Climate change, rising food insecurity and overwhelmed health systems have created a perfect storm for child undernutrition in parts of sub-Saharan Africa.

Philanthropy can help make every dollar deliver more impact.

I often think about a boy I met in Kajiado County, Kenya. He was the same age as my son, but half his weight. A World Health Organization (WHO) colleague measured the circumference of his arm to confirm what was already painfully clear: he was severely malnourished and needed urgent medical care.

He and his mother had walked to a clinic not far from fields of dead animals, victims of prolonged drought linked to climate change. It was one point in a chain of dominoes – failed rains, lost livestock, rising food insecurity, overwhelmed health systems – that would determine whether this child would have the chance to realize his full potential.

As governments reduce aid budgets and global health institutions confront growing financial pressure, it is imperative that we ground ourselves in how our decisions affect lives such as his.

Imperative to turn resources into sustained impact

The current crisis in global health is often described as a crisis of insufficient funding. That is true. But it is also something deeper: a growing imperative to turn resources into sustained impact more effectively.

In the past twenty-five years, global health financing has driven extraordinary progress against infectious diseases. Investments through organizations such as Gavi and the Global Fund cut child mortality in half and saved nearly 100 million lives. Those investments built systems that benefit everyone, from rapid vaccine development during COVID to catch-up immunization campaigns reaching millions of children.

Testing for hypertension. The burden of non-communicable diseases (NCDs) is growing globally, including in low- and middle-income countries.

Over that same period, the global health landscape has changed. Many countries are transitioning from low- to middle-income status and rightly want greater ownership of their own health priorities and systems. The burden of disease is increasingly shifting toward noncommunicable diseases (NCDs) and mental health conditions, whose prevention and treatment depend on strong regional and national health systems.

Identifying, scaling and sustaining what works

In this new environment, the WHO’s role becomes even more important.

WHO’s greatest value is not that it delivers services directly. Its value lies in helping countries identify, scale, and sustain what works: setting evidence-based norms and guidelines, coordinating surveillance and emergency response, convening governments around shared priorities, and supporting countries to adapt global knowledge into effective national action.

In the last year alone, the WHO helped additional countries eliminate neglected tropical diseases; prequalified the first malaria treatment for newborns and infants; and negotiated concrete global targets to control NCDs and promote mental health. In a more fragmented world, this work underscores why trusted global institutions are becoming more – not less – important.

This is also where philanthropy can play a transformative role. Not because philanthropy can replace governments; it cannot. Public financing will remain the foundation of global health. But philanthropy can help improve how all financing is mobilized and used.

Globally, charitable giving represents an enormous source of social investment – roughly $2 trillion annually. (For perspective, that is roughly 100 times larger than government aid for global health.) Yet only a small fraction supports global health, and an even smaller share strengthens the systems required to deliver health interventions at scale.

Some of the most compelling examples of WHO’s role are not always the most visible

Zambia started to roll out the malaria vaccine in December 2025. This baby is being vaccinated at the Lumezi Urban Clinic.

In my experience, mobilizing philanthropic capital requires clear theories of change, measurable outcomes, accountability for results, and the ability to adapt based on evidence. It requires organizations to explain not only what they will do, but why it matters, how progress will be measured, and how local institutions and communities will ultimately sustain impact.

Those disciplines improve the effectiveness not only of philanthropic dollars, but of all dollars invested in global health.

In its first five years, the WHO Foundation raised $214 million from charitable sources, including support from 84 new donors to the WHO, generating $4.40 in commitments for every dollar invested in fundraising. Our experience reinforces a simple lesson: philanthropy responds not only to need, but to clarity, trusted partnerships, measurable outcomes, and the confidence that institutions can deliver meaningful impact at scale.

Some of the most compelling examples are not the most visible.

WHO-supported measles surveillance networks, spanning hundreds of laboratories across more than 190 nations, help countries detect outbreaks early and sustain routine immunization. WHO’s Basic Emergency Care program has trained frontline health workers in low-resource settings to reduce mortality from trauma, sepsis, and shock. WHO’s work on mental health is helping countries integrate care into primary health systems, expanding access where services have historically been absent altogether.

Philanthropy can help accelerate the impact of global health investments

None of these efforts depend on philanthropy alone. But philanthropy can help accelerate them, strengthen accountability around them, drive new evidence, and demonstrate models that governments and national systems can sustain and scale over time.

The closing Plenary session of the 78th World Health Assembly at the Palais des Nations in Geneva, Switzerland, on 27 May 2025.

As global health leaders gather in Geneva for this year’s World Health Assembly, the conversation cannot simply be about how much money has been lost. It must also be about how effectively we use the money that remains – and how we build institutions capable of turning resources into measurable, equitable, and sustainable impact.

I think again of the boy and his mother in Kajiado County.

They do not care whether help comes from governments or philanthropies. They care whether systems work. Whether medicines and vaccines are available. Whether a health worker shows up before it is too late.

Yes, global health needs more money. But it also needs the discipline, partnerships, and institutions capable of turning resources into lives saved — consistently and at scale. In a period of shrinking aid budgets, that may matter as much as the funding itself.

 

Anil Soni is CEO of the WHO Foundation and a global health leader and innovator with nearly 30 years of experience expanding access to healthcare across the public, private, and nonprofit sectors.

Image Credits: Christine Olson/Flickr, WHO Global Report on Hypertension/Natalie Naccache, Temwanani Mtonga/ Gavi, WHO .

The World Health Assembly in Geneva. At this year’s 79th session, member states will review a proposed process for reforming the UN global health architecture.

Leaders of the international NGOs, Save the Children, Seed Global Health, AMREF, and LSE Health make five asks to member states attending next week’s 79th World Health Assembly, as they take the first steps to launch a joint UN process for reforming the global health architecture. 

As governments prepare for the 79th World Health Assembly (WHA79), the stakes could not be higher. On the table is a once-in-a-generation opportunity to reform the global health architecture (GHA) – triggered by the unprecedented cuts in foreign aid. But in the rush to redesign institutions and redirect funding flows, we risk losing the principle that should anchor every reform effort: universal health coverage (UHC), or the right of every person, everywhere, to access quality healthcare without financial hardship.

At the 158th WHO Executive Board, Member States requested the WHO to convene a joint process on global health architecture reform. The World Health Assembly remains uniquely positioned to convene Member States, civil society, donors, and multilaterals around a more coherent reform agenda.

The funding crisis is exposing deeper structural failures

The year 2025 saw the largest annual decline in total official development assistance (ODA) on record, with a 23.1% reduction compared to 2024, bringing global aid back to levels seen in 2015, at the outset of the 2030 Sustainable Development Goals (SDGs).

Preliminary data from the Organisation for Economic Co-operation and Development (OECD) indicate that 2025 saw the largest annual decline in total official development assistance (ODA) on record, with a 23.1% reduction compared to 2024, bringing global aid back to levels seen in 2015 at the start of the 2030 Agenda for Sustainable Development.

A further 5.8% decrease is anticipated for 2026. These cuts risk leading to an additional 22.6 million deaths by 2030, including 5.4 million children under the age of five.

This downturn exposes structural weaknesses in systems that have long depended on external financing. For women, children, and adolescents, the health systems consequences are profound and immediate: disrupted maternal and newborn care, collapsing immunization and nutritional programmes, and reduced access to sexual and reproductive health services.

In humanitarian settings, conflict-affected and displaced populations may soon have no safety net at all.

Although it is said that “crises create opportunities,” the funding shock has exposed a long-recognized reality within global health: an architecture dependent on a small group of donors is inherently unstable and unable to deliver UHC.

Preventing future crises will require new foundations: domestic financing models insulated from geopolitical shifts, institutional mandates that endure beyond individual funders, external partners aligning behind national priorities, and a global health architecture in which UHC is structurally embedded rather than dependent on external support. Central to this is a well-trained and adequately financed health workforce, without which neither health systems nor universal health coverage (UHC) can be achieved.

UHC must guide global health reform

Delivering Universal Healthcare requires countries to invest more in primary healthcare.

The 79th World Health Assembly will discuss several major issues separately: UHC (item 12.4) and primary health care (PHC) (item 12.5), implementation of the Pandemic Accord (item 13.3), the strategy on Economics of Health for All (item 15.5), and global health architecture (GHA) reform (item 20.1). While this reflects standard WHA procedures, the risk is that these discussions proceed in parallel rather than as part of a coherent reform agenda.

The appointment of Thailand and Andorra as co-facilitators for negotiations on the 2027 UN High-Level Meeting on UHC is politically significant. The 2027 UHC High Level Meeting (HLM) cannot become a separate process alongside GHA reform discussions. It should serve as one of the accountability mechanisms for reforms currently being debated in Geneva.

Five priorities for WHO Member States at WHA79

A Nepali woman with her child in a sling on her back. Global funding crisis has hit women and children especially hard.

For WHA79 to make a real impact, Member States must ensure their decisions translate into practical improvements for the people most affected by systemic failure. In the lead-up to the 2027 UN High Level Meeting on UHC, we call for five key changes:

  • Anchor GHA reform in UHC and country ownership
    Global health reform must align existing initiatives to avoid fragmentation. The WHO-led GHA reform process can help build that cohesion and should align mandates, structures, and incentives behind country-led priorities. Reform efforts need to address power imbalances, align behind country priorities, support global public goods, and strengthen mutual accountability. Country-led governance must be the foundation of any reformed architecture. To ensure commitments translate into action, Member States should establish clear, time-bound implementation milestones and accountability mechanisms, including civil society and affected communities. The 2027 UHC HLM should explicitly track and build on GHA reform commitments made in Geneva.
  • Invest in PHC and sustainable financing
    Governments should increase domestic public spending on health – including an additional 1% of GDP for primary health care – while strengthening public financial management and institutionalizing health financing coordination through country-led platforms. However, many low-income countries face severe debt distress, limiting their ability to expand fiscal space for health without broader reforms to debt architecture and progressive domestic taxation. Meeting UHC targets will require progressive financial reforms and renewed attention to the Economics of Health for All agenda. Financing must be directed toward essential services, health workers, and financial protection for vulnerable populations.
  • Strengthen the health workforce for UHC
    Health workers underpin resilient health systems, pandemic preparedness, and climate adaptation. Member States should expand fiscal space for the health workforce through sustained domestic financing, while aligning donor investments behind national workforce strategies and employment plans. This includes equitable recruitment, training, fair remuneration, and protection of frontline workers, including community health workers, particularly in underserved settings.  GHA reform and global financing mechanisms must support sustainable, country-led health systems rather than fragmented, short-term parallel programming.
  • Institutionalize social participation and accountability
    Civil society engagement is critical to shaping policies that reflect the needs of affected populations. WHA77’s resolution on social participation should now be operationalized by embedding participation and transparency as core accountability mechanisms. WHO should establish regional and national consultative bodies bringing together Ministries of Health and Finance, donors, civil society, and affected communities to enable continuous dialogue and oversight. This should be supported by transparent reporting of health financing data, building on national health accounts and the Global Health Expenditure Database with open access to disaggregated data.
  • Safeguard UHC in crisis and conflict settings
    GHA reform discussions cannot turn a blind eye to the humanitarian needs caused by conflicts and crises worldwide. Member States should mandate that GHA reform financing instruments – including the Pandemic Fund and IHR/Pandemic Agreement’s Coordinated Financing Mechanism – include ring-fenced allocations for essential health services in crisis-affected settings. In an era of rising polycrisis, protecting and advancing UHC reforms is not just morally necessary, but can also create momentum for health system reform.

WHA79 is a pivotal juncture. It will be remembered either as the moment governments anchored health reforms in equity and the needs of the people they serve, or as another missed opportunity clouded by consensus language and procedural paralysis.

Alhadi Khogali, is Senior Global Health Policy Advisor, Save the Children.

Renee de Jong is Senior Advocacy Advisor, Save the Children.

Marionka Pohl is Senior Director of Policy, Seed Global Health.

Rispah Walumbe is Health of Strategy & Policy, Amref Health Africa.

Arush Lal, is a Visiting Fellow at LSE Health, London School of Economics and Political Science.

Image Credits: WHO, OECD, WHO, Lisa Marie Theck/Unsplash.

Passengers being evacuated from MV Hondius, the ship affected by a hantavirus outbreak, in Tenerife on Monday.

All passengers were evacuated from the cruise ship, Hondius, by Monday night – and a Spaniard taken to a military hospital in Madrid to quarantine has become the 11th person from the ship to test positive for hantavirus.

The evacuation was completed 10 days after the World Health Organization (WHO) was notified about the outbreak – and experts have called for a review of the global response to identify and fix “gaps and vulnerabilities in the system”.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), and Spanish President Pedro Sánchez, described the evacuation as a success and a show of international solidarity.

Hondius captain Jan Dobrogowski, described the past few weeks as “extremely challenging”, as he and 24 crew, accompanied by a doctor and nurse, sailed on to Rotterdam. 

In a social media message on Monday, Dobrogowski thanked all passengers and staff for their “patience, discipline and the kindness they showed to each other” during the outbreak, particularly commending crew members for their “courage and selflessness”.

The Hondius evacuation had not taken place in Cabo Verde as the island lacked the capacity to handle the operation, Tedros clarified at a media briefing on Tuesday.

After docking in Cabo Verde for a couple of days, the ship sailed on to Tenerife in the Canary Islands, which is an autonomous community of Spain.

Under the International Health Regulations (IHR), of which Spain is a party, “countries are required not to allow people to be stranded at sea when they have the capacity to manage the risk safely and responsibly”, said Tedros.

‘Inhumane and unnecessary’

Spanish President Pedro Sánchez addresses the media on the evacuation of passengers from the cruise ship hit by hantavirus.

“There were some people around the world calling for the passengers to be contained on the ship for the full quarantine period. Our view was that would have been inhumane, and unnecessary,” he added.

“We were convinced it was possible to disembark these passengers in a way that was safe for them and the people of Tenerife, and that was respectful of the human rights of the passengers and crew.”

There were almost 150 people from 23 countries on the ship for weeks, “in what must have been a very frightening situation”, said Tedros, adding that “some of the passengers were facing mental breakdown” and “have the right to be treated with dignity and compassion”.

Meanwhile, Sánchez told the media briefing: “This world doesn’t need more selfishness, nor more fear. What it needs is countries that show solidarity and want to move forward.

He also appealed for “international cooperation and organisations like the WHO to be provided with the resources to realise their work”.

More cases possible

Three people travelling on the Hondius have died from hantavirus, the last of whom died on 2 May – the day that the WHO was first notified of the cluster of cases by the UK. South African scientists identified the virus in a British man flown to the country for treatment. 

“At the moment, there is no sign that we are seeing the start of a larger outbreak,” said Tedros. “But of course, the situation could change. And given the long incubation period of the virus, it’s possible we might see more cases in the coming weeks.”

The recommended quarantine period is 42 days, which is how long the virus can take to manifest.

Each country is responsible for monitoring the health of its citizens evacuated from the ship. Some, like Australia, will require them to remain in government quarantine facilities. Others, like the US, have stated that they will allow asymptomatic citizens to isolate at home.

The WHO recommends that they “should be monitored actively at a specified quarantine facility or at home for 42 days from the last exposure, which is the 10 May, which takes us to the 21 June,” said Tedros.

Is the system working?

Ellen Johnson Sirleaf and Helen Clark, co-chairs of The Independent Panel for Pandemic Preparedness and Response, which evaluated the global response to COVID-19, said that the hantavirus outbreak has “tested the international system”, ” demonstrating its strengths and gaps.

The pair, who previously described the WHO response to COVID-19 as “analogue” in a digital age, commended the international response to the hantaviris outbreak from 2 May.

“The identification and communication of the hantavirus results from South Africa to the United Kingdom, its subsequent reporting to the WHO [on 2 May], and from WHO to countries worldwide demonstrated the importance of rapid application of the International Health Regulations,” they said.

However, between the first death on board on 11 April and 2 May, “a series of events resulted in the growth of the hantavirus outbreak”, they noted. 

“There were risks to passengers onboard, to people interacting with them on remote islands, and following the 24 April disembarkation in St Helena, to those who contacted them on land, in the air, and in their next destinations,” said Sirleaf and Clark.

“A review should determine whether a more precautionary approach could have been applied pursuant to the guidelines in the WHO Handbook for Managing Public Health Events on Board Ships. 

In a social media recording of ship’s captain Dobrogowski notifying passengers of the first death, he assures them that it was due to the man’s underlying conditions and posed no risk to other passengers.

“While sadly deaths on ships do occur, as more people embark on adventure travel to remote locations, the need to protect travellers and those in contact with them from potential exposure to pathogens will increase,” they said.

Review of outbreak planning

The co-chairs appealed to governments to “review outbreak and pandemic planning to address vulnerabilities in the system, including in shipping, marine health and death-related protocols, port management, and protection of populations in remote locations”.

They also appealed to leaders to follow “all relevant protocols for contact tracing, infection control, reporting, isolation and supportive care” to break the chain of hantavirus transmission.

Despite negotiating a Pandemic Agreement since the end of the COVID-19 pandemic, WHO member states have been unable to agree on a Pathogen Access and Benefit Sharing (PABS) annex to set out how information about dangerous pathogens should be shared.

A few weeks back, at the conclusion of the last round of PABS negotiations, Tedros called for urgency, “because the next pandemic is a matter of when, not if”.

In September, the United Nations will convene a High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response (PPPR).

Member states need to “ensure that the Political Declaration [adopted by the HLM] includes measurable commitments to close the gaps in PPPR, including in One Health, in financing – including for surge financing, equity, monitoring, and accountability”, said Sirleaf and Clark.

Image Credits: BBC.

Fatmata Bamorie Turay (far left) and Elizabeth Tumoe, registered nurses look after newborns at the Princess Christian Maternity Hospital, in Freetown Sierra Leone

Recently, I met with African nursing leaders who told me stories of nurses in countries such as Ghana and Nigeria earning the equivalent of only a few hundred US dollars a month – sometimes less than $300 – while being offered opportunities abroad with salaries many times higher.

They described a growing crisis, where nurses are now leaving not yearly or monthly, but almost weekly. In some hospitals, managers only discover a nurse has accepted a post overseas when a resignation letter is pushed under the door. One nurse leader told me: “We are training nurses for export.”

 Migration itself is not the problem. Like anyone else, all nurses have the right to migrate and pursue opportunities. But many have been put in an impossible position, where they are also leaving behind families, colleagues and communities they care deeply about.

And the countries they leave behind are losing the experienced nurses they have trained, often with little evidence of any meaningful reinvestment in return.

This story is now being repeated across the world at an alarming scale. This is why, ahead of this month’s World Health Assembly (WHA), the International Council of Nurses (ICN) has written to WHO Member States recommending concrete actions to address the escalating international recruitment that is deepening workforce shortages in lower-income countries and threatening global health system sustainability. 

We are calling for coordinated co-investment by recruiting countries into nurse education, retention, and workforce and leadership development.

But this is not just a story about migration and workforce shortages.

This situation speaks to the profound global failure to understand the true power of nursing and the enormous cost of not investing in it.

No nurses, no care

A registered nurse vaccinates a child for polio in Beirut, Lebanon.

The world faces a global shortage of 11 million health workers. More than half, 5.8 million, are nurses.

That fact alone should be setting off alarm bells everywhere. No nurses means no healthcare. Nurses are the backbone of health systems. But right now, that backbone is showing signs of spinal instability.

We are asking nurses to carry more and more: ageing populations, rising chronic disease, pandemics, conflict, climate-related crises, mental health pressures, and widening inequalities. Yet too often we continue to treat nursing as a cost to be contained instead of one of the smartest investments societies can make.

That is why this year’s International Nurses Day report from ICN, Our Nurses. Our Future. Empowered Nurses Save Lives is so important.

The report moves beyond outdated, one-dimensional images of nursing to show how nurses both save and improve lives at scale. For too long, nursing has too often been portrayed only through the language of compassion and sacrifice. Compassion matters enormously. But nursing is also power: economic power, clinical power, leadership power, workforce power, and social power.

Our report sets out seven key nursing powers that are transforming health systems around the world.

There is the Power of Trust: year after year nurses remain the most trusted profession globally, a foundation that becomes critical during health emergencies, public health crises, and vaccination campaigns.

There is the Power of Practice: advanced nurse practitioners and specialist nurses are delivering high-quality care, reducing waiting times, improving outcomes, and expanding access, particularly in underserved communities.

There is the Power of Numbers: nearly 30 million nurses worldwide represent the single largest health workforce on earth.

Another of the most important powers is what we call the Power of Proximity.

Nurses are where people are. In hospitals, clinics, schools, refugee camps, conflict zones, remote villages, and people’s homes. Nurses are often the first health professional a person sees and the last one they remember. They understand communities because they are part of those communities.

That proximity saves lives.

And when nurses are empowered to work to their full potential, the evidence is overwhelming. Expanding primary healthcare, where nurses are central, could save 60 million lives by 2030. Closing global health workforce gaps could prevent  189 million years of life lost and add US$1.1 trillion to the global economy.

We can’t see these as “soft skills”. These are hard powers delivering hard outcomes.

Investing for impact

This year’s report builds on ICN’s wider work, including our 2024 report, Our Nurses. Our Future. The economic power of care. This has consistently shown that investing in nursing is not a cost to health systems and economies; it is one of the highest-return investments societies can make. Investing in health brings a $2–4 return per $1, while poor health reduces GDP by 15%.

Yet despite all this evidence, many countries continue to underinvest in nursing. Exacerbating inequalities, high-income countries continue to underinvest in educating enough nurses domestically while increasingly relying on international recruitment to fill workforce gaps.

This means many lower-income countries are effectively financing the health systems of wealthier nations through the loss of their trained nurses. Countries already facing severe shortages are losing experienced clinicians, educators, and leaders faster than they can replace them.

At the same time, destination countries are making substantial savings. Training costs are being avoided. Workforce gaps are being filled quickly. Tax revenues are being generated by internationally educated nurses working in destination countries.

But where is the reinvestment?

Recent evidence submitted by ICN to a UK All-Party Parliamentary Group inquiry highlighted the enormous financial benefit that recruiting countries derive from this model. By recruiting abroad, data shows that the UK has saved £14 billion in health workforce training costs. Canada has saved an estimated C$1 billion.

In effect, lower-income countries are subsidising the workforce costs of richer nations. Some high-income countries are effectively outsourcing responsibility for nurse education internationally while failing to adequately reinvest in the systems they depend upon.

That is neither sustainable nor equitable. It risks creating exactly the perceptions many countries are now voicing openly: neo-colonialism, exploitation, and a growing erosion of global solidarity.

 

Nurse Everlyne Esige examines an expectant mother at Vihiga County Referral Hospital in Kisumu, Kenya. 

WHA as a turning point

This is why ICN has urged WHO Member States to use this year’s World Health Assembly as a turning point.

In our letter, we call for practical and collective action to strengthen the WHO Global Code of Practice on the International Recruitment of Health Personnel.

That includes coordinated co-investment by major recruiting countries into nurse education, employment, retention, leadership development, and workforce planning in source countries.

We are proposing practical mechanisms: proportionate reinvestment linked to recruitment, directing a share of education savings and tax revenues into source-country health systems, debt relief linked to workforce investment, and even a global fund to strengthen fragile health workforces.

Imagine the impact if high-income countries pooled resources and coordinated action instead of acting individually and reactively.

The sums involved would not be insignificant. But neither are the savings currently being made.

And the return on investment would be enormous: stronger health systems, greater global health security, reduced inequalities, and a more sustainable global workforce for everyone.

Strengthen support for nursing

At the same time, we are increasingly concerned that the global focus on nursing and the health workforce risks being diluted precisely when it should be intensifying.

Last year, WHO Member States agreed to extend the Strategic Directions for Nursing and Midwifery and to accelerate progress. That word matters: accelerate.

Yet we are still hearing concerns about cuts and reduced capacity at exactly the institutions and programmes designed to support the global health workforce.

We understand the financial pressures that the WHO and many governments face. These are difficult decisions. But support for the very people who deliver healthcare, the foundations upon which health systems are built, must be the very last place to cut.

Because ultimately, this conversation is about far more than staffing numbers.

Nursing is also one of the largest majority-women workforces in the world. Investing in nursing means investing in women, in economic participation, in education, in families, and in reducing inequality.

This International Nurses’ Day, we should celebrate nurses. But celebration alone is not enough.

We must also recognise nurses’ power to change lives, strengthen economies, and transform societies and finally invest in that power for the sake of all our health.

International Council of Nurses CEO Howard Catton

Howard Catton is CEO of the International Council of Nurses.

 

Image Credits: World Bank/Flickr, Flickr – World Bank, International Council for Nurses, Brian Otieno /Global Fund, Studioregard.ch.

Evacuation of passengers from MV Hondius, the ship hit by hantavirus, continue.

Hantavirus has been confirmed in a French citizen evacuated from the MV Hondius cruise ship on Sunday, while two tests on a  US citizen turned up one “weakly positive” and one negative result – but it is still unclear how the virus is being transmitted.

The evacuation of passengers from the ship, now docked in Tenerife in the Canary Islands, continued on Monday under the supervision of health officials from Spain, assisted by the World Health Organization (WHO) and several other European countries. Passengers were only allowed to disembark to board chartered flights arranged by their countries.

However, countries differ on how they plan to treat citizens who do not test positive for the virus right away, given that it can take up to 42 days before symptoms appear.

Quarantine

Spain, the UK, and Australia will require citizens to quarantine in designated government facilities for varying periods.

The six Australians will spend up to 42 days in a government quarantine facility while undergoing PCR testing, according to Health Minister Mark Butler.

US health officials – many vehemently against lockdown measures to contain COVID-19 – have suggested that asymptomatic citizens will be allowed to return home.

Sixteen of the 18 US evacuated passengers are currently being assessed in a regional emerging special pathogen (RESPTC) treatment centre in Omaha, Nebraska. Two others, including the person with the weakly positive test, are being assessed in Atlanta. 

John Knox, deputy secretary for Strategic Preparedness and Response at the Department of Health and Human Services (HHS), told a media briefing on Monday afternoon that asymptomatic passengers may be able to complete 42 days of isolation at home if they remain without symptoms and have the necessary support.

On Sunday, Dr Jay Bhattacharya, acting director of the US Centers for Disease Control and Prevention (CDC), told CNN that asymptomatic passengers could not spread the virus.

However, Nebraska Governor Jim Pillen told Monday’s media briefing that “no one who poses a risk to public health is walking out the front door”.

How close is ‘close contact’?

Although most transmission is from rats, human-to-human transmission of the Andes virus, the hantavirus species affecting the ship, has previously been documented in Argentina in 2018. 

Genome sequencing of the current outbreak has shown it to be 99% similar to that outbreak, where the index patient attended a concert, subsequently infecting 34 people.


Human-to-human transmission is possible with “close contact”, according to the World Health Organization (WHO). 

However, there is some debate about the nature of this “close contact”. Professor Joseph Allen from Harvard’s Department of Exposure Assessment Science, said in a weekend TV interview that a doctor on board the ship had told him that some infected passengers had little interaction with the first three patients identified with the virus. These are a Dutch couple (now deceased), and a British man, currently making a slow recovery in South Africa.

The International Hantavirus Society and members of the international hantavirus research and clinical community have also warned against various “simplified conclusions”, including that the Andes virus (ANDV) has “minimal or negligible human-to-human transmission potential” and that only symptomatic patients are infectious.

Are asymptomatic people infectious?

The experts warned in a statement last week that “the precise timing of infectiousness remains incompletely defined”. 

“While symptomatic patients are likely to represent the highest-risk group, available outbreak reconstructions do not support overly categorical statements that transmission can occur only after clear symptom onset,” they said. 

“Transmission potential during prodromal, early symptomatic or minimally symptomatic phases, should be considered when designing contact tracing, testing and quarantine strategies.”

They stated that this is “particularly relevant in closed settings such as a cruise vessel where ANDV-exposed individuals may still be within the incubation period”.

Infectious disease specialist Dr Jeremy Faust, writing in his substack, on Monday said that “it remains possible that an animal on the ship spread [Andes virus] to multiple people, or that the infected people visited the same place on land where the virus was waiting for them”.

But, Faustus added, “given that human-to-human superspreader events of the Andes hantavirus have been documented, I’d bet that human-to-human transmission did occur here”, adding that the ship’s doctor also got infected.

Schools have to been directed  to build gender-segregated toilets and to keep stocks of menstrual hygiene products by India’s Supreme Court .

In January, India’s Supreme Court has ruled that menstrual health is a fundamental right, directing states and schools to take measures to facilitate menstrual health and sanitation.

The laws of the world’s most populous country are now in line with the United Nations (UN) stand on menstrual health taken in 2024, and one that is also echoed by the World Health Organization. 

India’s Supreme Court directed state governments and schools in the country to build gender segregated toilets, hold menstrual health awareness sessions for both boys and girls, and stock schools with menstrual hygiene products.  

After the ruling, Megha Desai, president of the Desai Foundation,  said she and her team jumped for joy. The foundation works across eight states in India on menstrual health and hygiene awareness, 

“Up until this ruling came through, the responsibility of managing menstruation was left to a 12-year-old girl,” said Desai. “With the Supreme Court ruling, what it has done is shifted that responsibility to the community, and in this case, the infrastructure of the school.”

Megha Desai, president of the Desai Foundation, that works on menstrual health.

The court relied on research that showed only half of the girls surveyed were aware of menstruation before puberty, toilets were scarce, and menstruation led to a high level of absenteeism. 

The issue is not restricted to India alone. A 2021 survey by global children’s non-profit Plan International done in the United Kingdom found that 64% of girls aged 14-21 missed part or a full day of school due to their period, and 13% of girls missed an entire day of school at least once a month.

The UN children’s organisation, UNICEF, has long raised the issue of girls staying out of school due to their monthly periods in several continents, such as Africa, apart from Asia.

Precedent for the developing world?

A community open session on menstrual health and hygiene in Jahelipatti village of Bihar state in India conducted by World Neighbors’ partner Ghoghardiha Prakhand Swarajya Vikas Sangh.

In many parts of the world, especially in rural areas, menstruation is still a taboo subject. Women can be labelled “unclean” and subjected to social isolation. Blood stains due to the periods are perceived to be shameful. 

“This is a very bold move by the Indian government, and I really hope other countries learn from that and decide to do more about it,” said Rannia Elsayed, regional portfolio director for South Asia, the Middle East, and North Africa at Pathfinder International, a non-profit that focuses on women’s health.

Elsayed, who is based in Egypt, said that talking about menstruation is taboo in many rural parts of Egypt and Jordan. 

India may have set a precedent in the developing world with its court ruling.

“In Kenya, there’s been a ruling that mandates free sanitary pads for public schools. Again, but there’s no constitutional rights framing for it,” she said. 

The ruling comes at a time when climate change is making heatwaves more intense and changing rainfall patterns in India as well as the rest of the world. A policy like this will help girls become more resilient to the impact of climate change on menstrual health, Elsayed said.  

Also read: Climate Change Driving India’s Unseasonably Severe Heat Wave

Slew of recent measures to improve health

India has built millions of new toilets in the past decade.


Over the past decade, the Indian government’s Swachh Bharat Mission has focused on building millions of new toilets in the country with an eye on improving health, sanitation, and women’s lives. 

Despite this, less than half of the schools researchers surveyed in India have gender segregated toilets. The Indian government  claims that 100 million toilets were built by 2019, but the reality is more complex than that. 

“In some of the schools I’ve seen [that the] toilet is there but no water, or the situation of toilets is in such a pathetic condition that you wouldn’t step in,” said Srijana Karki, who oversees the projects in India and Nepal for the international development organisation, World Neighbors.

But in communities where access to toilets has improved, this has also translated into increased mobility of women as they feel more confident about managing their periods, she added.

More toilets are just one of the many requirements to improve menstrual equity, however.

“You have to have awareness [on menstrual health], you have to be educated, and there has to be a functional toilet, not just a toilet, but a functional toilet… clean, have enough water, and then use of sanitary napkins or clean cloths, and knowledge about how to safely dispose the napkins or safely reuse the cotton cloths,” Karki said. 

But the Indian government’s campaign to build more toilets has started a conversation about the relationship between more toilets and improved women’s health. It has also created an appetite for such infrastructure among families, especially from women who are now pushing for it from within families.

“That wonderful campaign with beautiful intentions did change the mindset of communities and community leaders,” Desai said. 

Impact depends on implementation

A menstrual health awareness session in progress in India’s Tamil Nadu, organized by the Desai Foundation.

The immediate impact of the ruling is to provide impetus for development organizations working in this area to speed up their work. 

“Having the support of a ruling allows us to eliminate the debate. So, for me, I can tell you that time is now being saved on the ground where I am now saying, okay, now that we all agree that this is the way forward, let’s work together for the best way to implement,” Desai said. 

She also said that the government can play a big role in the implementation by supporting new infrastructure, and that it is likely that we will see more girls finish school as a result of this ruling.

The ruling has been welcomed by development organizations working in the region, while the non-profit International Planned Parenthood Federation’s South Asia team has called for such a ruling to be extended to workplaces.  

If India does get the implementation part right in the coming years, it could set an example for the rest of the developing world, Desai said.   

Image Credits: Desai Foundation, Yogendra Singh/ Unsplash, World Neighbors, Ignas Kukenys/ Openverse/ Flick.

Dr Abdi Mahamud, WHO’s director for Health Emergency Alert and Response Operations.

The first person suspected of contracting hantavirus outside of passengers on the Hondius cruise ship is currently in a Dutch hospital.

She is a flight attendant who came into contact with a former passenger who briefly boarded a KLM flight in Johannesburg, South Africa, but was prevented by airline staff from flying to Amsterdam as she was too sick. 

The woman died shortly afterwards in a Johannesburg hospital. Her husband had died on board the ship on 11 April, the first casualty in the ship’s hantavirus outbreak. She had left the ship at St Helena Island on 24 April to accompany his body home.

Cabo Verde permitted the medical evacuation of three patients, but denied permission for passengers to disembark. The ship has since sailed for Tenerife in the Canary Islands. It is expected to arrive by 11 May, where it is hoped that Spanish authorities will assist passengers to return home. 

However, the President of the Canary Islands, an autonomous community of Spain, has said he will not allow the ship to dock – although the Spanish President has assured the World Health Organization (WHO) that passengers will be able to leave the ship.

Cruise operator Oceanwide Expeditions said that two Dutch infectious disease doctors had joined the cruise to “ensure that optimal medical care can be provided if necessary, during the next stage of this evolving situation”.

The WHO has advised that “all passengers stay in their cabins. The cabins are being disinfected, and anyone who shows symptoms will be isolated immediately”, WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

A WHO expert and an expert from the European Centre for Disease Prevention and Control (ECDC) have also joined the ship.

Together with the two Dutch doctors, they are “conducting a medical assessment of everyone on board and gathering information to assess their risk of infection”, said Tedros.

“WHO is developing a step-by-step, operational guidance for the safe and respectful disembarkation and onward travel journey for all passengers when they arrive in the Canary Islands,” he added.

Tedros thanked Spanish President Pedro Sanchez for his “generosity and solidarity” for agreeing to accept the ship in the Canary Islands, describing the risk to the islands as low.

Dr Tedros thanked Spanish President Pedro Sanchez for agreeing to accept the cruise ship in the Canary Islands.

Eighth patient in Switzerland

Oceanwide Expeditions confirmed that all 30 passengers who disembarked at St Helena on 24 April have been contacted. One, a Swiss national with mild symptoms, is currently in a Zurich hospital.

“The Swiss Federal Office of Public Health (FOPH) has confirmed that a passenger who travelled on the first leg of the voyage has tested positive for hantavirus and is currently being treated at the University Hospital Zurich. His wife, who accompanied him, has not shown symptoms but is self-isolating as a precaution,” the company said in a statement

So far, eight passengers are suspected of hantavirus infection. Three have died, one is in hospital in Johannesburg, three were evacuated from Cabo Verde to undisclosed European hospitals – and the eighth is the Swiss man.

“Five of the eight cases have been confirmed as hantavirus, and the other three are suspected,” said Tedros.

“Hantaviruses are a group of viruses carried by rodents that can cause severe disease in humans. People are usually infected through contact with infected rodents or their urine, droppings or saliva. The species of antivirus involved in this case is the Andes Virus, which is found in Latin America and is the only species known to be capable of limited transmission between humans,” he added.

Collaboration with US

Dr Abdi Mahamud, WHO’s director for Health Emergency Alert and Response Operations, said that each country is responsible for repatriating citizens from the ship and tracing any citizens who may have had contact with those exposed to the virus.

Although the US decided to leave the WHO, it has citizens on board the ship and Mahamud said that collaboration with the US CDC is “going very well on a technical level”.

US CDC officials have joined meetings of the Global Outbreak Alert and Response Network (GOARN) “so the information flow is there, transparent and frank, and information sharing”, he added.

The US remains party to the International Health Regulations (IHR), which stipulates the conduct of countries in the event of disease outbreaks, and was receiving formal communication on the outbreak through that.

“This outbreak shows why the world needs a global entity that coordinates,” added Mahamud, also commending Argentina – which also quit the WHO – for coming forward with information, as the cruise started in that country.

Dr Anais Legand, WHO technical lead on viral haemorrhagic fevers, described “excellent collaboration” with her counterpart at US CDC, including sharing of technical assessments almost every day.

Dr Anais Legand, WHO technical lead on viral haemorrhagic fevers.

Long incubation

Mahamud confirmed that the incubation period for the virus is up to six weeks, but that only confirmed cases needed to isolate. 

Contacts of cases need “active monitoring”, which was up to host countries to define, he added.

At this stage, PCR testing by South African and Senegalese scientists had confirmed the Andes virus, a species of hantavirus found mostly in Argentina – which is where the cruise started.

Scientists are currently engaged in genome sequencing of the virus to see whether it was the same as that from an Argentinian outbreak in 2018, which affected 34 people, said Mahamud.

This is the only other known instance of human-to-human transmission. That outbreak evolved from an infected person who attended a concert.

Dr Maria Van Kerkhove, WHO’s Director of Epidemic and Pandemic Management. stressed the importance of “global solidarity”, adding that the WHO has “pulled together all of the global experts related to hantaviruses, in particular the Andes Virus”, to assist in managing the outbreak.

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

The cruise ship Hondius, affected by a hantavirus outbreak after setting sail from Argentina on 1 April, to Antartica and across the South Atlantic. The ship is now moored off the West African Archipelego of Cabo Verde.

Two more people linked to the cruise ship Hondius were reported to have fallen ill in Switzerland and France, according to Swiss and European media reports Wednesday. In the Swiss case, the infection and its links to the cruise ship were confirmed by the Swiss Federal Office of Public Health. On the reported French case, a WHO spokesperson said that the agency had “reached out to French authorities to verify”.

Meanwhile, one passenger and two crew members with suspected hantavirus cases were evacuated from the ship Hondius and flown to the Netherlands to receive medical care,  the World Health Organization also confirmed.

The ship at the centre of the hantavirus outbreak is currently moored off the coast of the West African Archipelago of Cabo Verde. It was supposed to sail to the Canary Islands and dock there on Saturday, where Spanish authorities will assess the remaining passengers, disinfect the ship and conduct a full epidemiological investigation, according to Maria van Kerkhove, director of the World Health Organization’s (WHO) Department of Epidemic and Pandemic Preparedness and Prevention, who spoke at a media briefing in Geneva on Tuesday.

Canary Island authorities, however, have balked at receiving the vessel, while Spanish government officials have said that the plan is in line with a WHO request and “international humanitarian principles.”

Wednesday’s evacuated crew members both were suffering from “acute respiratory symptoms, one mild and one severe”. The other evacuee was German passenger who had been in close company with a passenger who died on the ship on 2 May, according to cruise operator Oceanwide Expeditions. All of those remaining on board the ship, which was carrying almost 150 passengers when it first set sail from Argentina on 1 April, have been asked to remain in the cabins as a precaution until the ship reaches a port of call.

With the report of the Swiss case, eight cruise passengers or former passengers are suspected of having contracted the virus. But laboratory tests have only confirmed it in two of the cases, and one case appears asymptomatic, said Van Kerkhove at Tuesday’s briefing. Three passengers have died, two while on board, including a 69-year-old Dutch man on 11 April and a German citizen on 2 May. The Dutch man’s wife, also died shortly after being medically evacuated to South Africa. Another passenger who was medically evacuated to South Africa remains in intensive care. 

“Illness onset occurred between 6 and 28 April 2026 and was characterised by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.,” according to the WHO.

There is no specific treatment, and a high case fatality rate of up to 50% for the hantavirus found in the Americas, but “early supportive medical care is key to improving survival”, according to WHO.

A Swiss and French national each become ill in two more cases linked to the cruise

WHO’s Maria Van Kerkhove at a Geneva press briefing Tuesday on the hantavirus emergency.

The WHO has deemed the global threat posed by the outbreak to be “low”, based on the historically low incidence of human-to-human infection from the virus.

However, on Wednesday a French national was reportedly hospitalized in Europe with a suspected case of the virus after taking a flight with the Dutch woman evacuated from the ship to South Africa, and who later died.  The French woman had not been aboard the Hondius cruise ship at all.

In Switzerland, another former Hondius cruise passenger was being treated for the hantavirus at Zurich University Hospital after having spent some time on the cruise ship in April, according to the Swiss Federal Office of Public Health, which stated on Wednesday, “one person with a hantavirus infection is currently being treated at the University Hospital Zurich (USZ). The patient is male and returned to Switzerland after travelling on the cruise ship on which there were a number of hantavirus cases.”

The man’s wife has not shown symptoms, but is self-isolating, while Swiss authorities are tracing the couple’s contacts, the FOPH stated.

People usually contract hantaviruses from exposure to the urine, droppings or saliva of infected rats. Human-to-human transmission is “uncommon”.

Such transmission has, however, been documented in Argentina and Chile involving the Andes virus, a species of the hantavirus. The “working assumption” is that the Andes virus was responsible for the outbreak aboard the ship, Van Kerhkove said.  But health authorities will only know for sure after the virus is sequenced from the British patient being treated in South Africa. T

Even the Andes virus variant, however, will typically only spread between humans in “very close physical contact”, Van Kerhkove said.  “When you have an enclosed settings, you have people that are spending a lot of time together. These types of things can happen.” 

Andes virus, with some human-to-human transmission endemic to Argentina

Route of the infected cruise ship Hondius from Ushuaia, Argentina to Antartica and across the Atlantic.

The Andes virus is endemic to Argentina, where the cruise ship began its voyage across the South Atlantic on 1 April. It is thus possible that the index passenger was infected before he embarked in Ushuaia, Argentina, rather than on the ship, officials say.  The ship traveled to Antartica and then onto a number of islands and archipelegos off the coast of Africa, along a well-trod Southern Atlantic cruise route featuring spectacular landscapes of both glacial mountains and tropics. 

The first person to die was the Dutch 69-year-old male passenger “who suddenly became ill in the ship en route from Ushuaia to St Helena Island, and presented with fever, headache, abdominal pain, and diarrhoea”, according to the South African Department of Health. He died on arrival at St Helena. His wife then flew to South Africa from St Helena Island, but collapsed at Johannesburg airport and later died at a nearby health facility.

“The initial case and his wife joined the boat in Argentina, and with the timing of the incubation period of hantavirus, which can be anywhere from one to six weeks, our assumption is that they were infected off the ship,” said Van Kerkhove.

A third patient, a British national, became acutely ill while the ship was travelling from St Helena to Ascension Island, and was flown to a private health facility in South Africa. He has been confirmed with hantavirus and is in a “critical condition in isolation”.

Hantavirus infection was confirmed in two of the patients by South Africa’s National Institute for Communicable Diseases (NiCD). Further tests, including sequencing of the virus, is being conducted by NiCD, as well as well as testing the two symptomatic patients on board with the support from Institut Pasteur of Dakar in Senegal. 

President of Canary Islands opposes Spanish Government order to dock the ship

President of the Canary Islands Fernando Clavijo is speaking after opposing the Spanish government’s plan to let the ship dock there.

The president of the Canary Islands, Fernando Clavijo, told reporters in Tenerife that he opposed the Spanish government’s plan to let the ship dock there, Sky News reported.

Clavijo, who belongs to the main opposition party in Spain, said the cruise ship has requested to dock at Tenerife on Saturday.

“The World Health Organisation has explained that Cape Verde is unable to carry out this operation,” the Spanish Health Ministry said in response. “The Canary Islands are the ​closest location with the necessary capabilities. Spain has a moral and legal obligation to assist these people, among whom are also several Spanish citizens.”

Van Kerkhove described the collaboration with member states on the emergency as “excellent”.

The WHO was informed of “a cluster of severe acute respiratory illness” aboard the ship by the UK on 2 May, in terms of the International Health Regulations, she added.

The timeline issued by Oceanwide Expeditions is as follows:

  • On 11 April, the 69-year old Dutch passenger died on board. The cause of death could not be determined at the time.
  • On 24 April, his body was disembarked on St Helena, with his wife accompanying the repatriation.
  • On 27 April, Oceanwide Expeditions was informed that the wife, also a Dutch national, had become unwell during the flight to Johannesburg, South Africa, and had died shortly afterwards in a South African hospital. On 4 May,  a variant of hantavirus was confirmed in the woman.
  • On 27 April, another British passenger became seriously ill and was medically evacuated to South Africa. This person is currently being treated in the intensive care unit in Johannesburg and is in a critical but stable condition. A variant of hantavirus has also been identified in this patient.
  • On 2 May, another passenger, of German nationality, also died on board the ship. The cause has not yet been definitively established.

–Updated on 6 May with new developments, reported by Elaine Ruth Fletcher.

Image Credits: Franklin Braeckman/Oceanwide Expeditions , El Pais/OpenStreetMap, Sky News .

A midwife examines a pregnant woman.

The International Day of the Midwife (May 5) reminds us that safe birth is not a stand-alone event, but part of the broader continuum of sexual and reproductive health and rights

Most maternal deaths occur during labour, birth, or shortly after birth. Nearly 290,000 women died during and following pregnancy and childbirth in 2020, with 95% of these deaths occurring in low- and lower-middle-income countries. 

The major causes included severe bleeding, hypertensive disorders, infections, complications from unsafe abortion, and obstructed labour. Yet these events are largely preventable or treatable when skilled care, referral, medicines, blood, and emergency obstetric services are available. 

Midwives are often the first – and sometimes only – skilled provider able to detect and respond to such complications in a timely manner.  

But the world currently faces a shortage of up to a million midwives – part of a larger global health workforce crisis – that is concentrated in the countries and communities where maternal and newborn mortality is highest.

Although skilled birth attendance globally is around 80%, this figure hides severe inequities within and between countries. Women in rural areas, poor households, conflict settings, humanitarian crises, and marginalized communities are least likely to have access to a skilled midwife or other qualified birth attendant. 

Access is not only about whether a health care facility exists, but also depends on distance, transport, user fees, staffing, respectful care, medicines, referral systems, and whether women trust the system enough to use it.

Safe birth and post-natal care are not standalone events. They are part of the broader continuum of sexual and reproductive health and rights that includes health education, contraception, antenatal care, screening of sexually transmitted infections, safe birth, emergency response, postnatal and newborn care, breastfeeding support, and referral, as well as safe abortion and post-abortion care. 

High maternal mortality ratio

The current global maternal mortality ratio of 223 deaths per 100,000 live births is well above the Sustainable Development Goal target of achieving less than 70 deaths per 100,000 live births by 2030. 

Midwives can provide around 90% of essential SRHR care when they are educated, licensed, regulated, and supported to international standards. 

But in many low-resource settings, midwives are too few, poorly distributed, underpaid, ill-equipped, or not fully authorized to practice to their competencies.  

Scale-up to achieve universal coverage of midwife-delivered interventions is one of the clearest and most practical routes to faster progress and to averting a larger share of maternal and neonatal deaths and stillbirths. 

Investment in the workforce must include education, fair pay, regulation, safe working conditions and career pathways, supplies, data systems, and integration into primary health care. 

Policy settings need to remove financial barriers to care and treat SRHR as a complete package, rather than as a range of isolated services.

Countries are demonstrating increasing innovation in the midwifery field. In Sierra Leone, for example, structured preceptorship (mentorship) programmes are strengthening hands-on clinical skills and confidence among midwives, helping translate training into safer care at the bedside. 

In Ethiopia, a center of excellence in midwifery trains disadvantaged rural girls to become ethical and compassionate midwives in their own communities.  Efforts such as these are key to empowering midwives and the women and children they serve before, during and beyond childbirth.

Midwives already save lives every day. The task now is to ensure that they can do so for women everywhere.

 

Dr Teguest Guerma is the founder and CEO of LeDeG Midwifery College, established in 2015 to address critical gaps in maternal health across Ethiopia and beyond.

 

Image Credits: Elizabeth Poll/MMV, Twitter: @WHOAFRO.