Drone footage dispels the myth the Delhi’s air pollution improves in spring.

NEW DELHI – For years, residents of the Indian capital have looked to the skies in March with a sense of relief, believing that the notorious winter pollution had finally retreated. 

However, a drone armed with an air quality monitor has shattered this perception, revealing a massive blanket of toxic air hovering just above the city’s skyline. This vertical pollution acts like a pollution lid over the capital. It also contains unexpectedly high concentrations of dangerous particles that ground-level monitors often fail to capture.

Dark surprise in the spring sky

The study indicates the vast scale of Delhi’s pollution. One of the authors, Prof Sagnik Dey of  theIndian Institute of Technology (ITT) Delhi, estimates this to be roughly 240,000 kgs, equivalent to some 1,200 oil drums.

“Taking Delhi, 30 km by 40 km, and considering PM2.5 up to 1 km, we are talking 1200 km3 volume of air,” Dey told Health Policy Watch. 

“When PM2.5 is 200 ug/m3 on a day, we are talking about 2,40,000 kg of particles to be cleaned out.”

Another surprise is that this smog blanket occurred in mid-March when climatic conditions, including and temperature, favour the dispersal of pollution, unlike in winter.

The study was conducted by a team at IIT Delhi, from its South Delhi campus between 11-23 March, 2021. 

The research, published in Nature this month, shows that while the air at street level might seem manageable, the atmosphere 100 metres above the ground was 60% more toxic. 

The new findings raise questions about how much of Delhi’s air crisis is driven by local sources and why current emergency measures are failing to clear the sky.

There is a lot of complex chemistry at work, churning out the lethal cocktail of pollutants. The ingredients and level of pollution change depending on whether it is morning, noon, evening or night. 

The authors – numbering 20 from institutions in nine countries ranging from the UK to China – say that the study provides enough impetus to study the pollution above the city more deeply, using drones, to improve models and policy action to reduce air pollution. 

Toxic mornings 

The most dangerous window for residents is between 5am and 8am, when a “suppressed planetary boundary layer” acts like a physical ceiling below 200 metres altitude, trapping pollutants near the surface thanks to factors like cooler air, low/no wind, and humidity levels. 

The planetary boundary layer (PBL) can be as low as 50m and as high as a couple of thousand, depending on the temperature, time of day or year, and other factors. 

Usually, the higher the PBL, the lower the concentration of pollutants at ground level, which is why in summer the level of particulate matter tends to be lower in hot places like Delhi. 

On one day, the study found PM2.5 concentrations reached a staggering 160 µg/m³ (micrograms/cubic metre) at an altitude of 100m, typically the height of a 30-storey residential building. Ground monitors recorded only 100 µg/m³; WHO’s daily safe limit is 15 µg/m³. 

The altitude of the toxic haze shows the strength of local emissions and regional transport, Dey says. 

“This calls for prioritising emission reduction as the main mitigation strategy through systemic long-term measures rather than short-term emergency measures trying to filter this large volume of toxic air,” he added. 

The Delhi government has resorted to using hundreds of water sprinklers on trucks and buildings to subdue dust. In the past, it built ‘smog towers’, essentially outdoor air purifiers, before conceding these are ineffective. 

As the sun rises and the ground warms, this “lid” expands, allowing the toxic air to disperse into higher altitudes. By noon and into the early evening, the air becomes significantly clearer, with temperatures reaching 30-35°C and humidity dropping to 40-50%.

What causes Delhi’s pollution peaks?

Delhi air pollution during peak pollution days in mid-November.

The report breaks down a list of pollutants, secondary pollutants formed as a result of primary pollutants and other factors like temperature and chemical reactions. 

The chemicals produced include chloride, black carbon or soot, sulphur dioxide to some extent from coal combustion, nitrogen dioxide and ozone, especially during traffic rush hour. These are emitted by burning biomass, solid fuels, waste, and from industries. 

An increase in the levels of chloride and black carbon are linked to the burning of biomass and solid fuel, which could be in waste as well. Tackling waste burning has often been identified by experts as a top priority to reduce the region’s air pollution. 

Exposure to these pollutants, particularly fine particulate matter like black carbon, is linked to severe respiratory and cardiovascular diseases, including asthma, lung cancer, and strokes. Additionally, nitrogen dioxide and ground-level ozone can significantly reduce lung function and trigger chronic obstructive pulmonary disease (COPD) exacerbations.

Traffic is a prime suspect

A significant cause for this hovering haze is the city’s roads. The report highlights the staggering impact of vehicular pollution, noting that traffic contributes 40-50% of PM2.5 during peak hours. In areas near major traffic corridors, the drones detected high levels of “equivalent black carbon,” a particularly soot-heavy component of exhaust.

This traffic-led pollution does not simply blow away. Instead, emissions from the millions of vehicles on Delhi’s roads build up overnight, trapped by the shallow boundary layer. This nocturnal build-up is further complicated by other local sources, including waste burning, industrial activities, and residential cooking. The study found that chloride, often linked to the burning of plastic and electronic waste, spiked in the early hours of the morning, acting as a chemical trigger that causes particles to grow and thicken the haze.

Call for more drones 

To capture this data, researchers utilised a custom-designed drone platform built by an Indian start-up, BotLab Dynamics. The drone, weighing roughly 7.5 kg, was equipped with a modified low-cost sensor (LCS).

The study involved 40 separate drone flights near heavy traffic corridors. However, back in March 2021, time was tight due to Covid restrictions. Now, the authors have called for more drone-based surveillance, at higher altitudes, and with better equipment. 

In the right conditions, tons of these pollutants can descend and threaten public health. 

Image Credits: Gustaf von Zeipel/ Unsplash, Chetan Bhattacharji.

Gavi uses innovative finance to ensure ready cash-flow for vaccine campaigns: Seen here – Ebola ring vaccination of health workers in DR Congo.

Financial innovation is a key, underused tool that can be mustered to strengthen humanitarian outreach in crisis settings, while also strengthening public health systems over the long term, according to a new report published by The Geneva Health Forum.

“New sources of financing are developing, breaking with the traditional vision of charitable action financed by grants from humanitarian agencies and fundraising,” the report states. 

“Blending funds, implementing insurance systems, micro-levies and ‘sin’ taxes, regionalizing production, volume guarantees, co-investing and co-pay mechanisms, derisking, and the variability of licensing systems are all avenues worth exploring.” 

The report was the product of a GHF-organized event at the Geneva AidEx conference in October 2025 – an international gathering focused on humanitarian aid, disaster response, and development innovation. 

Geneva Health Forum sponsored event on innovative finance at AIDEX 2025.

The session brought together a select group of health leaders to examine how alternative financial tools can help bridge the gap between emergency response and health system strengthening in developing countries.

The panel featuring experts from the global public and private sectors, reflected a cross-section of public, philanthropic, and market-shaping perspectives.

Rethinking financial innovation in fragile contexts

Bridie Layden, The End Fund.

“Faced with major turbulence in humanitarian aid, with a sharp decline in traditional funding, there is an urgent need to rethink economic models to strengthen the sustainability of health systems in fragile and low-resource contexts,” said Bridie Layden, senior director of The END Fund and moderator of the panel discussion that forms the backbone of the report. 

A “collaborative philanthropic fund”, The End Fund recruits private capital to support innovative programmes fighting Neglected Tropical Diseases (NTDs). 

Layden cautioned against treating innovation as an end in itself: “The term innovation remains vague,” she warned. “What we really want to explore …is how certain financial tools can help us bridge the gap between emergency humanitarian response and the building of sustainable health systems.”

Clarifying what ‘innovation’ really means

Innovative financing tools push beyond traditional grants provided by bilateral donors, NGOs and philanthropies. They range from blended funds and insurance models to micro-levies and co-investment mechanisms. Innovative finance can be particularly meaningful in  offering, for instance: 

  • Liquidity to health systems for urgent needs when donor funds are promised – but not yet tangibly available.  
  • Insurance schemes that derisk private sector production of needed health products – ensuring more rapid response in times of need.  
  • Seed capital in the form of low-interest loans, equity, or guarantees for investments in new product development and health infrastructure that can both directly improve systems as well as leveraging more investments from the private sector.  

The report showcases good practice examples of such innovative tools aired at the panel. It emphasizes adapting and scaling proven mechanisms rather than introducing complexity for its own sake.

Gavi financial facility provides ready cash for vaccine procurement  

Jack Nichols describes Gavi’s Innovative Finance Facility.

One such model is Gavi, the Vaccine Alliance’s International Finance Facility for Immunization (IFFIm). 

The Finance Facility  “transforms future commitments from public donors into immediately available liquidity,” in the words of Jack Nichols, Gavi senior legal counsel.

“Financial innovation is based on how it advances our mission, not on the novelty of the structure,” he added.

The mechanism was created in 2006 by Gavi to streamline the rollout of vaccination programmes in the more than 90 low-and-middle income countries worldwide that receive Gavi support. 

Effectively, IFFIm issues “vaccine bonds” on international markets and investors buy the bonds, providing immediate funds. The money thus raised are transferred to Gavi, allowing it to fund the purchase and distribution of vaccines according to a systematic timetable. Later, when government pledges arrive, they are used to repay investors with interest.

The IFFIm is, in short, “a mechanism for making an organization’s liquidity available to meet needs at the right time,” said Nichols. 

Insurance de-risks private sector production scale-up

MedAccess derisks scale-up of critical medicines manufacture: CEO Jonathan Hutchins (right).

MedAccess offers an example of another critical niche instrument – insurance for the rollout or scale up of new health products. 

The non-profit organization protects private sector manufacturers against the risk of low sales and market slack, enabling them to scale up production of critical medicines and diagnostics in settings where product demand is not yet well defined.   

By enabling more production at scale at a faster pace, the scheme also helps keep prices down and expand access to medical innovations, said Jonathan Hutchins, CEO of MedAccess. He described how MedAccess work to de risk the rapid rollout of new generation BASF bednets and highly sensitive HIV diagnostics such as the Hologic HIV assay yielded savings of $35 million and $45 million respectively.  

And in seven years of operation, MedAccess has provided 15 insurance guarantees without any ever needing to be called in for payment. 

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

Micro-levies and seed finance to catalyze stronger health infrastructure

Matthew Lindley describes UNITAID’s micro-levy funding model.

MedAccess is just one example of a project initially funded by British International Investment, the UK’s development finance company responsible for investing in low- and middle-income countries.  

BII invests capital in the form of loans, equity, or guarantees in private companies and public infrastructure projects that alleviate poverty and yield economic benefits in emerging economies. And that includes infrastructure for health facilities as well as the energy, water and laboratory systems that support operations.  

By de-risking investments, the capital also helps mobilize additional private finance to amplify impacts. 

Another tactic, a micro-levy on airline tickets, led to the creation of UNITAID in 2006 and has sustained its core funding for nearly two decades.  

The solidarity tax on airline tickets, implemented by Brazil, Chile, France, Norway and the United Kingdom, is collected by national treasuries and then transferred to UNITAID. 

It has proved to be a stable and predictable source of revenue with a low cost of collection. 

UNITAID, in turn, has become an innovator in the testing of new and innovative health products, and in their subsequent procurement and scale up. Over the past two decades, UNITAID has partnered with both the private sector and global health agencies like WHO and UNICEF to roll out or expand access to some 100 new innovations – all lifesaving health products that together reach over 320 million people every year. 

Most of all, UNITAID operates as a vital link between the world of pharma innovation and developing countries that to facilitate market access to cheaper, more accessible, and easier to deliver health products, says Matthew Lindley Senior Resource Mobilization Manager, Unitaid. 

“Timetables and performance indicators between donors, institutions, and investors are rarely aligned and often diverge, and that’s when friction and delays arise,” he noted at the AIDEX event. 

Evaluation of impacts

Carolina Batista of Baraka Impact Finance: Local innovation exists but it doesn’t connect with capital.

Along with the schemes themselves, impact evaluation is a critical lubricant for the innovation ecosystem. Systematic assessment of the impacts using defined metrics can make new medicines and devices more “readable” and stimulate capital inputs from the private sector and mainstream investors.  

“Local innovation exists, but it doesn’t connect with capital: our role is to build this bridge,” said Carolina Batista, head of Global Health Affairs at the Swiss-based Baraka Impact Finance. The firm provides purpose-built analytical tools to investors assess the potential financial and market impact of new health products – and estimate future yields. 

Baraka also works with health product entrepreneurs to define key performance indicators (KPIs) that reflect the social and financial value of new medicines and devices they have created. These KPIs demonstrate how each dollar invested produces both a measurable social return and a lasting impact on local healthcare systems. 

Building a shared language across sectors

Along with the successes, many barriers remain. Panelists highlighted the operational challenges of deploying innovative finance in the health sector, with its wide diversity of stakeholders and actors. 

“Timetables and performance indicators between donors, institutions, and investors are rarely aligned and often diverge, and that’s when friction and delays arise,” UNITAID’s Lindley observed. 

The underlines the need to build active collaborations and mutual trust between finance and health communities.

Layden, as moderator, summed it up saying: “The challenge is not necessarily to create financial tools, but to adapt and learn from existing ones, and build a common language between finance and health.”

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

The report also emphasized the importance of local leadership and inclusion, noting that: “including local stakeholders from the project design stage is essential to ‘decolonizing’ health finance.”

The report concludes with ten key messages that frame both the potential and the limits of innovative finance in global health. Among those, three stand out:

  • Innovative financing can complement, but not replace, official development assistance:
  • Financial innovation is only valuable if it strengthens the public health mission and equity. 

And finally, “trust between stakeholders — donors, investors, and local partners — is as valuable as financing itself.”

First in a series on current issues in global health, published in collaboration with the Geneva Health Forum. Upcoming next week: Unlocking private sector engagement to build resilient health systems. 

Image Credits: WHO/L. Mackenzie , Geneva Health Forum , Geneva Health Forum.

In mid-February, Madagascar was hit by the worst cyclones recorded and some 380,000 people need assistance.

Mozambique and Madagascar are struggling to address the after-effects of cyclones and cyclone-related flooding, with huge increases in cholera cases and displaced people.

There has been a seven-fold increase in cholera cases in southern Africa in the first six weeks of 2026 in comparison to the same time last year, with 90% of the 4,300 reported cases in Mozambique, according to the World Health Organization (WHO) Africa region.

Meanwhile, UN agencies warn that 380,000 Madagascans need aid after two cyclones battered the island.

Dr Marie Roseline Belizaire, WHO Africa’s emergencies director.

“Mozambique accounts for the majority of reported cholera cases, particularly among flood-affected and displaced populations. Extensive floods due to cyclones have damaged water and sanitation systems, contaminated drinking water sources and displaced communities, creating conditions for rapid transmission of cholera and other water-borne diseases,” said Dr Marie Roseline Belizaire, WHO Africa’s emergencies director. 

Malawi, Namibia, Zambia and Zimbabwe are also experiencing cholera outbreaks.

“The sharp rise in cholera cases in Southern Africa is a clear reminder of how climate-related shocks are intensifying public health risks,” she told a media briefing this week.

“As extreme weather intensifies, displacement rises and infrastructure comes under severe strain, health systems must be equipped to manage multiple overlying risks simultaneously.”

Vaccination campaign

Dr Severin Ritter Von Xylander, WHO’s Representative in Mozambique, told a media briefing this week that 181 health facilities had been damaged and more than 700,000 people displaced by the cyclone that hit the country in mid-December.

The WHO is assisting the Mozambican government to vaccinate 1.7 million people against cholera, now that the vaccine shortage has eased.

“Our risk analysis flags a transmission period from March to August, particularly during floods,” said Von Xylander. 

Satellite imagery of Cyclone Gezani over the city of Toamasina.

Cyclone Gezani made landfall near Madagascar’s second biggest city, Toamasina, in mid-February, and officials reported that three-quarters of the city’s buildings were destroyed.

It developed as a result of warm sea temperatures (above 28 °C), wind shear below 20 kilometers per hour, and an unusually moist atmosphere, according to meteorologists with the Joint Typhoon Warning Center.

Madagascar is one of the worst-affected by cyclones in Africa, and the intensity of these is increasing with climate change.

Diphtheria outbreak

Meanwhile, eight African countries are affected by a diphtheria outbreak, with more than 26,000 suspected cases and over 1300 deaths reported. Up to 95% of cases are among unvaccinated or under-vaccinated children, according to WHO Africa.

“Strengthening routine immunisation, expanding the ‘Catch Up’ campaign, improving laboratory confirmation and ensuring access to diphtheria antitoxin remain urgent priorities across the meningitis belt in West Africa and the Sahel,” said Belizaire.

A Zimbabwean health worker administers an HIV test.

The government of Zambia acknowledged this week that it is unhappy with part of a proposed health aid deal with the United States that “does not align with the country’s interests”.

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

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

“We want to leverage US assistance to bring about reforms that will unleash business investment that enhances US access to critical supply chains and creates great jobs for the Zambian people,” said Caleb Orr, US Assistant Secretary of State for Economic, Energy, and Business Affairs.

However, Zambia indicated this week that it has requested “revisions” to the MOU, and that it is still in negotiations with the US.

A leaked version of the agreement indicates that the US has reduced its commitment from $1.5 billion over five years it offered last year, to $1.012 billion.

According to the draft MOU, Zambia would also commit to providing information about pathogens with pandemic potential to the US for 25 years and data-sharing for 10 years – although the MOU would only be in place for five years.

Zambia has increased domestic financing for medicines and medical supplies by 30% since the US started to cut aid.

Zimbabwe says no to ‘lopsided’ deal

This week, it emerged that Zimbabwe had also halted its bilateral health negotiations with the US, rejecting the terms of an MOU worth $367-million over five years.

A leaked letter from Albert Chimbindi, Zimbabwe’s Secretary for Foreign Affairs, told officials involved in the US talks that the President directed them to “discontinue any negotiations with the USA”.

The letter describes the MOU as “clearly lopsided” and “blatantly compromises and undermines the sovereignty and independence of Zimbabwe”.

The stumbling block for Zimbabwe was the US insistence on instant access to information about pathogens causing outbreaks, while refusing to agree to benefit-sharing of any products developed as a result of this access.

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

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

Zimbabwe is currently one of the leaders of the African region in its negotiations on a Pathogen Access and Benefit-Sharing (PABS) system at the World Health Organization (WHO).

The PABS system, the final piece of the Pandemic Agreement still to be negotiated, will set out how information about pathogens with epidemic potential should be shared – and how the products (benefits) derived from this information, including medicines and vaccines, should also be shared.

Mangwana explained that a bilateral pathogen-sharing arrangement with the US would undermine the WHO negotiations: “To accept a bilateral arrangement that bypasses this multilateral mechanism would undermine the very solidarity that African nations have been advocating for on the global stage.”

Zimbabwe, representing Africa, at a recent meeting of the WHO Intergovernmental Working Group that is negotiating a pathogen-sharing system.

This week, the US Embassy in Zimbabwe announced that the government of Zimbabwe “has communicated its decision to withdraw from negotiations” on the proposed bilateral health MOU.

“We believe this collaboration would have delivered extraordinary benefits for Zimbabwean communities – especially the 1.2 million men, women, and children currently receiving HIV treatment through U.S.-supported programs,” said US Ambassador to Zimbabwe Pamela Tremont. “We will now turn to the difficult and regrettable task of winding down our health assistance in Zimbabwe.”

The Zimbabwe College of Public Health Physicians (ZCPHP), which represents doctors and specialists, urged its country to re-engage with the US this week.

While acknowledging the progress Zimbabwe has made to improve health services and the importance of protecting national sovereignty, the ZCPHP warned that the country’s HIV programme – including antiretroviral treatment, laboratories and supply chains – is still heavily reliant on external funds.

“An abrupt discontinuation of such support could risk treatment interruption, increased transmission, the emergence of drug resistance, and additional strain on the health system,” the ZCPHP warned in a statement.

“Continued dialogue between both governments offers an opportunity to resolve outstanding concerns while ensuring that essential commodities and services remain uninterrupted as Zimbabwe gradually strengthens domestic financing mechanisms,” the College said.

The Zimbabwe National Network of People Living with HIV expressed “alarm” at the “potential consequences of the impasse”: “For decades, international partnerships including those with the US government through PEPFAR and USAID, have been the backbone of Zimbabwe’s successful HIV response”.

It called on the Zimbabwean government to re-engage with the US, convene a multi-stakeholder review of the MOU or provide a “roadmap” on how it will fill the $350 million gap.

This year, the Zimbabwean government committed to increasing its health spending to 15% of its budget, a substantial increase from previous years and it has also introduced an AIDS Levy to raise funds.

However, donors – particularly the US President’s Emergency Plan for AIDS Relief (PEPFAR) – have picked up three-quarters of the tab for its HIV spending in the past.

Between 2018 and 2020, PEPFAR covered 32% to 42% of Zimbabwe’s HIV spending, the Global Fund 26% to 41%, while the government’s contribution was 2% to 12%, according to UNAIDS. 

Meanwhile, Kenya’s High Court has frozen implementation of its US MOU after two separate court challenges by the Consumer Federation of Kenya (COFEK) and local Senator Okiya Omtatah over concerns about patients’ data privacy and the bypassing of Parliament.

Africa CDC offers support

Dr Jean Kaseya, Director-General of Africa CDC.

Dr Jean Kaseya, Director-General of the Africa Centre for Disease Control and Prevention (Africa CDC), told journalists on Thursday that the body would support Zambia and Zimbabwe – and the 17 African countries that have signed MOUs with the US.

“There are huge concerns regarding data, regarding pathogen sharing,” Kaseya acknowledged. “We want to own our data in Africa. We want to own our future. We cannot accept not owning our data.”

He added: “I’m supporting Zimbabwe if they want to have further negotiations. I’m supporting Zambia and other countries. But more than that, for countries who decided to sign, we’ll support them for the implementation because we don’t want to be accused of failure in terms of implementation of the programme.’

All the African MOUs signed so far involve the US winding down previous support for African countries’ priority health programmes, particularly PEPFAR support for HIV and tuberculosis. The MOUs involve five years of US waning aid alongside increasing domestic investment.

The MOUs, concluded in terms of the new US “America First Global Health Strategy”, make access to information about dangerous pathogens a priority.

Meanwhile, earlier this month, The Atlantic reported on a leaked memo from the US State Department that indicated that seven African countries would soon lose all US humanitarian aid, as there is “no strong nexus between the humanitarian response and US national interests.”

These countries are Burkina Faso, Cameroon, Malawi, Mali, Niger, Somalia, and Zimbabwe.

Panama first non-African state to sign MOU

This week, Panama became the first non-African country to sign an MOU in terms of the “America First Global Health Strategy”.

So far, the State Department has signed 18 bilateral global health MOUs with Botswana, Burkina Faso, Burundi, Cameroon, Cote d’Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mozambique, Nigeria, Panama, Rwanda, Sierra Leone, and Uganda.

Image Credits: DFID, UNICEF Zimbabwe.

Casey MeansSurgeon general
Dr Casey Means at her Senate confirmation hearing. Means is an advocate for “whole foods” diets and largely skirted questions on her support of vaccines.

Surgeon General nominee Dr Casey Means, a confidante of HHS Secretary Robert F Kennedy, was grilled in a tense Senate confirmation hearing on Wednesday. She fielded questions on vaccines, her conflicts of interest, pesticides, and birth control, and reaffirmed her focus on America’s chronic disease epidemic, promising to use her platform to promote “whole healthy foods” and informed patient consent.

Despite her nomination by the Trump Administration to become the “nation’s doctor,” Means deflected questions on vaccination, instead focusing on nutrition, environmental health, and her commitment to the MAHA movement.

She repeated her belief that vaccination is personal – and not a message she would take up in her role. Means also reiterated her drive to reform America’s healthcare system to address the root causes of chronic diseases.

Means testified for over two hours in front of the Senate Health, Education, Labor, and Pensions (HELP) Committee. She is expected to be confirmed later this week. 

The US has been without a Surgeon General for over a year now. Past Surgeon Generals have used their position as the nation’s doctor to ring the alarm on smoking, nutrition, loneliness, and HIV/AIDS. 

Notably, it was Surgeon General Dr Luther Terry who, in 1964, published a landmark report establishing that smoking causes cancer, and Dr C Everett Koop who launched the issue into the mainstream. 

Means would lead a cadre of 6,000 Uniformed Public Health Service officers and be the Administration’s leading health spokesperson – though the question of how critical the role is has been raised given the length of the vacancy. 

Senators grill Means on vaccines

CassidyMeans hearing
Senator Bill Cassidy (R-LA), Chair of the HELP Committee, attempted to clarify Casey Means’s stance on vaccines.

Both Republican and Democratic Senators thoroughly questioned the nominee on her stance on vaccines, which the Trump Administration has come under fire for casting doubt on a variety of vaccines – and for its response to a wave of measles cases in South Carolina and Texas.

Means fielded terse questions from the HELP committee chair, Senator Bill Cassidy (R-LA) saying she would not use her platform to urge parents to have their children vaccinated against life-threatening diseases.

“I’m not an individual’s doctor, and every individual needs to talk to their doctor before putting medication in their body,” Means said. “I absolutely am supportive of the measles vaccine, and I do believe vaccines save lives and are an important part of the public health strategy.”

At times, the senators appeared frustrated at Means’ response, with Committee Chair Cassidy, who is also a physician, repeatedly asking her if she supported universal Hepatitis B vaccination.

“I am a doctor, and I am very careful with my words,” she responded. “Broadly speaking, I want to reassure you that this is not an issue that I intend to complicate or bring an agenda on vaccines.”

Senator Lisa Murkowski (R-AK) also pushed back on Means’ comments, highlighting the fragile victory of fewer Hepatitis B cases in her home state of Alaska, especially for Native Americans. “The vaccine made a remarkable difference in Alaska,” the senator said. “Other states look to us as an example.”

“You have expressed skepticism about the Hep B vaccine for newborns, and I need to try to understand your thinking on that given the medical consensus that this vaccine prevents this serious liver disease and liver cancer,” Murkowski said.

Additionally, Means left the door open to the question of the connection between vaccines and autism, which leading medical and scientific institutions have roundly debunked.

“I also think that science has never settled…we should not leave any stones unturned,” Means said in response to questions from Cassidy. 

The Centers for Disease Control and Prevention (CDC) came under intense criticism for now saying that the scientific consensus that “vaccines do not cause autism” is not evidence-based.

Stance on birth control, pesticides

Senator Husted, a Republican from Ohio, displays corn ravaged by insects as a warning of the importance of pesticides. Means attempted to appease Republicans from agricultural areas in her statements on pesticides.

Questioning regarding her views on birth control and the pill used to induce abortions, mifepristone, was equally tense. 

Means, who historically is highly critical of birth control and the negative side effects it has for women with co-morbidities, said that oral contraceptives should be accessible – though patients should have extended and thorough informed consent conversations with their providers.

Similarly, she said, “I think that every medication has risks and benefits. All patients need to have a thorough conversation with their doctor and have true informed consent before taking any medication,” in response to questions about the abortion pill.

Senators on both sides of the aisle raised questions on Means’s focus on pesticides, with Republican Senator Jon Husted (R-OH) revealing a picture of an insect-ravaged ear of corn.

“This is the kind of thing that destroys our crops all across the country, corn, wheat, soybeans, fruit and vegetables –  if we fail to use proper pesticides, it will drive down crop yields,” Husted said.

Means walked a fine line between staying true to her belief that environmental factors, like pesticides, are contributing to chronic diseases, with the Trump Administration’s support of agrochemical companies.

President Trump recently unveiled an executive order boosting the production of glyphosate, the widely used herbicide in RoundUp.  

US EPA dismisses WHO Cancer Agency Determination that Widely Used Herbicide is ‘Probably Carcinogenic’

“There are grave issues with these chemicals. I think that we are in a very complicated moment for agriculture and food. We cannot overturn the entire agriculture system overnight. That would hurt farmers. It would hurt food prices,” Means said.

Yet, the Surgeon General nominee also said, “a key passion of mine is to understand how the cumulative burden of the exposures we have in our environment, across food, water, air, soil, the products we’re putting in and on our bodies, how these are affecting our health. We know that these diseases are going up rapidly. And of course, genetics have not changed over the past decades.”

“It’s environmental exposures that are making us sick, and we have not prioritized studying that.”

Despite her commitment to environmental health, the Trump Administration, through the National Institute of Environmental Health Sciences (NIEHS), which is the main funder of this research, has said that in response to federal research funding cuts, the institute would scale back investigator funding by 15%. 

Nutrition, junk food, social media, illicit drugs

MeansSaunders Vaccines
Senator Bernie Sanders (I-VT) said he mostly agreed with what Means claimed about nutrition and the dangers of junk food.

Means remained true to her critique of ultra-processed foods and the poor state of nutrition in the US, which she said leads to blood sugar issues, infertility, and metabolic diseases. 

“Mental and physical health are unraveling from shared root causes that we can fix,” she said in her opening statement. Means promised to fight to ban ultra-processed food ads, though she declined to state that healthcare is a human right after being asked by Senator Bernie Sanders (I-VT).

Many of the senators agreed with Means and applauded her attention to the issues. Others, like Senators Halwey, Marshall, and Husted, questioned the nominee on her commitment to combatting the youth mental health crisis – including putting warning labels on social media and stricter age restrictions.

Senators also questioned Means on her views that fall outside the medical establishment, such as her discussion of the benefits of illicit drugs.

Collins Means hearing
Senator Susan Collins (R-ME) holds up Casey Means’ book in reference to Means’ discussion of the benefits of certain illicit drugs.

“Illicit drug use remains a huge problem in this country,” Senator Susan Collins (R-ME) said. “And your use didn’t happen in your teen years. According to your book, in 2021 you began using illicit psychedelic mushrooms,” Collins said to Means during the hearing. 

“What I say as a private citizen is in many cases different than what I would say as a public health official joining a team where the purpose of this role is to communicate absolutely the best evidence-based science to the American people to keep them safe, thriving, and healthy,” Means said in response.

Confronting America’s health system

Kick Big Soda Out campaign
Means said she would work with Congress to remove junk food ads targeted at children. The US is one of only a handful of countries that allows for junk food ads and pharmaceutical ads. A campaign to remove ads from the Olympics, shown here.

Casey Means earned her medical degree from Stanford University in 2014 but resigned from her competitive residency in head and neck surgery to “focus on reforming the ‘sick care’ paradigm in American healthcare,” her website reads. 

She has spoken and written at length about the scale of issues plaguing America’s healthcare system, including healthcare worker burnout.

“I deeply respect doctors, but I want to be very clear on something: at every hospital in the United States, many doctors are doing the wrong things, pushing pills and interventions when an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them,” Means wrote in her book, Good Energy.

“I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system that is not working but seems too big to change or escape.”

Mean’s attention on functional medicine and metabolic health as an answer to the country’s health woes prompted her to help found the personalized continuous glucose monitoring and coaching company, Levels. The company offers an app subscription and glucose monitor for up to $1,500 a year.

Her books, podcast, and public appearances have pointed to processed foods, environmental exposures, and the US healthcare system’s reliance on pharmaceuticals as contributing to “widespread metabolic impairment,” according to her website. She also argued that “our human health is simply a reflection of the destroyed ecosystem of our globe.” 

But her work in the wellness space has prompted critics to label her an influencer – who would use her prominent role as surgeon general for profit. 

Ties to wellness companies, conflicts of interest

Several Senators accused Means of being untruthful in her financial disclosures of her interests in wellness companies, as shown in one of her social media posts.

With over 800,000 Instagram followers and 2,000 newsletter subscribers, Means has been a prominent voice in the popular medical space.

Her following, along with the popularity of her book and podcast, points to the growing frustration at America’s healthcare system and food environment. 

In her posts on a wide variety of popular health topics, Means will often mention a sponsor in the wellness industry, including prenatal vitamins, supplements, and other products. Senators picked up on the fact that the nominee profited from these endorsements – though Means pledged to divest from any such companies should she be confirmed.

“It does not inspire confidence that you’re here to make Americans healthy when you accept money to promote a company who had to pay a settlement because of violating the False Claims Act,” said Senator Tammy Baldwin (D-WI), referring to the company Genova Diagnostics.

“You made at least $325,000 from promoting supplements since the beginning of 2024, according to information provided to this committee. This includes nearly $135,000 for a so-called ‘longevity supplement’ and $46,000 for wellness teas and elixirs, both of which can cost upwards of $100 a month for somebody consuming them,” Baldwin said.

To Baldwin, Means’s proffered solutions to metabolic dysfunctions and the root drivers were “unaffordable” to everyday Americans – and a conflict of interest. 

But Means reiterated that in her role as chief medical spokesperson, she would take on the systemic drivers of America’s ill health.

“I think that we have a monumental blood sugar problem in this country that underlies most of the leading causes of death in this country. Dementia, cancer, diabetes, heart disease, stroke are all connected by metabolic dysfunction, elevated blood sugar,” Means said.

Image Credits: HELP Committee, Vital Strategies.

Ipas aims to prevent 30% of unsafe abortions in 10 countries by 2040.

The US based reproductive rights organisation Ipas has secured a substantial grant from The Audacious Project to expand global access to abortion and contraception.

The full amount has not been disclosed as Ipas is still negotiating with the donor. 

“Every year, 35 million people end pregnancies using unsafe methods, amounting to one unsafe abortion every second of every day, with life-altering and often fatal consequences for women, girls, and their families,” said Ipas in a statement on Tuesday.

“Our vision is to prevent 16.3 million unsafe abortions and 22.6 million unintended pregnancies and to avert 39,000 maternal deaths by 2032, reducing unsafe abortion by 30% in 10 high-need countries across Sub-Saharan Africa, Asia and Latin America by 2040.” 

But achieving this vision requires substantial resources, Ipas director in the Democratic Republic of Congo (DRC), Dr Jean-Claude Mulunda, told Health Policy Watch.

“A total investment of $350 million is required to reduce unsafe abortion by 30% across 10 countries, including six in sub-Saharan Africa region,” said Mulunda.

While an initial commitment has been secured from Audacious, “discussions with several donors are still underway, and we expect to have a clear picture soon of the exact level of funding that will be made available”, he added.

Priority countries

The organisation will focus on Côte d’Ivoire, DRC, Ethiopia, Kenya, Nigeria and Zambia, as well as Bangladesh, India, Pakistan and Mexico. 

Mulunga acknowledged that several of these countries have restrictions on access to abortion.

Some countries allow abortion when a woman’s life is in danger, but healthcare providers are unsure of when and how they can help, he added.

“Ipas works with partners, with government, with the health system, to clarify through guidance so it’s easy for health providers to identify when they can provide those services,” he explained.

“The abortion ecosystem needs to shift, but we don’t wait for everything to change. We try to leverage every single positive step to transform it as quickly as possible into tangible services for women, because that is the only way for us to protect women’s lives.”

Focus activities

Ipas will focus on three activities in Africa. 

“The first involves strengthening the health system to deliver high quality of abortion care to women, while looking at diversifying pathways to care,” said Mulunga.

This includes not only improving facility-level care, but also the possibility to train pharmacists to provide information and the abortion pill to women who can self- manage their abortion .

“The second level will be around advancing laws, policies and political will to support sexual reproductive health and rights, including the right for safe abortion,” Mulunga added.

The third focus will be on “reducing stigma, strengthening referral pathways, and building a movement that will support the advocacy,” he said.

This will involve partnering with civil society organisations to enable them to support abortion advocacy, information on where women can get pills and services, and social support.

“We are honoured to be part of this inspiring Audacious Project 2025 cohort,” said Ipas CEO Anu Kumar.

“We know access to abortion and contraception leads to immense benefits to individuals, families, communities, and even countries. We want every woman and girl, no matter where they live, to have healthy, prosperous lives.”

Audacious is a collaborative donor platform that includes ELMA Philanthropies, MacKenzie Scott, Melinda French Gates’ Pivotal Ventures, Netflix co-founder Reed Hastings and his wife, Patty Quillin, and the Skoll Foundation.

Image Credits: Center for Reproductive Rights.

Kenyan nurse Everlyne Esige examines an expectant mother. Access to medicine for maternal conditions has plunged in some counties.

Kenyans’ access to a range of health products – including HIV treatment, maternal medicine, and contraceptives – plunged in three counties last year, largely as a result of the closure of the US Agency for International Development (USAID).

In contrast, Zambia showed “modest improvements” in certain areas, particularly maternal health – largely thanks to a 30% increase in domestic financing for medicines and medical supplies.

This is according to new research from the Solutions for Supporting Healthy Adolescents and Rights Protection (SHARP) Project, which compared the availability, affordability, and frequency of stockouts for 50 commodities in Kenya’s Mandera, Isiolo, and Marsabit counties and Zambia between 2022 and 2025.

In Kenya, there was a “significant deterioration” in access, including “chronic stockouts of potentially life-saving medicines, in some cases lasting several months”, according to the researchers.

‘Near collapse’ of HIV treatment

In Kenya’s largely rural Mandera County, HIV treatment availability is at a “near-collapse”, with the average for all HIV treatment at 1,5%. Three of the seven antiretroviral (ARV) medicines available in 2022 were completely unavailable in 2025, in both public and private sector health facilities. However, ARV access in 2022 was also very low in the county, averaging at around 4.5%.

People on ARV treatment run a high risk of drug resistance if they stop their medication.

In Mandera, which borders Somalia and Ethiopia, only 1.8% of women use modern contraceptions, and the fertility rate (7.7%) is double the country’s average.

While the availability of all family planning commodities was “critically low”, there had been an improvement over 2022. Availability of the most common oral contraceptive pill had increased from 17% to 25.7% of facilities, while male condoms were found in 31.4% of facilities – a substantial increase from 13.3% in 2022. 

The availability of antiretroviral medicine has virtually collapsed in Mandera County, Kenya.

Dire shortage of maternal medicine

In Isiolo County, a dry region in the east, the availability of magnesium sulphate for the management of pre-eclampsia in pregnancy fell from 35.7% in 2022 to 15.4% in 2025.

The availability of male condoms and some oral contraceptives dropped sharply from over 80% to just 38.5%. 

There were also prolonged stockouts of two medicines to treat sexually transmitted infections (STI), namely benzathine benzylpenicillin and ceftriaxone  – lasting up to 218 days.

In Marsabit County, in the north bordering Ethiopia, there was a “dramatic decline” in the availability of life-saving maternal health commodities. For example, the availability of oxytocin, the gold standard for preventing haemorrhaging, dropped from 51.9% 2022 to just 14.3% in 2025. 

Kenya has a relatively high maternal mortality rate of 355 deaths per 100,000 births.

‘Post-USAID crisis’

To compile the report, data collectors from Health Action International (HAI) and Access to Medicines Platform Kenya (AMPK) visited 86 health facilities in 2022 and 91 health facilities in 2025 from the public, private and faith-based sectors in the three counties.

They surveyed the availability, stockouts and patient prices of 50 medicines and other products. These included family planning products, maternal health medicines, STI treatment, ARVs, HIV tests, and menstrual health products. 

Aside from county variations, researchers report that adolescents’ unmet need for family planning is as high as 34%: “Without access to condoms and self-test kits, we are facing a ‘triple threat’ of unintended pregnancy, STIs, and HIV.”

AMPK executive director Dorothy Okemo said that the results “suggest that Kenya experienced a post-USAID transition crisis.” 

“USAID had previously bridged the gap for high-cost sexual and reproductive health (SRH) commodities [and] their absence created a vacuum that the public sector has failed to fill,” said Okemo.

She added that the “lack of a robust, state-funded contingency plan following the devastating cuts has effectively privatised SRH access, with the public sector left unable to serve the vulnerable communities that traditionally rely on it.”

Zambia mitigates effects with investment

In contrast, similar research by HAI with Medicines Access and Research Platform (MedRAP) across public, private, and faith-based facilities in Zambia showed “modest improvements” in certain areas, particularly maternal health. 

Teams of data collectors visited 133 Zambian health facilities in 2022 and 105 in 2025 from the public, private and faith-based sectors. 

While there were fewer stockouts in 2025 than 2022, shortages of STI treatments and “the vast majority of HIV/AIDS commodities fell between 2022 and 2025.” 

“While changes in donor funding have also affected Zambia, a 30% increase in domestic financing for medicines and medical supplies has helped cushion the impact of reduced external support, particularly from the United States,” the research notes.

Sustainable domestic finance

“The findings of these reports highlight the fragility of access to essential SRH commodities and underscore the urgent need for sustainable domestic financing in the long term,” the report notes. 

“But without the support of donor countries and other stakeholders, vulnerable communities, especially women and adolescents, risk losing access to potentially life-saving health services.”

The European Union funded the research. Many EU members have also cut their aid budgets, including for HIV.

Image Credits: Brian Otieno /Global Fund.

cosmetics beauty products PFAS
A study published in Environment & Health identified dozens of chemicals linked to cancer and reproductive harm in hair extensions. The study follows others that have revealed hidden toxics in beauty products. Yet the US remains ‘far behind’ in regulating toxic chemicals in cosmetics.

Everyday beauty and hair products on drugstore and supermarket shelves can contain chemicals known to be harmful to human health. Ingredients like PTFE, phthalates, parabens, and parfum hide in make up, shampoo, and other products – and have been linked to cancers, reproductive harm, and endocrine disruption. 

Yet cosmetics and hair products in the US are “largely regulated” and subject to an “increasingly outdated set of federal cosmetics laws,” said Congressional Representative Jan Schakowsky (IL-9), in a statement to Health Policy Watch.

Schakowsky and several other US lawmakers are spearheading stricter standards and regulations of cosmetics and beauty products. A Bill introduced at the start of the Congressional session aims to give consumers “peace of mind” about the products they buy.

“Today, the US only bans or restricts 11 chemicals compared to the European Union, which bans nearly 1,700 chemicals that are known or suspected to cause cancer, genetic mutation, reproductive harm, or birth defects. The US has a lot of catching up to do,” said Schakowsky, who sits as a ranking member of the Commerce, Manufacturing, and Trade House subcommittee. 

The push for safer cosmetics – and the lack of federal oversight – has led a half dozen states to create their own legislation. California’s Toxic-Free Cosmetics Act bans 24 chemicals from cosmetics sold in the state, including mercury, formaldehyde, 13 PFAS chemicals, and several parabens and phthalates. 

Although states have created a patchwork set of chemical bans, advocates like the Breast Cancer Prevention Partners hope to see laws to bolster the Food and Drug Administration’s ability to regulate cosmetics.

“We all deserve access to personal care and beauty products that are free from cancer-causing and other harmful chemicals, no matter where we live, work, or shop,” the advocacy and research group said. 

“Fewer than 10% of breast cancer cases are due to family history,” the group said. 

Instead, it’s often chemicals in our environment that increase the risk of certain cancers, according to another breast cancer research organization, Silent Spring Institute, a Boston-based research non-profit.

‘Largely unregulated’

cosmetics beauty products exposure pathway
Exposure to chemicals in beauty products – like PFAS and fragrances – can occur through ingestion, inhalation, and absorption.

Four years ago, the US had updated its federal regulation of cosmetics for the first time in 84 years. Congress enacted the Modernization of Cosmetics Regulations Act of 2022 (MoCRA) to authorize the FDA to regulate fragrance allergen labeling, standardize testing methods for detecting asbestos and talc-containing products, ensure Good Manufacturing Practice requirements for cosmetics factories, and publish assessments of PFAS in cosmetics.

However, “there is still work to be done,” said Schakowsky. “While MoCRA significantly increased FDA’s oversight, we still must prioritize banning toxic chemicals linked to hormone disruption, cancer and other health problems once and for all.”

She also noted the need to “provide full ingredient transparency for consumers and manufacturers; and protect the health of women of color and salon workers, who are among the most highly exposed to toxic chemicals because of the products marketed to them or commonly found in their workplaces.”

The lack of transparency in ingredients in the US has meant that states, rather than the federal government, have picked up the slack in regulating cosmetics.

In addition to California’s Toxic-Free Cosmetics Act, the state also banned an entire class of PFAS from being added to cosmetics. These chemicals are added to improve consistency and texture in products like shampoos and foundations. 

Exposure to the PFAS in these products can happen through ingesting lipsticks, absorption of mascara through tear ducts or lotion through the skin, and inhalation or spray on products and powders, according to a University of Notre Dame study.

The researchers found that the ingredient lists of most products tested “did not disclose the presence of fluorinated compounds”, exposing a gap in US labeling laws.

“We must focus on transparency and ingredient disclosure,” said Schakowsky. “The FDA needs to require disclosure of ingredients and additional safety information between entities in the cosmetic industry supply chain. Consumers deserve to know that the products that they are using on themselves and their kids are safe and what exactly is in them.”

Hair extensions ‘laden’ with chemicals 

black hair chemicals cosmetics
“This is an industry that has long overlooked the health of Black women, who should not have to choose between cultural expression, convenience, and their health,” said lead author Dr Elissia Franklin.

The average American woman will use 13 personal care products a day. Teenage girls use, on average,17 products. The gap between men and women is shrinking; men now use 11 products daily, which is double the figure of two decades ago.  

But the toxicity of these products, especially in hair extensions, has been largely unexplored. 

Researchers at Silent Spring Institute examined 43 common hair extension products for a range of toxic chemicals in a recently published study. 

Their analysis revealed that weaves, wigs, and other products are laden with flame retardants, phthalates, pesticides, styrene, tetrachloroethane, and organotins – chemicals linked to cancer, hormone disruption, developmental problems, and effects on the immune system. 

“While prior reports have found some chemicals of concern in hair extensions, there’s still much we don’t know about their overall chemical makeup. We wanted to get a better picture of the extent of the problem,” said lead author Dr Elissia Franklin, an analytical chemist and research scientist at Silent Spring Institute, in a press statement. 

“This is an industry that has long overlooked the health of Black women, who should not have to choose between cultural expression, convenience, and their health.”

“[C]ompanies rarely disclose the chemicals used to achieve these properties, leaving consumers in the dark about the health risks from prolonged wear,” Franklin said. 

Fibers made from synthetic materials or even human hair are often treated with these chemicals to make them waterproof or antimicrobial. But woven onto wearers’ heads, they sit on the scalp and neck for extended periods of time. Franklin’s team used a non-targeted analysis to screen these samples and a combination of gas chromatography and high-resolution mass spectrometry to detect the toxic chemicals. 

The authors noted that all but two of the 43 samples contained hazardous chemicals, with nearly 10% harboring organotins – a compound typically used to heat stabilize PVC. 

For Silent Spring, the finding that 17 chemicals related to breast cancer were found in more than 80% of the products tests, were especially poignant, as the group was founded to focus on breast cancer prevention through uncovering the links between everyday chemicals and women’s health. 

A global market – and unequal exposure

black women cosmetics chemicals
Use of cosmetics and hair products is expected to grow globally as products become more affordable and accessible.

Worn for convenience, cultural, and personal reasons, hair extensions are now a global market projected to surpass $14 billion in 2028. The US leads in global imports. However, other regions, including Africa, are expected to start to make up a larger part of the market share.

The globalization of hair products – from sourcing in India to chemical treatment in China – has also meant an increase in everyday exposure for millions of women.

More than 70% of Black women reported wearing hair extensions at least once in the past year, according to a University of California Berkeley study. Less than 10% of women of other racial and ethnic groups use these products, meaning that the burden of exposure is unequal. 

Beyond hair products, Silent Spring notes that “studies show women of color face higher exposures to toxic chemicals relative to White women, regardless of socioeconomic status.

“Black women and children also have increased rates of hormone-mediated health conditions. For example, in the United States, Black women have higher rates of diabetes, experience earlier menarche, more prevalent fibroids, and more aggressive forms of breast and endometrial cancers.”

Schakowsky also underscored this disparity. Part of her bill package funds research, education and outreach, and the development of safer chemicals to protect the health of women of color and salon workers – and requires the FDA to regulate the safety of synthetic braids, which can contain toxic chemicals.

“Professional salon workers and communities of color bear a disproportionate burden of toxic exposures because of where they work, the products they work with, and the toxic products marketed to them,” she said.

And while the package was introduced last year to little traction, Schakowsky and her team are still optimistic that clean cosmetics have plenty of supporters in Congress.

“I strongly believe consumers should not have to wait another 84 years to get the cosmetic safety protections they want and deserve,” Schakowsky said.

Image Credits: S. Samantaroy/HPW, Whitehead et al, Unsplash, Unsplash.

The American Academy of Pediatrics (AAP) is contesting the CDC’s reduction in routine vaccines, warning that it will endanger babies.

The US Health and Human Services (HHS) has cancelled this week’s meeting of its Advisory Committee on Immunization Practices (ACIP) amid a court challenge to the committee’s composition and decisions, led by the American Academy of Pediatrics (AAP).

Meanwhile, the long-delayed Senate panel confirmation hearing for US President Donald Trump’s nominee for Surgeon General, Casey Means, convenes on Wednesday (25 February). Means, a 38-year-old wellness influencer who has linked vaccines to autism, was nominated on the advice of HHS Secretary Robert F Kennedy Jr, according to Trump

Her brother, Calley Means, co-founder of an online wellness sales platform, is Kennedy’s special advisor. The Means siblings co-authored a book called Good Energy, in which they argue that all chronic conditions are caused by metabolic dysfunction linked to lifestyle.

Since Kennedy took office last February, he has consistently chipped away at vaccines’ credibility and access.

Last June, Kennedy fired all 17 members of ACIP, which advises the US Centers for Disease Control and Prevention (CDC) on immunisation, and appointed several vaccine sceptics in their place.

In early January, the CDC announced that vaccines for Hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19 would no longer be routinely recommended but “remain on the schedule based on shared clinical decision-making”.

The AAP has issued its own routine child and adolescent vaccine schedule, endorsed by 12 other national health organisations, which retains as routine the vaccines that the CDC no longer recommends.

In the past, the AAP partnered with the CDC to present a unified set of vaccine recommendations, but says that “recent changes to the CDC immunisation schedule depart from longstanding medical evidence and no longer offer the optimal way to prevent illnesses in children.”

“AAP recommends immunisations that have been designed to teach the immune system to recognize and resist serious diseases,” said Dr Sean O’Leary, chair of the AAP Committee on Infectious Diseases. “They are carefully tested and monitored over time. The pacing and combination of vaccines are based on what we know about when your child’s immune system is ready to learn and respond best.”

The US has seen a resurgence in measles cases in the past year, fueled by misinformation and falling vaccination coverage. South Carolina has reported nearly 1,000 cases since October.

Casey Means, Trump’s nominee for Surgeon General, being interviewed on the Joe Rogan show.

Kennedy’s ‘arbitrary and capricious actions’

Last week, the AAP, American Public Health Association (APHA), American College of Physicians, Infectious Diseases Society of America and several other US medical organisations applied for a preliminary injunction to block the CDC’s changes to federal vaccine recommendations and to stop the ACIP meeting.

In their court papers, the bodies accuse Kennedy of “arbitrary and capricious actions” that “sow confusion and undermine public health, purposefully disregard and contravene required process, and ignore decades of established science.”

Judge Brian Murphy of the US District Court of Massachusetts has yet to rule on the application, which he heard on 13 February. But in the meantime, the ACIP meeting, which was due to start on Wednesday, has been called off.

But the decision to cancel the ACIP meeting, which removes the urgency for the judge to rule, may simply have been taken because the HHS failed to announce the meeting on the Federal Register within seven days and post an agenda, as required by law.

Kennedy’s former organisation, the Children’s Health Defense (CHD), also issued an urgent court application last week to join the case as a defendant, alongside Kennedy and the HHS. Murphy has yet to decide on CHD’s application.

CHD is routinely involved in opposing vaccinations, erroneously claiming on its website that “countless peer-reviewed observational studies show unvaccinated populations consistently have fewer chronic health conditions than vaccinated peers.”

Dr Susan Monarez, the former CDC director nominated by the Republican Party, who was fired by Kennedy after 29 days.

The next court hearing about the injunction is on 4 March. The case is part of a series of AAP-led court actions aimed at preserving federal vaccine recommendations, which started last July after HHS removed COVID-19 vaccines for children and pregnant women. The court papers have since been amended to include a challenge to Kennedy’s firing of all 17 ACIP members and the January changes to routine childhood vaccination.

Meanwhile, Kennedy ally Dr Jay Bhattacharya, currently head of the National Institutes of Health, has also been appointed  as acting CDC director. Bhattacharya can only serve until late March as federal law requires the US president to nominate a replacement within 210 days of HHS firing the previous director, Susan Monarez, which took place in late August.

After her firing, Monarez and Dr Debra Houry, the CDC’s former Chief Medical Officer, told a Senate health committee hearing that Kennedy is driving an agenda based on ideology not science, and he had tried to reduce the CDC to a rubber stamp.

Since Kennedy took over HHS, thousands of people working in the CDC, NIH and other government health bodies have been fired. The Trump administration has also dismantled major global health 

A snapshot of some of the changes to the CDC’s budget under the current Trump administration. Some functions have moved to the newly formed Administration for Healthy America (AHA). 

In response, several organisations have been formed to contest the views and actions of Kennedy and his allies. These include Stand up for Science, which was formed to oppose political interference in science, secure and expand funding for science and safeguard equal opportunities for all people to become scientists. It is leading a call to impeach and remove Kennedy. 

Fired CDC workers – estimated to number over 4,000 – have formed the National Public Health Coalition to champion health causes that are no longer supported in the current CDC, and monitor the health cuts via the CDC Data Project.

Image Credits: CDC/ Unsplash, CDC Data Project.

NIH director Jay Bhattacharya
Dr Jay Bhattacharya, seen here testifying before the Senate Health Committee, will now also serve as acting director of the CDC.

Dr Jay Bhattacharya, the director of the National Institutes of Health, will take on an additional role in the Administration of US President Donald Trump as acting director of the Centers for Disease Control and Prevention (CDC), long seen as a leading reference point for public health policy not only in the US but worldwide. 

Bhattacharya succeeds Dr Jim O’Neill, a science and tech investor who has been acting CDC director since August 2025.  O’Neill, who lacks any medical or research experience, is now being tapped to oversee the National Sciences Foundation in what critics described as a “musical chairs leadership shakeup for science agencies.”

Bhattacharya, meanwhile, will lead both NIH and CDC until President Trump appoints a permanent director for the latter – reflecting the tightening grip of a small coterie of Health Secretary Robert F Kennedy Jr and Trump confidantes around the leading US health policy, science and research institutions.

A permanent appointee to head the CDC would require Senate confirmation. Susan Monarez, the first Senate-confirmed CDC director under the Trump administration, led the agency briefly in 2025, before being ousted by Kennedy Jr just 29 days into her tenure.

In Senate testimony about her firing, Monarez told the Senate Health Committee members that she refused Kennedy’s requests to “replace evidence with ideology,” in pre-approving vaccine recommendation changes and in firing career public health officials.

Musical Chairs: Jim O’Neill (center) sworn in as Deputy HHS Secretary in June, 2025. In August he became Acting CDC Director. Now he is to lead the National Science Foundation.

Bhattacharya will have to balance managing the nation’s premier biomedical agency headquartered in Bethesda, Maryland, with running the federal public health agency, in Atlanta, Georgia. But the geographic distance is not the only challenge the incoming director faces.

Now positioned to reduce US vaccine schedules

The CDC vaccine advisory committee, also hand-picked by Kennedy, has made clear that its recommendations aim to reduce the number of shots American children should get, with the committee’s most recent recommendations dropping six common vaccines. The changes made good on Kennedy’s promises to reverse decades of US vaccine policy. 

As CDC’s acting director, hand-picked by Kennedy and a close ally, Bhattacharya is positioned to oversee further rollbacks in vaccine schedules, although the NIH director has stated he does support vaccinations for major childhood diseases. 

“The measles epidemic [is] best solved by parents vaccinating their children for measles,” he said during a Senate hearing in early February. The US has seen a resurgence in measles cases in the past year, fueled by misinformation and falling vaccination coverage. South Carolina reported nearly a thousand cases since October.

Along with the festering vaccine debate, the CDC has also seen mass layoffs as well as closures of departments that monitor infectious disease trends, support mental health, and manage tobacco and substance use prevention. 

Kennedy and his team claim that they have acted to reduce what they term “bureaucratic bloat” and conflicts of interest in the nation’s medical agencies. But some critics, including Dr James Alwine, speaking on behalf of  the alliance ‘Defend Public Health’,  argue that the movement championed by Kennedy is a new form of conflict of interest. 

“They promote ‘Medical Freedom,’ which is simply underwriting the largely unregulated multi-billion dollar wellness industry,” Alwine , an emeritus professor of cancer biologist at the University of Pennsylvania, said in a statement to Health Policy Watch.

“And the negative results of [this] movement are appearing as vaccine hesitancy rises, with increased cases of measles, whooping cough, flu, tetanus, mumps, and more. Children are suffering and dying.”

COVID-19 contrarian

HPV vaccine
Vaccine policy has been at the center of the Trump Administration’s public health controversy.

Bhattacharya rose to prominence during the COVID-19 pandemic as an outspoken critic of the US management of the pandemic – particularly state-mandated shutdowns, as well as CDC  recommendations regarding vaccination and public use of masks.  A Stanford economist and physician, Bhattacharya co-wrote the Great Barrington Declaration, which argued for minimal COVID restrictions to boost ‘natural’ herd immunity.

The declaration was embraced by the Trump Administration and conservative news outlets. But critics pointed out that achieving herd immunity for COVID-19 without vaccines is both unethical and improbable. 

Bhattacharya will have to contend with an agency gutted of its top leadership after conflicts with Secretary Kennedy over vaccine recommendations. 

“I resigned because CDC leaders were reduced to rubber stamps, supporting policies not based in science and putting American lives at risk,” said Dr Debra Houry, a career CDC official and former CDC Chief Medical Officer, during Senate testimony on her resignation in September 2025.

“Secretary Kennedy censored CDC science, politicized its processes, and stripped leaders of independence.”

Image Credits: C-SPAN, HHS Photo by Amy Rossetti, National Cancer Institute on Unsplash.