Air pollution is barely acknowledged in the draft political declaration for the upcoming fourth UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health. The omission of the world’s leading contributor to disease threatens global progress in tackling heart disease, respiratory diseases, stroke, cancer, and other chronic illnesses.

Since the last UN General Assembly High-Level Meeting on non-communicable diseases (NCDs) in 2018, air pollution has leapfrogged tobacco as a cause of disease and premature death worldwide.

Government representatives negotiating ahead of September’s meeting in New York City must commit to addressing this global health emergency of air pollution as the leading contributor to the global disease burden, causing more than one in ten deaths globally. 

Without clean air action, leaders will miss a golden opportunity to reduce the pressure on healthcare, improve the lives of billions of people living with NCDs, and prevent millions of cases of cardiovascular and respiratory disease, lung cancer, diabetes, mental health and neurological conditions including dementia.

In 2019, 99% of the world’s population was breathing air polluted beyond safe levels, according to WHO’s global air quality guidelines. The 2024 State of Global Air report by the Health Effects Institute shows that outdoor air pollution—driven largely by fossil fuels, transport, waste burning, and agriculture—causes 4.7 million deaths each year, while  household air pollution from cooking and heating with polluting fuels adds another 3.1 million deaths. 

That’s eight million preventable deaths every year—a staggering, unacceptable toll representing real people losing their lives to the very air they breathe.

The declaration of leaders meeting at UNGA must reflect the urgency of the issue, the life-saving potential of clean air, the cost-savings this offers to health services, and clearly call for integrated action on air pollution.

The unquestioned science

Almost everyone on earth breathes polluted air, with an impact far beyond the lungs. Fine particulate matter (PM2.5) enters the airways and is tiny enough to pass into the circulatory system and can reach nearly every organ, where it contributes to heart attacks, strokes, kidney disease, depression, anxiety, and impaired brain development in children. It also increases risks during pregnancy, including of miscarriage, stillbirth and low birth weight.

People living with NCDs are hit hardest. Air pollution causes more than a quarter of all deaths from ischaemic heart disease and stroke, almost half of all deaths from chronic obstructive pulmonary disease (COPD), and nearly a third of deaths from lung cancer, while worsening patients’ quality of life, prognosis and healthcare access. 

Countries are already off track to achieve SDG target 3.4—reducing premature NCD mortality by one-third by 2030. Most will find it impossible to meet this target without real action to reduce air pollution.

The good news is that proven, cost-effective solutions to allow us all breathe easier exist. Ministers of Health unanimously approved an updated WHO global roadmap on air pollution and health at last month’s World Health Assembly, including a target to halve mortality from anthropogenic air pollution by 2040. 

Progress towards the WHO Air Quality Guideline levels for healthy air is already underway in some regions. The European Union recently updated its Ambient Air Quality Directive, while China cut PM air pollution by more than half over the last decade, proving that clean air is compatible with rapid economic development. City mayors from every continent are showing leadership too, with 50 cities committing to stepping up clean air action earlier this year. 

Where the burden hits hardest 

Global map of national population-weighted annual average PM2.5 concentrations in 2020.

Like tobacco, alcohol and other major risk NCD factors, air pollution imposes an acutely unfair burden of disease on the lowest-income countries, and most marginalised communities. Ninety-five per cent of deaths linked to air pollution are of people in low- and middle-income countries, due to toxic pollution and under-resourced health systems. 

Despite the scale of this crisis, air pollution remains drastically underfunded. According to the State of Global Air Quality Funding 2024 report, clean air initiatives received less than 1% of international development funding between 2018 and 2022. This chronic neglect is not just a public health failure—it’s an economic catastrophe, with a toll counted in lost lives and livelihoods worldwide. 

The World Bank estimates that the cost of air pollution at US$6 trillion annually—equivalent to 5% of global GDP—from lost labour income due to illness and premature death, reduced productivity, and increased healthcare expenditures. In some of the hardest-hit countries, especially in South and South-East Asia and sub-Saharan Africa, air pollution costs exceed 10% of national GDP. 

These economic wounds stall development, entrench poverty, overwhelm fragile health systems and reveal a stark disconnect: the world is losing trillions to an entirely preventable crisis while making virtually no investment to stop it.

Fossil fuels: the overlooked driver 

An oil rig operates off the coast of Denmark.

NCD Alliance (NCDA) has voiced strong concerns over the draft political declaration, particularly the absence of any mention of fossil fuels—by far the leading driver of air pollution. Reducing fossil fuel extraction and use, phasing out subsidies, and ensuring just transition to clean energy must be central to NCD prevention efforts, but such commitments are currently absent.

NCD Alliance recommends clearly acknowledging the public health emergency posed by air pollution calls on governments to include an additional tracer target: “at least 80% of countries have adopted air quality standards to align with WHO air quality guideline level by 2030.” 

Air pollution was recognized as a major NCD risk factor by leaders at the last High-Level Meeting on NCDs in 2018, together with mental health and neurological conditions as one of the major NCD groups, creating a “5×5” framework for the NCD response. Since then, the evidence has only grown stronger on health impacts of air pollution, climate change and environmental degradation.

NCDA therefore calls for the stronger inclusion of air pollution, food systems and climate change in the text, and urges leaders to address this important nexus. Failure to do so would ignore emerging risks and lead to missed opportunities for more integrated, efficient, and forward-looking action.

Political momentum building

WHO’s Maria Neira, centre, receiving a health sector call for clean air action, presented by respiratory disease patients and paediatricians, at the WHO Air Pollution and Health Conference, March 2025.

At the 2nd WHO Global Conference on Air Pollution and Health in March 2025, governments and stakeholders endorsed a bold goal: halving the health impacts of air pollution by 2040. That target was formally approved by the 78th World Health Assembly. Achieving it would prevent three-to-four million premature deaths annually—most of them from NCDs. 

This aligns with the Sustainable Development Goals, including SDG 3.4 (reduce premature NCD mortality), SDG 3.9 (substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution), SDG 7.1 (ensure universal access to affordable, reliable and modern energy services) and SDG 11.6 (improve air quality in cities).

Leading health organizations have joined the call to action, singling out air pollution as a deadly yet underfunded and solvable crisis. The Union for International Cancer Control (UICC) has identified air pollution as a missed opportunity to improve cancer survival, noting significant differences in prognosis in more polluted countries and cities.

The World Heart Federation (WHF) has also sounded the alarm on air pollution as an under-addressed driver of cardiovascular disease, with over half of the nearly eight million annual air pollution-related deaths are due to cardiovascular conditions, according to its 2024 World Heart Report. 

WHF urges governments to adopt the 2021 WHO air quality guidelines as legally binding standards and to align clean air targets with climate and urban planning policies. Their message is clear: protecting heart health means tackling pollution at its source—especially fossil fuels—and integrating environmental, health, and economic agendas.

A test of global leadership

The General Assembly hall in the United Nations’ New York City Headquarters.

Omitting air pollution from the NCD agenda is not just an oversight—it’s a dangerous misstep. The upcoming High-Level Meeting is a unique opportunity to correct course. World leaders must explicitly commit to act on air pollution as a major NCD risk factor in their political declaration. 

This should include developing national air quality standards that align with WHO guidelines, curbing emissions from key sources, and evaluating the cost savings from cleaner air to inform health system planning and budgets. Governments and donors must step up with stronger investments in clean air, especially for the most affected communities.

Clean air is not a luxury—it is a human right, especially for people living with NCDs. 

Leaders have the power to reverse this public health failure and economic disaster while delivering clear public health policy success: hospital admissions falling within days and weeks, healthier babies born in the ensuing months, and NCD trends continuing to improve over decades.

The science is beyond doubt, the solutions are proven, and Ministers of Health and Environment have committed on the international stage. The world now needs leaders to recognize the urgency of this crisis and seize this opportunity to save both lives and money. Including air pollution in the NCD agenda is not optional—it is vital.

About the authors

Alison Cox is the Policy, Advocacy and Accountability Director of the NCD Alliance, a global network of civil society organisations dedicated to transforming the fight against noncommunicable diseases.

Nina Renshaw is a career-long advocate for clean air, joining Clean Air Fund as Head of Health in 2022. She has twenty years of experience of international policy and advocacy in diverse fields, including health, environment, economy, transport and international development.

Image Credits: Giorgia Galletoni , CC, Patrick Gruban.

USAID closes days after leading medical journal warned of millions of deaths per year from a halt to operations.

US Secretary of State Marco Rubio announced the official end of USAID, eliminating the world’s largest humanitarian aid agency just days after a landmark study warned the closure would cause 2.4 million preventable deaths every year.

The study published 30 June in The Lancet found USAID-supported programs saved 92 million lives in low- and middle-income countries over the past two decades, including 30.4 million children under the age of five. Without this support, researchers project 14 million additional premature deaths by 2030 – as a result of the closure of the agency founded in 1961.

“Unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030,” warned the 15 authors of the study, led by  researchers at Barcelona’s ISGlobal and five other Spanish institutes, the Institute of Collective Health in Brazil, the Centro de Investigação em Saúde de Manhiça, Mozambique, and the University of California, Los Angeles.

Rubio has ignored such warnings.

In a State Department memo titled “Make Foreign Aid Great Again” announcing the shutdown, Rubio laid into USAID, stating its “charity-based” model was against American interests and that it spawned “a globe-spanning NGO industrial complex at taxpayer expense.” He also attacked recipient countries and regions – notably Sub-Saharan Africa – for not repaying the US with UN votes despite billions in aid.

The move marks the final chapter in the rapid dismantling of the agency since January, upon which millions of the world’s most vulnerable people relied upon for vital health, nutrition and other development assistance. That saga began in January, when Elon Musk, the world’s richest man, famously tweeted he had skipped “some great parties” to put USAID “into the wood chipper,” telling the agency: “Time to die.”

The Trump administration had previously cancelled 83% of its aid operations earlier this year, throwing the international aid world into chaos. What remains of old US AID programmes will be “targeted and limited,” and be folded into the State Department, the memo said.

“USAID viewed its constituency as the United Nations, multinational NGOs, and the broader global community—not the U.S. taxpayers who funded its budget or the President they elected to represent their interests on the world stage,” Rubio wrote, adding that the agency “has little to show since the end of the Cold War.”

‘No one has died’

US Secretary of State Marco Rubio told Congress no one is dying from tens of billions in cuts to foreign aid.

Rubio’s State Department letter makes no mention of humanitarian concerns, instead reflecting the transactional view that has underpinned the Trump administration’s trade policy and America First foreign policy approach.

As for the estimates mortality projections tabled by scientists,  the architects of USAID’s dismantling tell a different story: no one is, has or will die.

“No one has died because of USAID [cuts,]” Rubio told Congress in late May, months after the majority of its operations were already terminated. “No children are dying on my watch.”

Musk echoed the same sentiment in March: “No one has died as a result of a brief pause to do a sanity check on foreign aid funding. No one.”

Fact Check

The stories at country level say something very different.

In Sudan, a mother described watching her toddler die from a treatable chest infection after the termination of antibiotic supplies to local clinics following the USAID cuts.  Others watched their babies starve while older children died begging for food, after soup kitchens were closed, according to one field report  by the Washington Post. And the absence of US-funded disease response teams has made it harder to contain deadly cholera outbreaks, doctors reported.

In East Africa countries like Zimbabwe, where USAID has long provided HIV medication, the sudden cuts left thousands without access to life-saving antiretroviral drugs, according to another report, by Health Policy Watch.  See related story.

Bribes and Rationing of AIDS Medicine in Zimbabwe as Trump’s Aid Cuts Bite

Thousands of organizations running health clinics, vaccination centres, food distribution sites, water purification drives, and other life-saving activities will be forced to curtail activities or shut down altogether, cutting off basic services.

In 2023 alone, USAID provided essential healthcare to 92 million women and children, as well as services to 20 million people infected with HIV. Many of those services now gone or in suspension until Congress decides if it will extend the lifespan of the President’s Emergency Program on AIDS Relief (PEPFAR), whose latest one-year authorization expired in March.

International aid organizations, including UN agencies and major charities, are struggling to cope with the loss of more than $60 billion in US funding. Facing steep staff cuts and slashed budgets, none are positioned to quickly replace USAID’s operations or maintain the same reach to vulnerable populations.

USAID’s Health Legacy

Elon Musk, who was named a “special government employee” by the Trump administration, secured the president’s backing to eliminate USAID, the country’s foreign aid agency, sending shockwaves through global humanitarian efforts.

That “sanity check” on foreign aid has since morphed into a total halt. This is particularly dramatic in the health sector, where the US has been the backbone of aid – totalling nearly a third of all health aid globally – for decades as the Lancet illuminates what will be lost.

The Lancet analysis found that higher levels of USAID funding—primarily directed toward low and middle-income countries, particularly in Africa—were associated with a 15% reduction in all-cause mortality and a 32% reduction in deaths of children under five.

The agency’s programs achieved remarkable reductions across multiple disease categories: a 65% reduction in HIV/AIDS deaths (saving 25.5 million lives), 51% reduction in malaria deaths (8 million lives), and 50% reduction in deaths from neglected tropical diseases (8.9 million lives).

Among the programs affected by the cuts is the President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved an estimated 26 million lives through HIV treatment and prevention. Its collapse would have immediate, devastating consequences: in just three months, nearly 136,000 babies – about 1,500 each day – would be born with HIV as pregnant women lose access to transmission-prevention medication.

Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrheal diseases, lower respiratory infections, and maternal and perinatal conditions.

“Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID,” James Macinko, a health policy researcher at UCLA and study co-author told NPR. “For that small amount, we’ve been able to translate that into saving up to 90 million deaths around the world.”

Charity is bad

Low-income countries on average depend on foreign aid for one-third of their national health spending. Eight of the world’s poorest countries—South Sudan, Somalia, Democratic Republic of Congo, Liberia, Afghanistan, Sudan, Uganda and Ethiopia—rely on USAID for over 20% of their total foreign assistance.

Facing their highest debt burdens in decades, many of the world’s poorest nations are unlikely to be able to compensate for the budget hole blown open by USAID’s withdrawal.

Former President Barack Obama called the decision to dismantle USAID a “colossal mistake,” saying the agency’s efforts to prevent disease, fight drought and build schools made it synonymous with America itself. “To many people around the world, USAID is the United States,” Obama said.

Citing two anecdotes – a Zambian man who told American diplomats teaching his countrymen to “learn to fish” instead of receiving US aid, and an Ethiopian woman praising two-way investment schemes – Rubio said the new model will provide “targeted and limited” aid, while favoring nations who demonstrate an “ability and willingness to help themselves” and welcome US investment.

“The charity-based model failed because the leadership of these developing nations developed an addiction,” Rubio said. “That ends today, and where there was once a rainbow of unidentifiable logos on life-saving aid, there will now be one recognizable symbol: the American flag.”

The United States flag has for decades been on the center of all aid packages distributed by the agency.

Image Credits: White House .

The World Health Organization flag flies above its headquarters in Geneva.

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus announced his new team of 36 directors at headquarters on Tuesday, according to an internal message to WHO staff, seen by Health Policy Watch.

Nine of the appointments, including key positions heading the Departments of Noncommunicable Diseases and Mental Health, and the newly-combined Department of Environment, Urban Health, Climate, Migration, and One Health, are “acting” with permanent appointees to be named at some point in the future, according to the message. 

The appointment of the directors completes the latest phase of WHO’s reorganisation following a budget crisis triggered by the withdrawal of the United States, WHO’s biggest donor, in January 2025, and its abrogation of dues payments, even for the 2024 year. 

In the wake of the US exit, WHO member states slashed WHO’s projected 2026-27 base budget by over 20%, yet it remains about $1.65 billion underfunded. In May, World Health Assembly members also agreed to a 20% increase in assessed fees for member states, handing a lifeline to WHO’s operations. Still, WHO is faced with a need to reduce overall staff costs by 20-25%. 

In May, Tedros slashed the number of major WHO programme divisions from 10 to just four, announcing a pared-down senior leadership team of six Assistant Director Generals, as compared to 11 previously.  Tedros also promised to reduce the number of costly D1 and D2 directors in WHO’s headquarters from over 76 to just 34, as the next step in the massive restructuring.

In fact 36 directors were named today, and the fate of other directors not named for positions at headquarters remains to be seen. As most directors hold long-term contracts, it’s likely the organisation will try to match them to positions elsewhere in regions, as contract termination costs would also represent a heavy expense.

The sweeping leadership cuts at WHO follow months of upheaval across UN agencies as organizations from UNHCR to OCHA that cut similar shares of staff to adapt to the first US withdrawal from their operations since the UN’s founding in 1945 – a loss of billions of critical dollars across Geneva.

New WHO organizational plan, announced on 22 April, reduces 10 divisions at headquarters to just four.

Health Promotion, Disease Prevention and Control

Top amongst the familiar names in the big new division of Health Promotion, Disease Prevention and Control, headed by Jeremy Farrar, are: Katherine O’Brien, as director of Immunization, Vaccines and Biologicals;  Luz Maria De Regil, as director of Nutrition and Food Safety previously the unit chief for Multisectoral Action in Food Systems; and Etienne Krug, longtime director of the Department of Health Promotion, Social Determinants and a politically powerful WHO actor with strong connections to donors.

Tereza Kasaeva, former head of WHO’s TB department, has been named director of the newly combined WHO Department of HIV, Tuberculosis, Hepatitis, and Sexually Transmitted Infections. 

Meg Doherty, who formerly headed the HIV Department, has meanwhile, been named as director of the department of Science, Research, Evidence and Quality for Health, under the new Chief Scientist, Dr Sylvie Briand. 

Tereza Kaseva in her previous role as TB department chief.

The twin appointments of Kasaeva, a Russian national,  to the new HIV/TB Department and Doherty, an American, to the department under the Chief Scientist’s office represent a kind of Solomonic choice for Tedros, observers said.  Despite the US abrogation of its engagement with WHO, Tedros has been careful about ruffling geopolitical feathers on either side of the Atlantic.   

Meanwhile, Pascale Allotey has been named director of two major departments that remain distinct in name, at least for now. Those include the new WHO Department of Maternal, Newborn, Adolescent and Child Health; Healthy Ageing, and Sexual and Reproductive Health, a merger of three former teams. Allotey is also slated to lead the Human Reproduction Programme, a WHO-hosted joint initiative with the UN Development Programme (UNDP), the UN Population Fund (UNFPA) and UNICEF, the UN Children’s Fund.

WHO Organization, as of January 2025, boasted 10 divisions and nearly 60 departments.

Health Systems

Dr Yukiko Nakatani (middle), heads Health Systems, one of three major programme divisions in the new WHO reorganization.

In terms of the second of three big new programme divisions, Health Systems, headed by Yukiko Nakatani, Rogerio Gaspar, a well-respected Portuguese researcher, has remained as director, Prequalification and Regulation of Medicines and Health Products – a critical WHO department that evaluates new medicines, vaccines, and medical devices. 

WHO’s “prequalification” seal of approval is regarded as a greenlight for bulk procurement by UNICEF, the Global Fund, and Gavi, The Vaccine Alliance, as well as for national ministries of health that lack capacity to do independent evaluations themselves.   

Similarly, Deusdedit Mubangizi is remaining as director, Policy and Standards for Medicines and Health Products, which works hand in hand to develop WHO’s Essential Medicines List decision. Notably a new EML on weight loss drugs and drugs for rare diseases is supposed to be forthcoming soon. 

In other key appointments to that division: Alain Bernard Labrique, a former professor at Johns Hopkins and WHO Director of Digital Health, is now the director of Data and Analytics, Digital Health, and Delivery for Impact; Dr Yvan Hutin is now director of  Antimicrobial Resistance; while Kalypso Chalkidou, who has led WHO’s Department of Health Financing and Economics since last year, was named as director of the newly-combined WHO Department of Governance, Financing, Economics, Primary Healthcare, Universal Health Coverage.  

Health Emergencies Preparedness and Response 

In the third new programme division of Health Emergencies Preparedness and Response, where Chikwe Ihekweazu has replaced the retiring Executive Director Mike Ryan is being replaced by, five department directors have been named.

Those named include: Altaf Sadrudin Musani, as director of Humanitarian and Disaster Management; Nedret Emiroglu, a long-time WHO European office figure as director of Pandemic and Epidemic Management; Stella Chungong, former director of Health Security Preparedness, now morphed into the Department of Health Emergency Preparedness. 

WHO ADG of Health Emergencies, Chikwe Ihekweazu (far right).

In terms of their public-facing profiles, they are largely unknown quantities, observers say. 

Other appointments include Oliver Morgan as director of WHO’s Health Emergency Intelligence and Surveillance, replacing Ihekweazu at the helm of the Berlin-based hub; and Abdirahman Sheikh Mahamud as head of the department of  Health Emergency Alert and Response Operations.

Notably, Maria Van Kerkhove, who was one of the most familiar faces of WHO during the COVID pandemic, and has remained the go-to expert on the virus in recent press briefings at WHO headquarters, was not named to a position in the Emergencies Division.

Director General’s Office 

In the Director General’s Office, Dr Jamal Abdirahman Ahmed is continuing as director of Polio Eradication following his appointment to the role in March.  

Derek Walton will remain in his role as chief legal counsel for the agency. Gaudenz Silberschmidt remains director, Partnerships, Resource Mobilization, Envoy for Multilateral Affairs. And Alia El-Yassir continues as director of Gender Equality, Human Rights, Health Equity, and Prevention of and Response to Sexual Exploitation and Abuse.

The WHO’s organizational restructuring accompanies a growing financial crisis at the agency, which faces a $1.65 billion budget shortfall for 2026-27 despite extensive fundraising efforts.

Unfilled and acting posts 

The nine key positions which remain officially vacant, and for which only acting directors have been named, include key strategic departments such as Noncommunicable Diseases and Mental Health (Devora Kestel) and the Department of Environment, Urban Health, Climate, Migration, and One Health, where Rüdiger Krech is taking over from WHO’s Maria Neira, the iconic face of WHO’s climate and environment work, who is retiring.  As per Tedros’ announcement, the old department of Health and Migration also appears to have also been grafted into that new mega-Department since the initial WHO organigram was published in May.

In the key post of WHO Director of Communications, Gaya Gamhewage, previously director of the Prevention & Response to Sexual Misconduct, will serve as acting director, taking over from Gabriella Stern, who is also retiring. 

Within the Division of Health Systems, the Director’s post for the Global Centre for Traditional Medicine will remain vacant, with Shyama Kuruvilla acting.

As for the new department of the WHO Academy, Health Workforce and Nursing – a merger of three former entities – the acting director is David Atchoarena, who was appointed in 2023 to head the WHO Academy, a flagship project of Tedros, following a long career at the UN Educational, Scientific and Cultural Organization, UNESCO. 

Dr. Gaya Gamhewage, Director, Prevention & Response to Sexual Exploitation, Abuse and Harassment, World Health Organization, speaks on 29 November, 2022 at the United Nations in Geneva.

The directorship of Malaria and Neglected Tropical Diseases also remains vacant, with Daniel Ngamije Madandi as acting.

In addition, the directorship of TDR, the Special Programme for Research and Training in Tropical Diseases, also remains vacant following the retirement just last month of John Reeder, an Australian national.  

With respect to TDR, another WHO-hosted programme, there has also been talk of appointing a director of a related WHO department as dual director for TDR – rather than making another distinct and costly appointment. 

Continuity or complicity? A leadership dilemma

Dr Mike Ryan, director of the World Health Organization’s emergency response division, held his final press conference Friday in Geneva after eight years leading the UN health agency’s response to global health crises.

While the new appointments mark an important step in WHO’s structural reform, they also underscore a deeper tension: how much continuity is too much?

Many of the individuals retained or reappointed to leadership positions are well-tested and respected professionals in their fields. Others, while familiar, are also emblematic of an entrenched culture that critics argue is ill-equipped for WHO’s current crisis.

But others arrived at WHO, not as a result of truly open global searches, but rather via internal handpicking — a trend that has accelerated under the current Director-General, eroding transparency and weakening trust in WHO’s merit-based system.

Some, like Dr Tereza Kasaeva, reportedly arrived with overt political backing (in her case, Russian authorities at the time of Dr Tedros’s first election), raising longstanding concerns about geopolitics shaping technical leadership.

Invisible retention and the illusion of reform

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, the Assistant Director-General for Business Operations at WHO address the committee following the successful vote on the agency’s new budget.

Despite the rhetoric of bold reform and downsizing, critics fear that many senior staff not formally reappointed may still be quietly retained within WHO’s financial system — undermining the promise of a leaner, more accountable leadership.

According to reports from staff with access to WHO’s Global Management System (GSM), the Canadian physician Bruce Aylward, formerly Assistant Director General for Universal Health Coverage and Life Course, so far remains listed on the WHO payroll records as a D2-level official until his retirement in 2027 –  even after being left out of the new six-member WHO senior leadership team, announced by Tedros in May.

Similarly, Santino Severoni, former director of Health and Migration, reportedly continues to be listed in WHO’s GSM records as a D1 director until 2029, despite the fact that he has not been named to any department so far.

These arrangements raise difficult questions about whether WHO is truly cutting fat or simply relocating it.

Meanwhile, others like Krech, who previously directed WHO’s Department of Health Promotion, was made the acting director of the newly merged Department of Environment, Urban Health, Climate, Migration, and One Health, despite a lack of intimate familiarity with that arena. 

“We hope there will be an open advertisement,” commented one source. 

Financial governance itself is now overseen in part by Sushil Rathi (acting director of finance), a figure whose own entry into WHO came via a process tied to the now-defunct Indian firm Satyam — the same company that originally built WHO’s Global Management System (GSM).

The hidden costs of keeping the old guard

WHO's New Leadership Team
World Health Organization headquarters in Geneva.

Financially, retaining internal appointees is the easier path. It avoids large indemnity payouts for terminated contracts and offers a surface-level appearance of continuity. But the cost of clinging to underperforming or politically tainted leaders may be far greater in the long run — eroding staff morale, weakening donor trust, and compromising the boldness needed for WHO to truly reinvent itself.

“We are caught in a trap. Either we recycle leaders who helped create this mess, or we bring in outsiders with no real grasp of WHO’s dysfunction,” said one senior staffer privately.

Without a robust, meritocratic and depoliticized process to identify the next generation of WHO leadership, the reforms risk being cosmetic — changing the structure while leaving the culture untouched.

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, WHO, WHO, 2025, Japan MoH, Edith Magak, Israel in Geneva/ Nathan Chicheportiche, Guilhem Vellut.

Dr Mike Ryan steps down after a near three decade career at WHO.

Dr Mike Ryan, director of the World Health Organization’s emergency response division, held his final press conference Friday in Geneva after eight years leading the UN health agency’s response to global health crises from war and famine to disease outbreaks.

In his farewell remarks, Ryan warned of an “era of collapsed funding” following the Trump administration’s decision to halt funding for UN agencies and international humanitarian efforts while withdrawing from WHO for a second time, compounding a global trend of declining humanitarian and health aid that has dropped a bomb on Geneva’s humanitarian sector.

“It’s easy to be brave when there’s nothing at stake. It’s hard to be courageous when everything’s at stake and I think we live in a world where a lot is at stake,” Ryan said. “Immunization is at stake, peace is at stake, health is at stake. Honesty is at stake. Truth is at stake. So I think we have a common cause.”

Ryan, an Irish epidemiologist who has led WHO’s Health Emergencies Programme since 2017, has been at the forefront of the organization’s response to humanitarian crises from Gaza to Myanmar and Sudan, as well as Ebola outbreaks and other disease emergencies across the globe. He became particularly visible during the COVID-19 pandemic, where his direct, plain-speaking style made him one of WHO’s most recognizable faces.

His farewell coincided with WHO’s release of the latest report from its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), which concluded that China continues to withhold data necessary to determine how COVID-19 emerged, leading Ryan to address the controversy and call for international cooperation despite ongoing conflicts.

“Would I like to know what the origins of this virus are? Yes, because we want to be able to shut the door, close the trap door, so that virus can never escape again, but there are many, many other viruses in the world,” he said.

“We need to continue to look at origins and everything else, but if that’s only been driven by political outcomes, if that’s only been driven by the intent to hurt, if your intent to investigate is only to punish, you will never have justice,” Ryan continued. “If your intent to investigate is to be enlightened, then you will find justice through the process.”

Ryan, who joined WHO in 1996, is one of the organization’s longest-serving senior officials. His field experience included coordinating responses to cholera, meningitis, and hemorrhagic fever outbreaks across Africa, Asia and the Middle East, often in areas affected by conflict and displacement.

Ryan defended the progress made during his tenure in global health cooperation through improvements in the International Health Regulations, pandemic accord negotiations, and institutions like Gavi and the pandemic fund.

“We’ve moved progressively in cooperation in the IHR revision of 2005 and into the IHR amendments provision under Tedros, the pandemic accord,” Ryan said. “We’re actually learning better ways to cooperate globally on epidemics and on emergencies.”

“Are we getting better at this? We are,” he added. “Are we perfect? No, we’re not.”

His acknowledgment of the imperfections of WHO, its sister UN agencies, and international aid organizations came with a plea for continued support, noting the complexity of their global mandates amid shrinking resources.

“In this era of collapsed funding, of mistrust in public institutions, of the attacks that international UN and NGO organizations are under, this is not helping,” Ryan said.

Ryan’s departure comes as WHO faces an existential funding crisis that has forced it to trim its ambitions across the world. The US funding cuts have transformed Geneva’s already underfunded humanitarian system, but Ryan argued that withdrawing support would only worsen global health security.

“One needs to be courageous at times like this,” he said. “Our job is to enlighten you as to what the real issues are. We have a framework that’s been approved by our member states. That’s enough to move forward.”

Dr Marietjie Venter, SAGO chair and Professor, University of Witwatersrand, South Africa

A four year WHO-sponsored investigation of the origins of the COVID pandemic by an international group of experts has concluded that “most scientific data and accessible published scientific evidence” support the hypothesis that the novel SARS-CoV2 virus first entered the human population either directly from virus-carrying bats, or from bats to humans via intermediate hosts.  

But the possibility that the virus escaped from a lab leak remains on the table, the Scientific Advisory Group for the Origins of of Novel Pathogens (SAGO) said in a press conference just ahead of the publication of its final report on Friday.

Large gaps in data provided by China, as well as a lack of access to key United States and German intelligence reports, have confounded investigation of the lab leak hypothesis, the 27-member report of international experts concluded.  

“ Much of the information needed to assess this hypothesis has not been made available to WHO and SAGO, despite repeated request to the government of China, and therefore this hypothesis could not be investigated or excluded,” said Dr Marietjie Venter, SAGO chair and Distinguished Professor at the University of the Witwatersrand, South Africa. 

“Data provided in intelligence reports was also assessed, but tended to be very speculative, based on political opinions and not backed up by science,” Venter added. 

“SAGO and WHO have requested further information from member states, including the government of China, Germany and the United States of America, on an unpublished [intelligence] report that has been reported in the press. However, at the time of writing the required information, has not been provided to WHO or SAGO.” 

Maria Van Kerkhove: Work on the origins of the COVID pandemic is ‘unfinished.’

“The work to understand the origins of COVID-19 is unfinished,” said Maria Van Kerkhove, WHO’s technical lead during most of the pandemic. “We really need official and further information from China, because this is where the first cases were reported.

“This is a global search, but it really is important to make sure that the comprehensive studies that need to be done in China, where those first cases were reported, are conducted. More work needs to be done,” she said.

Zoonotic transmission via the Wuhan live animal market or another source?

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, including: (a) King rat snake (Elaphe carinata), (b) Chinese bamboo rat (Rhizomys sinensis), (c) Amur hedgehog (Erinaceus amurensis) (the finger points to a tick), (d) Raccoon dog (Nyctereutes procyonoides), (e) Marmot (Marmota himalayana) (beneath the marmots is a cage containing hedgehogs), and (f) Hog badger (Arctonyx albogularis).

In terms of the most plausible hypothesis, questions also remain as to whether SARS-CoV2 first infected humans via animals in the Wuhan live animal market, or whether the market simply became an efficient site for the virus transmission after an infected human worked or visited there.

“SAGO is not currently able to conclude exactly when, where, and how SARS-CoV2 first entered the human population,” she explained, adding that “the closest known precursor strains were identified in bats in China in 2013 and in Laos in 2020.

“These strains are too distantly related to SARS-CoV2 to be the direct source of the COVID-19 pandemic,” Van Kerkhove said. “The Huanan seafood market in Wuhan, China, played a significant role in the early transmission and amplification of the virus, with 60% of early cases in December 2019 that could be traced to the market or [people who] lived in close proximity to the market with a risk of exposure to visitors or animal products from the market. No evidence exists of widespread human or animal cases prior to December, 2019, anywhere.” 

And at the same time, there are in fact two SARS-CoV2 lineages, which were identified in infected humans at the market. This suggests that there had already been prior evolution in animals or in humans, rather than a single source, she said.

“Metagenomic evidence identified several species of wildlife that were present in the market that can be considered as potential intermediate hosts and that might have infected early human cases. Comprehensive upstream investigation at the source of wildlife species trade at this market and other markets in and around Wuhan is, however, still lacking. It is therefore not yet clear if the seafood market was where the virus first spilled over into humans or if it occurred through upstream-infected humans or animals at the market.” 

As per those questions, China has shared some of this information, “but not everything that we have requested,” Venter said.  “China has provided hundreds of viral sequences from individuals with COVID-19 early in the pandemic, but more detailed information [is needed] on animals sold at markets in Wuhan, and information on work done and biosafety conditions at laboratories in Wuhan. 

Looked at four hypotheses 

The committee examined four hypotheses, including: a spillover from animals to humans, via bats or indirectly; an accidental lab leak during field investigations or due to a break in biosafety; a third hypothesis, promoted by the Chinese in the early days, that the virus was transmitted via imported frozen food products imported into China;  and a fourth hypothesis, promoted by conspiracy fans, that the virus was the product of deliberate laboratory manipulation.

The third hypothesis was ruled out, SAGO concluded, and the fourth, regarding deliberate manipulation, remains “largely unsupported by other scientific and intelligence reports,” Venter added.

SAGO will reevaluate these hypotheses, should additional scientific evidence become available. In the meantime, a zoonotic origin, with the spillover from animals to humans, is currently considered the best supported hypothesis by the available scientific data, until further requests for information are met,” she said, adding: “Until more scientific data becomes available, the origins of SARS CoV2, and how it entered the human population will remain inconclusive.” 

Image Credits: Trinity Care Foundation/Flickr, Nature .

Women and children are worst affected by pollution caused by cooking on open fires

While almost 92% of the world’s population now has basic access to electricity – an improvement since 2022 – over 666 million people remain without access, and the world is off track to reach universal access by 2030, according to the Tracking SDG 7: The Energy Progress Report 2025 released on Wednesday.

“Clean cooking access is progressing but below the rates of progress seen in the 2010s, as efforts remain hobbled by setbacks during the COVID-19 pandemic, following energy price shocks, and debt crises,” according to a media release from five bodies responsible for Social Development Goal (SDG) 7.

These are the International Energy Agency (IEA), International Renewable Energy Agency (IRENA), United Nations Statistics Division (UNSD), the World Bank and the World Health Organization (WHO).

Access to clean cooking 2000-2023

Little to no change was observed in access to clean fuels and technologies for cooking between 2022 and 2023, with around 2.1 billion people dependent on polluting fuels such as firewood and charcoal for their cooking needs.

“If current trends continue, only 78% of the global population will have access to clean cooking by 2030,” the bodies note.

Eighteen of the 20 countries with the largest electricity access deficits in 2023 were in sub-Saharan Africa, and 85% of people without electricity access live in the region.

Four in five families are without access to clean cooking, and the number of people without clean cooking access in the region continues to grow at a rate of 14 million people yearly.

In contrast, Central and Southern Asia, with both regions made “significant strides towards universal electricity access, reducing their basic access gap from 414 million in 2010 to just 27 million in 2023”, the report notes.

Access to electricity 2010-2023

IEA executive director Fatih Birol described the expansion of access to electricity and clean cooking as “disappointingly slow, especially in Africa”. 

Birol added that this is “contributing to millions of premature deaths each year linked to smoke inhalation, and is holding back development and education opportunities” and called for “greater investment in clean cooking and electricity supply”.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that “the same pollutants that are poisoning our planet are also poisoning people, contributing to millions of deaths each year from cardiovascular and respiratory diseases, particularly among the most vulnerable, including women and children”.

Lack of finance hobbles renewables

In 2022, almost 18% of energy came from renewable energy sources. But progress is unequal and insufficient to meet international climate and sustainable development goals. In addition, global efforts must address significant disparities. 

Least developed countries and sub-Saharan Africa had only 40 watts per capita in installed renewables capacity, compared to developed countries, which had over 1,100 watts installed.

On a more positive note, international financial flows to developing countries in support of clean energy increased by 27% from 2022 to reach $21.6 billion in 2023. 

But despite this increase, “only two regions in the world have seen real progress in the financial flows”, noted IRENA Director-General Francesco La Camera.

A “lack of sufficient and affordable financing” is a key reason for regional inequalities and slow progress, the report notes.

World Bank vice-president for infrastructure Guangzhe Chen said that 12 African nations have launched national energy compacts, committing to “substantial reforms to lower costs of generation and transmission, and scale up distributed renewable energy solutions”.

Image Credits: Mission 300 Summit, World Bank.

The introduction of the pentavalent vaccine in Nigeria, is estimated to save the lives of at least 30,000 children annually.

In an harsh reprimand at the global vaccine pledging summit Wednesday, US Health and Human Services Secretary Robert F Kennedy Jr. attacked Gavi’s record on vaccine safety and said the United States was halting support for the alliance, until it could “re-earn” the public trust.

He charged that Gavi had stifled “free speech and legitimate questions” during the COVID pandemic and had continued to make “questionable recommendations” encouraging pregnant women to receive  COVID vaccines – advise that has save women’s lives and those of their unborn children, according to the World Health Organization.

Despite the US snub, Gavi later announced that it had secured more than $9 billion out of it’s $11.9 billion pledging goal – with a record number of donors commiting for the coming five years (2026-30).

In his stunning pre-taped video message, Kennedy said he admired Gavi’s commitment to “making medicine affordable to all the world’s people” but that the United States would only re-engage after Gavi had “re-earned the public trust” on issues like vaccine safety.

Kennedy lashed out, in particular, against the Gavi policy of support for traditional diptheria, tetanus and whole cell pertussis vaccines (DTPw) as compared to newer DTaP (acellular pertussis) jabs that most developed countries have shifted to, and which cause fewer side effects.

“All currently available evidence suggests that the DTPw vaccine may kill more children from other causes than it saves from diptheria, tetanus and pertussis…” Kennedy said, citing what he described as a landmark 2017 peer-reviewed study by top experts. The Lancet study, a retrospective analysis based on data from one urban community in the 1980s indeed found that all cause mortality for 3-5 month children vaccinated with the DPTw jab was five times higher than mortality for the unvaccinated.  Co-administration of an oral polio vaccine, reduced that rate significantly. Nonetheless, the study authors called upon WHO to revisit its recommendations on DPTw, based on the findings.

Said Kennedy, “when the science was inconvenient today, Gavi ignored the science. I call upon Gavi to re-earn the public trust and to justify the $8 billion that America has provided in funding since 2001…. Consider the best science available even when the science contradicts established paradigms. Until that happens, the United States won’t contribute more to Gavi. Business as usual is over.”

But Kennedy’s reference to the evidence around the safety of DPTw vaccines was quickly challenged by experts.

“The study quoted by Kennedy is based on data from a non-randomized study collected 42 years ago on a small sample of children in Guinea-Bissau,” said British paediatrician Anthony Costello, former WHO director of maternal, child and adolescent health, and now a professor of University College London (UCL).

Gavi – DPTw vaccine is more effective for infants in high-risk settings

In a reply issued just after Kennedy’s address, Gavi stated that while the DTaP vaccine does have fewer side events (which it described as minor), “evidence also suggests it offers less long-lasting protection, requiring more regular booster shots.”

Such boosters are usually highly impractical, or impossible, in low- and lower-middle income settings where Gavi vaccine support is focused.

“Having reviewed all available data, including any studies that raised concerns, global immunisation experts continue to recommend DTPw for infants in high-risk settings,” the Gavi statement continued. “The disease burden for diphtheria, tetanus and pertussis in lower-income countries is much higher than in high-income countries, and health systems are far less equipped to offer frequent booster doses…

“By contrast, DTaP is more commonly used in high-income countries, where the disease burden is far lower and healthcare systems can support booster doses to extend protection.  In places where access to hospitals is limited and disease risk is high, the stronger protection from DTPw against these life-threatening diseases far outweighs the temporary side-effects this vaccine may cause, such as fever or swelling at the injection site (which are signs the immune system is responding).

“The DTPw vaccine has been administered to millions of children around the world for decades, and is estimated to have saved more than 40 million lives over the past 50 years,” Gavi said, citing another recent Lancet study, from 2024, modelled estimates of averted mortality since from 1974 when WHO’s Expanded Programme on Immunization was launched to make vaccinations available to all children, globally.

“Gavi’s utmost concern is the health and safety of children,” Gavi said. It’s new five-year plan aims to protect 500 million children from preventable diseases, saving 8-9 million lives, the organization said.

Gavi seeking $9 billion amidst projections that 2030 vaccine targets will be missed

Kennedy’s address had been long anticipated at the pledging summit, where Gavi was seeking funds to ramp up vaccinations, particularly for “zero-dose” children, in line with the 2030 Sustainable Development Goals.  The summit comes against news that 2030 childhood immunisation targets will be missed unless substantial improvements are made.

Prior to leaving office, former US President Joe Biden had pledged $1.58 billion to the global pledging round, for about $300 million a year. But in March, the Trump administration suggested those funds would be pared back, and there is no funding for Gavi in the massive US budget bill now before Congress. Kennedy’s long-known record on vaccine hesistancy also compounded the doubts. Even so, the complete cut off in funding seemed to take many by surprise.

Only countries in the “high-income super region” are projected to reach the World Health Organization’s (WHO) 2030 immunisation target of halving the number of zero-dose children compared to 2019, according to a report published in The Lancet, also on Wednesday.

“Global immunisation goals for 2030 will not be met without targeted, equitable immunisation strategies, alongside primary healthcare strengthening and efforts to tackle vaccine misinformation and hesitancy,” according to a media release from the University of Washington’s Institute for Health Metrics and Evaluation (IHME). which conducted the analysis, based on the 2023 Global Burden of Disease study.

Coverage of 90% or greater for each of the life-course vaccines  – diphtheria-tetanus-pertussis, measles vaccines, and pneumococcal vaccine – is the central target for 2030. Only 18 of 204 countries have already met this target.

In 2023, some 15.7 million zero-dose children received no DTPw or DTaP vaccines in their first year of life, and over half lived in just eight countries.

Nigeria tops the list with the largest number of unvaccinated children (2.5 million), followed by India (1.4 million), the Democratic Republic of Congo (882,000), Ethiopia (782,000), Somalia (710,000), Sudan (627,000), Indonesia (538,000) and Brazil (452,000).

By proportion, a mere 25.7% of Somalian children were vaccinated in 2023, by far the lowest percentage in the world, followed by 56.3% in South Sudan.

Vaccination rates were under 75% in Guinea, Central African Republic, Angola, Democratic Republic of Congo, Nigeria, Mali and Madagascar.

“Successful vaccination programmes are built on understanding and responding to people’s beliefs, concerns, and expectations,” said lead author Dr Emily Haeuser. “Vaccination services must prioritise trust-building, engage community leaders, and tailor interventions with more culturally appropriate local strategies to improve vaccine confidence and uptake.”

Gates support remains strong

The summit, co-hosted by the European Union and the Gates Foundation, sought support for Gavi amidst a broader global health funding crisis – due to the sharp decline in Overseas Development Assistance for health systems and services, since Donald Trump assumed the US presidency in January.

Ahead of the Gavi pledging event, the Global Summit: Health & Prosperity through Immunisation, the Gates Foundation announced it would commit $1.6 billion over the next five years.

“For the first time in decades, the number of kids dying around the world will likely go up this year instead of down because of massive cuts to foreign aid. That is a tragedy,” warned Bill Gates, chair of the Gates Foundation. “Fully funding Gavi is the single most powerful step we can take to stop it.”

Despite the funding hiatus, the US government recently put forward Mark Lloyd as its representative to the Gavi board. Lloyd is the assistant administrator for Global Health at the US Agency for International Development. A long-time conservative activist for the Tea Party, he was a USAID religious freedom advisor in the previous Trump administration and was criticized for anti-Islamic comments. 

The US is in the midst of one of its worst measles outbreaks in 30 years, and Kennedy recently fired the 17-person entire Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and replaced it with eight people comprising mostly of vaccine sceptics.

Kennedy faces heat in the US, including from Republican Senator Bill Cassidy, who has called for the meeting of the new ACIP – also scheduled for Wednesday – to be delayed.

 “Wednesday’s meeting should not proceed with a relatively small panel, and no CDC Director in place to approve the panel’s recommendations,” said Cassidy on X.

“The meeting should be delayed until the panel is fully staffed with more robust and balanced representation – as required by law – including those with more direct relevant expertise. Otherwise, ACIP’s recommendations could be viewed with skepticism, which will work against the success of this Administration’s efforts.”

  • Editor’s note, an earlier version of this story stated that Gavi had secured $11.9 billion from donors, in fact it secured over $9 billion in the pledging event out of its 5-year, $11.9 billion pledging goal.

Updated 26.6.2025

Image Credits: GAVI/2013/Adrian Brooks.

A community health worker uses a smartphone to collect medical information in Liberia.

Africa is at a crossroads in its health journey – not simply because of shifting geopolitical dynamics or shrinking donor aid, although these are real challenges, but because we must confront a deeper structural flaw in how our health systems are designed.

The continent, home to over 1.4 billion people and projected to house one in five of the world’s population in the coming decades, faces a critical paradox. Despite progress in tackling infectious diseases, African health systems remain fragile, underfunded, overstretched, and trapped in a cycle of curative interventions. These systems prioritise expensive, hospital-based care that waits for disease, while neglecting prevention, health promotion, and community engagement to reduce the disease burden.

This model is neither sustainable nor equitable, and it keeps us locked in the “curative consumption trap.” It drains our already limited resources, perpetuates inequities, and undermines our vision for universal health coverage (UHC).

Community-driven systems

It’s time to shift from a reactive, hospital-centric model to one that invests in health production — resilient, community-driven, people-centred systems that prevent disease, empower people, and build a healthier future for all Africans.

A quick back-of-the-envelope calculation shows that high-income countries spend around $4000 per capita on healthcare, mostly through public financing. In sub-Saharan Africa, that figure is closer to $40 –  and that is assuming countries meet the aspirational goal of allocating 15% of national budgets to health. Most do not.

Can Africa afford healthcare as currently structured? The answer is clearly no.

This consumption-based model has colonial roots built for the rich who came to Africa and needed a health system that reflected their needs, as they were used to back in their home countries, reinforced by political incentives that favour short-term infrastructure projects over long-term people-centred reforms. 

During the recent Africa Health Agenda International Conference (AHAIC) 2025 in Kigali, it was evident that many African health systems still focus on treating disease rather than preventing it — a legacy that must be urgently overcome.

Vicious cycle of curative consumption trap

Hospitals and clinics often serve as the epicentre of care, with resources skewed toward expensive, tertiary-level interventions that politicians prioritise to appeal to voters. This curative bias comes at the expense of preventative measures needed to reduce the disease burden, particularly the rising tide of non-communicable diseases (NCDs) like diabetes, hypertension, and cancer.

In 2019, NCDs accounted for 37% of deaths in sub-Saharan Africa, up from 24% in 2000, and the burden is rising. Our systems are ill-equipped to manage this growing crisis.

The curative consumption trap is fuelled by several factors. First, a post-colonial bias for infrastructure-heavy, specialist-led care over community-based approaches informed by the health needs of those who built the health systems. 

Second, a health workforce trained to treat illness, not promote wellness. In medical school, I spent just one lethargic month on community health, compared to years learning about diagnosis, surgery, and pharmacology. This narrative is supported by political incentive as infrastructure is a vote driver for politicians and historical budgeting approaches prioritise infrastructure and equipment procurement. 

Third, a lack of trust in unfriendly, distant, supply-driven health systems leads people to seek care only when they are really sick, resulting in late diagnoses and high treatment costs.

This isn’t just a health issue, but a social and economic crisis. When systems focus on curing instead of preventing, they consume scarce financial and human resources while ignoring root causes such as unsafe water, poor sanitation, undernutrition, and the proliferation of unhealthy processed foods full of industrial trans fats and sweetened beverages. 

The result is high costs for health services, with families pushed into poverty by catastrophic healthcare costs from out-of-pocket expenditure. The result is a vicious cycle where illness perpetuates poverty, and poverty perpetuates illness.

People collecting water from a pump in Kinshasa in the Democratic Republic of the Congo.  Several African countries including the DRC are experiencing cholera outbreaks caused primarily by lack of access to clean  water and proper sanitation.

Shifting the focus to health production

To break this cycle, we need to embrace a model of health production that keeps people healthy, empowers communities, and addresses social determinants of health. 

It should be proactive, equitable, people-centred and sustainable, ensuring that every African has access to the tools and knowledge to live a healthy life, including reproductive health services for adolescents and women. 

This requires two major shifts. First, we must prioritise preventive and promotive health. Prevention is the cornerstone of health production.

Evidence shows that primary healthcare, with a focus on primary care and prevention, community empowerment and engagement and multi-sectoral approaches, improves health outcomes, enhances equity, and increases system efficiency. Yet, only 48% of Africans have access to primary healthcare services, leaving 615 million people without adequate services. 

To address this, we need to invest in community health systems including community health workers (CHWs), who are the backbone of primary healthcare.

CHWs are often the first and only point of contact for underserved communities. They deliver preventive services such as vaccines, they educate communities on healthy practices, and detect early warning signs of disease, yet, many remain underpaid, under-trained, and disconnected from formal health systems. 

Governments need to commit to financing and integrating CHW programmes into national health systems, as outlined in the 2018 WHO guidelines – not as stopgaps, but as core pillars of national health strategy. 

Mapping of Community Health Worker accreditation and salary status worldwide.

Promotive health also means tackling the social determinants of health – poverty, education, clean water and sanitation, nutrition, and environmental factors. We also need policies that tackle risk factors. 

Taxing unhealthy products like industrial trans fats, tobacco, alcohol, and sugar-sweetened beverages can reduce the burden of NCDs while generating revenue for health programmes. These funds can be channelled into community-led initiatives that promote clean water, sanitation, and nutrition, addressing the root causes of disease.

Second, we need to empower communities as active participants in their health. Health systems cannot succeed without the trust and participation of the people they serve. 

Too often, African health systems are designed around institutions and diseases rather than people. Some have jokingly referred to our ministries of health as “ministries of disease” — a reflection of how disconnected the system can feel from lived realities.

Communities – including youth, women, and marginalised groups – must have a seat at the decision-making table. Health policies should be co-designed and governed by those they are meant to serve. 

It is time to update the current WHO framework and recognise “people” as the seventh building block of effective health systems, alongside service delivery, health workforce, information systems, health financing, access to medicines and health technologies, as well as leadership and governance.

Empowering communities also requires fostering accountability. Civil society-led mechanisms can hold governments, the private sector and other partners accountable for delivering on UHC commitments, ensuring that policies align with the principles of social justice. By giving communities a stake in their health systems, we can build trust, encourage early health-seeking behaviour and reduce the reliance on curative care.

Moreover, African governments must address inefficiencies and corruption, optimising the use of limited resources. By embracing digital technology and artificial intelligence, we can improve health data systems, enhance service delivery and target interventions more effectively. Technology must be deployed at the community level, not just in hospitals, to enhance equitable access, particularly at the last mile.

Building health systems of the future 

Shukulu Nibogore sits on her mother’s lap while Athanasie Mukamana, a community health worker in Rwanda, measures her arm for signs of malnutrition.

The curative consumption trap is a legacy of colonial health systems and misaligned global priorities. It is not inevitable. Africa has the opportunity to redefine its health agenda, leveraging its youthful population, rich cultural heritage, and growing technological innovation. But this requires bold leadership and collective action.

African governments should prioritise health in national budgets, recognising that health is not a cost but an investment in human capital for socioeconomic development. 

Donors and global health partners must shift their focus from short-term, disease-specific interventions to long-term health system strengthening in line with the Lusaka Agenda, an effort for all to prioritise strengthening health systems, promoting sustainable health financing and enhancing equity through national-level co-ordination. 

At Amref Health Africa, we are committed to this vision. Our work with community health workers, youth, and local leaders across 35 countries for over 67 years demonstrates that health production is possible when people are at the heart of the system. 

As we approach 2030, the deadline for achieving UHC, we must decide: do we continue down the path of reactive, costly care with limited returns or do we embrace a model that produces health, dignity, and opportunity for all?

The curative trap may be the legacy we inherited, but health production is the legacy we must build.

Dr Githinji Gitahi is the Group CEO of Amref Health Africa and a passionate advocate for pro-poor universal health coverage.

Image Credits: Last Mile Health, Eduardo Soteras Jalil/ WHO, Community Health Impact Coalition @Mapbox @OpenStreetMap, Cecille Joan Avila / Partners In Health.

Flavoured additives are designed to get young people hooked on new tobacco and nicotine products.

Three-quarters of the world’s citizens – 6.1 billion people – are covered by at least one of the six tobacco control measures advocated by the World Health Organization (WHO), according to the global body’s annual Tobacco Epidemic 2025 report launched at the World Conference on Tobacco Control in Dublin on Monday evening.

However, tobacco use still claims over seven million lives a year and the WHO warns that there are still significant global gaps in tobacco control, particularly to counter growing industry interference.  

The report focuses on the six proven WHO MPOWER tobacco control measures to reduce tobacco use, introduced in 2008.

Each of the letters of ‘MPOWER’ stands for an intervention:  Monitoring tobacco use and prevention policies; Protecting people from tobacco smoke with smoke-free air legislation; Offering help to quit tobacco use; Warning about the dangers of tobacco with pack labels and mass media; Enforcing bans on tobacco advertising, promotion and sponsorship; and Raising taxes on tobacco.

Some 155 countries have implemented at least one of the MPOWER measures, and four countries – Brazil, Mauritius, the Netherlands and Türkiye – have implemented all six measures. 

Seven countries have implemented five of the six measures, namely Ethiopia, Ireland, Jordan, Mexico, New Zealand, Slovenia and Spain.

Graphic health warnings

Warning labels on tobacco packs

The most striking gains have been in graphic health warnings, with 110 countries enforcing these on cigarette packs. The average size of warnings has also grown from a global average of covering 30% of the pack in 2007 to almost 60% in 2024, with two countries thus far increasing the size of the warning to 92.5% (on the front and back).

The WHO also warns of “major gaps”, as 40 countries that are home to two billion people still have no MPOWER measures, while 22 countries still do not have warning labels on cigarette packs. 

Health warnings should be applied to new and emerging nicotine and tobacco products including e-cigarettes and nicotine pouches, according to the WHO report, which describes e-cigarettes with nicotine as “highly addictive and harmful to health”.

“Twenty years since the adoption of the WHO Framework Convention on Tobacco Control, we have many successes to celebrate, but the tobacco industry continues to evolve and so must we,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the conference opening.

 “By uniting science, policy and political will, we can create a world where tobacco no longer claims lives, damages economies or steals futures. Together, we can end the tobacco epidemic.”

Tackling e-cigarettes

Bloomberg Philanthropies' Kelly Larso (centre) and WHO's Rűdiger Kretch address a media briefing on Monday.
FCTC Secretariat’s Andrew Black, The Union’s Professor Guy Marks, Bloomberg Philanthropies’ Kelly Larson and WHO’s Rűdiger Kretch address a media briefing on Monday.

Dr Rüdiger Krech, the WHO’s director of Health Promotion, told a media briefing on Monday that the WHO report highlights the new threats – the spread of e-cigarettes, heated tobacco products and other nicotine products like nicotine pouches – that are being “aggressively marketed to young people”.

Krech added that the tobacco industry was deliberately flooding the market with “thousands of new products”, which made it very difficult for government regulators to keep up.

“We are calling on governments to act boldly, raise tobacco taxes to best practice levels, give people the support they need to quit tobacco, strengthen health warnings and run sustained media campaigns and protect policies from tobacco industry interference,” said Krech.

He highlighted that “134 countries have failed to make cigarettes less affordable since 2022, just three have increased taxes to the best practice level, over 30 countries allow the sales of cigarettes without health warnings, one third of the world lacks access to basic smoke free environments, and only a third of people have access to cost-covered quit services.

“Tobacco control is one of public health’s greatest success stories, and without our tobacco control efforts, we would have 300 million more smokers today. But it is not a fight we have won. Progress has come through evidence, policy and perseverance to protect future generations. We must stay the course with renewed stamina, robust research and strong partnerships,” said Krech.

The WHO urges countries to act against new tobacco and nicotine products.

Raising taxes

While the global health sector has faced enormous aid cuts over the past few months, primarily from  United States, tobacco control has been relatively sheltered as it is supported by Bloomberg Philanthropies, which over the past 20 years has committed about $1.6 billion to strengthen tobacco control policies in low- and middle-income countries, according to Bloomberg’s Kelly Larson.

Expressing full commitment to the WHO’s urgent work, founder Michael Bloomberg said that, since Bloomberg Philanthropies started supporting global tobacco control efforts in 2007, “there has been a sea change in the way countries prevent tobacco use, but there is still a long way to go.”

However, Andrew Black, from the secretariat of the Framework Convention of Tobacco Control (FCTC), urged countries to raise taxes on cigarettes to compensate for the loss of overseas development assistance.

Image Credits: WHO, Chemist 4 U/Flickr, Filter.

Record heat levels in Asia are affecting rainfall, causing heatwaves, and accelerating the rate of glacier melt.

Asia, the world’s most populous continent, is warming twice as fast as the rest of the world, according to the latest State of the Climate in Asia 2024 report by the World Meteorological Organization (WMO) released on Monday.

In 2024, Asia’s average temperature was about 1.04°C above the average for 1991 to 2020, ranking as the warmest or second warmest year on record, depending on the dataset.

Sea surface temperatures were the highest on record, and as a result, sea level rise on the Pacific and Indian Ocean sides of the continent exceeded the global average, heightening flooding risks for low-lying coastal areas.

The heat has also adversely affected the marine ecosystem and coastal communities that depend on the oceans for their income.

“The State of the Climate in Asia report highlights the changes in key climate indicators such as surface temperature, glacier mass and sea level, which will have major repercussions for societies, economies and ecosystems in the region. Extreme weather is already exacting an unacceptably high toll,” said WMO Secretary-General Celeste Saulo at the launch of the report.

This heat has also caused rainfall patterns to change, and widespread heatwaves. In the central Himalayas and Tian Shan in Kyrgyzstan, 23 out of 24 glaciers suffered mass loss, leading to an increase glacial lake outburst floods and landslides and heightened  long-term risks for water security.

In addition, extreme rainfall and tropical cyclones that are worsening with high temperatures have wreaked havoc in the region.

The warming trend for Asia between the years 1991–2024 was almost double that during the 1961–1990 period.

Pace of warming has quickened

In 2024, Asia’s average temperature was about 1.04°C above the 1991–2020 average. The warming trend between the years 1991–2024 was almost double of that during the 1961–1990 period, indicating that the pace of warming has quickened.

Asia is warming so fast because it is the continent with the largest land mass, extending all the way to the Arctic, and land is warming more than the ocean, according to the report.

Prolonged heatwaves were reported across Asia in countries like China, Japan and the  Republic of Korea. Myanmar set a new national temperature record of 48.2°C in 2024, testing the limits of human endurance.

Rising ocean heat, melting glaciers

Most of the ocean area of Asia was affected by intense marine heatwaves , with the Northern Arabian Sea and the Pacific Ocean particularly affected, according to the report.

“Average sea surface temperatures increased at a rate of 0.24°C per decade, which is double the global mean rate of 0.13°C per decade,” the report said.

“During August and September 2024, nearly 15 million square kilometres of the region’s ocean was impacted – one tenth of the Earth’s entire ocean surface, about the same size as the Russian Federation and more than 1.5 times the area of China.”

This heat has also affected glaciers. The Himalayan region is often called the ‘Third Pole’ as it has the largest reservoir of frozen fresh water outside of the two poles. Ice cover here spans an area of around 100,000 sq km or roughly the size of Egypt.

Reduced snowfall during the winters coupled with hot summers is leading these life-sustaining glaciers to melt at a record pace. Billions of people living downstream in countries like India, Bangladesh, Nepal and China are affected as some of the world’s largest rivers – including the Ganga, Brahmaputra and the Yangtze – originate from these glaciers.

Glaciers in other mountain ranges in Asia are also melting at a faster rate. “Urumqi Glacier No.1, located in the eastern Tian Shan, recorded its most negative mass balance since measurements began in 1959,” the report read.

In addition to this, extreme events like cyclones and erratic rainfall have caused widespread damage across the region, the report said.

India’s Kerala state reported 350 deaths following extreme rainfall that triggered landslides on 30 July last year. The following month, floods in Nepal killed 246 people and caused $94 million damage to property.

In China, nearly 4.8 million people were affected by drought, which is estimated to have cost more than $400 million in direct losses.

The elephant in the room

What the report did not mention was Asia’s toxic air which, apart from worsening health indicators, has also been pushing up rates of glacier melt.

Nearly all of the world’s most polluted 50 cities in 2024 are in Asia, particularly in the densely populated Indo-Gangetic plain, which includes Pakistan, India and Bangladesh, according to data from IQAir, a Swiss air quality technology company.

Black carbon, or the soot left behind after the incomplete combustion of fossil fuels,  drives higher rates of glacier melt as it settles on ice, darkens the surface and causes higher absorption of sunlight. When in the air, black carbon absorbs sunlight and traps the heat, warming the air further.

Silver lining: Early warning systems

However, amidst the largely grim scenario, there was a silver lining. The report mentioned the case study of Nepal, nestled in the Himalayas, which has invested in early warning systems and managed to save lives. Climate monitoring helped officials to anticipate extreme weather events and reduce damage.

WMO has been pushing countries to invest in early warning systems for extreme weather events like floods and cyclones, which can anticipate risk and prepare communities to respond to climate change. This helped them protect lives and livelihoods.

“The work of National Meteorological and Hydrological Services and their partners is more important than ever to save lives and livelihoods,” Saulo said.

Image Credits: WMO, WMO.