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.

Soroka Medical Center healthworkers survey the aftermath of Thursday’s Iranian missile attack.

The World Health Organization decried Thursday’s direct hit by Iran on one of Israel’s largest hospitals, Soroka Medical Center, which put the 1200-bed facility serving most of the country’s southern region largely out of operation. 

In an X post, WHO Director General Dr Tedros Adhanom Ghebreyesus also deplored the deaths of three Iranian Red Crescent Society health workers three days ago, following an Israeli airstrike on Tehran three days ago. 

The Iranian missile packed with 400 kilograms of explosives destroyed a surgical wing on the sixth floor of the massive facility – sending a large plume of smoke up in the air. 

“This morning’s attack on Soroka Medical Center in Israel — the only major hospital in the south — resulted in dozens of patients being injured, some severely; 250 patients being evacuated to other health facilities; and damage to the facility, leaving it only partially functional,” said the Director General in his post, early Thursday evening. 

Some 40 people at the hospital were treated for largely minor injuries, thanks to the fact that patients and operations had already moved underground – including those in the affected wing only yesterday, Israeli authorities said. 

But the widespread destruction at the sprawling complex, including collapsed walls, shattered windows, and hundreds of broken computers and medical devices, led to the evacuation of most patients from the hospital, which serves over one million people in Israel’s southern region, including the Negev community of 250,000 Bedouin citizens.   

Israel protests WHO’s silence

Soroka Medical Center at the time of Thursday’s Iranian missile attack.

On Thursday afternoon, Israel’s Ambassador to Geneva, Daniel Meron, posted a video in front of the WHO headquarters, protesting the WHO’s silence over the attack that had happened around 6 a.m. Geneva time.  

“Where is the condemnation of WHO?”  asked Meron. “It is not a military site. It is a civilian hospital…. and the Iranians are targeting time after time, civilian targets in Israel. I am waiting for a condemnation and the selective silence of WHO is deafening,” he said, an oblique reference to the many WHO statements calling out Israel’s  destruction of Gaza’s health facilities, during its grinding 20-month war on Hamas.

When the WHO response came 12 hours later, the WHO Director General was careful to balance his comments, noting two attacks on health facilities experienced by Iran during the week-long Israeli assault on Iran’s nuclear and missile capabilities, as well as energy, telecom and oil infrastructure.  

“Following an airstrike on Tehran three days ago, three Iranian Red Crescent Society health workers were killed while reportedly rescuing injured people,” Tedros added. “On the same day, a hospital in Kermanshah was impacted by a nearby explosion, causing damage to the intensive care unit. As a result, around 15 staff and patients were injured.

“We call on all parties to protect health facilities, health personnel and patients at all times,” said Tedros, adding his signature slogan, “The best medicine is peace.”

Israelis and Iranian civilians both caught up in the exchanges 

Pride flag waves on one side and Israeli flag, on the other, of buildings hit by Iranian missile attack in central Israel Thursday.

The war began with a surprise attack by Israel early Friday, 13 June, on Iran’s nuclear infrastructure, with Israel saying that the Islamic Republic was on the verge of completing the development of a nuclear weapon.

According to independent human rights observers, an estimated  639 Iranians have died so far in the conflict – the lower numbers published by the regime is only partial data, they say. Meanwhile, 24 Israelis have died in daily waves of Iranian missile attacks – from missile that evaded Israel’s “Iron Dome” air defense system.  

Suburban Tehran building destroyed in Israeli airstrike on 13 June, the first day of attack on Iran.

“The Islamic Republic has targeted residential areas in Tel Aviv, Jerusalem, Haifa, and elsewhere. Casualties would be far higher if not for the high percentage of Islamic Republic attacks that have been intercepted by the Israeli Defense Forces, as well as the presence of an extensive system of shelters and warning sirens throughout Israel,” noted the New York City-based Center for Human Rights in Iran. The group called for an immediate cease-fire by both sides.

Thursday’s early morning missile blast that hit Soroka hospital was part of the largest volleys to penetrate the countru’s defenses since the first day of the war. Explosives hit four other sites in the Tel Aviv area cities of Holon and Ramat Gan, destroying multi-story buildings, and leading to dozens of injuries, six seriously. 

Some 35,000 homes in Israel have been damaged in the war so far, with 1000 more Israeli families displaced on Thursday from high-rises and neighborhoods that suffered the worst impacts of the half-ton Iranian missiles. 

Meanwhile, dozens of Iranian residential buildings have suffered hits and hundreds of thousands of Iranians have fled the capital of Tehran, and other strategically-placed areas, following Israeli warnings to evacuate areas near key military and government assets.  

Gazans languish in conflict and hunger

Smoke rises up from Gaza City as the Israeli-Hamas conflict lingers on.

While the world focuses on the Israel-Iran war, only a few dozen kilometers away from Soroka hospital, besieged Gaza continues to languish in the throes of the ongoing Israeli battle with Hamas forces, along with persistent food and fuel shortages. Some 53 Israeli hostages also remain in Hamas captivity, and time is running out for the estimated 20 still believed to be alive after more than 621 days living underground on meager rations and with minimal medical care, their families warn. 

Gaza’s drinking water supplies are dangerously low, UNICEF’s James Elder warned in a press briefing on Friday, saying. “Currently just 40 per cent of drinking water production facilities remain functional in Gaza (87 out of 217). Without fuel, every one of these will stop operating within weeks. Since all the electricity to Gaza was cut after the horrific attacks of 7 Oct 2023, fuel became essential to produce, treat and distribute water to more than two million Palestinians.

“If the current more than 100-day blockade on fuel coming into Gaza does not end, children will begin to die of thirst. Diseases are already advancing and chaos is tightening its grip.”

Earlier this month, heavy Israeli attacks in southern Gaza forced two key hospitals,  Al Nasser and Al Amal, to curtail or halt most services, with Al Amal rendered largely accessible to new patients.  Meanwhile, the Israeli military issued fresh evacuation orders to several neighborhoods in northern Gaza, while food distribution sites of the Israeli-backed Gaza Humanitarian Foundation (GHF) have seen continued chaos – and death.

In the latest incident, on Tuesday, lethal Israeli fire allegedly killed several dozen people near food distribution points, according to eyewitness reports and Gaza’s Hamas health authorities.  GHF, meanwhile, accused Hamas of killing eight Palestinian aid workers last week in an ambush of a bus transporting some two dozen team workers. 

In a statement on Wednesday, the UN Human Rights Office, OCHCR, called upon Israel to cease the use of lethal force around the GHF food distribution sites. 

“We are horrified at the repeated incidents, continuously reported in recent days across Gaza, and we call for an immediate end to these senseless killings,” said the  OCHCR statement. 

–Updated Friday 20.6.2025

Image Credits: Emmanual Fabian/Times of Israel, Emmanuel Fabian/Times of Israel , Israel Public Television, x/@DavidShoebridge, © UNOCHA/Olga Cherevko.

A mixture of corn, soy, wheat, sugar and oil is prepared to feed malnourished children and pregnant and lactating women in Abu Shouk camp for Internally Displaced Persons in Sudan’s North Darfur region.

Better nutrition is crucial to breaking the cycle of poverty affecting millions of people across the world. As international development funding faces unprecedented strain, private sector partnerships are a key piece of the jigsaw to close the nutrition funding gap. With the right approach, we can leverage private sector resources and innovation for mutually beneficial partnerships that drive impact at scale.

Access to good nutrition is essential for communities to thrive. It is deeply linked to global challenges such as poverty, climate change, gender inequality, education inequity, and food insecurity. When we address malnutrition, we save lives, strengthen economies, and break cycles of poverty.

Yet, nutrition remains the “orphan” sector of global health. It receives less than 1% of overseas development assistance, and progress in reducing stunting has plateaued due to a combination of factors including armed conflicts, climate shocks, the lasting impact of COVID-19, and rising living costs. 

Recent cuts to development aid have also raised serious concerns about further backsliding, pushing more people into hunger and poverty. The numbers are stark: 733 million people face hunger globally, and nearly half of deaths among children under five are linked to malnutrition.

With official development assistance shrinking and governments facing growing fiscal pressure, it’s clear that traditional funding sources alone cannot close the $128 billion global nutrition financing gap. This is where the private sector must play a greater role.

Finding shared purpose

At this year’s Nutrition for Growth summit, we saw real commitment from private sector actors, some relatively new to the space, as part of the nearly $28 billion raised towards the Sustainable Development Goals. 

While the private sector is not expected to replace traditional funding, its capital, innovation, and influence offer much-needed hope. We must seize this momentum. 

But aligning efforts between the nutrition and private sectors isn’t always straightforward. Projects that appeal to businesses often differ from those prioritised by development actors. The private sector tends to be drawn to initiatives that align with profit margins, brand identity, or short-term impact goals. 

In contrast, nutrition’s biggest challenges, such as reducing stunting, require long-term, systemic change and solutions that don’t deliver quick returns and directly attributable impact metrics.

Further complicating matters, the private sector is far from monolithic. Stakeholders range from food and beverage companies to agribusinesses, the healthcare sector, foundations, philanthropic organisations and high-net-worth individuals, each with their own motivations and priorities. Partnering effectively means understanding these differences and finding shared purpose.

Match-funding

The Power of Nutrition has spent a decade mobilising financing to address malnutrition in Africa and Asia. Through a catalytic match-funding model, we’ve leveraged $647 million in investments for 26 programmes, with 68% of funding coming from private sources. Partnerships with organisations like Unilever, Cargill, the PVH Foundation, and the Aliko Dangote Foundation have helped elevate the role of private capital in tackling global malnutrition.

While creativity and innovative thinking are key to developing tailored partnerships, we also recognise the importance of being targeted about who to engage with.

Not all private sector funding aligns with our mission, and we have a robust assessment process to ensure that any partner supports, rather than undermines, the long-term credibility and impact of our work. For example, we don’t work with companies that market breast milk substitutes, and we advocate for all partners to adhere to the International Code of Marketing of Breastmilk Substitutes.

One of our programmes in India, with partners including Cargill and Unilever, focuses on improving maternal and child nutrition. It promotes diet diversity during pregnancy, early initiation and continuation of breastfeeding, and timely complementary feeding with locally available foods. These partnerships go beyond funding as they support long-term behaviour change through community-based solutions.

Smart investing – not charity

To better understand what drives successful private sector engagement, we recently partnered with academics at the London School of Economics and Political Science (LSE) to evaluate how to make private sector engagement in nutrition financing more effective.

The evaluation identified key challenges – including difficulties in measuring impact and concerns about greenwashing – but also revealed valuable lessons. One thing was clear: economic arguments resonate best with the private sector.

Fortunately, we can prove that better nutrition boosts workforce productivity and human capital. In 95 low- and middle-income countries, childhood stunting costs the private sector at least $135.4 billion in sales annually. The same study found that every dollar spent in reducing stunting can yield up to $81 in economic returns. 

In Bangladesh, The Power of Nutrition’s partnership with the government, apparel company PVH Corp, and civil society is delivering results for maternal and child nutrition, showing that investment can offer both immediate benefits and long-term gains.

The programme, running in 20 PVH Corp suppliers’ garment factories, includes the setup of new safe breastfeeding spaces and breaks, childcare provision, the distribution of multiple micronutrient supplements and paid maternity leave. 

Based on the programme’s results, in line with their corporate and social responsibility targets, PVH Corp has now established a new partnership with The Power of Nutrition to work on a programme in India.

But a strong business case alone isn’t enough. The  evaluation by leading academics from LSE highlighted that, to build lasting partnerships, we need to:

  • Foster collaboration through a convening body, which helps to align incentives, pool resources, and facilitate joint action through tailored partnerships.
  • Expand nutrition investment through innovative financing mechanisms including private equity, venture capital, and non-traditional philanthropic sources.
  • Ensure transparency and impact by aligning investments with corporate goals, backed by strong accountability frameworks and clear metrics.

We know this approach works. In Ethiopia, a multi-sectoral nutrition programme brought together government, private sector and community actors across climate, health, and education to strengthen nutrition outcomes. The result: holistic interventions that combine maternal care, growth monitoring, deworming, cooking demonstrations, and behaviour change communications.

This integrated model avoids the inefficiencies of isolated efforts. Now, instead of having to go back and forth to health facilities to access different services, a parent or caregiver can access information, services and support in an integrated way, either at the community level or in fewer visits to a health centre. To date, the programme has reached over 7.4 million women and provided 1.2 million children with vitamin A and deworming treatments.

The private sector brings capital, reach, and innovation. The development sector offers expertise, networks, and accountability. By aligning these strengths through co-investment and shared outcomes, we can shift the trajectory of global nutrition. This isn’t charity, it’s smart, long-term investing. Without a mindset shift, malnutrition will continue to steal futures and undermine prosperity for generations.

Shelley Pigott, Director of Strategic Engagement at The Power of Nutrition. Shelley has over 20 years’ experience developing multi-million-dollar partnerships with organisations such as UNICEF UK and Save the Children. She is a board member of Medair UK and advises on sustainable income growth.

Dr Lucy Kanya, Assistant Professorial Research Fellow at LSE Health (London School of Economics and Political Science), specialises in health economics and policy. She has led evaluations of health financing programs in sub-Saharan Africa and recently authored a study on The Power of Nutrition’s private sector engagement (2015–2025).

 

  

 

Image Credits: UNICEF/Njiokiktjien, Flickr – UN Photo.

US Health Secretary Robert F Kennedy appearing before the Senate Health, Education, Labor and Pensions Committee in May.

While many public health experts have criticised United States Health Secretary Robert F Kennedy Jr for undermining vaccines, several think his focus on chronic illness and big food has potential – although they are sceptical of whether he will employ proven methods to improve citizens’ health.

Obesity, and associated problems of cardiovascular disease, diabetes and hypertension, have steadily increased over the past two decades in the US (with a brief dip in 2023), and the consumption of ultra-processed food (UPF) is a major driver of this. 

“Nearly 70% of an American child’s calories today come from ultra-processed foods (67%), and over two-thirds of all calories consumed by American children are ultra-processed grains, sugars, and fats,” according to the recent Make America Health Again (MAHA) report.

Last week, Kennedy met lawmakers from Arkansas, Idaho and Utah when they announced that they would no longer allow low-income families who benefit the Supplemental Nutrition Assistance Program (SNAP) to use the food aid buy junk food and sugary drinks.

This is part of a drive by the US Department of Agriculture, which administers SNAP, and six states have adopted waivers qualifying what SNAP beneficiaries can buy. One-in-five US children were beneficiaries of SNAP in 2023, according to the MAHA report.

Kennedy’s Department of Health and Human Services announced last week that it aims to launch “a series of bold, edgy national campaigns” to make people aware of the links between ultra-processed food and diabetes and “challenge individuals to adopt disciplined, lifelong habits – centered on eating real food, physical fitness, and spiritual growth.”

Correct analysis – but no proven interventions

Global food policy expert Professor Barry Popkin told Health Policy Watch that the MAHA report “addressed ultra-processed food quite correctly and appropriately”.

“As for actions and next steps, they will come out in a month or two with a policy document, which will show us what Acts and laws they are addressing,” said Popkin, distinguished professor at the Gillings School of Global Public Health at the University of North Carolina (UNC).

Dr Tom Frieden, CEO of Resolve to Save Lives and a former director of the Centers for Disease Control and Prevention (CDC), agrees that the MAHA report “correctly identifies serious health threats from unhealthy foods, environmental toxins, and insufficient physical activity among children”. 

Frieden also notes that the report’s “emphasis on reducing industry influence is important recognition of inappropriate commercial influence in health policy”. 

But Frieden says that it “overlooks proven cost-effective interventions that reduce chronic diseases, including front-of-package warning labels, restrictions on marketing unhealthy products to children, taxes on sugar-sweetened beverages and tobacco, and comprehensive tobacco control measures. 

Since August 2021,  Argentinian ultra-processed food companies have had to add warning labels to their products that are high in salt, sugar and other harmful ingredients.

“Countries implementing these policies have healthier kids, yet the report dismisses such regulatory approaches,” adds Frieden, whose organisation has extensive global experience in saving lives by addressing high blood pressure and unhealthy food.

“The report makes a compelling case for government intervention to address inappropriate corporate influences, then paradoxically rejects the regulatory solutions its own data supports.”

Frieden also criticises the report for failing to address tobacco use, the US’s leading preventable cause of death; advocating for voluntary industry agreements that have “repeatedly failed”, and not mentioning how primary healthcare can detect and manage chronic diseases.

MAHA: An opportunity and risk

Popkin and UNC colleague Dr Lindsey Smith Tallie describe the MAHA movement as “arguably the largest, most energised movement to date to address the USA’s twin epidemics of obesity and type 2 diabetes” in a recent article in The Lancet.

The growing focus on nutrition and NCDs is “long overdue” as poor diet has been a leading cause of death and disability in the US “for decades”, with 20% of children and 42% of adults living with obesity, they note.

“Over half of Americans consume sugary drinks on a daily basis, whereas approximately two-thirds of daily calories come from ultra-processed foods” but there has been “virtually no progression in policy to address poor diets”, they add.

But they acknowledge that while MAHA has “tremendous potential to transform the food system”, it also “carries serious risks unless policies are based on science”.

They point to Kennedy’s “record of denying or contradicting scientific evidence” and note that he may not be free of conflict-of-interests (he has close links with Big Wellness groups that stand to benefit from his policies).

They also warn that the Trump administration’s slashing of National Institute of Health funding will cripple biomedical research. 

New York City letter

New York City, a global leader in anti-tobacco and other campaigns to address NCDs,  has also weighed in on the MAHA report via a six-page letter to the MAHA Commissioner in May.

It urged the Food and Drug Administration to finalise sodium reduction targets and establish new added sugar reduction targets.

Michelle Morse, NYC’s Acting Health Commissioner, also offered the city’s expertise in promoting healthy food.

The city has paired its 1.5 million annual SNAP beneficiaries with farmers’ markets to offer incentives to both consumers and food producers. However, Morse warned that the Trump administration’s changes to SNAP “will make it harder for families to buy the foods they need to stay healthy. It is also critical thatthe federal government doesn’t place undue administrative burdens that may lessen the efficiency orincrease the cost of this effective and economy boosting program.”

“We encourage the administration to support evidence-backed policies, to lean on the expertise that exists within state and local health departments, and to consider the potential ramifications that budget cuts may have on the goal of reducing chronic disease,” the letter concludes.

Politicization of food policy?

Popkin and Smith question whether Kennedy and the Trump administration will be able to overcome massive opposition from the food industry to regulate the food environment.

They also stress that “transparent, rigorous, and conflict-free scientific processes are used, even if the outcomes do not align with the preferred policy positions”.

Otherwise, there is the risk of a greater politicization of food and nutrition policy to the detriment of everyone,” they warn.

Kevin Hall, one of the NIH’s most senior scientists studying nutrition, metabolism and  neuroscience, announced his “early retirement” in April, saying that his research had been censored “because of agency concerns that it did not appear to fully support preconceived narratives of my agency’s leadership about ultra-processed food addiction”. His attempts to discuss his concerns with NIH leaders were ignored.

Meanwhile, Frieden warns: “Real progress demands systematic implementation of proven interventions, including through policies, regulations, and comprehensive programs like the CDC programs that Secretary Kennedy just dismantled.”

Image Credits: Thomas Kelley/ Unsplash, C-Span, Global Health Policy Incubator .

Panel discussion members Eloise Todd (moderator), Ambassador Amprou, Ambassador Ambassador Umej Bhatia, Colombia’s Juliana Tenorio Quintero and the South Centre’s Viviana Muñoz-Tellez.

Mistrust undermined the pandemic agreement talks – but, ironically, the Trump administration’s withdrawal from the World Health Organization (WHO) galvanised member states to reach agreement, according to Ambassador Anne-Claire Amprou, co-chair of the talks.

“There was a lack of trust. That means that when member states wanted to make a proposal, sometimes it created suspicion – not because of the content but because of the delegation that put the proposal on the table, and that was not always very easy to navigate,” Amprou told a meeting in Geneva on Tuesday.

But after the US withdrew from the WHO on 20 January,  “we could feel that member states wanted to preserve the WHO, to preserve multilateralism, and I think that it helped to have a sense of compromise at the end,” she said.

The meeting, convened by the Geneva Graduate Institute’s Global Health Centre, the Pandemic Action Network (PAN) and the Global Preparedness Monitoring Board (GPMB), reflected both on the process of reaching on the agreement and on the road ahead.

Ambassador Umej Bhatia of Singapore credited Amprou with bringing trust to the negotiations when she became co-chair in July 2024, replacing Roland Driece of the Netherlands.

“Building trust requires folks to say: ‘Look, I’m going to come here and I’m going to put all the ego to the side and work on something important for humanity,” he said, crediting the women leaders in the talks for being particularly helpful. 

Bhatia also thanked “the president of a very big power” for pushing delegates over the line.

The pandemic agreement is the “first major agreement” where the US is absent and that “spurred” member states to ensure that they championed and protected multilateralism, he added.

While the agreement is symbolically important for multilateralism, it is also important because it is “a global acknowledgement of the importance of equity and inclusivity” – although that depends on getting PABS  [the annex on a Pathogen Access and Benefit Sharing system] done,” Bhatia stressed.

Negotiations on how a PABS system will work still has to be negotiated, and this is expected to be concluded by next year’s World Health Assembly (WHA).

Ambassador Anne-Claire Amprou and WHO Director-General Dr Tedros at the conclusion of the pandemic agreement talks.

COVID broke trust

Juliana Tenorio Quintero, Minister Plenipotentiary of Colombia’s Mission in Geneva, ascribed the lack of trust between member states to what happened during COVID-19, when developing countries could not get timely access to medical countermeasures.

She added that the pandemic agreement is “huge” – “like five agreements in one”. Talks were hard because there was a lack of expertise in crafting global health law treaties, member states were involved in the parallel process of negotiating the Intergovernmental Health Regulations (IHR), were under pressure from non-state actors – as well as the lack of trust and geopolitical context.

“Right at the end of the two years, we discovered that informal negotiations are the key to unlock negotiations,” said Quintero.

She also said that the personal commitment of delegates needs to continue to complete the next phase: “We became a family after many days and nights together – perhaps sometimes a dysfunctional family, as one colleague told me – but in any case, a family committed to deliver an instrument that served mankind.”

Three hundred days until deadline

WHO legal officer Steven Solomon said that the PABS annex had to be completed by 17  April 2026 if it was was to be passed by next year’s WHA.

“If you’re counting days, that’s 300 days. If you’re counting weeks, that’s 43 weeks and three days,” said Solomon.

An Intergovernmental Working Group (IGWG), which still needs to be set up, will manage the next phase of negotiations.

The South Centre’s Viviana Muñoz-Tellez said the two next steps – negotiating PABS and implementation – would determine whether the agreement enables global collaboration.

Muñoz-Tellez also called for “meaningful spaces for getting the inputs of all sorts of non-state actors” because we know that “industry will definitely be on top of PABS”, but we really need to get other parties to be involved.

Amprou said that the preparatory work for the implementation should start as soon as possible, in parallel to negotiations on the annex, which she thought should be a short document.

“I think that this negotiation should be much more technical than political. We know the political positions of different member states,” said Amprou.

Bhatia said that the PABS talks involved both national and hard commercial interests, which made reaching agreement very difficult.

He urged the PABS annex to emphasize “scientific collaboration”, describing it as under threat in a world where there’s a lot of anti-science sentiment.

Quintero said that the agreement’s technology transfer “lacks ambition”, and also called for an implementation committee. 

Closing the discussion, Norwegian Ambassador Angell-Hansen, said that the nationalisation of production benefits, in particular vaccines, posed a threat to the legal certainty of the agreement and it is “very important to have a maximum water-tight legal text on this”.

During the COVID pandemic, India prohibited the export of vaccines which were due to have been supplied to the global vaccine platform, Gavi, for global distribution.

“It is important that the PABS system works in a simple, transparent and fair manner,” said Angell-Hanson, who is a GPMB board member. 

“Here, I would like to make a special reference to the position paper that industry from both north and south jointly developed, and I would encourage them to develop this paper further and in very concrete ways.”

Image Credits: Thiru Balasubramaniam.

NIH main campus in Bethesda, Maryland
NIH building main campus in Bethesda, Maryland.

The Trump administration’s cancellation of hundreds of National Institutes of Health (NIH) grants “represents racial discrimination”, and were null and void, ruled United States District Court Judge William Young on Monday.

This follows the cancellation of some 2,100 NIH research grants valued over than $12bn based on their links to “diversity, equity and inclusion” or “gender ideology”, since Donald Trump assumed office in January.

“I am hesitant to draw this conclusion, but I have an unflinching obligation to draw it – that this represents racial discrimination. And discrimination against America’s LGBTQ community,” said Young, who was appointed by Republican President Ronald Reagan.

“I’ve sat on this bench now for 40 years. I’ve never seen government racial discrimination like this.”

A range of organisations including the American Public Health Association (APHA),  American Civil Liberties Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW), Center for Science in the Public Interest and Ibis Reproductive Health launch a court challenge to to grant cancellations in April.

Their central argument was that the NIH had not been motivated by science but “vague” new criteria in terminating the grants

“The ideologically motivated directives to terminate grants alleged to constitute DEI, ‘gender ideology,’ or other forbidden topics were, in fact, arbitrary and capricious, and have now been ruled unlawful,” said Peter G Lurie, president of the Center for Science in the Public Interest, one of the plaintiffs.

Ibis described the ruling as “a major victory for public health”, describing the NIH’s directives that led to the cancellation of grants to be “based on sweeping, politically driven criteria.”

Young has ordered the reinstatement of grants previously awarded to the organizations and 16 Democratic-led states that filed the lawsuit.

The federal government intends to appeal the ruling.

Image Credits: NIH.

Economic insecurity is impacting on people’s family choices.

Economic insecurity is a major factor driving declining fertility globally, according to the 2025 State of World Population report produced by the United Nations Population Fund (UNFPA).

Financial worries – including job insecurity, housing and childcare costs – were key factors influencing over half of those interviewed to opt for fewer or no children, according to UNFPA.

A quarter of respondents also cited health issues, including difficulty in conceiving,  while 19% said fears about the future including climate change, were impacting their decision to have children.

Some 14,000 people – women and men – across 14 countries representing almost 40% of the global population were interviewed for the report, which was released last week.

The countries covered (from lowest to highest fertility rates) were: Korea, Thailand, Italy, Germany, Hungary, Sweden, Brazil, Mexico, United States, India, Indonesia, Morocco, South Africa and Nigeria.

People from Korea (58%) and South Africa (53%) were most concerned about economic insecurity, followed by Thailand and Morocco.

“Vast numbers of people are unable to create the families they want,” said Dr Natalia Kanem, Executive Director of UNFPA. 

Lack of choice

“The issue is lack of choice, not desire, with major consequences for individuals and societies. That is the real fertility crisis, and the answer lies in responding to what people say they need: paid family leave, affordable fertility care, and supportive partners,” she added.

UNFPA describes the fertility crisis as a “crisis in reproductive agency – in the ability of individuals to make their own free, informed and unfettered choices about everything from having sex to using contraception to starting a family”. 

The human population is projected to peak within the century, and a quarter of people currently live in a country where the population size is estimated to have already peaked. 

However, one in three adults surveyed had also experienced an unintended pregnancy, and 20% of people reported being pressured to have children when they didn’t want to.

The most marginalised people have experienced few of the advances in sexual and reproductive health and rights, according to the report. UNFPA data over the past five years shows that about 10% of  women are unable to decide whether to use contraception, and roughly one quarter are unable to say no to sex. 

The report warns against simplistic or coercive responses to declining birth rates – such as baby bonuses or fertility targets – noting that these policies are largely ineffective and can violate human rights.

It cites Romania’s 1966 ban on abortion and contraception as a warning. While the ban led to an immediate increase in total fertility rate from 1.87 births in 1966 to 3.59 in 1967, “by 1970, the fertility rate had fallen below three” and the consequences were “grave”.

“By the time the policy ended in 1989, Romania had the highest maternal mortality rate in Europe, some 87% of which was attributable to unsafe abortion, as well as vast numbers of abandoned children,” according to the report.

Instead, UNFPA urges governments to empower people to make reproductive decisions freely, including by investing in “affordable housing, decent work, parental leave, and the full range of reproductive health services and reliable information”. 

It advocates for “a tailored mix of economic, social, and political measures” to help people to have the families that they want.

Image Credits: Jaya Banerji/MMV.