A woman prepares to get an HIV test in Uganda. The US will resume financing HIV tests, medicine and healthworkers delivering services.

The United States will resume funding HIV, tuberculosis, malaria and polio medicine and the salaries of health workers directly delivering most of these services to patients through bilateral deals with governments and faith-based organizations– at least for the 2026 financial year, according to the America First Global Health Strategy unveiled by the US State Department on Thursday.

The long-awaited strategy clarifies how the Trump administration aims to restructure the US President’s Emergency Plan for AIDS Relief (PEPFAR) and replace functions of the now defunct US Agency for International Development (USAID).

The three pillars underpinning the new strategy are to keep America safe, strong and prosperous, with aid for disease surveillance and containing outbreaks to feature in the new strategy as well.

US Secretary of State Marco Rubio described the strategy as “a positive vision for a future where we stop outbreaks before they reach our shores, enter strong bilateral agreements that promote our national interests while saving millions of lives, and help promote and export American health innovation around the world”.

Frontline investment to resume

Countries severely affected by the suspension of crucial US health aid when Donald Trump assumed office in January will welcome the news that around $1.3 billion in aid for HIV, TB and malaria diagnostics, drugs, and insecticide-treated bed nets will resume.

In addition, around $827 million for the salaries and benefits of healthcare workers directly serving affected patients will also resume in the 2026 financial year. 

Post 2026, the US “will cover a proportion of these costs, as countries will have required co-investment levels based on each country’s income level”.

It will “rapidly decrease”  funding that “does not go to frontline investments in commodities or healthcare workers”. The strategy flags international NGOs and social impact organisations, such as Abt, RTI International and Chemonics, which had traditionally played a major role as subcontractors implementing US aid programmes, as an approach the US will not support in future – citing outsize salaries for top executives as an example of waste. 

However, it aims to “leverage” faith-based hospitals and clinics to deliver health services, noting that these account for over 50% of the delivery capacity in countries such as Eswatini and Uganda.

Bilateral deals in a time-limited framework

The strategy thus favours bilateral deals over multilateralism, acknowledging that this is how China does business.

From next month, the US plans “intensive engagement with recipient country governments, other donors, and other in-country partners to shape a set of mutually agreeable priorities for future US health assistance”.

It aims to reach bilateral agreements with recipient countries by the end of 2025 and start implementing these agreements by April 2026. 

“These bilateral agreements will ensure funding for 100% of all frontline commodity purchases and 100% of all frontline healthcare workers who directly deliver services to patients,” according to the strategy.

However, the majority of 71 US-supported countries will “transition to full self-reliance during the term of the agreement,” the strategy also states – imposing a sharp time-limitation on most forms of aid. 

The new US global health strategy is aimed at making the US safe, strong and prosperous.

Integration of diseases

All US government health foreign assistance programs will be administered by the State Department, which “offers a tremendous opportunity to integrate across disease-specific programs including HIV/AIDS, TB, malaria, and polio”, according to the strategy.

Opportunities include the integration of supply chains, health workers, laboratories and data systems.

In the past, “separate disease-specific planning processes and implementing partners within an individual country that had little connection or collaboration with one another”, the strategy notes. 

This resulted in “duplication and missed opportunities to maximise and leverage investments across multiple diseases” and made it harder to integrate programs into countries’ existing health infrastructure, as these usually offer integrated care.

Aid as leverage

The strategy openly acknowledges aid as political leverage, saying that US health foreign assistance “has the potential to be an important counterweight to China, especially in Africa, a continent of strategic importance to US national interests”. 

“Africa also contains several of the largest deposits of key minerals and rare earth elements needed as inputs into advanced technologies that fuel critical military and commercial applications,” the strategy acknowledges.

“Rather than following the China model of loan-based agreements, which is aimed at extracting painful concessions from the country, the requirements that the United States will build into its agreements will be directed squarely at the achievement of public health goals and better facilitating transition towards country self-reliance,” the strategy notes.

Promoting US products as ‘commercial diplomacy’

The US will support the rollout of Gilead’s lenacapavir (branded as Sunlenca in the US) to prevent HIV infection.

It also wants US-supported global health programmes to use US-manufactured diagnostic tests and medicines.

In 2024, half the malaria rapid tests and 70% of the HIV rapid tests were purchased from American manufacturers, representing over $350 million of procurements. 

On 4 September, the US announced that it would support the US-based Gilead Sciences to roll out lenacapavir, a six-month injectable that has almost 100% efficacy in preventing HIV. 

It also acknowledges that US support for the Global Fund has created new markets for US products, with around $3.5 billion in US goods and services procured since 2010.

The US government will continue to make buying American products “a key component of future health foreign assistance programs, including ensuring that pooled procurement mechanisms are designed in a manner that facilitates access to the most critical medical innovations developed by US companies”.

It notes that the healthcare market in Asia alone is expected to reach $5 trillion by 2030, while Africa’s healthcare market is “projected to grow rapidly to more than $250 billion by 2030”, providing “several concrete opportunities where the US government can play a role in advancing commercial diplomacy”. 

A US official who spoke anonymously to Semafor shortly before the strategy was released said that, while Africa would continue to be a focus, the US is “going to invest more in the Western Hemisphere. We’re going to invest more in Asia-Pacific. We’re investing a quarter of a billion dollars in the Philippines, which is something we’re really, really excited about.”

‘Radical reset’

Dr Jirair Ratevosian, Hock Fellow at Duke University’s Global Health Institute

Dr Jirair Ratevosian, Duke University global health expert and former PEPFAR chief-of-staff, told Health Policy Watch that the strategy is “pragmatic, performance-oriented – and a bit ruthless”, marking “a radical reset” of how the US approaches global health.

Ratevosian welcomed the protection of life-saving medicine and the jobs of frontline health workers, and the integration of services.

“The next 18 months, as these bilateral agreements are signed, are going to be crucial. Civil society, the private sector, and global health advocates need to stay at the table to make sure this transition strengthens, rather than weakens, the fight against HIV, TB, malaria, and the next pandemic.”

He also noted that the strategy fails to mention South Africa, “the epicentre of the global HIV epidemic and a critical US partner”.

“The risk here is clear: the US may end up favouring countries that are geopolitically convenient rather than those where partnership is most needed to end AIDS,” he warned.

A nurse conducts an HIV test at a PEPFAR supported clinic in South Africa. It is unclear how much US support South Africa will get as the Trump administration has taken issue with various policy decisions.

The US has taken exception to various policy decisions taken by South Africa.

Ratevosian said that bilateral compacts with clear performance targets could make US aid more accountable and cut unnecessary overheads, “but only if countries actually can mobilise the money and systems to deliver”, he added.

“Many countries are nowhere near ready to pay 30–50% of program costs. If domestic budgets don’t materialise, we could see stock-outs, staff layoffs, and service collapse that could erase years of progress almost overnight.”

He also warned that bilateral deals could sideline the Global Fund and the global vaccine platform, Gavi, and their ability to pool resources to “create a united front against epidemics”. 

Meanwhile, AVAC warned that moving toward bilateral agreements “risks fragmenting coordination, intensifying the politicalisation of assistance, slowing disbursements, and creating uncertainty for countries already grappling with budget shortfalls”.

What about national sovereignty and generics?

The US wants aid recipients to buy US drugs and diagnostics.

Ratevosian noted that the strategy “doubles down on using foreign assistance to promote US health innovations” like lenacapavir, and this might not align with countries’ push for greater national sovereignty over their health programs.”

This was also flagged by pharmacist Andy Gray, who co-directs the World Health Organization (WHO) Collaborating Centre on Pharmaceutical Policy and Evidence-Based Practice in South Africa.

“There is an internal inconsistency in the plan, in that the US government wishes to promote countries taking responsibility for their own programme delivery, but at the same time, encourage dependence on US goods and services,” said Gray. 

“For many of the most important products, generic versions do not yet exist in the US,” noted Gray, adding that PEPFAR had been able to procure lower-priced, quality-assured generics from other countries. 

“Expecting African countries to continue to procure innovator lenacapivir from Gilead is unreasonable when lower-priced generic versions are expected within the next two years.”

UNAIDS ‘encouraged’ by HIV commitment

In its reaction, UNAIDS said it is “encouraged” by the strategy and its “strong commitment to continue to support people living with and affected by HIV”.

“The new strategy highlights several of UNAIDS’ global HIV targets as key benchmarks for US foreign health assistance, including ensuring that 95% of people living with HIV are aware of their HIV status, 95% of those who know their status are receiving lifesaving HIV treatment, and 95% of those on treatment achieve viral suppression,” UNAIDS noted.

The strategy is also committed to achieving a 90% reduction in new HIV infections and AIDS-related deaths by 2030 and eliminating mother-to-child transmission of HIV in high-burden countries.

UNAIDS added that it remains firmly committed to advancing and strengthening its “long-standing, strategic partnership with the US government and will continue to work hand-in-hand with PEPFAR to support countries to sustain durable, country-led HIV response”.

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI), Gilead, Witkoppen Clinic, Wikimedia Commons.

Dr Tedros Adhanom Ghebreyesus addressing the media briefing.

For every $1 invested in cost-effective “best buys” to prevent non-communicable diseases (NCDs) over the next five years, there would be a four-fold return in social and economic benefits, according to the World Health Organization (WHO).

The WHO’s 29 “best buys” focus on reducing tobacco and alcohol consumption, addressing unhealthy diets and lack of exercise, and strategies to reduce cancer, cardiovascular and chronic respiratory diseases.

Ahead of the United Nations High-Level Meeting (HLM) on NCDs and mental health in New York on 25 September, the WHO released a report on Thursday showing the rewards from implementing these strategies.

If all countries fully embrace the “best buys”, this would save 12 million lives, prevent 28 million cases of heart attacks and strokes and generate economic gains exceeding $1 trillion by 2030.

If investment is sustained for a decade – until 2035 – there could be a seven-fold return on investment.

“We have the tools to save lives and reduce suffering,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday. 

“This is not theoretical. Countries are doing it. Brazil has cut smoking rates in half by steadily increasing tobacco taxes. Mexico’s tax on sugary drinks reduced consumption while raising significant government revenue. Thailand channels tobacco and alcohol taxes into its National Health Promotion Foundation.”

The impact of implementing WHO ‘Best Buys”

Slowing progress

NCDs are the biggest global killer, while more than one billion people live with mental health conditions. Almost three-quarters of deaths related to NCDs and mental health – 32 million – take place in low- and middle-income countries. 

Only 19 of the 193 UN member states are on track to achieve the Sustainable Development Goal (3.4) of reducing NCD mortality by one-third by 2030.

Spending just 0.6% of the gross national income of LMICs could enable 90% of these countries to reach the SDG 3.4 target, according to the WHO.

While over 80% of countries have made progress in reducing NCD deaths since 2010, this has slowed down in 60% of countries from 2019 (in part because of COVID-19) in comparison to the previous decade.

Denmark has recorded the largest improvements, while China, Egypt, Nigeria, Russia, and Brazil have also reduced NCD deaths in both men and women.

“The biggest gains were driven by declines in cardiovascular disease and certain cancers—such as stomach and colorectal cancers for both sexes, cervical and breast cancers for women, and lung and prostate cancers for men,” according to the WHO.

“But pancreatic, liver cancers and neurological conditions contributed to rising mortality in many countries.”

HLM Political Declaration is ‘strongest’ yet

Dr Guy Fones, the WHO lead on NCDs

The final UN HLM political declaration is weaker than the zero draft, making higher taxes on tobacco and alcohol “considerations” not recommendations, and dropping any reference to taxing sugary drinks.

However, the targets of 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 have survived the negotiations.

Dr Werner Obermeyer, director of the WHO office at the UN in New York, described the declaration as “a very strong outcome document” when considered holistically.

“There is very strong language in the text on taxation or alcohol and tobacco marketing restrictions, and also in terms of the regulation of food products,” said Obermeyer.

Dr Guy Fones, the WHO lead on NCDs, said the declaration is “the strongest we’ve had… because it has delivered on its call for equity and integration”, crediting the co-facilitators, president of the UN General Assembly and member states for traversing “a very complex path to arrive at the final draft”.

Next week’s HLM is the fourth on NCDs since 2011, but previous declarations have avoided concrete targets.

Last week, Alison Cox, the NCD Alliance’s policy and advocacy director,  “warmly welcomed” the declaration’s “time-bound and tangible targets”, particularly three “150 million” targets.

“The fact these targets have survived a tough negotiation process is evidence that this declaration represents political commitment to faster action,” said Cox.

Meanwhile, Vital Strategies said in a media release on Thursday that the declaration “marks significant multilateral commitments to address the world’s leading causes of death, such as cancer, hypertension and lung disease”.

It urged governments to “pivot to urgent action”, describing taxes on tobacco, alcohol and sugary drinks as “among the most effective steps governments can take to prevent disease, save lives and generate sustainable financing”.

“The era of governments subsidizing the profits of private industries by footing the long-term health care costs of cheap tobacco, alcohol and sugary drinks must end. Recent bold tax initiatives from countries as diverse as Brazil, Mexico, Montenegro, Cabo Verde and Ethiopia show that rapid progress is possible and should inspire delegations at the meeting,” it added.

Commercial interests

Dr Etienne Krug, WHO head of health determinants, promotion and prevention.

While the “best buys” do not include a tax on sugary drinks, “taxing sugary drinks has full support from WHO, and we believe strongly in this as a very cost-effective intervention”, said Dr Etienne Krug, WHO’s head of health determinants, promotion and prevention. 

“There is a whole series of unhealthy products on the market right now, ranging from tobacco, unhealthy foods, alcohol, etc. Acting against the interests of some of these very powerful companies is not always easy and not always done with the same energy by different governments,” Krug noted.

“But unless we take action to promote healthy products and limit the sale of unhealthy products, we will not make enough progress on tackling NCDs and not fast enough.”

Image Credits: WHO .

Dr Susan Monarez, former CDC director

US Health Secretary Robert F Kennedy Jr is driving an agenda based on ideology not science, and tried to reduce the Centers for Disease Control and Prevention (CDC) to a rubber stamp, according to the two former top officials.

Former CDC director Dr Susan Monarez and Dr Debra Houry, former Chief Medical Officer and deputy director for Program and Science, provided damning testimony of Kennedy’s interference at a Senate health committee hearing on Wednesday, called after the mass resignation of the CDC’s top leaders late last month.

Senator Bill Cassidy, instrumental in confirming Kennedy’s appointment after being assured that he would not change the country’s vaccine schedule, called the hearing. 

Earlier, Kennedy told the Senate finance committee that he had removed Monarez – who was the Republican Party’s representative and appointed by the Senate health committee – after she admitted to being “untrustworthy”.

But Monarez told the Senate health committee that Kennedy informed her on 19 August that she “required prior approval from [her] political staff for CDC policy and personnel decisions”.

Six days later, Kennedy “demanded two things of me that were inconsistent with my oath of office and the ethics required of a public official”, she added. “He directed me to commit in advance to approving every Advisory Committee on Immunization Practices (ACIP) recommendation regardless of the scientific evidence. He also directed me to dismiss career officials responsible for vaccine policy, without cause.

“He said if I was unwilling to do both, I should resign. I responded that I could not preapprove recommendations without reviewing the evidence, and I had no basis to fire scientific experts.”

Earlier, Kennedy sacked all 17 ACIP members and replaced them with eight people – including at least half of whom are vaccine sceptics. This week, Kennedy appointed a further five ACIP members, four of whom have expressed doubts about vaccines’ efficacy, according to The Guardian.

Kennedy was one of the foremost proponents of anti-vaccine misinformation during the COVID-19 pandemic, and the organisation he founded, Children’s Health Defense, has received hundreds of thousands in donations to litigate against vaccines.

Interference in vaccine decisions

Dr Debra Houry, former CDC Chief Medical Officer

Houry’s testimony detailed several examples of Kennedy’s interference in scientific decisions that threaten the health of Americans. 

These include replacing the ACIP with “known critics of vaccines” who operate with “decreased transparency” and “a willful refusal to follow established scientific and decision-making procedures”, said Houry, a career bureaucrat who has served at the CDC under six different administrations, including the first Trump administration.

CDC staff were asked at the “last minute” to summarise evidence about the risk of thimerosal, an additive in approximately 4% of flu vaccines, for the June ACIP meeting. 

“This thimerosal evidence review included a summary of rigorous studies and was pulled from existing information on CDC and FDA websites about its safety and lack of an association with autism,” said Houry.

But Kennedy rejected the document “while allowing an unvetted presentation on thimerosal, containing scientific assertions that were not assessed for data quality and bias”. 

“Science must be allowed to stand or fall on its merits, not on whether a scientific conclusion fits one individual’s ideological narrative,” declared Houry, who earlier stressed that US life expectancy had almost doubled in the past 150 years due to vaccines.

No flu vaccine campaign, measles vaccine undermined

The CDC has not been permitted to restart flu vaccine campaigns for the upcoming season, despite 270 influenza-associated paediatric deaths during the 2024-2025 season – the highest number of paediatric deaths ever recorded in a non-pandemic year since reporting started in 2004, Houry reported. 

Around 90% of the children who died were not fully vaccinated.

Despite the highest measles cases in the US in 30 years, Kennedy has “sowed doubt” about the measles vaccine by claiming that it “contained foetal parts”, while questioning its effectiveness and length of protection, while “promoting vitamins and unproven treatments such as inhaled steroids”, said Houry. 

“These dangerous statements can lead to adverse events like the one during an outbreak in Texas, where a hospital reported cases of Vitamin A toxicity in children,” she added.

Interference ‘beyond vaccines’

Houry detailed interference “beyond vaccines”, cutting staff “who work to decrease use of tobacco, prevent the transmission of HIV, improve oral health, and screen newborns for early detection of treatable health conditions, and many more.

Houry said the CDC’s reduced capacity put the US “at risk for threats like Ebola, Marburg, and other viral haemorrhagic fevers”, and “we won’t know which flu or COVID strain is emerging globally and when it’s coming or how bad it will be”. 

This was the result of a 60% decrease in flu submission samples and a 70% decrease in COVID submission samples, meaning “we do not have good visibility into these threats any more”, she said.

Kennedy’s plan to move the CDC’s non-communicable programs to the Administration for a Healthy America “will result in siloed, fragmented approaches to outbreaks and health threats”, said Houry, adding that non-infectious and infectious diseases are connected.

Two more paediatric vaccines may be removed

Health Secretary Robert F Kennedy Jr has campaigned against several vaccines over decades.

She also described a situation of “science censored, processes politicized, and transparency curtailed”, while Kennedy conveyed major decisions unilaterally via social media.

“One example: the Secretary altered CDC’s COVID vaccine guidance through a social media post without consultation, data, or process. I first learned of this vaccine policy change, not from dialogue with the Secretary’s office, but rather from an X social media post,” said Houry.

“Due to the secretary’s actions, our nation is on track to see drastic increases in preventable diseases and declines in health,” said Houry.

The ACIP meets on Thursday and Friday to review and vote on two paediatric vaccines for the hepatitis B vaccine and the measles, mumps, rubella, and varicella (MMRV). 

Monarez told the Senate that, based on her observations of ACIP, “there is real risk that recommendations could be made restricting access to vaccines for children and others in need without rigorous scientific review”.

“The stakes are not theoretical. We have already seen the largest measles outbreak in more than 30 years, which claimed the lives of two children. If vaccine protections are weakened, preventable diseases will return,” she asserted.

“I was fired for holding the line on scientific integrity. But that line does not disappear with me. It now runs through every parent deciding whether to vaccinate a child, every physician counselling a patient, and every American who demands accountability.”

Image Credits: HHS.

In 2024, the ozone hole over Antarctica was smaller when compared to the previous years, says WMO.

The ozone layer that protects human and animal health from the sun’s harmful ultraviolet (UV) radiation continues to be on track for recovery in the coming decades, according to the World Meteorological Organization (WMO) in its latest report released this week.

In 2024, the ozone hole was smaller when compared to the previous years. This was partly due to the natural year-on-year fluctuations and partly due to the success of policies put into place to aid the recovery of the ozone layer.

“Forty years ago, nations came together to take the first step in protecting the ozone layer — guided by science, united in action,” said United Nations Secretary-General António Guterres. “The Vienna Convention and its Montreal Protocol became a landmark of multilateral success. Today, the ozone layer is healing. This achievement reminds us that when nations heed the warnings of science, progress is possible,” he said.

In another report also released this week, WMO, the UN agency that monitors atmospheric science, found that the world’s water cycle is growing more erratic, oscillating from extremes of drought to deluge.

In 2024, only about one-third of the global river basins had “normal” conditions, WMO’s State of Global Water Resources report found. The rest were either above or below normal for the sixth consecutive year.

Mixed bag for human health

Only one-third of river basins had normal conditions in 2024, according to the WMO’s latest report.

Taken together, the two reports present a mix of cheerful and grim news for the planet.

A reduction in the size of ozone hole significantly reduces the risks of skin cancer, cataracts, and ecosystem damage due to excessive UV exposure.

But 2024 was also the third straight year with widespread glacier loss. Many mountain communities depend on glaciers directly for sustenance while rivers originating from glaciers support billions downstream. All of these communities and their livelihoods stand to be affected if this continues and intensifies.

Severe drought gripped the Amazon basin, other parts of South America and southern Africa in 2024. Central, western and eastern Africa, parts of Asia and Central Europe were wetter than normal, WMO’s water report said. Both extremes of drought and floods affect human health.

An estimated 3.6 billion people face inadequate access to water for at least a month per year, and this is expected to increase to more than five billion by 2050, WMO said, quoting data from UN Water, which coordinates UN’s water efforts.

“Water sustains our societies, powers our economies and anchors our ecosystems. And yet the world’s water resources are under growing pressure and – at the same time – more extreme water-related hazards are having an increasing impact on lives and livelihoods,” WMO Secretary-General Celeste Saulo said.

The silver lining – ozone layer recovery in 2024

Ozone cover was higher in 2024 when compared to the previous years.

When compared to the previous years, the total stratospheric ozone cover was higher over much of the globe in 2024, according to the WMO.

The Antarctic ozone hole, which appears over the Antarctic in the South Pole every spring, was below the 1990–2020 average, with a maximum ozone mass deficit (OMD) of 46.1 million tonnes on 29 September (2024). This made the hole smaller than the relatively large holes between 2020 and 2023.

The onset of this hole was also relatively slow in 2024. Scientists observed a delayed ozone depletion through September that was followed by a relatively rapid recovery after the maximum deficit was reached.

“This persistent later onset has been identified as a robust indication of initial recovery of the Antarctic ozone hole,” WMO’s report said.

Ozone recovery – a policy success

WMO’s report on the ozone layer comes as the world marks the 40th anniversary of the Vienna Convention (1985), which first recognized ozone depletion as a global problem, and provided the framework for global action.

Two years after that Montreal Convention (1987) called for the global phase out of ozone-depleting substances like chlorofluorocarbons or CFCs used in refrigerators, air conditioners and even hair sprays.

The protocol has been wildly successful and has led to the phase-out of over 99% of the production and consumption of controlled ozone-depleting substances.

“WMO’s scientific research into the ozone layer dates back decades. It is underpinned by trust, international collaboration and commitment to free data exchange – all cornerstones of the world’s most successful environmental agreement,” WMO Secretary-General Celeste Saulo said.

WMO flags the need for monitoring, long-term action

Anomalies of mean river discharge for the year 2024 compared to the period 1991–2020, derived from the modelled river discharge data obtained from an ensemble of 12 GHMS simulations.

A key message from the scientists following both reports is the need to invest in science and continue supporting evidence-backed policies.

“Despite the great success of the Montreal Protocol in the intervening decades, this work is not yet finished, and there remains an essential need for the world to continue careful systematic monitoring of both stratospheric ozone and of ozone-depleting substances and their replacements,” said Matt Tully, Chair of WMO’s Scientific Advisory Group on Ozone and Solar UV Radiation.

WMO experts said they hoped countries would take a similar approach to managing their water resources.

“Reliable, science-based information is more important than ever before because we cannot manage what we do not measure.  The WMO’s State of Global Water Resources Report 2024 is part of WMO’s commitment to provide that knowledge,” she said.

Image Credits: WMO.

While South Sudan veers toward civil war, the government of President Salva Kiir spent 12 times more on president’s office than health, agriculture and social services combined since 2020.

Grand corruption schemes siphoning billions in state resources to government-linked elites have crushed South Sudan’s health system as the country teeters between famine and a new civil war, UN investigators found.

The findings of a two-year investigation by the independent UN Commission on Human Rights in South Sudan published on Tuesday document how systematic corruption has created one of the world’s worst health crises, leaving the youngest nation in the world with just $7.9 million in health spending last year for 12 million people — comparable to what it spent on its 12-player men’s national basketball team.

South Sudan ranks second-to-last globally in universal health coverage. One in 10 children dies before age five, with three-quarters of these deaths being preventable with basic medical care and immunisation programmes.

Women and girls face the highest maternal mortality rates globally. Life expectancy remains frozen at 55 years, one of the lowest in the world and nearly 20 years below the global average, unchanged since independence in 2011.

Over 7.7 million people — 65% of the population — face acute food insecurity. Among them are 2.3 million acutely malnourished children and 1.2 million malnourished pregnant and lactating women. Several provinces and over 20,000 people are currently facing famine.

“Corruption is killing South Sudanese: preventable deaths from illnesses are due to available resources being diverted from government services,” the UN Commission found. “The country has been captured by a predatory elite that has institutionalised the systematic looting of the nation’s wealth for private gain.”

The health catastrophe is unfolding as political instability threatens renewed civil conflict. President Salva Kiir arrested former deputy Riek Machar in March and charged him with treason last week, effectively ending hopes for the 2018 peace agreement that halted the last civil war, which killed 400,000 people shortly following South Sudan’s independence.

“Unless it addresses corruption meaningfully, the Government will not be able to meet the most essential needs of South Sudan’s population, or its range of international human rights law obligations, nor prevent the escalation of armed conflict,” the UN commission concluded. “If these measures are not vigorously pursued, the human misery will continue, and South Sudan will risk failure.”

Diverted billions

Health sector spending has hovered between 0.4% and 1.1% of national expenditure since 2021.

The commission’s report, “Plundering a Nation,” found the Ministry of Presidential Affairs spent $557 million between 2020 and 2024, over 12 times the combined $43.7 million received by the ministries of health, agriculture, social services, and social welfare over the same period.

The Presidential Medical Unit, exclusively serving the president and his inner circle, received more funding in 2022-2023 than the entire national health system meant to serve 12 million people.

The men’s national basketball team received $6.5 million that same year, double the combined funding for humanitarian affairs, disaster relief and social welfare ministries, which include the arms of government responsible for children and women’s health.

“Corruption is not incidental, it is the engine of South Sudan’s decline,” said Yasmin Sooka, who chairs the UN Commission. “It is driving hunger, collapsing health systems, and causing preventable deaths, as well as fuelling deadly armed conflict over resources.”

South Sudan received an estimated $25.2 billion in oil revenues since achieving independence in 2011, including $8 billion since the 2018 peace agreement that currently governs the country.

The UN Commission found “deliberate redirection” and “plundering” of these state revenues were the main culprits for the nation’s precipitous economic decline, which has seen GDP fall to a quarter of pre-independence value, resulting in a near total absence of government funding for public services.

Meanwhile, the “Oil for Roads” program diverted $2.2 billion to companies linked to Benjamin Bol Mel, appointed vice president in February. These companies, consuming 60% of government contracts in certain years, delivered less than $500 million in actual roads, leaving $1.7 billion unaccounted for.

“South Sudan’s political economy is constructed around an entrenched rent-seeking patronage network, through which elites convert public resources into private power,” the UN Commission said. “The ensuing cycle of grand corruption aided by total impunity has produced a devastating humanitarian and human rights crisis.”

A five-year plan developed by South Sudan’s own health ministry to provide basic health coverage to 65% of the population  by 2027 would cost $325.5 million in 2024. Current spending covers 2.3% of that, or $7.49 million for a whole year of the national health system intended to serve over 10 million people, 70 times lower than what the Presidential office has spent on expenses since 2020.

“These figures fall drastically short of policy targets, public health needs, and regional commitments, including the 15 per cent target committed to by African States in the Abuja Declaration,” the UN added.

Limited funds, when they reach the Ministry of Health at all, are also frequently misspent. In 2022-2023, the ministry spent twice as much on vehicles as on salaries and purchased no pharmaceuticals.

South Sudan’s government rejected the UN report, stating it was “meant to smear the good image of the people of South Sudan and its leadership.” Government spokesperson and information minister Michael Makuei Lueth also dismissed the UN’s findings: “They don’t consult the government. They just write whatever comes to their mind in their hotel rooms.”

Dying without medicine

Trend of increasing humanitarian aid needs and dependency, 2011 to 2025.

At government hospitals visited by UN investigators, doctors described working without reliable salaries, medicines or basic supplies, effectively operating under “emergency” conditions year-round. Untrained midwives deliver babies without equipment. For survivors of sexual violence, access to health care is “practically non-existent,” the Commission found.

Lack of investment in core infrastructure further complicates the picture. Power outages cripple the few functioning hospitals. Where roads don’t exist, medicine must be flown in at costs no one can afford. Only 12% of rural households have access to improved sanitation. Most South Sudanese, 61%, practice open defecation, fuelling cholera outbreaks.

“Three-quarters of child deaths are preventable, yet funds go to patronage and private pockets, not medicine or clean water,” said Commissioner Carlos Castresana Fernández. “The diversions translate into preventable deaths, widespread malnutrition, and mass exclusion from education.”

The abdication of core government functions from health, to food, and infrastructure has led to a near-total dependence on international aid. Foreign donors fund 80% of South Sudan’s health system, with the United States providing health assistance worth 235% of what the government spends on its own people.

South Sudan now faces the spectre of over half its health spending evaporating under the Trump administration’s foreign aid cuts. It is the third most reliant nation on United States funding for its health services, second only to Afghanistan and Somalia.

“The Government’s expectation, if any, is that others will cover the shortfalls,” the commission found. “While a small group of powerful actors pillage and loot the country’s wealth and resources, enriching themselves, the state has effectively abdicated its sovereign responsibilities to its population, outsourcing critical services — such as the provision of food, health care, and education to international donors.”

“Individuals implicated in corrupt acts receive government contracts for their businesses, are retained as public officials, and even promoted to the senior-most State positions,” the UN added. “This collusion in corruption at the highest levels is reflected in the deliberate absence of all forms of accountability.”

Hunger by design

Agriculture and food security national budget allocations and expenditure, 2020-2025.

The crisis extends to food security. In 33 of 79 counties, food insecurity is at ’emergency’ levels, one tier below famine. Over 22,000 people are likely already starving, while nearly 60% of the population faces life-threatening food insecurity.

The Ministry of Agriculture received $11 million over four years, 7% of its promised budget. The Ministry of Livestock and Fisheries received only 20% of its budget allocation, amounting to 0.09% of total regular budget expenditure.

Beyond climate change and conflict, the hunger crisis is also driven directly by the government’s economic mismanagement. The government’s money printing to fund corruption drives food inflation at a one-to-one rate, according to the International Monetary Fund. Any depreciation of the South Sudan Pound is fully passed on as food inflation within six months.

“In practice, the Government’s official policy choices are fuelling inflation and directly driving up the cost of food, trapping families in a cycle where government action itself intensifies hunger,” the UN said.

UN map of the floods as of 12 September, 2025.

Malaria, the leading cause of death, struck 2.8 million people in 2022. Médecins Sans Frontières warned in August of a “severe shortage of essential malaria medicines in public healthcare facilities across South Sudan,” noting the crisis would worsen with the rainy season and flooding.

“In some areas, supplies have been completely unavailable for months, even as malaria cases continue to rise,” MSF said. “With the rainy season approaching, we expect cases to rise sharply.”

Following MSF’s warning, massive floods displaced 100,000 people in recent weeks across Jonglei, Upper Nile and Unity states. Unity State is 70% underwater. Up to 400,000 people may be displaced by year’s end.

“On the ground, we have seen the widespread deprivation and the absence of basic infrastructure and services: direct outcomes of corruption,” said Sooka. “When public revenue becomes private fortune, peace cannot hold.”

Image Credits: CC.

Cash transfers
Dr Mona Hanna (left), director of Rx Kids, with two Michigan parents who received the cash transfer.

In Flint, Michigan, mothers face some of the highest risks of adverse health outcomes in the United States. But a new intervention is changing the outlook of Flint babies for the better.

More than 10 years after the city uncovered devastating lead water contamination, Flint still struggles with the highest child poverty rate in the country – nearly 60%, which is triple the national average.

Dr Mona Hanna, a pediatrician who has spent her career tackling the persistent health disparities in Flint, knew this poverty impacted every aspect of her patients’ health: “Poverty is a pathogen. It is a root cause and social determinant of health. It makes kids and communities sick.”

Hanna now has a new prescription at her disposal: unconditional cash transfers to pregnant women and new mothers in the form of the organization, Rx Kids.

The program is offering a solution to alleviate poor maternal and child health: up to $7,500 in cash for new mothers with no strings attached. They can buy a crib, diapers, nasal spray for their baby’s runny nose. All pregnant mothers are eligible, making it the first community-wide prenatal and infant cash transfer in the US.

While cash transfers have enjoyed success in 140 countries, the US remains an outlier in investing in the most critical window of development during pregnancy and early infancy.

“As a society, we consistently under-invest in this window, which makes it really hard to have a healthy pregnancy and have a healthy newborn,” Hanna said in an interview with Health Policy Watch.

Michigan’s program joins a list of others, like those in Kenya, that show a direct correlation between cash transfers and improved birth outcomes.

“With global health budgets shrinking, we think directing cash to pregnant women is a cost-effective way to stretch those dollars and save more lives,” said Laura Keen, a program director at the non-profit GiveDirectly, which administers cash transfer programs.

Pregnancy and first year shape health for life

Rx Kids and other cash transfer initiatives have lasered in on resources for new and expectant mothers because of the outsized role the first year of life plays in a child’s health and development.

“Babies’ brains double in size in that first year of life,” said Hanna, who is also associate dean of public health at Michigan State University College of Human Medicine.

This means that babies’ exposure to poverty, undernutrition, or environmental chemicals in that critical window disproportionately impacts on their health into adulthood.

Conversely, a caring, low-stress environment, breastfeeding, and stable housing can all boost a person’s health across the life course.

Although this is the most critical window for development, it is also the most financially challenging for families. A 2020 study revealed that American family income drops sharply near the birth of a child, often because the mother leaves work without adequate family leave pay, and because costs rise for a baby’s needs.

Supporting pregnant women and new mothers can also benefit communities struggling with an overburdened healthcare system. A recently published study estimates that Flint could save up to $6.2 million each year based on fewer preterm births, underweight babies, and neonatal ICU (NICU) admissions.

The city of Flint has one of the highest child poverty rate in the US.

Cash infusion halves child mortality in Kenya

While the US has been struggling with domestic health funding cuts, notably Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), overseas aid has also been crippled. The reverberations are already expected to threaten decades of global health progress, including for child and maternal health.

But a massive experiment in villages in Western Kenya found that cash could be as effective, if not more, than the typical aid interventions of bed-nets and malaria medications.

Starting in 2014, the same non-profit that facilitated Rx Kids gave $1,000 to over 10,000 households in Kenya after the birth of a child. This resulted in a reduction of almost 50% in infant mortality, from about 40 deaths per 1,000 births to 21 deaths.

The researchers tracked mortality in infants born to families who received the money and those born without. They found that access to cash increased the use of healthcare facilities, especially when families lived near clinics or hospitals.

Thus, the benefits of extra cash were most pronounced for families who could already access some form of healthcare. The researchers speculated that, like in Flint, new mothers struggled with having to work right up to or right after the birth of their child, which puts physical and mental strain on the mother.

“Despite not being the main aim of the original program, we show that unconditional cash transfers in this setting may be a cost-effective way to reduce infant and child deaths,” the authors write.

Outcomes for Flint babies and their mothers improved with the cash transfer.

Birth outcomes improve

Extra money for strollers, cribs, diapers, and transport to check-ups all relieves stress on expectant mothers, which can improve birth outcomes.

Flint babies are nearly twice as likely to have a low birth weight as the rest of the state, and have higher rates of preterm births.

However, a study measuring the effects of Rx Kids on preterm births, low birthweight, and NICU admissions in Flint over the past year, since the cash transfer program was implemented, found that it is already saving lives.

Using both Flint statistics and a comparison with matched cities, researchers found that Rx Kids was associated with a 2.7% decrease in the preterm birth rate and a 4.4% reduction in admissions to NICU.

The US struggles with poor birth outcomes and maternal mortality relative to other high-income nations. Cash transfers could help bridge this divide, noted Hanna.

“We don’t have to continuously react to poverty; we can prevent poverty, like in other countries,” she said.

Researchers hope to continue tracking the kids who received money for things like gun violence, poverty, and educational success.

Evidence for success in the US

This is the first community-wide prenatal and infant cash program in the US, partly inspired by the COVID-19 era expanded Child Tax Credit (CTC). The pandemic spurred the federal government to increase eligibility and the amount of cash for families under the American Rescue Plan. With this expanded credit, the US joined the list of some 140 countries that offer child cash-transfer programs, and initiated a historic decline in child poverty.

Although the CTC has since expired, Rx Kids was inspired to give direct transfers of $1,500 to women during pregnancy, and $500 a month for the baby for six months or a year.

“During COVID-19, as a nation, we became like all those other countries in the world, and we gave millions of families unconditional cash allowances, and that dropped child poverty to its lowest level ever,” said Hanna.

“Millions of kids in the United States came out of poverty. All these outcomes improved: housing stability, nutrition security, decreased debt, less abuse and neglect, decreased parental stress. The list went on and on of all these amazing outcomes, and that was not renewed by one vote in the US Senate, and millions of kids went back into poverty.”

Maternal mental health and well-being improve

The unconditional cash transfers enabled pregnant women to take time off from work and to get regular health check-ups.

The cash transfers also reduced postpartum depression rates and boosted mothers’ self-reported feelings of hopefulness. Families also reported better trust in healthcare institutions, something that has taken a hit during the pandemic, especially in poorer communities. The study compared a cohort of Flint mothers and infants to three other Flint cohorts who did not receive the cash transfer.

“This money allowed me to take more time off work,” is a common refrain among the moms, said Hanna. “Or, ‘I could afford to catch up on rent.’”

Because the program is universal, and not just for low-income families, there isn’t the same stigma that is sometimes associated with welfare programs.

“We’re targeting poor places with this intervention, not poor people. And that focus on poor places is easily replicated,” said Keen.

GiveDirectly is launching a similar program in the Democratic Republic of the Congo, and hopes to expand beyond Michigan into neighboring states.

Other metrics also improved. Evictions fell by 91%, being behind on rent or mortgages dropped, and nutritional access improved. These are often key measures of future stability and success in a child’s life, said Hanna.

‘Moms know what they need’

Cash transfers improve maternal health
“We’re targeting poor places with [cash transfers], not poor people. And that focus on poor places is easily replicated,” said Keen.
Direct cash transfer programs do run the risk of participants spending the money in ways not intended by the program.

“There are understandable concerns for the unconditionality of these programs,” said Keen. “You may think that people will spend the money on alcohol or cigarettes.”

But Keen points to results that show a reduction in spending on those goods.

Preterm births also may have dropped in Flint because those mothers may have reduced smoking, commonly linked to poor birth outcomes. Flint mothers who received cash transfers saw a 1.7% drop in smoking while pregnant, and a 5.7% increase in seeking adequate prenatal care, compared to their peers.

Spending on harmful products are minor concerns when compared to the overall efficiency of the unconditional cash transfer model, Keen noted. Without work, education, or even income requirements, there aren’t many administrative costs associated with running this kind of program.

Indeed, a Michigan-based economic think tank published a piece in support of the program, saying “spending your own money on yourself” is the most efficient way to spend money, unlike many of the government welfare programs that restrict eligibility.

Public health is often criticized for being paternalistic, notes Hanna. “We think we know what’s best for you. But this uproots that notion and conveys a sense of trust and empowerment.”

“Moms know what they need,” she said. Furthermore, the program’s unconditionality has been a boon in participation. Nearly every eligible newborn has been enrolled, unlike some federal welfare programs, which may only have 50% intake.

The program has bipartisan support, largely because of its efficient model. It’s already expanded to 11 rural and urban communities in Michigan.

Over 3,000 families have since been enrolled in the Rx Kids program, totalling $14.5 million in direct cash transfers.

“Bringing a child onto this earth is hard for everyone, and as a community, we should come together and support people through that process,” said Keen.

Image Credits: Sipho Ngondo/ Unsplash, International Confederation of Midwives, Rx Kids .

IGWG co-chairs, Brazil’s Tovar da Silva Nunes and the UK’s Mathew Harpur.

Amid rising disease threats, it is “critical” that the World Health Organization (WHO) presents a completed pandemic agreement to the United Nations (UN) High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response in 2026, WHO Director General Dr Tedros Adhanom told member states at the start of negotiations on the final outstanding annex to the agreement on Monday.

“The next pandemic or major global health emergency is not a question of if, but when,” Tedros told the Inter-governmental Working Group (IGWG) meeting in Geneva to conclude talks on a Pathogen Access and Benefit-Sharing (PABS) system.

The PABS annex is due to be adopted by the World Health Assembly in May next year, and thereafter taken to the HLM, said Tedros.

According to Article 12 of the pandemic agreement, the IGWG needs to develop provisions to govern the PABS System, “including definitions of pathogens with pandemic potential and PABS materials and sequence information, modalities, legal nature, terms and conditions, and operational dimensions”.

The negotiation timetable is extremely tight, but the IGWG Bureau has drawn up a draft outline of what PABS needs to cover, suggested definitions and compiled a list of experts to guide the talks.

Some of these experts were suggested at an informal meeting of the IGWG last week. They include the Dr Farida Al-Hosani from the United Arab Emirates, who chairs the WHO’s Pandemic Influenza Preparedness (PIP) Framework Advisory Group; Australia’s Dr Jodie McVernon, director of Doherty Epidemiology and public health lead at the Doherty Institute; Italian pharmocologist Dr Marco Cavaleri, who heads the European Medicines Agency’s (EMA) office of biological health threats and vaccines strategy, and Thailand’s Professor Punnee Pitisuttithum, head of the Vaccine Trial Centre at Mahidol University in Bangkok.

Member states have acknowledged that the process needs expert guidance as the annex will need to harmonise with several international agreements covering intellectual property and trade, as well as the Nagoya Protocol, which determines how to share the benefits arising from the use of genetic resources fairly and equitably.

Standard contracts

The Third World Network called for legally binding contracts with manufacturers under PABS.

Several stakeholders who addressed the open session of the IGWG called for the annex to include standard, legally binding contracts for manufacturers who want to use pathogens to develop vaccines, diagnostics and therapeutics.

Drugs for Neglected Diseases Initiative (DNDi) proposed “model contracts that embed equity”, and “non-exclusive licencing approaches” to enable technology and knowledge transfer and capacity strengthening.

The Third World Network advocated for legally binding contracts and clear governance mechanisms.

The Coalition for Epidemic Preparedness Innovations (CEPI) “embeds contractual obligations for access in our agreements with partners developing pandemic products”, but said that this “only addresses access in one part of the value chain”.

PABS benefit-sharing provisions should not discourage innovative developers and manufacturers, CEPI stressed. 

CEPI is developing a biospecimen sourcing initiative of samples from survivors of infectious disease outbreaks, “which will provide a practical example of how to enable timely, ethical access to clinical specimens for immunoassay development and vaccine development”. 

Avoid ‘excessive obligations’

The IFPMA’s Grega Kumer warned against “excessive or unclear obligations” and “a complex legal maze”, which would undermine the “fragile” pandemic innovation ecosystem.

“Free and unhindered access to pathogens and their associated sequence information is fundamental to global health security,” said Kumer.

“This openness, regardless of origin or intended use, must be preserved to maintain the agility of the research and innovation ecosystem.”

The IFPMA also wants PABS to be operational for pandemics only and not public health emergencies of international concern (PHEIC).

Gavi, the vaccine alliance, called for clear definitions of terms, particularly pathogens with pandemic potential, and called for a PABS system that can “deliver an end-to-end solution, from access to materials and sequence data to the fair allocation and delivery of vaccines, therapeutics and diagnostics”

The EU’s Americo Zampetti (right)

The European Union’s (EU) Americo Zampetti stressed that the PABS system should “increase the availability and affordability of safe vaccines, therapeutics and diagnostics (VTDs)” during a pandemic emergency.  

It should also “enhance the ability of WHO and other key partners in the UN system and beyond to swiftly and effectively act to save lives by distributing relevant and safe VTDs to those most in need”.

However, he warned that the EU “will not support a system that negatively impacts the innovation ecosystem and disincentivises innovation”.

‘Not a business deal’

Addressing the open session, Bangladesh urged member countries to remember that they are “not negotiating a business deal, but an agreement to save lives”.

Malaysia, speaking for the Association of Southeast Asian Nations (ASEAN), said the association has made significant strides to safeguard members in pandemics, including through the ASEAN Centre for public health emergencies and emerging diseases, biological threat surveillance centre and Emergency Operation Centre network. 

However, the PABS system will provide a “more coherent and structured regional framework for pandemic preparedness and response”, enabling “a regional platform for technology transfer”, pool procurement of VDTs, and building regional research, laboratory, regulatory and manufacturing capacity “so that benefit sharing is translated into lasting resilience”. 

Tanzania, speaking for the Africa plus plus Egypt, Sudan and Tunisia (usually part of WHO Eastern Mediterranean Region), said the annex presents an opportunity to “operationalize equity in tangible ways”.

“The Africa region underlines the need for legal certainty and for the primacy of mutual trust, cooperation, accountability and transparency in the PABS system.”

Global Fund Executive Director Peter Sands at a press briefing this week in Geneva.

While deaths from malaria have fallen by 29% since over the past two decades, mortality could rise again this year due to the cuts in global health funding seen recently, says Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“There has been a significant impact…and I suspect that we may well see an increase in the number of children dying of malaria this year in part due to the reductions in funding,” Peter Sands,  told reporters in Geneva as the organization released its annual Results Report.

Progress in reducing deaths from the disease, which still kills about 600,000 people a year, had already stalled during the pandemic. Meawhile, climate change drivers of more warm and wet weather are facilitating mosquito breeding and parasite transmission, while regional conflicts make drugs, vaccines and bed nets harder to distribute.  And to make matters worse, more pockets of parasitic resistance to currently available drugs are emerging, according to the Global Fund’s 2025 report.

Standing water post hurricane
Standing water in flood zones, seen here in the aftermath of Hurricane Otis, creates ideal grounds for mosquitoes to breed.

The net result could lead to more than 100,000 additional malaria deaths this year, Sands warned, a huge setback in the historic gains seen. Three-quarters of the 608,000 malaria deaths in 2022, the latest year for which data is available, were in children under the age of five, with Sub Saharan Africa bearing the brunt of the mortality, the report says.

Malaria infection rates can rise dramatically and abruptly, Sands noted, warning that “malaria is a disease that reacts very quickly.. and it doesn’t react in small percentage changes.”

For instance, Pakistan’s massive flooding in 2022, led to a whopping 2.6 million malaria cases that year – as compared to only about half a million in 2021.Fragile and conflict ridden states that are home to some 16% of the global population, bear nearly two-thirds of the global malaria burden, as well as one quarter of TB cases and 17% of new HIV infections.

Impressive results – so far

Global Funds results report summary

Despite the serious threats on the horizon, the recent report still reflects impressive results archived since the organization’s inception in 2002. In less than a quarter century, the combined death rate from AIDS, tuberculosis (TB) and malaria has been reduced by 63% – saving an estimated 70 million lives. 

 “This shows that with the right tools, strong partnerships and sustained investment, we can change the course of global health for the better,” Sands also said. “But in today’s fast-changing geopolitical environment, there is no room for complacency. The global health community must move faster to reduce fragmentation, eliminate duplication and make it easier for countries to work with us.” 

As of 2024, a record number of people were on antiretroviral therapy (ARVs) for HIV, a record number of people were receiving treatment for TB, and the scale-up of malaria prevention efforts was at a peak, with new vaccines approved by regulators launched in high-priority Sub-Saharan African nations, the report states.

HIV and AIDS

Over 79% of people in Global Fund-supported countries were on ARVs in 2024.

In 2024, 88% of people living with HIV in Global Fund-supported countries knew their status, 79% were on ARVs, rising to 85% of pregnant women living with HIV –  the highest levels ever recorded. Use of pre-exposure prophylaxis (PrEP) for HIV prevention surged, with 1.4 million people in Global Fund-supported countries receiving PrEP in 2024 – a 325% increase from 2023. 

 Since the Global Fund was founded in 2002, the AIDS-related mortality has been cut by 82% and HIV incidence rate by 73% in the countries where the Global Fund invests. Even so, in 2024, 630,000 people still died of AIDS-related causes, and there were 1.3 million new HIV infections globally – around 3.5 times more than the global target of fewer than 370,000 new infections by 2025. But amongst all the diseases covered, Sands sounded the strongest notes of optimism around teh possibility of making further progress on HIV and meet a key 2030  Sustainable Development Goal. 

“We really have the oportunity to accelerate the elimination of HIV as a public health threat,” said Sands. “We now have tools available to really change the trajectory,” he noted, referring to the new long-acting injectable drug lenacapavir that can be administered every six months and is nearly 100% effective in preventing disease. At the end of 2024, the Global Fund committed to reaching 2 million people with lenacapavir, a promising injectable for HIV prevention.

And just last week,  US Secretary of State Marco Rubio said the United States  would make a pre-market commitment to purchase lenacapavir from the pharma manufacturer Gilead Sciences, to support distribution by Global Fund in some 8-12 high burden countries, with Undersecretary of State Jeremy Lewin, praising the partnership.  The announcement, honoring a Biden-era commitment to support the drug’s distribution, represented one of the few global health “wins” since US President Donald Trump took over at the White House.  

Tuberculosis

A trial participant is prepared for a blood test as part of a trial of new TB drugs that can overcome drug resistant pathogens.

In 2023, treatment coverage for all forms of TB reached 75% in countries where the Global Fund invests – its highest ever level, up from 45% in 2010; 44% of people with drug-resistant TB started treatment. Of those starting TB treatment, 88% were successfully treated and 91% of people living with HIV who had TB were on antiretroviral therapy. 

Since 2002, efforts to provide equitable access to prevention, testing and treatment services, find and treat “missing” people with TB, fight drug‑resistant TB and reduce prices for TB commodities have helped drive down the mortality rate by 57% and the incidence rate by 28%.

“In 2024, more people were diagnosed, more people were treated, and the treatment success rates were higher than ever before. So actually, 24 was a year of great progress, on TB,” Sands said. Here, too, innovation will prove crucial to further progress, he stressed, citing the development and scale-up of AI-powered TB detection and mobile digital chest X-rays stations, enabling faster and better diagnosis – a longstanding barrier to TB treatment. 

But TB is still the world’s deadliest infectious disease. It killed an estimated 1.3 million people in 2023, and drug-resistant TB remains a major threat to global health security. Fragile health systems, conflict and economic pressures threaten to reverse the gains made over the past two decades, Sands warned.

Malaria 

Tomnjong Thadeus with his 3-year-old daughter Gabriella in Soa, Cameroon. One third of people in Africa’s most malaria-endemic countries still don’t have bednets.

As for malaria, the target of elimination of malaria as a public health problem is now within reach, as demonstated by the experiences of both Suriname and Timor-Leste – both countries with wet, tropical  “mosquito friendly” climates that were certified as malaria-free by the World Health Organization in 2025.

“With sufficient political will and sufficient resources, We can, end malaria,” Sands said.

In countries where the Global Fund invests, access to an insecticide-treated net reached 61%, with 53% of people at risk using a mosquito net in 2023 – the highest levels to date. More than 95% of people with signs and symptoms of malaria were tested.

Strengthened access to testing, treatment and prevention options, as well as the scale‑up of dual active ingredient insecticide‑treated nets to fight drug and insecticide resistance have contributed to the reductions in disease incidence and the death rate. 

But rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides are also complicating those efforts, raising risks of resurgence in the most vulnerable groups – such as children under 5 and pregnant women. 

“With sufficient political will and sufficient resources, We can, end malaria,” Sands said. “However, in the places where malaria is biggest, and that’s almost all in, Africa, we’re not making the kind of progress we need to.

“In fact, progress has stalled, and we are facing significant challenges due to a combination of climate change, conflict in some of the most malaria-affected places; resistance, the malaria mosquitoes have become resistant to some of the most commonly used insecticides, and  we’re increasingly seeing resistance, to some of the most commonly used treatments. And frankly, inadequate funding.

“Because to beat malaria, you have to have a concentration of investment across a multiple set of tools in order to drive down, transmission,” he pointed out, citing newer, and the dual active ingredient bednets as an example.
“They’re 45% more effective than conventional insecticide-impregnated bed nets, and they only cost 70 cents more. The challenge we face is that we’re still in a position where only two-thirds of the people who could benefit from having a bed net actually have a bed net. So a third of the population in the malaria-endemic places are, sleeping without that basic protection.”

Health systems strengthening and global health security

Examining an expectant mother in Kisumu, Kenya. Since 2019, a partnership between the Global Fund, Takeda Pharmaceuticals and the Liverpool School of Tropical Medicine has supported training for health care workers to integrate HIV, TB and malaria services into antenatal and postnatal care .

While the story is “rather different” across the three diseases, the Global Fund has also stepped up its investments in health systems – for a total of $2.7 billion in 2024. Those investments yield cross-cutting benefits that “go way beyond HIV, TB and malaria,” Sands said.

For instance, strengthened laboratory and diagnostic networks have not only enhanced national responses to HIV, TB and malaria, but also enabled better detection and management of co-infections such as hepatitis B, hepatitis C and human papillomavirus, the Global Fund says. In addition, they have increased countries’ capacity to safely test for high-risk diseases including mpox, Ebola, Marburg virus and Crimean-Congo hemorrhagic fever.

“Over the last few years, and triggered by the experience of COVID, we have [also] invested over $600 million in improving the provision of medical oxygen in low- and middle-income countries. And this is often investing in what are called pressure swing absorption plants, PSA plants, which, about the size of this room, which essentially create medical oxygen out of the atmosphere,” he said that during the pandemic, 9 out of 10 hospitals did not have medical oxygen prior to the pandemic. Now, they have access for other services such as neo-natal treatmetns, material health, acute trauma and surgery.”

Eighth Replenishment drive 

The Global Fund’s Eighth Replenishment – launched in February 2025 – is a defining moment for the organization. It aims to raise some $18 billion by the end of November for the next three-year funding cycle, which runs from  2027 to 2029. 

So far, the Global Fund has raised close to $700m from countries, including Australia, Luxembourg, Norway and Spain, as well as private sector donors like the London-based Children’s Investment Fund Foundation.  At the same time, the US retreat from most global health funding commitments, and the downsizing of contributions from other traditional donors, is adding to an already challenging fiscal environment.

In July, the Global Fund confirmed that it was cutting $1.43 billion from the remainder of its 2025-2026 budget. And further adjustments are now being made to the “realities of the funding situation,” Sands admitted. Although the organization has released no data on staff cutbacks, Sands tacitly admitted these are happening, including termination of staff on short term contracts or COVID-related contracts in the Geneva headquarters, where some 1000 people have been employed.  

From the early days, the organization also made national self-reliance an integral part of its funding strategy. Since 2002, 52 HIV, TB and malaria disease programs across 38 countries have transitioned from the Global Fund. By 2026, another 12 programs from eight countries are expected to transition away from Global Fund support.

With a successful Replenishment, the Global Fund projects that it could help save up to 23 million lives between 2027 and 2029 and reduce the mortality rate from AIDS, TB and malaria by 64% by 2029, compared to 2023 levels, while strengthening health and community systems to fight new outbreaks and accelerate pathways to self-reliance.

At the same time, Sands admits, “this has been, a volatile year, let’s say, and there have been… has been significant disruption, to global health funding. And I think it’s important to recognize that we have a lot to gain and a lot to lose. We have made enormous progress, in improving the health of the poorest communities in the world. But that… those gains are fragile and could be reversed.”

Image Credits: Vincent Becker/ Global Fund, Global Fund , Direct Relief/Felipe Luna, The Global Fund/ Saiba Sehmi, TB Alliance, Brian Otieno /Global Fund.

Unhealthy diets are driving NCDs worldwide. Around 70% of primary school children in rural Mexican had a sugary drink for breakfast.

The final political declaration for the United Nations High-Level Meeting (HLM) on NCDs is substantially weaker than the zero draft, no longer referring to taxing sugar-sweetened beverages – while describing higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

However, targets for reducing tobacco use and increasing access to hypertensive management and mental health care have survived the negotiations.

Health Policy Watch can exclusively reveal the final declaration (see link below), after negotiations between the 193 UN member states were concluded last week. The declaration is due to be adopted  at the HLM on 25 September.

READ: Political Declaration of UN High-Level Meeting on NCDs

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

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

The WHO has developed a wealth of evidence-based strategies to address the group of killer conditions – including cardiovascular disease, cancer, diabetes and hypertension – that are driving deaths globally.

Only 19 of the 193 UN member states are on track to achieve the earlier goal of reducing NCD mortality by one-third by 2030 (Sustainable Development Goal 3.4).

Tangible targets

Alison Cox, the NCD Alliance’s policy and advocacy director

Alison Cox, the NCD Alliance’s policy and advocacy director, told a media briefing on Wednesday that the alliance “warmly welcomes” the declaration’s “time-bound and tangible targets”, particularly 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030.

“The fact these targets have survived a tough negotiation progress is evidence that this declaration represents political commitment to faster action,” said Cox.

The three previous UN HLMs on NCDs (since 2011) “have stopped short of including this kind of specific measure”, she added.

She also welcomed two other targets related to access to NCD medicines and care, and financial protection policies to cover patient care.

The first aims for “at least 80% of primary health care facilities in all countries have availability of WHO-recommended essential medicines and basic technologies for non-communicable diseases and mental health conditions, at affordable prices, by 2030” (clause 63).

The second target is for “at least 60% of countries have financial protection policies or measures in place that cover or limit the cost of essential services, diagnostics, medicines and other health products for non-communicable diseases and mental health conditions by 2030.

“These two targets would be critical in delivering care while reducing the growing amount of out-of-pocket expenditure,” said Cox, adding that around 1.3 billion people have been pushed into poverty by health spending. 

Influence of health-harming industries

However, Cox decried the dilution and weakening of commitments to “well-established, evidence-based interventions”, particularly the removal of excise taxes on harmful products.

This was likely to be the result of “the health-harming industries, who lobby governments so hard – industries like tobacco, alcohol, ultra-processed food and sugar sweetened beverages, and indeed, fossil fuels”, said Cox.

“We’ve heard from early this year that representatives of these companies were seeking meetings with governments in their capitals and with their missions in New York, and it’s very frustrating because these interactions are often not documented and they’re not transparent, yet we can see these interests represented in the outcome of this negotiation process.”

Cox said that while the alliance did not know which countries had pushed for references to taxes to be dropped, many countries in the European Union opposed additional taxes on alcohol because they have a large wine industry.

The declaration also makes no mention of action against food high in salt, fat and sugar, which Cox described as “a missed opportunity”.

Government under-spending on NCDs

Dr David Watkins

Cox was speaking at the launch of an NCD Alliance report published on Wednesday on financing for NCDs, which found that most countries are “dangerously underspending” on the leading cause of death worldwide, according to the NCD Alliance.

Countries should spend 1.1% to 1.7% of their gross national income (GNI) on NCDs to provide universal coverage – but currently spend just 0.26% to 0.46% of GNI, according to the report.

The report, compiled by University of Washington researchers, exposes “the scale of the chronic underinvestment that we’ve seen in NCDs for decades”, said Katie Dain, NCD Alliance CEO.

A significant proportion of government spending on NCDs goes to medicines, with a wide variation in medicine prices across countries.

Dr David Watkins, lead author of the report, models potential cost-savings of 20% to 50% if the best prices were available globally. 

“Ministries of Health and Finance must act decisively on these findings,” said Watkins. “This analysis provides governments with data to support smarter investment on NCDs, mental health, and neurological conditions in their policies and budgets. It’s not just about increasing investment but about making health budgets go further.” 

Image Credits: Thomas Stellmach/Flickr, Unsplash.

US Health and Human Services Secretary Robert F Kennedy Jr at the MAHA strategy launch.

 After a month-long delay, the Make America Healthy Again (MAHA) Commission’s strategy to address child health was released by the White House on Tuesday – but it offers few concrete proposals and no curbs on ultra-processed food or pesticides.

“We are now the sickest country in the world,” said US Health and Human Services (HHS)Secretary Robert F Kennedy Jr at the launch of the event, revealing that 76.4% of Americans are suffering from a chronic disease.

“We have the highest chronic disease burden of any country in the world. Yet we spend more on healthcare than any country in the world. We spend two to three times more than  European nations,” added Kennedy.

The strategy is the follow-up to MAHA’s first report, released in May, which laid out the commission’s assessment of the drivers of the ill-health of America’s children. 

While the MAHA strategy was intended to outline how to address these drivers, instead it presents a shopping list of 128 recommendations. that focus on conducting more research. This includes for nutrition, one of the key drivers of the US epidemics of obesity and non-communicable diseases (NCDs).

Ironically, the MAHA report was published on the eve of a global UNICEF report on childhood nutrition, which blames obesity in children on the increased consumption of ultra-processed food high in sugar, refined starch, salt, unhealthy fats and additives.

Noting that 21% of US children are obese, UNICEF proposes “mandatory policies to improve children’s food environments”, such as front-of-pack labelling on unhealthy products, restricting marketing to children, and higher taxes on unhealthy products.

In contrast, all that the MAHA strategy proposes is three nutrition-related recommendations: a standard definition of ultra-processed food, possible revisions to “front-of-pack nutrition information” after public comment and “potential industry guidelines to limit the direct marketing of certain unhealthy foods to children”.

‘Waffle words’

Marion Nestle, Emeritus Professor of Nutrition, Food Studies, and Public Health at New York University, said that the strategy “states intentions, but when it comes to policy, it has one strong, overall message: more research needed”.

Nestle, one of the world’s leading researchers on the influence of Big Food on health, was reacting to a leaked draft of the strategy in August, which has remained essentially the same as that released this week.

“Regulate?  Not a chance, except for the long overdue closure of the GRAS loophole (which lets corporations decide for themselves whether chemical additives are safe),” wrote Nestle.

“Everything else is waffle words: explore, coordinate, partner, prioritize, develop, or work toward.”

She also highlighted contradictions, such as prioritising “whole healthy foods” in nutrition assistance programs and promoting healthy meals in child care settings – while the Trump administration has cut the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which give food support to low-income people, pregnant women, breastfeeding mothers and mothers of children under the age of five.

“It doesn’t look like this is anything more than voluntary (and we know how voluntary works with the food industry; it doesn’t).  None of this says how or has any teeth behind it,” Nestle concluded.

Pesticides: Industry has prevailed

One of the dangers that the first MAHA report identified is children’s exposure to chemicals – including “heavy metals, PFAS [“forever chemicals”], pesticides, and phthalates”.

It also highlighted that studies of the pesticide, glyphosate (marketed as Roundup), “have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances”, while experimental animal studies have shown that exposure to another pesticide, atrazine, “can cause endocrine disruption and birth defects”.

The US uses more than one billion pounds of pesticides annually, which linger in the soil and groundwater. A 2021 study reported that pesticides had been found in 90% of the 442 US streams sampled by federal scientists.

However, farmers’ bodies – part of Trump’s rural support base – asserted that restricting pesticides such as atrazine and glyphosate will push up their costs and reduce yields. 

Conflict over pesticides between MAHA supporters and Trump allies is likely to have delayed the release of the report.

Ultimately, lobbying by farmers and the chemical industry has worked, as the MAHA strategy makes no mention of either atrazine or glyphosate, and simply affirms support for the Environmental Protection Agency’s (EPA) process to control pesticides. 

“EPA, partnering with food and agricultural stakeholders, will work to ensure that the public has awareness and confidence in EPA’s pesticide robust review procedures and how that relates to the limiting of risk for users and the general public and informs continual improvement,” is the report’s only statement on pesticide control.

US Environmental Protection Agency (EPA) Administrator Lee Zeldin.

However, the EPA under Administrator Lee Zeldin has systematically removed environmental regulation over industries – from pollution controls to pesticide restrictions – since Trump assumed office.

Zeldin told Tuesday’s launch that the strategy “outlines the keys to success, from pro-growth policies that advance research to driving innovation, private sector collaboration, [and] increased public awareness”.

Moms Across America, an important part of Kennedy’s MAHA alliance, said it is 

“deeply disappointed that the committee allowed the chemical companies to influence the report”, describing the reference to the EPA improving its communication of its review process as “a pathetic attempt to assuage the American people”.

“Clearly, eliminating the words ‘glyphosate and atrazine’ (that were in the first report) is not a result of new science that shows these two most widely used herbicides to be safe, but rather a tactic to appease the pesticide companies,” the group said in a statement.

“Better words on the EPA’s website WILL NOT reduce childhood chronic illness, only bans and restrictions of pesticides will.”

Farmers are satisfied

In contrast, farmers generally expressed satisfaction with the strategy, particularly the powerful American Soybean Association, with almost half a million members who are massive consumers of glyphosate and atrazine, 

“Soybean farmers are thankful the MAHA Commission recognized EPA’s approval process as the global gold standard,” said ASA President Caleb Ragland. “Between the May report and today’s strategy, the Commission was accessible and open to learning more about modern farming practices. We truly felt like we had a seat at the table, and for that, we are incredibly appreciative.”

American Farm Bureau Federation President Zippy Duvall welcomed “a renewed focus on American-grown fresh fruits, vegetables and meat, along with reintroducing whole milk into the school meal programs”.

“Prioritizing voluntary conservation efforts for farmers and ranchers and optimizing EPA’s already robust pesticide regulatory process to accelerate innovation are welcome recommendations,” added  Duvall.

Vaccine pronouncements

The strategy also promises to “ensure that America has the best childhood vaccine schedule” by “addressing vaccine injuries, modernising vaccines with transparent, gold standard science, correcting conflicts of interest and misaligned incentives” and “ensuring scientific and medical freedom”.

The American Academy of Pediatrics, which has clashed with Kennedy over changes in access to COVID-19 vaccines, said that it “cannot ignore the fact that this report is being published in the context of other recent harmful actions by the administration and Congress that undermine many of the report’s recommendations”. 

“This administration’s unprecedented cuts to Medicaid and SNAP, along with its chaotic, confusing actions restricting vaccine access are worsening – not resolving—efforts to improve children’s health,” noted AAP, which represented 67,000 paediatricians.

Professor Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development, described the strategy as “more of the same wellness/influencer grift and pseudoscience that antivaccine activists have been pushing for years”.

Hotez, who is also Dean of the National School of Tropical Medicine at Baylor University, added that “medical freedom” is a “propaganda term that accelerated in the 2010s to deny kids access to life-saving vaccines, as announced in Florida last week”.

Action on medicines

The strategy has proposed a working group on prescriptions for medicines including selective serotonin reuptake inhibitors, antipsychotics and mood stabilisers.

Late Tuesday, President Donald Trump issued a presidential memorandum to ensure that “direct-to-consumer prescription drug advertisements are providing consumers with full and accurate information”.

The memorandum directs Kennedy to ensure that prescription drug advertisements increase the amount of information regarding any risks associated with the use of prescription drugs.