INB co-chairs Anne-Claire Amprou and Precious Matsoso

On the eve of the final round of pandemic agreement negotiations ahead of the World Health Assembly (WHA), 30 legal experts have cautioned against using “voluntary” to describe technology transfer.

The latest draft of the pandemic agreement (text agreed by end of 21 February) states that technology transfer for the production of pandemic-related health products shall be on “mutually agreed terms” in a yet-to-be-agreed  footnote in Article 11. 

This inherently implies that it is voluntary, the experts state in a letter sent to the co-chairs of the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) on Wednesday.

But if the agreement also describes tech transfer as “voluntary”, this will undermine member states’ “sovereign right … to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, according to the experts, who hail mostly from law departments of global universities.

“By insisting on manufacturers only coming to the negotiating table voluntarily, States Parties are limiting their options for facilitating or otherwise incentivising technology transfer, and for taking non-voluntary measures even where their domestic laws do or would provide for them,” they note.

Domestic non-voluntary measures

Several countries have laws allowing non-voluntary measures under exceptional circumstances, including the United States Defense Production Act, and Germany’s 2020 Act on the Protection of the Population in Case of an Epidemic Situation of National Significance, passed during COVID-19.

Insisting solely on voluntary measures will “defeat two principles that guide the Pandemic Agreement’s core objective: respect for the sovereign right of States to implement legislation within their jurisdiction, and equity in pandemic preparedness and response”, they note.

“The challenge during the COVID-19 pandemic was that manufacturers had little incentive to do transfer technology. By enshrining technology transfer as ‘voluntary,’ the pandemic agreement would codify an approach that has failed,” they note.

Article 11 is one of the few clauses where substantial disagreement exists, with Germany in particularly digging its heels in about the use of “voluntary tech transfer”.

“Among the European Union countries, it seems that Germany is taking a hard line and continues to insist on adding the term ‘voluntary’ in addition to ‘mutually agreed terms and conditions’,” according to Ellen ‘t Hoen, one of the signatories. 

“This raises eyebrows because Germany recognised, early in the Covid-19 pandemic, that it needed to amend its legislation to enable effective use of compulsory measures,” added ‘t Hoen, who heads Medicines Law & Policy based in Europe.

Another signatory, Nina Schwalbe from the O’Neill Institute for National & Global Health Law at Georgetown University in the US, notes that United Nations agreements on global health challenges “define tech transfer as occurring on mutually agreed terms—without specifying that it must be voluntary”.

‘The bottom line is that adding ‘voluntary’ is unnecessary and could weaken governments’ ability to act in future pandemics. Keeping the language as is ensures flexibility while upholding sovereign rights and equity in pandemic response,” says Schwalbe.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has stated several times to the INB that “respect of intellectual property in pandemic times, support for tech transfer on voluntary and mutually agreed terms, the strengthening of regulatory agility and harmonization, and the removal of trade restrictions” are key to “to harness and leverage industry’s expertise”.

Article 12 on Pathogen Access and Benefit-Sharing System (PABS) is the other key area lacking in agreement. This article covers one of the most substantial parts of the agreement: that each manufacturer that is part of the PABS system will make 20% of their pandemic-related vaccines, therapeutics and diagnostics available to the WHO, with at least 10% as a donation.

‘Get it done’

The INB convenes from 7-11 April – next Monday to Friday – for the last time before the May WHA.  There is widespread acknowledgement that momentum and political will is likely to trickle rapidly away should negotiators fail to conclude an agreement to present to the Assembly.

The Pandemic Action Network and allies urged negotiators to “get it done” in a statement on Tuesday.

“New and resurging infectious diseases with pandemic potential threaten our collective health as our world becomes more fractured,” they note

“As currently drafted, the pandemic agreement secures important gains, including on research and development, equitable access to pandemic countermeasures, and a One Health approach to pandemic threats.

“While not all policy goals have been achieved, this potentially historic agreement lays essential groundwork for equitable, collective preparedness and response now and can be strengthened through additional protocols in the future. We urge Member States to stay laser focused on the end-goal, and find room to give-and-take to reach agreement.”

Candida auris is a multi-drug-resistant fungus

There is a “critical lack” of medicines and diagnostic tools for invasive fungal diseases, according to the World Health Organization (WHO), which released its first analysis of antifungals on Tuesday.

Invasive fungal diseases are on the rise, particularly in immune-compromised people – yet they get little attention or resources, asserts the global body.

Common infections such as candida (which causes oral and vaginal thrush) are growing increasingly resistant to treatment, but there are not enough medicines in the pipeline to combat this.

Several current anti-fungal treatments cause serious side effects, frequent drug-drug interactions, and treatment requires prolonged hospital stays. 

“Invasive fungal infections threaten the lives of the most vulnerable but countries lack the treatments needed to save lives,” said Dr Yukiko Nakatani, WHO interim Assistant Director-General for Antimicrobial Resistance. 

“Not only is the pipeline of new antifungal drugs and diagnostics insufficient, but there is a void in fungal testing in low- and middle-income countries, even in district hospitals,” added Nakatani.

“This diagnostic gap means the cause of people’s suffering remains unknown, making it difficult to get them the right treatments.”

Only four new drugs in a decade

In the past decade, only four new antifungal drugs have been approved by regulatory authorities across the United States, the European Union and China. 

Nine antifungal medicines are in clinical development against the most health-threatening fungi identified in the WHO’s fungal priority pathogens list (FPPL), according to the WHO analysis, which conducted a rigorous evaluation of antifungal agents in clinical and preclinical development with the assistance of an expert advisory group on the R&D of novel antifungal treatments.

Only three of the nine are in phase 3 trials, which means “few approvals are expected within the next decade”, according to the WHO. 

“Children are particularly underserved with few clinical trials exploring paediatric dosing and age-appropriate formulations,” the global body notes.

Critical priority pathogens

Many of the fungi in the critical priority pathogen (CPP) category of the WHO’s FPPL are deadly, with mortality rates reaching as high as 88%.

This critical group includes Cryptococcus neoformans (which causes cryptococcal meningitis); Candida auris (causes infections, including in wounds and blood); Aspergillus fumigatus (causes aspergillosis, a lung infection) and Candida albicans (thrush). 

These infections disproportionately affect those with weakened immune systems, including people undergoing cancer chemotherapy, living with HIV, and who have had organ transplants.

Candida auris is particularly drug-resistant and often acquired by vulnerable people in hospitals.

The nine new antifungals all target the critical group – and most target more than one of these fungal infections. 

Aspergillus fumigatus is targeted by the highest number of antifungal candidates, followed by Candida albicans and Candida auris. Cryptococcus neoformans gets the least attention.

There are 22 drugs in pre-clinical development, but this is “insufficient” given the dropout rates, risks and challenges associated with earlier development stages, says the WHO.

Antifungal drugs preclinical pipeline

Diagnostic challenges

Current tests for fungal priority pathogens “rely on well-equipped laboratories and trained staff, which means that most people in low- and middle-income countries (LMICs) do not benefit from them”, according to the WHO’s diagnostics analysis. 

In addition, these tests “work only for a limited range of fungi, are insufficiently accurate and take a long time to obtain results”. Health workers often lack knowledge about fungal infections.

WHO recommends investing in global surveillance, expanding financial incentives for drug discovery and development, funding basic research to help identify new and unexploited targets on fungi for medicines, and investigating treatments that work by enhancing patients’ immune responses.

It also urges the development of “faster, more accurate, cheaper and easier” tests for a broad range of fungal priority pathogens.

Image Credits: Science Media Centre, WHO.

air pollution quilt
Air pollution impacts the most vulnerable, including children showcased in a quilt from the Indian advocacy group Warrior Moms.

CARTAGENA, Colombia – From Warsaw to Mexicali, a group of mothers from six cities worldwide came together to create and present a quilt highlighting the threat of dirty air to their children at the World Health Organization (WHO) Conference on Air Pollution and Health held here last week.

Each block of the quilt tells the story of a child suffering from the harmful effects of poor air quality, highlighting the devastating impact of pollution on children’s health in Warsaw (Poland), Quito (Ecuador), Jharia (India), Akim Wenchi (Ghana), Mpumalanga (South Africa) and Mexicali (Mexico).

The idea of a quilt surfaced a couple of months before the 2021 climate change conference, COP26, within the Indian movement, Warrior Moms. They wanted it to carry the faces of children from across India and intertwine their stories of pollution, representing at least one city from each state. 

Logistical challenges prevented the project from taking off in time for COP26, but  a few months ago, as a new global delegation of mothers called ‘The Clean Circle’ was taking shape, the idea resurfaced.

Warrior Moms, founded by Bhavreen Kandhari, reignited the project weeks ahead of WHO’s Air Pollution and Health conference. 

After meetings that lasted until midnight meetings, a proposal was put to WHO, which enthusiastically embraced and encouraged the initiative.

Kandhari, the mother of twins, has been at the forefront of the fight for clean air to ensure a better life for future generations.

“Air pollution is a child killer, accounting for one in five deaths of children under five. The ‘Quilt of Hope’ is a living testimony to the urgency of the air pollution crisis, calling on political leaders to safeguard our children’s future,” Kandhari said.

Six regions, one health challenge

This time, the logistics were meticulously planned. Sustainability remained at the heart of the project, with upcycled fabrics forming the quilt’s foundation. 

Small fabric samples were exchanged, tested, and reworked. But beyond materials and design, the real challenge for these mothers was to find artisans who would stitch this powerful symbol with the care and reverence it deserved. 

That’s when the craftswomen ‘Shades of India’, stepped in and pieced together – not just fabric, but stories, hope and resilience with skills and unwavering dedication. 

The process of gathering these images faced numerous challenges. The resolution of photos varied, making it difficult to ensure uniformity in print. 

In Jharia, where pollution from coal fires darkens the skies, finding high-quality images was especially tough. But photographer Vishal Singh captured striking images of the children, ensuring that their stories were not just seen but felt by every individual.

While the quilt features stories from six different regions, the health consequences of air pollution remain tragically similar: bronchitis, asthma, and other respiratory illnesses.

Ana Badillo, the mother of a five-year-old child, said that she put her child’s image on the quilt to show that the air pollution crisis is real, personal, and urgent.

“As a mother, I watch my child breathing toxic air in a city that should be full of life, not smog. Quito’s air is stealing our children’s health and their futures. Clean air is not a privilege, it is their right. We want leaders to feel this concern of mothers across the globe,” Badillo said. 

Asthma and developmental delays

The top left section of the quilt depicts a mother with her two children, one of whom is wearing an oxygen mask in Mpumalanga in South Africa, a region where coal-fired power plants release some of the highest levels of sulphur dioxide in the world, contributing to rising cases of asthma and developmental delays in children.

The story of a 12-year-old boy, Suresh, from Jharia, India, is highlighted in the top left corner. Suffering from chronic bronchitis since childhood due to underground coal fires in his region, Suresh’s experience is a stark reminder of the long-term health effects of air pollution.

The centre of the quilt showcases narratives from Mexico and Ghana, representing worsening asthma attacks and limited access to healthcare.

In Warsaw, Poland, smog from vehicle emissions and coal heating during winter fills the air, forcing children like Maciek, whose image appears in the bottom right corner, to carry an inhaler just to get through the school day. The seven-year-old has been struggling with bronchial hyperreactivity for the past year.

The last image from Quito, Ecuador, shows a five-year-old child wearing a mask and holding a banner.

 A call to action

Each panel in the ‘Quilt of Hope’ is not just fabric, it holds the emotions, struggles, and resilience of mothers who, despite living continents apart, are united by the same fight for their children’s right to breathe clean air. It is a testament to sustainability, craftsmanship, and resilience.

According to the delegation of mothers, the Quilt for Hope was not just a display at the WHO Conference in Cartagena, it was a call to action.

“As policymakers, scientists, and health professionals gathered to discuss the urgent need for cleaner air, the quilt serves as a tangible reminder that, behind every statistic, there is a child struggling to breathe,” the mothers said.

 

Image Credits: A. Bose/ HPW.

Over 2,600 people are now reported to have died in the two powerful earthquakes that devastated central Myanmar last Friday, while thousands have been injured or are missing, trapped under the rubble.

The 7.7- and 6.4 strength quakes hit regions of Mandalay, Nay Pyi Taw, Sagaing, Bago, and Shan regions, which are also where most of the almost 20 million people displaced by conflict have been living.

Thailand’s capital, Bangkok, was also affected with 17 people reported dead, while in Ruili city, in China’s southeastern Yunnan province, 2,840 people have also been affected and 847 houses have been damaged.

The World Health Organization (WHO) is “responding at its highest level of emergency activation”, but the cash-strapped global body has appealed for donations, as it needs $8 million to “deliver life-saving trauma care, prevent disease outbreaks, and restore essential health services over the next 30 days”.

Three hospitals have been destroyed and 22 have been partially damaged in the country, according to the WHO.

“Hospitals are overwhelmed with thousands of injured in need of medical care. There is a huge need for trauma and surgical care, blood transfusion supplies, anaesthetics, essential medicines, management of mass causality, safe water and sanitation, mental health and psychosocial support among others,” reported WHO.

UNICEF has also called for “urgent funding to scale up the delivery of life-saving support to children and families affected by the earthquake, including clean water, medical care, protection, psychosocial support, and emergency education”.

Myanmar has been controlled by a military junta since 2021, and foreign media are not allowed into the country. 

Meanwhile, China, Russia, India, Thailand, Malaysia and Vietnam have sent aid to the country – but the United States, which has dismantled its Agency for International Development (USAID) has not yet responded, according to the New York Times.

Some staff were preparing a response on Friday rwhen the received layoff notices, the newspaper added.

Myanmar, which has been controlled by a military junta since 2021, has reportedly refused to allow foreign media into the country to cover the earthquake.

However, Myanmar miliary leader Min Aung Hlaing issued a rare “open invitation to any organizations and nations willing to come and help the people in need within our country,” after the quakes – an indication of the severity of the disaster.

Image Credits: UNICEF.

As the World Health Organization (WHO) grapples with an estimated $600 million funding gap for 2025, it is planning to slash its biennial 2026-27 budget by 21% from $5.3 billion to $4.2 billion, according to an email Friday from Director General Dr Tedros Adhanom Ghebreyesus, obtained by Health Policy Watch.

But despite the DG’s promises that the WHO “Staff Association will play an active role”, critical decisions about workforce reductions, budget allocations, and organizational restructuring are being made behind closed doors so far.

The Staff Association, representing WHO’s 9,473 staff members worldwide including 2,666 in headquarters, has had no real access to the data underpinning critical choices that must be made over how and where to cut the budget. 

“This is not just about numbers – it’s about trust,” said one senior staff member. “We were promised transformation with people at the center. What we’re seeing now feels like a rollback of everything we fought for.”

In his recent message to staff, Tedros promised that the restructuring, however tough, will also be conducted “with fairness, transparency, and humanity.”

 “Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce,” he said. “This reduction will begin at headquarters, starting with senior leadership, but will affect all levels and regions.”

Key information about costs, organigram remain unpublished  

According to an internal briefing presented to member states last week, and seen by Health Policy Watch, WHO is weighing a series of measures to cope with the financial shock that include:

  • A 20% average budget cut across all base programmes
  • The elimination of over 40% of current outputs – eg. products that are typically part of the World Health Assembly 
  • A 25% reduction in staff positions
  • The merging of entire divisions, departments, and units
  • Relocation of functions away from Geneva to regional and country offices.
Budget projection from the internal briefing presented to member states.

These are hard, necessary decisions. But without access to information about current costs and staff positions, it ia almost impossible for either member states or staff members to play an active role in reviewing priorities or plans. The most glaring omissions include items such as:  

  • A current organigram of staff and management distribution: the most recent one is from 2019 when WHO’s initial “transformation” process, intended to make the organization more efficient and fit-for-purpose, was launched by Tedros shortly after he first assumed office.  Despite multiple ad hoc changes since, the only organisational mapping current to 2025 is of divisions and their department heads at headquarters
  • Costs of staff positions by grade and region: real costs vary wildly from published salaries due to multiple layers of post adjustments, entitlements and agency contributions to pension and insurance funds.
  • Costs of consultancies along with more granular data about the number of full-time-equivalent consultants per region.

Also critical to consider are the savings that could be gained from other big-ticket items such as moving key tasks and staff to regional or country offices, 

But along with the resistance to “mobility plans” by staff at headquarters, there is also fierce debate within the organization about what tasks could be most effectively relocated, and what core functions (eg WHO standards and guidelines development) would best be retained at headquarters. Irrespective of which way the debate ends, keeping key HQ normative functions can still be retained if relevant staff are moved to less expensive duty stations, 

Certain technical support functions, such as IT support, could feasibly also be moved to much cheaper European locations, such as Lyon and Istanbul. More digitized administrative processes could also save administrative costs and staff. 

Directors without portfolios?

Sources: Appendix 1 to WHO staff rules 2024, effective as of January 2023, EB 2023 Salaries of Ungraded Positions and 31 July 2024 HR update: Estimates are based on costs of a D2 at Step VI and a D1/P6 at Step X of the published salary scale.

In an exclusive, Health Policy Watch documented the top-heavy structure of WHO’s senior leadership that has evolved, unbeknownst to most since 2017. Over the past eight years, the number of senior directors (D2) has nearly doubled, and the total cost of directors at both D1 and D2 grades, plus WHO’s senior leadership (ADGs and Regional Directors) are now costing the organization close to $100 million annually.

In terms of a top-heavy senior management, WHO insiders also point to the uneven distribution of tasks between different directors and the large teams associated with every Assistant Director General as potential areas for efficiencies.

While some directors manage large departments of dozens of people, others manage teams that include only a handful of staff or may not actively manage teams or departments at all, insiders report.  

“When we began looking at the directors in our region, we found that two D2s had been appointed for six-month contracts without any clarity about their roles,” said one senior scientist working in a regional office. 

Another issue emerging is the entourage of staff around each of the 10 Assistant Director Generals serving on Tedros’ leadership team in headquarters, not to mention the Deputy Director General and the office of the Director General. 

It is estimated that each ADG is managing a team of 6-7 people – which together with the ADG’s own post. But even an ADG plus a team of just 4-5 people, will  cost the organization an estimated $1.5 million, as a conservative figure, considering an average cost of $250,ooo per position for a team including senior advisors and professionals along with administrative staff.  Again, since no organigram or published costs of staff posts exists, only estimates can be made.   

The March Health Policy Watch investigation also revealed that consultants now make up over half of WHO’s workforce – 7,579 posts in comparison to the 9,473 staff. That is a precarious and costly staffing model in light of the administrative management requirements of consultancy contracts.  

Can’t continue to operate like a think tank

Sources: WHO bi-annual HR reports, and UN salary scales, in comparison to proportion of costs attributable to entitlements and benefits. Note: Costs of P6 positions, while comparable to D1, are included in the P- category, not D category.

“WHO cannot continue to operate as if it were a luxury think tank,” one anonymous official told Health Policy Watch. “We need boots on the ground not bloated bureaucracy in headquarters.”

The situation has led many to ask: If WHO is indeed undergoing a prioritization process, why are all divisions still fighting to preserve their full portfolios? Why have no clear de-prioritizations been communicated? 

In a climate where transparency is a necessity, the apparent sidelining of frontline voices adds to a growing anxiety about how this restructuring will unfold.

A WHO Global Town Hall is scheduled for Tuesday, April 1, where senior leadership is expected to provide further clarity to staff. But for now, trust is fraying and WHO stands at a crossroads: either double down on the values of its 2019 transformation—or risk losing the confidence of the very people it relies on to carry out its mission.

 

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, WHO, WHO HR and EB records, 2023-2024.

The Department of Health and Human Services oversees the US health system, including the FDA, CDC, NIH, and Medicare and Medicaid programs that serve millions of Americans.

The Department of Health and Human Services will cut an additional 10,000 full-time employees, bringing total reductions to nearly a quarter of the federal workforce responsible for Americans’ health.

HHS Secretary Robert Kennedy Jr., who rose to prominence as the leader of the world’s largest anti-vaccine activist group before taking control of the US health system, announced Thursday the cuts would save $1.8 billion annually from the agency’s $2 trillion budget – a cost reduction of 0.09% in exchange for a loss of 20,000 total employees.

“I think most Americans would agree with me that throwing more money at healthcare isn’t going to solve the problem, or it would have solved it already,” Kennedy said in an address posted to social media. “Obviously, what we’ve been doing hasn’t worked.”

The cuts are part of an all-out assault by the Trump administration on the federal workforce overseen by billionaire Elon Musk and his pseudo agency, the Department of Government Efficiency, or DOGE, HHS said in a media release. 

“The entire federal workforce is downsizing now, so this will be a painful period for HHS as we downsize from 82,000 full-time employees to around 62,000,” Kennedy said, describing the agencies he oversees as “pandemonium,” “fiefdoms,” and a “sprawling bureaucracy.”

Despite cutting thousands of government programs, billions in grants, and eliminating tens of thousands of federal jobs, the Trump administration has so far failed to slow spending, with the US government spending more during Trump’s first month than during the same period last year.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said. “This Department will do more – a lot more – at a lower cost to the taxpayer.”

‘All that money’

The cuts will be distributed across several key agencies, according to a fact sheet posted by HHS.

The Food and Drug Administration will lose approximately 3,500 employees, though officials insist drug reviewers and food inspectors won’t be affected. The CDC will shed about 2,400 staff members as it “returns to its core mission” of epidemic response. The National Institutes of Health will eliminate 1,200 positions by consolidating administrative functions. The Centers for Medicare and Medicaid Services will cut 300 employees, with officials claiming this won’t impact services to beneficiaries.

These identified cuts account for just 7,400 positions, leaving thousands more staff reductions still unspecified in the department’s announcements.

The fact sheet characterized the changes as a “dramatic restructuring” while noting that under the Biden administration, health spending increased by 38% and staffing grew by 17%. Kennedy sharply criticized those increases as ineffective and wasteful: “All that money has failed to improve the health of Americans. We are the sickest nation in the world and have the highest rate of chronic disease.”

The Biden-era budget expansions had targeted initiatives related to pandemic preparedness, mental health, and public health infrastructure.

Critics argue these workforce reductions will harm Americans’ access to healthcare while yielding minimal savings. Kennedy and HHS have already been under fire for mass firings, failure to respond to a measles outbreak that has killed the first two Americans in over a decade, and billions in medical research cuts.

Senator Ed Markey, Democrat of Massachusetts, blasted the decision on social media: “RFK Jr. wants to cut 10,000 more jobs at HHS. People are waiting too long and paying too much for care. Meanwhile, this Administration is cutting grants for lifesaving medical research and fighting to cut Medicaid—all to pay for billionaire tax breaks. It’s outrageous.”

The US spends up to four times as much as comparable nations on healthcare per capita, despite being the only developed country without universal health care, according to data from the Commonwealth Fund.

Americans already pay the highest amount per capita for healthcare globally, spending nearly double its OECD counterparts and up to four times more than health systems in South Korea, New Zealand and Japan. Despite these costs, the United States remains the only high-income nation without universal health coverage.

More significant than staffing numbers in America’s healthcare cost crisis is the inability of US taxpayers to negotiate fair prices with pharmaceutical companies that wield enormous influence in Washington. Prescription drugs frequently cost two to four times more in the US than in Canada, the European Union, or Mexico.

HHS oversees all major US health agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. The vast majority of HHS funding supports Medicare and Medicaid, which provide healthcare coverage for elderly, disabled, and low-income Americans.

“We are going to do more with less,” Kennedy added. “No American will be left behind.”

Health in Trump’s image

Robert Kennedy Jr.’s banner photo on X, formerly Twitter, where he boasts over 4.5 million followers.

Across federal agencies, the Department of Health and Human Services is undergoing perhaps the most profound ideological transformation, reflecting the priorities of both President Trump and Kennedy.

Internal memos obtained by news agencies reveal an expanding list of scientific topics the National Institutes of Health now “no longer supports” – including research on vaccine hesitancy, COVID-19, diversity initiatives, climate change health effects, and transgender healthcare.

Since Kennedy’s appointment, HHS agencies have terminated hundreds of previously approved scientific studies.

Among the hundreds of terminated studies are grants that reveal a clear ideological pattern in the administration’s scientific priorities: investigations into Alzheimer’s disease in sexual and gender minority older adults, mental health interventions for LGBTQ+ communities affected by COVID-19, strategies to improve vaccine acceptance among Alaska Native populations, and research examining how institutional trust influences vaccine decisions—representing just a fraction of studies canceled for addressing topics now disfavored by Kennedy’s HHS.

Sample of federal grants cut by HHS since Kennedy took over the department.
Studies show that air pollution is associated with worsening mental health outcomes.

Air pollution has been linked to poor brain development, as well as a higher risk of dementia and stroke. A link has also been established between exposure to air pollution and depression as well as higher suicide rates.

The subject received attention at the second WHO’s global conference on air pollution and health in Cartagena, Colombia this week.

“Air pollution is increasing the risk of new mental health problems and worsening mental health in people with pre-existing mental health problems,” Alessandro Massazza, policy and advocacy advisor at United for Global Mental Health, a global non-profit that focuses on mental health advocacy, told Health Policy Watch.

The societal costs of mental disorders due to air pollution, climate-related hazards, and inadequate access to green space are estimated to reach around $47 billion annually by 2030 — a significant portion of the massive $8.1 trillion annual price tag for the overall health impacts of air pollution.

Alessandro Massazza (right) speaking on the impact of air pollution on mental health during a session at WHO’s global conference on air pollution and health in Colombia’s Cartagena.

Around 99% of the world’s population breathes air that does not meet the air quality standard set by the World Health Organization (WHO). Exposure to high levels of air pollution claim over eight million lives worldwide every year.

“It’s not just that we’re all exposed to air pollution, not just that it affects everybody, but it affects non-communicable diseases (NCDs),” said Mark Miller of the World Heart Federation. He pointed out that NCDs are already the world’s biggest killer, responsible for 74% of all deaths annually.

“Tackling NCDs has to be one of the greater priorities for the world, no matter what sector of life that you’re in,” Miller said.

 How air pollutants reach the brain 

Burcin Ikiz, neuroscientist and director at EcoNeuro.

The exact pathway through which air pollutants reach the brain is now becoming clearer.

“The pollutants from the air enter our brains through two mechanisms. One is directly from our nasal cavities up to our olfactory bulb, but also from systemic inflammation,” Burcin Ikiz, neuroscientist and director at EcoNeuro, a research and consulting company working in global health, told Health Policy Watch.

“When the lungs get inflamed due to the pollutants in the air, those send inflammatory responses into the bloodstream, and through the bloodstream reaches the blood-brain barrier,” Ikiz explained. “Normally, our blood-brain barrier should be our protective layer that protects the brain from any outside pollutants or harmful substances. But it’s not perfect. It’s a leaky system.”

Children, the elderly population, and those living with other neurological conditions such as multiple sclerosis and Alzheimer’s are especially vulnerable, she added.

Potential pathways for air pollutants to reach the brain and create an impact

“We know less about what may be driving this association between air pollution but it’s likely to be the result of a mixture of biological (e.g., inflammation), social (e.g., not being able to go outside or socialize outdoors), and psychological (e.g., impact on mood, cognition, or sleep) mechanisms,” Massazza said.

Air pollution is also linked to poor brain development in children, starting in utero.

“Looking at pregnant women and their babies that are still in the womb being exposed to pollution, we see their brain structures changing,” Ikiz said. Post-birth, “we see them having…. developmental delays and lower IQs and so on.”

Adolescence has been identified as another crucial period during which many mental health disorders first develop.

The risk of strokes in which the blood flow to the brain is reduced, also increases due to air pollution, studies have found. Air pollution is also among the 14 modifiable risk factors for dementia.

Air pollution has also been found in several studies to be associated with depression on both short and long-term time scales, drawing attention to its impact on poor mental health outcomes.

Need for evidence-based interventions

The additional societal costs of these mental health disorders influenced by environmental factors are expected to rise further, according to an estimate that pegs it at US $537 billion by 2050, relative to the baseline scenario in which the environmental factors remain at 2020 levels.

“People with chronic and severe mental health problems often live with co-morbid non-communicable diseases such as respiratory or cardiovascular conditions, which can further increase their vulnerability to the physical health impacts of air pollution,” Massazza.

Limited research on interventions shows that significant mental health gains are seen when air pollution is reduced. One study from China demonstrates how the country’s clean air policies are not only contributing to large reductions in air pollution but have also been deemed responsible for preventing 46,000 suicides over just five years.

Significant data gaps remain, with only a handful of studies on air pollution’s impact on mental health coming from low- and middle-income countries. Experts say efforts are needed to improve research in understanding the pathways between environmental stressors and mental illness.

In September, the UN headquarters in New York will host a high-level meeting on NCDs and mental health, where the impact of climate change on NCDs and mental health is likely to be discussed.

“Clean air policies are mental health policies. From reduced energy poverty and more access to green spaces to increased physical activity resulting from active modes of transport, actions aimed at reducing air pollution have considerable potential co-benefits for mental health,” Massazza said.

Sophia Samantaroy contributed reporting. 

Image Credits: Unsplash, By arrangement, Elaine Fletcher, Air quality and mental health: evidence, challenges and future directions.

Dr Susan Monarez, newly appointed head of the US CDC (2nd left) and other US government officials meet Africa CDC Director General Dr Jean Kaseya and Dr Ngashi Ngongo in Washington.

Leaders of the Africa Centres for Disease Control and Prevention (Africa CDC) held a five-hour meeting with Dr Susan Monarez, newly appointed head of the US CDC, and other US officials on Wednesday – for the first time since the US slashed funding to Africa’s health sector.

Discussion centred on health security, funding for Africa CDC and options for health financing on the continent, Dr Ngashi Ngongo, Africa CDC’s incident management head, told a media briefing on Thursday.

“From the [US] administration’s perspective, they would like to see more of health as a business, rather than something that functions on grants,” added Ngongo. 

African programmes worst affected by the US’s abrupt termination of funding are those dealing with maternal and child health, HIV, malaria and emergency preparedness and response, said Ngongo, speaking from Washington DC, where he and Africa CDC Director General Dr Jean Kaseya are meeting a range of US leaders.

Aside from Monarez, the meeting was attended by high-level officials from the White House, the US State Department’s Bureau of Global Health Security and Diplomacy, Health and Human Services (HHS), and an assistant secretary from the President’s Emergency Plan for AIDS Relief (PEPFAR).

“We made the point, which was accepted by our American counterparts, that global health security starts with what happens outside the US,” said Ngongo, adding that the Trump administration “remains committed to addressing health security”. 

‘Health as a business’

Ngongo said that the Trump administration is interested in “exploring how can we go into a partnership that translates into health as a business”, adding that private sector opportunities exist in the local manufacturing of medicines, digitalisation of health records and the electrification of clinics.

“On programmes, we discussed malaria, HIV, and also support in the area of systems for emergency preparedness and response, in particular surveillance, laboratory capacity strengthening, and the health workforce,” said Ngongo.

The aim of the meeting, he added, was “to make sure that we understand them and they also understand the priorities for Africa CDC”. Discussions with US government officials will continue in April around the World Bank’s spring meeting in Washington, he added.

A report published in The Lancet this week predicted that, across all low and middle-income countries, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support “could cause an additional 4·43–10·75 million new HIV infections and 0·77–2·93 million HIV-related deaths between 2025 and 2030”.

If PEPFAR support is “reinstated or equivalently recovered, this reduced to 0·07–1·73 million additional new HIV infections and 0·005–0·061 million HIV-related deaths”, the modelling study adds

“Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations,” the authors note.

Funding gap

Meanwhile, Africa CDC has a funding gap of $224 million – in part due to the US walking away from a pledge made to the continent by the Biden administration.

Official development assistance (ODA) for Africa has dropped from $81 billion in 2021 and to $25 billion 2025, yet there has been a 41% increase in disease outbreaks on the continent between 2022 and 2024. 

Lack of funds, weak health systems and conflict “risk the reversal of two decades of health achievement on the continent”, said Ngongo

“We are also concerned about the risk of another African pandemic, which … would translate into more crisis, with the economic vulnerability that will push more Africans into poverty,” said Ngongo.

“But it really doesn’t help to complain. We have to be proactive in terms of thinking that, if that is the new normal, if that is the direction that the world is taking, how do we remain fit in that context?”

Options include increasing domestic financing, a “solidarity levy” on all airline tickets sold on the continent, higher “sin taxes” on alcohol and tobacco and partnerships with the private sector.

Three-pronged plan to raise funds for African health

“The European Union (EU) has already committed to imposing a minimal import levy on goods that are imported to Africa” to assist, he added.

“All that is on the backbone of the optimization of the use of resources to ensure that there is less corruption, there is less misuse and inefficiencies,” said Ngongo, adding “you cannot really leave your health in the hands of the partners”.

New mpox plan

An updated plan to address the ongoing mpox outbreak was recently completed by the Africa CDC’s Incident Management Support Team.

Its goals are to stop the human-to-human transmission, halve the burden of impact and strengthen the health system as part of countries’ epidemic preparedness and response.

“The response strategy is mainly community-centred under the leadership of community health workers,” said Ngongo.

It is a multi-sectoral approach that relies on strengthening co-ordination, digitalizing surveillance – which will assist with other diseases, and completing laboratory decentralisation.

“We need to vaccinate about 6.4 million people during the next six months on this second plan and on the case management, we target at least 80% of confirmed cases that need to be taken care of,” he added.

The total budget estimated is $429 million, of which a quarter will be for surveillance and a quarter for vaccination and logistics. 

Mpox cases rose by 22% increase over past week to 3,323 cases. Confirmed cases also rose from 381 to 925. The Democratic Republic of Congo (DRC), Burundi and Uganda account for 91% of all cases.

Surveillance was slightly improved in the DRC with 21 out of 26 provinces reporting (up from 19 the previous week) and testing up from 13% to 20% of suspected cases. There were 2,451 new cases in comparison to 2,183 the week before, with 312 confirmed cases in comparison to 150.

Sierra Leone, which has 114 confirmed cases, became the sixth country to start vaccinating people on Thursday.

A baby gets a BCG vaccination in a Gavi-supported programme.

The United States plans to stop funding the global vaccine alliance, Gavi, which assists developing countries to buy vaccines to protect their children, according to a spreadsheet obtained by the New York Times.

Gavi is one of the 5,341 US Agency for International Development (USAID) grantees that the US intends to cut, according to the 281-page spreadsheet sent to Congress this week.

The US covers 13% of Gavi’s budget, and its vaccine programmes are estimated to have saved almost 19 million lives over its 25-year existence.

We have not received a termination notice from the US government and are engaging with the White House and Congress with a view to securing $300m approved by Congress for our 2025 activities and longer term funding for Gavi,”  Dr Sania Nishtar, CEO of Gavi, told Health Policy Watch.

“A cut in Gavi’s funding from the US would have a disastrous impact on global health security, potentially resulting in over a million deaths from preventable diseases and endangering lives everywhere from dangerous disease outbreaks.”

Responding to the news on X, Gavi said that it could save “over eight million lives over the next 5 years and give millions of children a better chance at a healthy, prosperous future”. 

An investment in Gavi will also keep the US safe, it added: “By maintaining global stockpiles of vaccines against deadly diseases like Ebola, mpox and yellow fever we help keep America safe. These diseases do not respect borders, they can cross continents in hours and cost billions of dollars.”

“Every dollar we invest in lower income countries generates a return of $54. This helps countries develop and communities thrive, taking away pressure to migrate in search of a better life elsewhere.”

‘Political decision to ignore science’

Public Citizen’s Liza Barrie said that the Trump administration’s decision “abandons 25 years of bipartisan commitment to global immunisation and undermines the very systems that help prevent deadly outbreaks from reaching our own doorsteps”.

“The administration is walking away from a $2.6 billion pledge — jeopardizing routine vaccinations for 75 million children over the next five years,” said Barrie, who heads the organisation’s global vaccine access programme.

“This isn’t fiscal responsibility. It’s a political decision to let preventable diseases spread— to ignore science, lend legitimacy to anti-vaccine extremism, and dismantle the infrastructure that protects us all,” she stressed, adding that Congress has authority over foreign assistance funding.

“The administration’s attempt to unilaterally walk away from its Gavi commitment raises serious legal questions and should be challenged. Lawmakers must stand up for the rule of law, and for the belief that the value of a child’s life is not determined by geography.”

Schoolgirls line up to receive the HPV vaccine in Central Primary School in Kitui, Eastern Kenya

The US also plans to ditch the United Nations Food and Agriculture Organization, which tracks zoonotic diseases despite the US being in the midst of a months’ long H5N1 outbreak in cattle that has also infected farm workers.

Only 898 grantees will be retained, including scaled back support for HIV and tuberculosis and food aid during humanitarian crises.

Around 60% of grants for the US President’s Emergency Plan for AIDS Relief (PEPFAR) were administered by USAID and at least eight countries are on the brink of running out of HIV medicine.

Only 869 USAID staff are still in office out of over 6,000 and the US State Department has taken control of the agency.

Earlier, Health Policy Watch reported on a leaked plan for US foreign aid which would see a new body, the Agency for International Humanitarian Assistance (IHA), take over the remnants of USAID.

The plan envisages three “pillars” for future aid thematically organised as “safer”, “stronger”, and “more prosperous”.

The “safer” pillar will cover “humanitarian assistance, disaster response, global health and food security” under a new body, which will fall under the State Department.

US Vice President JD Vance is in charge of deciding on the future of USAID.

Updated on 27 March to include comment from Gavi CEO Sania Nishtar,

Image Credits: Gavi, the Vaccine Alliance, Keystone / EPA / Karel Prinsloo / GAVI.

Panelists Rachel Huxley, Claire Henly, and Pierpaolo Mudu discussed the threat of super pollutants ahead of the WHO Air Pollution and Health Conference.

CARTAGENA, Colombia – A small group of climate pollutants– including the air pollutants black carbon, methane, and ozone – are responsible for nearly half of global temperature increases to date. 

Reducing these emissions, which only remain in the atmosphere for a few weeks to decades, could serve as the “emergency brake” critical to halting runaway climate change, said experts Monday on the eve of the second WHO Air Pollution and Health Conference.

Although these pollutants exert enormous 20-year climate-warming potential that is 80 to 2,000 times greater than carbon dioxide (CO2) per ton of emissions, their lifespan is far shorter than CO2, which remains in the atmosphere for a century or more.

These pollutants are also projected to continue warming the climate with greater potency than CO2 over the next century.

“If you reduce them today, we’ll see impacts in our lifetimes,” said Claire Henly, executive director of the Super Pollutant Field Catalyst, a US start-up NGO, at a media briefing ahead of the conference

While CO2 has received the overwhelming amount of climate mitigation attention, Henly and others argued that addressing a class of “super pollutant” greenhouse gases and particles, also known as “short-lived climate pollutants,” offers the greatest opportunity to have a rapid, and meaningful impact on both health and climate.

Henly and others identified ozone, black carbon, and methane as super pollutants because of their wide-ranging impacts on food security, health, and climate change. Slowing the rate of climate change would make it easier for the “world to adapt to climate change,” said Henly. 

Nexus of climate change, air pollution and health

It is also the nexus where health, climate, and food security concerns directly converge – leading scientists to dub them “super pollutants” precisely due to those wide-ranging impacts. 

Black carbon is a sub-component of dangerous particulate matter, associated with some 7 million deaths annually from air pollution. 

Ground-level ozone, formed as pollutants emitted by vehicles, industry and waste, is a leading factor in respiratory illness, particularly asthma, as well as damaging some 90% of global crop production every year. Methane, emitted by waste dumps, agriculture, and oil and gas flaring, is a leading precursor to ozone formation.  

Slowing emissions would also slow the rate of climate change, buying time for the world to transition to cleaner energy sources and other longer-range climate solutions, said Henly. 

Two leading super pollutant gases, methane and nitrous oxides (N2Ox), are formally recognized in the Paris climate agreement as powerful greenhouse drivers with a climate forcing potential that is 80, and 270, times more than CO2 respectively in the next 20 years. But black carbon is ignored, leading to a fragmented approach.  

Super pollutants sources chart
Compared to carbon dioxide, super pollutants exert stronger climate warming in both the short and longterm, but drop out of the atmosphere faster.

Similarly, the shared concerns of climate and health sectors around super pollutant emissions are often siloed, said Sergio Sanchez, senior policy director at the Environmental Defense Fund. Greater recognition of super pollutants as detrimental to both health and climate could help break through the barriers to more climate action, he said.

Reducing these pollutants could avoid four times more warming by 2050, as opposed to decarbonization policies alone – and also prevent some 2.4 million deaths a year from air pollution. 

Yet emissions of super pollutants, including methane, are currently on the rise.

Agricultural sector is getting more attention

Punjab environmental officers put out fires set by Pakistani farmers in Province, an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke.

Most attention on super pollutants has focused on methane leaks from the fossil fuel industry. These occur at nearly every stage of the extraction and production cycle, with natural gas flaring the most glaring example of methane emissions. 

However, another key source of potent methane emissions is the agricultural sector, which accounts for  40% of global human-made methane emissions, with livestock, rice cultivation and crop debris being key sources. 

People often forget the fact that in some regions, such as the European Union, the agricultural sector accounts for 54% of methane emissions, noted Pierpaulo Mudu, WHO scientist.

Another 34% of global methane emissions comes from fossil fuels and 19% from rotting urban and household solid waste. Some methane is also emitted by natural sources, such as peat bogs and wetlands. Overall, two-thirds of global methane emissions come from human activities, according to the Global Carbon Project. 

Methane emissions from agriculture harder to track

Methane emissions from agriculture, however, are much harder to track and monitor than emissions from the oil and gas sector.

“In agriculture, these pollutants are not emitted in high concentrations,” said Henly. 

“The emissions are distributed, and the kind of detection, whether it’s through on the ground sensors or remote detection, is just a bit more challenging than in the oil and gas coal sectors.

Whereas previously, only big methane spikes or leaks from oil and gas installations could be detected, that is changing now, Henly said. 

Recently, new technology, in the form of higher resolution satellite imaging, has opened the way for more granular estimates from sources like agriculture.

This week’s WHO conference will therefore feature the first session ever about the links between methane emissions in agriculture, climate, and health.  Solutions that can be promoted,, experts say, include biogas capture from anaerobic digestion of crop waste and manure as well as improved compost management – so that methane gas is not produced at all.

Ozone chokes crops

But agriculture is also impacted by super pollutants, particularly ozone. It’s now estimated that ozone leads to a loss of 12% of wheat, 16% of soybean, 4% of rice, and 5% of corn production every year.  

“So we can see that the super pollutants are a real growing threat to food security,” said Rachel Huxley, Head of Climate Mitigation and Health at Wellcome Trust.

Ground level ozone (O3) is a product of the vicious cycle of super pollutant formation. Gases produced by cars and industry, crop and waste incineration, interact in sunlight, leading to ozone’s creation. 

Unlike the “good” layers of stratospheric ozone that protect the planet and people from harmful ultraviolet radiation levels, ground level ozone is harmful to crop production as well as human health. 

Inhaling ozone leads to respiratory and a host of other health issues. And when over farmland, the pollutant can dramatically disrupt staple crop growth, according to a 2025 report by the Clean Air Fund.

This week, for the first time ever, WHO is convening a meeting on agriculture, air pollution, climate and health, with the hopes of drawing more attention to these linkages within health and environment circles. 

“Everyone is obsessed with transport,” said Mudu, the WHO scientist leading the session. “Because of the visibility of the black smoke, but there are many different sources of air pollution with many sorts of invisible gases.”

Black carbon and snowmelt 

A traditional brick factory in southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of black carbon emissions.

On the other side of the coin, when urban and household waste or crop debris is burned, rather than left to rot, it produces smoke – a mixture of gases and particles, including black carbon. 

The burning of rice crop debris regularly envelopes large parts of the Indian subcontinent in billowy smoke every autumn. Burning of household and urban solid waste is also a common practice in many developing regions. 

Waste burning, together with the use of wood and charcoal for household cooking and heating, as well as in traditional brick kilns, cast a chronic pallor of smoke or smog over cities and farmland in many other low- and even middle-income regions of the world – also contributing to the formation of ozone.   

super pollutants
Super pollutants exist at the nexus of climate and air quality, making them cost effective pollutants to target.

But the tiny specks of black contained in the smoke do even more harm than other types of fine particles. They accelerate climate change in mountain regions, where they settle on snow and ice, absorbing additional sunlight and thus increasing snow and ice melt. 

Scientists estimate that  black carbon is responsible for 39% of glacier melt in certain Himalayan glaciers, and there are similar impacts being observed in the Himalayas, Alps, Andes and the Rockies, according to a 2025  Clean Air Fund report

Locally, glacier melt reduces the reliability of water sources that rural regions of Nepal and northern India rely on for crop irrigation as well as domestic use. 

But there are global implications as well. It is a major reason that the Arctic is warming four times faster than other parts of the world, increasing the chances of “dangerous climate tipping points being breached,” the report stated.

Regulation and action

super pollutants
Often “forgotten” as potent drivers of climate change and poor health, super pollutants contribute to nearly half of warming.

Regulation of super pollutants is challenging – because so many pollutants, and sectors, are involved. In the case of ground level ozone, as well, the pollution is not emitted directly, but rather is a product of reactions between methane, nitrogen oxides, and volatile organic compounds. So the precursors need to be regulated. 

Despite such complexities, the fact that black carbon as well as methane, ozone and other powerful short-lived gases – only reside in the atmosphere for weeks to decades, makes Huxley hopeful that policymakers can see the “economic sense” in cutting back on such emissions. 

“This is one of the most effective ways to keep 1.5ºC alive,” she said, referring to the Paris climate agreement goal. “This is our emergency brake on climate change.” 

The Global Methane Pledge aimed at reducing the gas, was launched at COP26 by the United States and the European Union and has so far been supported  by over 150 countries, including over two dozen African nations. 

“Methane has been globally recognized as a super pollutant since COP26, thanks to the launch of the Methane Global Pledge and the commitments made by countries since then,” said Elisa Puzzolo, Super Pollutants policy manager at the Clean Air Fund.

“Now, is the time to raise our ambition and address all super pollutants, including black carbon and troposheric ozone, to protect the climate, safeguard public health, and support most-affected regions and communities.”

Super-pollutants ‘movement’

air pollution quilt
Air pollution impacts the most vulnerable, including children showcased in a quilt from the Indian advocacy group Warrior Moms.

What Wellcome and the Clean Air Fund want to foster is a more coordinated super-pollutants “movement” that cuts across sectors – together with the UN Enviroment Programme-hosted Climate and Clean Air Coalition.

“Solutions are proven,” Puzzolo said. For super-pollutants though, the regulatory landscape is a bit more complicated. Black carbon, though harmful to health and the climate, is not included in the Paris Climate agreement because it is a particle.

“Reducing black carbon, alongside other super pollutants, is the fastest, most effective way to slow climate change, while also mitigating the enormous health impacts of air pollution,” said Jane Burston, CEO of the Clean Air Fund. “Yet to date not enough has been done.”

“Action on short-lived climate pollutants is a matter of time and temperature,” said Martina Otto, head of the secretariat at the Climate and Clean Air Coalition, which was founded over a decade ago specifically to spearhead awareness and action on superpollutants. 

“They have a higher warming potential than CO2 and don’t accumulate in the atmosphere. Cutting them turns down the heat within decades and reduces air pollution now. A double dividend that we cannot afford to miss.”

Image Credits: WHO/Diego Rodriguez, E. Fletcher/HPW, Climate and Clean Air Coalition, Punjab Enviornment Department, Climate and Clean Air Coalition, A. Bose/ HPW.