Can AI Democratize the Global Fight Against Malaria? 26/11/2025 Felix Sassmannshausen AI tools will help drug discovery researchers like Cláudia Fançony, principle investigator at Centro de Investigação em Saúde de Angola (CISA). Artificial intelligence could compress years of drug discovery into months – helping to overcome growing drug resistance to existing treatments for malaria and other vector-borne diseases. But scientists in low-income countries are often left behind. Jeremy Burrows, Medicines for Malaria Venture (MMV) vice president, head of drug discovery, explains how a new open-access, AI-powered drug discovery tool co-developed by MMV aims to level the playing field. Given the growing role of Artificial Intelligence (AI) in healthcare, what concrete contributions can the new technology offer in the fight against malaria? Jeremy Burrows: At MMV, we are focused on the mission to discover, develop, and deliver new antimalarials. Along the entire value chain, from the point where you first come up with a possible molecule all the way to the end, to delivering a medicine, there are huge opportunities for AI to have an impact. I work in the early stages of drug discovery. It is particularly in these phases where AI can play a major role in terms of helping us to identify new starting points, optimize these molecules toward candidate drugs, and then actually profile these compounds to ultimately be the medicines of the future. Jeremy Burrows, MMV vice president, head of drug discovery. AI is best at analysing large amounts of data. How do you make use of that? Burrows: Since our foundation in 1999, MMV has worked with about two dozen pharmaceutical partners around the world, screening millions of compounds that can target the world’s deadliest and most prevalent malaria parasite, Plasmodium falciparum, which gives us extensive data. We’ve modelled that data and created an open-access machine learning model malaria inhibitor prediction platform (MAIP), available for free. Anyone can go there, enter a virtual chemical structure, and receive a prediction of whether that compound is likely to be active against malaria. Through validation exercises, this approach gives a tenfold increase in hit rate, which is substantial for making choices about what compounds we acquire and work on. However, our major focus is actually using AI to help optimize the medicinal chemistry design of new compounds — that is the deliberate design of compounds in a process called generative design. A 3D model of the cofolded structure prediction of a Malaria Libre compound inhibiting Plasmodium cytochrome. So, your goal is to increase efficiency and accessibility? Burrows: Yes, we are working with the Gates Foundation and a London-based company called deepmirror to deliver a tool called Drug Design for Global Health (referred to as dd4gh). This tool will be delivered in March 2026 and will be available for free only for scientists working in global health. It allows a scientist to upload their chemistry and biology data, where everything is modelled. Scientists also have access to all models built on public domain data, hosted in the MMV network. With dd4gh, they can do generative design, creating virtual chemical structures that can be scored against the models to predict which ones will be good. We can boil down thousands of options to maybe 20 compounds to synthesize and test in an iterative design cycle. This process, called model-informed active learning, in which the models improve with each design cycle, can potentially reduce the number of cycle times required to deliver a candidate drug. Regarding accessibility, many tools like this are currently prohibitively expensive. Delivering dd4gh is therefore democratizing AI for scientists in lower- and middle-income countries to fight malaria. The dd4gh learning loop to improve compound design. You speak of democratisation. What are the main challenges of applying these AI-driven tools in low-resource settings? Burrows: There is clear inequity in access to these technologies. The investments needed are beyond the scope of most academic groups in lower- and middle-income countries. However, there are excellent scientists in Africa, and often good internet connectivity exists – even if the data centres running the algorithms will likely not be in Africa, all the ingredients are there. A major challenge in drug discovery in Africa is the logistics: how long it takes to order and receive components to make a compound. We are tackling this directly by encoding DD4GH with information about the local availability of building blocks so that it would prioritize compounds to make that can be accessed quickly. Our strategy involves free access to a high-end tool, training, and co-creation together. Jeremy Burrows presenting advances in AI at the MMV symposium in Geneva. Does your tool rely on a proprietary algorithm? And how is data-sharing organized amongst partners? Burrows: MMV, with the help of the Gates Foundation, has secured a licence that ensures long-term access. Critically, AI allows us to share information confidentially between partners so that it can be modelled without actually sharing data. In our recent MMV workshop where the tool was discussed, we asked participants if they would contribute their data into such a tool, and the response was unanimously positive. What other opportunities do you see for AI in drug discovery? Burrows: AI is opening up many new opportunities in drug discovery and MMV has multiple projects underway, including developing better models of how the immune system fights malaria and how drugs interact with the human body. We are partnering with some leaders in this field so we are excited to see what it can do. There is widespread scepticism regarding AI. What advice do you have for drug discovery scientists facing this new reality? The future of AI is promising but requires a healthy degree of scepticism. While there are many bold claims, it’s essential to validate new models and understand their limits. Human oversight remains critical. AI should be used as a tool to enhance, not replace, human judgment. Continuous learning, openness to outside expertise, and adapting to new ways of working will be key. Ultimately, AI has the potential to transform how we use data, democratize technology for scientists worldwide, and co-create tools that change the way we work, especially in global health. See related story: Looming Malaria Drug Resistance Spurs Global Search for New Treatments Burrows spoke with Health Policy Watch on the margins of the recent MMV Science of malaria medicine symposium in Geneva. Image Credits: Supplied by Cláudia Fançony, Violaine Martin/ MMV, DD4GH, Jeremy Burrows. Phasing Out Mercury in Cosmetics Requires ‘Detoxifying’ Perceptions of Beauty 25/11/2025 Disha Shetty Khalilou, second from left, disguises himself as a woman to compete in a beauty pageant and challenge norms about skin colour in Timpi Tampa. “Why is it always those who have light skin that win,” asks a young Senegalese man tasked with handing out flyers for a local beauty pageant. The setting is Dakar, where the newly-released film Timpi Tampa tells the story of a young man, Khalilou, whose mother is diagnosed with cancer, potentially from using skin-lightening products contaminated with mercury. He disguises himself as a woman named Leila to join a beauty pageant dominated by light‐skin standards, with the intent to challenge that system. The film highlights how global efforts to remove mercury from cosmetics – still widely used in whiteners – need to go hand-in-hand with changes in social attitudes that combat “colourism” – that is the still prevalent idea that whiter skin has inherently greater beauty than darker brown and black colours. The film was aired in an unusual evening at the intersection of art and environmental policy on the margins of the recently concluded COP6 Conference of Parties to the Minamata Convention. The latest COP, which aims to eliminate harmful uses mercury, a highly toxic metal for both health and the environment, ended on 7 November with a decision to step up advocacy and action around the cosmetics issue. The side-event was organized by the Global Health Platform and Global Health Centre of the Geneva Graduate Institute. It was co-hosted by the United Nations Environment Programme; World Health Organization; Global Mercury Partnership; Biodiversity Research Institute, and the Global Environment Facility. Many cheap skin lightening products contain toxic mercury and its compounds that are harmful to human health. While mercury is banned in cosmetics, it continues to be used widely, especially in poor-quality and artisanal products commonly used for skin lightening. At the recent COP-6, countries committed to clamping down further on the availability of mercury-containing cosmetics as well as cross-border trade. Mercury’s toxic compounds can have a range of impacts on human health affecting nervous, digestive, immune systems and also on lungs, kidneys, skin and eyes, according to the World Health Organization (WHO). For the next COP7, scheduled in 2027, the WHO has also been invited to prepare a strategy advising countries about measures to prevent the use, manufacture, import and export of mercury-contaminated cosmetics. See related story: Dental Amalgam Set to Be Phased out by 2034 to Reduce Toxic Mercury Exposures Growing market for skin-lightening products “For us in Geneva, it might not be so obvious, but skin-lightening products are a growing market. The estimated figure was $9.2 billion in 2023 and it’s expected to almost double to 16 million in 2032 with Asia Pacific dominating the market for the production and end use,” said Ludovic Bernaudat, Senior Programme Management Officer at Chemicals and Health Branch, United Nations Environment Programme (UNEP). “People use these products because in many societies lighter skin means better job, better prospect of marriage, and means beauty or status.” Skin-lightening cosmetics represent one of the fastest-growing parts of the beauty industry, with the Asia-Pacifiic region having a market share of over 50%. Skin whitening products with mercury easy to access Side-event in Geneva earlier this month at the Geneva Graduate Institute discussed the beauty ideals that allow cosmetics with mercury to stay in the market. From left to right: Ludovic Bernaudat of UNEP, Serge Molly Allo’o Allo’o of WHO, Ellen Rosskam of International Geneva Global Health Platform and Angélica Dass of project Humanae. In poor communities in Gabon, like other places in West Africa, people often resort to cosmetic bleaching as a way to lighten their skin, said Serge Molly Allo’o Allo’o, Project Coordinator working on eliminating mercury from skin-lightening products at WHO’s Gabon office. “When you go to the market, you have cosmetic bleaching [is] everywhere, everywhere. And that is very cheap. But that is why in Gabon, we set up a regulatory framework to ban this kind of importation, most of which is informal,” he said. The problem is not just in Africa. Skin bleaching is also widespread in Asia and Latin America. Most of these countries still linger under a colonial legacy where whiter skin was the standard of beauty. This standard remains embedded in large segments of the population, experts said. UNEP is developing a project with 13 countries in Africa as well as with five countries in Asia, Latin America and the Caribbean to address regulations around mercury-containing cosmetics, said Bernaudat, adding that the agency hopes to gradually expand that footprint “so that we can make a difference at the global level.” Using art to leverage awareness Khalilou in a poster of Timpi Tampa, which addresses colourism as a driver of consumption of cosmetics that contain mercury and other toxics. While regulation is critical to limiting the availability and movement of mercury-contaminated cosmetics, consumer preferences need to change to address the root problem – why these products are purchased in the first place. And art can help ‘detoxify’ such perceptions of beauty. In Timpi Tampa, a film by Senegalese director Adama Bineta Sow, social pressures around “colourism” are discussed through the story of Khalilou, who finds out that skin bleaching caused his mother’s skin cancer. He disguises himself as a young woman, Leila, and enters a beauty contest to encourage women with dark skin to be proud of their colour “Now, most of [the] women in my country… have light skin. It’s not the[ir] natural skin. And I’ve always wanted to go to each of them and to tell them you were already beautiful the way you were before,” Sow said during the interaction following the screening of her movie at the event. Sow said she wrote the movie out of her experiences growing up in Senegal. Although she never tried lightening cosmetics herself, she witnessed first-hand the harmful beauty standards and social pressures that can lead many teenage girls and women to use such products – including ones that may contain mercury. Portraits taken by photographer Angélica Dass as part of her project Humanae. “When we are not able to talk with each other, when words are not enough… I think that art speak[s] clear, loud,” said Angélica Dass. Dass is the creator of the exhibit Humanae, which also addresses the topic of colourism. As a part of her project Dass took 5,000 portraits across 39 cities and 20 countries capturing her subjects’ bare shoulders, skin and hair, in natural, unadorned poses. “The most important information that you find about these people is exactly the lack of information. Anything that you put in these people just belongs to your own stereotypes,” said Dass, who also participated in the evening panel discussion. And changing the colour of ones skin or hair doesn’t provide an authentic escape from the related social prejudices of race and ethnicity, Dass pointed out. For instance, when a curly-haired girl in the picture uses skin whitening, her identity still remains that of a black girl, Dass observed, suggesting that identity needs to be embraced rather than modified superficially. The key is to teach new generations to understand and celebrate who they are. The amount of melanin someone has in their skin should never be a dehumanizing factor. Tackling colourism an important human rights issue Mercury and its compounds can cause immense damage to human health. While the government can enact laws and regulations, artists like Dass and Sow can impact deeply perceptions of beauty and thus contribute to behavioural change, Bernaudat said, adding that looking at the issue of mercury in cosmetics through the lens of human rights can also help address the issue. “People need to have the same chance, wherever they look like, whatever gender they are, etc, and that’s where we need to start. And I think from this we need to change behaviours,” he said. At the same time, legislation, when well crafted, can help with accelerating this behavioural change, He pointed out, citing UNEP’s work with The Minamata Convention on Mercury as one such example. “That is an extraordinary international treaty that UNEP pushed through with an entire health component,” said Ellen Rosskam, Coordinator, International Geneva Global Health Platform and the Global Health Centre, who moderated the conversation. “And that is something really exceptional.” Image Credits: Timpi Tampa trailer , By arrangement, Global Health Centre, Geneva Graduate Institute, IMDB, Angélica Dass. UNAIDS: Funding Cuts Pose ‘Perilous Risks’ for HIV Response 25/11/2025 Kerry Cullinan Many prevention campaigns, such as this by Alliance Côte d’Ivoire, have been cut for due to lack of funds. Abrupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world, according to the 2025 UNAIDS report released on Tuesday. “People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available,” notes the UNAIDS report, aptly called Overcoming Disruption: Transforming the AIDS response. “Over two million adolescent girls and young women have been deprived of essential health services, and community-led organisations have been devastated, with many being forced to close their doors.” The UN agency has been forced to slash staff by more than half as it too has been defunded by the US government since the Trump administration took charge in January and froze all foreign aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR). “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS. “Before, we had places to go, people to talk to, and we knew someone cared. I felt supported when there were peer groups and community counsellors.” A South African sex worker and mother of three who lost access to antiretroviral (ARV) therapy for four months told the agency: “The only thing I could think of was my kids, and that I am going to die.” Immaculate Bazare Owomugisha, of the International Community of Women Living with HIV based in Uganda, said that “community structures that supported people to remain engaged in care and come in for testing have been phased out” and her organisation had to retrench more than 30 people who did community-based monitoring. PEPFAR supported 20 million people living with HIV in 55 countries, including 222,000 people on ARVs and 190,000 healthcare workers, according to the PEPFAR Program Impact Tracker. It estimates that the funding freeze has caused 132,933 adult deaths and 14,150 child deaths (by 25 November). Long-lasting effects of disruptions Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients has been in jeopardy. Although funding for some PEPFAR-supported HIV programmes has restarted, “service disruptions associated with these and other funding cuts are having long-lasting effects on almost all areas of the HIV response”, according to the report. Access to treatment for many people with HIV in West and Central Africa was disrupted as donors cover 90% of the costs for antiretroviral (ARV) medicine. In eastern and southern Africa, this figure is 38%. In Eswatini, which has the highest HIV prevalence in the world (23% of adults aged 15- 49 years), the HIV programme lost 20% of its funding. In Ghana, 29% fewer pregnant women with HIV received ARVs to prevent HIV transmission to their babies during the first six months of 2025 Vital tests – CD4 counts and viral loads which gauge whether ARV treatment is working – have plummeted in several countries. Some people didn’t get ARVs because funding cuts affected procurement and supply-chain management systems, resulting in stock-outs of HIV medicines in the Democratic Republic of the Congo, Ethiopia and Kenya. But even quantifying the disruptions is difficult, as data capturers have lost their jobs and community-led monitoring has been disrupted. However, the report identifies the most vulnerable areas as being HIV testing, prevention and care; data collection; community-led responses; services for “key populations” and human rights and gender equality. Collapse of services for key populations “Key populations” refers to groups most vulnerable to HIV and where the virus is hardest to eliminate – often because these groups are heavily stigmatised. These include adolescent girls and young women, men who have sex with men (MSM), sex workers, people who inject drugs, transgender people and prisoners. “Donor funding accounts for most of the funding (100% in western and central Africa) for tailored HIV testing services in settings focusing on key populations,” according to the report. In Zimbabwe, for example, many HIV services for sex workers and other key populations have “effectively collapsed” this year. Most key population clinics in Kenya and at least five in Nigeria have closed. Over three-quarters (77%) of harm reduction programmes and other HIV services for people who inject drugs had been “severely disrupted by funding cuts”, according to a UNAIDS survey in April. Prevention disrupted Getting an HIV/AIDS test at Witkoppen Clinic in Gauteng, among many in South Africa highly dependent on US funding prior to the dismantling of USAID. Funding cuts have substantially affected access to pre-exposure prophylaxis (PrEP), antiretroviral therapy to prevent HIV infection, usually also targeted at groups at the highest risk of HIV. When the US government resumed funding via bridging agreements in October, it made it confined several services, including PrEP, to pregnant and breastfeeding women only. By mid-October, the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people have lost access PrEP this year. This includes 64% of people in Burundi, 38% in Uganda and 21% in Viet Nam. Meanwhile, male condom distribution fell by 55% in Nigeria between December 2024 and March 2025, The number of HIV tests performed declined by 43% in Cameroon from January through July. Community outreach ‘eliminated’ Community-led organisations play an important role in HIV prevention, testing, care and treatment services, including direct provision of these services – particularly for “key populations”. “Community outreach services have been reduced or eliminated in Angola and Eswatini due to funding cuts’” the report notes. “Over 60% of women-led HIV organisations have lost funding or been forced to suspend essential programmes, leaving entire communities without access to vital services”, while a survey of 45 youth organisations found that 60% had experienced a sudden and significant loss of resources. Community-led organisations of men who have sex with men in Kenya, Mozambique and Viet Nam reduced staffing by at least one-third. African solutions Increasing domestic financing for HIV is essential, but tricky for many countries in western and central Africa, where public debt service is on average 5.5 times greater than public health allocations. However, UNAIDS estimates that it is feasible for the domestic share of HIV financing to rise from 52% in 2024 to two-thirds by 2030. This year, Nigeria approved a $200 million increase in its health budget. Uganda is taking steps to double its domestic spending on health, while Côte d’Ivoire and South Africa have increased their domestic investments to help mitigate the effects of reduced donor support. Twenty-six of the 61 countries reporting to UNAIDS stated they expect to increase their domestic public HIV budgets. African leaders adopted the Accra Reset earlier this year, calling for “a new era of health sovereignty rooted in national ownership, investment and leadership”. Meanwhile, an extraordinary session of the African Union Assembly is being convened in next month to secure support for the implementation of the African Union’s roadmap on “sustaining the AIDS response, ensuring systems strengthening and health security for the development of Africa”. African leaders have also committed to strengthening local manufacturing of medical products, and the vaccine alliance, Gavi, has committed $ 1.2 billion to the Africa Vaccine Manufacturing Accelerator initiative. The report also introduces the new Global AIDS Strategy (2026–2031), to be adopted by the UNAIDS Programme Coordinating Board in December. The new strategy is “person-centred and has fewer focused targets”. It focusses on integrating HIV services into national programmes, reducing stigma, and securing sustainable financing. UNAIDS estimates that $21.9 billion will be needed annually until 2030 to achieve global HIV targets in low- and middle-income countries. “HIV programmes are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services and the organisations that support those communities are being decimated,” the report notes. “There is hope, however, as seen through the political will and the resilience that both communities and countries have demonstrated in the past months. The world has come a very long way already on this journey and now is not the time to pause or step back. Now is the time to keep the promise and end AIDS by 2030.” Image Credits: JB Russel/ The Global Fund/ Panos, UNAIDS, Witkoppen Clinic. COP30 Ends With No Text on Fossil Fuels Phase-Out – but Plans for a Conference in 2026 24/11/2025 Stefan Anderson Two weeks of negotiations in Belém, Brazil, delivered voluntary measures and delayed finance targets, but no phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. The UN climate summit marking the tenth anniversary of the Paris Agreement to keep global warming under 1.5 °C ended in trademark UN fashion: a text laying out next steps to speak about plans to agree to make more plans. The package of voluntary measures dubbed the “Global Mutirão,” Portuguese for collective effort, nixed any mention of fossil fuels and failed to include a deforestation roadmap backed by over 90 nations, exposing deep fractures in global climate diplomacy. More than half of the nearly 200 nations in attendance opposed even non-binding language on oil, gas and coal phase-out despite scientific projections showing the world remains on track for 2.6 to 2.8 degrees Celsius of warming. The health front scored several incremental victories. The outcome text included the first direct acknowledgement of the health benefits of mitigating emissions in a COP decision, while the Belém Health Action Plan – a voluntary policy package of best practices for adapting health systems to the climate crisis – was endorsed by about 10% of nations but received no money from governments. The action plan also invites nations to report progress on health adaptation in their submissions to the Global Stocktake at COP33, making health adaptation part of countries’ official climate progress reporting for the first time. “No one is saying this will be easy or we are on track,” UN Environment Programme Inger Andersen said after the summit. “We must do much more, move much faster. Escalating climate impacts continue that spare no nation.” Fossil fuel, deforestation roadmaps to be developed outside the UN process Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. In the closing days of the conference, more than 80 developed and developing countries, led by the United Kingdom and the European Union, had backed a COP commitment to developing a “fossil fuel roadmap” as well as a reference to “fossil fuel transition” in the outcome document. The group of nations backing the language combined represent just 7% of global fossil fuel production. “I cannot contradict science,” said Colombian President Gustavo Petro, who hosted the COP16 biodiversity talks in Cali last year. “It is not clearly stated, as science says, that the cause of the climate crisis is the fossil fuels used by capital. If that is not said, everything else is hypocrisy.” Over 90 countries also supported a roadmap on halting and reversing deforestation, including recognition of wildfires as a major source of climate emissions that need more sustainable management. Forest fires represent 20% of global black carbon emissions, both a super pollutant and a major source of air pollution. The combined pressures of those alliances failed to move the powerful bloc of the world’s major oil-producing nations, led by Saudi Arabia, Russia and their allies, which threatened to collapse negotiations if fossil fuels were mentioned in the deal. Ultimately, over 100 nations – a clear majority – declined to support the roadmaps pushed by Brazil’s COP30 Presidency. The stand-off on fossil fuels and deforestation places significant pressure on the remainder of the Brazilian COP presidency to deliver on these two roadmaps and bring more countries on board by COP31 in Antalya, Turkey. COP President André Corrêa do Lago announced that Brazil would instead lead the development of the two roadmaps outside the formal UN COP negotiating process. A “First International Conference for the Phase-out of Fossil Fuels” will be held in Colombia in April 2026, he said to applause as the conference ended Saturday evening, after an entire day of delays. COP30 President André Corrêa do Lago speaks to reporters at the close of the summit. Meanwhile, the US did not participate in the talks for the first time in history. As fire burned through the COP30 conference centre in its closing hours, US President Donald Trump proposed plans to drill new oil fields, emboldening opponents to the fossil fuel phase-out in Belém. China, which now controls the majority of the green economy, declined to step into a leadership vacuum, instead joining the majority of nations in opposing the fossil fuel roadmap and declining to contribute to Brazil’s Tropical Forest Forever Facility. China also used its influence to push back against measures like the EU’s carbon border tax, which aims to protect European industries from imports of cheaper, carbon-intensive products. In remarks to AFP after the talks, China’s vice environment minister Li Gao said China was “happy with the outcome,” calling it “success in a very difficult situation.” Despite setbacks in addressing major drivers of the climate crisis, Brazilian officials sought to put a positive spin on the outcomes. “I’m being very honest: I believe COP30 was very, very, very good,” do Lago said after gaveling the end of the summit at 8:44 p.m. Saturday, 22 November, some 27 hours after COP30’s planned finish on 21 November. “I’m really, really very happy.” ‘Our people are losing their lives’ Negotiations in Belém finished after a 27-hour overtime. The last COP to finish on time took place in Milan in 2003. In total, the “Belém package” contains 29 separate decisions spanning over 150 pages. But amid the sea of UN diplomatic language — “recalling,” “acknowledging,” “reaffirming” — there are no legally binding commitments. The outcome text “recalls with concern” that carbon dioxide emissions account for 80%of the global carbon budget available to remain under 1.5 degrees Celsius and “recognises” that limiting warming to 1.5C “requires deep, rapid, and sustained” cuts to greenhouse gas emissions. It also sets out a voluntary process to begin making plans to start discussions on what to do next on fossil fuels. For nations on the frontlines of the climate crisis, time is running out. “Right now, our people are losing their lives and livelihoods from storms of unprecedented strength, which are being powered by warming seas. The truth is that our coral reefs, the lifeblood of our nation’s food systems, culture, and economies, are at a tipping point in dieback at 1.5 degrees Celsius,” said Palau environment minister Steven Victor on behalf of the Alliance of Small Island States. “Forest ecosystems are at a tipping point. The window to protect lives and economies is closing.” The text urges an array of other measures and reaffirms the importance of past COP deals, including the COP28 agreement in Dubai, which called for a “transition away” from fossil fuels, a key concession awarded to stop the European Union and other nations from vetoing the final deal. “We’re living through complicated geopolitical times. So there is intrinsic value, no matter how difficult, to seek to come together,” EU climate commissioner Wopke Hoekstra said of the bloc’s retreat from a veto threat. “We’re not going to hide the fact we would have preferred to have more. And yet the world is what it is, the conference is what it is, and we do think this on balance is a step in the right direction.” “I couldn’t call this COP a success,” French environment minister Monique Barbut added. Finance delayed The Tropical Forest Forever Facility, a signature initiative of Brazilian President Lula da Silva, launched in Belem with a combined $6.6 billion provided by Norway, Brazil, Indonesia, Germany and France. Nations also agreed to “call for” tripling climate adaptation finance over the 2021 Glasgow COP goal of $40 billion – but pushed back the date for that adaptation finance goal to be met from 2030 to 2035. Increasing adaptation funding had been billed as a key focus of the summit by the Brazilian presidency. By 2035, the amount to be recruited for adaptation would amount to $120 billion per year, as part of the $300 billion target annually in overall climate finance agreed to at COP29 in Baku last year. That was still a disappointment for many frontline states, which wanted $120 billion to be committed in addition to the original the Glasgow and Baku finance targets. The $300 million annually is supposed to leverage some $1.3 trillion per year from public and private sources per year. However, economists project the real needs of developing nations to fight the climate crisis at around $2.3 trillion annually. “Every country is now experiencing the impacts of climate change in real time,” said Jeni Miller of the Global Climate and Health Alliance. “Pushing out the delivery date compared to the 2030 timeline requested by developing countries means many more people will suffer, many more people will die.” The final COP30 decision “further reaffirms the call on all actors to work together” to scale up total annual climate finance to $1.3 trillion by 2035. Both goals remain aspirational, with no significant finance pledges made throughout COP30. “Wealthy countries showed up with big speeches, but once again failed to deliver on the most urgent need: real money to fund a fast and fair transition,” said Ilan Zugman of 350.org. Forests forgotten The Tropical Forest Forever Facility, billed by Brazil as a highlight of the summit, also underwhelmed. It received support from just 50 nations, with only five contributing significant resources to the project, totalling $6.6 billion. While that number dwarfs the funding of other widely hailed but so far ineffectual funds, including the Loss & Damage Fund and the Cali Fund for Biodiversity, the unique structure of TFFF means it requires massive funding to become effective. The fund works as a large endowment, relying on returns on its base capital to generate returns for governments and private investors that contribute to it. At current funding levels, the TFFF stands to generate around $3 million per year for each tropical forest nation – a 96% decrease from its target value, which would require an additional $120 billion to achieve. See related story: Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? Health co-benefits get a nod Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO led health-climate adaptation plan. For the first time, the final COP decision text formally recognised health co-benefits of mitigation, in a reference to: “the economic and social benefits and opportunities of climate action, including economic growth, job creation, improved energy access and security, and improved public health.” The inclusion of language on health is the product of more than 20 years of health-focused assessments on the co-benefits to health of climate mitigation, including the potential to save millions of lives a year by reducing air pollution from fossil fuels, as well as health gains from more sustainable diets and access to more physical activity in greener cities. The Clean Air Fund welcomed the COP30 outcome text’s acknowledgement as “a step in the right direction”, but said governments need to go further to put health at the heart of climate negotiations next year. “It is essential that adaptation and mitigation consider climate change and health,” the Clean Air Fund said. Global health leaders, including WHO Director-General Dr Tedros Adhanom Ghebreyesus, have called for health to be included in formal negotiations at future COPs. Belém health plan launched Following a modest victory at COP29 in Baku last year to maintain health as a parallel track to official negotiations, there was hope that momentum could continue to build. That happened – sort of. The Belém Health Action Plan, co-authored by the Brazilian COP30 presidency and the World Health Organisation, received limited political support, garnering endorsements from around two dozen nations of the 195 in attendance in Belém. See related story: Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance The voluntary plan represents a menu of best practice policies on adapting the health sector to the impacts of climate change, which is projected to cause up to 15.6 million additional deaths and incur health costs of $15.4 trillion by 2050, according to World Bank data. The Action Plan also invites nations to submit data, plans and progress on health sector adaptation as part of national submissions to the UN “stocktake” process, which takes place every five years. While this reporting remains voluntary, it represents incremental progress in moving health’s relationship to climate change away from the sidelines and closer to the core official negotiations. “UN Climate Conferences will always involve compromise and incremental progress while every country has to agree a final text,” said Alan Dangour, director of Climate and Health at Wellcome. But COP30 saw “increased action” on the health front adding: “The Belém Health Action Plan and the important decision on the Global Goal on Adaptation will ensure the inclusion of robust, evidence-based action and indicators on health that are vital to protect lives and livelihoods in the years ahead.” The Action plan, as such, received no financial support from governments despite backing from European Union states and other high-income nations, including Japan, Canada and the United Kingdom. Philanthropies committed a $300 million to support measures outlined in the plan. The finance gap remaining threatens to undermine the real-world impact of the action plan. The UNFCCC estimates global health adaptation needs at $26.8 to $29.4 billion per year by 2050, compared to current flows between $500 and $700 million. “The Belém Health Action Plan has excellent advice for adapting health systems to climate change,” said Dr Courtney Howard of the Global Climate and Health Alliance. “However, given the current severity of impacts, it is clear that even in a high-income country, we cannot adapt in a healthy way to the emissions trajectory we are on. The infrastructure, supply chains and workforce that high-quality healthcare depends on will fray.” Bending the emissions curve Outside the formal negotiations, climate and health activists saw momentum on super pollutants, with new initiatives to cut black carbon and methane. Both are short-lived climate pollutants, also known as superpollutants, which have an outsize impact on warming but fall out of the atmosphere within weeks or decades – as compared to centuries for CO2. Methane also is the second largest climate forcer after CO2, with a global warming impact 28 times larger, per volume of gas. A Methane Summit prior to COP saw countries express renewed commitment to the Global Methane Pledge, reached at COP26 in Glasgow, to reduce methane emissions 30% by 2030 as compared to 2020 levels. A NOW! (No Organic Waste) Initiative highlighted efforts to reduce methane emissions from organic waste. Along with methane leaks from oil and gas extraction and livestock, improper waste management is one of the key sources of methane emissions. Words have yet to translate into momentum, however. The first UN Environment Programme stocktake of methane emissions since the landmark Glasgow pledge backed by over 160 countries found the world is far behind the 30% target set for 2030, on course to deliver just a fourth of promised reductions. See related story: World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline Methane is an important precursor to tropospheric ozone, a potent air pollutant that harms human health through increased respiratory illness and asthma, as well as reducing crop production. Key methane sources, like poor landfill management, have other knock-on health impacts. Although methane is the second most powerful climate warmer after CO2, per unit of emissions, and one of the six greenhouse gases covered by the original UN Framework on Climate Change (UNFCCC), it has received less attention in formal climate negotiations until recently. Black carbon and other short-lived climate pollutants and tropospheric ozone precursors aren’t mentioned at all in the UNFCCC, revealing a gap in climate accounting. A COP30, nine countries also made a first-of-its-kind announcement to tackle black carbon emissions. Commonly known as soot, BC is a key component in health-harmful particulate matter as well as a climate pollutant that persists in the atmosphere for a few days or weeks, while fallen soot particles also acclerate snowmelt in the Himalayas and other mountain glacier systems. The countries pledged to integrate black carbon mitigation into climate strategies through targeted interventions in sectors such as electricity, transport and vehicle emissions standards, as well as oil and gas. “Cutting super pollutants is our emergency brake on near-term warming. We can avoid 0.6 °C of warming by 2050 by tackling super pollutants, such as methane, black carbon and tropospheric ozone, while reducing carbon dioxide emissions. The increased attention on super pollutants at COP30 shows ambition on climate and health is growing,” said Jane Burston, CEO of Clean Air Fund. Accelerating towards 2.6 °C UN Secretary-General Antonio Guterres addresses COP30. The summit also launched a “Belém accelerator” programme to address why countries are not meeting the plans they already committed to, known as nationally determined contributions. The final decision calls for bending the emissions curve “based on the full implementation” of the latest NDCs. Those targets, if fully implemented, would set the world on course for around 2.6 °C of warming — reducing emissions by just 12% of the 55% cut required by 2035 to hit 1.5 °C, according to a UNEP assessment ahead of the summit. More than 70 nations did not file NDCs at all. “The talk of the COP has been to ’embrace science’ and move away from negotiations to focus on implementation,” said Bill Hare, CEO of Climate Analytics, which produces the Climate Action Tracker report. “There is a massive risk that the outcome of COP30 will just leave countries to ‘implement’ policies that will warm the Earth to 2.6 °C.” “There is no point in ’embracing the science’ if it’s not acted on, just as there is no point agreeing to global energy goals if they’re not implemented,” Hare added. With no binding commitments placed on countries and an array of passive language used throughout the final decision, the text represents a lowest common denominator of what words can be put on a page. But in a fractured world, that means something, the UN chief said. “This shows that multilateralism is alive, and that nations can still come together to confront the defining challenges no country can solve alone,” said UN Secretary-General António Guterres. “But COPs are consensus-based — and in a period of geopolitical divides, consensus is ever harder to reach. I cannot pretend that COP30 has delivered everything that is needed.” Consensus under fire Overtime negotiations to reach a legally binding treaty on plastic pollution collapsed in August as major fossil fuel producers blocked an agreement. The victory of the constellation of petrostates and their allies at COP30 marks the second time in recent months that a similar alliance has derailed ambitious climate negotiations. The alliance of Like-Minded Developing Countries torpedoed the successful conclusion of a Plastics Treaty in Geneva in August, sticking firm to red lines so watered down that countries championing an agreement deemed it better to walk away than pass a final text. The successive failures have shone a spotlight on the viability of consensus-based UN negotiations, which require every nation’s sign-on to be agreed. That structure leaves ambitious countries with no choice but to compromise or leave empty-handed, while nations attempting to stymie progress have no incentive to change their stance. “The traditional COP model is under serious strain in a fractured, multipolar world, particularly from countries prepared to sacrifice the well-being of the world for fossil fuel interests,” Hare said. Some observers said the UNFCCC process has run its course. “This is an empty deal,” said Nikki Reisch, director of climate at the Center for International Environmental Law. “COP30 provides a stark reminder that the answers to the climate crisis do not lie inside the climate talks – they lie with the people and movements leading the way toward a just, equitable, fossil-free future.” “While the countries most responsible for pushing the planet to the brink point fingers, dig in their heels, and tighten their purse strings, the world burns,” Reisch said. “That’s why governments committed to tackling the crisis at its source are uniting to move forward outside the UNFCCC — under the leadership of Colombia and Pacific Island states — to phase out fossil fuels rapidly, equitably, and in line with 1.5°C.” UNFCCC executive secretary Simon Stiell defended the process after the deal was gavelled through. “I understand the various frustrations of different groups on different issues. Many countries want to move faster on fossil fuels, finance and responding to spiralling climate disasters,” Stiell said. “Certainly, if you look inside these halls, you may raise questions, but if you look at the signals that are sent over the past 30 COPS to the real world, they are there.” “With or without navigation aids our direction is clear, the shift from fossil fuels to renewables and resilience is unstoppable. We’re building day by day, step by step, COP by COP, a better world for billions more people in every part of the world.” Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. Image Credits: COP30, Stefan Anderson. Eliminating the “Period Tax” on Feminine Hygiene Products – A Battle For Freedom and Dignity 23/11/2025 Leslie Ramsammy ‘Your access to menstrual products shouldn’t depend on your postal code,’ proclaims a Mexican Facebook ad for better access, produced by #MenstruaciónDignaMéxico In August 2025, Guyana’s President Irfaan Ali removed all taxes and customs duties on feminine hygiene products. Now, Guyana’s Ambassador to the UN in Geneva calls on other countries to follow suit. In most developing countries male condoms are distributed freely. Free access to condoms is a globally recognized harm reduction strategy in public health. And yet, in those same countries, and even in some developed countries, menstrual hygiene products are often inaccessible and largely unaffordable to women and girls. Altogether, more than 500 million girls and women around the world are estimated to lack access to sanitary pads or tampons or other menstrual products. The unaffordability of menstrual hygiene products is exacerbated by both customs duties and VAT taxes that governments commonly place on menstrual hygiene products. These taxes are discriminatory – part of the gender divide and an assault on the dignity and the Right to Health for women and girls. And they are regressive taxes, hitting the poor much harder than other groups. Guyana’s Menstrual Hygiene Initiative Guyana’s first lady Arya Ali launches a menstrual hygiene initiative in one of the country’s remote regions in June 2025. Even prior to 2025, tampons and menstrual pads were VAT-free in Guyana. Then in mid-August, President Ali announced that the government would remove all remaining taxes on those products. The country is now in the process of adding these products to the public sector medical supplies list for free distribution to girls and women through public health clinics and centers. While it is a work in progress, a free menstrual packages program is also being rolled out for all girls in both public and private sector schools as part of a Guyana Menstrual Hygiene Initiative, launched in 2021. The initiative was launched following a Ministry of Education showing that one-third of female secondary school students struggle to afford or access sanitary pads – leading to missed classes and educational setbacks. Guyana’s First Lady, Arya Ali, has meanwhile been championing feminine hygiene products as a human rights issue since 2020. For Guyana, making menstrual health affordable falls under the government’s harm reduction initiatives. Guyana has taken a lead in ensuring that menstrual health packages are treated as public good and as a fundamental human right. It is a bold move. Movement is catching on worldwide Free periods protest in the United Kingdom in 2017 – one of the first to inspire a global movement. But the movement is catching on regionally and worldwide. A 2024 Lancet Review found that menstrual product taxes were applied in more than 63.2% of the locations in the Americas, with a tax averaging about 10%. At the same time, nine countries and one territory have eliminated taxes over the past decade, thanks in part to civil society advocacy – with VAT-free products now available in Barbados, Canada, Colombia, Ecuador, Jamaica, Nicaragua, Mexico, Puerto Rico, Saint Kitts & Nevis, and Trinidad & Tobago, as well as Guyana. Elsewhere in the world, other nations, including Australia, Bhutan, the United Kingdom, India, Ireland, Kenya, Lebanon, Lesotho, the Maldives, Malaysia, Mauritius, Namibia, Nigeria, Rwanda, South Africa, and Uganda, are among a growing list that have removed VAT from pads and other female hygiene products. In the United States, which has no national VAT, 28 states have eliminated sales taxes on the products. In 2021, Scotland became the first country in the world to offer tampons and sanitary pads for free “to anyone who needs them,” – setting a precedent for which countries such as Guyana are now poised to advocate more widely. Challenges elsewhere Turkish women discuss menstrual hygiene as part of the ‘We need to talk’ movement. But the picture is hardly uniform. In Pakistan, a young female lawyer, Mahnoor Omer, has gained international fame for her campaign to lower the tax on pads. Omer’s argument is that menstrual products should be placed into Pakistan’s tax-exempt “essential goods” list, which includes items ranging from milk and cheese to agro inputs like cattle semen. Currently, Pakistan’s tax can add up to 40% to the price of hygiene products, according to a 2023 report by UNICEF, which has been campaigning on the issue for a number of years. As a result, only about 16% of women and girls in rural Pakistan use appropriate sanitary products, homemade or purchased, according to one peer-reviewed journal study by a team of researchers from Agha Khan University in Karachi. Others use unhygienic materials or none at all. According to UNICEF, the high tax is a factor in Pakistan, which in 2018 had the lowest uptake of the products among four countries in the region. From tax free to entirely free Uganda’s She for She Pads is one of many social enterprises and civil society groups advocating for better access to female menstrual products worldwide. Even without taxation, in most developing countries, sanitary pads are unaffordable for most girls and women who represent about one-half of the global population – and will require such products for about 40 years of their lives. Non-access to sanitary products affects women’s and girls’ dignity, access to health, education, and workplaces, as well as participation in public activities. It is a good example of systematic gender subordination, gender segregation and economic prejudice through taxation applied solely against women. Increasingly, civil society groups led by women and girls around the world are rising up and rejecting this unequivocal assault on women’s rights. These groups see the elimination of taxation on menstrual products as critical to promote gender equity, female empowerment, human rights, and menstrual justice. In Colombia, for instance, A civil society campaign called Menstruacion Libre (free menstruation) advocated for the elimination of menstrual product taxes. In response, the Supreme Court of Colombia exempted taxes on menstrual pads and tampons in 2018. Other examples of political activism leading to removal of taxes for sanitary pads are #MenstruaciónDignaMéxico (Menstruation with dignity) in Mexico, Inua Dada and Days for Girls in Kenya, Free Periods in the United Kingdom, Qrate in South Africa, We Need to Talk in Turkiye, She for She Pads in Uganda, Myna Mahila in India, Herself in Brazil, With Red in Taiwan and many more. Rallying around ‘Menstruation Health Day’ Woman to woman – sharing information about menstrual products in India. The Right to Health has centrality in the fight for freedom and democracy around the world. Menstrual justice is another frontline in the wider battle. While this commentary highlights the issue of affordability and access to menstrual pads, menstruation justice is much more than access to pads. It also is about access to facilities, education and awareness, sound environmental management of hygiene waste products, and support. It is also about elimination of stigma. Moreover there is the issue of women in vulnerable circumstances, such as women prisoners, who have no access to menstruation pads. Governments and other stakeholders must craft a comprehensive approach to combat period poverty. This is a “best buy” in the fight for Health for All. Recognition of this, as part of an action plan crafted by WHO member states, for instance, could help amplify the issue and solutions. On Wednesday, I will be appearing on a panel of Ambassadors to the UN in Geneva at a hybrid event co-sponsored by Barbados, Canada and Malawi to kick off discussions on the intersection of menstrual health with trade policies. We can further scale up our campaigns by ensuring that the annual Menstruation Health Day, May 28, is incorporated into national public health education and awareness calendars. Access to period pads, soap, cups, facilities, education and awareness, fighting stigma and discrimination and access to environmentally safe and dignified disposal must be central in the gender equality agenda, not only for the Ministers of Health, but also for Ministers of Education, Social Welfare, Women and for the Human Rights organs of governments. Ambassador Leslie Ramsammy In our polarized world, social progressives and conservatives should all be able to unite around one single truth: Menstruation is a God-given biological activity. It should be safe, hygienic…and tax-free. Dr Leslie Ramsammy is Guyana’s Ambassador to the UN in Geneva and a former Minister of Health. Editor’s note: An earlier version of this oped appeared in DemocracyGuyana.com on 5 November. Image Credits: News Room , #MenstruaciónDignaMéxico, Free Periods , We Need to Talk , She for She pads. , Myna Mahila , CeHDI. Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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Phasing Out Mercury in Cosmetics Requires ‘Detoxifying’ Perceptions of Beauty 25/11/2025 Disha Shetty Khalilou, second from left, disguises himself as a woman to compete in a beauty pageant and challenge norms about skin colour in Timpi Tampa. “Why is it always those who have light skin that win,” asks a young Senegalese man tasked with handing out flyers for a local beauty pageant. The setting is Dakar, where the newly-released film Timpi Tampa tells the story of a young man, Khalilou, whose mother is diagnosed with cancer, potentially from using skin-lightening products contaminated with mercury. He disguises himself as a woman named Leila to join a beauty pageant dominated by light‐skin standards, with the intent to challenge that system. The film highlights how global efforts to remove mercury from cosmetics – still widely used in whiteners – need to go hand-in-hand with changes in social attitudes that combat “colourism” – that is the still prevalent idea that whiter skin has inherently greater beauty than darker brown and black colours. The film was aired in an unusual evening at the intersection of art and environmental policy on the margins of the recently concluded COP6 Conference of Parties to the Minamata Convention. The latest COP, which aims to eliminate harmful uses mercury, a highly toxic metal for both health and the environment, ended on 7 November with a decision to step up advocacy and action around the cosmetics issue. The side-event was organized by the Global Health Platform and Global Health Centre of the Geneva Graduate Institute. It was co-hosted by the United Nations Environment Programme; World Health Organization; Global Mercury Partnership; Biodiversity Research Institute, and the Global Environment Facility. Many cheap skin lightening products contain toxic mercury and its compounds that are harmful to human health. While mercury is banned in cosmetics, it continues to be used widely, especially in poor-quality and artisanal products commonly used for skin lightening. At the recent COP-6, countries committed to clamping down further on the availability of mercury-containing cosmetics as well as cross-border trade. Mercury’s toxic compounds can have a range of impacts on human health affecting nervous, digestive, immune systems and also on lungs, kidneys, skin and eyes, according to the World Health Organization (WHO). For the next COP7, scheduled in 2027, the WHO has also been invited to prepare a strategy advising countries about measures to prevent the use, manufacture, import and export of mercury-contaminated cosmetics. See related story: Dental Amalgam Set to Be Phased out by 2034 to Reduce Toxic Mercury Exposures Growing market for skin-lightening products “For us in Geneva, it might not be so obvious, but skin-lightening products are a growing market. The estimated figure was $9.2 billion in 2023 and it’s expected to almost double to 16 million in 2032 with Asia Pacific dominating the market for the production and end use,” said Ludovic Bernaudat, Senior Programme Management Officer at Chemicals and Health Branch, United Nations Environment Programme (UNEP). “People use these products because in many societies lighter skin means better job, better prospect of marriage, and means beauty or status.” Skin-lightening cosmetics represent one of the fastest-growing parts of the beauty industry, with the Asia-Pacifiic region having a market share of over 50%. Skin whitening products with mercury easy to access Side-event in Geneva earlier this month at the Geneva Graduate Institute discussed the beauty ideals that allow cosmetics with mercury to stay in the market. From left to right: Ludovic Bernaudat of UNEP, Serge Molly Allo’o Allo’o of WHO, Ellen Rosskam of International Geneva Global Health Platform and Angélica Dass of project Humanae. In poor communities in Gabon, like other places in West Africa, people often resort to cosmetic bleaching as a way to lighten their skin, said Serge Molly Allo’o Allo’o, Project Coordinator working on eliminating mercury from skin-lightening products at WHO’s Gabon office. “When you go to the market, you have cosmetic bleaching [is] everywhere, everywhere. And that is very cheap. But that is why in Gabon, we set up a regulatory framework to ban this kind of importation, most of which is informal,” he said. The problem is not just in Africa. Skin bleaching is also widespread in Asia and Latin America. Most of these countries still linger under a colonial legacy where whiter skin was the standard of beauty. This standard remains embedded in large segments of the population, experts said. UNEP is developing a project with 13 countries in Africa as well as with five countries in Asia, Latin America and the Caribbean to address regulations around mercury-containing cosmetics, said Bernaudat, adding that the agency hopes to gradually expand that footprint “so that we can make a difference at the global level.” Using art to leverage awareness Khalilou in a poster of Timpi Tampa, which addresses colourism as a driver of consumption of cosmetics that contain mercury and other toxics. While regulation is critical to limiting the availability and movement of mercury-contaminated cosmetics, consumer preferences need to change to address the root problem – why these products are purchased in the first place. And art can help ‘detoxify’ such perceptions of beauty. In Timpi Tampa, a film by Senegalese director Adama Bineta Sow, social pressures around “colourism” are discussed through the story of Khalilou, who finds out that skin bleaching caused his mother’s skin cancer. He disguises himself as a young woman, Leila, and enters a beauty contest to encourage women with dark skin to be proud of their colour “Now, most of [the] women in my country… have light skin. It’s not the[ir] natural skin. And I’ve always wanted to go to each of them and to tell them you were already beautiful the way you were before,” Sow said during the interaction following the screening of her movie at the event. Sow said she wrote the movie out of her experiences growing up in Senegal. Although she never tried lightening cosmetics herself, she witnessed first-hand the harmful beauty standards and social pressures that can lead many teenage girls and women to use such products – including ones that may contain mercury. Portraits taken by photographer Angélica Dass as part of her project Humanae. “When we are not able to talk with each other, when words are not enough… I think that art speak[s] clear, loud,” said Angélica Dass. Dass is the creator of the exhibit Humanae, which also addresses the topic of colourism. As a part of her project Dass took 5,000 portraits across 39 cities and 20 countries capturing her subjects’ bare shoulders, skin and hair, in natural, unadorned poses. “The most important information that you find about these people is exactly the lack of information. Anything that you put in these people just belongs to your own stereotypes,” said Dass, who also participated in the evening panel discussion. And changing the colour of ones skin or hair doesn’t provide an authentic escape from the related social prejudices of race and ethnicity, Dass pointed out. For instance, when a curly-haired girl in the picture uses skin whitening, her identity still remains that of a black girl, Dass observed, suggesting that identity needs to be embraced rather than modified superficially. The key is to teach new generations to understand and celebrate who they are. The amount of melanin someone has in their skin should never be a dehumanizing factor. Tackling colourism an important human rights issue Mercury and its compounds can cause immense damage to human health. While the government can enact laws and regulations, artists like Dass and Sow can impact deeply perceptions of beauty and thus contribute to behavioural change, Bernaudat said, adding that looking at the issue of mercury in cosmetics through the lens of human rights can also help address the issue. “People need to have the same chance, wherever they look like, whatever gender they are, etc, and that’s where we need to start. And I think from this we need to change behaviours,” he said. At the same time, legislation, when well crafted, can help with accelerating this behavioural change, He pointed out, citing UNEP’s work with The Minamata Convention on Mercury as one such example. “That is an extraordinary international treaty that UNEP pushed through with an entire health component,” said Ellen Rosskam, Coordinator, International Geneva Global Health Platform and the Global Health Centre, who moderated the conversation. “And that is something really exceptional.” Image Credits: Timpi Tampa trailer , By arrangement, Global Health Centre, Geneva Graduate Institute, IMDB, Angélica Dass. UNAIDS: Funding Cuts Pose ‘Perilous Risks’ for HIV Response 25/11/2025 Kerry Cullinan Many prevention campaigns, such as this by Alliance Côte d’Ivoire, have been cut for due to lack of funds. Abrupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world, according to the 2025 UNAIDS report released on Tuesday. “People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available,” notes the UNAIDS report, aptly called Overcoming Disruption: Transforming the AIDS response. “Over two million adolescent girls and young women have been deprived of essential health services, and community-led organisations have been devastated, with many being forced to close their doors.” The UN agency has been forced to slash staff by more than half as it too has been defunded by the US government since the Trump administration took charge in January and froze all foreign aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR). “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS. “Before, we had places to go, people to talk to, and we knew someone cared. I felt supported when there were peer groups and community counsellors.” A South African sex worker and mother of three who lost access to antiretroviral (ARV) therapy for four months told the agency: “The only thing I could think of was my kids, and that I am going to die.” Immaculate Bazare Owomugisha, of the International Community of Women Living with HIV based in Uganda, said that “community structures that supported people to remain engaged in care and come in for testing have been phased out” and her organisation had to retrench more than 30 people who did community-based monitoring. PEPFAR supported 20 million people living with HIV in 55 countries, including 222,000 people on ARVs and 190,000 healthcare workers, according to the PEPFAR Program Impact Tracker. It estimates that the funding freeze has caused 132,933 adult deaths and 14,150 child deaths (by 25 November). Long-lasting effects of disruptions Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients has been in jeopardy. Although funding for some PEPFAR-supported HIV programmes has restarted, “service disruptions associated with these and other funding cuts are having long-lasting effects on almost all areas of the HIV response”, according to the report. Access to treatment for many people with HIV in West and Central Africa was disrupted as donors cover 90% of the costs for antiretroviral (ARV) medicine. In eastern and southern Africa, this figure is 38%. In Eswatini, which has the highest HIV prevalence in the world (23% of adults aged 15- 49 years), the HIV programme lost 20% of its funding. In Ghana, 29% fewer pregnant women with HIV received ARVs to prevent HIV transmission to their babies during the first six months of 2025 Vital tests – CD4 counts and viral loads which gauge whether ARV treatment is working – have plummeted in several countries. Some people didn’t get ARVs because funding cuts affected procurement and supply-chain management systems, resulting in stock-outs of HIV medicines in the Democratic Republic of the Congo, Ethiopia and Kenya. But even quantifying the disruptions is difficult, as data capturers have lost their jobs and community-led monitoring has been disrupted. However, the report identifies the most vulnerable areas as being HIV testing, prevention and care; data collection; community-led responses; services for “key populations” and human rights and gender equality. Collapse of services for key populations “Key populations” refers to groups most vulnerable to HIV and where the virus is hardest to eliminate – often because these groups are heavily stigmatised. These include adolescent girls and young women, men who have sex with men (MSM), sex workers, people who inject drugs, transgender people and prisoners. “Donor funding accounts for most of the funding (100% in western and central Africa) for tailored HIV testing services in settings focusing on key populations,” according to the report. In Zimbabwe, for example, many HIV services for sex workers and other key populations have “effectively collapsed” this year. Most key population clinics in Kenya and at least five in Nigeria have closed. Over three-quarters (77%) of harm reduction programmes and other HIV services for people who inject drugs had been “severely disrupted by funding cuts”, according to a UNAIDS survey in April. Prevention disrupted Getting an HIV/AIDS test at Witkoppen Clinic in Gauteng, among many in South Africa highly dependent on US funding prior to the dismantling of USAID. Funding cuts have substantially affected access to pre-exposure prophylaxis (PrEP), antiretroviral therapy to prevent HIV infection, usually also targeted at groups at the highest risk of HIV. When the US government resumed funding via bridging agreements in October, it made it confined several services, including PrEP, to pregnant and breastfeeding women only. By mid-October, the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people have lost access PrEP this year. This includes 64% of people in Burundi, 38% in Uganda and 21% in Viet Nam. Meanwhile, male condom distribution fell by 55% in Nigeria between December 2024 and March 2025, The number of HIV tests performed declined by 43% in Cameroon from January through July. Community outreach ‘eliminated’ Community-led organisations play an important role in HIV prevention, testing, care and treatment services, including direct provision of these services – particularly for “key populations”. “Community outreach services have been reduced or eliminated in Angola and Eswatini due to funding cuts’” the report notes. “Over 60% of women-led HIV organisations have lost funding or been forced to suspend essential programmes, leaving entire communities without access to vital services”, while a survey of 45 youth organisations found that 60% had experienced a sudden and significant loss of resources. Community-led organisations of men who have sex with men in Kenya, Mozambique and Viet Nam reduced staffing by at least one-third. African solutions Increasing domestic financing for HIV is essential, but tricky for many countries in western and central Africa, where public debt service is on average 5.5 times greater than public health allocations. However, UNAIDS estimates that it is feasible for the domestic share of HIV financing to rise from 52% in 2024 to two-thirds by 2030. This year, Nigeria approved a $200 million increase in its health budget. Uganda is taking steps to double its domestic spending on health, while Côte d’Ivoire and South Africa have increased their domestic investments to help mitigate the effects of reduced donor support. Twenty-six of the 61 countries reporting to UNAIDS stated they expect to increase their domestic public HIV budgets. African leaders adopted the Accra Reset earlier this year, calling for “a new era of health sovereignty rooted in national ownership, investment and leadership”. Meanwhile, an extraordinary session of the African Union Assembly is being convened in next month to secure support for the implementation of the African Union’s roadmap on “sustaining the AIDS response, ensuring systems strengthening and health security for the development of Africa”. African leaders have also committed to strengthening local manufacturing of medical products, and the vaccine alliance, Gavi, has committed $ 1.2 billion to the Africa Vaccine Manufacturing Accelerator initiative. The report also introduces the new Global AIDS Strategy (2026–2031), to be adopted by the UNAIDS Programme Coordinating Board in December. The new strategy is “person-centred and has fewer focused targets”. It focusses on integrating HIV services into national programmes, reducing stigma, and securing sustainable financing. UNAIDS estimates that $21.9 billion will be needed annually until 2030 to achieve global HIV targets in low- and middle-income countries. “HIV programmes are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services and the organisations that support those communities are being decimated,” the report notes. “There is hope, however, as seen through the political will and the resilience that both communities and countries have demonstrated in the past months. The world has come a very long way already on this journey and now is not the time to pause or step back. Now is the time to keep the promise and end AIDS by 2030.” Image Credits: JB Russel/ The Global Fund/ Panos, UNAIDS, Witkoppen Clinic. COP30 Ends With No Text on Fossil Fuels Phase-Out – but Plans for a Conference in 2026 24/11/2025 Stefan Anderson Two weeks of negotiations in Belém, Brazil, delivered voluntary measures and delayed finance targets, but no phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. The UN climate summit marking the tenth anniversary of the Paris Agreement to keep global warming under 1.5 °C ended in trademark UN fashion: a text laying out next steps to speak about plans to agree to make more plans. The package of voluntary measures dubbed the “Global Mutirão,” Portuguese for collective effort, nixed any mention of fossil fuels and failed to include a deforestation roadmap backed by over 90 nations, exposing deep fractures in global climate diplomacy. More than half of the nearly 200 nations in attendance opposed even non-binding language on oil, gas and coal phase-out despite scientific projections showing the world remains on track for 2.6 to 2.8 degrees Celsius of warming. The health front scored several incremental victories. The outcome text included the first direct acknowledgement of the health benefits of mitigating emissions in a COP decision, while the Belém Health Action Plan – a voluntary policy package of best practices for adapting health systems to the climate crisis – was endorsed by about 10% of nations but received no money from governments. The action plan also invites nations to report progress on health adaptation in their submissions to the Global Stocktake at COP33, making health adaptation part of countries’ official climate progress reporting for the first time. “No one is saying this will be easy or we are on track,” UN Environment Programme Inger Andersen said after the summit. “We must do much more, move much faster. Escalating climate impacts continue that spare no nation.” Fossil fuel, deforestation roadmaps to be developed outside the UN process Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. In the closing days of the conference, more than 80 developed and developing countries, led by the United Kingdom and the European Union, had backed a COP commitment to developing a “fossil fuel roadmap” as well as a reference to “fossil fuel transition” in the outcome document. The group of nations backing the language combined represent just 7% of global fossil fuel production. “I cannot contradict science,” said Colombian President Gustavo Petro, who hosted the COP16 biodiversity talks in Cali last year. “It is not clearly stated, as science says, that the cause of the climate crisis is the fossil fuels used by capital. If that is not said, everything else is hypocrisy.” Over 90 countries also supported a roadmap on halting and reversing deforestation, including recognition of wildfires as a major source of climate emissions that need more sustainable management. Forest fires represent 20% of global black carbon emissions, both a super pollutant and a major source of air pollution. The combined pressures of those alliances failed to move the powerful bloc of the world’s major oil-producing nations, led by Saudi Arabia, Russia and their allies, which threatened to collapse negotiations if fossil fuels were mentioned in the deal. Ultimately, over 100 nations – a clear majority – declined to support the roadmaps pushed by Brazil’s COP30 Presidency. The stand-off on fossil fuels and deforestation places significant pressure on the remainder of the Brazilian COP presidency to deliver on these two roadmaps and bring more countries on board by COP31 in Antalya, Turkey. COP President André Corrêa do Lago announced that Brazil would instead lead the development of the two roadmaps outside the formal UN COP negotiating process. A “First International Conference for the Phase-out of Fossil Fuels” will be held in Colombia in April 2026, he said to applause as the conference ended Saturday evening, after an entire day of delays. COP30 President André Corrêa do Lago speaks to reporters at the close of the summit. Meanwhile, the US did not participate in the talks for the first time in history. As fire burned through the COP30 conference centre in its closing hours, US President Donald Trump proposed plans to drill new oil fields, emboldening opponents to the fossil fuel phase-out in Belém. China, which now controls the majority of the green economy, declined to step into a leadership vacuum, instead joining the majority of nations in opposing the fossil fuel roadmap and declining to contribute to Brazil’s Tropical Forest Forever Facility. China also used its influence to push back against measures like the EU’s carbon border tax, which aims to protect European industries from imports of cheaper, carbon-intensive products. In remarks to AFP after the talks, China’s vice environment minister Li Gao said China was “happy with the outcome,” calling it “success in a very difficult situation.” Despite setbacks in addressing major drivers of the climate crisis, Brazilian officials sought to put a positive spin on the outcomes. “I’m being very honest: I believe COP30 was very, very, very good,” do Lago said after gaveling the end of the summit at 8:44 p.m. Saturday, 22 November, some 27 hours after COP30’s planned finish on 21 November. “I’m really, really very happy.” ‘Our people are losing their lives’ Negotiations in Belém finished after a 27-hour overtime. The last COP to finish on time took place in Milan in 2003. In total, the “Belém package” contains 29 separate decisions spanning over 150 pages. But amid the sea of UN diplomatic language — “recalling,” “acknowledging,” “reaffirming” — there are no legally binding commitments. The outcome text “recalls with concern” that carbon dioxide emissions account for 80%of the global carbon budget available to remain under 1.5 degrees Celsius and “recognises” that limiting warming to 1.5C “requires deep, rapid, and sustained” cuts to greenhouse gas emissions. It also sets out a voluntary process to begin making plans to start discussions on what to do next on fossil fuels. For nations on the frontlines of the climate crisis, time is running out. “Right now, our people are losing their lives and livelihoods from storms of unprecedented strength, which are being powered by warming seas. The truth is that our coral reefs, the lifeblood of our nation’s food systems, culture, and economies, are at a tipping point in dieback at 1.5 degrees Celsius,” said Palau environment minister Steven Victor on behalf of the Alliance of Small Island States. “Forest ecosystems are at a tipping point. The window to protect lives and economies is closing.” The text urges an array of other measures and reaffirms the importance of past COP deals, including the COP28 agreement in Dubai, which called for a “transition away” from fossil fuels, a key concession awarded to stop the European Union and other nations from vetoing the final deal. “We’re living through complicated geopolitical times. So there is intrinsic value, no matter how difficult, to seek to come together,” EU climate commissioner Wopke Hoekstra said of the bloc’s retreat from a veto threat. “We’re not going to hide the fact we would have preferred to have more. And yet the world is what it is, the conference is what it is, and we do think this on balance is a step in the right direction.” “I couldn’t call this COP a success,” French environment minister Monique Barbut added. Finance delayed The Tropical Forest Forever Facility, a signature initiative of Brazilian President Lula da Silva, launched in Belem with a combined $6.6 billion provided by Norway, Brazil, Indonesia, Germany and France. Nations also agreed to “call for” tripling climate adaptation finance over the 2021 Glasgow COP goal of $40 billion – but pushed back the date for that adaptation finance goal to be met from 2030 to 2035. Increasing adaptation funding had been billed as a key focus of the summit by the Brazilian presidency. By 2035, the amount to be recruited for adaptation would amount to $120 billion per year, as part of the $300 billion target annually in overall climate finance agreed to at COP29 in Baku last year. That was still a disappointment for many frontline states, which wanted $120 billion to be committed in addition to the original the Glasgow and Baku finance targets. The $300 million annually is supposed to leverage some $1.3 trillion per year from public and private sources per year. However, economists project the real needs of developing nations to fight the climate crisis at around $2.3 trillion annually. “Every country is now experiencing the impacts of climate change in real time,” said Jeni Miller of the Global Climate and Health Alliance. “Pushing out the delivery date compared to the 2030 timeline requested by developing countries means many more people will suffer, many more people will die.” The final COP30 decision “further reaffirms the call on all actors to work together” to scale up total annual climate finance to $1.3 trillion by 2035. Both goals remain aspirational, with no significant finance pledges made throughout COP30. “Wealthy countries showed up with big speeches, but once again failed to deliver on the most urgent need: real money to fund a fast and fair transition,” said Ilan Zugman of 350.org. Forests forgotten The Tropical Forest Forever Facility, billed by Brazil as a highlight of the summit, also underwhelmed. It received support from just 50 nations, with only five contributing significant resources to the project, totalling $6.6 billion. While that number dwarfs the funding of other widely hailed but so far ineffectual funds, including the Loss & Damage Fund and the Cali Fund for Biodiversity, the unique structure of TFFF means it requires massive funding to become effective. The fund works as a large endowment, relying on returns on its base capital to generate returns for governments and private investors that contribute to it. At current funding levels, the TFFF stands to generate around $3 million per year for each tropical forest nation – a 96% decrease from its target value, which would require an additional $120 billion to achieve. See related story: Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? Health co-benefits get a nod Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO led health-climate adaptation plan. For the first time, the final COP decision text formally recognised health co-benefits of mitigation, in a reference to: “the economic and social benefits and opportunities of climate action, including economic growth, job creation, improved energy access and security, and improved public health.” The inclusion of language on health is the product of more than 20 years of health-focused assessments on the co-benefits to health of climate mitigation, including the potential to save millions of lives a year by reducing air pollution from fossil fuels, as well as health gains from more sustainable diets and access to more physical activity in greener cities. The Clean Air Fund welcomed the COP30 outcome text’s acknowledgement as “a step in the right direction”, but said governments need to go further to put health at the heart of climate negotiations next year. “It is essential that adaptation and mitigation consider climate change and health,” the Clean Air Fund said. Global health leaders, including WHO Director-General Dr Tedros Adhanom Ghebreyesus, have called for health to be included in formal negotiations at future COPs. Belém health plan launched Following a modest victory at COP29 in Baku last year to maintain health as a parallel track to official negotiations, there was hope that momentum could continue to build. That happened – sort of. The Belém Health Action Plan, co-authored by the Brazilian COP30 presidency and the World Health Organisation, received limited political support, garnering endorsements from around two dozen nations of the 195 in attendance in Belém. See related story: Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance The voluntary plan represents a menu of best practice policies on adapting the health sector to the impacts of climate change, which is projected to cause up to 15.6 million additional deaths and incur health costs of $15.4 trillion by 2050, according to World Bank data. The Action Plan also invites nations to submit data, plans and progress on health sector adaptation as part of national submissions to the UN “stocktake” process, which takes place every five years. While this reporting remains voluntary, it represents incremental progress in moving health’s relationship to climate change away from the sidelines and closer to the core official negotiations. “UN Climate Conferences will always involve compromise and incremental progress while every country has to agree a final text,” said Alan Dangour, director of Climate and Health at Wellcome. But COP30 saw “increased action” on the health front adding: “The Belém Health Action Plan and the important decision on the Global Goal on Adaptation will ensure the inclusion of robust, evidence-based action and indicators on health that are vital to protect lives and livelihoods in the years ahead.” The Action plan, as such, received no financial support from governments despite backing from European Union states and other high-income nations, including Japan, Canada and the United Kingdom. Philanthropies committed a $300 million to support measures outlined in the plan. The finance gap remaining threatens to undermine the real-world impact of the action plan. The UNFCCC estimates global health adaptation needs at $26.8 to $29.4 billion per year by 2050, compared to current flows between $500 and $700 million. “The Belém Health Action Plan has excellent advice for adapting health systems to climate change,” said Dr Courtney Howard of the Global Climate and Health Alliance. “However, given the current severity of impacts, it is clear that even in a high-income country, we cannot adapt in a healthy way to the emissions trajectory we are on. The infrastructure, supply chains and workforce that high-quality healthcare depends on will fray.” Bending the emissions curve Outside the formal negotiations, climate and health activists saw momentum on super pollutants, with new initiatives to cut black carbon and methane. Both are short-lived climate pollutants, also known as superpollutants, which have an outsize impact on warming but fall out of the atmosphere within weeks or decades – as compared to centuries for CO2. Methane also is the second largest climate forcer after CO2, with a global warming impact 28 times larger, per volume of gas. A Methane Summit prior to COP saw countries express renewed commitment to the Global Methane Pledge, reached at COP26 in Glasgow, to reduce methane emissions 30% by 2030 as compared to 2020 levels. A NOW! (No Organic Waste) Initiative highlighted efforts to reduce methane emissions from organic waste. Along with methane leaks from oil and gas extraction and livestock, improper waste management is one of the key sources of methane emissions. Words have yet to translate into momentum, however. The first UN Environment Programme stocktake of methane emissions since the landmark Glasgow pledge backed by over 160 countries found the world is far behind the 30% target set for 2030, on course to deliver just a fourth of promised reductions. See related story: World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline Methane is an important precursor to tropospheric ozone, a potent air pollutant that harms human health through increased respiratory illness and asthma, as well as reducing crop production. Key methane sources, like poor landfill management, have other knock-on health impacts. Although methane is the second most powerful climate warmer after CO2, per unit of emissions, and one of the six greenhouse gases covered by the original UN Framework on Climate Change (UNFCCC), it has received less attention in formal climate negotiations until recently. Black carbon and other short-lived climate pollutants and tropospheric ozone precursors aren’t mentioned at all in the UNFCCC, revealing a gap in climate accounting. A COP30, nine countries also made a first-of-its-kind announcement to tackle black carbon emissions. Commonly known as soot, BC is a key component in health-harmful particulate matter as well as a climate pollutant that persists in the atmosphere for a few days or weeks, while fallen soot particles also acclerate snowmelt in the Himalayas and other mountain glacier systems. The countries pledged to integrate black carbon mitigation into climate strategies through targeted interventions in sectors such as electricity, transport and vehicle emissions standards, as well as oil and gas. “Cutting super pollutants is our emergency brake on near-term warming. We can avoid 0.6 °C of warming by 2050 by tackling super pollutants, such as methane, black carbon and tropospheric ozone, while reducing carbon dioxide emissions. The increased attention on super pollutants at COP30 shows ambition on climate and health is growing,” said Jane Burston, CEO of Clean Air Fund. Accelerating towards 2.6 °C UN Secretary-General Antonio Guterres addresses COP30. The summit also launched a “Belém accelerator” programme to address why countries are not meeting the plans they already committed to, known as nationally determined contributions. The final decision calls for bending the emissions curve “based on the full implementation” of the latest NDCs. Those targets, if fully implemented, would set the world on course for around 2.6 °C of warming — reducing emissions by just 12% of the 55% cut required by 2035 to hit 1.5 °C, according to a UNEP assessment ahead of the summit. More than 70 nations did not file NDCs at all. “The talk of the COP has been to ’embrace science’ and move away from negotiations to focus on implementation,” said Bill Hare, CEO of Climate Analytics, which produces the Climate Action Tracker report. “There is a massive risk that the outcome of COP30 will just leave countries to ‘implement’ policies that will warm the Earth to 2.6 °C.” “There is no point in ’embracing the science’ if it’s not acted on, just as there is no point agreeing to global energy goals if they’re not implemented,” Hare added. With no binding commitments placed on countries and an array of passive language used throughout the final decision, the text represents a lowest common denominator of what words can be put on a page. But in a fractured world, that means something, the UN chief said. “This shows that multilateralism is alive, and that nations can still come together to confront the defining challenges no country can solve alone,” said UN Secretary-General António Guterres. “But COPs are consensus-based — and in a period of geopolitical divides, consensus is ever harder to reach. I cannot pretend that COP30 has delivered everything that is needed.” Consensus under fire Overtime negotiations to reach a legally binding treaty on plastic pollution collapsed in August as major fossil fuel producers blocked an agreement. The victory of the constellation of petrostates and their allies at COP30 marks the second time in recent months that a similar alliance has derailed ambitious climate negotiations. The alliance of Like-Minded Developing Countries torpedoed the successful conclusion of a Plastics Treaty in Geneva in August, sticking firm to red lines so watered down that countries championing an agreement deemed it better to walk away than pass a final text. The successive failures have shone a spotlight on the viability of consensus-based UN negotiations, which require every nation’s sign-on to be agreed. That structure leaves ambitious countries with no choice but to compromise or leave empty-handed, while nations attempting to stymie progress have no incentive to change their stance. “The traditional COP model is under serious strain in a fractured, multipolar world, particularly from countries prepared to sacrifice the well-being of the world for fossil fuel interests,” Hare said. Some observers said the UNFCCC process has run its course. “This is an empty deal,” said Nikki Reisch, director of climate at the Center for International Environmental Law. “COP30 provides a stark reminder that the answers to the climate crisis do not lie inside the climate talks – they lie with the people and movements leading the way toward a just, equitable, fossil-free future.” “While the countries most responsible for pushing the planet to the brink point fingers, dig in their heels, and tighten their purse strings, the world burns,” Reisch said. “That’s why governments committed to tackling the crisis at its source are uniting to move forward outside the UNFCCC — under the leadership of Colombia and Pacific Island states — to phase out fossil fuels rapidly, equitably, and in line with 1.5°C.” UNFCCC executive secretary Simon Stiell defended the process after the deal was gavelled through. “I understand the various frustrations of different groups on different issues. Many countries want to move faster on fossil fuels, finance and responding to spiralling climate disasters,” Stiell said. “Certainly, if you look inside these halls, you may raise questions, but if you look at the signals that are sent over the past 30 COPS to the real world, they are there.” “With or without navigation aids our direction is clear, the shift from fossil fuels to renewables and resilience is unstoppable. We’re building day by day, step by step, COP by COP, a better world for billions more people in every part of the world.” Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. Image Credits: COP30, Stefan Anderson. Eliminating the “Period Tax” on Feminine Hygiene Products – A Battle For Freedom and Dignity 23/11/2025 Leslie Ramsammy ‘Your access to menstrual products shouldn’t depend on your postal code,’ proclaims a Mexican Facebook ad for better access, produced by #MenstruaciónDignaMéxico In August 2025, Guyana’s President Irfaan Ali removed all taxes and customs duties on feminine hygiene products. Now, Guyana’s Ambassador to the UN in Geneva calls on other countries to follow suit. In most developing countries male condoms are distributed freely. Free access to condoms is a globally recognized harm reduction strategy in public health. And yet, in those same countries, and even in some developed countries, menstrual hygiene products are often inaccessible and largely unaffordable to women and girls. Altogether, more than 500 million girls and women around the world are estimated to lack access to sanitary pads or tampons or other menstrual products. The unaffordability of menstrual hygiene products is exacerbated by both customs duties and VAT taxes that governments commonly place on menstrual hygiene products. These taxes are discriminatory – part of the gender divide and an assault on the dignity and the Right to Health for women and girls. And they are regressive taxes, hitting the poor much harder than other groups. Guyana’s Menstrual Hygiene Initiative Guyana’s first lady Arya Ali launches a menstrual hygiene initiative in one of the country’s remote regions in June 2025. Even prior to 2025, tampons and menstrual pads were VAT-free in Guyana. Then in mid-August, President Ali announced that the government would remove all remaining taxes on those products. The country is now in the process of adding these products to the public sector medical supplies list for free distribution to girls and women through public health clinics and centers. While it is a work in progress, a free menstrual packages program is also being rolled out for all girls in both public and private sector schools as part of a Guyana Menstrual Hygiene Initiative, launched in 2021. The initiative was launched following a Ministry of Education showing that one-third of female secondary school students struggle to afford or access sanitary pads – leading to missed classes and educational setbacks. Guyana’s First Lady, Arya Ali, has meanwhile been championing feminine hygiene products as a human rights issue since 2020. For Guyana, making menstrual health affordable falls under the government’s harm reduction initiatives. Guyana has taken a lead in ensuring that menstrual health packages are treated as public good and as a fundamental human right. It is a bold move. Movement is catching on worldwide Free periods protest in the United Kingdom in 2017 – one of the first to inspire a global movement. But the movement is catching on regionally and worldwide. A 2024 Lancet Review found that menstrual product taxes were applied in more than 63.2% of the locations in the Americas, with a tax averaging about 10%. At the same time, nine countries and one territory have eliminated taxes over the past decade, thanks in part to civil society advocacy – with VAT-free products now available in Barbados, Canada, Colombia, Ecuador, Jamaica, Nicaragua, Mexico, Puerto Rico, Saint Kitts & Nevis, and Trinidad & Tobago, as well as Guyana. Elsewhere in the world, other nations, including Australia, Bhutan, the United Kingdom, India, Ireland, Kenya, Lebanon, Lesotho, the Maldives, Malaysia, Mauritius, Namibia, Nigeria, Rwanda, South Africa, and Uganda, are among a growing list that have removed VAT from pads and other female hygiene products. In the United States, which has no national VAT, 28 states have eliminated sales taxes on the products. In 2021, Scotland became the first country in the world to offer tampons and sanitary pads for free “to anyone who needs them,” – setting a precedent for which countries such as Guyana are now poised to advocate more widely. Challenges elsewhere Turkish women discuss menstrual hygiene as part of the ‘We need to talk’ movement. But the picture is hardly uniform. In Pakistan, a young female lawyer, Mahnoor Omer, has gained international fame for her campaign to lower the tax on pads. Omer’s argument is that menstrual products should be placed into Pakistan’s tax-exempt “essential goods” list, which includes items ranging from milk and cheese to agro inputs like cattle semen. Currently, Pakistan’s tax can add up to 40% to the price of hygiene products, according to a 2023 report by UNICEF, which has been campaigning on the issue for a number of years. As a result, only about 16% of women and girls in rural Pakistan use appropriate sanitary products, homemade or purchased, according to one peer-reviewed journal study by a team of researchers from Agha Khan University in Karachi. Others use unhygienic materials or none at all. According to UNICEF, the high tax is a factor in Pakistan, which in 2018 had the lowest uptake of the products among four countries in the region. From tax free to entirely free Uganda’s She for She Pads is one of many social enterprises and civil society groups advocating for better access to female menstrual products worldwide. Even without taxation, in most developing countries, sanitary pads are unaffordable for most girls and women who represent about one-half of the global population – and will require such products for about 40 years of their lives. Non-access to sanitary products affects women’s and girls’ dignity, access to health, education, and workplaces, as well as participation in public activities. It is a good example of systematic gender subordination, gender segregation and economic prejudice through taxation applied solely against women. Increasingly, civil society groups led by women and girls around the world are rising up and rejecting this unequivocal assault on women’s rights. These groups see the elimination of taxation on menstrual products as critical to promote gender equity, female empowerment, human rights, and menstrual justice. In Colombia, for instance, A civil society campaign called Menstruacion Libre (free menstruation) advocated for the elimination of menstrual product taxes. In response, the Supreme Court of Colombia exempted taxes on menstrual pads and tampons in 2018. Other examples of political activism leading to removal of taxes for sanitary pads are #MenstruaciónDignaMéxico (Menstruation with dignity) in Mexico, Inua Dada and Days for Girls in Kenya, Free Periods in the United Kingdom, Qrate in South Africa, We Need to Talk in Turkiye, She for She Pads in Uganda, Myna Mahila in India, Herself in Brazil, With Red in Taiwan and many more. Rallying around ‘Menstruation Health Day’ Woman to woman – sharing information about menstrual products in India. The Right to Health has centrality in the fight for freedom and democracy around the world. Menstrual justice is another frontline in the wider battle. While this commentary highlights the issue of affordability and access to menstrual pads, menstruation justice is much more than access to pads. It also is about access to facilities, education and awareness, sound environmental management of hygiene waste products, and support. It is also about elimination of stigma. Moreover there is the issue of women in vulnerable circumstances, such as women prisoners, who have no access to menstruation pads. Governments and other stakeholders must craft a comprehensive approach to combat period poverty. This is a “best buy” in the fight for Health for All. Recognition of this, as part of an action plan crafted by WHO member states, for instance, could help amplify the issue and solutions. On Wednesday, I will be appearing on a panel of Ambassadors to the UN in Geneva at a hybrid event co-sponsored by Barbados, Canada and Malawi to kick off discussions on the intersection of menstrual health with trade policies. We can further scale up our campaigns by ensuring that the annual Menstruation Health Day, May 28, is incorporated into national public health education and awareness calendars. Access to period pads, soap, cups, facilities, education and awareness, fighting stigma and discrimination and access to environmentally safe and dignified disposal must be central in the gender equality agenda, not only for the Ministers of Health, but also for Ministers of Education, Social Welfare, Women and for the Human Rights organs of governments. Ambassador Leslie Ramsammy In our polarized world, social progressives and conservatives should all be able to unite around one single truth: Menstruation is a God-given biological activity. It should be safe, hygienic…and tax-free. Dr Leslie Ramsammy is Guyana’s Ambassador to the UN in Geneva and a former Minister of Health. Editor’s note: An earlier version of this oped appeared in DemocracyGuyana.com on 5 November. Image Credits: News Room , #MenstruaciónDignaMéxico, Free Periods , We Need to Talk , She for She pads. , Myna Mahila , CeHDI. Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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UNAIDS: Funding Cuts Pose ‘Perilous Risks’ for HIV Response 25/11/2025 Kerry Cullinan Many prevention campaigns, such as this by Alliance Côte d’Ivoire, have been cut for due to lack of funds. Abrupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world, according to the 2025 UNAIDS report released on Tuesday. “People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available,” notes the UNAIDS report, aptly called Overcoming Disruption: Transforming the AIDS response. “Over two million adolescent girls and young women have been deprived of essential health services, and community-led organisations have been devastated, with many being forced to close their doors.” The UN agency has been forced to slash staff by more than half as it too has been defunded by the US government since the Trump administration took charge in January and froze all foreign aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR). “It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS. “Before, we had places to go, people to talk to, and we knew someone cared. I felt supported when there were peer groups and community counsellors.” A South African sex worker and mother of three who lost access to antiretroviral (ARV) therapy for four months told the agency: “The only thing I could think of was my kids, and that I am going to die.” Immaculate Bazare Owomugisha, of the International Community of Women Living with HIV based in Uganda, said that “community structures that supported people to remain engaged in care and come in for testing have been phased out” and her organisation had to retrench more than 30 people who did community-based monitoring. PEPFAR supported 20 million people living with HIV in 55 countries, including 222,000 people on ARVs and 190,000 healthcare workers, according to the PEPFAR Program Impact Tracker. It estimates that the funding freeze has caused 132,933 adult deaths and 14,150 child deaths (by 25 November). Long-lasting effects of disruptions Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients has been in jeopardy. Although funding for some PEPFAR-supported HIV programmes has restarted, “service disruptions associated with these and other funding cuts are having long-lasting effects on almost all areas of the HIV response”, according to the report. Access to treatment for many people with HIV in West and Central Africa was disrupted as donors cover 90% of the costs for antiretroviral (ARV) medicine. In eastern and southern Africa, this figure is 38%. In Eswatini, which has the highest HIV prevalence in the world (23% of adults aged 15- 49 years), the HIV programme lost 20% of its funding. In Ghana, 29% fewer pregnant women with HIV received ARVs to prevent HIV transmission to their babies during the first six months of 2025 Vital tests – CD4 counts and viral loads which gauge whether ARV treatment is working – have plummeted in several countries. Some people didn’t get ARVs because funding cuts affected procurement and supply-chain management systems, resulting in stock-outs of HIV medicines in the Democratic Republic of the Congo, Ethiopia and Kenya. But even quantifying the disruptions is difficult, as data capturers have lost their jobs and community-led monitoring has been disrupted. However, the report identifies the most vulnerable areas as being HIV testing, prevention and care; data collection; community-led responses; services for “key populations” and human rights and gender equality. Collapse of services for key populations “Key populations” refers to groups most vulnerable to HIV and where the virus is hardest to eliminate – often because these groups are heavily stigmatised. These include adolescent girls and young women, men who have sex with men (MSM), sex workers, people who inject drugs, transgender people and prisoners. “Donor funding accounts for most of the funding (100% in western and central Africa) for tailored HIV testing services in settings focusing on key populations,” according to the report. In Zimbabwe, for example, many HIV services for sex workers and other key populations have “effectively collapsed” this year. Most key population clinics in Kenya and at least five in Nigeria have closed. Over three-quarters (77%) of harm reduction programmes and other HIV services for people who inject drugs had been “severely disrupted by funding cuts”, according to a UNAIDS survey in April. Prevention disrupted Getting an HIV/AIDS test at Witkoppen Clinic in Gauteng, among many in South Africa highly dependent on US funding prior to the dismantling of USAID. Funding cuts have substantially affected access to pre-exposure prophylaxis (PrEP), antiretroviral therapy to prevent HIV infection, usually also targeted at groups at the highest risk of HIV. When the US government resumed funding via bridging agreements in October, it made it confined several services, including PrEP, to pregnant and breastfeeding women only. By mid-October, the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people have lost access PrEP this year. This includes 64% of people in Burundi, 38% in Uganda and 21% in Viet Nam. Meanwhile, male condom distribution fell by 55% in Nigeria between December 2024 and March 2025, The number of HIV tests performed declined by 43% in Cameroon from January through July. Community outreach ‘eliminated’ Community-led organisations play an important role in HIV prevention, testing, care and treatment services, including direct provision of these services – particularly for “key populations”. “Community outreach services have been reduced or eliminated in Angola and Eswatini due to funding cuts’” the report notes. “Over 60% of women-led HIV organisations have lost funding or been forced to suspend essential programmes, leaving entire communities without access to vital services”, while a survey of 45 youth organisations found that 60% had experienced a sudden and significant loss of resources. Community-led organisations of men who have sex with men in Kenya, Mozambique and Viet Nam reduced staffing by at least one-third. African solutions Increasing domestic financing for HIV is essential, but tricky for many countries in western and central Africa, where public debt service is on average 5.5 times greater than public health allocations. However, UNAIDS estimates that it is feasible for the domestic share of HIV financing to rise from 52% in 2024 to two-thirds by 2030. This year, Nigeria approved a $200 million increase in its health budget. Uganda is taking steps to double its domestic spending on health, while Côte d’Ivoire and South Africa have increased their domestic investments to help mitigate the effects of reduced donor support. Twenty-six of the 61 countries reporting to UNAIDS stated they expect to increase their domestic public HIV budgets. African leaders adopted the Accra Reset earlier this year, calling for “a new era of health sovereignty rooted in national ownership, investment and leadership”. Meanwhile, an extraordinary session of the African Union Assembly is being convened in next month to secure support for the implementation of the African Union’s roadmap on “sustaining the AIDS response, ensuring systems strengthening and health security for the development of Africa”. African leaders have also committed to strengthening local manufacturing of medical products, and the vaccine alliance, Gavi, has committed $ 1.2 billion to the Africa Vaccine Manufacturing Accelerator initiative. The report also introduces the new Global AIDS Strategy (2026–2031), to be adopted by the UNAIDS Programme Coordinating Board in December. The new strategy is “person-centred and has fewer focused targets”. It focusses on integrating HIV services into national programmes, reducing stigma, and securing sustainable financing. UNAIDS estimates that $21.9 billion will be needed annually until 2030 to achieve global HIV targets in low- and middle-income countries. “HIV programmes are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services and the organisations that support those communities are being decimated,” the report notes. “There is hope, however, as seen through the political will and the resilience that both communities and countries have demonstrated in the past months. The world has come a very long way already on this journey and now is not the time to pause or step back. Now is the time to keep the promise and end AIDS by 2030.” Image Credits: JB Russel/ The Global Fund/ Panos, UNAIDS, Witkoppen Clinic. COP30 Ends With No Text on Fossil Fuels Phase-Out – but Plans for a Conference in 2026 24/11/2025 Stefan Anderson Two weeks of negotiations in Belém, Brazil, delivered voluntary measures and delayed finance targets, but no phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. The UN climate summit marking the tenth anniversary of the Paris Agreement to keep global warming under 1.5 °C ended in trademark UN fashion: a text laying out next steps to speak about plans to agree to make more plans. The package of voluntary measures dubbed the “Global Mutirão,” Portuguese for collective effort, nixed any mention of fossil fuels and failed to include a deforestation roadmap backed by over 90 nations, exposing deep fractures in global climate diplomacy. More than half of the nearly 200 nations in attendance opposed even non-binding language on oil, gas and coal phase-out despite scientific projections showing the world remains on track for 2.6 to 2.8 degrees Celsius of warming. The health front scored several incremental victories. The outcome text included the first direct acknowledgement of the health benefits of mitigating emissions in a COP decision, while the Belém Health Action Plan – a voluntary policy package of best practices for adapting health systems to the climate crisis – was endorsed by about 10% of nations but received no money from governments. The action plan also invites nations to report progress on health adaptation in their submissions to the Global Stocktake at COP33, making health adaptation part of countries’ official climate progress reporting for the first time. “No one is saying this will be easy or we are on track,” UN Environment Programme Inger Andersen said after the summit. “We must do much more, move much faster. Escalating climate impacts continue that spare no nation.” Fossil fuel, deforestation roadmaps to be developed outside the UN process Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. In the closing days of the conference, more than 80 developed and developing countries, led by the United Kingdom and the European Union, had backed a COP commitment to developing a “fossil fuel roadmap” as well as a reference to “fossil fuel transition” in the outcome document. The group of nations backing the language combined represent just 7% of global fossil fuel production. “I cannot contradict science,” said Colombian President Gustavo Petro, who hosted the COP16 biodiversity talks in Cali last year. “It is not clearly stated, as science says, that the cause of the climate crisis is the fossil fuels used by capital. If that is not said, everything else is hypocrisy.” Over 90 countries also supported a roadmap on halting and reversing deforestation, including recognition of wildfires as a major source of climate emissions that need more sustainable management. Forest fires represent 20% of global black carbon emissions, both a super pollutant and a major source of air pollution. The combined pressures of those alliances failed to move the powerful bloc of the world’s major oil-producing nations, led by Saudi Arabia, Russia and their allies, which threatened to collapse negotiations if fossil fuels were mentioned in the deal. Ultimately, over 100 nations – a clear majority – declined to support the roadmaps pushed by Brazil’s COP30 Presidency. The stand-off on fossil fuels and deforestation places significant pressure on the remainder of the Brazilian COP presidency to deliver on these two roadmaps and bring more countries on board by COP31 in Antalya, Turkey. COP President André Corrêa do Lago announced that Brazil would instead lead the development of the two roadmaps outside the formal UN COP negotiating process. A “First International Conference for the Phase-out of Fossil Fuels” will be held in Colombia in April 2026, he said to applause as the conference ended Saturday evening, after an entire day of delays. COP30 President André Corrêa do Lago speaks to reporters at the close of the summit. Meanwhile, the US did not participate in the talks for the first time in history. As fire burned through the COP30 conference centre in its closing hours, US President Donald Trump proposed plans to drill new oil fields, emboldening opponents to the fossil fuel phase-out in Belém. China, which now controls the majority of the green economy, declined to step into a leadership vacuum, instead joining the majority of nations in opposing the fossil fuel roadmap and declining to contribute to Brazil’s Tropical Forest Forever Facility. China also used its influence to push back against measures like the EU’s carbon border tax, which aims to protect European industries from imports of cheaper, carbon-intensive products. In remarks to AFP after the talks, China’s vice environment minister Li Gao said China was “happy with the outcome,” calling it “success in a very difficult situation.” Despite setbacks in addressing major drivers of the climate crisis, Brazilian officials sought to put a positive spin on the outcomes. “I’m being very honest: I believe COP30 was very, very, very good,” do Lago said after gaveling the end of the summit at 8:44 p.m. Saturday, 22 November, some 27 hours after COP30’s planned finish on 21 November. “I’m really, really very happy.” ‘Our people are losing their lives’ Negotiations in Belém finished after a 27-hour overtime. The last COP to finish on time took place in Milan in 2003. In total, the “Belém package” contains 29 separate decisions spanning over 150 pages. But amid the sea of UN diplomatic language — “recalling,” “acknowledging,” “reaffirming” — there are no legally binding commitments. The outcome text “recalls with concern” that carbon dioxide emissions account for 80%of the global carbon budget available to remain under 1.5 degrees Celsius and “recognises” that limiting warming to 1.5C “requires deep, rapid, and sustained” cuts to greenhouse gas emissions. It also sets out a voluntary process to begin making plans to start discussions on what to do next on fossil fuels. For nations on the frontlines of the climate crisis, time is running out. “Right now, our people are losing their lives and livelihoods from storms of unprecedented strength, which are being powered by warming seas. The truth is that our coral reefs, the lifeblood of our nation’s food systems, culture, and economies, are at a tipping point in dieback at 1.5 degrees Celsius,” said Palau environment minister Steven Victor on behalf of the Alliance of Small Island States. “Forest ecosystems are at a tipping point. The window to protect lives and economies is closing.” The text urges an array of other measures and reaffirms the importance of past COP deals, including the COP28 agreement in Dubai, which called for a “transition away” from fossil fuels, a key concession awarded to stop the European Union and other nations from vetoing the final deal. “We’re living through complicated geopolitical times. So there is intrinsic value, no matter how difficult, to seek to come together,” EU climate commissioner Wopke Hoekstra said of the bloc’s retreat from a veto threat. “We’re not going to hide the fact we would have preferred to have more. And yet the world is what it is, the conference is what it is, and we do think this on balance is a step in the right direction.” “I couldn’t call this COP a success,” French environment minister Monique Barbut added. Finance delayed The Tropical Forest Forever Facility, a signature initiative of Brazilian President Lula da Silva, launched in Belem with a combined $6.6 billion provided by Norway, Brazil, Indonesia, Germany and France. Nations also agreed to “call for” tripling climate adaptation finance over the 2021 Glasgow COP goal of $40 billion – but pushed back the date for that adaptation finance goal to be met from 2030 to 2035. Increasing adaptation funding had been billed as a key focus of the summit by the Brazilian presidency. By 2035, the amount to be recruited for adaptation would amount to $120 billion per year, as part of the $300 billion target annually in overall climate finance agreed to at COP29 in Baku last year. That was still a disappointment for many frontline states, which wanted $120 billion to be committed in addition to the original the Glasgow and Baku finance targets. The $300 million annually is supposed to leverage some $1.3 trillion per year from public and private sources per year. However, economists project the real needs of developing nations to fight the climate crisis at around $2.3 trillion annually. “Every country is now experiencing the impacts of climate change in real time,” said Jeni Miller of the Global Climate and Health Alliance. “Pushing out the delivery date compared to the 2030 timeline requested by developing countries means many more people will suffer, many more people will die.” The final COP30 decision “further reaffirms the call on all actors to work together” to scale up total annual climate finance to $1.3 trillion by 2035. Both goals remain aspirational, with no significant finance pledges made throughout COP30. “Wealthy countries showed up with big speeches, but once again failed to deliver on the most urgent need: real money to fund a fast and fair transition,” said Ilan Zugman of 350.org. Forests forgotten The Tropical Forest Forever Facility, billed by Brazil as a highlight of the summit, also underwhelmed. It received support from just 50 nations, with only five contributing significant resources to the project, totalling $6.6 billion. While that number dwarfs the funding of other widely hailed but so far ineffectual funds, including the Loss & Damage Fund and the Cali Fund for Biodiversity, the unique structure of TFFF means it requires massive funding to become effective. The fund works as a large endowment, relying on returns on its base capital to generate returns for governments and private investors that contribute to it. At current funding levels, the TFFF stands to generate around $3 million per year for each tropical forest nation – a 96% decrease from its target value, which would require an additional $120 billion to achieve. See related story: Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? Health co-benefits get a nod Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO led health-climate adaptation plan. For the first time, the final COP decision text formally recognised health co-benefits of mitigation, in a reference to: “the economic and social benefits and opportunities of climate action, including economic growth, job creation, improved energy access and security, and improved public health.” The inclusion of language on health is the product of more than 20 years of health-focused assessments on the co-benefits to health of climate mitigation, including the potential to save millions of lives a year by reducing air pollution from fossil fuels, as well as health gains from more sustainable diets and access to more physical activity in greener cities. The Clean Air Fund welcomed the COP30 outcome text’s acknowledgement as “a step in the right direction”, but said governments need to go further to put health at the heart of climate negotiations next year. “It is essential that adaptation and mitigation consider climate change and health,” the Clean Air Fund said. Global health leaders, including WHO Director-General Dr Tedros Adhanom Ghebreyesus, have called for health to be included in formal negotiations at future COPs. Belém health plan launched Following a modest victory at COP29 in Baku last year to maintain health as a parallel track to official negotiations, there was hope that momentum could continue to build. That happened – sort of. The Belém Health Action Plan, co-authored by the Brazilian COP30 presidency and the World Health Organisation, received limited political support, garnering endorsements from around two dozen nations of the 195 in attendance in Belém. See related story: Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance The voluntary plan represents a menu of best practice policies on adapting the health sector to the impacts of climate change, which is projected to cause up to 15.6 million additional deaths and incur health costs of $15.4 trillion by 2050, according to World Bank data. The Action Plan also invites nations to submit data, plans and progress on health sector adaptation as part of national submissions to the UN “stocktake” process, which takes place every five years. While this reporting remains voluntary, it represents incremental progress in moving health’s relationship to climate change away from the sidelines and closer to the core official negotiations. “UN Climate Conferences will always involve compromise and incremental progress while every country has to agree a final text,” said Alan Dangour, director of Climate and Health at Wellcome. But COP30 saw “increased action” on the health front adding: “The Belém Health Action Plan and the important decision on the Global Goal on Adaptation will ensure the inclusion of robust, evidence-based action and indicators on health that are vital to protect lives and livelihoods in the years ahead.” The Action plan, as such, received no financial support from governments despite backing from European Union states and other high-income nations, including Japan, Canada and the United Kingdom. Philanthropies committed a $300 million to support measures outlined in the plan. The finance gap remaining threatens to undermine the real-world impact of the action plan. The UNFCCC estimates global health adaptation needs at $26.8 to $29.4 billion per year by 2050, compared to current flows between $500 and $700 million. “The Belém Health Action Plan has excellent advice for adapting health systems to climate change,” said Dr Courtney Howard of the Global Climate and Health Alliance. “However, given the current severity of impacts, it is clear that even in a high-income country, we cannot adapt in a healthy way to the emissions trajectory we are on. The infrastructure, supply chains and workforce that high-quality healthcare depends on will fray.” Bending the emissions curve Outside the formal negotiations, climate and health activists saw momentum on super pollutants, with new initiatives to cut black carbon and methane. Both are short-lived climate pollutants, also known as superpollutants, which have an outsize impact on warming but fall out of the atmosphere within weeks or decades – as compared to centuries for CO2. Methane also is the second largest climate forcer after CO2, with a global warming impact 28 times larger, per volume of gas. A Methane Summit prior to COP saw countries express renewed commitment to the Global Methane Pledge, reached at COP26 in Glasgow, to reduce methane emissions 30% by 2030 as compared to 2020 levels. A NOW! (No Organic Waste) Initiative highlighted efforts to reduce methane emissions from organic waste. Along with methane leaks from oil and gas extraction and livestock, improper waste management is one of the key sources of methane emissions. Words have yet to translate into momentum, however. The first UN Environment Programme stocktake of methane emissions since the landmark Glasgow pledge backed by over 160 countries found the world is far behind the 30% target set for 2030, on course to deliver just a fourth of promised reductions. See related story: World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline Methane is an important precursor to tropospheric ozone, a potent air pollutant that harms human health through increased respiratory illness and asthma, as well as reducing crop production. Key methane sources, like poor landfill management, have other knock-on health impacts. Although methane is the second most powerful climate warmer after CO2, per unit of emissions, and one of the six greenhouse gases covered by the original UN Framework on Climate Change (UNFCCC), it has received less attention in formal climate negotiations until recently. Black carbon and other short-lived climate pollutants and tropospheric ozone precursors aren’t mentioned at all in the UNFCCC, revealing a gap in climate accounting. A COP30, nine countries also made a first-of-its-kind announcement to tackle black carbon emissions. Commonly known as soot, BC is a key component in health-harmful particulate matter as well as a climate pollutant that persists in the atmosphere for a few days or weeks, while fallen soot particles also acclerate snowmelt in the Himalayas and other mountain glacier systems. The countries pledged to integrate black carbon mitigation into climate strategies through targeted interventions in sectors such as electricity, transport and vehicle emissions standards, as well as oil and gas. “Cutting super pollutants is our emergency brake on near-term warming. We can avoid 0.6 °C of warming by 2050 by tackling super pollutants, such as methane, black carbon and tropospheric ozone, while reducing carbon dioxide emissions. The increased attention on super pollutants at COP30 shows ambition on climate and health is growing,” said Jane Burston, CEO of Clean Air Fund. Accelerating towards 2.6 °C UN Secretary-General Antonio Guterres addresses COP30. The summit also launched a “Belém accelerator” programme to address why countries are not meeting the plans they already committed to, known as nationally determined contributions. The final decision calls for bending the emissions curve “based on the full implementation” of the latest NDCs. Those targets, if fully implemented, would set the world on course for around 2.6 °C of warming — reducing emissions by just 12% of the 55% cut required by 2035 to hit 1.5 °C, according to a UNEP assessment ahead of the summit. More than 70 nations did not file NDCs at all. “The talk of the COP has been to ’embrace science’ and move away from negotiations to focus on implementation,” said Bill Hare, CEO of Climate Analytics, which produces the Climate Action Tracker report. “There is a massive risk that the outcome of COP30 will just leave countries to ‘implement’ policies that will warm the Earth to 2.6 °C.” “There is no point in ’embracing the science’ if it’s not acted on, just as there is no point agreeing to global energy goals if they’re not implemented,” Hare added. With no binding commitments placed on countries and an array of passive language used throughout the final decision, the text represents a lowest common denominator of what words can be put on a page. But in a fractured world, that means something, the UN chief said. “This shows that multilateralism is alive, and that nations can still come together to confront the defining challenges no country can solve alone,” said UN Secretary-General António Guterres. “But COPs are consensus-based — and in a period of geopolitical divides, consensus is ever harder to reach. I cannot pretend that COP30 has delivered everything that is needed.” Consensus under fire Overtime negotiations to reach a legally binding treaty on plastic pollution collapsed in August as major fossil fuel producers blocked an agreement. The victory of the constellation of petrostates and their allies at COP30 marks the second time in recent months that a similar alliance has derailed ambitious climate negotiations. The alliance of Like-Minded Developing Countries torpedoed the successful conclusion of a Plastics Treaty in Geneva in August, sticking firm to red lines so watered down that countries championing an agreement deemed it better to walk away than pass a final text. The successive failures have shone a spotlight on the viability of consensus-based UN negotiations, which require every nation’s sign-on to be agreed. That structure leaves ambitious countries with no choice but to compromise or leave empty-handed, while nations attempting to stymie progress have no incentive to change their stance. “The traditional COP model is under serious strain in a fractured, multipolar world, particularly from countries prepared to sacrifice the well-being of the world for fossil fuel interests,” Hare said. Some observers said the UNFCCC process has run its course. “This is an empty deal,” said Nikki Reisch, director of climate at the Center for International Environmental Law. “COP30 provides a stark reminder that the answers to the climate crisis do not lie inside the climate talks – they lie with the people and movements leading the way toward a just, equitable, fossil-free future.” “While the countries most responsible for pushing the planet to the brink point fingers, dig in their heels, and tighten their purse strings, the world burns,” Reisch said. “That’s why governments committed to tackling the crisis at its source are uniting to move forward outside the UNFCCC — under the leadership of Colombia and Pacific Island states — to phase out fossil fuels rapidly, equitably, and in line with 1.5°C.” UNFCCC executive secretary Simon Stiell defended the process after the deal was gavelled through. “I understand the various frustrations of different groups on different issues. Many countries want to move faster on fossil fuels, finance and responding to spiralling climate disasters,” Stiell said. “Certainly, if you look inside these halls, you may raise questions, but if you look at the signals that are sent over the past 30 COPS to the real world, they are there.” “With or without navigation aids our direction is clear, the shift from fossil fuels to renewables and resilience is unstoppable. We’re building day by day, step by step, COP by COP, a better world for billions more people in every part of the world.” Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. Image Credits: COP30, Stefan Anderson. Eliminating the “Period Tax” on Feminine Hygiene Products – A Battle For Freedom and Dignity 23/11/2025 Leslie Ramsammy ‘Your access to menstrual products shouldn’t depend on your postal code,’ proclaims a Mexican Facebook ad for better access, produced by #MenstruaciónDignaMéxico In August 2025, Guyana’s President Irfaan Ali removed all taxes and customs duties on feminine hygiene products. Now, Guyana’s Ambassador to the UN in Geneva calls on other countries to follow suit. In most developing countries male condoms are distributed freely. Free access to condoms is a globally recognized harm reduction strategy in public health. And yet, in those same countries, and even in some developed countries, menstrual hygiene products are often inaccessible and largely unaffordable to women and girls. Altogether, more than 500 million girls and women around the world are estimated to lack access to sanitary pads or tampons or other menstrual products. The unaffordability of menstrual hygiene products is exacerbated by both customs duties and VAT taxes that governments commonly place on menstrual hygiene products. These taxes are discriminatory – part of the gender divide and an assault on the dignity and the Right to Health for women and girls. And they are regressive taxes, hitting the poor much harder than other groups. Guyana’s Menstrual Hygiene Initiative Guyana’s first lady Arya Ali launches a menstrual hygiene initiative in one of the country’s remote regions in June 2025. Even prior to 2025, tampons and menstrual pads were VAT-free in Guyana. Then in mid-August, President Ali announced that the government would remove all remaining taxes on those products. The country is now in the process of adding these products to the public sector medical supplies list for free distribution to girls and women through public health clinics and centers. While it is a work in progress, a free menstrual packages program is also being rolled out for all girls in both public and private sector schools as part of a Guyana Menstrual Hygiene Initiative, launched in 2021. The initiative was launched following a Ministry of Education showing that one-third of female secondary school students struggle to afford or access sanitary pads – leading to missed classes and educational setbacks. Guyana’s First Lady, Arya Ali, has meanwhile been championing feminine hygiene products as a human rights issue since 2020. For Guyana, making menstrual health affordable falls under the government’s harm reduction initiatives. Guyana has taken a lead in ensuring that menstrual health packages are treated as public good and as a fundamental human right. It is a bold move. Movement is catching on worldwide Free periods protest in the United Kingdom in 2017 – one of the first to inspire a global movement. But the movement is catching on regionally and worldwide. A 2024 Lancet Review found that menstrual product taxes were applied in more than 63.2% of the locations in the Americas, with a tax averaging about 10%. At the same time, nine countries and one territory have eliminated taxes over the past decade, thanks in part to civil society advocacy – with VAT-free products now available in Barbados, Canada, Colombia, Ecuador, Jamaica, Nicaragua, Mexico, Puerto Rico, Saint Kitts & Nevis, and Trinidad & Tobago, as well as Guyana. Elsewhere in the world, other nations, including Australia, Bhutan, the United Kingdom, India, Ireland, Kenya, Lebanon, Lesotho, the Maldives, Malaysia, Mauritius, Namibia, Nigeria, Rwanda, South Africa, and Uganda, are among a growing list that have removed VAT from pads and other female hygiene products. In the United States, which has no national VAT, 28 states have eliminated sales taxes on the products. In 2021, Scotland became the first country in the world to offer tampons and sanitary pads for free “to anyone who needs them,” – setting a precedent for which countries such as Guyana are now poised to advocate more widely. Challenges elsewhere Turkish women discuss menstrual hygiene as part of the ‘We need to talk’ movement. But the picture is hardly uniform. In Pakistan, a young female lawyer, Mahnoor Omer, has gained international fame for her campaign to lower the tax on pads. Omer’s argument is that menstrual products should be placed into Pakistan’s tax-exempt “essential goods” list, which includes items ranging from milk and cheese to agro inputs like cattle semen. Currently, Pakistan’s tax can add up to 40% to the price of hygiene products, according to a 2023 report by UNICEF, which has been campaigning on the issue for a number of years. As a result, only about 16% of women and girls in rural Pakistan use appropriate sanitary products, homemade or purchased, according to one peer-reviewed journal study by a team of researchers from Agha Khan University in Karachi. Others use unhygienic materials or none at all. According to UNICEF, the high tax is a factor in Pakistan, which in 2018 had the lowest uptake of the products among four countries in the region. From tax free to entirely free Uganda’s She for She Pads is one of many social enterprises and civil society groups advocating for better access to female menstrual products worldwide. Even without taxation, in most developing countries, sanitary pads are unaffordable for most girls and women who represent about one-half of the global population – and will require such products for about 40 years of their lives. Non-access to sanitary products affects women’s and girls’ dignity, access to health, education, and workplaces, as well as participation in public activities. It is a good example of systematic gender subordination, gender segregation and economic prejudice through taxation applied solely against women. Increasingly, civil society groups led by women and girls around the world are rising up and rejecting this unequivocal assault on women’s rights. These groups see the elimination of taxation on menstrual products as critical to promote gender equity, female empowerment, human rights, and menstrual justice. In Colombia, for instance, A civil society campaign called Menstruacion Libre (free menstruation) advocated for the elimination of menstrual product taxes. In response, the Supreme Court of Colombia exempted taxes on menstrual pads and tampons in 2018. Other examples of political activism leading to removal of taxes for sanitary pads are #MenstruaciónDignaMéxico (Menstruation with dignity) in Mexico, Inua Dada and Days for Girls in Kenya, Free Periods in the United Kingdom, Qrate in South Africa, We Need to Talk in Turkiye, She for She Pads in Uganda, Myna Mahila in India, Herself in Brazil, With Red in Taiwan and many more. Rallying around ‘Menstruation Health Day’ Woman to woman – sharing information about menstrual products in India. The Right to Health has centrality in the fight for freedom and democracy around the world. Menstrual justice is another frontline in the wider battle. While this commentary highlights the issue of affordability and access to menstrual pads, menstruation justice is much more than access to pads. It also is about access to facilities, education and awareness, sound environmental management of hygiene waste products, and support. It is also about elimination of stigma. Moreover there is the issue of women in vulnerable circumstances, such as women prisoners, who have no access to menstruation pads. Governments and other stakeholders must craft a comprehensive approach to combat period poverty. This is a “best buy” in the fight for Health for All. Recognition of this, as part of an action plan crafted by WHO member states, for instance, could help amplify the issue and solutions. On Wednesday, I will be appearing on a panel of Ambassadors to the UN in Geneva at a hybrid event co-sponsored by Barbados, Canada and Malawi to kick off discussions on the intersection of menstrual health with trade policies. We can further scale up our campaigns by ensuring that the annual Menstruation Health Day, May 28, is incorporated into national public health education and awareness calendars. Access to period pads, soap, cups, facilities, education and awareness, fighting stigma and discrimination and access to environmentally safe and dignified disposal must be central in the gender equality agenda, not only for the Ministers of Health, but also for Ministers of Education, Social Welfare, Women and for the Human Rights organs of governments. Ambassador Leslie Ramsammy In our polarized world, social progressives and conservatives should all be able to unite around one single truth: Menstruation is a God-given biological activity. It should be safe, hygienic…and tax-free. Dr Leslie Ramsammy is Guyana’s Ambassador to the UN in Geneva and a former Minister of Health. Editor’s note: An earlier version of this oped appeared in DemocracyGuyana.com on 5 November. Image Credits: News Room , #MenstruaciónDignaMéxico, Free Periods , We Need to Talk , She for She pads. , Myna Mahila , CeHDI. Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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COP30 Ends With No Text on Fossil Fuels Phase-Out – but Plans for a Conference in 2026 24/11/2025 Stefan Anderson Two weeks of negotiations in Belém, Brazil, delivered voluntary measures and delayed finance targets, but no phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. The UN climate summit marking the tenth anniversary of the Paris Agreement to keep global warming under 1.5 °C ended in trademark UN fashion: a text laying out next steps to speak about plans to agree to make more plans. The package of voluntary measures dubbed the “Global Mutirão,” Portuguese for collective effort, nixed any mention of fossil fuels and failed to include a deforestation roadmap backed by over 90 nations, exposing deep fractures in global climate diplomacy. More than half of the nearly 200 nations in attendance opposed even non-binding language on oil, gas and coal phase-out despite scientific projections showing the world remains on track for 2.6 to 2.8 degrees Celsius of warming. The health front scored several incremental victories. The outcome text included the first direct acknowledgement of the health benefits of mitigating emissions in a COP decision, while the Belém Health Action Plan – a voluntary policy package of best practices for adapting health systems to the climate crisis – was endorsed by about 10% of nations but received no money from governments. The action plan also invites nations to report progress on health adaptation in their submissions to the Global Stocktake at COP33, making health adaptation part of countries’ official climate progress reporting for the first time. “No one is saying this will be easy or we are on track,” UN Environment Programme Inger Andersen said after the summit. “We must do much more, move much faster. Escalating climate impacts continue that spare no nation.” Fossil fuel, deforestation roadmaps to be developed outside the UN process Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. In the closing days of the conference, more than 80 developed and developing countries, led by the United Kingdom and the European Union, had backed a COP commitment to developing a “fossil fuel roadmap” as well as a reference to “fossil fuel transition” in the outcome document. The group of nations backing the language combined represent just 7% of global fossil fuel production. “I cannot contradict science,” said Colombian President Gustavo Petro, who hosted the COP16 biodiversity talks in Cali last year. “It is not clearly stated, as science says, that the cause of the climate crisis is the fossil fuels used by capital. If that is not said, everything else is hypocrisy.” Over 90 countries also supported a roadmap on halting and reversing deforestation, including recognition of wildfires as a major source of climate emissions that need more sustainable management. Forest fires represent 20% of global black carbon emissions, both a super pollutant and a major source of air pollution. The combined pressures of those alliances failed to move the powerful bloc of the world’s major oil-producing nations, led by Saudi Arabia, Russia and their allies, which threatened to collapse negotiations if fossil fuels were mentioned in the deal. Ultimately, over 100 nations – a clear majority – declined to support the roadmaps pushed by Brazil’s COP30 Presidency. The stand-off on fossil fuels and deforestation places significant pressure on the remainder of the Brazilian COP presidency to deliver on these two roadmaps and bring more countries on board by COP31 in Antalya, Turkey. COP President André Corrêa do Lago announced that Brazil would instead lead the development of the two roadmaps outside the formal UN COP negotiating process. A “First International Conference for the Phase-out of Fossil Fuels” will be held in Colombia in April 2026, he said to applause as the conference ended Saturday evening, after an entire day of delays. COP30 President André Corrêa do Lago speaks to reporters at the close of the summit. Meanwhile, the US did not participate in the talks for the first time in history. As fire burned through the COP30 conference centre in its closing hours, US President Donald Trump proposed plans to drill new oil fields, emboldening opponents to the fossil fuel phase-out in Belém. China, which now controls the majority of the green economy, declined to step into a leadership vacuum, instead joining the majority of nations in opposing the fossil fuel roadmap and declining to contribute to Brazil’s Tropical Forest Forever Facility. China also used its influence to push back against measures like the EU’s carbon border tax, which aims to protect European industries from imports of cheaper, carbon-intensive products. In remarks to AFP after the talks, China’s vice environment minister Li Gao said China was “happy with the outcome,” calling it “success in a very difficult situation.” Despite setbacks in addressing major drivers of the climate crisis, Brazilian officials sought to put a positive spin on the outcomes. “I’m being very honest: I believe COP30 was very, very, very good,” do Lago said after gaveling the end of the summit at 8:44 p.m. Saturday, 22 November, some 27 hours after COP30’s planned finish on 21 November. “I’m really, really very happy.” ‘Our people are losing their lives’ Negotiations in Belém finished after a 27-hour overtime. The last COP to finish on time took place in Milan in 2003. In total, the “Belém package” contains 29 separate decisions spanning over 150 pages. But amid the sea of UN diplomatic language — “recalling,” “acknowledging,” “reaffirming” — there are no legally binding commitments. The outcome text “recalls with concern” that carbon dioxide emissions account for 80%of the global carbon budget available to remain under 1.5 degrees Celsius and “recognises” that limiting warming to 1.5C “requires deep, rapid, and sustained” cuts to greenhouse gas emissions. It also sets out a voluntary process to begin making plans to start discussions on what to do next on fossil fuels. For nations on the frontlines of the climate crisis, time is running out. “Right now, our people are losing their lives and livelihoods from storms of unprecedented strength, which are being powered by warming seas. The truth is that our coral reefs, the lifeblood of our nation’s food systems, culture, and economies, are at a tipping point in dieback at 1.5 degrees Celsius,” said Palau environment minister Steven Victor on behalf of the Alliance of Small Island States. “Forest ecosystems are at a tipping point. The window to protect lives and economies is closing.” The text urges an array of other measures and reaffirms the importance of past COP deals, including the COP28 agreement in Dubai, which called for a “transition away” from fossil fuels, a key concession awarded to stop the European Union and other nations from vetoing the final deal. “We’re living through complicated geopolitical times. So there is intrinsic value, no matter how difficult, to seek to come together,” EU climate commissioner Wopke Hoekstra said of the bloc’s retreat from a veto threat. “We’re not going to hide the fact we would have preferred to have more. And yet the world is what it is, the conference is what it is, and we do think this on balance is a step in the right direction.” “I couldn’t call this COP a success,” French environment minister Monique Barbut added. Finance delayed The Tropical Forest Forever Facility, a signature initiative of Brazilian President Lula da Silva, launched in Belem with a combined $6.6 billion provided by Norway, Brazil, Indonesia, Germany and France. Nations also agreed to “call for” tripling climate adaptation finance over the 2021 Glasgow COP goal of $40 billion – but pushed back the date for that adaptation finance goal to be met from 2030 to 2035. Increasing adaptation funding had been billed as a key focus of the summit by the Brazilian presidency. By 2035, the amount to be recruited for adaptation would amount to $120 billion per year, as part of the $300 billion target annually in overall climate finance agreed to at COP29 in Baku last year. That was still a disappointment for many frontline states, which wanted $120 billion to be committed in addition to the original the Glasgow and Baku finance targets. The $300 million annually is supposed to leverage some $1.3 trillion per year from public and private sources per year. However, economists project the real needs of developing nations to fight the climate crisis at around $2.3 trillion annually. “Every country is now experiencing the impacts of climate change in real time,” said Jeni Miller of the Global Climate and Health Alliance. “Pushing out the delivery date compared to the 2030 timeline requested by developing countries means many more people will suffer, many more people will die.” The final COP30 decision “further reaffirms the call on all actors to work together” to scale up total annual climate finance to $1.3 trillion by 2035. Both goals remain aspirational, with no significant finance pledges made throughout COP30. “Wealthy countries showed up with big speeches, but once again failed to deliver on the most urgent need: real money to fund a fast and fair transition,” said Ilan Zugman of 350.org. Forests forgotten The Tropical Forest Forever Facility, billed by Brazil as a highlight of the summit, also underwhelmed. It received support from just 50 nations, with only five contributing significant resources to the project, totalling $6.6 billion. While that number dwarfs the funding of other widely hailed but so far ineffectual funds, including the Loss & Damage Fund and the Cali Fund for Biodiversity, the unique structure of TFFF means it requires massive funding to become effective. The fund works as a large endowment, relying on returns on its base capital to generate returns for governments and private investors that contribute to it. At current funding levels, the TFFF stands to generate around $3 million per year for each tropical forest nation – a 96% decrease from its target value, which would require an additional $120 billion to achieve. See related story: Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? Health co-benefits get a nod Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO led health-climate adaptation plan. For the first time, the final COP decision text formally recognised health co-benefits of mitigation, in a reference to: “the economic and social benefits and opportunities of climate action, including economic growth, job creation, improved energy access and security, and improved public health.” The inclusion of language on health is the product of more than 20 years of health-focused assessments on the co-benefits to health of climate mitigation, including the potential to save millions of lives a year by reducing air pollution from fossil fuels, as well as health gains from more sustainable diets and access to more physical activity in greener cities. The Clean Air Fund welcomed the COP30 outcome text’s acknowledgement as “a step in the right direction”, but said governments need to go further to put health at the heart of climate negotiations next year. “It is essential that adaptation and mitigation consider climate change and health,” the Clean Air Fund said. Global health leaders, including WHO Director-General Dr Tedros Adhanom Ghebreyesus, have called for health to be included in formal negotiations at future COPs. Belém health plan launched Following a modest victory at COP29 in Baku last year to maintain health as a parallel track to official negotiations, there was hope that momentum could continue to build. That happened – sort of. The Belém Health Action Plan, co-authored by the Brazilian COP30 presidency and the World Health Organisation, received limited political support, garnering endorsements from around two dozen nations of the 195 in attendance in Belém. See related story: Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance The voluntary plan represents a menu of best practice policies on adapting the health sector to the impacts of climate change, which is projected to cause up to 15.6 million additional deaths and incur health costs of $15.4 trillion by 2050, according to World Bank data. The Action Plan also invites nations to submit data, plans and progress on health sector adaptation as part of national submissions to the UN “stocktake” process, which takes place every five years. While this reporting remains voluntary, it represents incremental progress in moving health’s relationship to climate change away from the sidelines and closer to the core official negotiations. “UN Climate Conferences will always involve compromise and incremental progress while every country has to agree a final text,” said Alan Dangour, director of Climate and Health at Wellcome. But COP30 saw “increased action” on the health front adding: “The Belém Health Action Plan and the important decision on the Global Goal on Adaptation will ensure the inclusion of robust, evidence-based action and indicators on health that are vital to protect lives and livelihoods in the years ahead.” The Action plan, as such, received no financial support from governments despite backing from European Union states and other high-income nations, including Japan, Canada and the United Kingdom. Philanthropies committed a $300 million to support measures outlined in the plan. The finance gap remaining threatens to undermine the real-world impact of the action plan. The UNFCCC estimates global health adaptation needs at $26.8 to $29.4 billion per year by 2050, compared to current flows between $500 and $700 million. “The Belém Health Action Plan has excellent advice for adapting health systems to climate change,” said Dr Courtney Howard of the Global Climate and Health Alliance. “However, given the current severity of impacts, it is clear that even in a high-income country, we cannot adapt in a healthy way to the emissions trajectory we are on. The infrastructure, supply chains and workforce that high-quality healthcare depends on will fray.” Bending the emissions curve Outside the formal negotiations, climate and health activists saw momentum on super pollutants, with new initiatives to cut black carbon and methane. Both are short-lived climate pollutants, also known as superpollutants, which have an outsize impact on warming but fall out of the atmosphere within weeks or decades – as compared to centuries for CO2. Methane also is the second largest climate forcer after CO2, with a global warming impact 28 times larger, per volume of gas. A Methane Summit prior to COP saw countries express renewed commitment to the Global Methane Pledge, reached at COP26 in Glasgow, to reduce methane emissions 30% by 2030 as compared to 2020 levels. A NOW! (No Organic Waste) Initiative highlighted efforts to reduce methane emissions from organic waste. Along with methane leaks from oil and gas extraction and livestock, improper waste management is one of the key sources of methane emissions. Words have yet to translate into momentum, however. The first UN Environment Programme stocktake of methane emissions since the landmark Glasgow pledge backed by over 160 countries found the world is far behind the 30% target set for 2030, on course to deliver just a fourth of promised reductions. See related story: World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline Methane is an important precursor to tropospheric ozone, a potent air pollutant that harms human health through increased respiratory illness and asthma, as well as reducing crop production. Key methane sources, like poor landfill management, have other knock-on health impacts. Although methane is the second most powerful climate warmer after CO2, per unit of emissions, and one of the six greenhouse gases covered by the original UN Framework on Climate Change (UNFCCC), it has received less attention in formal climate negotiations until recently. Black carbon and other short-lived climate pollutants and tropospheric ozone precursors aren’t mentioned at all in the UNFCCC, revealing a gap in climate accounting. A COP30, nine countries also made a first-of-its-kind announcement to tackle black carbon emissions. Commonly known as soot, BC is a key component in health-harmful particulate matter as well as a climate pollutant that persists in the atmosphere for a few days or weeks, while fallen soot particles also acclerate snowmelt in the Himalayas and other mountain glacier systems. The countries pledged to integrate black carbon mitigation into climate strategies through targeted interventions in sectors such as electricity, transport and vehicle emissions standards, as well as oil and gas. “Cutting super pollutants is our emergency brake on near-term warming. We can avoid 0.6 °C of warming by 2050 by tackling super pollutants, such as methane, black carbon and tropospheric ozone, while reducing carbon dioxide emissions. The increased attention on super pollutants at COP30 shows ambition on climate and health is growing,” said Jane Burston, CEO of Clean Air Fund. Accelerating towards 2.6 °C UN Secretary-General Antonio Guterres addresses COP30. The summit also launched a “Belém accelerator” programme to address why countries are not meeting the plans they already committed to, known as nationally determined contributions. The final decision calls for bending the emissions curve “based on the full implementation” of the latest NDCs. Those targets, if fully implemented, would set the world on course for around 2.6 °C of warming — reducing emissions by just 12% of the 55% cut required by 2035 to hit 1.5 °C, according to a UNEP assessment ahead of the summit. More than 70 nations did not file NDCs at all. “The talk of the COP has been to ’embrace science’ and move away from negotiations to focus on implementation,” said Bill Hare, CEO of Climate Analytics, which produces the Climate Action Tracker report. “There is a massive risk that the outcome of COP30 will just leave countries to ‘implement’ policies that will warm the Earth to 2.6 °C.” “There is no point in ’embracing the science’ if it’s not acted on, just as there is no point agreeing to global energy goals if they’re not implemented,” Hare added. With no binding commitments placed on countries and an array of passive language used throughout the final decision, the text represents a lowest common denominator of what words can be put on a page. But in a fractured world, that means something, the UN chief said. “This shows that multilateralism is alive, and that nations can still come together to confront the defining challenges no country can solve alone,” said UN Secretary-General António Guterres. “But COPs are consensus-based — and in a period of geopolitical divides, consensus is ever harder to reach. I cannot pretend that COP30 has delivered everything that is needed.” Consensus under fire Overtime negotiations to reach a legally binding treaty on plastic pollution collapsed in August as major fossil fuel producers blocked an agreement. The victory of the constellation of petrostates and their allies at COP30 marks the second time in recent months that a similar alliance has derailed ambitious climate negotiations. The alliance of Like-Minded Developing Countries torpedoed the successful conclusion of a Plastics Treaty in Geneva in August, sticking firm to red lines so watered down that countries championing an agreement deemed it better to walk away than pass a final text. The successive failures have shone a spotlight on the viability of consensus-based UN negotiations, which require every nation’s sign-on to be agreed. That structure leaves ambitious countries with no choice but to compromise or leave empty-handed, while nations attempting to stymie progress have no incentive to change their stance. “The traditional COP model is under serious strain in a fractured, multipolar world, particularly from countries prepared to sacrifice the well-being of the world for fossil fuel interests,” Hare said. Some observers said the UNFCCC process has run its course. “This is an empty deal,” said Nikki Reisch, director of climate at the Center for International Environmental Law. “COP30 provides a stark reminder that the answers to the climate crisis do not lie inside the climate talks – they lie with the people and movements leading the way toward a just, equitable, fossil-free future.” “While the countries most responsible for pushing the planet to the brink point fingers, dig in their heels, and tighten their purse strings, the world burns,” Reisch said. “That’s why governments committed to tackling the crisis at its source are uniting to move forward outside the UNFCCC — under the leadership of Colombia and Pacific Island states — to phase out fossil fuels rapidly, equitably, and in line with 1.5°C.” UNFCCC executive secretary Simon Stiell defended the process after the deal was gavelled through. “I understand the various frustrations of different groups on different issues. Many countries want to move faster on fossil fuels, finance and responding to spiralling climate disasters,” Stiell said. “Certainly, if you look inside these halls, you may raise questions, but if you look at the signals that are sent over the past 30 COPS to the real world, they are there.” “With or without navigation aids our direction is clear, the shift from fossil fuels to renewables and resilience is unstoppable. We’re building day by day, step by step, COP by COP, a better world for billions more people in every part of the world.” Next year’s COP31 will take place in Antalya, Turkey, with Australia serving as “president of negotiations” in an unprecedented power-sharing arrangement. Image Credits: COP30, Stefan Anderson. Eliminating the “Period Tax” on Feminine Hygiene Products – A Battle For Freedom and Dignity 23/11/2025 Leslie Ramsammy ‘Your access to menstrual products shouldn’t depend on your postal code,’ proclaims a Mexican Facebook ad for better access, produced by #MenstruaciónDignaMéxico In August 2025, Guyana’s President Irfaan Ali removed all taxes and customs duties on feminine hygiene products. Now, Guyana’s Ambassador to the UN in Geneva calls on other countries to follow suit. In most developing countries male condoms are distributed freely. Free access to condoms is a globally recognized harm reduction strategy in public health. And yet, in those same countries, and even in some developed countries, menstrual hygiene products are often inaccessible and largely unaffordable to women and girls. Altogether, more than 500 million girls and women around the world are estimated to lack access to sanitary pads or tampons or other menstrual products. The unaffordability of menstrual hygiene products is exacerbated by both customs duties and VAT taxes that governments commonly place on menstrual hygiene products. These taxes are discriminatory – part of the gender divide and an assault on the dignity and the Right to Health for women and girls. And they are regressive taxes, hitting the poor much harder than other groups. Guyana’s Menstrual Hygiene Initiative Guyana’s first lady Arya Ali launches a menstrual hygiene initiative in one of the country’s remote regions in June 2025. Even prior to 2025, tampons and menstrual pads were VAT-free in Guyana. Then in mid-August, President Ali announced that the government would remove all remaining taxes on those products. The country is now in the process of adding these products to the public sector medical supplies list for free distribution to girls and women through public health clinics and centers. While it is a work in progress, a free menstrual packages program is also being rolled out for all girls in both public and private sector schools as part of a Guyana Menstrual Hygiene Initiative, launched in 2021. The initiative was launched following a Ministry of Education showing that one-third of female secondary school students struggle to afford or access sanitary pads – leading to missed classes and educational setbacks. Guyana’s First Lady, Arya Ali, has meanwhile been championing feminine hygiene products as a human rights issue since 2020. For Guyana, making menstrual health affordable falls under the government’s harm reduction initiatives. Guyana has taken a lead in ensuring that menstrual health packages are treated as public good and as a fundamental human right. It is a bold move. Movement is catching on worldwide Free periods protest in the United Kingdom in 2017 – one of the first to inspire a global movement. But the movement is catching on regionally and worldwide. A 2024 Lancet Review found that menstrual product taxes were applied in more than 63.2% of the locations in the Americas, with a tax averaging about 10%. At the same time, nine countries and one territory have eliminated taxes over the past decade, thanks in part to civil society advocacy – with VAT-free products now available in Barbados, Canada, Colombia, Ecuador, Jamaica, Nicaragua, Mexico, Puerto Rico, Saint Kitts & Nevis, and Trinidad & Tobago, as well as Guyana. Elsewhere in the world, other nations, including Australia, Bhutan, the United Kingdom, India, Ireland, Kenya, Lebanon, Lesotho, the Maldives, Malaysia, Mauritius, Namibia, Nigeria, Rwanda, South Africa, and Uganda, are among a growing list that have removed VAT from pads and other female hygiene products. In the United States, which has no national VAT, 28 states have eliminated sales taxes on the products. In 2021, Scotland became the first country in the world to offer tampons and sanitary pads for free “to anyone who needs them,” – setting a precedent for which countries such as Guyana are now poised to advocate more widely. Challenges elsewhere Turkish women discuss menstrual hygiene as part of the ‘We need to talk’ movement. But the picture is hardly uniform. In Pakistan, a young female lawyer, Mahnoor Omer, has gained international fame for her campaign to lower the tax on pads. Omer’s argument is that menstrual products should be placed into Pakistan’s tax-exempt “essential goods” list, which includes items ranging from milk and cheese to agro inputs like cattle semen. Currently, Pakistan’s tax can add up to 40% to the price of hygiene products, according to a 2023 report by UNICEF, which has been campaigning on the issue for a number of years. As a result, only about 16% of women and girls in rural Pakistan use appropriate sanitary products, homemade or purchased, according to one peer-reviewed journal study by a team of researchers from Agha Khan University in Karachi. Others use unhygienic materials or none at all. According to UNICEF, the high tax is a factor in Pakistan, which in 2018 had the lowest uptake of the products among four countries in the region. From tax free to entirely free Uganda’s She for She Pads is one of many social enterprises and civil society groups advocating for better access to female menstrual products worldwide. Even without taxation, in most developing countries, sanitary pads are unaffordable for most girls and women who represent about one-half of the global population – and will require such products for about 40 years of their lives. Non-access to sanitary products affects women’s and girls’ dignity, access to health, education, and workplaces, as well as participation in public activities. It is a good example of systematic gender subordination, gender segregation and economic prejudice through taxation applied solely against women. Increasingly, civil society groups led by women and girls around the world are rising up and rejecting this unequivocal assault on women’s rights. These groups see the elimination of taxation on menstrual products as critical to promote gender equity, female empowerment, human rights, and menstrual justice. In Colombia, for instance, A civil society campaign called Menstruacion Libre (free menstruation) advocated for the elimination of menstrual product taxes. In response, the Supreme Court of Colombia exempted taxes on menstrual pads and tampons in 2018. Other examples of political activism leading to removal of taxes for sanitary pads are #MenstruaciónDignaMéxico (Menstruation with dignity) in Mexico, Inua Dada and Days for Girls in Kenya, Free Periods in the United Kingdom, Qrate in South Africa, We Need to Talk in Turkiye, She for She Pads in Uganda, Myna Mahila in India, Herself in Brazil, With Red in Taiwan and many more. Rallying around ‘Menstruation Health Day’ Woman to woman – sharing information about menstrual products in India. The Right to Health has centrality in the fight for freedom and democracy around the world. Menstrual justice is another frontline in the wider battle. While this commentary highlights the issue of affordability and access to menstrual pads, menstruation justice is much more than access to pads. It also is about access to facilities, education and awareness, sound environmental management of hygiene waste products, and support. It is also about elimination of stigma. Moreover there is the issue of women in vulnerable circumstances, such as women prisoners, who have no access to menstruation pads. Governments and other stakeholders must craft a comprehensive approach to combat period poverty. This is a “best buy” in the fight for Health for All. Recognition of this, as part of an action plan crafted by WHO member states, for instance, could help amplify the issue and solutions. On Wednesday, I will be appearing on a panel of Ambassadors to the UN in Geneva at a hybrid event co-sponsored by Barbados, Canada and Malawi to kick off discussions on the intersection of menstrual health with trade policies. We can further scale up our campaigns by ensuring that the annual Menstruation Health Day, May 28, is incorporated into national public health education and awareness calendars. Access to period pads, soap, cups, facilities, education and awareness, fighting stigma and discrimination and access to environmentally safe and dignified disposal must be central in the gender equality agenda, not only for the Ministers of Health, but also for Ministers of Education, Social Welfare, Women and for the Human Rights organs of governments. Ambassador Leslie Ramsammy In our polarized world, social progressives and conservatives should all be able to unite around one single truth: Menstruation is a God-given biological activity. It should be safe, hygienic…and tax-free. Dr Leslie Ramsammy is Guyana’s Ambassador to the UN in Geneva and a former Minister of Health. Editor’s note: An earlier version of this oped appeared in DemocracyGuyana.com on 5 November. Image Credits: News Room , #MenstruaciónDignaMéxico, Free Periods , We Need to Talk , She for She pads. , Myna Mahila , CeHDI. Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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Eliminating the “Period Tax” on Feminine Hygiene Products – A Battle For Freedom and Dignity 23/11/2025 Leslie Ramsammy ‘Your access to menstrual products shouldn’t depend on your postal code,’ proclaims a Mexican Facebook ad for better access, produced by #MenstruaciónDignaMéxico In August 2025, Guyana’s President Irfaan Ali removed all taxes and customs duties on feminine hygiene products. Now, Guyana’s Ambassador to the UN in Geneva calls on other countries to follow suit. In most developing countries male condoms are distributed freely. Free access to condoms is a globally recognized harm reduction strategy in public health. And yet, in those same countries, and even in some developed countries, menstrual hygiene products are often inaccessible and largely unaffordable to women and girls. Altogether, more than 500 million girls and women around the world are estimated to lack access to sanitary pads or tampons or other menstrual products. The unaffordability of menstrual hygiene products is exacerbated by both customs duties and VAT taxes that governments commonly place on menstrual hygiene products. These taxes are discriminatory – part of the gender divide and an assault on the dignity and the Right to Health for women and girls. And they are regressive taxes, hitting the poor much harder than other groups. Guyana’s Menstrual Hygiene Initiative Guyana’s first lady Arya Ali launches a menstrual hygiene initiative in one of the country’s remote regions in June 2025. Even prior to 2025, tampons and menstrual pads were VAT-free in Guyana. Then in mid-August, President Ali announced that the government would remove all remaining taxes on those products. The country is now in the process of adding these products to the public sector medical supplies list for free distribution to girls and women through public health clinics and centers. While it is a work in progress, a free menstrual packages program is also being rolled out for all girls in both public and private sector schools as part of a Guyana Menstrual Hygiene Initiative, launched in 2021. The initiative was launched following a Ministry of Education showing that one-third of female secondary school students struggle to afford or access sanitary pads – leading to missed classes and educational setbacks. Guyana’s First Lady, Arya Ali, has meanwhile been championing feminine hygiene products as a human rights issue since 2020. For Guyana, making menstrual health affordable falls under the government’s harm reduction initiatives. Guyana has taken a lead in ensuring that menstrual health packages are treated as public good and as a fundamental human right. It is a bold move. Movement is catching on worldwide Free periods protest in the United Kingdom in 2017 – one of the first to inspire a global movement. But the movement is catching on regionally and worldwide. A 2024 Lancet Review found that menstrual product taxes were applied in more than 63.2% of the locations in the Americas, with a tax averaging about 10%. At the same time, nine countries and one territory have eliminated taxes over the past decade, thanks in part to civil society advocacy – with VAT-free products now available in Barbados, Canada, Colombia, Ecuador, Jamaica, Nicaragua, Mexico, Puerto Rico, Saint Kitts & Nevis, and Trinidad & Tobago, as well as Guyana. Elsewhere in the world, other nations, including Australia, Bhutan, the United Kingdom, India, Ireland, Kenya, Lebanon, Lesotho, the Maldives, Malaysia, Mauritius, Namibia, Nigeria, Rwanda, South Africa, and Uganda, are among a growing list that have removed VAT from pads and other female hygiene products. In the United States, which has no national VAT, 28 states have eliminated sales taxes on the products. In 2021, Scotland became the first country in the world to offer tampons and sanitary pads for free “to anyone who needs them,” – setting a precedent for which countries such as Guyana are now poised to advocate more widely. Challenges elsewhere Turkish women discuss menstrual hygiene as part of the ‘We need to talk’ movement. But the picture is hardly uniform. In Pakistan, a young female lawyer, Mahnoor Omer, has gained international fame for her campaign to lower the tax on pads. Omer’s argument is that menstrual products should be placed into Pakistan’s tax-exempt “essential goods” list, which includes items ranging from milk and cheese to agro inputs like cattle semen. Currently, Pakistan’s tax can add up to 40% to the price of hygiene products, according to a 2023 report by UNICEF, which has been campaigning on the issue for a number of years. As a result, only about 16% of women and girls in rural Pakistan use appropriate sanitary products, homemade or purchased, according to one peer-reviewed journal study by a team of researchers from Agha Khan University in Karachi. Others use unhygienic materials or none at all. According to UNICEF, the high tax is a factor in Pakistan, which in 2018 had the lowest uptake of the products among four countries in the region. From tax free to entirely free Uganda’s She for She Pads is one of many social enterprises and civil society groups advocating for better access to female menstrual products worldwide. Even without taxation, in most developing countries, sanitary pads are unaffordable for most girls and women who represent about one-half of the global population – and will require such products for about 40 years of their lives. Non-access to sanitary products affects women’s and girls’ dignity, access to health, education, and workplaces, as well as participation in public activities. It is a good example of systematic gender subordination, gender segregation and economic prejudice through taxation applied solely against women. Increasingly, civil society groups led by women and girls around the world are rising up and rejecting this unequivocal assault on women’s rights. These groups see the elimination of taxation on menstrual products as critical to promote gender equity, female empowerment, human rights, and menstrual justice. In Colombia, for instance, A civil society campaign called Menstruacion Libre (free menstruation) advocated for the elimination of menstrual product taxes. In response, the Supreme Court of Colombia exempted taxes on menstrual pads and tampons in 2018. Other examples of political activism leading to removal of taxes for sanitary pads are #MenstruaciónDignaMéxico (Menstruation with dignity) in Mexico, Inua Dada and Days for Girls in Kenya, Free Periods in the United Kingdom, Qrate in South Africa, We Need to Talk in Turkiye, She for She Pads in Uganda, Myna Mahila in India, Herself in Brazil, With Red in Taiwan and many more. Rallying around ‘Menstruation Health Day’ Woman to woman – sharing information about menstrual products in India. The Right to Health has centrality in the fight for freedom and democracy around the world. Menstrual justice is another frontline in the wider battle. While this commentary highlights the issue of affordability and access to menstrual pads, menstruation justice is much more than access to pads. It also is about access to facilities, education and awareness, sound environmental management of hygiene waste products, and support. It is also about elimination of stigma. Moreover there is the issue of women in vulnerable circumstances, such as women prisoners, who have no access to menstruation pads. Governments and other stakeholders must craft a comprehensive approach to combat period poverty. This is a “best buy” in the fight for Health for All. Recognition of this, as part of an action plan crafted by WHO member states, for instance, could help amplify the issue and solutions. On Wednesday, I will be appearing on a panel of Ambassadors to the UN in Geneva at a hybrid event co-sponsored by Barbados, Canada and Malawi to kick off discussions on the intersection of menstrual health with trade policies. We can further scale up our campaigns by ensuring that the annual Menstruation Health Day, May 28, is incorporated into national public health education and awareness calendars. Access to period pads, soap, cups, facilities, education and awareness, fighting stigma and discrimination and access to environmentally safe and dignified disposal must be central in the gender equality agenda, not only for the Ministers of Health, but also for Ministers of Education, Social Welfare, Women and for the Human Rights organs of governments. Ambassador Leslie Ramsammy In our polarized world, social progressives and conservatives should all be able to unite around one single truth: Menstruation is a God-given biological activity. It should be safe, hygienic…and tax-free. Dr Leslie Ramsammy is Guyana’s Ambassador to the UN in Geneva and a former Minister of Health. Editor’s note: An earlier version of this oped appeared in DemocracyGuyana.com on 5 November. Image Credits: News Room , #MenstruaciónDignaMéxico, Free Periods , We Need to Talk , She for She pads. , Myna Mahila , CeHDI. Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. 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Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. Posts navigation Older postsNewer posts