Yellow fever vaccination Americas
Yellow fever cases has surged this year in the Americas, mostly due to spillover events from animals.

The region of the Americas has seen eight times the number of yellow fever cases this year, compared to the same period in 2024. The vaccine-preventable, viral, mosquito-borne disease has surged as cases “spillover” from animals, according to a Pan American Health Organization (PAHO) rapid risk assessment.

Dense jungles in Colombia and Brazil have seen the most sylvatic – or “jungle” – yellow fever cases originating from an animal host. In these areas, unvaccinated humans can be infected from mosquitoes that are carrying the virus after biting infected monkeys and other primates.

Brazil, Bolivia, Colombia, Ecuador, and Peru have reported 221 confirmed human cases of yellow fever, and 89 deaths. Brazil accounts for nearly half of these cases and deaths.

These countries typically see jungle cases each year, but the combination of increased spillover events and a persistent unvaccinated population has meant there is now a risk of urban outbreaks. Almost all cases and deaths reported this year and last were in unvaccinated people.

PAHO has denoted the public health risk of yellow fever as high, even though a single dose of the vaccine is enough to provide life-long protection.

Prior to the COVID-19 pandemic, vaccine rates in the 12 countries in the region prone to yellow fever were quite high, ranging between 57-100% in young children, according to PAHO. But rates have dropped to below the recommended 95% coverage in 10 out of the 12 countries with circulating yellow fever, leaving a “substantial proportion” of the population unprotected, according to PAHO. 

Symptoms like fever, muscle pain, headache, nausea, and vomiting occur three to four days after a mosquito bite. Roughly 15% of patients will develop a toxic, hemorrhagic phase. The mortality rate of this type of yellow fever is over 50%. 

Yellow fever transmission
Sylvatic, or “jungle,” yellow fever is fueling transmission in the Amazon region.

While recent vaccination campaigns have increased the number of people protected, fewer vaccine suppliers, cost, and the long process to make the vaccine means that there’s a limited global supply. “Current supplies [are] unable to cover demand in the Americas and in Africa,” said PAHO in a statement.

This has led countries to consider splitting doses among multiple people, so that each jab is one-fifth the normal dose. This smaller dose provides immunity for up to 12 months.

Historically notorious, but preventable disease

Yellow fever has a long history in the Americas, with periodic epidemics crippling cities and rural areas alike in the 19th and 20th centuries. 

But following the introduction of an effective vaccine, most cases remained concentrated in the Amazon and mountainous regions in Brazil, Colombia, Ecuador, and Peru. But this year, Colombia and Brazil have detected cases outside the typical Amazon region, in the state of São Paulo in Brazil and the department (state) of Tolima in Colombia.

This increase in yellow fever is primarily due to the reactivation of the jungle transmission cycle in the Amazon region, according to a recent PAHO epidemiological alert.

The expansion of cases beyond the typical regions points to an increase in human-forest interaction in forest edges.

“These areas provide ideal conditions for canopy-dwelling mosquitoes to transmit the disease to human populations from non-human reservoirs,” said PAHO in its alert.

While this year marks a concerning surge, it still hasn’t reached the levels of epidemics of the past decade, such as in 2016, said Dr Andrea Vicari, unit chief of infectious hazards at the World Health Organization (WHO).

Vaccine hesitancy delays containment

In Colombia, all yellow fever deaths have been of unvaccinated people. 

“All mortality has been among people not vaccinated,” said Dr Diana Pava, director of the Colombian National Institute of Health, told a PAHO briefing. The populations most affected are older adult men who work in the agricultural sector. 

Few, if any children catch yellow fever because the vaccine is “obligatory,” Pava noted. Children receive the jab with their measles, mumps, and rubella (MMR) vaccine. The same isn’t true for older generations, hence the concentration of cases in adults 65 and older.

Yellow fever 2023-2025 map Americas
Yellow fever has now been detected in new regions in Brazil and Colombia, impacting unvaccinated older adults.

Colombia’s rising cases highlight the difficulties in reaching older, rural, and isolated communities for vaccination. 

“In the rural areas, the beliefs may be different, or they don’t want the vaccine,” Pava said.

Colombia’s health ministry is concentrating its outreach efforts on these areas, especially because any outbreak, even in a remote area, could lead to cases in more populated regions.

For Brazil, which has seen over one hundred cases this past year, challenges include high vector density, and outright vaccine refusal out of fear, said Dr Daniel Ramos, arbovirus coordinator for the Brazilian Ministry of Health. Despite this, Ramos praised Brazil’s high vaccination rate, which has protected Brazilians even with increased circulation of the disease in animals.

Need to monitor animal hosts

Changing ecological conditions have also made it easier for yellow fever to jump from non-human primates like monkeys, to people.

Urbanization, “edge” habitats, and ecosystem fragmentation are all connected to a greater risk of yellow fever spread, noted Vicari. 

As a result, PAHO and health ministries have flagged the need to monitor yellow fever not only in humans, but in animals too. Tracking monkey deaths serves “an early warning to identify yellow fever circulation,” said PAHO in its alert. This could then alert officials to vaccinate people nearby. 

“While vaccination is certainly a key action, it must be integrated within a balanced response,” said Vicari, such as animal surveillance, clinical management, risk communication, vaccine stock management, and even contingency planning for potential urban outbreaks.

Image Credits: PAHO, PAHO.

A mother at Tygerberg Hospital in Cape Town with her newborn.

The quest for new treatment options for newborns with drug-resistant sepsis took another step forward this week with the enrollment of the first baby in a trial of a combination of three older antibiotics.

It is the second part of a clinical trial by the Global Antibiotic Research and  Development Partnership (GARDP) to evaluate various antibiotic combinations for newborn babies with sepsis.

The first part of the trial, called NeoSep1, was launched in 2023 and it tested two antibiotics – fosfomycin and flomoxef. In this part of the trial, a third antibiotic, amikacin, has been added to the first two antibiotics.

The two combinations will be ranked against five commonly used antibiotic regimens for neonatal sepsis with the overall goal of identifying the optimal treatments to reduce neonatal deaths. 

Baby One was enrolled at Tygerberg Hospital in Cape Town, and GARDP aims to reach 3,000 newborn babies in hospitals across nine countries in Africa and Asia by 2028.

Neonatal sepsis affects up to three million babies a year globally, and 250,000 babies in Africa alone die from sepsis every year. The crisis is exacerbated as an increasing number of newborns are becoming resistant to recommended antibiotic treatments.

“Newborn babies are particularly vulnerable to infections, yet appropriate antibiotic treatments are often not available, especially in African countries,” said Sally Ellis, Children’s Antibiotics Project Leader for GARDP.

“If a baby picks up a serious infection, it can be a matter of life and death. New antibiotic treatments are sorely needed. GARDP’s clinical trial on neonatal sepsis hopes to help fill the treatment gap, so that babies with sepsis stand a better chance of survival and a good outcome.”

NeoSep1 is sponsored by the GARDP in collaboration with the Medical Research Council Clinical Trials Unit at University College London; City St George’s at the University of London, and the paediatric science research grou,p Penta.

The trial is part of a five-year project by a consortium of African and European partners called SNIP-AFRICA, which aims to reduce mortality among newborns with sepsis in hospitals in Africa.

Image Credits: Global Antibiotic Research and Development Partnership (GARDP).

WHO Director-General Dr Tedros Adhanom Ghebreyesus (centre) applauding the vote on the pandemic agreement in Committee A, flanked by Committee A chair, Namibian Health Minister Dr Esperance Luvindao (left) and his Deputy Director-General, Dr Mike Ryan.

The World Health Assembly (WHA) adoption of the Pandemic Agreement sent a powerful message: Multilateralism remains alive and countries can still find common understandings on collective problems. Many steps still need to be completed, and thus the agreement will not be open for signature for at least another year, as negotiations continue on contentious issues around an Annex on the Pathogen Access and Benefit-Sharing System (PABS). This sixth issue of the Governing Pandemics Snapshot explores the trade-offs made in a final agreement and the steps remaining for it to be ready for parties’ signature, setting off the countdown for it to enter into force.

The 78th World Health Assembly (WHA) adoption of the Pandemic Agreement (PA) on 20 May was the end of an arduous three-year negotiating process. But it also marked the beginning of another round of difficult negotiations on an annex for Pathogen Access and Benefit Sharing (PABS). 

The agreement will not be open for signature for at least another year as negotiations continue on the PABS Annex. It must be signed by at least 60 countries for it to enter into force, a process that could take years.

This article reviews the tense 11th hour debates and tradeoffs that led to the final agreement, as well as the next steps to expect in the PABS negotiations. 

Tone shifts in late negotiations

In 2025, the International Negotiating Body (INB) met twice. The 13th meeting of the INB took place on from 17 to 21 February, based on a new text proposed by the Bureau, a group of six country representatives leading the process. 

The list of unresolved articles was long and included some of the most contentious issues that had seen little convergence over the previous years: prevention and One Health, technology transfer, PABS, supply chain and logistics, and governance elements in Chapter III. 

This was also the first session held without the participation of the United States, following the announced withdrawal from the World Health Organization (WHO) after the inauguration of the second Trump administration. Against this backdrop, progress was made – albeit slowly.

Some observers suggested that the absence of the US, combined with a heightened sense of urgency due to mounting pressures on the global health architecture and ongoing funding cuts, might have contributed to a more constructive attitude of delegation and a shift in tone. 

Ambassador Pamela Hamamoto, leader of the US delegation during the Biden administration.

The resumed session of INB13 – the final meeting on the INB calendar – took place on from 7 to 11 April, with nightly sessions stretching into the early hours of the morning on each day of negotiations. 

Progress was steady. Negotiators gradually cleared all remaining articles, reaching consensus on the framework for the PABS System – including a fixed commitment for each participating manufacturer to share a percentage of real-time production during pandemics, one of the key requests of developing countries – followed by agreement on prevention and One Health (see Ricardo Matute’s piece for an analysis of this topic). 

One by one, key issues began to fall into place during an extenuating week of negotiations. 

On the final day, negotiators worked continuously for over 24 hours to achieve full consensus. However, one final point of contention remained: Article 11 on technology transfer. Divisions persisted between countries favoring a strictly voluntary approach and those advocating for stronger obligations, including mechanisms to compel access to manufacturing know-how for pandemic-related health products during crises. 

With consensus on the full text within reach, the meeting was suspended around 9am on Saturday 12 April, after 24 hours of deliberation, and scheduled to resume on Tuesday 15th.

In the early hours of April 16th, the text was fully greened – culminating in an emotional and symbolically powerful moment. 

The deadlock on technology transfer was resolved by inserting a footnote defining the expression “as mutually agreed” after each reference in the text. (A more detailed analysis of the outcome of this compromise is provided by Ellen ‘t Hoen in the Snapshot.)

Adoption survives a surprise last-minute vote 

Following the green-lighting of the text in April, the INB transmitted the final draft of the agreement along with a draft resolution that was agreed upon shortly after the finalization of the agreement, to the 78th World Health Assembly (WHA) for formal adoption. 

The PA was the first item for consideration in Committee A, one of the main committees of the WHA focusing on programmatic and technical issues, and with a consensus ready text, agreement should have been straightforward. 

Yet, a last-minute curveball came from Slovakia, which unexpectedly called for a vote. A statement released by the Slovak Prime Minister Robert Fico claimed that the agreement “violates the principle of the sovereignty of the member states and disproportionately interferes with the area of human rights.” 

Despite this challenge, member states overwhelmingly showed support for this hard-won treaty: the final vote recorded 124 in favor, zero objections and 11 abstentions. A number of countries were absent from the meeting or had their right to vote suspended due to their arrears in assessed contributions. 

The following day, the text moved to the plenary session, where it was adopted by consensus, surrounded by cheers and a surge of emotion in the room.

Key officials of the Intergovernmental Negotiating Body celebrate after the WHA adopts the pandemic agreement on 20 May 2025.

Several crucial steps before entry into force

Negotiators deliberately designed the PA’s architecture to accommodate further negotiations, particularly those required to operationalize the PABS System. 

Although the PA includes a dedicated article on PABS, it merely establishes the system’s foundational principles. The specifics — such as how benefits will be shared and what obligations apply to countries and companies — remain to be determined. 

To this end, the WHA mandated the creation of an Intergovernmental Working Group (IGWG), open to all WHO Member States, to negotiate the elements necessary to operationalize the PABS System in the form of an annex to the agreement that will have to be adopted separately by the WHA.

A consequential addition was made to Article 33 on signature: the PA will only be open for signature once the PABS Annex has been adopted by the WHA. 

The IGWG is scheduled to hold its first meeting no later than 15 July 2025, during which it will presumably determine the composition of the Bureau that will lead the next phase of negotiations, and its program of work. It is unclear whether former INB Bureau members will be reappointed or if new leadership will step in. 

The IGWG must present the outcome of its work – whatever this may be – to the 79th WHA in May 2026. This leaves less than a year to resolve one of the agreement’s most complex and contentious components. (A detailed analysis of what to expect from these negotiations is addressed by Adam Strobeyko in another piece of this Snapshot.)

Should consensus prove elusive, it will fall to the WHA to decide how to proceed. 

Importantly, the IGWG’s mandate extends beyond finalizing the Annex. It is also tasked with laying the groundwork for the agreement’s implementation and eventual entry into force. 

These tasks include drafting the rules of procedure for the Conference of the Parties, establishing financial rules and a draft budget; defining the structure and functions of the Global Supply Chain and Logistics Network; suggesting reporting obligations; and proposing details on the functioning of the implementation mechanism for the PA. (These institutional and procedural issues are explored further by Gian Luca Burci in in Snapshot.)

Once the annex is adopted, the PA will be open for signature and ratification. It will require ratification by at least 60 countries to enter into force — a process that could take years. 

As many analysts have indicated, the adoption of this historic agreement marks not an endpoint but rather a beginning. As negotiations continue on the PABS Annex and the operational structures needed to implement the agreement, the focus must now shift to ensuring that these ambitious commitments are translated into real-world impact, strengthening global preparedness and response to future pandemics.

This is one of six article in the latest Governing Pandemics Snapshot produced by the Global Health Centre at the Geneva Graduate Institute.

Daniela Morich is Senior Manager and Adviser at the Global Health Centre, Geneva Graduate Institute. 

Ava Greenup is Project Associate of the Governing Pandemics Initiative at the Global Health Centre, Geneva Graduate Institute.

Image Credits: WHO.

The world is within striking distance of enforcing the first legally binding treaty to protect vast areas of waters beyond national jurisdictions that cover two-thirds of the planet’s surface, a historic step that would place biodiversity in the long-lawless high seas under international law for the first time.

Nineteen countries ratified the High Seas Treaty this week at the UN Ocean Conference in Nice, France, bringing the total to 50 ratifications, just 10 short of the 60 needed for the treaty to take legal effect. The agreement was first passed by consensus at the UN and signed by 132 nations in 2023.

“The surge of ratifications of the High Seas Treaty is a tidal wave of hope,” said Rebecca Hubbard, director of the High Seas Alliance. “While many international agreements take years to enter into force, the action here in Nice today is a testament to the global momentum and urgency of action for the ocean.”

French President Emmanuel Macron confirmed that five additional countries would ratify the treaty immediately, with another 15 formally committed to joining on confirmed dates after the conference and a further 15 pledging to complete ratification by year’s end.

The rapid pace of ratifications represents lightning speed by UN standards. While the UN Convention on the Law of the Sea took 12 years to reach the ratification threshold, this agreement could enter into force just two years after signing.

“This means that this treaty will be able to enter into force on January 1 of next year, which means we would finally have an international framework to regulate and administer the high seas,” Macron said. “So that’s a win.”

Why the treaty matters and what comes next

The High Seas Treaty, or Biodiversity Beyond National Jurisdiction Treaty in official UN speak, would mark a historic moment in regulating the global commons from the overexploitation pushing the planet’s forests, oceans, weather systems, flora and wildlife to the limit.

“The ocean generates half of the oxygen we breathe. It feeds 3 billion people and sustains 600 million livelihoods,” UN Secretary-General Antonio Guterres said. “The ocean is the ultimate shared resource. But we are failing it.”

The treaty establishes binding requirements for countries to protect marine areas beyond their territorial waters, ensure sustainable use of marine resources such as fish, technology transfer, and mandate environmental impact assessments for commercial activities such as industrial fishing in international waters.

Key provisions include protecting 30% of international waters by the end of the decade, up from just 1.5%, which complements the broader 30×30 goal under the Montreal-Kunming agreement, which calls on nations to protect 30% of the world’s oceans by 2030, including their territorial waters.

The European Union, Brazil, and South Korea have championed the treaty. But vocal opposition has come from Trump’s United States—a significant setback given America’s role in crafting the agreement under the previous administration. Major players who haven’t signed include Russia, Saudi Arabia, Iran, and Japan.

Once the 60-ratification threshold is reached, a 120-day countdown begins before the treaty becomes international law. Within a year of entry into force, the first Conference of the Parties will convene—adding another “COP” to the growing list of UN climate, biodiversity, and desertification summits that has environmental diplomats joking they need new acronyms.

Undecided nations face a deadline: countries must ratify before the first Ocean COP to secure voting rights in the consensus-based decision-making process that will determine how the treaty operates.

Entry into force marks the beginning of a familiar UN process, with multiple agreements running in parallel and competing for limited diplomatic resources. Ratified members must establish enforcement and monitoring mechanisms, secure funding, and build the institutional framework to implement the treaty’s provisions.

Without protection against the mounting pressures of climate change, sea level rise, ocean acidification, record temperatures, and industrial-scale fishing by massive trawler fleets, marine ecosystems face escalating threats. Fish stocks are collapsing. Overconsumption and illegal fishing are pushing marine life to the brink.

“The deep sea cannot become the Wild West,” Guterres said. “When we protect marine areas, life returns. What was lost in a generation can return in a generation. The ocean of our ancestors – teeming with life and diversity – can be more than legend. It can be our legacy.

The absent architect

In what is becoming a familiar pattern in the international organization world, the United States and its absence cast a large shadow over the proceedings in Nice, which were shrouded in wildfire smoke crossing the Atlantic to the Mediterranean city from Canada, America’s “51st state.”

Last week, the US confirmed it would not send an official delegation to the talks, with the State Department saying the ocean preservation targets in the treaty were “at odds” with the administration’s position.

The US instead sent two observers to the negotiations, both political appointees from President Trump’s taskforce tasked with dismantling US engagement at home and abroad with efforts to fight the climate crisis. Delegations are normally made up of scientists.

The tectonic shift in the White House is a major blow for the High Seas Treaty, which the Biden administration was key to shepherding over the line. John Kerry, Biden’s special envoy for climate, wrote in the Financial Times that the treaty could “provide critical reassurance to the world that the multilateral architecture built after the Second World War is just as relevant today.”

Despite Kerry’s sentiment, it is clear—from withdrawing from the Paris climate accord, to kneecapping US efforts to monitor pollutants that cause climate change, and a complete U-turn on its support for the plastic treaty due in August—that the architect of that system has left it behind.

The Trump administration issued an executive order, “RESTORING AMERICAN SEAFOOD COMPETITIVENESS,” lauded by the fishing industry and the latest step in the withdrawal from marine protection, which includes reopening national marine monuments off New England and Pacific islands to commercial fishing.

“Federal overregulation has restricted fishermen from productively harvesting American seafood, including through restrictive catch limits, selling our fishing grounds to foreign offshore wind companies, inaccurate and outdated fisheries data, and delayed adoption of modern technology,” the administration wrote.

“The erosion of American seafood competitiveness at the hands of unfair foreign trade practices must end.”

Deep sea drama

Trump has also thrown his weight behind another key threat to the oceans: deep sea mining.

In April, the administration said it would work to “unleash” America’s offshore resource extraction in the deep sea, asserting the US’s right to mine seabeds in international waters.

The move defies the International Seabed Authority, the body in charge of such decisions under the Law of the Sea, to which the US is not party, which has placed a moratorium on mining until the full scientific picture can emerge about the threats it poses to nature.

The President of the ISA, biologist Leticia Reis de Carvalho, who defeated an industry-connected opponent in a critical election last year, called Trump’s move “a dangerous precedent that could destabilize the entire system of global ocean governance.”

“The abyss is not for sale, any more than Greenland is up for grabs,” Macron said. In another direct shot at Trump, the French president contrasted his nation’s new “Neptune Mission” for scientific exploration of the world’s oceans as the absent US charts a course to Mars.

“Rather than rushing off to Mars, let’s already get to know our final frontier and our best friend, the ocean,” Macron said.

Familiar money problems

The financial challenges facing the High Seas Treaty are daunting even by UN environmental standards.

The ocean-focused Sustainable Development Goal, known as “Life Below Water,” is by far the least funded, receiving just $10 billion over five years from 2015 to 2019—less than 0.01% of global sustainable development funding.

The UN estimates marine protection requires at least $175 billion annually. Figures from the UN High Level Panel on Ocean Economies show the funding gap comes at a considerable cost, holding back critical progress on marine conservation, fisheries reform, and the blue economy, where every $1 invested yields at least $5 in global benefits by 2050.

In March, the United States announced that it “rejects and denounces” the sustainable development goals altogether amid a projected $4 trillion total financing gap to achieve their targets, the first deadline for which was 2020.

“Agenda 2030 and the SDGs advance a program of soft global governance that is inconsistent with U.S. sovereignty and adverse to the rights and interests of Americans,” Edward Heartney of the US mission told the General Assembly.

The $175 billion in annual funding will be difficult to come by as the financial climate for international environmental treaties grows increasingly crowded as the climate crisis intensifies.

Funding gaps in the hundreds of millions already exist in UN negotiations from biodiversity to climate to desertification, competing for the same limited funds that no state or bloc appears able or willing to provide.

The UN itself, and many of its agencies, are facing existential financial crises largely as a result of the US administration’s exit from the international diplomatic world.

A high-level conference in Monaco in the days before the Nice summit attempted to galvanize funding, resulting in the launch of a public-private partnership that isn’t expected to be operational until 2028 at the earliest, when the next ocean conference is scheduled.

Subsidies strike back

Money is being spent on the ocean, just not on protection.

“These are symptoms of a system in crisis, and they are feeding off each other,” UN Secretary-General António Guterres said. “The ocean generates half of the oxygen we breathe. It feeds 3 billion people and sustains 600 million livelihoods. The ocean is the ultimate shared resource. But we are failing it.”

While funding for conservation remains functionally non-existent, subsidies that promote overfishing total $35.4 billion annually. Subsidies going directly to fuel for fishing vessels—some floating factories that rival any ship on the open water in size—alone total $7.2 billion per year, far outweighing investment in SDG 14.

The result is ships taking economically unviable voyages supported by public funds, with fishing fleets operating at 2.5 times sustainable capacity, benefiting large-scale industrial operations over small-scale fishers.

The oddity of the fishing industry’s subsidy framework is that, on paper, unsustainable management of fisheries in the long term will decimate the companies that cause their extinction.

The National Institutes of Health estimates that underperforming fisheries cost fishing companies between $51 and $83 billion every year in unrealized economic benefits from better management of fish stocks. In total, the current course charted by industrial fishing trawlers will wipe $2 trillion off the balance sheets of companies in the next three decades.

The world’s largest subsidisers are China ($7.3 billion), the EU ($3.8 billion), the US ($3.4 billion), South Korea ($2.6 billion), and Japan ($2.4 billion).

A process known as “Fish 2” is underway at the World Trade Organization seeking to limit or eliminate subsidies that contribute to overfishing.

A first-of-its-kind InfluenceMap report found that 29 of the 30 largest seafood companies oppose the very protections that would ensure their survival, actively lobbying against marine reserves and fishing restrictions.

The list includes household names like Cargill and Mitsubishi Corporation— yes, the car company, little known for being one of the world’s largest fishing conglomerates.

“Protection is not the problem—overfishing is the problem,” said marine scientist Enric Sala. “The worst enemy of the fishing industry is themselves.”

US President Donald Trump and Health Secretary Robert F Kennedy during the presidential election campaign in 2024.

Three days after removing all 17 members of the Centers for Disease Control and Prevention’s (CDC) vaccine advisory group, United States Health Secretary Robert F Kennedy Jr has made eight new appointments – at least half of whom have spoken out against the handling of COVID-19 and vaccines.

The new appointees to the Advisory Committee for Immunization Practices (ACIP) are Dr Joseph Hibbeln, Martin Kulldorff, Retsef Levi, Dr Robert Malone, Dr Cody Meissner, Dr Michael Ross, Dr James Pagano and Vicky Pebsworth.

Making the announcement via X, Kennedy said that the eight will attend the committee’s scheduled meeting on 25 June. It is unclear whether additional appointments are in the offing, as eight is the statutory minimum for ACIP.

Malone has promoted several false and alarmist claims about COVID-19 vaccines, said they did not work and promoted the use of hydroxychloroquine and ivermectin as SARS-CO-V2 treatments despite numerous studies showing they did not work.

Part of Kennedy’s Make America Healthy Again (MAHA) movement, Malone was banned from Twitter during the pandemic for violating the platform’s misinformation policies and The New York Times has described him as a “COVID vaccine misinformation star”.

Recently, Malone controversially claimed that an eight-year-old child, Daisy Hildebrand, who died of measles in Texas had died of sepsis not measles, and blamed a medical institution for mismanaging her illness. Malone made these claims on social media before the child’s death had been made public. 

However, the Texas health department announced Hildebrand’s death on 6 April due to “measles pulmonary failure”, and noted that “the child was not vaccinated and had no reported underlying conditions”.

Kennedy describes Malone as “a physician-scientist and biochemist known for his early contributions to mRNA vaccine technology”.

Alternatives to vaccines

Pebsworth, Pacific regional director for the National Association of Catholic Nurses, is a director and board member at the National Vaccine Information Center. The centre is known for questioning the safety of COVID-19 vaccines and encouraging people to seek alternatives to vaccines.

Some 40% of the centre’s funding is from Dr Joseph Mercola, who sells alternative health products and was named the biggest source of COVID-19 misinformation on Facebook and Twitter by the Center Countering Digital Hate.

A biostatistician and epidemiologist, Kulldorff was co-author of the Great Barrington Declaration with Dr Jay Battacharya, new director of the National Institutes of Health, which favoured herd immunity to address COVID-19 for all but the most vulnerable.

Meissner, Professor of Paediatrics at the Geisel School of Medicine at Dartmouth, was part the Food and Drug Administration (FDA) vaccine advisory panel that recommended the use of COVID vaccines. However, he has spoken out against children wearing masks and is in favour of children and pregnant children being excluded from the COVID-19 vaccine schedule.

Levi, Professor of Operations Management at the MIT Sloan School of Management, has questioned the safety of COVID-19 vaccines

Hibbeln is a psychiatrist and neuroscientist. Pagano is an emergency medicine physician and Ross is a Clinical Professor of Obstetrics and Gynecology at George Washington University and Virginia Commonwealth University.

Previously, Kennedy pledged to keep ACIP in place to Senator Bill Cassidy, who was considering blocking his appointment as health secretary.

US Health Secretary Robert F Kennedy Jr.

The decision by United States Health Secretary Robert F Kennedy Jr to fire all members of the Centers for Disease Control and Prevention’s (CDC) vaccine advisory group is “a dangerous and unprecedented action that makes our families less safe”, according to Dr Tom Frieden, CEO of Resolve to Save Lives.  

The Advisory Committee on Immunization Practices (ACIP) develops recommendations on how to use vaccines to control disease in the US, according to the CDC.

“Seventeen dedicated doctors, paediatricians, scientists, and parents who served on the ACIP  were just fired by Secretary Kennedy based on false claims of conflicts of interest,” said Frieden, a former head of the CDC, late Monday.

Kennedy announced the move a few hours earlier in an op-ed published in the Wall Street Journal, claiming that “a clean sweep is needed to re-establish public confidence in vaccine science”.

He added that “vaccines have become a divisive issue in American politics”, and that the “committee has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.”

But Dr Tina Tan, president of the Infectious Diseases Society of America President, said that “unilaterally removing an entire panel of experts is reckless, short-sighted and severely harmful”.

“This is one of the darkest days in modern public health history,” said Dr Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). “Science does not matter to Mr Kennedy.” 

Frieden warned that “if this leads to vaccines not being recommended, millions of people could lose access, pay more for vaccines and for preventable illnesses, and children will be at greater risk of diseases we haven’t faced in decades.”

There have been 17 measles outbreaks in the US this year so far, and by 5 June, a total of 1,168 confirmed measles cases had been reported by 34 jurisdictions, according to the CDC. Some 95% of cases were either unvaccinated or their vaccination status was unknown.

The measles caseload is four times higher than in 2024 and is nearing a 30-year high, according to ABC news. The rise in measles cases stems from waning vaccination levels, with a vaccination rate of over 95% required to keep the highly infectious disease in check.

Anti-vax ‘empire’

Measles vaccination. Despite the growing US outbreak, routine vaccination against this and other highly infectious childhood diseases is under attack.

Biomedical scientist and science communicator Dr Andrea Love said that Kennedy, not ACIP, “is the one who has created distrust around vaccines and legitimate scientific experts”,  adding that he has spent “over 20 years systematically attacking vaccines for profit”.

“RFK Jr has built a multi-million dollar empire manufacturing vaccine distrust. His organisation, Children’s Health Defense (CHD), raked in over $16 million in 2021 alone – money made by terrifying parents, undermining public health, and selling false solutions,” Love wrote in her Immunologic newsletter.

During the COVID-19 pandemic, the Centre for Countering Digital Hate identified Kennedy as the second biggest purveyor of anti-vaccine disinformation, based on its analysis of  Facebook and Twitter during March 2021.

Eleven of the 12 “disinformation dozen” were selling alternative remedies for COVID-19, while the non-profit CHD, which Kennedy founded and ran until his presidential bid, receives donations to question vaccines.

“Every vaccine controversy he fabricates, every conspiracy theory he spreads, every scientific institution he attacks leads to donations, book sales, legal fees, speaking fees, and supplement partnerships,” said Love.

New members are ‘under consideration’

Replacement committee members are “currently under consideration” by Kennedy, and ACIP is still scheduled to meet on 25 June, according to an announcement by the US Department of Health and Human Services (HHS).

“ACIP’s new members will prioritize public health and evidence-based medicine. The Committee will no longer function as a rubber stamp for industry profit-taking agendas,” according to HHS.

Until Monday, ACIP was chaired by Dr Helen Talbot, professor of Medicine and Health Policy at Vanderbilt University in Tennessee, who also co-leads the university’s Emerging Infections Program that is working on understanding viral respiratory disease epidemiology. Other members were also primarily medical experts based at universities and research institutions.

ACIP members are “required to declare any potential or perceived conflicts of interest” during their tenure, and recuse themselves from deliberations and voting should they have such conflicts, according to the CDC, which publishes members’ disclosures.

Kennedy and Trump’s recent high-level health appointees give an indication of the likely direction of the new appointees.

Casey (left) and Calley Means after being interviewed about their book by conservative talk show host Tucker Carlson (centre)

Last month, President Donald Trump nominated Casey Means, who has linked vaccines to autism, as Surgeon General on the advice of Kennedy.

Her brother, Calley Means, co-founder of an online wellness sales platform, is Kennedy’s special advisor. 

The Means siblings co-authored Good Energy, in which they argue that all chronic conditions are caused by metabolic dysfunction linked to lifestyle.

The Means, like new National Institutes of Health (NIH) Director Dr Jay Bhattacharya; Food and Drug Authority (FDA) head Dr Marty Makary; and Dr Mehmet Oz, head of the Center for Medicare and Medicaid Services, are critical of mainstream medicine and how the COVID-19 pandemic was handled.

Image Credits: WHO, Facebook.

NIH staff are protesting against the politicisation of the body.

Over 300 employees of the US National Institutes of Health (NIH) have urged NIH director Dr Jay Bhattacharya to “restore grants delayed or terminated for political reasons so that life-saving science can continue”.

They have also appealed to him to reinstate staff, enable global collaboration, and research to be published in peer-reviewed journals.

“We dissent to [Trump] Administration policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe,” the staff declared in a letter sent to Bhattacharya and Health Secretary Robert F Kennedy Jr on Monday morning.

In the letter, which they name the “Bethesda Declaration” after the location of the NIH headquarters, the staff say they are “compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.”

They describe themselves as “workers from every Institute and Center at NIH”, including some who have signed anonymously “due to a culture of fear and suppression”.

“Standing up in this way is a risk, but I am much more worried about the risks of not speaking up,” said Dr Jenna Norton, one of the declaration organisers, in a media release circulated by a group called Stand Up for Science.

“If we don’t speak up, we allow continued harm to research participants and public health in America and across the globe,” added Norton, who is a programme director at the National Institute of Diabetes and Digestive and Kidney Diseases.

The letter is timed to coincide with Bhattacharya’s appearance at the Senate’s Appropriations Committee for the NIH’s budget request on Tuesday.

‘Multiple universities’ targeted for ‘political aims’

The staff decry the Trump administration’s “politicisation of research by halting high-quality, peer-reviewed grants and contracts” based on “political ideology”. 

Since Trump took office on 20 January, NIH has terminated 2,100 research grants totaling around $9.5 billion and $2.6 billion in contracts

Targets include “multiple universities” who have been hit “with indiscriminate grant terminations, payment freezes for ongoing research, and blanket holds on awards regardless of the quality, progress, or impact of the science’ for political aims, according to the letter.

“Many [research] terminations contradict federal regulations that mandate protections for research participants and require grant awards to specify potential termination reasons.”

Some terminations eliminate years of hard work and millions of dollars

“Ending a $5 million research study when it is 80% complete does not save $1 million, it wastes $4 million,” the letter notes.

In addition, “NIH trials are being halted without regard to participant safety, abruptly stopping medications or leaving participants with unmonitored device implants.”

“The partnership between NIH and the academic community has made huge contributions to almost every aspect of the health of people across the US,” said Jeremy Berg, former director of the National Institute of General Medical Sciences.

Reinstate staff, restore global partnerships

The NIH Clinical Center, formed in 1953, is a hospital devoted entirely to finding cures for a range of diseases.

They urge Bhattacharya to “reinstate the people who make NHI work”, noting that firing “talented, hard-working professionals and critical departments without thought to their purpose or need has slowed the pace of science, held up extramural grant and contract funding, made NIH less transparent and efficient, and put Clinical Center patients at risk.”

The NIH Clinical Center is the largest US hospital devoted entirely to clinical research, including of cancer, dementia and rare diseases.

They also urge him to “allow rigorously peer-reviewed research with vetted foreign collaborators to continue without disruption”, as American scientists are being “cut off from the global scientific community”.

South Africa may lose 70% of its medical research capacity following the cancellation of NIH funds, crippling 16 universities and setting back two decades of HIV and tuberculosis research.

This follows the NIH decision to prohibit US scientists from working with foreign researchers via “sub-awards”, leading to the immediate and mass cancellation of such grants with South African institutions.

At least 39 TB and HIV clinical research sites in South Africa are under threat due to NIH funding cuts, jeopardising at least 27 HIV trials and 20 TB trials, according to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF) mostly of grants from the NIH’s Division of AIDS (DAIDS).The “unprecedented reduction in NIH spending does not reflect efficiency but rather a dramatic reduction in life-saving research,” they conclude.

Stand up for Science, a Washington-based non-profit formed to defend science and democracy, has also mobilised high-profile scientists, including 19 Nobel laureates, to support the NIH staff.

Echoing Great Barrington Declaration 

The Bethesda Declaration is deliberately styled after the Great Barrington Declaration, published by Bhattacharya and others during COVID-19, which argues against any measures to prevent COVID-19 other than “focused protection” for those most vulnerable, while allowing widespread SARS-CoV-2 infection to enable “herd immunity”.

The Great Barrington Declaration, sponsored by the American Institute for Economic Research (AIER), a libertarian free-market think tank associated with climate change denial, was widely condemned as being unscientific.

Last month, NIH staff staged a walkout during a Town Hall addressed by Bhattacharya in which he said he supported the idea that the COVID-19 pandemic was “caused by research conducted by human beings,” possibly partly sponsored by the NIH.

“If it’s true that we sponsored research that caused a pandemic – and if you look at polls of the American people, that’s what most people believe, and I looked at the scientific evidence; I believe it – what we have to do is make sure that we do not engage in research that’s any risk of posing any risk to human populations,” Bhattacharya said in a recording obtained by CNN.

Image Credits: Stand up for Science, NIH.

People collect water from a pump in Kinshasa in the Democratic Republic of Congo. Cholera is an acute enteric infection, primarily linked to insufficient access to safe water and proper sanitation.

Cholera in Africa is being driven by years of under-investment in water and sanitation, according to the Africa Centres of Disease Control and Prevention (Africa CDC).

Four countries – Angola, Democratic Republic of Congo (DRC), Sudan and South Sudan  – account for over 85% of the continent’s cholera cases and all have above-average death rates, according to Dr Ngashi Ngongo, Africa CDC incident lead on mpox.

Access to clean water, sanitation and hygiene (WASH) is poor in all four countries. Only 35% of Sudanese have access to safe water, and although the DRC leads the group, only around two-thirds of its citizens have clean water, according to the Africa CDC.

Only 16% of those living in South Sudan have access to basic sanitation and almost three-quarters of the rural population practises open defecation.Only 10% of schools in South Sudan have handwashing facilities for children.

Half the Angolan population has basic sanitation, the best of the group.

South Sudan has the biggest cholera outbreak with 48,828 cases and 908 deaths. It is followed by DRC with 25,520 cases and 557 deaths, then Angola with 21,000 cases and 630 deaths and Sudan with 13,743 cases and 296 deaths, Ngongo told the Africa CDC media briefing on Thursday.

Ngongo said that the expected case fatality rate should be around 1% but this was far higher in all four countries. South Sudan’s rate is 1.9%, DRC is 2.1%, Sudan is 2.5%, and Angola is 3%.

Multi-sectoral, continental commitment

Earlier in the week, African Heads of State from the 20 countries worst affected by cholera convened and resolved to create a continental Incident Management Support Team (IMST) similar to that coordinating the mpox response, to reinforce cross-border surveillance. 

The countries also pledged to establish national presidential task torces on cholera to “strengthen multisectoral coordination, mobilise domestic resources, and enforce accountability frameworks”, according a media release from Africa CDC. 

Angolan President and African Union chairperson João Manuel Gonçalves Lourenço urged countries to “invest robustly in water, sanitation, and health systems”. 

Meanwhile, Africa CDC Director General Dr Jean Kaseya told the leaders that the systemic drivers of the crisis were “limited WASH infrastructure, insecurity, weak coordination, and vaccine shortages”.

“Africa needs 54 million doses of oral cholera vaccine annually but receives barely half. This gap is unacceptable. Urgent action is needed to scale up local production and secure supply,” said Kaseya.

Only one manufacturer is currently making the vaccine globally, producing around half the vaccines that are needed. 

“Africa needed 80 million doses but only received 26 million doses [in 2024] because doses had to be distributed also to other regions,” said Ngongo.

“This is the reason why there’s a greater push from Africa CDC, and now also from the Head of State for local manufacturing,” he said, adding that $150 million was needed to finance this.

In closing, Zambian President and meeting host Hakainde Hichilema said: “We have issued a clear Call to Action. Now we must deliver—through scaled-up domestic investments, strengthened cross-border coordination, and community-driven responses. Africa needs one continental IMST, one community-centred plan, and one accountability framework.”

Mpox ‘most concerning’ in Sierra Leone

The mpox outbreak in Sierra Leone, which accounts for over half of the new mpox cases in the past week, is the “most concerning”, said Ngongo.

The country has 4,032 suspected cases reported so far (3140 confirmed) and 15 deaths. Cases seem to be falling, with 531 cases in the past week in comparison to 684 the previous week, but the country’s surveillance is inadequate, he noted.

“What is of really great concern is the test positivity rate, which is at 93% overall for the entire country, with seven districts reporting 100% positivity rate,” said Ngingo.

“This means that people come themselves to health facilities, and those that come are already at advanced stage. It’s a reflection that the surveillance is primarily passive.” 

However, Ngongo acknowledged that Sierra Leone’s surveillance programme involving community health workers “has stopped because of difficulties in funding”.

While mpox appears to be stabilising in the DRC, which is where the majority of cases are, the country’s low testing rate “makes it very difficult to interpret the stabilisation that we are seeing”, said Ngongo.

However, he confirmed that conflict in North and South Kivu provinces was settling, enabling vaccination.

The DRC is the only country that is now vaccinating children below 18 years using the Japanese vaccine LC16. Japan has donated 4.5 million LC16 doses to the DRC, while France has donated 100,000 Bavarian Nordic doses and the United Arab Emirates has donated 20,000 doses.

Image Credits: Eduardo Soteras Jalil/ WHO.

Protestors gathered outside USAID headquarters in Washington DC.

Governments have been advised to impose ‘sin taxes’ on tobacco, alcohol and other unhealthy products to offset the severity of cuts to official development assistance (ODA), World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a tuberculosis meeting on Thursday.

His statements came two days after the administration of US President Donald Trump formally requested his country’s Congress to cancel previously approved budget allocations for global health programmes and projects amounting to $9.4 billion. Tuesday’s request was made by Russ Vought, head of the Office of Management and Budget in Trump’s office, and co-author of Project 2025, the conservative blueprint for the Trump presidency based on expanded presidential power and an ultra-conservative social vision.

Should Congress agree, this would officially endorse the cuts already made in grants to the US Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR) by the Department of Government Efficiency (DOGE) under the leadership of Elon Musk, who resigned from his DOGE role this week as well. Congressional action would also cement cuts to UN agencies including the WHO, UN Children’s Fund (UNICEF), UN Development Program (UNDP), and the UN Population Fund (UNFPA).

“In the past few months, I have spoken to many ministers, and the impact on their  programmes of the sudden cuts in official development assistance is severe,” Tedros told a WHO Town Hall meeting on tuberculosis.

“We are seeing treatment interruptions, clinics closed, health workers losing their jobs, disruptions and more – not just for TB, but for malaria, HIV, neglected tropical diseases, vaccinations, maternal and child health, sexually transmitted infections, family planning and so on.”

The WHO’s advice to countries trying to raise domestic resources to offset the cuts is to start immediately with the “sin taxes” while, in the longer-term, implementing social health insurance and community-based health insurance, Tedros added.

‘Reject rescission package’

Meanwhile, the Global Health Council urged US Congress to reject the rescission package, describing it as “a systematic effort to diminish the longstanding role of the United States as a global health leader” that puts lives at risk.

The One Campaign also called on Congress “to reject rushed attempts to override their previous decisions and to continue supporting smart, effective international assistance programs.”

One Campaign added that the rescissions package “gives scant detail about the nature and impact of the proposed cuts. When lifesaving assistance is at stake, Congress needs real details. For example, the package cuts nearly a billion dollars from health and infectious disease funding which deserves more explanation than 11 vague sentences.”

Trump claims the cuts are aimed at “wasteful foreign assistance spending” to “eliminate programs that are antithetical to American interests”.

Speaking in the US Senate on Thursday, Democratic Senator Dick Durbin asked “why in the world would we cut such low cost but impactful programmes?”

“If there were international programmes that were ineffective, and I admit such work can be difficult and with mistakes, the place to fix them is through the regular appropriations process, not the wholesale gutting of a complete programme like USAID.”

The US Congress has 45 days to consider the proposal.

Gutting of USAID

USAID staff offload emergency supplies.

The Trump administration wants to rescind $500 million of the USAID’s global health programs for “activities related to child and maternal health, HIV/AIDS, and infectious diseases”, claiming that this would not reduce treatment but “eliminate programs that are antithetical to American interests and worsen the lives of women and children, like ‘family planning’ and ‘reproductive health,’ LGBTQI+ activities, and ‘equity’ programs.”

Projections from March indicated that up to 29,000 health workers had lost or were at risk of losing their jobs in Uganda alone due to cuts in foreign assistance. Other African countries severely affected by the US cuts include Ethiopia, Nigeria, and the Democratic Republic of Congo.

“As Uganda’s health workers and Ministry of Health were mounting an effective, coordinated response to contain the Ebola outbreak, the sudden freeze of US foreign assistance created serious challenges,” said Irene Atuhairwe, Seed Global Health’s Country Director in Uganda.

“Health workers lost their jobs, and contact tracing and surveillance efforts had to be scaled back. With limited resources and reduced staffing, health officials were forced to narrow their efforts, potentially increasing the risk of further spread,” added Atuhairwe.

“Diseases like Ebola don’t stay within borders. It takes just one infected traveller boarding a plane or crossing borders for a local outbreak to go global. The very abrupt cuts to foreign assistance have made all of us less safe.”

There were more than 50 USAID-funded staff dedicated to outbreak response in Uganda, but that number has been reduced to just six, who are now responsible for preparedness and response efforts for Ebola, Marburg virus, mpox, and bird flu.

The Trump administration also wants to rescind $400 million of the $6 billion appropriated for HIV programmes, namely the PEPFAR grants administered via USAID.

Numerous African HIV treatment programmes receiving PEPFAR grants through USAID have had to scale down or close because their grants have been terminated, potentially affecting 20 million people.

Also on the rescinding chopping block is $2.5 billion in USAID development assistance to “end extreme poverty and promote resilient, democratic societies”, and $496 million for international disaster assistance in response to natural disasters, conflicts, and other emergencies.

Trump wants to rescind  $1.7 billion from the Economic Support Fund for “countries of strategic importance to the US”, claiming this has been used “to fund radical gender and climate projects.” However, it has largely assisted countries transitioning to democracy and for Middle East peace talks.

Trump also wants to jettison the entire $125 million allocated to the Clean Technology Fund, as it invests in “climate-friendly projects in developing countries that do not reflect America’s values or put the American people first”. 

The fund provides low-cost finance for “promising low-carbon technologies in developing countries”, including “renewable energy, energy efficiency, sustainable transport, and green industry projects.”

International organisations and programmes

The entire $437 million allocated to international organisations and programmes is up for rescission, which would eliminate funding for the UNICEF, UNDP, UNFPA and the Montreal Protocol, which regulates ozone-depleting substances. 

“Eliminating these programs will do real harm,” said Global Health Council President and CEO, Elisha Dunn-Georgiou. 

“These are not fringe initiatives. They make the world safer, healthier, and more just. When the US invests in equitable, inclusive, and evidence-based global health programs, we don’t just improve lives abroad – we strengthen public health security, global cooperation, and America’s reputation as a principled and effective leader.”

The council urged people to “push back against efforts to politicise public health”, noting that “these proposed cuts are about ideology, not money. And they put lives at risk.”

Image Credits: Reuters Youtube, USAID Press Office.

Ambassador Amma Twum-Amoah (left) and Dr Delese Mimi Darko.

CEO of Ghana’s Food and Drugs Authority (FDA) Dr Delese Mimi Darko has been appointed the inaugural Director-General of the African Medicines Agency (AMA) by the agency’s Conference of State Parties (CoSP) at a meeting in Rwanda this week.

Darko has a “wealth of experience and a distinguished track record in regulatory excellence”, according to a media release from the African Union.

Darko has been CEO of Ghana’s FDA since 2017, currently chairs the WHO African Vaccines Regulatory Forum and serves on several international and local committees related to medicines and regulation.

“The appointment of the Director General is an important step toward the operationalisation of AMA,” said Ambassador Amma Twum-Amoah, the AU’s Commissioner for Health, Humanitarian Affairs and Social Development. 

“The AMA has been established to harmonise and strengthen regulatory systems for medical products across Africa. We are confident that under Dr Darko’s leadership, the agency is poised to accelerate its efforts in coordinating and standardising regulatory practices, facilitating joint assessments and inspections, and fostering a harmonised approach to medicines regulation that will ultimately benefit all African citizens,” added Twum-Amoah.

Dr Francine Dekandji, Chad’s Minister of State of Health and chairperson of the CoSP, said that AMA “is crucial for ensuring that medical products on our continent meet international standards of quality, safety, and efficacy”. 

The CoSP also elected a new Bureau to guide its future work and endorsed an additional member to the AMA Governing Board. 

Establishing the agency has been a slow process in the evolution of the harmonisation of the regulation of medicines on the continent.

“The appointment of Dr Darko as the Director General of the AMA represents an important milestone for the organization. The depth of her scientific and regulatory experience will be invaluable in shaping the future of medicine regulation in Africa,” said David Reddy, Director General of the International Federation of Pharmaceutical Producers and Manufacturers Associations (IFPMA).

“By supporting national regulatory authorities across the continent, the AMA has real potential to help facilitate faster access to quality medicines, contribute to tackling substandard and falsified medicines, and support medical innovation.”

Bunmi Femi-Oyekan and Zainab Aziz, co-chairs of the Africa Regulatory Network at IFPMA, both offered their congratulations.

“Under her leadership, the AMA can make important progress in its mission to strengthen initiatives to harmonise medicines regulation and promote cooperation and reliance of regulatory decisions,” said Femi-Oyekan.

Aziz described her appointment as “a crucial step toward a fully functional agency that has the potential to transform access to quality-assured medicines across Africa and foster a more predictable, efficient regulatory environment for innovation”. 

Image Credits: African Union.