Dr Tedros Adhanom Ghebreyesus (right) opens the 13th round of the pandemic talks, flanked by co-chair Anne-Claire Amaprou

“It’s now or never,” World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyussus told the start of the 13th round of talks on a pandemic agreement on Monday morning.

Five days of talks are scheduled this week with another five days scheduled in April. Thereafter, the plan is for an agreement to be presented at the World Health Assembly in May.

Those close to the process said that the “stock take” this Friday will be an important gauge of whether the talks will succeed.

Negotiators’ failure to reach agreement may mean the end of the road for the global endeavour to pandemic-proof the world. Energy and interest in the talks have waned considerably over the four-plus years of talks.

“I’m confident that you will choose ‘now’, because you know what is at stake. You remember the hard-won lessons of COVID-19, which left an estimated 20 million of our brothers and sisters dead,” said Tedros.

“We know that the next pandemic is a matter of when, not if. There are reminders all around us – Ebola, Marburg, measles, mpox, influenza and the threat of the next Disease X,” he added.

“No country can protect itself by itself. Bilateral agreements will only get you so far. Prevention is the responsibility of all countries. Preparedness is the responsibility of all countries, and response is the responsibility of all countries.” 

The US, although still technically part of the WHO until next January, informed the WHO last Friday (14th) that it would not take part in the Intergovernmental Negotiating Body (INB) overseeing the talks.

Trump’s executive order withdrawing the US from WHO explicitly states that “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.” 

“Like the [US] decision to withdraw from WHO, we regret this decision and we hope the US will reconsider,” Tedros told the INB.

Moving away from grandstanding?

INB co-chairs Precious Matsoso (left) and Anne-Claire Amprou.

INB co-chair Precious Matsoso told the meeting that the Bureau, which co-ordinates the talks, had taken heed of countries’ request to “propose text for all the outstanding work”.

“We did just that, and we’re hoping that, with what we’ve presented before you, to be able to move as fast as possible because we’ve got only 10 [negotiating] days left before we present the pandemic agreement to the World Health Assembly,” said Matsoso.

The latest draft of the pandemic agreement reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points. 

Matsoso also urged member states at the opening to confine their comments to the text at hand rather than making general comments – and for the first time, the open session was not dominated by repetitive grandstanding. 

With only Iran using the opening to make a general point, member states’ restraint is a positive indication that countries may finally be moving away from rigidly held positions.

Equity and solidarity

Stakeholders, who are not allowed into the negotiations, used their time slots during the open session to appeal for the deal to be struck, for equity to remain a cornerstone and to advocate for technology transfer to prepare for pandemics.

“Do not walk away from this vital mission,” urged the Pandemic Action Network’s Rafael Garcia Aceves.

“Bank and build on the promising consensus agreed thus far. Continue to advance a pandemic agreement that can lay the essential groundwork for equitable collective preparedness and response in 2025, which can be made stronger and more detail added in future through protocols.”

Ellen ‘t Hoen of Medicines Law and Policy.

Ellen ‘t Hoen of Medicines Law and Policy said that “more than ever, the world needs a signal that multilateralism works, that solidarity is at the core of the pandemic agreement and that no country will be left alone to deal with pandemics, either current or future ones”.

“That is not the predominant spirit in Geneva – or the world for that matter – at the moment, but you can bring it back.”

Spark Street senior researcher Elliot Hannon warned that “the world has changed immeasurably” since the last negotiating session in December before US President Donald Trump took over.

“The global multilateral system is under siege, threatening the very institutions developed to promote and protect health around the world,” said Hannon.

“The pandemic agreement is a concrete action against this great dismantling. Its completion would not only make the world safer but affirm the commitment to equity, integrity and solidarity,” said Hannon, adding that trying to perfect every aspect of the agreement was an unaffordable luxury.

The South Centre stated that, “without legal commitments to enhance sharing of technology and know how, and surge financing, it will not be possible to ensure timely global production of and equitable access to effective vaccines during pandemics, as during COVID-19.

The South Centre said that a “democratic vote” was the way forward to settle “divergencies” rather than “continuously” watering down the text down “to find consensus”, deferring  decisions “to uncertain future negotiations or decisions by the Conference of the Parties”.

Jamie Love

Knowledge Ecology International’s Jamie Love pointed out that the agreement’s definition of “technology transfer” was weaker than that permitted by US and European law, while, Oxfam’s Mogha Kamal-Yanni called for the agreement to contain “legal obligations” to share technology and remove intellectual property barriers.

This round of talks ends on Friday evening.

Dr. Sania Nishtar, Chief Executive Officer, Gavi, in Cairo.

In a breakthrough moment for Africa’s vaccine independence, two landmark deals could help put the continent on a path to becoming a producer, not just a buyer, of life-saving vaccines.

For the first time, an end-to-end mRNA vaccine production platform will be built in Africa, with plans to manufacture 100 million doses annually. A separate cross-continental partnership is advancing homegrown mRNA technology. These landmark agreements, signed in Cairo, are backed by a $1.2 billion investment from Gavi, The Vaccine Alliance. They aim to ensure vaccines are made by Africa, for Africa, and set the stage for expanded local vaccine production and cross-continental collaboration.

The first deal, signed in Cairo on the sidelines of the 2nd Vaccine & Other Health Products Manufacturing Forum, brings together EVA Pharma (Egypt) and European biotech firms DNA Script (France), Quantoom Biosciences (Belgium), and Unizima (Belgium) to establish Africa’s first “digital-to-biologics” end-to-end mRNA vaccine production platform. The facility is expected to produce up to 100 million vaccine doses annually, a significant boost for Africa’s ability to respond rapidly to infectious disease outbreaks and strengthen routine immunization programs.

2nd Vaccine Manufacturing Forum

In a second agreement, Biogeneric Pharma (Egypt) and Afrigen (South Africa) will expand their collaboration on mRNA vaccine technology development, reinforcing cross-continental expertise in cutting-edge mRNA vaccine applications to new diseases that have a high burden in Africa. 

“These agreements are proof that Africa is no longer just a buyer of vaccines—we are becoming producers,” said Dr. Jean Kaseya, Director-General of Africa CDC, at the conference’s closing ceremony. “This is the future of health security on the continent.”

Gavi’s $1.2 Billion Investment to Drive Manufacturing Growth

Afrigen’s mRNA hub in Cape Town, launched in February 2022, and now set to expand.

The two deals were announced alongside a broader effort to accelerate vaccine manufacturing in Africa, backed by a $1.2 billion investment from Gavi, the Vaccine Alliance.

The catalytic investments, recruited for Gavi’s newly formed African Vaccine Manufacturing Accelerator (AVMA), launched in June 2024, will be deployed over the next ten years to incentivize African manufacturers to produce priority vaccines, such as cholera and mRNA-based immunizations. AVMA leverages Gavi’s role as one of the world’s largest purchaser of vaccines to promote local manufacturing in Africa. Crucially, Gavi’s financial model ensures that licenses are held by African manufacturers, keeping intellectual property and production capacity on the continent.

“This is about building a sustainable vaccine ecosystem in Africa,” said David Kinder, Director of Development Finance at Gavi. “We are using our market power to drive investment where it’s most needed—ensuring Africa can produce its own vaccines, for its own people.”

Securing Demand and Regulatory Readiness

BioNTech’s modular mRNA vaccine manufacturing opened in Rwanda in 2023.

At present, while demand for vaccines in Africa is valued at over US$ 1 billion annually – Africa’s vaccine industry provides only around 0.1% of global supply. The African Union has set a target for the continent to produce 60% of the vaccines it needs by 2040.

While some new investments in vaccine production were made on the wave of interest created by the COVID pandemic, such as the Afrigen mRNA research hub, launched with WHO support in 2022, and BioNTech’s modular mRNA vaccine facility, in Rwanda, African manufacturers still face a major challenge: securing stable demand. Historically, global health agencies and African governments have sourced vaccines from long-established manufacturers in the Global North, leaving local producers struggling to compete.

To address this, officials at the Cairo summit called for a continent-wide pooled procurement mechanism, modeled after Egypt’s Unified Procurement Authority (UPA). Egypt’s system has successfully lowered costs and stabilized supply chains, and experts believe a similar approach at the African Union level could ensure consistent demand for vaccines produced within Africa.

“We must ensure that African-made vaccines have a guaranteed market,” said Dr. Khaled Abdel Ghaffar, Egypt’s Minister of Health and Population. “A pooled procurement system could be a game-changer, ensuring fair pricing and sustainability.”

Another critical issue discussed at the forum was Africa’s regulatory capacity. While manufacturing is expanding, vaccines must meet strict international quality standards to be used across the continent and beyond.

In December 2024, Egypt achieved WHO’s Maturity Level 3 in terms of the quality of its national regulation of vaccines and medicines – following South Africa, which reached that milestone in 2022.  The African Medicines Agency (AMA) , still in the process of establishment, is supposed to lead effort to harmonize regulatory approvals across Africa, making it easier for locally made vaccines to reach wider markets. See related stories here:

African Medicines Agency Countdown

Gavi’s Replenishment and Africa’s Push for Funding

The investments in African manufacturing come at a pivotal moment for Gavi, which is seeking $9 billion in new funding for 2026-2030 to sustain its work in Africa and beyond.

At the Cairo forum, African leaders threw their support behind Gavi’s replenishment effort, pushing for global donors to meet the funding target.

“We need a well-funded Gavi,” said Dr. Kaseya, who pledged to push for African leaders to back Gavi’s funding request at the upcoming African Union Assembly.

Momentum for local vaccine production will continue in June 2025, when Africa’s first annual vaccine and biopharmaceutical manufacturing exhibition, Africa Excon, will be held in Egypt. The event will showcase progress in local production and attract investment, ensuring Africa’s vaccine ambitions continue to gain traction.

Despite the challenges, leaders at the Cairo summit were optimistic about the future. “We are no longer just talking about vaccine sovereignty,” Dr. Kaseya said in his closing remarks. “We are making it happen.”

Image Credits: Rodger Bosch for MPP/WHO, BioNTech.

A tuberculosis patient in Mozambique who completed treatment thanks to a USAID-supported health worker. USAID administers all US bilateral aid for fighting TB.

A coalition of American non-profit, legal and small business groups welcomed a federal judge’s temporary restraining order (TRO) halting the Trump Administration’s executive order freezing virtually all USAID activities – followed by a “stop work” order on the agency by new US Secretary of State Marco Rubio. 

The ruling Thursday evening in a Washington DC District Court came in response to a lawsuit filed by the Global Health Council, the Small Business Association for International Companies, HIAS, the Jewish-American refugee aid agency; and the American Bar Association.

“This ruling is a vital first step toward restoring U.S. foreign assistance programs,” said Elisha Dunn-Georgiou, President of the Global Health Council, a member based body. “It clears the path for organizations to resume their life saving work, showcasing the best of American values: compassion, leadership, and a commitment to global health, stability, and shared prosperity.”

In their suit, the groups contended that by attempting to dismantle an independent agency established by Congress, the Trump Administration was “unlawfully withholding billions” in foreign aid. 

“The Administration has forced businesses large and small to shutter programs and lay off employees. These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support,” the charged the plaintiffs in the suit, which included Management Sciences for Health, Chemonics International, DAI Global, and Democracy International – non-profit and for-profit groups that are major USAID subcontractors.

Impacts and ongoing uncertainties 

MANA Nutrition Factory in Fitzgerald, Georgia, which produces specialized nutritious foods to treat acute malnutrition. Among the thousands of US businesses affected by the USAID freeze.

On paper, the TRO blocks the government from taking actions that would disrupt U.S. foreign assistance programs including:

  • Suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or
  • Issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.

However, with USAID personnel around the world on forced furloughs, budget systems frozen, and grain donations rotting in US ports, it remained unclear if a temporary order, on its own, could rapidly reboot the massive $40 billion-a year apparatus  – including $8.5 billion in global health assistance. 

“Despite the restraining order, much of the damage to US foreign assistance and to our agencies and humanitarian workers is already done. Within a matter of weeks, the President has succeeded in all but decimating USAID and has perhaps irreparably damaged the goodwill and reputation of the United States,” said Lawrence Gostin of Georgetown University.

“It is hard to describe the chaos at USAID, with funds frozen, staff let go, and partners all over the world feeling shattered. Even foreign aid programs that have received a waiver from the freeze cannot carry out their functions. This has caused enormous human suffering and hardship, with children starving and at risk of stunting, persons living with HIV unable to access their medications, and humanitarian assistance at a grinding halt,” he added, citing a recent article in the peer-reviewed journal Health Affairs.

Gostin, who heads a WHO Collaborating Center on law and global health policy, was pessimistic about the possibility of legal action changing policies in the long-term, saying, “no matter what the courts ultimately do, the harms will be real and palpable. And in the end, the President will probably prevail in the courts. He may be forced to actually follow a logical process and not be arbitrary and capricious. He may have to unfreeze funds until he can get Congress to join him in decimating USAID. But the president has a highly compliant Supreme Court that seems to back him on almost anything consequential.”

Pressure growing on  Trump administration 

At the same time, the pushback, coming from multiple corners could help swing the pendulum back over time.  “Some push back is good and in the end things will not be as bad as first thought,” one USAID insider, speaking confidentially, told Health Policy Watch. 

Pressures are building, for instance, from farmers in so-called “Red” or Republican states, who sell hundreds of millions of dollars in grain to USAID and, via USAID, to the World Food Programme (WFP) every year, to feed hungry people around the world. Ambassadors, who see USAID as a vital form of “soft power” for the US in the geopolitical competition with China, Russia and Islamic extremists, are also likely to protest quietly.

“I have been waiting for the agriculture sector to weigh in. They will take a big hit from the President’s actions,” Gostin said. While WFP said on Tuesday that its deliveries of food aid stuck in US ports were allowed to resume on 11 February, the Trump-ordered pause in new food aid purchases and stop work orders on new WFP purchases has remained in effect.

Biggest provider of global health foreign aid

“By attempting to dismantle an independent agency established by Congress and unlawfully withholding billions in foreign-assistance funding, the Administration has forced businesses large and small to shutter programs and lay off employees,” said the Global Health Council in its statement on the temporary restraining order.

“These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support.”  

USAID implements most US global health funding.

With a global health budget of $8.5 billion annually, USAID is the largest US provider of global health assistance, far outpacing the Department of Health and Human Services, and PEPFAR, the President’s Emergency Plan for AIDS Relief.  In fact, USAID implements most US bilateral global health funding, including 60% of  PEPFAR’s $4.2 billion budget for HIV/AIDS in 2023. 

Along with the already well-reported impacts of USAID’s collapse in battles against infectious diseases like polio, HIV/AIDS, influenza, malaria, marburg and Ebola, there has been a ripple effect to an even broader range of activities related to global health security,  health services, and nutrition, the GHC noted in a briefing note issued last week. Some of those include: 

  • A halt to the flow in over $1 billion in pharmaceutical donations, including HIV drug supplies; as well as USAID facilitated global biotech and research partnerships with US companies; 
  • Interruption in the services of thosuands of maternal and child nutrition centers; care for pregnant women and orphans; in conflict zones and the world’s poorest countries.
  • A halt to USAID support for thousands of frontline health clinics in vulnerable countries and conflict zones, including: Afghanistan, Ethiopia, Myanmar, the Democratic Republic of Congo; Guatemala and Honduras.

For maternal and child health and TB, USAID was the implementer of all US bilateral support in 2023. It also managed 99% of family planning and reproductive health funds and 96% of funds for malaria control efforts.

CDC finally reports on avian flu spread   

CDC finds vets working with dairy cattle unknowingly exposed to H5N1 avian flu.

In other developments, the US Centers for Disease Control, finally issued an update on Avian flu to its Morbidity and Mortality Weekly Report (MMWR), which showed that some veterinarians working with cattle were unknowingly infected with the H5N1 (avian flu) virus last year.

The report is the latest to indicate that the outbreak in dairy cattle is spreading further under the wire. The CDC report was one of several MMWR reports on avian flu that were to have been released three weeks ago. 

Inother report published this week, the CDC cited new USDA data on the rapid spread of H5N1 bird flu in poultry, showing some 157 million birds have so far been affected, since the first detections in 2022. The outbreak has caught the attention of the US public as the price of eggs soars to a 50-year high. 

Avian flu continues to spread amongst US poultry flocks.

States can opt out of testing dairy cattle for avian flu 

As for the dairy herds, USDA tables and maps showing trends in the spread of the highly pathogenic virus in dairy herds, across different states, which typically linked to the MMWR reports were no longer visible on the web page.  The USDA pages have not been updated since 17 January.  

But even that data, when available, was incomplete since federal law allows states to opt out of testing dairy cattle, noted Kay Russo, a dairy and poultry veterinarian.  He said the new CDC report on the silent spread of the virus among veterinarians underscores an urgent need for more routine monitoring of animals in agriculture.

“The frequency may be insufficient to proactively warn and safeguard workers,” Russo told the Washington Post. 

“This is a critical worker safety issue for farm and processing plant workers,” said Russo, who has worked on the outbreak since last March. “I can’t help but feel we’re missing huge pieces of the puzzle at this time.”

–Updated 16 February, 2024

Image Credits: Arnaldo Salomão Banze, ADPP Mozambique, USAID, KFF , US CDC , US CDC .

INB negotiations underway in Geneva for a pandemic agreement

Civil society groups have urged World Health Organization (WHO) member states to “continue to advance a pandemic agreement that can lay the essential groundwork for equitable, collective preparedness and response” ahead of the 13th meeting of the negotiating forum on Monday  (17 February). 

Only 10 negotiating days are left until the World Health Assembly in May, which is due to adopt the pandemic agreement. 

“Despite geopolitical and policy challenges, do not walk away from this vital mission. We urge Member States to stay focused on the end goal. Bank and build on the promising consensus agreed thus far,” urged the Pandemic Action Network, Panel for a Global Public Health Convention, Spark Street Advisors and The Independent Panel for Pandemic Preparedness and Response in a statement.

The latest draft of the pandemic agreement (from INB12, 6 December) reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points as countries struggle to devise a global plan to advance pandemic prevention, preparedness, and response. 

However, the new draft also contains more detail about what is expected from each member state to prevent outbreaks from becoming pandemics – which is an anxiety for poorer nations who fear this might mean more onerous financial commitments.

Since the last meeting of the Independent Negotiating Body (INB) in December, “we have witnessed deepening outbreaks of mpox and H5N1 and new outbreaks of Sudan Ebola and Marburg viruses. Any one of these threats risks spreading further without strong and decisive leadership and action,” the groups note.

“The finish line is in sight. Pandemic threats remain. The world needs member states to agree to a historic pandemic agreement and demonstrate the solidarity essential to keep us all safer. We are counting on you to pull together and get the agreement done.”

While the US and Argentina have given notice that they intend to withdraw from the WHO,  the US has to give a year’s notice so it technically remains part of all WHO member state bodies. At the recent WHO Executive Board meeting, the US was represented by technical officers at the US Geneva Mission. But US delegates to the EB made just one statement, on Taiwan, along with voting on geopolitically charged issues, such as an Israeli motion to combine the annual debates on two resolutions related to the health situation in the Occupied Palestinian Territories, into the agenda of WHO’s broader emergency work – a motion which lost.

However, sources told Health Policy Watch that US diplomats would not attend the INB negotiations at all. In fact, the Trump executive order withdrawing from WHO explicitly states that the “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.”  Amendments to the IHR, intended to provide for faster notice by countries to WHO and more efficient global response on epidemic threats, were approved in fact at the 2024 World Health Assembly, so it’s unclear if the US can retroactively declare that those have no binding force.  See related story.

‘The World Has Won’: New International Regulations to Protect Against Pandemics Finally Approved

As for Argentina, there is in fact no process for members states besides the US to withdraw without first obtaining agreement of the World Health Assembly – remaining in WHO as an “inactive” member is an option a few member states have used in the past, said Chief Legal Counsel Steve Solomon in a WHO press briefing Wednesday.

Solomon explained that when the United States first joined the WHO in 1948, it did so with a condition that it was entitled to withdraw if it chose to do so, but no other member state made that a provision of their original membership.

Robert F Kennedy Jr, Trump’s pick for US Health Secretary, was confirmed Thursday morning after weeks of contentious debate.

WASHINGTON, DC – The US Senate on Thursday voted to confirm Robert F Kennedy Jr as the next Secretary of Health and Human Services – with most Republicans setting aside concerns about his long record of vaccine hesitancy as well as skepticism of scientific research on infectious diseases. 

Republic Senator Mitch McConnell, himself a polio survivor, cast the sole Republic vote against Kennedy, a former Democrat, turned independent who then aligned himself with Donald Trump in the final stages of his campaign. Some 47 other senators –all Democrats – voted against his confirmation.

Kennedy, an environmental lawyer, has for decades been the face of a vocal anti-vaxxer movement claiming that even the polio vaccine had killed more people than it had saved. 

But in the past months, he has re-entered America’s political consciousness with his promise “to make America healthy again (MAHA).” After a failed bid for president as an independent, Kennedy joined Donald Trump’s campaign. President Trump vowed to let Kennedy “go wild” on healthcare. 

With his MAHA refrain, Kennedy quickly gained his own national following with his vow to “put the health of Americans back on track,” citing America’s growing chronic disease rates.  During Senate confirmation  hearings last month, he did not entirely renounce his anti-vax views, but said that he would not curtail Americans’ access to vaccines. 

While many of Kennedy’s critics have said that while his interest in addressing the triple American crises of obesity, mental health and substance abuse, is welcome, his reluctance to apply scientific solutions to infectious diseases could threaten Americans’ health very immediately – particularly if a virus like H5N1 avian flu, which has infected millions of poultry and dairy cattle across the United States, spins out of control.

Schumer kennedy debate
Senate Minority leader Chuck Schumer (D-NY), called Kennedy “of the least qualified people” to ensure America’s health.

Speaking just before the vote on Thursday, Senate Minority leader Chuck Schumer (D-NY), called Kennedy “of the least qualified people” to ensure America’s health. In his final appeal to colleagues, Senator Ron Wyden (D-OR) also warned that a vote for Kennedy could spell the end of Medicare for older Americans and healthcare coverage for American children – as the Kennedy would not stand in the way of Trump administration plans to slash funding for long standing entitlement programs.

Overseeing a $1.7 trillion agency 

As head of HHS, Kennedy would oversee a $1.7 trillion agency that manages domestic Medicare and Medicaid programs, as well as the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and the National Institutes of Health (NIH).

The latter three not only manage public health but also play a major role in funding and supporting scientific research that has made the US a leader worldwide in the development of new treatments, medicines and vaccines for a range of conditions. 

That leadership role is now threatened with a string of recent Trump administration actions that have seen the muzzling of CDC domestic and foreign scientific exchanges as well as public health communications, and just last week, an order imposing severe cuts on NIH grants. 

Kennedy, has nonetheless pledged to cut the NIH workforce by some 600 people– while turning his attention to chronic diseases.

“I’m gonna say to NIH scientists: God bless you all,” Kennedy said in 2023 to a crowd of supporters during his presidential bid. “Thank you for public service. We’re going to give infectious disease a break for about eight years.”

Days of grueling hearings 

Robert F Kennedy Jr (RFK Jr) day 2 confirmation hearing
Robert F Kennedy Jr on Day 2 of his Senate Confirmation hearings for the nomination of Secretary of Health and Human Services.

Kennedy’s confirmation came after a series of grueling Senate hearings last week, and on Wednesday, a late-night debate over Kennedy’s controversial statements on vaccines, abortion, and other issues.  

In Wednesday’s debate, a long lineup of senate Democrats implored their fellow Republicans on the other side of the aisle to vote ‘no’ on the nomination, which they said could set Americans’ public health back generations. 

“I don’t know if this is going to mark one of the most important public health moments in American history, but I can’t think of another time where we actually have the technology, we have the medicine, we have the science, we have the distribution system. We have the public infrastructure to keep people safe, and we just decide by a vote of 53 to 47 to make people unsafe,” said Brian Schatz, Democrat from Hawaii, speaking about how Kennedy’s anti-vaccine activism in Samoa in 2019 led to the deaths of 83 children from a measles epidemic.

RFK JR kennedy senate debate 2025
Brian Schatz, of Hawai’i, notes that 83 children died of measles in Samoa after vaccine hesitancy swept the island.

“He’s not talking about whether or not it’s appropriate to require masks in public – which  Democrats and Republicans are still arguing about. He’s talking about stuff like, if you’re a parent, and now you don’t know whether when your kid goes to school, they’ve reached herd immunity stuff that goes way, way, generations back,” he said, referring to measles, polio and other vaccine-preventable diseases. “So if you think it’s a good idea to leave all of these diseases in the rear view mirror, then this is a very very bad person to be running the Department of HHS.”

Cervical cancer vaccine at risk 

Ron Wyden, D-Oregon, pointed to Kennedy’s refusal to renounce past statements questioning the safety of the HPV vaccine that protects women against cervical cancer – as well as his financial interest in ongoing litigation over the vaccine’s side effects, as just one example of Kennedy’s “concerning” stances. 

The vaccine, “has become routine for young people about 20 years ago,  and since then, it has successfully cut cervical cancer rates into just a fraction of what they were before the drug came to market,” Wyden noted. 

But when queried about his stake in the lawsuits during the first Senate hearings in late January,  “he refused to answer questions about his 10% stake in any settlement agreements – instead passing them off to his son.  He refused to recuse himself from taking any actions that might affect his family’s financial interest,” Wyden said. 

At the hearings, Kennedy said he’d give up his 10% share in the litigation to his son.

 “All of this adds up to a future HHS secretary who stands to profit off undermining this vaccine, and the result raised cervical cancer rates, to quote my Republican colleague, Senator Cassidy, a physician, Mr. Kennedy is financially vested in finding fault with vaccines.”

Research support in question

Kennedy debates
Heinrich Martin (D-NM) lamented the loss of millions of dollars of research funding should the Trump administration’s budget cuts go through.

Other Democrats expressed concerns about how Kennedy’s appointment would affect the US biomedical research – as well as public health. 

“HHS plays a critical role in overseeing Medicare, overseeing Medicaid and the Affordable Care Act,” said Martin Heinrich, D-New Mexico.

“But HHS also supports the medical research that helps us to develop the next vaccine, prevent the next pandemic and find cures to cancer and chronic diseases like diabetes. We have already seen President Trump, Elon Musk and his DOGE minions target scientific and medical research at agencies like the National Institutes of Health. 

“Just last week, we saw them announce an estimated $4 billion cut for health research at universities across the nation, including an estimated $17 million impact at the University of New Mexico alone. And just like many of the unilateral and illegal actions of this emboldened Trump administration. This one received a temporary halt from the federal judge. 

“But whether this particular attack holds up in court or not, the Trump administration’s intention is clear, dramatic cuts to medical research into treatment cures that countless Americans are depending on to save their lives. Mr. Kennedy plans to lead this effort and even to expand on it.”

Kennedy floats different vaccine schedule for African Americans

Kennedy black children vaccines statement
“Black children already have lower vaccinations than their peers,” noted Angela Alsobrooks (D-MD), calling Kennedy’s views. “dangerous.”

Angela Alsobrooks, D-Maryland also expressed alarm at Kennedy’s remarks to the effect that Black Americans needed a different vaccine schedule than their White counterparts – a contention that she noted had been debunked by the very scientists that Kennedy had cited in support of his claims. 

“Just three years ago, Kennedy said, and I quote, ‘we should not be giving black people the  same vaccine schedule that’s given to whites because their immune system is better than ours. 

“When I asked him this question, Mr. Kennedy referenced a study…. he assured me….  that, indeed, certain races required a different vaccine schedule. That was a lie. In fact, the study’s own authors stated the data doesn’t support a change in vaccine schedule based on race. Mr. Kennedy’s response was damning and his response was dangerous.

“Black children already have lower vaccinations than their peers,” noted Alsobrooks. “That is why I said, your claims on this issue were dangerous.”

Polio survivor lone Republican to vote ‘nay’

While a number of leading Republican senators pushed back on Kennedy’s anti-vax and anti-research statements in the lead-up to today’s vote, 52 Republicans voted for the nominee, including Senators Susan Collins (R-ME) and Bill Cassidy (R-LA). 

John Fetterman, a Democrat for Pennsylvania, who earlier had spoke favorably about Kennedy’s views on chronic disease, sided with party colleagues against the nominee. 

The sole exception was Senator Mitch McConnell, who had spoken out against Kennedy’s claims about the side effects of the polio vaccine earlier in the confirmation process. McConnells’  childhood battle against polio before the development of the vaccine made him particularly sensitive to Kennedy’s debunked rhetoric claiming that vaccines cause autism. 

McConnell released a statement after the vote, saying “I’m a survivor of childhood polio. In my lifetime, I’ve watched vaccines save millions of lives from devastating diseases across America and around the world. I will not condone the re-litigation of proven cures, and neither will millions of Americans who credit their survival and quality of life to scientific miracles.

“Individuals, parents, and families have a right to push for a healthier nation and demand the best possible scientific guidance on preventing and treating illness. But a record of trafficking in dangerous conspiracy theories and eroding trust in public health institutions does not entitle Mr. Kennedy to lead these important efforts.

Opening statements centered on healthcare access

Senate vote for RFK Jr
52 senators voted for RFK Jr, confirming his appointment as HHS Secretary.

Thursday’s final statements centered on healthcare access. 

“On issue after issue, Mr. Kennedy has demonstrated a profound lack of knowledge at best, and deeply dangerous views at worst,” said Senator Wyden (R-OR) in opening statements. “Mr. Kennedy was given ample opportunity to share how he would improve these programs [Medicare and Medicaid], lower costs, save taxpayers money, and improve care. Instead, he showed a complete lack of basic understanding of Medicare and how it functions.”

“Republicans, with Donald Trump at the helm, are steering this country towards a healthcare cliff.” Wyden then accused Republican colleagues of plans to take away Medicare and Medicaid.

Mike Crapo (R-ID) countered that the Senate debates late last night were about securing the border, not about taking away Medicare. He defended Kennedy’s past anti-vaccine statements, saying that the secretary “just wants to see that the research on them [vaccines] is done, and done well.”

Republicans praise his emphasis on chronic diseases 

Throughout the two week confirmation process, Senate Republicans praised Kennedy’s  emphasis on addressing the chronic disease burden in the US, and expanding rural health care access. “Mr Kennedy, you represent a voice for an inspiring coalition of Americans who are deeply committed to improving the health and well-being of our nation,” said committee chair Senator Mike Crapo (R-Idaho). Crapo continued his praise for Kennedy in the opening statements prior to the vote.  

But others questioned his shifting stance on abortion, vaccines, and food policy, accusing Kennedy of switching his views for political and monetary gain.

As founder of the non-profit Children’s Health Defense, Kennedy has repeatedly cast doubt on the safety and efficacy of childhood vaccinations, and his organization continues to push the debunked claim that vaccines cause autism. 

Even so, Kennedy insisted in the hearings that he was not “anti-vaccine”, and that he merely supports more testing and safety studies.

“News reports have claimed that I am anti-vaccine or anti-industry. Well, I am neither; I am pro-safety … All of my kids are vaccinated, and I believe vaccines have a critical role in healthcare,” said Kennedy in his opening statement in Senate hearings in late January. 

A chance to “make America healthy again”

At the same time, he said he’d find new ways to tackle high drug prices, and address the root causes of America’s obesity and addiction epidemics with healthier foods and more mental health services – messages that clearly resonated with many senators.

As part of that, he has also pledged  to tackle unhealthy processed foods to “make America healthy again” – as well as confronting big Pharma and high drug prices – messages that clearly resonated with many senators.

Kennedy also described how his experience as an environmental lawyer working with hunters,  fisherman and farmers along the Hudson River had sensitized him to the health impacts of pesticides and environmental pollutants early in his career. 

“Something is poisoning the American people and we know that the primary culprits are our changing food supply, highly processed foods,” he said, citing the unusually high proportion of obese people in the US in comparison to other developed nations, something that he called an “existential threat”.

He stressed that the government needed to support a transition away from agriculture dependent on heavy chemical inputs to “regenerative” agriculture to support healthier food production.

But it’s unclear how much leeway he’d really have to move such a massive agenda in the new Trump administration – which is deeply indebted to big food and the pharma industry for supporting Trump’s election campaign.

Last updated 13 February 2025.

Image Credits: Associated Press, Economic Times.

Dancers at the opening of the NCD Alliance Forum in Rwanda

KIGALI, Rwanda – At least two-thirds of the cost of treating non-communicable diseases (NCDs) is carried by patients, and civil society advocates are pressurising governments to step up.

Over 700 NCD advocates from 89 countries have gathered in Kigali for the Global NCD Alliance Forum to press for meaningful targets to be adopted at the United Nations High-Level Meeting (HLM) on NCDs in September.

One billion people are living with obesity, 1.3 billion with hypertension, a billion are living with a mental health disorder, and half a billion people living with diabetes and chronic respiratory diseases. 

“In the five short years since we last held the forum, in Sharjah in the UAE, we have lost 215 million people to NCDs. To put that in context, that is the population of Nigeria,” said NCDA CEO Katie Dain.

NCD Alliance CEO Katie Dain

“We live in an era of polycrisis, with pandemics, climate change, conflicts and humanitarian crises locking horns across the globe.

“The Trump administration’s recent freeze on development aid and the potential dismantling of USAID has sent a shockwave through the global health community,” added Dain at a media briefing on Thursday shortly before the forum opened.

“It is paralysing health programmes that are providing lifesaving medication and treatment to people and turning upside down the health financing landscape as we knew it. Any hit to global health financing is a hit for all health issues, including NCDs.”

Describing the last five years as a “policy success but an implementation failure”, Dain outlined the NCDA’s five priorities for the HLM.

The first is the accelerated national implementation of evidence-based NCD policies.

Breaking down silos in global health, sustainable financing, accountability for delivery and community engagement make up the other priorities.

Kenyan cancer survivor Prisca Githuka drew attention to the “financial toxicity” faced by African patients living with NCDs, highlighting that her breast cancer treatment cost around $35,000.

“African patients are told to go and buy their own drugs. Where do you get chemotherapy drugs in Kenya? There are also problems with the radiation machines. You can wait three months to get treatment then the machine breaks down,” Githuka told the media briefing.

Rwanda’s NCD successes

Rwanda’s Minister of State for Health, Dr Yuvan Butera, opens the NCD Alliance Forum

Rwanda was chosen as the first African country to host the forum because of its success in addressing NCDs.

Just this week, the government doubled its tax on tobacco products and imposed a 65% tax on beer, Dr Yuvan Butera, Rwanda’s Minister of State for Health, told the opening plenary.

Through taxes and curbs on smoking in public, the number of smokers has been reduced from 13% in 2012 to only 7% currently. It has also managed to reduce diabetes slightly.

Almost 60% of Rwandans are now dying from NCDs, and the country has reoriented its health system from treatment to prevention, said Butera.

The health system has been decentralised to ensure people can get treatment close to their homes at health posts (primary health clinics staffed by a few nurses). Staff at district hospitals have been trained to manage NCDs.

The bottom rung of the health system is community health workers, over 58,000 of them spread in over 14,000 villages 

Over 90% of people are covered by Community-Based Health Insurance (CBHI), with a sliding payment scale based on income. The country is incrementally increasing what the CBHI can cover and recently extended coverage to kidney dialysis and heart surgery.

Focus on prevention

Dr Uwinkindi Francois, NCD Division Manager at the Rwanda Biomedical Center (left) and Rwanda NCD Alliance head Dr Joseph Mucumbitsi.

Over 95% of Rwandans get the required exercise of at least 150 minutes a week, although this is mostly through their work, explained Dr Uwinkindi Francois, NCD Division Manager at the Rwanda Biomedical Center.

But exercise features big in the country’s NCD programme. Since 2016, the capital city of Kigali has held “car-free days” in the city – currently twice a month – to reduce air pollution and promote exercise. During this time, screenings are also offered for various NCDs. Every Friday, work ends at 3pm in the city to enable people to exercise.

NCD awareness is also integrated into school health programmes.

But it is struggling to contain alcohol consumption and hypertension.

In preparation for the HLM, Butera urged stakeholders to work together to take action against NCDs.

“Governments need to increase financing and integrate prevention and treatment of NCDs into universal health coverage,” said Butera, while urging the private sector to invest in innovative solutions to bridge access gaps to treatment.

“Civil society must amplify patients’ voices.”

Image Credits: Rwandan Biomedical Center.

NIH research building
The NIH is the world’s leading public funder of biomedical research, spending some $48 billion annually on universities, hospitals, labs, and other institutions.

WASHINGTON, DC – The abrupt decision by the United States National Institutes of Health to slash funding for overheads to the nation’s research centers and universities has provoked a fresh outcry among leading US researchers, global health experts and even some Republican politicians  – with leading one expert saying this latest move could “seriously jeopardize” the US’s global dominance in biomedical research and innovation.

“If the Trump administration goes ahead with its plan to slash NIH research funding, it would seriously jeopardize the standing of the US worldwide,” said Lawrence Gostin, Distinguished University Professor in Global Health Law at Georgetown University, in a statement to Health Policy Watch. 

Similar reactions echoed across the research world after NIH’s Friday announcement cutting grants to research institutions for their “indirect costs” – which include expensive laboratory equipment and technologies vital to cutting edge research.  The cuts to biomedical research investments followed a shock list of recent Trump measures to drastically curtail the public health watchdog activities of the US Centers for Disease Control, as well as dismantle USAID and related global health programs. 

Susan Collins, a Republican  from Maine, who chairs the powerful Senate Appropriatiations commitee, also expressed opposition to what she called “the poorly conceived directive imposing an arbitrary cap on the indirect costs,” adding that the Congressional act under which the NIH allocations are made, also forbids arbitrary alterations. But even so, she posted a statement saying that she would vote to approve PresidentDonald Trump’s nominee Robert F Kennedy Jr, a vaccine skeptic who has also questioned the solidity of research underpinning recent vaccines, as Secretary of Health and Human Services, when the issue comes before the Senate, presumably later this week. 

Judge temporarily freezes NIH funding cuts 

Researcher
A researcher tests the efficacy of a generic drug. 80% of the NIH’s budget goes to universities, hospitals, or other research institutions.

On Monday, a Massachusetts judge  issued a nationwide order, temporarily halted the directive to slash the NIH grants from the Office of the Director, just before it was due to take effect. The suspension came as 22 state attorney generals sued the federal government for violating the 2018 Congressional appropriations law, which prohibits the NIH from altering its indirect cost rates “without proper authorization,” according to the filing. US District Judge Angel Kelley scheduled a hearing for 21 February for further arguments. 

Another lawsuit was filed on Monday on behalf of private and public universities and hospital systems, which stand to lose millions in federal dollars. The American Association of Universties, American Council on Education, Brandeis, Brown, George Washington, Cornell, Johns Hopkins, University of Rochester, Massachusetts Institute of Technology, and the University of California, among others, joined in filing suit against HHS, NIH, and the acting heads of these two agenices. These also argue that the funding cuts violate the Congressional appropriations law, and breaks prior negotiated indirect costs rates.

Across the country, from Birmingham to Buffalo, NIH research dollars fuels economic growth, medical innovation, and offers jobs to millions of Americans. In 24 states, hospital or university systems are the single largest employers, and leading the US’s global dominance in cancer, cardiovascular, and public health research. 

The storm unfurled Friday, after the Office of the Director of the National Institutes of Health, under an order by the Trump administration, issued a notice limiting the indirect costs biomedical research relies on to fund laboratories, equipment, facilities, new faculty, and software, to a standard 15% across all grants and institutions receiving them. 

The move was widely condemned by universities, research institutions, and medical centers who said that the one-size-fits all payment fails to reflect the real costs of research, in terms of investments in laboratories, technology and other hardware. 

Chipping away at the NIH’s status as the ‘envy of the world’

NIH funding impacts graphic
24 US states have hospital or university systems as their largest single employer.

At stake, critics say, is the National Institutes of Health (NIH) and the US biomedical research operation’s preeminence as the leading research innovator in the world, at the forefront of cancer therapies, personalized medicine, and brain health, to name a few domains. The administration’s moves have deeply rattled the NIH, with  the number two official, Dr. Lawrence Tabak to resigning 12 February. 

“The NIH is the envy of the world and sets the gold standard for scientific research and innovation. NIH funding has led to breakthroughs, ranging from treatments for cancer and cardiovascular diseases to vaccines for infectious diseases, and so much more,” said Gostin. 

The economic and scientific impacts could reverberate across the country – and in cancer clinical trials and drug-development labs. 

“NIH does incredible work, and this seems like it’s an obscure overhead issue. It is not,” said Senator Mark Warner (D-Virginia) in a town hall for residents.

“If these cuts, without any congressional review go through, we will have less research, less cures.” The senator pointed out that institutions have already negotiated and signed contracts at existing indirect cost rates. “You cannot arbitrarily change the reimbursement level for existing contracts by executive order.” Warner alluded to the multitude of Trump-issued executive orders that violate the law.

Ttop universities and medical centers stand to lose “$100 million a year or more” if the sweeping changes to how the National Institutes of Health reimburses research costs takes effect, according to an analysis from STAT news. 

White House claims moves allows ‘more money and resources available for legitimate scientific research’

In a post on X, the NIH framed its decision as a cost-cutting move, given that elite universities have tens of billions of dollars in endowment funds. Even so, research institutions at Harvard University, Yale University, and Johns Hopkins University all receive indirect rates over 60%, the NIH said. The post highlights that the 15% cap would save $4 billion per year. About $9 billion of the $35 billion awarded to researchers through grants in 2023 was in the form of indirect costs.

“Contrary to the hysteria, redirecting billions of allocated NIH spending away from administrative bloat means there will be more money and resources available for legitimate scientific research, not less,” said White House spokesperson Kush Desai in a statement to Fox News Digital. The comment implies that the administration does not believe that current scientific research is not “legitimate.”

And on X, Elon Musk, the un-elected billionaire who leads Donald Trump’s Department of Government Efficiency (DOGE), echoed this sentiment, saying over the weekend “Can you believe that universities with tens of billions in endowments were siphoning off 60% of research award money for ‘overhead’? What a ripoff!”

But most universities are not Harvard, Gostin countered, saying, “Most small to medium sized universities actually take a loss in taking NIH dollars even with indirect payments,” he said in a statement to Health Policy Watch. 

“Research costs an enormous amount, including paying researchers, running laboratories, and conducting large clinical trials. Many universities could not afford to take NIH research grants with such low indirect costs. That means the pipeline of research innovation could dry up.”

“What administrative bloat?” he asked. 

Collins, Britt, say cuts could harm Republican states 

 

The NIH distributes about 80% of its $48 billion budget to research institutions in the US – in Republican as well as Democratic-majority states. As a result, lawmakers from both parties have scrambled to the defense of universities, hospitals, and institutions that rely on NIH funding.

“I oppose the poorly conceived directive imposing an arbitrary cap on the indirect costs that are part of NIH grants and negotiated between the grant recipient and NIH,” said Senator Susan Collins (R-Maine) in her statement, saying she’s heard from laboratories and research institutions and other schools in Maine about the cuts, which “would be devastating, stopping vital biomedical research and leading to the loss of jobs.”

Collins, who chairs the Senate Appropriations Committee, and noted that the fiscal 2024 appropriations law, which funds the federal government, “includes language that prohibits the use of funds to modify NIH indirect costs,” indicating that the NIH is not allowed to arbitrarily change its funding policies.

Still supporting Kennedy for Secretary of HHS

Despite her opposition to the NIH’s cap, Collins said she would support Robert F Kennedy Jr, Trump’s nominee for Secretary of Health and Human Services. Kennedy’s record of support for biomedical research has been uneven, at best, expressing skepticism over vaccine studies, in particular. Even so, Collins said she had contacted Kennedy about the cuts, and said he pledged to “reexamine” the issue.

During his Senate confirmation hearings, Kennedy repeatedly dodged questions as to whether he would continue NIH’s funding for vaccines, including the cutting-edge mRNA technology developed for the COVID-19 vaccines. And in the months following his nomination, Kennedy said he would cut 600 NIH jobs. 

Kennedy could afford three “no” votes from Republicans and still be confirmed. 

Alabama Senator also expresses misgivings over NIH cuts

Another Republican senator and Trump ally, Katie Britt of Alabama, also expressed misgivings over the funding cuts.

“While the administration works to achieve this goal at NIH, a smart, targeted approach is needed in order to not hinder life-saving, groundbreaking research at high-achieving institutions like those in Alabama,” Britt told AL.com, an Alabama-based news agency. Alabama is home to several research universities who receive billions in NIH funding.

The University of Alabama is the single largest employer in the state. 

The University is an example of how universities and hospitals often support entire towns, cities, or even states. 

In Western New York, the University of Rochester is the largest private employer in the region, generating approximately 56,000 jobs across Upstate New York. And in Pennsylvania, the University of Pittsburgh Medical Center system creates nearly a million jobs, and is the largest employer in the state.

In their filings against the NIH, leading US universities disclosed they received up to $1 billion dollars in NIH funding, in the case of Johns Hopkins. The University of Rochester disclosed receiving $188 million in fiscal year 2024, and with the current indirect cost rate at 15%, it stands to lose $40 million. The filing also revealed that universities in conservative states would lose tens of millions – the University of Florida would lose $70 million in funding.   

Department of Defense, philanthropies, and private companies unable to fill funding void

NIH Research
Scientist conducting coronavirus vaccine research at NIAID’s Vaccine Research Center, Moderna’s original collaborator on the SARS-CoV-2 vaccine.

With the rationale of government efficiency, DOGE has singled out the NIH’s funding structure as the leading public funder of biomedical research. Some observers hope that the Department of Defense (DOD), a frequent partner, could pick up some of the slack with its $800 billion budget. The DOD spent $1.5 billion on such biomedical research in fiscal year 2021.

But Trump has instructed DOGE to turn its attention to Defense spending next, saying in an interview on Friday “And I’ve instructed him [Musk] to go check out Education, to check out the Pentagon, which is the military. And you know, sadly, you’ll find some things that are pretty bad.”  Others have suggested that the private sector might step into NIH’s shoes. But historically,  private sector investors have not been eager to fund the kind of basic research that NIH supports – which often then lead to the breakthroughs, such as mRNA vaccine technology, that the private sector later develops.  

As for the DOD, Gostin notes that “it is possible that the DOD would expand its research portfolio but Musk will probably also cut Defense spending. But the main point is there is no substitute for the NIH. Many scientists want peer-to-peer relationships with NIH scientists and may be leary in getting too close to military applications of their research.”

The US has been the world’s leader in research and biomedical innovation for over 80 years. 

In a letter to the university community, Harvard president Alan M. Garber expressed the widespread sentiment: “At a time of rapid strides in quantum computing, artificial intelligence, brain science, biological imaging, and regenerative biology, and when other nations are expanding their investment in science, America should not drop knowingly and willingly from her lead position on the endless frontier.” 

Last updated 12 February.

Image Credits: NIH, FDA/Michael Ermarth, Kristy Ainslie, NIAID.

South African programmes like this one, to encourage people living with HIV to adhere to treatment, face an uncertain future following US President Donald Trump’s latest Executive order cutting off aid to the country.

CAPE TOWN – A coalition of South African civil society groups have urged South Africa’s President Cyril Ramaphosa to “step up” and lead a coordinated national and regional response to prevent “mass healthcare disruptions, preventable deaths, and surges in new HIV infections and drug resistance,” in the wake of the US President Donald Trump’s cut off of aid to the country. 

Trump last week issued an Executive Order halting all aid to South Africa, citing “unjust racial discrimination” against the country’s Afrikaner farmers as well as the country’s case against Israel at the International Criminal Court, alleging genocide in Gaza. The Trump order was referring to a new South African government law that makes it easier to expropriate unused land from white landowners without compensation – when it’s deemed to be in the “public interest“. The new law is being challenged in court.

“Action is critical, particularly in his role as the African Union (AU) Champion on Pandemic Prevention, Preparedness and Response (PPPR) and as South Africa takes on the G20 Presidency,” said the coalition, Community Health and HIV Advocate Navigating Global Emergencies (CHANGE), in a statement on Saturday.

A few organisations have received waivers, but many haven’t

South African schoolgirls campaign on World AIDS Day.

While a few South African organisations delivering HIV and tuberculosis services through the US President’s Emergency Plan for AIDS Relief (PEPFAR) confirmed to Health Policy Watch that they had received PEPFAR waiver letters on Saturday exempting them from the 90-day freeze on PEPFAR activities, originally announced in late January, many others have seen activities cut or curtailed.

However, in light of the most recent Trump order, there is uncertainty about the fate of all PEPFAR-supported South African programmes beyond the 90 days exemption period. Meanwhile, the US Agency for International Development (USAID), which disburses a significant portion of the PEPFAR funding, is being dismantled and PEPFAR’s long-term future is in doubt as its budget comes up for consideration before the US Congress in late March.

Adding to the confusion, several other organisations have not received waivers, while forcing them to cut certain activities. 

For example, at least 9,000 people have lost access to needle exchange and opioid substitution therapy (OST), according to the South African National AIDS Council’s (SANAC) civil society forum.

Funding for HIV clinics catering for those most vulnerable to HIV – “key populations” including sex workers, men who have sex with men and trans people – is likely to be cut permanently.

Funding for a game-changing intervention for groups vulnerable to HIV – twice-yearly injections of lenacapivir that are 100% effective in preventing HIV infection or pre-exposure prophylaxis (PREP) has also been cancelled, according to various reports.

Witkoppen Clinic’s HIV services in Gauteng are among many South African clinics receiving PEPFAR funds via USAID.

Calling on Ramaphosa to “personally intervene” 

CHANGE has urged President Ramaphosa to “personally intervene before the situation worsens and to ensure a whole-of-government and civil society response.”

Sibongile Tshabalala, TAC chairperson.

“The reckless freezing of US foreign aid is nothing short of a death sentence for thousands of people in South Africa,” warned Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC) which advocates for people living with HIV.

“Critical healthcare infrastructure is being dismantled, clinics forced to close, frontline workers without support, all while lives hang in the balance. We are watching decades of progress on HIV being decimated.” 

Historically, South Africa has had one of the highest rates of HIV infection in Africa and in the World.  However, rates of new infections have declined sharply thanks to aggressive campaigns to get those infected on anti-retroviral drugs.  Overall HIV prevalence is about 14% in South Africa, and nearly 20% amongst people aged 15-49 years.

No idea what is happening – people are going to start dying soon

“Health workers and people have no idea what is happening across the region. People are going to start dying soon. Can you imagine being dependent on treatment to save your life, and having it snatched away from you like this, with no alternative?” warned HIV clinician Dr Francois Venter, who directs the Ezintsha research centre in Johannesburg.

New HIV infections have declined sharply as ARV uptake increased.

Fatima Hassan, head of Health Justice Initiative (HJI), confirmed that while some projects had been given waivers “the issue is still the concern about key populations and what the waiver seeks to cruelly limit”.

“The loss of US government funding has left sex workers without life-saving healthcare, HIV prevention, and critical support. Without these services, they face higher risks of violence, stigma, and disease—pushing them further into isolation and vulnerability,” said Kholi Buthelezi of Sisonke, the National Sex Worker Movement of South Africa.

Grassroots organisations that fund outreach workers, peer educators, and service providers have been “left destitute”. “While the communities they serve face even greater barriers to safety and healthcare. Without urgent funding, these lifelines will disappear, leaving sex workers more isolated and at risk than ever,” said Buthelezi.

In light of the additional orders directed at South Africa, communities are also calling on Ramaphosa to use “all available domestic, as well as compulsory measures,” to ensure that life-saving tools and medicines reach all who need them.

Image Credits: UNAIDS, AIDS Healthcare Foundation, Witkoppen Clinic, TAC, UNAIDS.

The United States conducts a nuclear test, code-named Seminole, at Enewetak Atoll in the Marshall Islands in 1956.

Russia has rejected a World Health Organization initiative to update its assessment of the health effects of nuclear weapons use, breaking with nations still grappling with the devastating legacy of Cold War-era explosions. The opposition comes as Russia has threatened to resume nuclear testing amid its war in Ukraine.

In regions known as “sacrifice zones,” where thousands of nuclear tests have left the soil poisoned and communities ravaged, residents continue to face elevated rates of cancer and birth defects decades after the last Soviet-era detonations.

“The Russian delegation is not in favour of discussing this topic,” Russia’s representative told the WHO Executive Board on Saturday, arguing that “the negative impact of the destructive factors of nuclear explosions on humans and the environment, on which we have sufficient scientific data, is already obvious.”

The proposed initiative, which needs to be approved by the EB in order to go before the entire World Health Assembly in May, would update WHO’s guidance on the “Health effects of nuclear weapons and nuclear war on health and health services”, last revised in 1993. It is co-sponsored by the Marshall Islands, Micronesia and three other Pacific island states, as well as Iraq and Kazakhstan – regions where fall out from nuclear testing continues to have devastating health consequences generations after test explosions by either Russia or the United States.

“Nuclear weapons do not discriminate and have catastrophic consequences on health and the environment,” Samoa’s delegate said. “In the interest of health and in the interest of humanity, we need to ensure that nuclear weapons and nuclear war are fully understood.”

The expert study would cost $540,000, according to a cost assessment submitted to the EB. Kazakhstan called the cost a “modest but necessary investment in global health security.”

“The Pacific region has a painful nuclear legacy,” the Marshall Islands’ representative said. After taking control from Japan in 1944, the United States conducted 67 nuclear tests there. The delegate noted that “many other countries with similar nuclear legacies” would benefit from the resolution.

The initiative was dismissed by North Korea, which joined Russia in opposition. North Korea’s foreign policy relies heavily on its nuclear threat, and it has threatened nuclear strikes against targets like Guam. “Sufficient research and analysis in this regard has already been conducted,” its delegate said.

The last nuclear test was conducted in 2017 by North Korea. The U.N. Treaty on the Prohibition of Nuclear Weapons bans all forms of nuclear testing.

Nuclear threats 

Vladimir Putin has threatened to restart nuclear testing throughout his invasion of Ukraine.

The two nations opposing the WHO health study — Russia and North Korea — come as both face international scrutiny over their nuclear threats.

Russian President Vladimir Putin has repeatedly threatened nuclear weapon use during his invasion of Ukraine. Russia has lowered its threshold for nuclear weapon use, placed its arsenal on heightened alert, and deployed tactical nuclear weapons to Belarus – the first time since the Soviet Union’s collapse in 1991.

Putin’s threats to resume nuclear testing carry particular weight for nations like Kazakhstan that still bear the scars of Soviet-era explosions. These threats followed Russia’s withdrawal from the New START treaty — the last remaining agreement limiting nuclear weapons between the United States and Russia.

North Korea, meanwhile, has deepened ties with Russia throughout the Ukraine war, providing millions of artillery shells and ballistic missiles in exchange for economic support and military technology that experts warn could enhance its nuclear capabilities.

“The additional research proposed by a number of countries as regards the consequences of using nuclear weapons, are not capable of introducing radically new elements to international discourse on nuclear weapons,” Russia’s delegate said. Russia will “once again raise the issue of counterproductiveness of adopting this draft resolution” at the World Health Assembly in May, he said. 

The WHO’s EB moved to suspend debate on the initiative until the end of the session next week.  The Board has taken the same move on every draft decision and resolution to come before it so far  – with the exception of aid to Gaza – due to the WHO budget crisis triggered by the US announcement last month that it is withdrawing from the global health agency, to which it is the largest single contributor.

Haunting health legacy of nuclear testing

Craters dot the former Soviet Union nuclear test site Semipalatinsk, Kazakhstan.

Since the invention of the atomic bomb, Russia has conducted hundreds of nuclear weapons tests among more than 2,000 detonations worldwide. The United States is responsible for the largest share – nearly half – followed by France, the United Kingdom and China.

Five hundred of these tests were conducted in the atmosphere rather than underground, releasing radiation equivalent to 29,000 Hiroshima bombs. The radioactive particles dispersed remain in the soil, air and water around test sites decades later. “The legacy of nuclear testing is nothing but destruction,” U.N. Secretary-General António Guterres said in 2019.

Health impacts persist across generations

The health impacts persist across generations. Hereditary cancers, chronic health conditions and birth defects — from missing limbs to infants born with cancer — continue to afflict indigenous populations living near the more than 60 sites where nuclear explosions were conducted since 1945.

In the Kazakh steppes, where Russia detonated hundreds of nuclear bombs throughout the Cold War, populations in nearby cities like Semipalatinsk, home to 120,000 people just 75 miles from the testing site, were blanketed in radioactive ash. Doctors were forbidden by the government from diagnosing cancers, while authorities maintained the tests had no adverse health effects.

“Local people began to get sick and die young. Women suffered through miscarriages, complicated pregnancies, and stillbirths. Babies were born with missing limbs, Down syndrome, and other disabilities linked to radiation exposure,” according to the Carnegie Endowment for Peace.

Kurchatov city, East Kazakhstan Province, Kazakhstan – the center of the Semipalatinsk nuclear test site.

A series of studies by Kazakhstan’s Institute of Radiation Medicine and Ecology found significantly higher mortality rates amongst those exposed to radiation, with elevated risks of serious illness continuing through their children and grandchildren. The data on the fourth generation remains under study, but ongoing birth defects and elevated cancer rates in the region suggest the fallout will affect their health too.

“If you travel to the villages near the former testing site, you’ll meet small children born without limbs or sick with cancer, suggesting that the damage from the site continues to this day,” the Carnegie Endowment reported.

While Russia’s nuclear legacy haunts Kazakhstan, the United States left its own trail of devastation. Hundreds of nuclear tests were conducted on Native American land in Arizona, Nevada and Utah, yet the U.S. government has never studied or investigated the health effects on these communities. More than 900 tests were conducted on the land of the Shoshone nation, earning them the moniker of “the most bombed people on earth.” 

Similar patterns of official neglect persist in Pacific island nations, where the United States has refused to fully compensate populations for widespread damage to their health and ecosystems from nuclear testing.

“WHO must speak with the authority bestowed to it by its constitution to provide the most recent science and research to support the call for peace,” Samoa’s delegate said. “We need to ensure the negative consequences of nuclear weapons and nuclear war are fully understood for all people and the world.”

Image Credits: Comprehensive Nuclear-Test-Ban Treaty Organization, RIA Novosti archive.

Bird flu in USA. Outbreaks in Ohio and NY
Bird flu is circulating across the US, affecting over 25 million poultry. Complicating outbreak efforts is the hampered health communication from the federal government, and the efforts to reduce the federal workforce by 10%.

The US Centers for Disease Control has not updated its bi-weekly bird flu (H5N1) situation summary since 17 January – even if it finally published a limited edition of its Mortality and Morbidity Weekly Report (MMWR) on Thursday, 6 February. In the wake of the CDC information flow shutdown and the US withdrawal from WHO, Dr Lynn Goldman, Dean of the Milken Institute School of Public Health, spoke with Health Policy Watch about how public health communications and global health collaboration remains all the more critical.

The highly pathogenic avian influenza has affected millions of US poultry birds since December 2024, with Ohio accounting for 10 million of these birds where infections were detected, according to the US Department of Agriculture (USDA). The pathogen, which has sickened 68 people and caused one death, led global experts to criticize the US response as inadequate and “inept” – long before the Trump administration began to curtail reporting operations of the US Centers for Disease Control.  

Politicizing the federal workforce

Now, educating the public and the agricultural workforce about the risks of bird flu, and how to combat them, has only become more complicated by the ongoing communications pause imposed by the Department of Health and Human Services, says Goldman, who also served in the US Environmental Protection Agency (EPA) during the administration of former US President Bill Clinton (1993-2001).

But Goldman expressed hopes that specialised US government agencies will remain anchored by civil service professionals, where “people are really just serving the public…They’re not serving a politician. They’re serving the public. They are experts, and we’re proud that they’re there for merit, not loyalty.”

However, that civil service workforce is shrinking rapidly. 

About 65,000 of 2.3 million federal employees – including those who work at key public health agencies such as US CDC, the US Department of Health and Human Services – have taken up the Trump administration’s offer to resign now, with pay until September. And on Friday, the new US administration was poised to lay off nearly 95% of the US Aid and International Development agency’s (USAID) workforce, following a freeze on operations announced earlier this week. Only 294 of the more than 10,000 employees worldwide appear set to remain. 

The implications for public health range from impeded infectious disease communication, slowed research, and hampered global collaboration, according to Goldman. 

Bird flu response jeopardized

CDC bird flu website Feb 2025
The CDC’s bird flu website displays a message saying the page is “being modified to comply with President Trump’s Executive Orders.”

Since last year’s ongoing avian flu outbreak, the US has seen 67 human cases and one death – and countless poultry, dairy cows, and wildlife sickened. Most of these cases originated in dairy herds or poultry farms. And on 31 January, a new variant of H1N5 was reported in a dairy herd in Nevada, according to the US Department of Agriculture (USDA). Egg farmers must cull or depopulate their flocks if the virus is detected. New York state shut down live poultry markets 7 February after bird flu was detected.

“As this flu spreads around, it is affecting the price of eggs and eventually will increase the price of milk as well,” said Goldman.

In fact, over the past month, eggs prices in the US soared to an average of $5.30 per dozen, up from $3.50 the same time last year. The situation is complex, and the communications “need to be very finely tuned,” argued Goldman.

“It’s very complicated to communicate to the public the risks around food products,” Goldman added, referring to issues such as risks of virus transmission through raw milk consumption. “It’s very complicated because you don’t want to create untoward concern because of the way you communicate it. 

“Stopping the communications means you’re not controlling the public health threat, because a good part of doing your job in public health, especially with regard to infectious diseases, like bird flu, is that you communicate.”

Communicating with the public is not the only aspect that worries Goldman. For physicians, the recent tumult in the transition has meant the relative lack of messaging from the federal government on bird flu can impact medical practice.

“As a pediatrician, I want to always have up to date information about what’s going on with bird flu. I need to know what’s going on if I’m in the clinic seeing people. Is this something I should be looking for? Has it been identified in my part of the country? That’s important for doctors to know.”

Halting NIH grant reviews – ‘highly unusual’ with a severe ‘financial downside’

The NIH is the world’s leading public funder of biomedical research, spending some $48 billion on universities, hospitals, labs, and other institutions.

While the Trump administration’s decision to freeze health communications and grants processes for a short transition period might be “fairly normal,” the halt to routine NIH grant review meetings is “highly unusual,” Goldman observed.

“I don’t know why you want to throw a wrench into that work,” said Goldman, adding, that new staff may simply be uninformed about research – although that is worrisome as well. “Maybe they’re just coming from a very negative point of view about the government and don’t understand those things.” 

The grant review meetings, also known as study sections, are often scheduled far in advance and they focus on the peer review of new scientific proposals on biomedical topics, such as cancer therapeutics. Although some reviews were reportedly resumed this week, NIH advisory panels across several research areas remained in hiatus. The National Science Foundation (NSF) pause of grant review panels also was ongoing as of this publication. 

“We are so dependent on the NIH to develop the science that we need for protecting the health of the public. No corporation does what they do. No one else will do it, including philanthropy.” The NIH is the largest single public funder of biomedical research in the US, with a $48 billion budget. Everything from the discovery of hundreds of new drugs, gene therapy and vaccines can trace its funding back to the NIH. Every $1 investment in this biomedical research yields a $2.46 return, according to the Office of Budget. 

With almost an entire month’s pause on the grant process, there could be a serious “financial downside,” noted Goldman. “This one month halt on meetings could result in a reduction in NIH expenditures for the year, unless they can play catch up. 

“And it’s important, as expenditures are what support scientists to do the research we need.”

Censoring diversity criteria in clinical trial research – a particularly acute impact

In addition to the CDC pages on urgent outbreaks like bird flu, the main page of the Food and Drug Administration’s “Diversity Action Plan” guidelines to pharmaceutical companies for including diverse populations in clinical trials of new new medicines and vaccines also has been taken down. That’s despite the fact that decades of research shows that considering ethnicity, gender, age and other similar factors is essential for assessing a vaccine or medicine’s overal efficacy.  

Helping to oversee the entire Department of Health and Human Services’ management is the HHS Office of the Inspector General (OIG), an independent watchdog responsible for fighting waste, fraud, and abuse in the department. On 31 January, the Trump administration fired 17 Inspector Generals, including the HHS IG. The two-sentence termination emails took the IG community by surprise, as the role is intended to be independent and non-partisan. 

“It’s not just the NIH, but it’s an effort across the federal government to politicize all the personnel in the government,” said Goldman. She noted that “it is part of our process” for certain but not largescale to occur during administration transitions. 

Goldman hopes the nominee to head the NIH, Dr Jay Battacharya, will outline his vision for the agency during his hearing process, which is not yet scheduled. “That is something all of us – the American public, the scientific community, and the public health community – need to hear from him.”

WHO withdrawal, USAID shutdown means US is ‘lagging behind’

The Trump administration’s decision to begin pulling the US out of the World Health Organization, the specialized United Agency which enjoys support from 194 member states since its founding in 1948, sent reverberations through the global health community. The administration also ordered CDC to cease communicating with the WHO. Similarly, the recent moves to dismantle the US foreign aid agency, USAID, which has saved tens of  millions of lives through work targeting maternal and newborn health, malnutrition, malaria, tuberculosis and HIV, threatens to leave a “vacuum” for geopolitical adversaries.

“Russia and China are cheering the work of DOGE [Department of Government Efficiency]. It’s not efficient to destroy capacity. We’re talking about world class expertise. It’s not an overhaul, it’s a destruction,” said Dr Atul Gawande, former global health head at USAID, in a CBS interview about the agency. He also noted that the fallout means monitoring for bird flu has been cut off in 49 countries, and that the malaria program has been shut down. 

“Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations. If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook,” Dr Judd Walson, chair of International Health at Johns Hopkins, said in an interview 28 January. 

“If we actually have an approaching bird flu pandemic, [withdrawing from WHO] would make that doubly worse, because we need global collaboration when epidemics are erupting globally,” said Goldman.

When it’s not just a local problem, we need to be able to share the data from across the world.”

 

Image Credits: Julio Reynaldo, CDC, NIH.