US conservative Christian group Family Watch International president Sharon Slater (centre) meets with Uganda’s first lady, Janet Museveni, and other government officials in April 2023 to encourage passage of a new anti-homosexuality law.

Women’s groups and human rights organisations have raised the alarm about an African anti-rights conference taking place this weekend in Uganda, followed by another next week in Nairobi, featuring prominent US conservatives, aimed at developing “an African charter on family sovereignty and values”. 

Previous conferences have been used to mobilise for anti-LGBTQ laws and promote restrictions on sexual and reproductive rights on the continent, critics say.

Similar “African family” conferences have tried to “strip women of their basic human rights and dignity and reinforce the dominance of men within our society using ‘family values’ as a vehicle”, notes Women’s ProBono Initiative (WPI), a Ugandan women’s rights group.

The Entebbe Inter-Parliamentary Forum opened on Friday (9 May). Since its inception three years ago, it has served as a conservative platform for ultra-conservative African Members of Parliament.

Hosted by Uganda’s president and parliament, the forum has mobilised for copycat anti-LGBTQ laws in Uganda and Ghana with prison terms for those who identify as lesbian, gay, transgender, and bisexual. Conservative Kenyan MPs are working on a similar law.

Other concerning examples of shared policies are the Kenyan government’s 2023 “family protection policy” which undermined no-fault divorce, instead forcing parties into mediation even in cases of domestic abuse, says WPI. This has since been replicated by Uganda.

The Entebbe conference aims to adopt a conservative African ‘Charter’.

Notorious ‘hate groups’

The Entebbe forum taking place over the weekend is co-sponsored by Family Watch Africa, the continental branch of the Arizona-based Family Watch International (FWI), an anti-choice, abstinence-only organisation, also designated as a ‘hate group’ by the Southern Poverty Law Center in the US for its anti-LGBTQ agenda. 

Family Watch International’s Sharon Slater is due to speak at both anti-rights conferences.

FWI president Sharon Slater, who is presenting the opening session, is notorious for championing anti-LGBTQ laws in Africa and organises annual “training sessions” for African politicians in Arizona on how to lobby for conservative causes at the United Nations and other multilateral forums.

“Whenever an anti-LGBTQ law is passed in Africa, you are assured Sharon Slater had a hand in it!” says Tabitha Saoyo Griffith, a human rights lawyer and Amnesty International Kenya board member.

Last year’s forum featured addresses by two of the continent’s most vociferous anti-vaxxers, Shabnam Mohamed and Wahome Ngare, who delivered blistering attacks on several life-saving vaccines, as reported by Health Policy Watch.

Mohamed heads the Africa chapter of Children’s Health Defense, the anti-vaccine group founded by Robert F Kennedy Jr, currently the US Secretary of Health and Human Services.  

Ngare is a director of the conservative lobby group, the Kenyan Christians’ Professionals Forum (KCPF). Nine Ugandan medical professional bodies issued a statement disavowing Wahome’s misinformation after his address. 

This year’s forum will not be public, and attendees have to agree to abide by “Chatham House rules” (no disclosure or attribution of information) when registering. 

“This is worrying because these elected representatives, discussing African family values, are accountable to the people who elected them. The secretive nature of these discussions points to a sinister plan that will result in harmful decisions with life-and-death consequences,” says Joy Asasira, a sexual and reproductive health rights advocate from Uganda.

From Entebbe to Nairobi

On Monday, May 12, a day after the Entebbe forum ends, the Pan-African Conference on Family Values convenes in Nairobi, Kenya. 

Co-hosted by anti-vaxx Ngare’s KCPF, this is an even bigger gathering than Entebbe. It aims at “promoting and protecting the sanctity of life, family values and religious freedom”, as well as equipping delegates “with tools to strengthen advocacy efforts at national, regional, and global levels,” according to pre-conference publicity. 

Ironically, its keynote speakers are predominantly white conservative men from the United States and Europe. US Secretary of State Marco Rubio had even been invited to speak, but cancelled his planned visit to Kenya – reportedly in protest against Kenyan President William Ruto’s recent visit to China.

There is a proliferation of white Western men as  keynote speakers for the Pan-African Conference on Family Values in Nairobi that starts on 12 March.

The cast of speakers includes Austin Ruse, the president of the ultra-conservative Center for the Family and Human Rights (C-Fam), who describes himself as “descended of colonists” and a “Knight of Malta”, a Catholic order.

Also due to speak are Family Watch International’s Slater; Dutch conservative lobbyist Henk Jan van Schothorst; and US anti-LGBTQ politicians Robert Destro, a deputy secretary of state under the first Trump administration, and former senator John Crane; as well as leaders of the ultra-conservative Polish group, Ordos Iuris. Kenya’s Labour Ministry is also supporting the conference.

Advisors to Trump’s ‘Project 2025’ co-sponsoring events

Two of the Nairobi conference co-sponsors – C-Fam and the Alliance Defending Freedom – were on the advisory committee of Project 2025, the conservative blueprint being followed by the US Trump administration which has led to life-threatening cuts to development aid in Africa. Meanwhile, another sponsor, FWI, has worked with the Heritage Foundation, which authored Project 2025.

Project 2025’s proposals to slash US Agency of International Development (USAID) grants, prioritise funding for faith-based organisations and prohibit funding for “sexual reproductive health and reproductive rights” and “gender equality” programmes have all been implemented.

“It is outrageous that these organisations have been given a platform, when they are part of an initiative that pushed for slashing aid that is harming Africa families, and undermining the health of children, women and men and vulnerable communities,” said Dr Haley McEwan, a research associate at the University of Witwatersrand’s Centre for Diversity Studies in South Africa.

“This conference is part of decades-long activities of US Christian right organisations in the region. The fact that it features high-profile government speakers shows that they are gaining influence and power and this is even more concerning, particularly in light of the damaging funding cuts.”

Three of the sponsors of the Pan-African Conference on Family Values in Nairobi served on the Project 2025 advisory committee that proposed the Trump administration slashes development aid.

“Why are these white American men so concerned about African families? Is this not another form of colonialism? ” asks Kemi Akinfaderin, chief global advocacy officer for Fòs Feminista, a global network of over 150 organisations working for sexual and reproductive rights.

“They are trying to instil fear by claiming that there is an agenda to reduce Africa’s fertility and population rates, but this is an imposition of Western problems, such as declining fertility rates, on Africa.” 

Human rights organizations petition against use of Red Cross-owned hotel 

Over 20 Kenyan human rights organisations, backed by more than 12,000 signatories, petitioned the Red Cross, the main shareholder of Nairobi’s Boma Hotel where next week’s conference is being held, to try to persuade them to refuse to host the gathering.

In their letter, the human rights organisations point to the KCPF’s opposition to laws aimed at curbing maternal mortality in Kenya and its involvement in promoting Uganda’s Anti-Homosexuality Act. The KCPF is also opposing access to contraception for people under the age of 18.

“By giving the conference a platform, Red Cross Kenya is endorsing discriminatory ideologies that contradict the Red Cross’s commitment to alleviating human suffering and prioritising the lives of the most vulnerable,” they wrote.

However, the Red Cross, a principal recipient of the Global Fund grants in Kenya, responded that it was not involved in the day-to-day running of the hotel.

Human rights organisations have also sponsored billboards on the road from Nairobi’s airport to the hotel, stating: “True family values bring everyone together – not tear us apart.”

Billboards on the road from Nairobi’s airport protest anti-rights conferences with messages calling for an inclusive definition of families.

Narrow Western definition of ‘family’

Akinfaderin notes that the anti-rights groups have a “Western-centric, Eurocentric definition” of the family centred on a man as the head of the family, which is “not aligned with the more expansive realities of African families”.

“According to these groups, women’s rights, LGBTQI rights, access to safe abortion and comprehensive sexuality education, are anti-family initiatives,” says Akinfaderin.

“Their justification is that, if more women and girls know their rights and having a sense of value and empowerment, it means that they’re less likely to want to stay home and bear children. But women’s and girls’ aspirations are greater than their reproductive capacities. They want to go to school, work, and earn their income. They want the right to decide for themselves: physical, economic, social, and bodily autonomy,” she adds.

Anti-LGBTQ legislation was introduced in Uganda and Ghana shortly after previous year’s conferences. Ghana’s former president did not sign his country’s bill into law but conservative MPs are planning to reintroduce it under the new government. 

There are fears that this month’s events will galvanise Kenyan MPs to do the same, particularly as the conference is supported by Kenya’s Department of Labour and President Ruto is an evangelical Christian with close ties to US conservatives.

Sierra Leone is debating a Safe Motherhood Bill that will allow access to abortion to reduce its high maternal mortality rate.

Meanwhile, Akinfaderin points to several other ‘family values’ conferences in the offing in Africa in the coming months, including the Strengthening Families Conference organised by the Church of Latterday Saints (Mormons) in June in Sierra Leone. FWI’s Slater is a Mormon.

Sierra Leone’s lawmakers are currently considering the Safe Motherhood Bill, which would allow abortion up to 12 weeks (24 weeks in cases of rape, incest or danger to the mother’s health) as a measure addressing the country’s currently high maternal mortality rate. An estimated 10% of maternal deaths are due to now illegal, unsafe abortions. Lobbying by religious anti-abortion groups has thwarted a 2016 initiative to decriminalise abortion in Sierra Leone.

“It’s no mistake that they’re targeting Sierra Leone,” says Akinfaderin.

Where are the pro-family initiatives?

If these organisations and conferences are really pro-family, why are they not promoting policies that support families to thrive, ask the women’s groups and activists?

“Families need food, water, housing, access to healthcare, and protection,” says Saoyo Griffith.

“They should be talking about policies that help individuals to be able to make informed decisions about having children,” says Akinfaderin. “Pro-family policies should be about expanding access to contraception and family planning, assisted reproductive techologies like in vitro fertilisation (IVF), child care services, parental leave, social protection, and ending sexual violence in the home.” 

Women are at the core of families and if MPs want to support families, they should fast-track laws that protect women, such as the East African Community Sexual and Reproductive Health Bill, and laws on sexual offences and policies to extend social protection to single parents, says WBI.

“Families should never be a place where women’s rights are stripped away or where women live as second-class citizens who only exist to serve men. Instead, families should be a place of liberation where women can thrive and live life to the fullest on their own terms,” adds WBI.

Image Credits: Africa News.

Vadym, a Ukranian living with HIV, with a box of ARV medication. Ukraine’s HIV response has been severely affected by the US government’s withdrawal of funds.

As countries dependent on United States aid for their HIV response report looming shortages of antiretroviral medicine, the Joint UN Programme on HIV/AIDS (UNAIDS) is also fighting for survival.

Meanwhile, more shocks may be ahead for the HIV sector as the US Health and Human Services plans to curtail research collaboration between US scientists and foreign researchers, a common occurrence in the HIV sector.

UNAIDS is cutting full-time staff by more than half – from 608 to 280 – and almost halving country offices, from 75 to 36, according to a communique sent to staff, as reported by Devex.

This follows the Trump administration’s decision to end US Agency for International Development (USAID) funds to UNAIDS, which affects around 40% of its budget.

Further cuts may be necessary if a proposal from an internal UN task force is heeded, which would see UNAIDS merging with the World Health Organization, as previously reported by Health Policy Watch.

But Farhan Aziz Haq, deputy spokesperson for the UN Secretary General’s Office, said that the UN restructuring proposals are “the preliminary result of an exercise to generate ideas and thoughts from senior officials”. The UN80 task force will report its final recommendations to the UN General Assembly in 2026.

UNAIDS executive director Winnie Byanyima and International AIDS Society chair Sharon Lewin at the launch of the UNAIDS report in Munich

Medicines, supply chains disrupted

While UNAIDS faces an internal crisis, so too do the countries and communities worst affected by HIV that it serves.

By the end of 2023, 30.7 million people were accessing antiretroviral (ARV) treatment and 61% lived in just 10 countries – South Africa, Mozambique, India, Nigeria, Tanzania, Kenya, Zambia, Uganda, Zimbabwe and Malawi.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) was one of the biggest purchasers of ARVs and the breakthrough injectable ARV, cabotegravir, that prevents HIV infection that was being rolled out as pre-exposure prophylaxis (PrEP).

PEPFAR spent almost $500 million a year on ARVs and PrEP, and any reduction in its orders is likely to push global prices up, yet another obstacle in the fight against HIV.

“Sustained predictability in HIV commodity demand forecasts is essential to guarantee a stable supply, maintain prices, and ensure the availability of affordable generic medicines for national HIV responses,” according to a UNAIDS report issued on 30 April.

PEPFAR also funded ARV supply chains and logistics in many countries, and almost half (46%) of the 56 countries most affected by HIV have reported supply chain disruptions in the past month or so, according to UNAIDS.

By the end of April, seven countries out of the 56 most HIV-affected reported that they had six or less months of stock in at least one antiretroviral line. These are Burundi, Côte d’Ivoire, Ghana, Haiti, Uganda, Ukraine and Zimbabwe.

The Democratic Republic of Congo (DRC), one of the biggest PEPFAR beneficiaries, expects both ARV and condom stockouts in the next three to six months.

It’s antenatal testing of pregnant women, delivery care for women living with HIV, early infant diagnosis and paediatric treatment services are all affected, UNAIDS reported last week.

However, 22 countries said that they were not reliant on PEPFAR funding for ARV procurements but that the loss of funds had disrupted their medicine supply chains.

Focus on ‘key populations’ is lost

The HIV sector’s focus on the “key populations” most vulnerable to HIV is likely to be lost – possibly forever – due to a lack of funds. 

Key populations comprise groups that face heavy stigma – sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs and prisoners. 

HIV is stubbornly high in these groups, who are generally difficult to reach and often face legal barriers to access treatment. 

However, the scientific consensus in the sector is that HIV can only be stopped if it is addressed in these groups – and until Donald Trump became US president, PEPFAR was prepared to fund this approach.

In South Africa, for example, only 17% of the country’s HIV response was covered by PEPFAR, but the vast majority of those funds went to providing services for key populations.

But all PEPFAR-supported services for key populations have been stopped, as these groups are pariahs for Trump Republicans.

So too has a plan to integrate mental health and HIV services, according to Dr Gloria Maimela from the Foundation for Professional Research.

However, South Africa also prioritises young women who are amongst the most vulnerable to HIV, and outreach to them has also been curtailed.

The HIV treatment centre in Bahir Dar in Ethiopia geared to helping young people and key populations has closed.

The situation is similar in Ethiopia, where centres for key populations and young people have closed as staff have not been paid.

Centres offering services to key populations and young people in Bahir Dar to Mikadra, Humera, and Dansha have stopped.

“For two months, no new clients have been enrolled in PrEP, the prevention prophylaxis taken orally that protects from HIV infection. HIV testing has dropped by 43%. More than 800 people have faced treatment interruption. And 215 survivors of gender-based violence have lost access to the support services they once relied on,” according to a UNAIDS report issued last week.

Numerous countries report longer-term closures of certain ARV dispensing points, particularly at community level and those serving key populations, according to UNAIDS

Global PrEP rollout affected

PEPFAR funding covered more than 90% of PrEP initiations globally in 2024, and numerous countries report that they have been unable to sustain high-risk patients on PrEP, including in Guatemala, El Salvador, Haiti, Ukraine, Viet Nam and Zambia.

Last year, PEPFAR purchased 95% of ViiV’s cabotegravir stock for PrEP, but it has not delivered much of this to low and middle-income countries as promised, including to South Africa which was promised 230,000 doses.

“Restrictions in eligibility to access US government-funded HIV prevention commodities effectively leaves out numerous populations at high risk of acquisition,” UNAIDS notes.

HIV-linked commodities such as condoms and opiod replacement medication have also been disrupted thanks to the dominant role of PEPFAR in their  procurement, distribution and delivery.

Close to a quarter (23%) of countries reported six or less months of condom or PrEP stocks.

A recent survey by International Network of People who Use Drugs (INPUD) reports a large-scale suspension of outreach and harm reduction programmes, including needle and syringe distribution, HIV and hepatitis C testing, overdose prevention and legal support services.

Centres distributing opioid agonist maintenance therapy (OAMT) closed for a month in Uganda and Tanzania, for example.

OAMT is often prescribed as oral medication to alleviate the symptoms of withdrawal and reduce injecting drug use. In 2022, the risk of acquiring HIV was 14 times higher for people who inject drugs than the overall adult population.

“Fearing a stock out of methadone–the OAMT medicine–we have witnessed people returning to heroin use and hitting the black market,” Banza Omary Banza, director of Community Peers for Health and Environment Organisation in Tanzania, told UNAIDS.

Millions of lives at risk

While the Global Fund is helping to address some gaps, it is unable to fill the gap left by PEPFAR. 

UNAIDS modelling predicts that the permanent discontinuation of PEPFAR-supported HIV programmes would lead to an additional 6.6 million new HIV Infections (about 2300 per day) and an additional 4.2 million AIDS-related deaths (over 600 per day) by 2029.

Image Credits: The Global Fund/ Saiba Sehmi, Global Fund, UNAIDS.

Afghan families navigate daily life under challenging conditions, with the WHO warning that 80% of the health facilities it supports may close by June due to aid cuts.

Bibi Sharifa’s grandmother died of tuberculosis when there was no medicine available in her village in central Afghanistan and visiting shrines of the dead holy men was the only healing they could get.

That was two decades ago when the country’s entire healthcare system was in shambles under the first term of a brutal Taliban regime in the late 1990s. Then, when the west-backed democracy was set up following the US invasion in 2001, Afghanistan saw the establishment of clinics and community healthcare centers in villages and towns that revived the miserable population’s hopes and trust in modern medicine to some extent.

Now, Sharifa herself is infected by that consuming disease which killed her grandmother. With the drastic cuts by the Trump administration to the healthcare system worldwide, she told Health Policy Watch she has no hope of healing except by visiting the dead holy men’s graves.

“I cough all night and head to the Mazar (shrine) of Hakeem Senai in Ghazni in the day. Whenever I visit and ask for help, the preachers there advise me to either just touch and kiss the shrine, or they give me a paper with something written on it to put in a leather cover and wear it. I don’t even know what is written on it and it hasn’t helped me stop coughing,” Sharifa explained.

She was referring to a ‘taweez’, or amulet worn on the body in some beliefs to give the wearer protection. 

Dr Siraj Uddin, a physician in Ghazni province, Bibi’s home town, told the Health Policy Watch that many deadly diseases, such as TB  are prevalent. Until the latest aid cut, medicines and treatments were available to keep them under control.

“These days, all the government hospitals and the few charity-run clinics throughout Afghanistan are running out of medicine and other resources and with the cut in aid announced by (President Donald) Trump, it is going to get worse”, he said.   

Patients like Sharifa are facing the effects of this aid cut already. 

“There is no healthcare or medicine available even when we go to the hospitals,” she lamented, her voice heavy with despair. “And if it is in the private pharmacies, it’s too expensive. We pay for both healthcare and visiting the Mazar. If I could, I would rather pay the money for medicine to get some relief because the Mazar could not heal my grandmother,” she said.

The situation is similarly bleak in the capital, Kabul.

“First, we lost access to female doctors due to the Taliban’s policies, and now the lack of access to medicines via aid agencies is only making our difficulties worse,” said Sumaya Ahmadi, speaking on the telephone from  western Kabul while visiting a shrine in Karte Sakhi to seek help for her daughter’s chronic kidney condition.

“My husband and I brought our daughter to Mazar. We also visited a holy man in our area who wrote something on a piece of paper and performed a blessing over our daughter. If she drinks the water with that paper in it, hoping it will help. We try to manage, but it’s never enough.”

Vicious cycle of poverty and suffering

Afghan children are particularly vulnerable as immunization rates are critically low and food insecurity is widespread.

The United Nations (UN) has urged the global donor community to continue critical support to Afghanistan, where almost 23 million people will need humanitarian assistance this year.

“If we want to help the Afghan people escape the vicious cycle of poverty and suffering, we must maintain support to meet urgent needs while laying the foundation for long-term stability,” said Indrika Ratwatte, UN Resident and Humanitarian Coordinator in Afghanistan.

The UN has warned that the global funding crisis “could jeopardize the fragile improvements achieved in stabilizing Afghanistan over the last four years, such as improved food security levels and moderate economic growth”.

The World Health Organization (WHO) has also sounded the alarm, warning that 80% of the health services it supports could cease by June due to funding shortages.

By early March, 167 healthcare facilities had closed, depriving 1.6 million Afghans of access to healthcare. Another 220 are at risk of closing, affecting 1.8 million people.

“Afghanistan is already battling multiple health emergencies, including outbreaks of measles, malaria, dengue, polio and Crimean-Congo haemorrhagic fever,” according to the WHO.

“Without functioning health facilities, efforts to control these diseases are severely hindered. Over 16 000 suspected measles cases, including 111 deaths, were reported in the first 2 months of 2025. With immunization rates at critically low levels (only 51% for the first dose of the measles vaccine and 37% for the second), children are at heightened risk of preventable illness and death.”

The Trump administration’s decision to slash United States aid to Afghanistan is particularly devastating given that the US is the country’s largest donor, contributing over 43% of the $1.72 billion in aid raised last year. While the US has pledged waivers for life-saving aid, the scope and reliability of these waivers remain unclear.

The UN-coordinated $2.4 billion Afghanistan Humanitarian Needs and Response Plan for 2025 is only about 13% funded.

Meanwhile, a woman dies every two hours from preventable complications in Afghanistan and 3.5 million children and 1.2 million pregnant or breastfeeding women are acutely malnourished or at risk of becoming so.

Women like Sharifa and Ahmadi know little about the geopolitical decisions that are stripping away their access to healthcare. 

In desperation, they turn to shrines and holy men, seeking the only kind of healing still available to them. But their stories raise a critical question for the international community: where does the moral responsibility of the global healthcare system begin – and end?

Image Credits: WHO EMRO.

In the first episode of “Trailblazers with Gary,” Global Health Matters podcast host Dr Garry Aslanyan sat down in South Africa with Professor Tulio de Oliveira — one of TIME Magazine’s 100 most influential people in global health.

Oliveira leads the Centre for Epidemic Response and Innovation at Stellenbosch University and was part of the team that first identified the Beta and Omicron variants of COVID-19.

Aslanyan and Oliveira met in Oliveira’s lab to talk about the real story behind the Omicron discovery, how Africa came together to fight the pandemic, and why pandemic preparedness must remain a top priority, even as the world moves on.

Oliveira opened up about his roots in Brazil, his family’s move to Africa during the post-apartheid years, and how those early experiences shaped his life’s mission. Oliveira said he sees global health not as a job, but as a moral responsibility — one that requires constant vigilance, collaboration, and investment.

Aslanyan and Oliveira also discussed how climate change is already fueling new health crises across the globe. From dengue outbreaks in Ethiopia to cholera in Malawi, Oliveira explained how extreme weather, flooding, and increased mobility are making epidemics more likely — and more dangerous.

His message was clear: global health funding cuts are not just short-sighted — they’re dangerous. Pathogens don’t respect borders. Without strong, coordinated systems in place, we’re setting ourselves up for the next pandemic to hit even harder.

His advice to the global health community? Stay focused. Deliver results. And never underestimate the power of preparation.

Watch the full episode:

 

Image Credits: TDR – Global Health Matters.

Heated tobacco products (left and middle) are electronic devices that heat tobacco inserts. (The device on the right is an e-cigarette.)

Big tobacco companies are marketing heated tobacco products (HTP) as a less harmful alternative to cigarettes, but researchers warned this week that there is no evidence to support this or the industry claim that they can help smokers to quit.

HTPs are electronic devices that heat an insert of processed tobacco, often in a stick or pod, to produce an aerosol containing nicotine and other chemicals. The tobacco insert is often flavoured, including with flavours such as bubble gum and lime that appeal to young people.

“There are three key things policymakers and consumers need to know,” said Dr Sophie Braznell, a researcher from the University of Bath who co-authored a brief on HTPs released on Wednesday by STOP, a tobacco industry watchdog.

“First, heated tobacco products cause harmful effects. Second, there is no clear evidence that they are safer or less safe than other tobacco and nicotine products, even cigarettes. Third, available research lacks the independence and quality that might help us draw any conclusions about the impacts of real-world use,” Braznell told a media briefing on Wednesday.

Billion-dollar market

The main players in the HTP market.

The HTP market is estimated to be worth $36.7 billion and is projected to grow by over 52% between now and 2032, according to market research company Stellar.

“HTPs are available in at least 57 countries across Europe, North and South America, Eurasia, and East Asia. The market for HTPs in Africa and the Middle East is small but growing,” according to Stellar, with Asia Pacific being the fastest-growing region in the market.

HTPs have become more popular than cigarettes in Japan, while sales are surging internationally with promotions at events aimed at youth.

The HTP market leader is Philip Morris International’s (PMI) IQOS, an abbreviation of “I Quit Ordinary Smoking”, while British American Tobacco (which makes Glo) and Japan Tobacco International (Ploom) are the other key players.

HTPs are available in a limited number of African countries, including South Africa, Kenya, Nigeria, Botswana, Zambia, Zimbabwe and Ghana. 

However, the cost of the device is a barrier, acknowledged Frederic de Wilde, PMI’s president for South and Southeast Asia, the Commonwealth of Independent States, the Middle East, and Africa region.

“Africa definitely has a role to play and we are committed to coming up with smoke-free products to offer alternatives to African smokers,” de Wilde told African Business in an interview in late December 2024.

But he said that the current HTPs were “premium devices”, and PMI is “piloting a new simple device that is less expensive and targeted for medium and low price segments”.

How PMI’s Heated Tobacco Products are being consumed across the world.

Biased clinical trials

Braznell has spent the past five years reviewing clinical trials involving HTPs. She and colleagues found 49 clinical trials on humans, but 34 were linked to the tobacco industry, with one-third linked to Philip Morris International. 

In addition, they were usually run over a very short time – five days or less – and in controlled settings like laboratories, rather than real-world settings.

“Overall, 39 of the trials were judged to have a high risk of bias,” said Braznell, including selective reporting of results. She and colleagues also published their findings on the trials in the BMJ this week.

Aggressive marketing

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group, told the media briefing that big tobacco companies were aggressively marketing their HTPs to young people.

President Ferdinand Marcos has hosted PMI since he assumed office in 2022, and the company has promoted its smoke-free products at events organised by First Lady Liza Araneta Marcos.

Renowned DJ Steve Aoki promotes IQOS products, and there is a ‘limited edition” HTP bearing his name. However, a range of NGOs and community organisations stopped an IQOS-sponsored concert featuring Aoki on the grounds that it violated advertising bans on tobacco products.

Marketing of PMI’s IQOS in Philippines was boosted by support from DJ Steve Aoki, with limite edition devices branded in his name.

Dmytro Kupyra, executive director of “Life,” a Ukrainian NGO working to reduce mortality and morbidity from non-communicable diseases, said his country had increased taxes on HTP six-fold in 2021, which had contained sales. 

However, in 2024, the Ministry of Finance reduced HTP taxes by 25%, after the tobacco companies conducted an intense campaign for taxes to be reduced. This means that Ukraine is no longer aligned with the European Union on taxation.

“For next four year, between 2025 to 2028, Ukraine will lose around $500 million in tobacco excise taxes, and Ukraine will have around 24,000 additional deaths from hamful tobacco use,” said Kupyra, who said that about 15% of young Ukrainians aged 18 to 28 use HTPs thanks to aggressive marketing.

Ukraine backtracked on HTP taxation in 2024.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH), said that PMI had a three-pronged strategy to promote HTPs.

“First of all, they want to aggressively secure a share of the nicotine market for their heated tobacco product, and are aggressively marketing them in ways that the UK Government does not believe is in line with the law,” said Cheeseman, whose public health charity set up by the Royal College of Physicians to end the harm caused by tobacco in the UK.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH)

“They’re also seeking to secure a beneficial regulatory environment for their products through their lobbying efforts. But also, they want to be seen as a credible partner by the UK government on the basis that they have this apparently less harmful product,” said Cheeseman.

The UK’s comprehensive advertising restrictions on tobacco products were passed before HTPs existed, so PMI had marketed HTPs more aggressively and openly than they could for cigarettes, said Cheeseman.

When the UK government challenged PMI, they undertook to suspend marketing – but there are  numerous pop-up promotions of IQOS.

Questionable industry claims

“We are often told by the industry that heated tobacco products are a scientifically backed better alternative for adult smokers. But our own research shows us that we should be questioning whether, in fact, they are better for health,” said Braznell.

We’ve brought up questions and concerns about the quality of the available evidence, as well as other research that we’ve done over the last few years, which has shown that the tobacco industry continues to manipulate and misuse science for profit. 

“Work of our colleagues around the world has shown that many heated tobacco product users are not successfully quitting smoking using these products, and in fact, are perpetually continuing to use both heated tobacco products and cigarettes. 

“And lastly, we know that again and again, the tobacco industry is not just marketing heated tobacco products at smokers, but also to non-smokers and children.”

Image Credits: Filter, PMI.

Save Hands for Girls campaigns against female genital mutilation in The Gambia.

Urgent measures are needed to curtail the rising “medicalization” of female genital mutilation (FGM) and to engage health workers to prevent the practice, according to a new guideline published by the World Health Organization (WHO).

The guideline recommends professional codes of conduct that expressly prohibit health workers from performing FGM and stresses the need to train health workers to prevent the harmful practice. 

In several parts of the world, the practice is now increasingly performed by health workers. An estimated 52 million girls and women alive today were subjected to FGM by health workers –  around a quarter of all cases, according to the WHO.

The guideline offers sensitive communication approaches that can help health workers effectively decline requests to perform FGM, while informing people about its serious immediate and long-term risks, according to the WHO.

“Female genital mutilation is a severe violation of girls’ rights and critically endangers their health,” said Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Health and Research, and the United Nations’ Special Programme for Human Reproduction (HRP). 

“The health sector has an essential role in preventing FGM – health workers must be agents for change rather than perpetrators of this harmful practice, and must also provide high-quality medical care for those suffering its effects.”

Typically carried out on young girls before they reach puberty, FGM includes all procedures that remove or injure parts of the female genitalia for non-medical reasons.

Care for survivors

Over 230 million women and girls are estimated to be living with the effects of FGM. These include genital tissue damage, genitourinary tract infections, menstrual difficulties, urological complications (urinary tract infections and difficulty urinating), and sexual complications (dyspareunia and sexual dysfunction).

FGM/C is concentrated in a swath of countries from the Atlantic Coast to the Horn of Africa (2020 figures).

There is also an increased risk of obstetric complications including prolonged or obstructed labour, obstetric tears, caesarean birth, postpartum haemorrhage, episiotomy, fetal distress,, neonatal asphyxia and stillbirths. 

FGM also causes mental health disorders such as anxiety, depression, post-traumatic stress disorder [PTSD] and somatoform disorders.

Evidence shows that no matter who performs FGM, it causes harm. Some studies suggest it can even be more dangerous when performed by health workers, since it can result in deeper, more severe cuts. 

Its “medicalization” also risks unintentionally legitimizing the practice and may thereby jeopardize broader efforts to abandon the practice.

“Research shows that health workers can be influential opinion leaders in changing attitudes on FGM, and play a crucial role in its prevention,” said Christina Pallitto, Scientist at WHO and HRP, who led the development of the new guideline. 

“Engaging doctors, nurses and midwives should be a key element in FGM prevention and response, as countries seek to end the practice and protect the health of women and girls.”

Alongside effective laws and policies, the guideline highlights the need for community education and information, including community awareness-raising activities that involve men and boys. 

The guideline also includes several clinical recommendations to help ensure access to empathetic, high-quality medical care for FGM survivors. Given the extent of both short and long-term health issues that result from the practice, survivors may need a range of health services at different life stages, from mental health care to management of obstetric risks and, where appropriate, surgical repairs.

Burkina Faso has halved FGM prevalence among 15  to 19-year-olds over the past 30 years, while Sierra Leone and Ethiopia have reduced the incidence by 35% and 30% respectively, through collective action and political commitment to enforce bans and accelerate prevention.

Since 1990, the likelihood of a girl undergoing genital mutilation has decreased threefold but it remains common in 30 countries, and an estimated four million girls each year are still at risk.

 

Image Credits: Safe Hands for Girls, UNICEF.

Solar power at primary health centres in Karnataka state in India is improving healthcare delivery.

There’s an urgency to scale climate change solutions quickly, was the unofficial mantra at the World Health Summit, as delegates called for faster change and more funds.

NEW DELHI – It doesn’t cost much to ensure that a mother does not deliver her baby by candlelight, increasing the chances of the newborn’s and mother’s survival. 

Thousands of primary health centres (PHC) in India are benefiting from a solar project rollout that provides clean and sustainable power for around $4,000 to $5,000 per centre. This checks several sustainable development goal (SDG) boxes – for the planet, affordable and clean energy, good health and well-being and climate action. 

Installing solar at 25,000 primary and other health centres is scheduled to be completed next year, up from 15 centres ten years ago.

This was one of the few celebrated examples of climate action at scale at the World Health Summit (WHS) in New Delhi, a twice-a-year, influential gathering of health stakeholders, which ended on Sunday. 

Leading experts flagged hurdles that are slowing down such sustainable projects and programmes, ironically just as these should be accelerated, given the rapidly warming climate.

From scaling up affordable cooling, to faster funding mechanisms, to better data, experts from multilateral bodies such as the World Bank and Asian Development Bank (ADB), funders, NGOs and CSOs listed their priorities. 

Economic growth now vs net zero later

As if on cue, the WHS coincided with northern India experiencing extreme heat, southern India’s heat index topping 50°C, and Europe posting its hottest March on record.

Decarbonisation is the usual response to rising heat, but this needs to be looked at from another lens, Marion Jane Cros, the World Bank’s  (WB) Senior Economist for Health, pointed out. Decreasing the carbon footprint is important, but it’s more urgent in the short term to tackle heat and protect economic growth. 

The WB estimates that heat stress could result in 34 million job losses in India by 2030 and reduce GDP by up to 4.5%,, amounting to $150-250 billion.

It makes a case, in its AHEAD programme with the government, for action to reduce heat stress through affordable, energy-efficient cooling systems. With heat waves expected to intensify in the coming years, Cros made an argument to protect human capital.

“If you are affected by climate health-sensitive disease, by heat stroke, or different heat-related diseases, you might not be able to go to work,” said Cros.

“Then if you have to go to the health facility, you might not have health insurance. You have to pay some money. Then you might encounter a catastrophic health expenditure. So again, if you are protected against (this), it makes you more resilient, in particular for the vulnerable population.”

Nearly half of the Indian population lives below $3.65 per day, Cros says, and can’t afford many of the cooling systems currently available. 

Keeping cool on a tight budget

One of the groups rolling out affordable cooling solutions is the Mahila (women) Housing Trust (MHT).  They work with women in communities who can’t afford air coolers, let alone air conditioners, and support them to paint their roofs in white reflective paint, which has been estimated to reduce the temperature by 2°C to 6°C.

The cool-roofs project involves painting roofs white, which can reduce indoor temperatures by 2-6° according to the Mahila Housing Trust.

For a deeper engagement, MHT’s executive director Bijal Brahmbhat says, they explain the science to the women, install thermometers to log the temperature and ask the women to compare it with a non-cooled house or the Met department’s temperature for that day.

“They understand, and slowly they started taking it up at a settlement level and also talking to the government,” she says.

MHT’s other initiative is to cool bus stops, and it launched the first site in Ahmedabad along with the local administration in mid-March amid a heat wave warning. The low-cost tech uses a combination of curtains made of grass to block the sun and mist fans to absorb the heat. It reduces the heat by a significant 6-7°C; the city’s highest temperature has been 48°C.

India’s “first cool bus stop” launched in Ahmedabad.

The low-cost cooling solution has led to inquiries from other cities, including Delhi, Brahmbhat says. The first one was expensive at a little over $4,000. 

“The first cooling station we did was net zero, but the solar cost was around 350,000 rupees. At places where we didn’t have the funds and we couldn’t go for solar, we used energy-efficient systems which would go on for a certain time and then stop for a certain time.”

Climate vs health to climate and health

As local administrations scale up responses to climate change, an Asian Development Bank (ADB) official told the WHS how governments in the region have changed their approach to climate and health in the last few years. 

Dinesh Arora, ABD’s principal health specialist, recalls that countries used to tell the bank to go and talk to the Ministry of Environment when it wanted to discuss climate change and health.

“I’m seeing a sea-change. Indonesia is talking about a full climate and health directorate within the health systems,” said Arora.

The ADB is working to see how the infrastructure of public health hospitals can be more resilient and withstand, say, a flood or an earthquake or how quickly it can resume functions.

Funding challenges

The WHS brought health and climate together in a way that the UN’s Conference of the Parties (COP) gathering has rarely done. But funding is a challenge for health projects. 

“There’s an urgency here. We need to scale solutions quickly,” says Neeraj Jain, of the global health non-profit, PATH. The challenge described by several speakers was a chicken-and-egg situation: funders need data on the possible impact, but collecting the data needs funds. This creates delays in launching new solutions for climate change adaptation and mitigation.

A popular proposal for a way forward is for funders to start a climate action project, monitor its operational impact and course correct as needed. But this approach makes it easier for adaptation funding over mitigation, where the impact can be seen relatively quickly, for instance, greening of urban spaces to reduce the urban heat island effect, compared to setting up a wind power project.

The focus of funders is on real impact, not policy and narrative, says Jain, who is PATH’s Director of Growth Operations, Asia, Middle East and Europe at PATH. This is particularly the case in low and middle-income (LMICs) countries where the effects of climate change on health are most visible. 

“We as practitioners need to move into action mode and roll out solutions that have real, measurable impact. The impact has to be at scale and sustainable for the support from government, private, as well as philanthropic financing to flow in.”

Governments chase win-win climate solutions.

One of the largest examples of a decentralised decarbonisation and, so far, successful projects is the one by SELCO Foundation to solarise primary health centres (PHCS) in India. 

It began with 15 PHCs in 2016, and aims to cover 25,000 by 2026 at a cost of about $117 million (₹1,000 crores). So far, it has installed solar power in 10,000 PHCs for lights, fans, baby warming equipment, foetal monitoring systems, oxygen concentrators, vaccine and medicine storage refrigerators, diagnostics and so on. 

Twelve state governments have signed up for this, and SELCO’s director, Huda Jaffer explains that there are benefits in savings and health outcomes, including no deliveries by candlelight. 

“The way the program is packaged, they’re able to see a very tangible saturation based on a scale program for the state itself. Helping the fact is some catalytic capital, and systems in place for them to show that it has been rolled out, implemented and owned within a certain time frame at a certain saturation scale.”

Installing solar power in primary health centres in Karnataka state in India is making healthcare safer, including ensuring births don’t happen by candlelight, and addressing a warming planet.

But this demonstrable success comes with underlying constraints. India has well over 200,000 PHCs and sub-centres, many of which do not have reliable power from the grid or need diesel generators. 

The SELCO project only covers 12.5% of PHCs, costing about $4,000 to provide solar power per PHCs. It’s a model that could be scaled to Africa, where the electrification of health centres is low. 

Another issue is that several funders for such projects support the initial setting up of the systems (capex) but leave the running and maintenance (opex) to local communities and administrations that are usually understaffed, untrained, and have tight budgets. 

In India, there needs to be a dedicated government team to scale this from 25,000 PHCs to 200,000 plus, and ensure the solar set-up is maintained, Jaffer said, adding that SELCO is playing the role of a dedicated secretariat.

“But in Africa it has to be donor monies, and donor design is always capex-based systems, which typically leads to opex issues as there is no long-term ownership that is built in from the program design team.”

Equity: The same victims again and again

In the end, strip away the layers, and climate action is ultimately about equity.  Speaking at WHS, Dr Soumya Swaminathan, the former WHO Chief Scientist, said that every time we plan something, we must address where there are equity issues that we are forgetting about. 

Sustained heat exposure poses health risks like dehydration and cardiovascular diseases, especially for India’s informal workforce (85% of workers) and women engaged in household chores in poorly ventilated spaces, for example.

“Ultimately, those same people get left out of all programs, whether they are the elderly, the disabled or the very poor or women who have multiple of these risk factors,” said Swaminathan.

Image Credits: Selco Foundation, Mahila Housing Trust.

Self-care (illustrative)

Self-care can be a key strategy in tackling the global crisis of non-communicable diseases that are responsible for three-quarters of premature deaths globally and 86 percent of early deaths (before age 70) in low- and middle-income countries (LMICs). Moreover, dentists, pharmacists and community health workers are trained professionals who can provide innovative forms of self-care advice and guidance – reaching communities and individuals that are often beyond the reach of mainstream medicine, noted experts at a recent Global Self-Care Federation (GSCF) webinar held in the leadup to September’s High-Level meeting on NCDs.

Through these groups, countries are finding innovative ways to deliver informed self-care knowledge and tools to individuals and commnunities, which could help prevent many NCDs related to unhealthy diets and lifestyles – as well as making other disease conditions easier to diagnose and treat.

“I think it is important that society understands that the healthcare profession consists of physicians, pharmacists, dentists, and the nursing sector. It’s not just a focus on one of those four groups,” explained Greg Perry, GSCF director general. He added that it is important to look at how community health workers and other skilled health professionals can work together with individuals to expand access to self-care tools and encourage their use.

Stimulating such innovation around self-care is critical as the global health community prepares for the 2025 Fourth High-level Meeting on NCDs in New York this September, said experts from Africa CDC, patients organisations and the private sector at the recent GSCF webinar.

Inconsistent progress on self-care issues

Progress on integrating self-care into broader global strategies on NCDs has so far been inconsistent. The World Health Organization (WHO) has published a series of guidance on self-care strategies in various domains.  But so far, neither the WHO Global NCD Action Plan (2013–2030), nor the NCD and Universal Health Coverage aims of the UN Sustainable Development Goals, have sufficient emphasis on self-care strategies, critics say. At the same time, the world remains far from reaching the goals for reducing NCDs set forth in the UN SDGs or WHO action plans, and health systems, particularly in LMICs, are struggling to meet the growing demand for NCD care. GSCF has highlighted that a siloed approach to healthcare has failed in many regions.

In a new policy paper, GSCF makes the case for prioritizing self-care as a central pillar of the global NCD response. In that context, it calls for three key actions: Member states need to recognise self-care as a vital tool for easing the global burden of NCDs and reduce pressure on healthcare systems, including formally integrating certain self-care tools and tactics into national health coverage plans. Secondly, the 2025 High Level Political Declaration on NCDs should explicitly highlight the role of self-care in reducing NCD risks and improving prevention and management. And thirdly, self-care should be acknowledged as essential to empowering individuals and improving health outcomes.

According to Orajitt Bumrungskulswat, a board member of the International Alliance of Patients’ Organisations, several barriers hinder the greater integration of self-care into NCDs management. These include a lack of knowledge and skills about NCDs and self-care practices. Financial constraints also play a role, limiting access to affordable, high-quality self-care products and services. In addition, many communities face insufficient health education and a lack of supportive environments, networks, and peer groups.

Thailand’s campaign for healthier habits

In Thailand, there are 6.5 million people living with diabetes, 40 million with high blood pressure, approximately 1 million with kidney disease at various stages, 140,000 cancer cases per year, and up to 10 million people dealing with mental health issues, Bumrungskulswat said, citing Ministry of Health estimates.

“This is mainly because of individual behaviours and because people are not really aware of how to practice self-care,” Bumrungskulswat said.

To change this trajectory, the ministry launched a campaign aimed at encouraging healthier habits—such as reducing salty, oily, and sugary foods and increasing physical activity – particularly in southern Thailand’s more urbanised regions, where unhealthy diets and sedentary lifestyles are more prevalent. The campaign includes distributing prevention guidelines on social media and in communities and strengthening support networks and patient groups. These groups now collaborate closely with professionals and local healthcare centres to promote prevention and self-care education. Thailand is already beginning to see the impact of these efforts, Bumrungskulswat said.

Ireland’s dentists take the lead

In Ireland, dentists have been empowered to innovative forms of self-care guidance on topics like vaccination as well as smoking cessation.

Expanding the network of care providers is also proving to be a key strategy in the fight against non-communicable diseases. Dr Dympna Kavanagh, chair of the Platform for Better Oral Health, shared how Ireland has leveraged its dental professionals to support this goal.

“Embedding oral health into wider self-care and prevention frameworks, we can achieve better outcomes, not just for individuals, but for healthcare systems, populations and societies as a whole,” Kavanagh said.

In Ireland, Kavanagh’s program has redefined the free dental examination for lower-income patients to include oral check-ups, risk assessments, and lifestyle advice. Payments for delivering these services were increased by more than 25% to reflect dentists’ expanded role.

“We do see that there has been an increase of over 8,000 patients attending per month seeking treatment since introducing this change,” Kavanagh said.

Advice on smoking cessation and vaccination in oral health exams

And the same oral health checkups also support other preventative health measures, he noted, pointing out that:  “Dentists remain amongst the top three healthcare professionals providing tobacco cessation advice in Ireland.”

According to Ireland’s “Healthy Ireland” surveys, smoking rates have plateaued at 17%.

In recent years, oral health professionals have also been empowered to take on a role in advocacy around vaccinations.

Vaccination, a critical component of self-care, became a focal point during the COVID-19 pandemic. Ireland achieved high vaccine uptake in part by passing emergency legislation that authorised dentists and hygienists to administer vaccines. This policy has since been made permanent.

Today, Irish dentists are also supporting HPV vaccination efforts, which play a crucial role in preventing oral – as well as cervical – cancers.

“In our population campaigns, we are fortunate to see an uptake of 80% in girls and 76% in boys,” Kavanagh said.

She emphasised the need to keep oral health front and center in discussions about NCDs: “We must continue to amplify oral health as part of the global NCD agenda. We must remind policymakers and governments that prevention doesn’t begin with policy alone and doesn’t end with policy alone. It begins with empowered individuals who are supported to care for their own health by reducing tobacco and alcohol use, improving their diets, accessing vaccination and maintaining consistent oral hygiene.”

Expanding access through pharmacies

Purchasing drugs at a pharmacy in Johannesburg, South Africa.

Pharmacists are another group of caregivers who can play a vital role in guiding self-care strategies and choices, according to Mfonobong Timothy, Disease Prevention and Self-Care program coordinator for the International Pharmaceutical Federation (FIP). She explained that pharmacies are widely recognised as first-line healthcare providers—personal healthcare professionals who are knowledgeable and highly accessible.

“Pharmacists are also playing a crucial role in promoting the role of vaccination in good health and wellbeing,” Timothy said. “In 56 countries and territories, we now have pharmacy-based vaccination, and we continue to advocate for this to ensure policymakers know that this is a form of self-care that we can provide to individuals towards having good health and wellbeing.”

In addition to their role in vaccination, Timothy emphasised that pharmacists provide essential hands-on guidance for using medical devices—a key part of supporting patients in their daily self-care routines.

“Without the strong support system, individuals may not feel motivated,” Timothy noted.

Community Health Workers can support shift from treatment to prevention of NCDs

Community Health Workers attend a training session on HIV prevention in Kirehe, Rwanda.

In some low and middle-income countries, there has been a shift away from the traditional medical model toward a community- or society-based model of care, often led by Community Health Workers. This shift is helping societies move from treatment toward prevention – and along with that, more informed self-care practices, explained GSCF’s Perry.

“In high-income countries, we have the drugs, we have the guidelines, we have the digital tools, yet we still see that healthcare-associated costs are increasing along with life expectancy,” said Dr Adelard Kakunze, lead for the NCDs, Injuries and Mental Health Program at the Africa CDC. “The question is why? Why, if we have all the knowledge and tools, are we not able to really control these conditions?”

Kakunze believes the answer lies in the lack of personal engagement with self-care. In most countries, he said, health systems have failed to encourage citizens to practice the daily discipline required for self-care—what he describes as the “invisible work” that begins after the clinic door closes. This can include checking one’s blood pressure, adjusting one’s diet, or going for a walk – before resorting to drug-based treatments.

In Africa, however, this approach is gaining traction, he maintains. With limited access to specialists and resources, countries on the continent have been forced to innovate. At the core of this innovation is community. Kakunze noting that many African countries have strong networks of community health workers (CHWs), embedded in nearly every neighbourhood.

“We have learned that those specialized services are too expensive, so we need to rely on communities,” he said.

“We also now have a political commitment to deploy and equip 2 million community health workers on the continent, and what we’ve been seeing in many countries [is] that they have really embraced this with a contextualized, adapted training curriculum now that integrates NCDs,” he said. “Now, those community health workers can screen, counsel, and follow thousands of patients at home.”

Examples in mental health

A lay counsellor sits with a community member on the Friendship Bench in Zimbabwe.

In the mental health arena, one example is the Friendship Bench project, developed in Zimbabwe and cited by recent WHO guidance as a global model of community-based mental health support.

Using a cognitive behavioural therapy-based approach, trained community volunteers—affectionately called “grandmothers”—deliver structured problem-solving therapy to people suffering from common mental health conditions like anxiety and depression. Patients meet with the grandmothers for six 45-minute sessions on discreet wooden benches at local clinics, creating a safe and welcoming space for healing.

Since its launch, the Friendship Bench has shown impressive results. A 2016 study published in JAMA found a significant reduction in depressive symptoms amongst participants. The model’s success has inspired adaptations beyond Zimbabwe, including in Malawi, Zanzibar, and even New York City—showing how solutions developed in low-income countries can transform mental health care around the world.

More recently, community health workers have been paired with primary healthcare centres or general practitioners who can provide supervision and standardised health checklists.

“We have seen the impact of those community health workers when they are supervised; the impact is really increasing a lot,” Kakunze said.

Looking ahead, the Africa CDC is now exploring the use of advanced technologies and tools to support community health workers and enhance their effectiveness.

Kavanagh echoed similar sentiments. She noted that Europe has taken a “very siloed, very narrow” approach to the healthcare workforce, defining it strictly as doctors, dentists, pharmacists, and nurses. She suggested countries should also consider tapping into their ageing populations to broaden that workforce.

“Talented people retire, and then the country loses their wealth of knowledge,” she said.

Kavanagh also proposed that older medical professionals could be engaged to play a meaningful role in community healthcare, helping fill workforce gaps while contributing valuable experience.

Private-sector partnerships

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

Finally, experts say the private sector also has a vital role to play in advancing self-care.

Dr Vinayak Mohan Prasad, head of the No Tobacco Unit at WHO, noted that there are 1.25 billion tobacco users worldwide—and more than 60% of them want to quit. To address this, WHO established a consortium that brings together private companies, non-state actors, and state actors to collaborate on tobacco cessation.

“We have a pharma pillar, so all the pharma companies can come in. We have a digital tech pillar, and we have a couple of very powerful tech companies already in the consortium,” he said. “We also have a health system group. We have the research group because there are a lot of research gaps still existing.”

This collaborative model is being applied beyond tobacco control. Tamara Rogers, chief marketing officer for Haleon, highlighted how private and public actors can also partner to improve access to healthcare.

She explained that while private industry can drive innovation and develop affordable health products and solutions, non-governmental organisations can play a key role in ensuring these tools reach the people who need them most.

“I think building trustful, stable, multi-year partnerships is really pivotal in making sure that we can best maximize all of the collective resources, expertise and innovation,” Rogers said.

–Part of a supported series in collaboration with the Global Self-Care Federation

Image Credits: Caroline LM/ Unsplash, Wikimedia Commons, Cecille Joan Avila / Partners In Health, Sarah Johnson.

MSF Nurse Gatwech Tuoch immunizes a child against measles at the MSF Mobile Clinic in Bulukat, Upper Nile State South Sudan.

During this World Immunization Week (24-30 April), Médecins Sans Frontières (MSF), shares recommendations for how Gavi – which is developing its new five-year strategy amidst looming funding cuts – can strengthen collaboration between governments and humanitarian organisations to ensure that more children up until the age of at least five, especially those living in fragile and humanitarian settings, get their routine vaccinations.

On 10 January 2024, South Sudan declared a measles outbreak in its Western Equatoria state. With an alarming number of people in Western Equatoria never having been vaccinated against measles, there was an urgent need to start a large-scale measles vaccination to curb the spread of the disease in the area and its surroundings, protect people from contracting measles and, ultimately, save as many lives as possible.

However, obstacles around getting and using the measles vaccine in-country meant that it took almost four months for any measles vaccinations to begin in Western Equatoria. In the interim, thousands of people fell ill and at least thirteen people died, seven of whom were children under five years old.

For over five decades, MSF (Doctors without Borders), a medical humanitarian organization working in over 70 countries has been vaccinating people through routine vaccination, preventive vaccination campaigns, and in response to disease outbreaks in some of the world’s most challenging settings. Sometimes, we – and other humanitarian, non-governmental organisations – are the only providers of vaccination for people who are not reached by government-led vaccination activities. This can happen for various reasons, including security constraints, geographic and infrastructural challenges, and sometimes, deliberate exclusion.

Our years of experience have taught us invaluable lessons about vaccinating in humanitarian settings, and it’s because of this that we know the delay in South Sudan was not exceptional. Often, getting access to vaccine supplies requires months of negotiations around how and when they can be accessed – negotiations which often start anew each time there is a need. Such slow-moving coordination wastes valuable time and risks lives.

Delays don’t have to be the norm

But we don’t think it has to be this way.

Right now, Gavi, The Vaccine Alliance – an organisation which supports governments of the world’s poorest countries vaccinate children against some of the world’s deadliest diseases – is preparing its strategy for the next five years. As part of this, Gavi is designing a “Fragility and Humanitarian Approach” to reach communities that consistently miss out on immunization.

In fragile and humanitarian settings, such as war zones, refugee camps, and hard-to-reach areas cut off from health care, it is often more difficult for people to access routine vaccination services, and ‘zero-dose’* children are disproportionately found in these environments. For example, as of July 2024, 31 World Health Organization member countries with fragile, conflict-affected settings accounted for 55% of unvaccinated children.

Gavi’s effort to address this is therefore much welcomed. However, it must include the recommendations of non-governmental, humanitarian organisations – like us – that have spent years working in and understand these settings.

Returning to South Sudan’s Western Equatoria, a flexible system allowing for rapid access to vaccines could enable faster and smoother emergency vaccination responses. One way to make this happen, would be for Gavi to work with governments and humanitarian organisations together, to ensure a closer collaboration: we don’t operate in a void, and effective cooperation with country governments allows us to better support them and work where they are not.

Developing standing agreements

The MSF Mobile Clinic in Bulukat Transit Centre, Upper Nile State in South Sudan. Bulukat hosts over 5,000 people who fled the conflict in Sudan.

Specifically, instead of having to negotiate with governments on a case-by-case basis, Gavi should help develop standing agreements to allow humanitarian organisations rapid access to existing in-country vaccine stockpiles in order to complement national immunisation efforts by vaccinating the children that fall outside of national immunisation programmes.

We’ve seen how this can work. In South Sudan’s Upper Nile State, MSF set up mobile clinics to screen and vaccinate displaced people, preventing outbreaks. This relatively simple intervention allowed people outside of national immunisation programmes to receive healthcare, and was successful because of sufficient vaccine supplies and space to work.

There is another critical part to getting vaccines to as many children as possible in hard-to-reach places, which is making sure that when we do vaccinate, including in targeted campaigns, we reach all children who previously missed out on their basic childhood vaccines, regardless of their age. Unfortunately, due to national policies, age-limited Gavi support and – therefore – limited vaccine supplies, children over the age of two often are left out of  vaccination drives. This leaves older children who are still at an increased risk of falling ill from vaccine preventable diseases unprotected and makes any future response to an outbreak even tougher.

In our experience, missing out on vaccinations can have devastating impacts. In last year’s response to the measles outbreak in Western Equatoria, 20 per cent of children treated for measles at MSF-supported facilities were over five. While the Big Catch Up – an initiative by Gavi, UNICEF and WHO – aims to reach zero-dose children up to the age of five with vaccination, this effort will come to a close at the end of this year. Going forward, we urgently need country policies that allow for vaccination until at least the age of five matched with dedicated financial support from an ambitiously funded Gavi.

Of course, sustainable funding for immunisation is essential. And due to logistical and geographic challenges that often exist in fragile and humanitarian settings, the delivery of vaccines can be more expensive than in “stable” settings. That’s why it’s especially critical for all institutional and government donors to ensure the effort to reach children in humanitarian settings with immunisation is ambitiously supported, both financially and politically.

It’s abundantly clear that we in global health must work better together to reach every child in a fragile or humanitarian setting with lifesaving childhood, routine, or emergency vaccination. Health systems need to be strengthened so that country-led responses remain at the core of immunisation efforts, with humanitarian partners able to support where children are not reached.

This means the learnings and recommendations of humanitarian organisations must be reflected in the policies and practices that aim to reach children in humanitarian settings with vaccination. Actively dismantling the barriers in getting timely access to and using vaccine supplies is a particularly key part of ensuring that children up until at least age five will have a better chance of being protected from vaccine preventable diseases, and getting a real shot at life.

Victorine de Milliano is a vaccine policy and advocacy advisor for Médecins Sans Frontières/Doctors Without Borders (MSF).

 

 Pamela Onango is medical coordinator in South Sudan for Médecins Sans Frontières/Doctors Without Borders (MSF).

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*’Zero-dose’ children are defined as children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine (DTP3).

Read MSF’s full recommendations on how Gavi can do more to reach people outside of government vaccination activities here, and for more information on Vaccination Barriers in complex settings, see here.

Image Credits: Gale Julius Dada/MSF, Gale Julius Dada/MSF.

Africa CDC headquarters, Addis Ababa, Ethiopia.

Uganda is set to declare an end to its Ebola outbreak on April 26 if no new cases emerge, Africa’s top public health agency announced Thursday. The country’s 83% recovery rate among confirmed cases significantly exceeds the typical 30-40% survival rate for Ebola outbreaks, with Uganda managing to contain the disease while simultaneously responding to mpox cases.

“We really keep our fingers crossed,” said Professor Yap Boum, Executive Director of the Institut Pasteur of Bangui, during the weekly Africa Centers for Disease Control and Prevention briefing. “The country will declare the end of Ebola.”

Boum, who delivered the briefing on behalf of Africa CDC Director John Kaseya, who was attending IMF-World Bank Spring meetings in Washington, also reported “promising news” on mpox, citing declining cases in several countries despite the disease’s continued spread.

“We can see a decrease in the decline in number of suspected cases, but also the confirmed cases,” Boum said. “This is due partly to Burundi, but also to some other countries.”

However, Malawi reported its first four cases of mpox on April 16, including a 2-year-old child. None of the patients had a recent travel history, indicating local transmission. The child’s case highlights what Boum called an “important opportunity” for countries to approve mpox vaccination for children between the ages of one and 12.

The Democratic Republic of Congo remains “the epicenter” of the continent’s mpox outbreak, though intensified community surveillance shows some positive trends, Boum said. Contact tracing has increased from an average of 1.7 to 7 contacts per case in recent weeks, indicating authorities’ surveillance of the outbreak is improving. 

“The Kivus are the place that carries the highest burden in internal number of cases,” Boum noted, adding that implementation of vaccination and other measures in this conflict-affected region of the Democratic Republic of Congo – where mpox has been endemic since at least the 1970s – would be “the turning point to the response in DRC and therefore in the continent.”

Boum also highlighted progress on a rapid diagnostic test for mpox that could deliver results in 15 minutes without requiring electricity, potentially replacing the current system that can take up to 30 days for results to reach patients, nullifying their efficacy to contain outbreaks. Africa CDC expects to receive updates on the performance of the rapid diagnostic tests in the second week of May, and anticipates improvement from the previous 23% sensitivity rate for accurate diagnosis, Boum said. 

As the continent slowly gets mpox under control, Africa CDC’s Emergency Committee will meet on May 17 to evaluate whether to maintain the Public Health Emergency of Continental Security declaration for mpox that was issued in August 2024.

The updates came as Africa CDC leadership attended IMF-World Bank Spring Meetings in Washington to discuss health financing amid funding cuts. Boum emphasized the need to increase domestic health financing, noting that only three of 44 African member states currently meet the Abuja Declaration target of allocating 15% of GDP to health.

Angola’s recent $5 million pledge to Africa CDC was cited as an example of “championing the Africa-led financing strategy,” particularly amid what Boum described as “an era where we need to do more with less” amid vast funding cuts from the largest supporter of the continent’s health systems – the United States – during Donald Trump’s first 100 days in office.

“This is an opportunity for our countries to follow the example of Angola, to increase the expenditure on health, especially considering the new era that we are in,” Boum said, adding Africa CDC leadership’s conversation in Washington will center on “how we should navigate considering the cuts that are happening.”

“Next week, when the Director-General will be back, we’ll have more outcomes on how Africa CDC, and the continent will benefit from this challenging environment,” Boum said.

Image Credits: Africa CDC.