WHO Director General Tedros Adhanom Ghebreyesus addressing the 158th session of WHO’s Executive Board in Geneva in February. His term ends in August 2027.

Several WHO member states about to join the Executive Board have dubious human rights records, but they will shortlist Director General candidates at the Organization’s most consequential period in a generation.

The World Health Organization (WHO) Executive Board does not make headlines. It should. This is the body that screens Director General candidates, whittles the field down to three, and presents them to the World Health Assembly (WHA) for confirmation.

Whoever is confirmed to the board at this year’s WHA in Geneva in May will have an outsized say in who leads the world’s most important health organization at arguably its most precarious moment. And precarious is putting it kindly. Member states are fleeing, including the historically largest donor, the United States, which said it had officially completed its withdrawal in January. 

Right now, across all six WHO regions, the deals are being done to determine who fills the rotating seats on the board’s 34-member roster, with 10 members rotating out in 2026 and 10 new ones taking their place.

EB will select three DG candidates 

So why does any of this matter? The countries entering the Executive Board in 2026 will screen the Director General (DG) candidates and narrow the field to three finalists before the full WHA makes its final call in 2027. 

That process begins this year. Any serious candidate already knows it. As Health Policy Watch reported in February, those with their eye on the top job are already touring capitals, working the conference circuit, and calling in favors – with exactly the countries now taking their seats on this board. 

They still need the golden ticket: a formal nomination from their own Ministry of Foreign Affairs, and that clock starts the moment Tedros issues his call for candidates, anticipated later this month.

The question is whether the incoming countries will have the mettle to reverse the damage done to the organization, or whether they will simply provide fresh cover for an institution that is at risk – budget-wise and politically – before a new DG even gets the chance to restore some credibility. 

China in the new EB line-up

So who do we have? Up first is the Western Pacific Region (WPRO). At the 76th session of the WPRO, held behind closed doors in Nadi, Fiji, in October 2025, member states made a little-publicized decision to nominate China to WHA 2026, replacing Australia, whose term expires next month.

The closed-door nature of the proceedings suggests this was contentious, a reading reinforced by the chair’s report, which notes that the equitable distribution of seats within WPRO will be revisited for a final decision sometime in 2026. 

What exactly happened in that room? The context matters. Former WPRO Regional Director Takeshi Kasai was terminated following allegations of misconduct, leaving the region reeling and lacking leadership. 

One could reasonably assume that both Indonesia, which recently and controversially opted to depart WHO’s South East Asia Region (SEARO) for WPRO, and New Zealand, had their own ambitions for a board seat.

The internal turmoil is likely to have done little to smooth the path to consensus on China’s nomination.

China described the US withdrawal from the WHO as a lack of leadership at the WHO Executive Board in February.

European region

Then we head to the European Region, where Georgia and the United Kingdom have been allocated Executive Board seats beginning May 2026. Yes, the UK is still in WHO’s far-flung European Region of 53 member states, which extends from Iceland eastward to the Russian Federation and Central Asian republics. The UK and Georgia will replace Switzerland and Ukraine whose terms end this month. 

You really have to read the fine print to find this, and scratch around in Georgian news to confirm it. The UK’s inclusion is unsurprising. Based on Resolution EUR/RC53/R1, permanent members of the UN Security Council within the European Region are entitled to Executive Board membership for three out of every six years. 

France, on the same basis, is already confirmed to follow in 2027. Worth noting too that Ukraine loses its board seat while its medical facilities and civilian infrastructure continue to be bombed by Russia, a detail that speaks for itself. Reports indicate that Russia stood as a competing candidate for the seat ultimately won by Georgia, meaning it was not afforded the same rotating privileges extended to the United Kingdom and France.

African and Eastern Mediterranean Regions

Over in the African Region, four out, four in: Cote d’Ivoire, Guinea, Mozambique, and South Sudan replace Togo, Cameroon, Comoros, and Lesotho respectively, with Cote d’Ivoire also tapped to serve as Vice-Chair of the Executive Board from the 159th session onwards.

From the Eastern Mediterranean Region (EMRO), Qatar completes its term at the close of the 79th World Health Assembly in 2026, with Kuwait set to take its seat through to May 2029.

Question marks in South East Asia and Americas

All four regions – Africa, EMRO, EURO and WPRO – have now published their nominations, though they are buried deep inside the archives of WHO’s never-ending pile of papers. 

Two question marks remain. First, who will replace the Democratic People’s Republic of Korea (DPRK)  from SEARO? Given the region’s smaller size, the list of viable candidates is short. Replacing one pariah with another in the form of Myanmar seems unlikely. The Maldives has limited diplomatic capacity. That leaves India, Sri Lanka, or Bangladesh, given Nepal and Thailand still have time left on their existing terms. 

If India is paying attention, and it almost certainly is, it may well calculate that with China joining the board, it cannot afford to remain aloof. The cold diplomatic war between the two countries, and their competing claims to the title of pharmacy of the world, gives India every reason to want influence over an organization that can directly shape that designation.

Second, the Americas. With Barbados going out, logic suggests another Caribbean nation could come in, but no reporting has yet confirmed a nomination. Jamaica or Trinidad and Tobago would both have the diplomatic capacity to make a push and represent the region credibly. And notably, the United States will not be at the table, given their recent exit from the WHO.

The board that emerges from Geneva in May will be imperfect. Based on historical precedent, including the DPRK being confirmed to the board three years ago despite its status as a global health pariah, it is hard to see any of the proposed names being rejected.

That said, several of the countries to be represented have human rights records that would raise eyebrows anywhere else. But they will help decide who leads WHO through its most consequential period in a generation. The world will be watching. One can only hope they set politics aside and do what the role demands: govern.

Following WHA 2026, the Executive Board is expected to be composed of the following Member States:

Staying on (continuing terms):

  •   AFRO: Cabo Verde (2025-2028), Central African Republic (2025-2028), Zimbabwe (2024-2027)
  •   AMRO/ PAHO: Chile (2024-2027), Costa Rica (2024-2027), El Salvador (2025-2028), Haiti (2025-2028), Panama (2025-2028)
  •   SEARO: Nepal (2025-2028), Thailand (2024-2027)
  •   EURO: Bulgaria (2024-2027), Israel (2024-2027), Norway (2024-2027), Poland (2024-2027), Serbia (2025-2028), Spain (2025-2028)
  •   EMRO: Egypt (2025-2028), Lebanon (2024-2027), Saudi Arabia (2025-2028), Somalia (2024-2027)
  •   WPRO: Brunei Darussalam (2024-2027), Japan (2025-2028), Republic of Korea (2024-2027), Solomon Islands (2025-2028)

Rotating in from May 2026:

  •   AFRO: Cote d’Ivoire, Guinea, Mozambique, South Sudan
  •   AMRO: TBC (replacing Barbados)
  •   SEARO: TBC (replacing DPRK)
  •   EURO: United Kingdom, Georgia (replacing Switzerland, Ukraine)
  •   EMRO: Kuwait (replacing Qatar)
  •   WPRO: China (replacing Australia).

Image Credits: WHO/X.

Exposure to air pollution, particularly in the long term, is associated with an increased risk of diabetes.

Air pollution increases the risk of diabetes, particularly when exposure is long-term, according to emerging evidence.

A 2025 study from China involving 18,606 middle-aged and elderly adults found that long-term exposure to air pollution – both indoor and outdoor – significantly increased their risk of metabolic disorders like diabetes.

“This national cohort study shows that outdoor air pollution -– particularly PM1, PM2.5, and their chemical components – is an important environmental factor contributing to GMDs [glycolipid metabolic disorders],” according to the study, published in the World Journal of Diabetes.

Long-term exposure results in higher toxicity than short-term exposure.

This is one of a series of studies on the association between diabetes and air pollution produced in the past decade.

But researchers need to factor in several variables that could affect the results, such as sugar consumption, genetics and socio-economic conditions, Arindam Roy, climate science advisor at the Clean Air Fund, told Health Policy Watch.

“It’s difficult in terms of getting the data right, because you need to have a substantial amount of air quality monitors, or by any means, you need air quality information at a very high resolution. You also need health information at a very high resolution,” Roy said.

A 2022 study published in The Lancet concluded that, “in 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure.”

While type 1 diabetes is an autoimmune condition where the body attacks the insulin-producing cells, type 2 diabetes is influenced by environmental factors, diet and exercise.

Solid fuel not linked to higher diabetes risk

Using solid fuels does worsen indoor air pollution, but research does not show any association with metabolic disorders like diabetes.

The 2025 study from China looked at air pollution as a result of various particle sizes ranging from PM1, PM2.5 and PM10. It studied the health impact over a five-year (long-term) and one-year (short-term) period.

Researchers found that while any kind of exposure to air pollution increases the risk of developing diabetes, the impact of long-term exposure was strongest.

The terms short-term and long-term are not very well defined, but short-term usually refers to episodic high exposure around events like wildfire or a season of high exposure. Long-term duration is usually measured in a timeline of years.

The use of solid fuels for cooking, which is known to push up indoor air pollution, did not appear to increase the risk of developing diabetes in the China study.

The researchers concluded that the lack of any association with air pollution from solid fuels and metabolic disorders like diabetes “underscores the urgent need for targeted interventions to improve outdoor air quality and reduce metabolic risks at the population level.”

This result is also in line with another four-year multi-country trial, the Household Air Pollution Intervention Network (HAPIN), which studied 3,200 households in Guatemala, India, Peru, and Rwanda. Study participants switched from cooking on solid stoves to LPG but did not see any significant health gains – a result that surprised the study’s researchers.

Also read: Switching from Biomass to LPG Failed to Show Health Gains in Four-Country Study of Household Air Pollution

Lack of adequate ground monitors is getting in the way

A 2022 study from Denmark that studied 1.9 million people found that exposure to all air pollutants was associated with a higher risk of diabetes.

Studying the health impacts of air pollution requires two sets of data – one on air pollution, and the other on health. Currently, very few countries have both these datasets at hand.

Air pollution data requires better monitoring on the ground using ground monitors.

“We do have satellite-based or modelled air quality data, which are very high resolution, like one kilometre or so. But again, you need ground-based monitors to validate the data in those particular areas to give you more confidence in your research,” Roy said.

Sharing health data is also often fraught with ethical challenges, apart from the fact that institutions in many countries might not even have them in digital format. Then there is the issue of both health and environmental researchers working in silos.

Evidence is lagging in most parts of the world

High-quality evidence on air pollution’s impact on health is available only in some countries and regions, such as the US, UK, and Europe.

“China is one example of a country where AQ (air quality) data has been improved during the recent past. There are other countries as well where accessibility has improved,” Roy said.

Africa in particular, and much of the developing world in general, suffers from the lack of evidence, researchers told HPW.

“The monitoring is not nationwide. A lot of the monitoring is centered in urban areas, and especially in the capital cities. Most of this monitoring is not national government activities,” said Gordon Dakuu, a Ghana-based analyst with Clean Air Fund.

“These are mostly project-based initiatives using Low-Cost Air Quality Sensors with a few Reference Grid monitoring. So, in Kenya, it is just Nairobi. In South Africa, it is Johannesburg, then when you come to Ghana, [it] is just Accra.”

The US administration’s cuts to the budget of its Environmental Protection Agency (EPA) have further disrupted air quality monitoring in several global locations.

Currently, the awareness of the air pollution-diabetes connection is also low.

“We tried engaging [people] on how air pollution can lead to some of these conditions. And you see, people’s perception of the linkages between air pollution and diabetes is still very weird,” Dakuu said.

“They think diabetes has to do with eating sugar, especially white sugar. So, I think there is still a lot for us to do as far as public health sensitization of people is concerned about the risk factors.”

Image Credits: isensusa/Unsplash, hailegebrael Berhanu/Unsplash.

Thousands of Somalis escaping drought and conflict have been arriving every month in sprawling settlements on the outskirts of towns, like this one in Baidoa, south-central Somalia, pictured in August 2022. The World Food Programme is the largest humanitarian organisation operating in the country.

The Trump administration has put forward Luke J Lindberg, the US Department of Agriculture trade and foreign agricultural affairs under secretary, as its pick for executive director of the United Nations World Food Programme (WFP). 

Lindberg would succeed Cindy McCain, who announced her resignation in October due to health issues. 

“Throughout his career, Under Secretary Lindberg has demonstrated the strategic vision, geopolitical insight, and focus on accountability that are necessary to lead WFP in delivering emergency food assistance,” the State Department said in its media note.

The WFP, founded in 1961, is the largest humanitarian organization in the world, offering emergency food relief, direct cash assistance, and technical and development assistance.

The programme is overseen by an executive director, who is appointed jointly by the UN Secretary General, and the Food and Agricultural Organization (FAO) Director-General.

The US is the single largest WFP donor, and has chosen its executive director for each five-year term since 1992. Under the first Trump Administration, WFP head David Beasly, the former South Carolina governor, oversaw the agency raising  $55 billion in funding and a Nobel Peace Prize.

From trade to aid

USAID and WFP channelled American-grown food to countries in need.

Prior to serving as USDA under secretary, Lindberg founded South Dakota Trade, an association that assists Midwestern businesses in accessing international markets. Lindberg has also held roles at the Export-Import Bank of the United States, where he served as chief of staff and chief strategy officer; and at Sanford World Clinic, a Sioux Falls-based health system.

Lindberg is also a fellow at the America First Policy Institute, a conservative think tank founded by Trump administration officials in 2021, and a member of the Council on Foreign Relations. 

The State Department pointed to Lindberg’s experience overseeing the McGovern-Dole Food for Education Program, Food for Progress program, and the Food for Peace program as demonstrating “proven operational excellence at the scale required for WFP leadership.”

World Food Programme in crisis

Grain shipment in SudanWorld Food Programme
The prolonged conflict in Sudan is hindering key humanitarian aid, including the World Food Programme’s work.

Lindberg’s nomination comes at a fraught time for the UN agency. Under the second Trump administration, WFP saw its funding slashed in half following the shuttering of the US Agency for International Development (USAID).

The loss of $2.6 billion in US funding triggered the layoff of a third of its staff – and a surge in malnutrition in some of the most fragile humanitarian states. 

WFP has issued emergency appeals to aid Sudanese refugees, Afghan families, and Ukrainians – some of the 103 million people supported by the agency in 2023.

The war in the Middle East further complicates WFP’s mission of providing life-saving aid. “If this conflict continues, it will send shockwaves across the globe, and families who already cannot afford their next meal will be hit the hardest,” said Carl Skau, WFP deputy executive director and chief operating officer in a press statement. “Without an adequately funded humanitarian response, it could spell catastrophe for millions already on the edge.”

“The more consequential question is whether Trump’s pick will rebuild WFP’s lifesaving mission, or continue dismantling an enterprise awarded the Nobel Peace Prize just six years ago,” wrote Sam Vigersky, an international affairs fellow at the Council on Foreign Relations in a March opinion piece. “Humanitarian aid is no longer billed as a needs-based charity, but an explicit lever of statecraft.”

Vigersky argued that the UN Secretary General is likely to green-light Trump’s pick, given the tense status of US-UN relations and the US stake in its financing.

With the State Department and USDA now channelling money back into the WFP, it remains to be seen whether WFP under Lindberg’s leadership will recover its funding and its impact.

The State Department reiterated its stance: “Our support for Luke J Lindberg’s candidacy demonstrates the U.S. commitment to keeping the WFP focused on its core mission: feeding those in need.”

Image Credits: Mercy Corp/ TNH, WFP/Abubakar Garelnabei.

Displaced people sleeping on the street in Beruit’s ​​Ain El Mreisseh, Lebanon, last month.

The World Health Organization (WHO) has only mobilised 37% of the funds it needs for the Eastern Mediterranean Region (EMRO) amid a “deteriorating health situation”, regional director Dr Hanan Balkhy told a media briefing on Wednesday.

Welcoming the two-week ceasefire between Iran and the United States-Israel, Balkhy called for the “permanent cessation of hostilities”, warning that the damage from the regional wars would take generations to address. She also called for the ceasefire to apply to Lebanon, which Israel claims is not covered.

Fourteen countries in EMRO are affected by wars, and over 4.3 million people have been displaced as a result. The damage in the region ranges from physical and psychological trauma to destroyed health facilities, and missed targets on maternal and child health and non-communicable diseases (NCDs), she explained.

“Stability is on a knife-edge across the region,” said Balkhy. “Public health risks are rising. Displacement is increasing the threat of outbreaks. Essential services are being disrupted, and environmental hazards are raising serious concerns about safe drinking water, air pollution and longer-term health impacts. 

Aside from violent conflict large parts of the region, a recent 5.8 magnitude earthquake in Afghanistan has also affected health services.

“Even before this escalation of hostilities, emergency operations were critically underfunded,” Balkhy said. “Of the $689 million required for 2026, only 37% has been secured. This week, the WHO launched a $30.3 million flash appeal to support the health response in Lebanon, Iran, Iraq, Syria and Jordan.” 

The flash appeal includes almost $7 million to provide trauma response and basic health services in Lebanon, and $5.2 million to provide the same in Iran.

Environmental concerns

Balkhy also warned of the environmental impact of the war, particularly on water and energy supplies, and air pollution.

“The Middle East is among the most water-stressed regions globally. The Gulf hosts approximately 400 desalination plants producing 40% of the world’s desalinated water. Several countries rely on desalination for up to 90% of their municipal water supply,” she added.

One of Iran’s desalination plants is inoperable after being bombed, while there have been “near misses or debris damage” near plants in Bahrain, Kuwait and the United Arab Emirates (UAE), Balkhy said.

She also warned of respiratory illnesses from degraded air quality.

“We cannot live without water and oxygen. We need both of them. The damage that’s happening to the environment could contaminate the water and the air.” 

Nuclear fears

“We are also extremely concerned about the increasing risk of radiological or nuclear incidents,” said Balkhy.

The International Atomic Energy Agency (IAEA) has notified the WHO of eight strikes in the vicinity of Iranian nuclear facilities, “marking an alarming pattern”, she noted. 

One of the strikes hit 75 metres from the perimeter of a nuclear site, according to the IAEA.

“Any strike near a nuclear facility could have severe and far-reaching consequences for public health and the environment.”

The WHO is working with national authorities and partners to strengthen preparedness and response measures for potential chemical, biological, radiological or nuclear (CBRN) incidents, she added.

“Continued military activity near an operating plant with large amounts of nuclear fuel could have severe consequences for people and the environment in Iran and beyond.”

While WHO has expertise in dealing with health crises, “when it comes to CBRN, when it comes to radiological and nuclear incidents, the level of expertise becomes thinner and thinner. 

“WHO’s job is to keep health systems prepared for exactly that kind of low probability, high impact event. But it is not easy, and the best way out of this is to sustain the ceasefire and the peace .”

Global impact of health system collapse

Following the US-Israeli attack on Iran on 28 February, hostilities between Israel and the Lebanese-based Hezbollah have escalated and Israel has sent ground troops into the country last month.

Dr Abanisar AbuBaker, WHO Representative in Lebanon, said that “So far, six hospitals have been closed, 200 hospitals have been damaged, and 51 primary healthcare centres are closed.”

One in five people – around a million – have been displaced in Lebanon, nearly 5000 have been injured, and more than 1500 have died.

Since 1 April, WHO has mobilised over 187 metric tonnes of medical supplies valued at more than $3.1 million for high priority settings. 

In Lebanon, a convoy has delivered 22 tonnes of supplies, supporting 50,000 patients. A 22.2 tonne convoy is currently on its way to Gaza, with enough supplies for 110,000 patients, while a 78.5 tonne air shipment to Afghanistan is underway, aimed at reaching over five million people in need. 

“In a region already carrying half of global humanitarian needs, health system collapse will not stay contained. That is a very unfortunate situation. It will have regional and global consequences,” Balkhy warned.

“At the same time, other crises continue to unfold, from Sudan’s massive humanitarian emergency to the recent 5.8 magnitude earthquake in Afghanistan, further stretching already overwhelmed systems.

“Even before this escalation of hostilities, emergency operations were critically underfunded.”

Image Credits: World Food Programme .

French President Emmanuel Macron opening the One Health Summit in Lyon, France.

The European Commission announced that it will contribute €700 million to the next funding cycle of the Global Fund to Fight AIDS, Tuberculosis and Malaria at the G7 One Health Summit in Lyon on Tuesday.

This was one of several pledges made at the summit, as the World Bank, vaccine alliance Gavi, governments, philanthropies and private companies made commitments to improve the health of humans, animals and plants.

Jozef Síkela, European Commissioner for International Partnerships, told the summit that Europe was able to commit €185 million to the Global Fund for the first year to kickstart the €700 million allocation. 

The Commission had been expected to announce its commitment at the Fund’s executive board meeting in February, but is facing intense pressure from its members amid the worsening global security situation.

Síkela also announced a €46.5 million commitment to health security in Africa and Europe, involving a partnership between the European Centre for Disease Control and Prevention (ECDC), Africa CDC and the European Food Safety Authority.

The European Commission is also investing €30 million in research and development (R&D) to combat antimicrobial resistance, and €20 million in R&D for new dengue treatments.

Jozef Síkela, European Commissioner for International Partnerships.

The World Bank intends to invest $750 million for One Health activities, its vice-president for development finance, Akihiko Nishio, told the summit.

The Bank will also strengthen the One Health implementation of regional health programmes in West and Central Africa.

Boost for vaccine development

Gavi executive director Dr Sania Nishtar told the summit she would ask her board to approve up to $200 million for upstream support to boost African vaccine manufacturing at its July meeting. 

Gavi has already pledged $1 billion to the African Vaccine Manufacturing Accelerator (AVMA) to promote commercial vaccine manufacturing on the continent. 

Gavi is also allocating $380 million to a “resilience mechanism to ensure that immunisation is at the heart of the response to crises in fragile settings”, Nishtar added.

Later in the summit, the South African generic drug company, Aspen, announced that it intends to prequalify two childhood vaccines, the hexavalent and pneumococcal vaccines, and start to manufacture these for the continent by the end of the year.

Aspen’s Dr Stavros Nicolaou said that his company would also start producing human insulin with Novo Nordisk by May to address the “sinister” explosion of type 2 diabetes.

Dr Sania Nishtar, Executive Director of Gavi, the Vaccine Alliance

Climate change

Opening the summit, co-chair French President Emmanuel Macron reminded delegates that “75% of emerging infectious diseases come from animals and that figure is sufficient justification for this meeting”.

The COVID-19 pandemic “became a global phenomenon in just the space of a few weeks,” he added, urging collaboration and a convergence of global and country-based strategies to address One Health.

“Progress must be based on science, which is free, open and independent,” Macron stressed.

Ghana’s President, John Mahama, co-chair of the summit.

Co-chair President John Dramani Mahama of Ghana told the summit that there is an “overwhelming surge of health threats across borders.”

 “Every species is in the crosshairs – animals, humans and plants. And the environmental catastrophe confronting us is in the waves of the sea. It’s in the glaciers. It’s in the rainforests. It’s in the desert storms. 

“In Ghana, a blight of disease and pests affects smallholder cocoa farmers, threatening millions of households. Illegal gold mining leads to forest degradation and pollution of our water bodies, threatening the survival of precious populations of birds and insects critical to our biodiversity. And the foundation of all these crises is the phenomenon of climate change.”

Mahama stressed that “everything is interconnected, from the outbreak of infectious diseases to antimicrobial resistance, and from climate-related disruptions to food systems.”

However, these risks are converging and intensifying in “frequency, complexity and severity” more than at any time in human history. 

“The One Health approach is thus a practical matter for us. In Africa, we traditionally lived our lives in lockstep with nature. We’re an integral part of nature. More than 50% of our population relies on herbs and other natural forest resources for their medicines,” he said.

“Our lived experience leads us to accept without question that human survival, animal wellbeing and plant health and environmental care form a single interconnected system.”

Echoing Mahama’s experience, Botswana’s President Duma Gideon Boko, also warned of the impact of climate change: “We’ve now begun to experience floods even in areas that were desert. It’s very strange, and it has undermined our climate-resilient infrastructure.” 

Role of philanthropy

Wellcome Trust CEO John-Arne Røttingen.

Wellcome Trust CEO John-Arne Røttingen told the summit that several philanthropic organisations had developed a declaration on One Health based on three pillars.

The first is to sustain investment in product development. The second is applying a One Health lens to this, particularly in the context of climate change.

Third, while philanthropies “are really proud to play a role in the system that’s dear to our heart… our role is only catalytic, complementary and driving collaborations”, said Røttingen.

“We are, as philanthropy, committed to partnerships, to collaborate. We need to tackle climate change. We need to tackle the infectious disease threats that are linked to climate change and to the One Health agenda, but we can only do it in partnership; in collaboration with governments, with industry, and civil society.”

Smaller pharmaceutical companies and those outside countries with trade deals with the US will bear the brunt of President Donald Trump’s 100% tariff on imported patented pharmaceuticals and their active ingredients announced last week.

The tariff will be imposed on large companies 120 days from the announcement, and in 180 days for smaller ones.

Pharmaceutical companies from the European Union, Japan, the Republic of Korea, Switzerland and Liechtenstein will pay a 10% tariff and UK pharma companies are exempt from tariffs, thanks to earlier deals with the US.

Meanwhile, 16 big pharma companies, including Pfizer, Novo Nordisk, Eli Lilly and Johnson & Johnson, will also escape the 100% tariff as they reached “onshoring agreements” with the US Department of Commerce last year. Some of these companies also entered into “Most Favored Nation (MFN) pricing agreements with the US Department of Health and Human Services (HHS)”.

Companies that have both onshoring and MFN agreements will pay no tariffs, while those with onshoring agreements only face a 20% tariff.

However, commentators warn that many smaller pharma companies don’t have the flexibility or capital to make such deals.

Swiss pharma warning

The Swiss pharma association, Interpharm, warned last week that the tariffs “endanger global production and supply chains for pharmaceuticals, hinder research and development and ultimately harm patients worldwide.”

“Even if those companies that have concluded a deal with the USA are to be exempted, this decision may have an impact on security of supply,” said Interpharm, which represents all the major research-based pharmaceutical companies in Switzerland.

It also “demanded” that Switzerland secures an agreement with the US similar to that of the UK, and implements “extensive reforms” to ensure that the country “remains attractive for investment in research and development of innovative medicines in the future.”

Interpharm’s members include Johnson & Johnson, Novartis, Roche, AbbVie,, AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Lilly, Merck, Pfizer and Sanofi.

Making his announcement, Trump said that, in 2025, approximately 53% of patented pharmaceutical products and 15% of APIs distributed in the US were imported.  

Last year, the US imported $274 billion in pharma and medical products, but 80% of these were from the EU, Japan, South Korea, Switzerland and the UK.

Meanwhile, companies supplying an estimated two-thirds of branded medicines had already made deals with the US.

This means that only around $12 billion of imported medicines will be taxed at 100%.

Generic and animal medicines and biosimilars are exempt from tariffs, but this policy will be reviewed in a year’s time.

‘Jeopardise investment’

Stephen Ubl, CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), warned that the tariffs “on cutting-edge medicines will increase costs and could jeopardise billions in US investments announced in the last year.”

“Every dollar spent on tariffs is a dollar that can’t be invested in communities across the country,” said Ubl. 

“The innovative biopharmaceutical sector has a robust US manufacturing footprint. In fact, two-thirds of the medicines that are consumed in the US. are made in America. And when innovative medicines or their inputs are sourced from other countries, these products overwhelmingly come from reliable US allies, like Europe and Japan.”

The gas that keeps hospital MRI scanners running has been caught in the crossfire of the war in Iran, raising the prospect of diagnostic delays, rising costs and rationing of one of modern medicine’s most important imaging tools.

Roughly a quarter of all helium consumed worldwide goes toward cooling the superconducting magnets inside MRI scanners. While helium is the second most abundant element in the universe, on Earth, it is found only in trace quantities within certain natural gas deposits. It cannot be synthesised and requires highly advanced equipment to transport, making its supply chain so shaky that the global current helium shortage is the fifth in the past two decades.

Iranian missile strikes on Qatar’s Ras Laffan Industrial City in late February caused three fires and destroyed approximately 17% of the country’s LNG export capacity. QatarEnergy, the state-run energy firm, halted all production on March 2, stating production will resume only when security in the Strait of Hormuz is guaranteed, taking a third of global helium supply offline.

When secure passage through the strait, which is currently locked down by Iran amid war with the United States and Israel, will become a reality is, at present, anyone’s guess. Reuters reported on Monday that the text of a possible ceasefire agreement brokered by Pakistan had been sent to the US and Iranian delegations for review.

Two days earlier, US President Donald Trump referred to his Iranian intermediaries as “crazy bastards” who would “be living in hell” if they did not back down from restricting access to the narrow maritime waterway through which 20% of the world’s LNG and oil, and about 25% of total trade passes.

“Open the Fuckin’ Strait!” Trump declared on his social media platform, Truth Social.

While the US views the opening of the Strait of Hormuz as the single key concession necessary from Iran in any deal to conclude the conflict, Iran’s closure has demonstrated the power its geography allows it to exert over the global economy. The shutdown has sent energy markets spiralling, spread rolling blackouts across the globe, and caused fears of a new global hunger crisis.

Iran’s government is now seeking to establish permanent tolls, and is unlikely to relinquish its newfound chokehold on the world economy. Senior Iranian officials told Reuters on Monday that a temporary ceasefire would be insufficient to reopen the strait. US diplomats, meanwhile, called the proposal “one of many ideas,” adding: “Trump has not signed off on it. Operation Epic Fury continues.”

Competitors crowd the helium market as price doubles

Liquid helium must be transported in specialised cryogenic ISO containers maintained near absolute zero. There are roughly 6,000 such containers in the world.

Virtually all of Qatar’s helium exports leave by sea through the Strait of Hormuz, with no alternative maritime route. When the strait closed to most commercial traffic in early March, roughly 200 cryogenic containers were stranded in or near Qatar. The containers sitting idle near the Gulf cannot be filled elsewhere, as every stranded unit represents lost helium and lost transport capacity for the entire global network.

Even the best-insulated units can only hold liquid helium for about 45 days before it warms, boils off, and escapes. This means helium supply chains cannot absorb delays the way oil or grain markets can. The containers must stay on the move, or the fragile deadlines and important positioning of each container in the systems is thrown off entirely.

With billions of dollars in lost gas revenue and a war still underway, restoring a relatively niche byproduct such as helium is not the top priority. The helium market is worth about $6 billion annually, compared to over $170 billion in global LNG trading.

Following the attack on Ras Laffan, QatarEnergy announced a permanent 14% cut in liquid helium exports. Two other key production hubs in Algeria, which hold the world’s third-largest helium reserves, have moved away from capturing helium due to skyrocketing gas prices in Europe, to which it has a direct pipeline.

LNG sold directly through pipeline channels does not go through the process of separating helium, causing rising gas prices to have a snowball effect on helium available on global markets as producers try to sell directly. With European gas prices up 60% since the conflict began, Algerian pipeline gas flows to Europe rose 22% in early 2026.

For hospitals, the crisis is compounded by who they are competing against for this shrinking supply, as bidding wars have more than doubled helium prices on the open market.

Helium is essential for the chip industry, which, propelled by the AI boom, is one of the most powerful forces in the global economy, underpinning the titans from Nvidia to Google, OpenAI, Meta and Oracle, buoying over a third of the United States GDP. It is also critical to drones, rockets, and all kinds of semiconductors underpinning everything with a microchip in it: cars, weapons, fridges, laptops, phones, and more.

Hospitals, already operating on regulated pricing and thin margins, cannot outbid that kind of purchasing power. In this shortage, medical uses risk being an afterthought.

The medical world has known this for some time. After five helium shortages in 20 years, researchers and MRI manufacturers have been racing to build scanners that do not depend on the gas at all. However, the vast majority of the world’s MRI fleet still runs on technology that needs helium.

Replacing its critical role in MRI scanners will be impossible in the short term.

“This is the big one that we always feared would happen, it’s the black swan event,” Cliff Cain of Pulsar, a helium exploration company, told the Wall Street Journal. “It is just going to be a building crescendo of who’s going to be able to get their molecules and who is not.”

cairo pedestrian streets
A busy street in the Almazah neighborhood of Cairo.

CAIRO, Egypt – In the bustling neighbourhood of Heliopolis in Africa’s most populated city, it’s nearly impossible to cross the streets without risking a 40-mile-per-hour collision. A man driving a motorcycle nestles his phone against his ear. A car whizzes by with a child sitting on the lap of the driver. The chaotic scene was the norm in the city I volunteered in for several months in 2025.

Sparse traffic lights, limited seatbelt use, and crosswalks that are not always observed, while a daily reality for the city’s residents, pose significant challenges for pedestrian safety in Cairo. Researchers point to the city’s rapidly-built roads and infrastructure programs, designed to improve traffic congestion, as further limiting pedestrian access. 

Over 75,000 traffic-related injuries occurred in the North African country, with more than 5,000 deaths each year, according to the latest statistics from Egypt’s national bureau. Pedestrians accounted for a third of these deaths, and researchers say the figures likely underestimate the true burden.

The greater Cairo region, like the rest of the country, is designed around vehicles. An estimated 97% of streets in Egypt lack traffic lights, and 78% of streets do not have footpaths for pedestrians, according to a 2019 World Bank estimate cited in an American University in Cairo (AUC) analysis.

“Already the [pedestrian] mortality rate has increased in Heliopolis,” said Mennah Fathy, an urban researcher with the Institute for Traffic and Development Policy (ITDP) Cairo office. 

Children under 15 years and pedestrians are the most likely to be fatally injured.

Cairo is just one of several African megacities. Nigeria’s Lagos, the Democratic Republic of Congo’s Kinshasa, and Angola’s Luanda are all expected to continue surging in population. 

Urban health experts link limited pedestrian infrastructure to higher pollution exposure, reduced physical activity, and traffic congestion. The city also ranks in the top 200 most air polluted cities, according to the recent IQAir report – and the country  as a whole is ranked ninth. Yet recent initiatives from the city and from other organizations have both raised awareness – and begun to tackle the dangers of Cairo’s streets. 

New throughways and cut trees deter walking 

People walking in the streets of Misr Gedida.

In Cairo’s eastern neighborhoods of Misr Gedida, Heliopolis, and Medinat Misr, coffee shops, grocery stores, and markets line the streets. But despite their proximity, pedestrians often struggle to reach them across wide, fast-moving throughways. 

Other Cairenes noted that they rarely use the broken and blocked sidewalks.

“If you need to walk, we walk on the streets,” said Fatma Khalid, a cultural guide at a Cairo language school. She joked that locals can “immediately tell” if someone is not from Egypt if they try to walk on the sidewalks.

But broken sidewalks are only part of the problem, said ITDP’s Fathy. Expanded roadways have made walking both riskier and less appealing in Cairo’s heat as tree cover and greenery essential to keeping pedestrians cool make way for asphalt. 

“Cairo didn’t used to be this way,” said Shahyra, a 30-year-old real estate consultant, at a Cairo coffee shop. “We used to walk, be outside. Now we sit in the AC and Uber for ten minutes to the grocery store.”

The combined pressures of rapid urban growth, rising temperatures, and worsening air quality have also changed how many residents move around the city. Cairenes who can afford it increasingly opt for shorter car rides instead of walking.

With fewer opportunities to walk, residents lose an important source of daily physical activity which researchers say contributes to rising obesity and type 2 diabetes in Egypt and other LMICs.  

Heliopolis’s original urban design, which dates back to the early 20th-century when the Belgian industrialist Edourd Empain commissioned the city, had walking-friendly squares and intentional public transit systems. Now, “that’s been destroyed in favor of highways,” said Fathy. 

In the newer developments built on reclaimed desert, like the 6th of October City, the New Administrative Capital, and the 5th Settlement, the entire urban design is car-oriented, according to the ITDP, which has researched and proposed ways to improve active mobility in the new settlements. 

In both older and newer areas, “these changes deter walking and active mobility” and threaten road safety, said Fathy.

Traffic-related deaths are not “accidents”

cairo pedestrians
A street sweeper on a bridge crossing the Nile.

Some 30 years ago, Hany Kamel’s training as a pilot was cut short in a car crash on the highway from Alexandria to Cairo. Injuries to his arms and head forced him to leave his specialized training school and recuperate.

He made a career as a professional driver instead, racking up accreditations from driver safety programs. 

The scars on his arms are a physical reminder of the cost of unsafe roads. “People here don’t follow many of the rules,” he said of the Cairo drivers swerving in and out of traffic.

“Driving in Egypt is extremely dangerous,” the US State Department warns its citizens in its travel guidance to the country. “Egypt has one of the highest rates of road deaths in the world due to unmarked surfaces, pedestrians and animals crossing streets, and speed bumps along major highways.”

Urban experts don’t place the blame solely on road users, but on the design of highways and roads. 

“Safe roads are a right, not a luxury,” Dr Etienne Krug, WHO director of the department of social determinants of health, argued in a recent commentary. “While drivers are bound to make errors, transportation planners work on the basis of reducing risks.”

The approach focuses on improving road design, vehicle safety, speed management, and post-crash care.

Proven measures to keep pedestrians safe include crosswalks, appropriate driving speeds, and improved visibility for pedestrians. The approach, focusing on improved road design, vehicle safety, speed management, and post-crash care, has proven challenging to implement in many countries. 

International calls for safer roads

pedestrian safety
The World Health Organization has called for a decade of raod safety.

More than one pedestrian or cyclist is killed every two minutes on the world’s roads. Nearly 1.2 million people are killed and as many as 50 million are injured each year, making road traffic injuries a leading cause of death and disability worldwide, according to the World Health Organization (WHO). 

For young people aged five to 29 years, cars, buses, trucks, and motorcycles are the number one cause of death. Pedestrians and cyclists face particularly high risks in low- and middle-income countries (LMICs). 

“The risk is remarkably high in low and middle-income countries, where millions face huge risks each day as they walk to work or school on streets with no sidewalks, and no safe places to cross busy roads. Just a tiny fraction of the world’s roads – far less than 1% – have safe cycle lanes,” said the WHO’s Krug.

The overwhelming majority of traffic fatalities – 92% – occur in LMICs, even though these countries have 60% of the world’s vehicles.

That’s not to say the problem is solely concentrated in lower-and-middle income countries. The pedestrian fatality rate in the US is two to five times higher compared to other developed peer nations. That rate has jumped 80% since 2009, per a 2025 AAA Foundation for Traffic Safety report. Those in urban, lower-income areas are at highest risk. The report underscored that pedestrians in US urban centers are often forced to walk along poorly lit roads without sidewalks to reach the nearest crosswalk. 

In light of this, the United Nations announced in May 2025 its 8th annual Global Road Safety week with the goal of spurring local and national action for safer roads. 

“These actions will help promote and facilitate a shift to walking and cycling, which are more healthy, green, sustainable and economically advantageous modes of transport,” said the UN in a statement.  

The safety awareness week comes as traffic fatalities have grown in the past decade across multiple regions.

Safer streets also mean cleaner air, more active population

A quiet, shaded street in the historic neighborhood of Dokki.

Fathy said city authorities have often overlooked the health and safety benefits of walkable urban design. In discussions with city authorities about active transport, the ITDP found that walkability was not a main priority.

“They don’t always see the health co-benefits,” said Fathy, referring to reductions in air pollution and increases in active mobility. Even when the health benefits are recognized, walking is often not convenient for daily commutes to school, the metro, or work, Fathy added.

air pollution
The Swiss-based air pollution data organization IQAir’s 2025 most polluted countries in the world. Egypt ranks 9th globally for fine particulate matter pollution. 

WHO’s Krug calls safe streets a “treasure trove” of add-on benefits: walking or cycling reduces the risk of chronic diseases, curbs air pollution, reduces traffic congestion, and limits climate pollutants. 

Egypt, like many others in the Middle East and North Africa, is facing a growing chronic disease crisis the benefits of safe streets could play a role in alleviating. Two-thirds of the population is either overweight or obese; nearly a quarter of all adults live with diabetes. 

New metro, bus systems offers promise of expanded, but patchwork public transportation

Cairo metro pedestrian safety
Cairo’s new third metro line offers regular, affordable transportation west to east across the city.

Cairo’s traffic intensity has improved dramatically in the past decade as a new metro line and bus rapid transit (BRT) system provide alternatives for its residents. 

The new metro line runs east to west through the city and is packed in rush hour, offering air-conditioning and two “ladies only” cars. Similarly, the Western BRT bus corridor is part of Egypt’s vision to improve the public transport sector. 

The result, however, has been what some experts describe as a “patchwork” network of improved public transport.

A metro stop in a neighbourhood may not be accessible or have a nearby bus stop. Other Cairenes complain of having to take Ubers just to reach a metro stop.

“I either take an Uber or I walk to the microbus stop and then transfer from the microbus to the autobus line,” said Manal, an HR trainer in Cairo’s Dokki quarter. 

Fathy’s commute is also a trek – driving her car to a metro stop and then Ubering to her workplace. “These new settlements, and moving the administrative capital to the eastern side of Cairo, means that people have to commute across Cairo. We don’t have a culture of moving to be close to work.” 

Gathering municipal and cultural support

A boy crosses a road behind a municipal bus.

If you asked a school-age child in the 6th October settlement in Cairo to envision roads in their neighbourhoods, they would draw wide, multi-lane highways with no trees. 

“The younger generations living in the new cities are increasingly removed from the idea of walking, cycling, or public transport,” said Fathy. “They’re not aware of the advantages.” 

These insights emerged from focus groups Fathy and colleagues conducted in three schools in the car-centric peripheries of Cairo. After these workshops, the researchers later proposed safer street designs around school zones to improve air quality and promote walking and cycling. 

And in the historic quarter of Heliopolis, initially designed to be transport and walking-friendly, the loss of tree cover and the bisecting throughways present a still larger challenge. 

Fathy notes that “transformation” of an area like Heliopolis requires a return to its past culture of walkability and green streets, through initiatives like car-free pedestrian zones.

cairo pedestrian
A throughway at dusk in Cairo.

Even though international groups like ITDP have struggled to gain permission and government cooperation for these initiatives, Fathy hopes that with a return to a walkability mindset, Cairo’s rapid growth can include space for smart, green urban design. 

Halfway through this “decade of road safety,” Cairo’s road safety progress mirrors that of other megacities, where population growth has so far outpaced infrastructure and public transport projects.

While the primary aim of these investments has been to reduce traffic time and congestion, these improvements fall in line with the United Nations General Assembly’s 2020 goal of preventing at least 50% of road traffic deaths and injuries by 2030. 

“We’ve seen a lot of improvement in the past five-to-ten years,” she said. The expanded metro system, and public bus lines are all “significant improvements,” especially efforts to make public transport safer for women, and reducing the number of private cars on the roads.

But whether Cairo’s future streets resemble the wide highways drawn by schoolchildren — or greener boulevards built for walking and cycling — may depend on how quickly the city reimagines its roads.

Image Credits: S. Samantaroy/HPW, WHO, IQAir, S. Samantaroy.

Colorized brain scan. Current techniques probing brain function are costly. But research anchored in the Global South can yield affordable strategies, experts say.

DAVOS – In this snow-covered Alpine town where the world’s rich, powerful and elite met in January for the World Economic Forum, a quiet but consequential shift in thinking about dementia research crystallized – one with the potential to shape political engagements and research investments for the coming decade. 

Long treated as a disease primarily studied, diagnosed and managed with treatments developed in wealthy countries, Alzheimer’s and related disorders are now a global equity challenge— one where the best new solutions may, paradoxically, emerge from the low- and middle-income regions also facing the biggest future burden. 

The simple but powerful approach is central to a strategy being rolled out by the Davos Alzheimer’s Collaborative in 2026 – which aims to make diversity an underpinning of dementia research. 

New initiatives across Africa, India and beyond

Aga Khan University, Kenya – one of a number of DAC collaborations in studies testing and validating simpler tools for Alzheimer’s diagnosis and treatment.

The strategy, articulated at the dome-shaped “Brain House” here in Davos, underpins a series of new DAC initiatives being rolled out in Africa, India and elsewhere in the Global South to test new diagnostics; better harness the potential of AI; and build big data platforms that can link research communities and their findings. 

In an interview with Health Policy Watch, Drew Holzapfel, DAC Chief Operating Officer (COO), outlined a strategy for a fundamentally different model of dementia research— rooted in global collaboration. Key elements include:

    • Expanding diverse data collection
       “We’re going into Kenya, Chile, Egypt… so that we get some better understanding of the heterogeneity of the disease.”
    • Breaking down data silos and building large-scale, harmonized datasets
       “Creating platforms that allow researchers to “share, access and analyze brain health and dementia-related data… in giant data sets… so that you can draw some through lines.
    • Developing AI-driven discovery platforms
      Integrating multimodal data to map “causal mechanisms to biomarkers, targets, and personalized prevention.”
    • Driving personalized treatments – Al that integrates data from genomics, clinical, prevention and trials – mapping causal mechanisms to biomarkers, targets, and personalized prevention and therapeutic strategies.
DAC’s Drew Holzapfel, discusses new initiatives in India, Africa and Latin America.

Harnessing the power of big data sets

The new DAC collaboration with the Gates-funded Alzheimer’s Disease Data Initiative (ADDI)  and the African Population Cohorts Consortium (APCC) is a leading example of how the power of big data can be harnessed.  

The initiative aims to create an intraoperative data-sharing platform enabling African researchers to share, access and analyze brain health and dementia-related data. 

“Giant integrated data sets ideally are harmonized  across different populations, so that you can draw some through lines. The fact that we’ll be getting diverse data means we can better understand the heterogeneity of the disease, Holzapfel said.

The numbers of people whose health and lives are at stake are equally big. 

As George Vradenburg, DAC founder and chairman put it: “The Global South will have 80% of cases of dementia in the next 20 years.” That reality is forcing researchers, policymakers and investors to confront a new truth: innovation that ignores the global majority is not just inequitable—it is incomplete.

WHO DG Tedros: Neurological conditions affect more than 40% of the world’s population.

Neurological conditions of some kind affect more than 40% of the world’s population somehow, causing over 11 million deaths each year – with the largest gaps in care in low and middle income countries, pointed out WHO’s Dr Tedros Adhanom Ghebreyesus, speaking at a Brain House session. 

“Demographic and environmental pressures are intensifying these challenges: ageing populations, hypertension and diabetes, pollution, injuries and climate change are driving a sharp rise,” he said. 

The ‘Global Majority’ as an innovation catalyst

But investing in brain health research and development in the Global South is not only about equity – it is about efficiency.  As such, it’s a win-win for both rich and poor countries alike.

For decades, biomedical research into dementia has been shaped by data drawn largely from populations of primarily European ancestry.  And that lends a very incomplete picture of the disease and related conditions, observed Holzapfel: “90% of the data in GWAS [genome-wide association studies] is built upon  European ancestry… but only 10% of the world is of that ancestry.”

Because genetic analysis is focused overwhelmingly on white Europeans, we have an incomplete understanding of the way Alzheimer’s disease impacts diverse populations.

That imbalance is not just a scientific gap—it is a barrier to discovery.

Diverse populations bring diverse genetic profiles, environmental exposures and disease pathways, explained Michael Cook, Chief Science Officer of the UK-based research entity Our Future Health .  As he put it, “diversity will help… make sure that we create medications and interventions that fit for all populations.”

Added Vradenburg, the Global South is “a potential area of innovation on how to lower cost and increase the access to the products that we would like to have.” 

Lawrence Jones, author of the “Influential Minds” podcast series, reframed the conversation with a simple linguistic shift: “Instead of the Global South, we should be referring to that part of the world now as the Global Majority.” 

The biology of diversity

‘Influential Minds’ Author Lawrence Jones with DAC founder George Vradenburg at WEF side event focusing on why diversity is critical to dementia research.

Beyond pure cost-efficiencies, the Global South offers richer understanding of the disease itself.

Dementia is not a single condition. As Sam Barrell, CEO of the UK-based non-profit medical research organization LifeArc, explained: “It’s a bit like saying there’s just one type of cancer.” In reality, it is a constellation of subtypes, each with distinct biological drivers.

Research in diverse populations is essential to untangling that complexity. 

Environmental exposures—heat, pollutants, agricultural chemicals—vary dramatically across regions and may shape disease pathways in ways not yet understood, said Vradenburg. Noting that even basic factors like water quality and brain health remain understudied, he pointed to  the need for more “exposome research across a wide variety of different exposures.” 

There are also gender disparities. “Two thirds more likely to happen in women than men,” Barrell noted, emphasizing how much remains unknown.

Without inclusive data, the patterns remain hidden. With it, entirely new avenues for prevention and treatment may emerge.

Rethinking access: from clinics to communities

A fingerprick test for Alzheimer’s would making diagnosis far more accessible in primary health care centers, including the Global South.

In this new R&D  paradigm: health system constraints— including limited infrastructure, fewer specialists, tighter budgets—are not just obstacles. They are catalysts for entirely new models of care.

And while bringing solutions to the proverbial “last mile” is an especially acute challenge in low- and middle-income countries, where specialist care is scarce and even basic electricity infrastructure spotty, the same bottlenecks exist in wealthy nations too. 

“Wait times now, over a year in the United States,” Vradenburg said, noting that some patients effectively “time out” before they can access treatment.

At the same time, barriers exist to bringing new and potentially transformational research findings to market. 

Vradenburg described the challenge starkly: “you can have the most brilliant new discovery… but if, in fact, it doesn’t get through a regulatory system… a clinical trial system…then it is dead in the water.  

“The government can fund research,” he added. “But the investors have to take that research into the marketplace through the translational so-called ‘valley of death’. You have to get that [innovation] picked up and bought by an exit strategy with large pharma, and you have to get that through a regulatory system that is hopefully willing to take a degree of risk.

“So you need innovation, a friendly regulatory system, and then you need somebody to pay for this.”

Global cohorts initiative

DAC’s Global Cohort programme is supporting research projects in 7 countries (orange on the map) involving some 350,000 participants.

Moving beyond Africa, the DAC Global Cohorts initiative aims to reduce research costs and amplify results by linking up like-minded initiatives worldwide in North-South collaboration nodes. The programme involves seven research cohorts extending from Kenya to Malaysia and the Caribbean, supported by funders ranging from DAC to the pharma industry and the National Institutes of Health. 

Researchers in the cohorts are testing new diagnostics tools as varied as digital voice imprints and olfactory glands – with the aim of bringing successful models to scale.

“Just think of what Kenya community health workers can do,” Vradenburg said, as a simple measure of feasibility. “They’re not going to take a venous blood drop. They’re not going to do a half-hour long, paper and pencil test.” 

Disruptive diagnostics 

Sam Barrell (center) CEO of LifeArc.

The race to develop more low-cost diagnostics that can predict the risks of developing dementia years before symptoms occur is one recurring theme that illustrates both the challenge and the potential of more linked-up R&D engagements.

Today’s gold-standard diagnostics—such as PET scans and spinal fluid tests—are costly, invasive and inaccessible to most of the world. “Most people do not have access to that,” noted Barrell, the  driving force behind LifeArc.

The UK-based self-funded non-profit, is co-sponsoring a multi-country research project on lower cost alternatives, due to yield results due in 2028. The research  is comparing the current “gold standard” diagnostics with finger prick tests for blood-based biomarkers and digital tests for other biomarkers, including cognitive tests delivered via smartphones.

Already, blood-based tests based on venous draws can detect certain pathological changes in the brain associated with Alzheimer’s long before symptoms appear: “potentially up to 15 to 20 years before you actually have clinical signs,” Barrell said.

So if the same proteins can be picked up accurately from a fingerprick test, the shift to earlier  detection—could redefine the entire trajectory of the disease.

“Early predictive diagnostic tests… can be transformative, particularly if they are scalable, low- cost alternatives to the expensive scans we’ve got now,” Barrell said, noting that preliminary data from the study appears promising.

“If you can intervene earlier on those lifestyle factors that make you more likely to develop dementia and you could fast-track people into the right trials with the right treatments that would make a big difference in the longer term,” she added, noting that there are pioneering treatments in R&D due to come to market in the near term.

And because these tools are being designed with low-resourced settings in mind, they would ultimately benefit everyone. A finger-prick test that works in rural Africa will also be cheaper in Europe or the United States.

“So in the utopia of the future,” Barrell said, “You and I would get a little card in the post; we would just prick ourselves; and put our blood on it… and then… using a digital app, hopefully get a result of our risk of dementia with a high degree of accuracy.”

AI: promise and pitfalls

AI offers unprecedented reach, but…Susan Arminger, Catalight (center). L-R: Michael Cook, Our Future Health; Peter Lee, Microsoft Research in Davos.

Artificial intelligence is another force reshaping the research landscape—but its role is complex.

On one hand, AI offers unprecedented reach. As Susan Armiger, CEO of Catalight, explained, “AI can offer a ‘direct to consumer approach’… somebody could come to a website… and they would talk about whatever they’re experiencing without having the barrier of a medical professional.”

In contexts where doctors are scarce, that could be cost-efficient as well as revolutionary. “Sometimes we find that they are the barrier to someone getting into a screening or a diagnostic evaluation,” added Arminger, who heads America’s leading network of healthcare providers for autism and developmental disabilities.

But prevailing AI models also reinforce existing inequities.

Or as Peter Lee, President of Microsoft Research warned, “AI model training today is oriented towards the Global North… the lack of cultural alignment… continues to be a problem.” Language, imagery and cultural context all shape how AI systems interpret symptoms—and misalignment can lead to misdiagnosis or exclusion.

He also highlighted a deeper structural challenge faced by rich and poorer health systems alike: “Cognitive health intervention involves a mix of different audiences – professional healthcare deliverers, community workers and informal/ family caregivers.  And that mix of different communities and people amplifies the trust issues and creates practical problems …that you need [to overcome] in order to collaborate.” 

Innovation ‘in all directions’ can benefit us all

Along with the new African data initiative, DAC is also establishing an India branch in collaboration with the Indian government. 

This will include a workplace-based study on cognitive health in collaboration with the Indian Institute of Technology as well expanded  research into new AI-based diagnostics assessing voice imprints and eye movements.

“There’s a belief that you can detect a cognitive impairment through voice, and so we’re trying  to validate that in India, which has incredible throughput and volume,” observed Holzapfel. “So we’re set up in a giant office park, and we are taking voice samples at a pace you would never believe. 

“If you fast forward, the real opportunity here is to have the ambient voice collection when you’re in the doctor’s office that’s listening and determining if you have cognitive impairment.”

And it is planning for a series of high-level events this year to build political will and commitment – from the United Nations General Assembly in New York  to technical meetings in Africa that lay the framework for the Global Mental Health Summit in Rwanda in early 2027.

As Vradenburg put it in a moment of stark clarity: we are investing hundreds of billions in artificial intelligence, while the health of the human brain—“eight pounds powered by less than a light bulb”—remains underfunded.

Politicians need to understand that “only when innovation flows not just from North to South, but in all directions. Only when equity is not an afterthought, but a driver of discovery – then the solutions built for the most constrained settings may ultimately benefit us all.”

Image Credits: Flickr: Florey Institute of Neuroscience & Mental Health, DAC , DAC , Martin et al., 2019, Health Policy Watch, Witkoppen Clinic, DAC , Health Policy Watch .

A new review links vaping to oral and lung cancer.

Vaping is likely to cause oral and lung cancer, according to a comprehensive review of over 100 studies of the effects of nicotine-based e-cigarettes, published this week in the journal, Carcinogenesis.

Carcinogenicity was evident in human studies that monitored biomarkers of harm, including DNA damage, oxidative stress, and “epigenetic change and inflammation in oral and respiratory tissue”, according to the researchers, who hail from a range of Australian universities.

Meanwhile, studies on mice showed that they developed lung tumours after exposure to vape aerosols.

The researchers focused on studies from 2017 of people who only used nicotine-based e-cigarettes or on studies that compared smokers and vapers, and excluded studies that involved people who used both tobacco and e-cigarettes.

“Though direct epidemiological evidence of cancer causation takes time to accumulate, carcinogenicity of e-cigarettes is evident from different types of investigation,” the study concluded.

“To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” according to co-author Bernard Stewart from the University of New South Wales.

In a commentary published alongside the research, Stewart and co-author Freddy Sitas note that it took a long time before the harms of smoking were recognised. The first study to report a link between smoking and tuberculosis was published in 1886, yet smoking was only definitively linked to lung cancer in 1964. 

“Though smoking was once given the benefit of doubt, the same should not now be accorded to vaping given the strength of relevant carcinogenicity data,” they write.

The tobacco industry has promoted vaping as a tool to help smokers to quit, while promoting e-cigarettes to young people who have never smoked.

Image Credits: pixabay.