body, they can travel from head to toe, according to Palak Balyan, research lead at Climate Trends, headquartered in New Delhi.

There are two ways patients can develop dementia, a broad term describing a decline in mental abilities severe enough to interfere with a person’s everyday life, says Balyan.

One is a natural consequence of ageing, while the other is caused by blockage in the brain – including by air pollution.

“These small particles (PM2.5) block a lot of arteries, veins or small capillaries in our brain. That also leads to dementia,” she said.

Black carbon

While PM2.5 and PM10 do get some attention, black carbon does not.

“Most studies have focused on PM2.5 and NO₂, but we need much more attention on black carbon, given its major role in both health harms and climate change. These pollutants mainly come from car exhaust, power plants, industry, and diesel engines,” said Khreis, who added that black carbon or soot is sometimes smaller than PM2.5 and sticky.

“If that small sized black carbon particle sticks inside your lung or inside any other capillary in your body, that can create more damage than any other bigger sized particle,” Balyan explained.

Limited evidence from Global South

Most of the world’s population breathes in polluted air.

Of the 51 studies that were examined, 20 (39%) were done in Europe and 17 (33%) in North America, representing more than half of the overall evidence.

“Most of the data comes from high-income countries, and often from White, urban populations. That means we’re missing critical evidence from low- and middle-income countries, and from groups that face the highest exposures because of structural inequalities,” Khreis said.

She added that the global burden is probably underestimated and the risk in some groups within urban areas is concealed.

“It is likely that the deleterious impact of PM2.5 on dementia risk is mediated by other factors such as overall health status, specific co-morbidities, exercise and nutrition. Hence it is important to generate data from geographically and socioeconomically diverse populations across the world to develop a more customized and holistic framework for risk reduction interventions,” said Vaibhav A. Narayan, PhD, head of innovation and strategy for the Davos Alzheimer’s Collaborative, which is supporting a “Global Cohorts Programme” with other research partners to generate such data in low-resourced settings.

A majority of the world’s most polluted cities are in the developing countries. In 2024, 49 of the world’s most polluted cities were in Asia and one in Africa, according to data from IQAir, a Swiss air monitoring company.

But only 12 studies (24%) from Asia were included and none from Africa or Latin America. Two (4%) others were from Oceania (both in Australia).

Some of the earliest studies linking air pollution and impacts on the brain were conducted in Mexico City. Dogs living in polluted environments in Mexico City had more neurodegeneration than dogs living in cleaner environments outside Mexico City, according to one study. Similar studies were also done with children going back to 2008.

Evidence from India also suggests that those using polluting sources of cooking fuel were at a higher risk of cognitive impairment, especially rural women, given that they tend to have higher exposure to polluting cooking fuels like firewood.
“A majority of studies are currently from Europe or North America, or China, and we need a broader global evidence base representing other regions,” Pant said.

“Having said that, with the available evidence, the case for addressing air pollution to help reduce the dementia burden at the population level is strong,” she added.

A ‘modifiable risk factor’ for dementia

WHO’s outgoing director of the Department of Environment, Climate Change and Health, Dr Maria Neira, is widely credited with increasing awareness about air pollution.

The Lancet Commission has included air pollution as a modifiable risk factor for dementia in 2024, as it is possible to improve air quality.

Balyan sees some positive trends in addressing air pollution, including more awareness, more funding for research on air pollution and more collaboration.

“Now engineers and doctors are collaborating, they are working together. So that kind of collaboration has also increased which is leading to more number of studies. International collaboration has also increased because of this easy to work online system,” she said.

Dr Maria Neira, the outgoing director of the World Health Organization’s (WHO) Department of Environment, Climate Change and Health since 2005, is widely credited with increasing awareness about the impact of air pollution on health.

Image Credits: WHO, U.S. Environmental Protection Agency (EPA), WHO, US Mission Geneva .