CSW chair Maritza Chan Valverde from Costa Rica, and UN Secretary General Antonio Guterrez at the 70th session of the commission.

The United States was isolated in its opposition to the adoption of “agreed conclusions” at the Commission on the Status of Women (CSW) on Tuesday, recording the only “no” vote at the United Nations headquarters in New York on Monday.

There were 37 votes in favour and six abstentions from Côte d’Ivoire, the Democratic Republic of Congo, Egypt, Mali, Mauritania, and Saudi Arabia. The CSW is made up of 45 elected members.

“Prior to the adoption, the representative of the United States [Dan Negrea] first proposed that its consideration be deferred, then that the text be withdrawn and then proposed eight amendments to the text,” according to a UN media release.

The US sought the removal of “controversial social issues” from the document, Devex reports. US objections included “ambiguous language promoting gender ideology”, “vague, unqualified commitments to sexual and reproductive health that can be interpreted as implying abortion rights”, and “censorship language on regulating artificial intelligence”, according to the UN media release.  

Earlier, Nigeria and Egypt called for more time to reach consensus – the usual route for UN decision-making and the only route the CSW has taken in 70 years. Pakistan later proposed voting separately on each of the US’s eight amendments.

However, CSW chair Maritza Chan Valverde from Costa Rica said that “every effort has been made to listen to delegations and to reflect the diversity of views expressed”.  

“We are convinced that the text represents the most balanced outcome achievable at this stage,” Valverde said, adding that her Bureau has decided to put the text to a vote.

Measures to address gender-based violence

UN Women director Sima Bahous and CSW chair Maritza Chan Valverde from Costa Rica

The CSW, which was established in 1946, is the main global intergovernmental body exclusively dedicated to the promotion of gender equality, and the rights and the empowerment of women. 

The theme of this year’s CSW is “ensuring and strengthening access to justice for all women and girls” by eliminating discriminatory laws, policies, and practices, as well as structural barriers to justice

The agreed conclusions “seek to create justice systems that work for everyone equally”, according to Valverde.

The proposals focus strongly on justice for survivors of gender-based violence, including integrating gender-responsive access to justice across sectors, formally recognising community justice actors, and introducing new language on digital justice and AI governance aimed at protecting women and girls.  

The text also strengthens standardised systems for gender-based violence data and promotes a whole-of-society approach that recognises civil society’s role.

Valverde stressed that hard-won progress on gender equality must not be reversed.  “We owe it to the trailblazers who charted the path for us, and to those who shall follow in our footsteps.  To our mothers, grandmothers, daughters, and sisters,” she said.

‘Epstein criminal enterprise’

President of the UN General Assembly Annalena Baerbock.

President of the UN General Assembly Annalena Baerbock told the opening of CSW that the backlash against women’s rights “feels as though we are forced to fight the same old battles again and again, battles from 80 years ago”.

Baerbock, a former German foreign minister, pointed out that she is only the fifth woman to be President of the General Assembly and that, in 80 years, a woman has never been Secretary-General. 

“If we do not address the fact that three-quarters of parliamentarians worldwide are men, and 103 countries have never had a female Head of State, then we will hardly deliver on justice.

“Women’s rights are nothing new,” she added. “They have been embedded in the DNA of this institution from the very beginning.”

“We will not stop fighting for equal representation and women’s rights… until the women of Afghanistan are free and girls worldwide are not being forced anymore to marry before they finish school; until we see justice for survivors of sexual abuse, whether it occurs at home or as part of an exploitive global sexual network as exposed in the Epstein files; where women are equally paid and represented, whether in newsrooms, in boardrooms, in governments and yes, at the helm of this institution, our United Nations,” said Baerbock.

UN Special Rapporteur on violence against women and girls, Reem Alsalem, also referred to Jeffrey Epstein, remarking that “the partial release of the information on the atrocities committed by the Epstein criminal enterprise… have been committed across the globe for decades, while flaunting nauseating levels of impunity.”

Deeply contested

Maitree Muzumdar, co-convenor of the Young Feminists’ Caucus,
Josefina Sabate, co-convenor of the Young Feminists’ Caucus,

“The decision to break consensus and proceed to a vote underscores how deeply contested commitments to gender equality, human rights and access to justice remain in this current geopolitical moment,” Maitree Muzumdar, co-convenor of the Young Feminists’ Caucus, told a media briefing on Tuesday.

“The negotiations revealed resistance by powerful states and mobilised anti-gender, anti-rights actors.”

Muzumdar, who is based in India. also criticised member states for approaching access to justice as a “technical issue rather than a political issue, focusing on procedural reforms without addressing the structural conditions that produce injustice.”

The negotiations revealed resistance by powerful states and mobilised anti-gender, anti-rights actors, 

Argentinian activist Josefina Sabate, also co-convenor of the Young Feminists’ Caucus, paid tribute to the CSW’s chair’s ability to ensure that a document was adopted.

Sabate said there has been a “real pushback in terms of gender equality policies” in Latin America following the election of conservatives in Argentina and now Chile.

Nobel laureate Malala Yousafzai addresses the CSW opening session.

The United Nations Commission on the Status of Women (CSW) began its 10-day session in New York on Monday, amid efforts by the United States to weaken women’s rights proposed in the draft outcome document.

The theme of the CSW, the world’s biggest global meeting on women’s rights, is “ensuring and strengthening access to justice for all women and girls.”

But the US, after initially abstaining from negotiations on the outcome document to be adopted by CSW, changed tack in the past few days and urged the removal of “controversial social issues” from the document, Devex reports.

The US wants references to climate change and a gender-responsive justice sector removed, and does not support the proposed reparations fund for survivors of violence, for example.

However, the entire purpose of the CSW’s 70th session is to chart a path to eliminating gender discriminatory laws, policies, and practices, as well as structural barriers to justice – and the outcome document due to be adopted by the end of Monday was supposed to guide this.

However, the US stance is similar to last year, when it refused to endorse the CSW’s final declaration last year, rejecting references to the UN’s Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and dismissing gender quotas, climate policies and even the Sustainable Development Goals as “globalist overreach”.

Fewer rights

Women only have 64% of the legal rights of men, according to a report issued last week by the UN Secretary-General.

“Globally, 54% of countries lack consent-based legal definitions of rape, while 72% allow child marriage in all or some circumstances,” according to the report.

“More than 45 countries retain at least one provision in their legislation regarding nationality that discriminates on the basis of gender, and 44% of countries do not have legislation that mandates equal remuneration for work of equal value.”

Extract from the UN Secretary General’s report on the status of women.

In many countries, women’s rights are weakening. The position of women and girls who live near conflicts – 676 million in 2024 – is particularly dangerous. 

“The number of conflict-related sexual violence violations documented by the United Nations has increased by 87% in just two years,” according to the report.

Iran, Gaza and Afghanistan

Raising the plight of women and children in Iran, Gaza and Afghanistan, Nobel laureate Malala Yousafzai told the CSW opening session: “Never have I seen so many children suffering from war and violence, injured and dying at the hands of unaccountable leaders.

“I am devastated for families in Iran whose daughters left for school and did not return home, for parents in Gaza who buried their children beneath the rubble of their classrooms, for Afghan girls living under the brutal Taliban regime for nearly five years,” said Yousafzai, the Pakistani activist shot in the head as a schoolgirl for advocating for the right of girls to education.

“You will be hearing a lot this week about access to justice, but true justice does not defend the humanity of children in one place and ignore it in another,” added Yousafzai, who lived in a territory of Pakistan under Taliban rule.

“It is not selectively applied. It does not claim that our rights are dependent on where we were born or what is politically safe for the people in this room. Under international law, killing children in their classrooms is a war crime.

Nobel laureate Malala Yousafzai addresses the CSW, appealing for justice for all women and girls.

“When civilians are deprived of food, water, medicine and shelter, the law obligates states to act. Looking around the world today, we must ask ourselves why justice is a privilege.”

Yousafzai said that nowhere is the backlash against women and girls more evident than in Afghanistan: “Since the Taliban took over the country in 2021, they have controlled courts, the police, and they have used their power to abuse women and girls, preventing them from going to school or university. Women cannot go to work, leave their homes without a male chaperone, or even speak in public.”

Afghan singer Sunbul Reha also addressed the CSW opening, appealing to the UN delegates to “protect a girl’s right to an education, defend a woman’s right to speak out safely and without retaliation [and] fight to block the erosion of our progress.”

Afghan singer and student Sunbul Reha with Sima Bahous, executive director of UN Women.

Merger plan?

Country delegates may also discuss the potential merger of UN Women and UNFPA, which deals with sexual and reproductive health, first mooted by the UN Secretary-General in his plan to reform the UN, UN80.

The US has withdrawn from both bodies and defunded them, sparking a serious resource crisis.

The global feminist organisation, Fos Feminista, and other groups have opposed the merger, stressing that the two have different functions with little overlap.

For Fos Feminista, UN Women was created to “hold the entire UN system accountable for gender equality” with a mandate to ensure “gender equality is not treated as an afterthought but as a binding obligation”.

“UNFPA, meanwhile, leads on sexual and reproductive health and rights (SRHR), population data and demographic analysis, humanitarian gender-based violence coordination and reproductive health supply chains that reach women in the most fragile settings. Its work is technical, operational and often lifesaving.”

Sister Miriam Chibale Mushoda RN, at the ultrasound station in the new Nakachenje Mini Hospital, Zambia – one of 108 facilities built with GE Healthcare, the Zambian Ministry of Health and NMS Infrastructure, a private Zambian firm.

As USAID programmes funding vital treatments for HIV/AIDS, malaria, maternal and child health, and other critical needs were imploding across Africa last year, a for-profit social enterprise startup geared up for its first real test.

Using medicines procurement as its lever, the Swiss-based startup Axmed called for a radical reboot of national systems — to digitize and streamline purchases, scale up pooled procurement, and drive down medicine costs.

“Has the system crumbled enough to finally compel us to rethink medicine procurement entirely? Asked Sofia Radley-Searle, Axmed COO, in a March 2025 oped.

“While deep-rooted barriers such as market fragmentation, regulatory complexity, supply chain inefficiencies, weak infrastructure, and financial constraints persist, real targeted solutions already exist,” she argued.

“Technology- enabled platforms, digital pooled procurement, data-driven forecasting, and new financing mechanisms are no longer theoretical concepts; they are active interventions reshaping healthcare systems. It is time we dared to imagine, and build, a world where fragmented, inefficient procurement cycles are replaced by digital platforms that match demand and supply in real-time, eliminating costly delays and unnecessary complexities.”

Over the past year, Axmed — a spinoff of the Gates Foundation — did just that.

Medicines delivered through the Axmed online logistics platform.

It integrated more than 5,000 essential health products in 10 therapeutic areas into a cutting-edge business-to-business (B2B) marketplace connecting healthcare buyers in low- and middle-income countries (LMICs) directly with suppliers.

Working with more than 130 commercially active procurers and suppliers, some 4.2 million patients were reached with a 35% average savings on medicines and other health products, said Alejandro Bes, Axmed General Counsel.

He was speaking at a gathering of private and public sector leaders focused on “unlocking private sector engagement” to improve health systems at the Geneva AIDEX 2025 conference, an annual global conference on humanitarian aid and development. Bes and other experts are featured in a newly published report by the Geneva Health Forum on ‘Unlocking Private Sector Engagement for more Resilient Health Systems.’  

Public-private partnerships increasingly urgent 

‘Can we imagine new forms of collaboration that support vital action … while avoiding pitfalls of conflicts of interest?’ Benoît Miribel (far left) asks panelists.

The private sector has long been deployed across the entire healthcare value chain – from the R&D and manufacture of  medicines, vaccines and medical devices, to logistics and supply chains, digital and technological solutions, workforce training, and health system management.

But how can such engagement be used more optimally to advance more robust and sustainable health facilities in a world of mounting humanitarian crises and declining donor aid? 

“Can we imagine new forms of collaboration that support vital action where resources are scarce, while avoiding the pitfalls of conflicts of interest? “ asked Benoît Miribel,  Secretary General of the Sustainable Health for All Foundation, France,who moderated the GHF session.

“Beyond financial contributions, these alliances can take many forms: technical support, joint operational projects, research and development of crisis-adapted solutions, or even the deployment of new technologies to strengthen the humanitarian response.”

“This is a reflection on the future of solidarity, at a time when finding new paths has become an essential necessity.”

Procurement: a neglected lever of access

Alejandro Bes, Axmed

Axmed, founded in 2024, identified developing country medicine procurement systems as a niche opportunity for win-wins. 

While bulk procurement has long been a practice of multilateral groups like the Global Fund, little attention has been given to practices in national marketplaces. 

In LMICs, those are often characterized by outdated, manual purchasing systems, complex regulations, and fragmented patterns of demands, driving inefficiencies and markups of 250% or more.

Axmed’s Business to Business (B2B) technology platform aggregates medicine demand across countries and presents it to manufacturing suppliers.

“In doing so, we created a viable economic model where none previously existed, reducing dependence on aid and strengthening health systems,” Bes said.

“Automation is central to our approach,” he explained. “We replace fragmented, manual systems with integrated digital solutions. We also deploy predictive technologies that assess future medicine needs based on historical consumption patterns.”

Rather than maintaining stockpiles, medicines are sourced directly from manufacturers with careful supply chain management to ensure reliable flow to partners.

“This allows us to anticipate demand, identify when medicines will be needed, and respond quickly.”

As a for-profit social enterprise, AXMED caps its markup at 10% in a market where markups of 250% are common, and redeploys 30% of profits back into the health systems it serves.

“Our objective is to reduce dependency on humanitarian aid and direct donations, and to transform existing models into more resilient, long-term systems that can sustain themselves over time,” said Bes.

Win–wins in hospital strengthening

Nakachenje Mini Hospital, Zambia – one of 108 rural facilities built through a public-private collaboration with GE Healthcare.

Large private-sector firms are also reshaping partnerships in LMICs. GE Healthcare is a flagship example.

In the past 15 years, the medical technology company — which controls about 60% of the global medical device market — has developed partnerships in more than 160 countries, with a focus on low- and middle-income settings, said Chris Bonnett, who heads its strategic projects initiatives.

“Our approach goes well beyond the delivery of medical equipment: we co-develop projects from both clinical and architectural perspectives, support implementation on the ground, and accompany our partners throughout the entire project lifecycle,” Bonnet said.

“Our ambition is to act as a long-term partner in strengthening health systems and improving access to quality care worldwide.”

The approach is a win-win because the more developed a country’s infrastructure becomes, the better equipped it is to procure and use the newest and most life-saving medical products that GE Healthcare produces. 

In Zambia, for instance, GE Healthcare worked with the UK government and partners to design and deploy deploy 108 primary healthcare centers in rural areas since 2020. The centers function as “mini-hospitals,” enabling women in some regions to access prenatal care for the first time.

“This initiative had a direct and tangible impact on maternal and child health,” said Bonnet.

“Real impact requires partnerships, shared ownership, and accountability. One of our projects in Ethiopia is a strong example of this approach. It was designed, monitored, and evaluated solely based on outcome indicators. Through close collaboration with the government, local midwives, and other partners, we succeeded in reducing neonatal mortality by 24%,” he said, citing the results of a 2018 pilot study on outcomes. 

Strengths and pitfalls of private sector engagement

Ethiopia vaccines
First doses of the AstraZeneca COVID-19 vaccine arrive in Addis Ababa, Ethiopia in March 2021. Rapid COVID vaccine development was the fruit of private-public partnerships although inequalities in rollout highlighted the importance of finding better ways to collaborate.

In its engagements, the private sector can call upon inherent resources such as: strong innovation capacity, control over industrial and production processes, operational efficiency, experience in managing complex projects and the ability to scale solutions rapidly. 

The private sector’s capacity to move quickly from design to implementation is a critical asset in emergency contexts. At the same time, there are also limitations and risks. 

For companies, the risks include financial exposure, reputational risk and staff security. For health systems, poorly coordinated engagement may result in parallel systems, increased dependency or misalignment with national health strategies. 

Conflicts of interest cannot be ignored and must be proactively managed, participants at the AIDEX event underlined. 

Key safeguards include clear governance arrangements, transparency around funding and partnerships, separation between public decision-making and commercial objectives, and alignment with priorities set by national authorities and multilateral organizations. 

These can  mitigate risks and help ensure that private-sector engagement reinforces—rather than undermines— trust in health systems. 

Mobilizing private sector know-how for emergencies

Aurélien Hubert, Foundation S

“Mobilizing private-sector expertise, resources, and operational capacity is essential if we want to respond more effectively to emergencies and support health systems in an increasingly complex global context, observed Aurélien Hubert, head of Emergency Responses and Operations at Foundation S, the philanthropic arm of Sanofi.

“The idea is to use public money more imaginatively, to unleash the potential of the private sector to achieve impact.

He described the Foundation’s role in emergency situations, such as the 2023-2024 wartime crisis in Lebanon, when his role included securing needed medicines internally while negotiating with local NGOs on the ground to organize transport.

“Everything starts with manufacturing, but production alone is not enough. Medicines must be distributed, delivered safely, and administered properly, especially in crisis settings,” Hubert observed.

“However, this process does not always succeed.”

“Failures do happen, and they can occur for many reasons. One of the most challenging situations arises when we cannot guarantee the quality of a product once it reaches the field.

A key factor is often lack of appropriate infrastructure on the ground, he added, citing the absence of cold chain equipment critical for many vaccines as well as insulin.

“Without a reliable cold chain, it is impossible to ensure that insulin can be transported and administered safely. In such cases I sometimes have to make the difficult decision to stop [deliveries].

Reliance on local NGO capacity is critical

Dozens of white tents stand outside Türkiye’s Gaziantep train station housing Turks and Syrian refugees, shortly after the February 6 2023 earthquake.

At the same time, there are moments when everything comes together, Hubert added. 

He recalled the February 2023 earthquake in southern Turkey as one such moment – when the Foundation managed to deliver DT (diphtheria and tetanus)  vaccines to extremely hard-to-reach areas within just two days.

“Vaccines were shipped from the United States to Turkey in full compliance with regulatory requirements, enabling rapid support to affected populations. This response was made possible through close collaboration with partners such as the Red Crescent, he said adding:

“These experiences highlight a key lesson: as a private-sector actor, it is essential to rely on efficient local and international NGOs capable of operating in crisis situations. Public aid alone is no longer sufficient. Collaboration is not a slogan; it is a necessity. To improve effectiveness, control costs, and maximize efficiency, all actors must work together.

Cutting edge technology emerging out of crises 

Familiy member connects safely with an Ebola-infected patient in DR Congo in 2022, thanks to the innovative “cube” developed by ALIMA with private partners.

Crises can also accelerate private-public partnerships that yield important new  innovations. The 2014-2016 Ebola crisis in West Africa offers one such example.

Together with a private-sector partner, the international medical NGO, ALIMA co-developed a major innovation: the “Cube” to protect health workers from the highly infectious and deadly virus. 

The modular medical unit was installed directly within villages, allowing Ebola patients to be isolated, protecting healthcare workers through fully transparent plastic walls, and keeping patients close to their families. 

The innovation caught on across the region, winning prizes from the African Presidential Council as well as the 2019 Global Innovation Accelerator Prize by the Bill & Melinda Gates Foundation. 

“This example reflects our core belief: by combining medical expertise, innovation, strong partnerships, and deep local engagement, we can respond effectively to health crises and contribute to the long-term strengthening of health systems,” said Alexandra Seidel-Lauer, ALIMA’s  director of development. 

ALIMA’s Cube, developed with partners in the 2014-16 West African Ebola outbreak, was deployed again in DR Congo during the 2018-19 emergency.

How USAID’s collapse fast-tracked AXMED’s rollout

Similarly, the 2025 collapse of USAID proved to be a turning point for AXMED’s new procurement model – fast-tracking its uptake.

“When USAID abruptly suspended its operations, many of our clients—who rely heavily on its support— were deeply worried, and so were we,” recalls Bes. “The question was simple: what do we do now?

The company fast-tracked deployment of its B2B system. What began as a proof of concept became a scalable model.

This year, the system is now set to expand to more than 20 LMIC countries, primarily in Africa, supported by a second $5 million Gates Foundation grant and additional investor backing.

“Ultimately, this approach allows us to move away from constant emergency response and instead build sustainable, replicable procurement models that strengthen health systems over the long term,” Bes said.

“This success demonstrates that while traditional aid approaches remain important, building resilient health systems also requires thinking differently and developing innovative solutions to address chronic challenges such as weak infrastructure, limited funding, and unreliable supply networks. This is what we aim to do: make a modest but meaningful contribution to the steady and sustainable improvement of health systems in LMICs.”

Second in a series.  See also: Innovative Finance can Strengthen Fragile Health Systems 

Image Credits: GE Healthcare , Axmed, Geneva Health Forum , Gerneva Health Forum , GE Healthcare , WHO, Geneva Health Forum , Abdulsalam Jarroud/TNH, ALIMA , Caroline Thirion/ALIMA .

The US has seen record-breaking outbreaks of measles in the past year. Experts point to falling vaccination rates.

The World Health Organization (WHO) has pushed back against speculation that a critical review of the US measles elimination status was delayed until November for political reasons. Rather, the WHO said that there were strong technical reasons for postponing the review from April until November so that more data could be collected.

This came as US health officials asked an independent panel to delay its review of the country’s measles elimination status until later this year. 

The review of the measles elimination status is now set to happen after the US midterm elections, reportedly sparking concerns over political motives. However, authorities strongly insist that the extensive delay is necessary to guarantee an uncompromising and exhaustive epidemiological review of recent circulation data. 

It is essential that “all of the data, all of the evidence, all of the analysis has been done and scrupulously done,” noted Kate O’Brien, WHO director of the Department of Immunization, Vaccines, and Biologicals.

The review, which is to be led by the Pan American Health Organization (PAHO), WHO’s regional arm in the Americas, could lead to the embarrassing loss of the US status as a country that has eliminated measles, due to the multiple outbreaks that have occurred there over the past year.  

It comes at a time when PAHO, a semi-autonomous entity, is keen to retain the US as a partner – even after the US pulled out of the WHO as a global entity.

Last November, PAHO’s Measles, Rubella, and Congenital Rubella Syndrome Elimination Regional Monitoring and Re-Verification Commission resolved that Canada had lost its measles elimination status after 12 months of continuous transmission.

The US has seen record-breaking outbreaks concentrated in Texas and South Carolina in the past year, with the most recent outbreak exceeding 1,000 cases. Experts point to waning vaccination rates and community transmission.

The US achieved elimination status in 2000, marking a victory over a disease that once infected nearly every child and claimed 500 deaths per year before widespread vaccination. 

PAHO points to technical reasons for postponement

map world measles elimination status
The number of reported measles cases in the last 6 months of 2025.

The WHO carries out routine elimination verification of its member states every year, assessing whether a country had no local transmission of the same strain within the past 12 months. 

PAHO initially invited both Mexico and the US to meet in April to review their elimination statuses following recent outbreaks. Under the organization’s frameworks, the panel meets annually, but may “also convene at other times as needed to carry out its mandate.”

“The meeting date has been set to give national health authorities and national sustainability committees sufficient time to prepare comprehensive reports, including descriptions and analyses with detailed epidemiological and laboratory evidence, for review by the commission,” the announcement read.

Now, though, PAHO has said they want to “harmonize” the commission’s schedule.

The WHO defended the rationale for postponing the review: “The [status review] meeting normally takes place in the fourth quarter of the year,” said O’Brien, responding to questions during a WHO press briefing. 

“That is when the review of the evidence will take place by that committee to determine whether [countries] retain or do not retain their elimination status.”

Another reason that the meeting wasn’t held earlier was to ensure all data and analysis were completed with the necessary rigor and depth, she explained. This preparation would ensure that external committee members have every piece of information required to reach their conclusions.

US could join UK, others, in losing elimination status

measles elimination vaccines map US
The percentage of American kindergarten children who have been vaccinated against measles has declined in the past two decades.

In January, the UK, Spain, Armenia, Azerbaijan, and Uzbekistan also lost their measles elimination status after the Europe and Central Asia regional committee met to review the status.

The Region of the Americas has historically maintained the most countries to reach elimination status.

But outbreaks across the region – notably the US, Canada, and Mexico – threaten the region’s reputation as the only group that has achieved total measles elimination. 

Slipping vaccination rates in higher-income countries help explain a resurgence of infections. In the last school year, 13 US states had vaccination rates below 90%. In 2010, only six states fell below 90%, according to CDC data.

And when using the WHO’s threshold for herd immunity – 95% – only 10 states currently meet that criteria. 

Nearly 100,000 deaths a year among unvaccinated

Globally, 95,000 measles deaths occur each year, mostly among unvaccinated or under-vaccinated children under the age of five. 

Cases and deaths are mostly concentrated in low- and middle-income countries and in low-resource or conflict settings.

Yemen, Indonesia, India, Pakistan, and Angola accounted for the majority of the disease burden in 2025. 

The disease is one of the most contagious viruses that can lead to severe complications and death, according to the WHO. Vaccination, though, averted nearly 59 million deaths in the past quarter-century.

The measles virus infects the respiratory tract and then spreads throughout the body. Symptoms include a high fever, cough, runny nose and a rash all over the body, per the WHO.

Image Credits: WHO, WHO, CDC.

Residents of Kakola–Ombaka being evacuated after their homes were flooded.

For decades, residents of Kakola-Ombaka village in Western Kenya lived through cycles of seasonal heatwaves and droughts on the shores of Lake Victoria without significant harm. 

That changed in 2019, when heavy rainfall of unprecedented intensity struck the area. The entire village and surrounding communities were inundated. The lake swelled, water levels rose steadily, banks eroded, and backflows spread across the land. Many residents were forced to flee to higher ground. 

For over a month, much of the village remained submerged. Families camped at local schools until those, too, were overtaken by water. Canoes and boats became the primary means of transport, though many residents with insufficient access to vessels continued to wade through the floodwaters on foot.

When the water eventually receded, families returned home. But the following year, the flooding returned, and then again, with increasing frequency. Historically, the area experienced a single rainy season. 

In recent years, two have become the norm — one from March to May and another from October to December. Residents have barely recovered from one episode before the next begins. Today, four camps of permanently displaced people remain in the area.

Water contaminated by pit latrines

Carren Onjala, a local community health promoter (CHP), said that almost all the pit latrines were submerged in the floods.

Many homes in this impoverished area rely on pit latrines, most of which were in a state of disrepair. When the floods came, virtually all of these were submerged. 

Carren Onjala, a local community health promoter, explained that faeces-filled stagnant water quickly became a breeding ground for snails, worms, and mosquitoes. Water and sanitation systems were seriously disrupted across the entire community.

The warmer, wetter conditions also accelerated the life cycle of parasites. The result has been a marked increase in cases of Schistosomiasis (commonly known as bilharzia) and other diseases transmitted by parasitic worms, known as helminths.

Dr Martin Mutuku, a neglected tropical disease expert from the Kenya Medical Research Institute (KEMRI), explained that rising temperatures combined with unpredictable rainfall create ideal conditions for the breeding of the snails that serve as intermediate hosts for the Schistosomiasis parasite. Many communities in Western Kenya, particularly those living along the shores of Lake Victoria, have been affected.

Children most affected

A school girl collecting water fetching water for domestic use in Kakola- Ombaka.

Schoolchildren were particularly vulnerable. Many were required to walk through floodwaters twice a day to attend school and collect water for their families, making prolonged contact with contaminated water unavoidable. 

Prisca Awuor Aende, a teacher at Nyamasao Primary School in Kakola-Ombaka village, recalled seeing children playing in stagnant water. 

Many stopped attending school altogether as a result of bilharzia infections. Younger children stayed away for fear of the rising water. Others lost their books in the floods, and academic performance across the school declined sharply.

The broader economic toll on the community has also been severe. Families have lost livestock, household goods, and property. Some have suffered damage to their homes; others have lost their land entirely, driving a rise in poverty across the area.

Neglected Tropical Diseases and climate

Neglected Tropical Diseases (NTDs) are a broad group of conditions caused by a range of pathogens, including parasites, bacteria, viruses, and fungi. 

According to the World Health Organization (WHO), more than one billion people are affected by NTDs globally, and approximately 200,000 die from them each year. 

In rural Western Kenya, the twin pressures of rising temperatures and shifting rainfall patterns are emerging as significant drivers of NTD spread, with Schistosomiasis and soil-transmitted helminths (STHs) finding new footholds as ecological changes bring parasites closer to vulnerable communities.

These climate-related risks were anticipated long before the 2019 floods. The Nyando and Kadibo sub-counties rank among the worst affected by climate change in Kisumu County, according to the county’s Special Programme and Disaster Management data. 

As early as 1966, the Kenyan government had predicted that changing weather patterns and lake flooding would place residents of Kadibo sub-county at risk. In response, the government purchased land in the Muhoroni Scheme and resettled affected communities. But after years passed without major flooding, many residents returned to their original homes and lived without incident — until 2019.

Ombaka Dispensary in Kakola –Ombaka submerged in flooded water.

The first indications that community members were suffering from bilharzia came when men and male children began presenting with swollen abdomens, an unusual symptom for their demographic. 

Those affected were taken to Ahero Sub-County Hospital, where they were diagnosed. In response, the Ministry of Health, various NGOs, UNICEF, and the Red Cross intervened with food, sanitary products, clothing, water containers, books, and medication, including Praziquantel, the primary drug used to treat Schistosomiasis.

But the delivery of these supplies was complicated by the fact that the nearby dispensary was also flooded, requiring health workers to distribute medicine and mosquito nets by boat and canoe.

Despite annual deworming programmes conducted by the Ministry of Health, re-infection rates remained high., said Maurice Murithi, the area’s Disease Surveillance Officer. 

Residents continued to wade through floodwaters to check on their submerged homes, exposing themselves repeatedly to contaminated water. The area also lacked reliable access to clean water, leaving residents with little alternative but to use what was available.

The deputy county director for special programmes, Migosi Oluoch, pointed to another contributing factor: the chronic contamination of the lake, rivers, and streams.

Waste discharged without adequate treatment from nearby industries and hotels enters the water system, creating a persistent snail habitat. When rains or lake backflows occur, this contaminated water spreads into surrounding communities, increasing exposure to both bilharzia and soil helminths.

 Mutuku highlighted structural reasons why NTDs persist despite intervention. Mass drug administration and deworming programmes are typically conducted in schools, leaving adults at home without treatment and resulting in poor overall coverage. 

Pharmaceutical companies also have limited commercial incentive to manufacture NTD drugs, as these are diseases that predominantly affect people living in poverty. This dynamic has led to a scarcity of bilharzia medication. 

Without reliable access to safe water, communities will continue to have unavoidable contact with contaminated sources. 

Flood mitigation 

Oluoch confirmed that flooding is the foremost climate-related disaster facing Kisumu County, with Kadibo among the most severely affected.

The county government has responded by opening water channels and canals to direct floodwater back towards the lake,while a Disaster Management Committee, co-chaired by the Governor and the County Commissioner, has been established to coordinate the response at the county level.

Residents of Kakola-Ombaka and the wider Kadibo and Nyando sub-counties have called for the construction of dykes, a recommendation that Oluoch supports.

He also urged the national government to accelerate the completion of the Koru-Soin Dam, which could help regulate water levels significantly.

He further proposed that vacant land rendered unusable by flooding – including the sites of former institutions such as Ombaka High School and several other abandoned settlements – be repurposed for a research centre or university.

Simultaneous actions

The situation in Kakola-Ombaka illustrates the relationship between climate change and neglected tropical diseases.

Controlling the spread of Schistosomiasis and soil helminths in Western Kenya will require action on several fronts simultaneously.

Infrastructure investment – including dams, dykes, and improved water and sanitation systems – is essential to reduce flooding and the contamination it brings. 

So too is the elimination of industrial and commercial waste entering the lake. Community-wide mass drug administration, rather than school-focused programmes alone, would improve treatment coverage. And sustained public education remains critical to equipping communities with the knowledge to protect themselves.

As Mutuku noted, vector-borne diseases that were once controlled can re-emerge whenever climate change raises temperatures and disrupts rainfall patterns. In Kakola-Ombaka, that re-emergence is already well underway

The war in Iran has paralyzed the delivery of WHO supplies from Dubai’s humanitarian hub, the world’s largest.

The US-Israeli war with Iran, which has paralyzed air travel across the Middle East, has also frozen deliveries of vital medical supplies from the world’s largest humanitarian supply hub in Dubai to conflict-wracked countries from Afghanistan to Lebanon, said the World Health Organization on Thursday. 

“Operations at WHO’s logistics hub for global health emergencies in Dubai, are currently on hold due to insecurity,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at a WHO press briefing in Geneva.

WHO Director General Dr Tedros Adhanom Ghebreyesus speaks about the Iran war’s domino effect on medical supply routes throughout the region.

The airspace closures as well as restrictions on cargo traffic through the Straits of Hormuz have put the hub’s operations “temporarily on hold,” echoed Hanan Balkhy, WHO Regional Director of the Eastern Mediterranean Regional Office  (EMRO), at the briefing. 

She said that the disruption is preventing access to some $18 million in humanitarian health supplies, while another $8 million in shipments has been stranded and unable to reach the hub in Dubai. 

“More than 50 emergency supply requests from 25 countries are currently affected. And $6 million in medicines for Gaza as well as $1.6 million in polio laboratory supplies are also held up,” Balkhy said. WHO’s emergency operations across the region currently face a 70% funding gap, she added. “Without urgent financial support, essential services will cease and preventable suffering will deepen.” 

One-half of world’s humanitarian needs are in Eastern Mediterranean Region

Hanan Balkhy, WHO Director of the Eastern Mediterranean Regional Office.

The airspace and sea lane closures have had broad repercussions insofar as one-half of global humanitarian needs are concentrated in the eastern Mediterranean region – which extends from Pakistan all the way to Tunisia. 

The Dubai hub, alongside one of the world’s busiest airports, also serves as a logistics junction for WHO-supported medical supplies traveling to Africa, South-East Asia and beyond. 

“Last year, WHO’s global health emergencies logistics hub in Dubai fulfilled more than 500 emergency orders for 75 countries across all six WHO regions. However, humanitarian health supply chains are now being jeopardized,” said Balkhy.  

Deepening humanitarian crisis

The crisis comes just as WHO and other humanitarian partners are attempting to pre-position trauma supplies and essential medicines in vulnerable regions, like southern Lebanon, in preparation for potential mass casualties -as well as population displacement. 

Israel on Wednesday ordered the evacuation of some 300,000 people from southern Lebanon and on Thursday evening called for the evacuation of all of Beirut’s southern suburbs – moves that will almost certainly lead to an even wider humanitarian crisis in the region.

The Israeli  moves on Lebanon came after Iran’s ally, the Shi’ite Hizbullah militia, entered the war earlier this week pounding northern and central Israel with repeated volleys of rocket fire.

The war began last Saturday morning, when Israel and the US launched a surprise attack on Iranian military and missile sites – after negotiations to curb Iran’s nuclear ambitions and missile arsenal faltered. Iran then  sent missiles flying across the region, hitting not only Israel but Dubai’s airport, as well as military and civilian sites across the Gulf and as far away as Jordan. That has paralyzed air traffic, stranding hundreds of thousands of tourists and travelers in a widening arc of conflict.    

There are also concerns over a potential nuclear event as Israel and the United States target Iran’s nuclear facilities and Iran threatens retaliation against Israel’s nuclear facility in the Negev Desert region of Dimona, WHO’s Director General warned.  

“The threat of nuclear facilities being impacted is also concerning,” said Tedros. “Any compromise to nuclear safety could have serious public health consequences.” 

Efforts to carve out alternative supply routes

Annette Heinzelmann

As the arc of the war extends across most of the region’s air space,  WHO is exploring alternative overland supply routes as an alternative to air transport together with UNICEF and the World Food Programme, said Annette Heinzelmann – EMRO emergency director 

“We are assessing the possibility of working through our other UN logistic hubs, notably in Nairobi and in Brindisi, which are close to the region… we are also working with our logistics hub in Dakar to look into alternative shipment routes,” Heinzelmann said 

“And there is the potential of local supply sources, as well as shipments through land routes,”  she said, noting that the opportunities and barriers vary widely country by country – citing Afghanistan as an example where alternative routes of access are “highly complex.”. 

Impacts on Gaza 

Gaza tent camp amidst rain and rubble in January 2026. WHO describes progress in rehabilitation since the October 2025 cease-fire as ‘marginal.’

For Gaza, already devastated by two-years of war with Israel, the fresh conflict with Iran and Lebanon is a huge setback in an “extremely fragile situation,” she added. 

For the first few days of the war, Israel also closed key humanitarian aid corridors.  Those have since been partially reopened, “but there is really not enough humanitarian aid going in.  

“And we still do not have enough patients [able to] leave Gaza to seek medical care outside. 

Tedros described the progress in Gaza since the October cease-fire as “marginal,” saying “we need 600 trucks to cross into Gaza every single day. But currently it’s not more than 100 between 100 or 150 – and some of those tracks are actually commercial, and that doesn’t really help with humanitarian services.”

He also renewed an appeal to Israel to allow Gaza patients who can’t be treated properly in the enclave to access more specialized medical care in East Jerusalem. This, in light of the dearth of countries willing to take in the more than 10,000 Palestinians awaiting medical treatment abroad. 

“I’d like to use this opportunity to ask Israel to allow us to take patients to East Jerusalem and West Bank,” Tedros said.. 

Casualties and attacks on health facilities 

Since the war began in an early morning surprise attack by Israel and the United States on Saturday, 28 February, some 1000 people have been reportedly killed in Iran, according to the Islamic regime; 50 in Lebanon, 13 people in Israel and eleven in other countries, WHO said.

In addition, WHO has verified 13 attacks on health care in Iran and one in Lebanon, according to Balkhy, citing data culled from WHO’s  dashboard on attacks on healthcare facilities or health workers. 

The WHO dashboard, however, contains only data provided by the Islamic Regime. It has no records of the many reported regime attacks on health workers and hospitals during the month of January unrest. In that period, there were multiple, credible reports of heavily armed forces bursting into hospital emergency wards to obstruct care, arrest or kill injured patients as well as health care workers. 

Over the course of that month, the Iranian regime’s systematic killing of protestors led to an estimated 10,000 to 30,000 deaths – a death toll that the regime went to great extremes to conceal.

During the current war, members of its Islamic Revolutionary Guard Corps (IRGC)  and its affiliated Basij paramilitary volunteers, are reportedly being embedded in schools, mosques and hospitals, making them targets of attack, according to independent news reports.

KurdPa Human Rights news agency Instagram post Wednesday: Sanandaj – Forced evacuation of the Seyyed al-Shuhada private hospital and deployment of Revolutionary Guard forces.

Speaking at the WHO press briefing, Heinzelmann said that she had no information about the incursion of armed forces in health facilities. 

Reached by Health Policy Watch, a WHO spokesperson did not explain why the January attacks on health facilities by regime forces were not included in the WHO dashboard of attacks on health care. However, the spokeperson noted that the Director General had posted a remark on X about some of the reported incidents.     

Image Credits: Dubai Humanitarian , Palestinian Water Authority , Instagram/Kurdpafarsi news agency.

A UNICEF-supported mobile clinic provides healthcare to people displaced by violence in Darfur, Sudan.

The first vaccines to reach Sudan’s South Kordofan state in nearly three years were delivered this week, according to Save the Children.

South Kordofan has not received any vaccines since July 2023 due to a siege by the Rapid Support Forces (RSF),which has blocked medical and humanitarian supplies. 

“This left thousands of children without protection from preventable disease at a time when malnutrition and displacement were putting them at heightened risk,” said Save the Children.

The organisation delivered two truckloads containing 18 metric tons of routine vaccines to Kadugli town in the south-central state over the past few days. 

The shipment includes the tuberculosis BCG vaccine, oral polio vaccine (OPV) and pentavalent vaccine (against diphtheria, tetanus, hepatitis B, whooping cough and Hib), as well as vaccines for rotavirus, pneumococcal, measles, meningococcal A, inactivated and Yellow Fever.

The vaccines, funded by Gavi, will support immunisation in five localities, including Kadugli where famine was confirmed in September 2025. 

Families in Al Reif Alshargi, Aldalang, Habila and Al Goos will also benefit, with more than 24,500 children set to receive routine vaccinations this year. In addition, nearly 6,000 women will receive the tetanus vaccine.

“Vaccines are one of the simplest and most effective tools we have to prevent child deaths,” said Dr Bashir Kamal Eldin, Save the Children’s health and nutrition director in Sudan.

“This vaccine delivery is a breakthrough for thousands of children and mothers who have endured months without reliable access to food and basic health services, conditions that have put their lives at serious risk.”

However, Eldin warned that the situation remains extremely fragile: “Without sustained peace and guaranteed humanitarian access, these gains could quickly be reversed.”

‘Humanitarian catastrophe’

The World Health Organization (WHO) has described the situation in Sudan as a “humanitarian catastrophe of staggering dimensions” in its latest report on the conflict.

The WHO estimates that 33,7 million people require assistance.  Some 11.5 million people have been forcibly displaced, with over 4.2 million fleeing into neighbouring countries. Chad recently closed its border with Sudan as it cannot cope with the influx of refugees.

“More than 21.2 million people are experiencing acute food insecurity,” said the WHO, with violence disrupting food and aid supply chains and agricultural production.

Some areas, including El Fasher (North Darfur) and Kadugli (South Kordofan), are facing famine, categorised as “Integrated Phase Classification Phase 5 (IPC Phase 5)”, when over 20% of households face an extreme lack of food and over 30% of children face acute malnutrition.

“The latest nutrition survey in Um Baru (North Darfur) recorded a Global Acute Malnutrition rate of 53%, of which 35% were classified as Severe Acute Malnutrition. Coupled with high rates of malnutrition, an overstretched health system and low immunisation coverage, this increases the risk of disease outbreaks and their catastrophic impacts,” said the WHO.

“Multiple disease outbreaks are occurring simultaneously, including cholera, dengue, malaria, measles, hepatitis E, and diphtheria.

“Over 40 000 injuries have been reported amid the ongoing conflict. Civilians continue to be killed, injured and displaced in ongoing attacks in the Darfur and Kordofan regions. Sexual violence remains pervasive.”

Between 15 April 2023 and 31 December 2025, the WHO has formally validated 201 attacks on health care, 1,858 deaths and 490 injuries.

“Many health facilities have been destroyed, looted, or are functioning with severe shortages of staff, medicines, vaccines, equipment, and supplies,” the WHO concludes.

Image Credits: Mohammed Jamal / UNICEF.

Senegal’s President Ousmane Sonko.

The Parliaments of both Ghana and Senegal are considering harsher penalties for same-sex relationships.

Last month, Ghana’s Parliament had its first reading of an anti-LGBTQ Bill, which is now being considered by its Committee on Constitutional, Legal and Parliamentary Affairs.

Meanwhile, Senegal’s Cabinet approved a Bill for its Parliament last month that will double the maximum penalty for same sex relationships – up to 10 years in prison.

Ghana passed an anti-LGBTQ bill in 2024, but it was not signed into law by the country’s then-president, Nana Akufo-Addo. The current president, John Mahama, was elected in 2024 and has stated his readiness to pass anti-LGBTQ laws.

Ghana’s Human Sexual Rights and Family Values Bill is similar to the one passed in 2024, and contains some of the most wide-ranging legal restrictions on human sexuality.

First off, the Bill aims to criminalise LGBTTQAP+ people. This applies to “a lesbian, gay, bisexual, transgender, transsexual, queer, ally, pansexual or a person of any other sexual orientation that is contrary to the sociocultural relationship between a male and a female”.

Any sexual activities by LGBTTQAP+ people will get a prison sentence of between two months and three years.

Meanwhile, “gross indecency” – defined as a “public show of romantic relations” or “cross-dressing” can get six to 12 months in prison.

LGBTTQAP+ organisations are also banned.

Ghanaians have a duty to report transgressions. The Bill also requires “parents, teachers, religious bodies, media and state institutions” to “promote and protect… human sexual rights and family values” and ensure they are “preserved and integrated into the fabric of national life.” 

Senegal’s Prime Minister Ousmane Sonko, who also came to power in 2024, told his Parliament that the Bill will punish “acts against nature” with prison sentences from five to 10 years.

DRC Health Minister Dr Roger Kamba, US Charge D’Affaires in DRC, Ian McCary, DRC Prime Minister Judith Tuluka Suminwa and Finance Minister Doudou Fwamba, at the signing of the health MOU last week.

The United States has moved at speed to secure several new bilateral health Memoranda of Understanding (MOUs) in the past week, including, for the first time, four in Latin America – with the Dominican Republic, El Salvador, Guatemala and Panama.

To date (2 March), the US has signed 24 bilateral health MOUs in terms of the Trump administration’s America First Global Health Strategy.

Announcing its agreement with Panama, the first MOU within Latin America, the US State Department described it as “strengthening Western hemisphere health security”, which it added is “a priority”.

The four Latin American agreements involve smaller grants and are almost wholly focused on disease surveillance.

The other 20 bilateral agreements are all with African countries – mostly previous recipients of health grants via the now disbanded US Agency for International Development (USAID) and decimated US President’s Emergency Fund for AIDS Relief (PEPFAR).

Several of these countries are facing dire shortages of medicines for HIV, tuberculosis, and maternal and child health as a result of the US withdrawal of funds.

The five-year MOUs are aimed at rapidly transferring financial responsibility for these key health services to countries themselves – as some, such as Kenya, Uganda and the Democratic Republic of Congo (DRC) – derived over half their HIV budgets from donors, particularly the US. In the DRC, for example, at least half the antiretroviral medication it used was covered by the US.

High parting price

However, the parting price for these transitional MOUs includes extensive investment in infectious disease surveillance networks. The aim is to supply the US with pathogen information within a week of any outbreak to not only “keep America safe” but to give US firms exclusive access to pathogen information, which will enable them to make vaccines, medicines and diagnostics to combat these.

The US-DRC MOU, signed on 26 February, focuses extensively on “strengthening the DRC’s capacity to detect and contain infectious disease outbreaks before they spread internationally”, according to a US State Department statement.

The DRC has experienced recent Ebola outbreaks and, for the past year, the biggest mpox outbreak in the world.

According to the MOU, the US commits to investing up to $900 million over five years and the DRC commits to increasing its health expenditure by $300 million.

The bulk of the money will go into “a national integrated surveillance and outbreak response system, including a high-quality laboratory network capable of detecting and investigating infectious disease outbreaks within seven days”. 

“Under this system, relevant authorities, including the United States and other partners, will coordinate epidemic preparedness and rapid response measures to contain outbreaks and prevent their spread to neighboring areas,” according to the statement.

The MOU also aims to modernise data and disease surveillance systems with “enhanced electronic medical records and interoperable platforms”, professionalise community health workers and “expand integrated delivery of essential health services for HIV, tuberculosis, malaria, polio, and maternal and child health”. 

First, the minerals…

Guinea and the US signed a minerals MOU before the health MOU.

The US held off signing an MOU with the DRC in terms of its “America First Global Health Strategy” on 5 December, when it signed deals with Rwanda and Kenya on the sidelines of the signing of a peace accord between Rwanda and the DRC.

Instead, the US and the DRC signed a “strategic partnership agreement” to  “promote secure, reliable, and mutually beneficial critical mineral flows for commercial and defense purposes”. 

The DRC is one of the world’s most important sources of rare earth minerals, but China has dominated the purchasing and processing of its minerals. In the past two months, the DRC has opened its rare minerals supply to the US.

In late January, the DRC sent the US a shortlist of state-owned assets involving manganese, copper, cobalt, gold and lithium, for US investors to consider as part of a minerals partnership, Reuters reports.

Meanwhile, the US MOU with Guinea, signed on 27 February, was also preceded by a minerals MOU, signed with the US on 5 February, giving the US access to “critical minerals”.

The health MOU prioritises strengthening the country’s “laboratory networks with biosafety and biosecurity management aligned with international standards by 2027”.

Legal backlash in DRC

But not all countries want to exchange their minerals and other assets for aid.

A group of lawyers in the DRC are challenging the minerals MOU in their Constitutional Court, arguing that it violates the country’s Constitution in various ways, including undermining national sovereignty over natural resources.

“By filing this case with the Constitutional Court, we are assuming our responsibility as Congolese citizens to protect the sovereignty of our country and safeguard our patrimony for future generations,” said attorney Jean-Marie Kalonji, one of the plaintiffs. The case has yet to be heard.

Meanwhile, Zimbabwe recently backed out of talks with the US as it was unhappy with what the US required from it in terms of outbreaks.

“Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations—such as vaccines, diagnostics, or treatments—that might result from that shared data,” explained Nick Mangwana, Secretary for Information, Publicity and Broadcasting Services.

“In essence, our nation would provide the raw materials for scientific discovery without any assurance that the end products would be accessible to our people should a future health crisis emerge. The United States, meanwhile, was not offering reciprocal sharing of its own epidemiological data with our health authorities.”

Kenya’s MOU with the US, the first of the series, has been halted by the country’s High Court as it faces two separate court challenges for giving the US access to patient data and pathogen information.

The government of Zambia acknowledged last week that it is unhappy with part of a proposed health aid deal with the United States that “does not align with the country’s interests” and has requested “revisions” to the MOU.

The Zambia-US bilateral health deal was due to be signed last December, but it faltered after the US linked the billion-dollar deal to access to Zambian minerals, particularly copper and cobalt.

Just four days before the MOU was due to be signed, the US announced that the two countries had committed to a plan to unlock “a substantial grant package of US support in exchange for collaboration in the mining sector and clear business sector reforms that will drive economic growth and commercial investment that benefit both the United States and Zambia”.

‘Extractive’ policy

Sophie Harman, professor of international politics at Queen Mary University of London, argues in last week’s BMJ that “extraction is the core principle of US President Donald Trump’s America First global health policy”.

“The current US administration does not aim to improve health worldwide, instead it intends to make US companies richer and facilitate ‘leveraging US global health leadership to compete with China’,” writes Harman.

“Entering a deal with the US government is a potential lose-lose for states. These countries risk losing resources and opportunities for wealth creation in their own countries, threatening alliances with China for relatively small advances in health, and creating political turmoil in domestic courts.”

Smoking prevalence is higher amongst European women than anywhere else in the world.

Europe is failing to curb tobacco use – particularly in women and girls – and will have the world’s highest prevalence by 2030, the World Health Organization’s (WHO) European region revealed this week.

Of the region’s 53 states, tobacco use is highest in Serbia, North Macedonia, Bulgaria and Montenegro – all exceeding 30% prevalence in people over the age of 14.

The global average for tobacco use in people aged 15 and over is 19.5%, while in the WHO European Region it is 24.1%.

The rate of female smokers is the highest in the world at 17.3% – or one in five women. This is almost double the prevalence of the next highest region, 9.1% in the Americas. 

Europe is the only WHO region not expected to meet the global target of a 30% reduction in tobacco use among women by 2025. It is currently projected to achieve only a 12% reduction between 2010 and 2025.

“The 62 million female smokers in the European Region represent over 40% of the 143 million female smokers in the world,” according to the WHO, which released 10 new factsheets on tobacco consumption this week.

“European girls aged 13 to 15 now have the highest tobacco use rates among their age group anywhere in the world,” continued Kluge. 

“That is not an accident, it’s the result of deliberate industry strategy targeting young people with flavoured products and sophisticated social media marketing. 

“Countries like Belgium, Denmark and the Netherlands are proving it is possible to push back – by regulating novel products, banning flavours and restricting advertising. Every country in this region should be doing the same, to protect future generations.”

Slow decreases

While Europe’s tobacco consumption is decreasing, it is happening fairly slowly. In 2000, 47,5% of European men used tobacco, and by 2025 this was 30,3%. In women, tobacco use decreased from 22,3% in 2000 to 17,3% in 2025.

“Tobacco use already causes over 1.1 million deaths from noncommunicable diseases in the European Region each year – and without accelerated action, we will stay the worst-performing region in the world by 2030,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. 

“We have a responsibility to change course now: to shield young people from nicotine addiction, prevent industry interference in health policy, and enforce the regulations that will prevent a lifetime of avoidable harm.”

Uneven use of taxes

Tax increases are being applied in some European countries – and in 28 countries, taxes represented more than 75% of the retail price of the most popular brand of cigarettes in 2024  – an increase from 16 countries in 2008.

Twelve countries have increased prices since 2014, including Belgium, Czechia, Finland, France, Germany, Kazakhstan, North Macedonia, Slovakia, Turkmenistan, Ukraine, the United Kingdom and Uzbekistan. 

But cigarettes have become more affordable in 19 countries – up from just nine in 2022 – which may lead to higher smoking initiation, the WHO warned.

Cigarettes are cheapest in Belarus, Uzbekistan, Tajikistan and Azerbaijan,  and most expensive in Turkmenistan, Ireland, the UK and France.

Uneven regulation

Regulating e-cigarettes is uneven across the region. 

The region has the second-highest e-cigarette use prevalence in the world, with an estimated 31.4 million users, and regulation of e-cigarettes is fragmented.

“Decades of progress are at risk unless policies keep pace with a rapidly evolving nicotine landscape,” said Kristina Mauer-Stender, Regional Adviser for Tobacco Control at WHO/Europe. 

“Applying the same strong tobacco control tools to new and emerging products is essential if we want to protect young people and sustain public health gains.”

The fact sheets show that, while most countries in the region have strong tobacco monitoring systems and require large health warnings on packaging, implementation is uneven across other measures. 

Only 18 countries have comprehensive smoke-free laws covering all public spaces. Just 12 provide national quit lines and cover the cost of cessation services. Comprehensive bans on tobacco advertising and promotion exist in only 13 countries.

Image Credits: Zaya Odeesho/ Unsplash, pixabay.