Dr Tedros addresses the closing session.

Negotiators working to nail down the pandemic agreement have offered assurances that they can meet the May deadline – for the sake of global security and to restore faith in multilateralism.

Despite only five formal days of talks remaining in April, Pakistan’s Umair Khalid said his country believes there is enough time to clinch the agreement. 

“I don’t think any treaty is negotiated and agreed within a 9am-to-6pm, Monday to Friday setting. So you always have to put in some extra hours, and we have been doing that, and  we’ll continue to do that,” Khalid told a gathering of civil society groups meeting in Geneva during lunchtime on Friday.

“We will use March, we will use April, and we will use all the time that we have.”

India’s Dr Pradeep Khasnobis said that talks “are moving forward” and that “some of those very tough articles, at least have some kind of a landing zone”. 

Eswatini, speaking for the African region, Egypt and Sudan in the closing session, described the week’s talks as “constructive”.

“While we acknowledge concerns about the moderate pace, we are optimistic that the remaining issues, though critical, are manageable,” said Eswatini. 

“We must prepare to conclude our discussions in the five days allocated for the month of April, and we thank the Bureau for proposing additional discussions to address these gaps. We are ready to burn the midnight oils.”

The Philippines, speaking for a 11 diverse countries including Brazil, Canada and the UK, stressed the importance of reaching agreement to restore faith in multilateralism.

“Given the increased challenges facing this organisation, and multilateralism itself, there is a need to demonstrate that countries can indeed come together to solve common problems. We did this in May when we amended the International Health Regulations. This year, we need to adopt the WHO Pandemic Agreement,” said the Philippines, adding that member states managed to make “incremental improvements” to the text “by really listening to one another”.

“We have sat together in this room too many times over the last three years to not have a decent understanding of each other’s positions. We all have some sense of what the consensus text should look like,” id added.

“Let us finish what we have started. Adopting a meaningful Pandemic Agreement will be a win for all of us. The conclusion of the pandemic agereement in May will be a testimony to the world of our commitment to global health and of the continuing relevance of WHO in a time of major political challenges.”

Colombia’s Maria Tenorio Quintero told the civil society gathering that meeting the May deadline would take “extra effort”, and appealed to civil society to help raise public awareness about the positive impact that the agreement could have.

Norway’s Eirik Bakka stressed that the draft agreement “is not an empty shell, and there are important elements that are already agreed to bring it to the finishing line”.

‘Use every opportunity to find common ground’

Joining the closing session, Dr Tedros Adhanom Ghebreyessus, World Health Organization (WHO) Director-General, said that the 13th meeting of the Intergovernmental Negotiating Body (INB) had made progress – but “maybe not as much as you would have hoped”.

“As you move to finalize the pandemic agreement in time for the World Health Assembly, you have one week of formal negotiations left. 

“But you’re so close, closer than you think. You’re on the cusp of making history. This agreement should not fail on a word; it should not fail on a comma and it should not fail on a percentage.

 “History will not forgive us if we fail to deliver on the mandate the world needs, and a sign that multilateralism still works. Reaching a WHO pandemic agreement in the current geopolitical environment is a sign of hope.”

Tedros concluded with two messages: “We believe you can do it” and “Use every opportunity during the intercessional period to come closer together towards finding common ground.”

Civil society anxiety

Nina Jamal of Four Paws and KEI’s Jamie Love.

Civil society organisations following the pandemic agreement negotiations over the past three years are anxious that it won’t be completed by May – and that impetus for the initiative will fizzle and further undermine multilateralism.

A sombre group of over 75 people met in person and online in Geneva over lunch on Friday to express frustration at the slow pace of talks over the past five days. 

With only five official negotiating days remaining – 7-11 April – many complex parts of the agreement are not agreed. The group also raised concerns about provisions being watered down of provisions, particularly on technology transfer and intellectual property, and the absence of clauses on prevention.

Knowledge Ecology International’s Jamie Love expressed disappointment over “the lowering of the ambitions on the initial versions of the text and watering down of provisions”.

He also raised that it may suit some parties, particularly the European Union, not to have an  agreement in May given the “rise of the anti vaxxers and right-wing populism”.

Ellen ‘t Hoen of Medicines Law and Policy described reaching agreement as “crucial now in the current political context and the huge global health crisis caused by the United States withdrawal of aid and European countries slashing their aid budgets”.

“This makes the need for having a signal that multilateralism still works even more important than in the earlier days of the pandemic. This total lack of international solidarity is of huge concern.”

Meanwhile, Four Paws’ Nina Jamal said member states seemed to accept the importance of the agreement for multilateralism

However, Jamal added that pandemic prevention offers the best chance to protect people in countries with weak health systems.

“This is the deepest level of equity that we can achieve. And we are disappointed because a lot of countries who  support prevention and are taking action nationally on prevention with a One Health approach are not being vocal in the negotiations because they think if they talk about prevention, they’re disadvantaging their negotiating position for medical countermeasures, preparedness and response.”

Health professionals – icluding those working on outbreak investigation, maternal mortality, and vector-borne disease – across HHS’s 13 divisions saw mass layoffs as the Trump administration attempts to reduce the size of the federal workforce.

The large-scale government firings have now targeted thousands of probationary employees at the Department of Health and Human Services (HHS), wiping out the ranks of young and up-and-coming scientists from the nation’s leading health and research agencies as well as the more senior staff who had advanced to new positions. 

Although it is unclear how many workers the Trump administration plans to cut, dismissing scientists on probation who do not yet enjoy the same job protections in the civil service system, offer an easy target for termination. 

“It’s using a machete instead of a surgical knife,” Dr Michael Osterholm, an epidemiologist and director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch in an interview. 

Contrary to popular perceptions about government bloat, he noted that the federal government workforce is slightly smaller today than 50 years ago in the 1970s despite a 68% growth in the US population. The number of government contractors, however, has doubled. 

Dismissal emails continue to be sent out to the 13 operating divisions under HHS citing “poor performance,” even though many had just received “outstanding” job reviews. 

Last Thursday, the Office of Personnel Management (OPM) directed all federal agencies to terminate those in their probationary period.

Federal employees remain on probation for one to two years after hiring, depending on the position and agency, many of which are highly competitive. Probationary status lacks the benefits of permanent employment, making them easier to remove. Those in probation include recent hires and career staffers who began new positions or were promoted.

Public health experts targeted

“The probationary period is a continuation of the job application process, not an entitlement for permanent employment. Agencies are taking independent action in light of the recent hiring freeze and in support of the President’s broader efforts to restructure and streamline the federal government to better serve the American people at the highest possible standard,” an OPM spokesperson said in a statement, and as reported by The Hill.

The move is a reversal from an OPM directive just days earlier, when agencies were told to remove probationary employees only if they were poor performers.

The exact number of health professionals has not been released, but the New York Times reports that 1,200 NIH employees were dismissed, and National Public Radio reports that 750 Centers for Disease Control and Prevention (CDC) experts received notice of their removal. 

FDA, CMS, CDC see lay-offs, other divisions spared

Indian health service flags
The Indian Health Service (IHS) serves 2.8 million American Indians and Alaskan Natives. The order to fire over 1,000 IHS employees was rescinded.

Emails firing probationary employees were sent to the Food and Drug Administration (FDA), Centers for Medicare and Medicaid Services (CMS), and the Administration for Strategic Preparedness and Response (ASPR). Staff affected include researchers investigating emerging diseases, such as rabies, dengue, oropouche, and others, reports the Washington Post, in what it called the “Valentine’s Day massacre” of federal layoffs.

Also nixed is the CDC’s Public Health Associate’s Program, which places trainees into local, state, and tribal public health agencies in an effort to alleviate workforce shortages.

Initially, over 1,000 Indian Health Service (IHS) employees received notice of their removal last Friday, reported Native News Online. The IHS provides care to 2.8 million indigenous Americans and Alaska Natives, who suffer disproportionately high rates of diabetes, cancer, COVID-19, and other illnesses.

But later in the evening, the firings were rescinded. The newly confirmed HHS Secretary, Robert F Kennedy Jr, told Native News that he acknowledged that IHS “was chronically understaffed and underfunded.” 

At the CDC, similar turmoil and mixed messaging meant that the Epidemic Intelligence Service (EIS) was potentially facing disbanding last Friday. But the quick public outcry meant that the nation’s deployable “disease detectives” were spared. 

“Efficiency is more than cutting dollars— it’s about improving processes, strengthening infrastructure, and ensuring sustainability – making every dollar work to its fullest potential for Americans,” said Dr Katelyn Jetelina, an epidemiologist and founder of Your Local Epidemiologist. “Prevention and early intervention are an investment – often paying 2-60x in return by reducing healthcare costs, improving workforce productivity, and making communities safer.

“There’s room for improvement, but if we want to lose weight, let’s not cut off our legs.”

Even so, this is less than the 10% cuts promised by the administration.

The firings were not unique to public health operations – air traffic controllers at the FAA, TSA agents, and the National Science Foundation were also affected. Some experts have been asked to come back – notably nuclear safety officers – after the new administration realized their work is vital to government operations. The Trump administration is reportedly having trouble reaching these experts.

On Thursday, a federal judge denied a lawsuit filed by unions representing federal workers that OPM is overstepping its authority. The judge said he did not have jurisdiction over the matter as it should be decided by the Federal Labor Relations Authority.

For public health experts, the indiscriminate firings are a matter of American public health security. 

“Whether it be at FDA, CDC, NIH, I think those three agencies in particular are going to be severely challenged over the weeks and months ahead,” said Osterholm, in an interview with Health Policy Watch. 

“I don’t think we have any idea yet of just what the breadth of those cuts are going to be or how it happens.”

Dr Georges Benjamin, executive director of the American Public Health Association, echoed this sentiment in a statement to NPR, calling the cuts at the CDC “indiscriminate, poorly-thought-out layoffs” that would be “very destructive to the core infrastructure of public health.”

Bird flu response in flux

Officials trying to contain bird flu were among those fired over the weekend. USDA says it is “working swiftly to rectify the situation.”

The US Department of Agriculture (USDA), which trying to contain the ongoing avian influenza epidemic, has been trying to reach the experts it “accidentally” fired over the weekend.

“Although several positions supporting [bird flu efforts] were notified of their terminations over the weekend, we are working to swiftly rectify the situation and rescind those letters,” a USDA spokesperson said in a statement. 

“USDA’s Food Safety and Inspection Service frontline positions are considered public safety positions, and we are continuing to hire the workforce necessary to ensure the safety and adequate supply of food to fulfill our statutory mission.”

Lawmakers on both sides of the aisle have expressed concerns over the firings, which are part of the Department of Government Efficiency (DOGE)’s attempts to cut back on government spending.

“They need to be more cautious,” Rep. Don Bacon (R-NE), a member of the Agriculture Committee, told NBC News in a statement about the DOGE team. 

“There’s an old saying, ‘Measure twice, cut once.’ Well, they are measuring once and having to cut twice. Some of this stuff they’re going to have to return back. I just wish they’d make a better decision up front.”

Cuts are ‘arbitrary’ 

The public health activities of HHS span overseeing food and drug safety, responding to and containing disease outbreaks, and providing direct healthcare to hundreds of thousands of Americans. 

But critics point to the growing US deficit, which has grown to $1.3 trillion since 2001, as a compelling reason for DOGE to continue cutting the federal workforce. 

DOGE “senior advisor,” billionaire Elon Musk, has said that his goal is to cut federal spending by $2 trillion, out of a $6.75 trillion annual budget in the latest fiscal year. The entrepreneur has made unsubstantiated claims that he has already saved $8 billion.

In reality, the federal workforce has not grown in proportion to the US population. “I understand the need to address the growing deficit problem,” said Osterholm. “But…we should be looking to find ways to strategically and tactically [reduce the deficit], and not just arbitrarily. 

“There’s no real rhyme or reason as to who you’re cutting or why.”

RFK commission to ‘scrutinize childhood vaccine schedules’

Robert F Kennedy Jr (RFK Jr) day 2 confirmation hearing
Amid mass lay-offs of federal health workers, HHS Secretary Robert F Kennedy Jr has set up a commission to look at childhood vaccines.

Efforts to downsize the nation’s public health workforce come just as new HHS Secretary Robert F  Kennedy Jr, said he was moving forward with plans to create a presidential commission to scrutinize childhood vaccine schedules. 

That commission, part of the overall effort to “Make America Healthy Again” will likely target CDC’s Advisory Committee on Immunization Practices, which sets influential vaccine recommendations. 

“Nothing is going to be off limits,” Kennedy said in an HHS meeting that was reported by several news outlets. 

“Some of the possible factors we will investigate were formally taboo or insufficiently scrutinized. Childhood vaccine schedule, electromagnetic radiation, glyphosate, other pesticides, ultra-processed foods, artificial food allergies, SSRI [antidepressants] and other psychiatric drugs, PFAS, PFOA, microplastics — nothing is going to be off limits,” Kennedy said on Tuesday. And late Thursday, HHS ordered CDC to halt some vaccine advertisements to emphasize “informed consent.”

His moves come despite promises by the HHS secretary after his confirmation that employees who are “involved in good science” or who “care about public health” have “nothing to worry about.”

 

Image Credits: CDC, IHS, Charlotte Kesl/ World Bank.

People flee Goma during the latest clashes

 The eastern part of the Democratic Republic of Congo (DRC) particularly around Goma and Bukavu, may become a hotspot for disease transmission following renewed conflict and the freeze in aid from the United States, warned Dr Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Amid fighting when M23 rebels recently seized the two towns from DRC forces, over 400 mpox patients fled from health facilities, while outbreaks of cholera and measles are also affecting the region.

Over a million displaced people living in Goma and over 150,000 in Bukavu are particularly vulnerable to disease.

“This can be the entry point for a new pandemic,” warned Kaseya, adding that none of the regions affected by insecurity are reporting on diseases and laboratory testing has been disrupted by the United States freeze on foreign funds.

“In regions like South Kivu and North Kivu, we don’t have information, either because of insecurity or the pause in the US government funding, because the mechanism that we had in place in terms of sample referral was based on US funding provided to DRC,” Kaseya told a media briefing on Thursday. 

The DRC’s mpox response is affected by conflict and lack of funds.

“The combination of insecurity, lack of funding and lack of medical countermeasures, [means] we are playing with fire.”

Earlier in the week, Grégoire Mateso Mbuta, president of the DRC Red Cross said that “the humanitarian situation is dire in Bukavu and Goma.

“In Goma, the morgues and hospitals are overwhelmed. Around 190 DRC Red Cross volunteers and a team of coordinators are working tirelessly to recover the bodies left in the streets, take measures to prevent epidemics and give the victims a dignified burial. In the face of so much need, more help must be provided urgently, ” he added in a joint statement released by the International Committee of the Red Cross, the International Federation of the Red Cross and the Red Cross Society in the DRC.

New fund for epidemics

Dr Jean Kaseya

The African Union finally gave the go-ahead for an African Epidemic Fund to raise money to address continental disease outbreaks at its meeting last week, which is crucial in the wake of the US  withdrawal of foreign funding.

The fund will be administered by Africa CDC and facilitate a flexible and speedy response to outbreaks, according to Kaseya.

“We can receive funding without any limitation, without any bureaucracy, to use that to support African countries to prepare and to respond to outbreaks,” said Kaseya.

Africa CDC will provide the secretariat for the fund, which will be guided by a board.

Aside from the DRC’s mpox outbreak, continental malaria, tuberculosis and HIV efforts, have been affected by the US aid freeze. 

The US under President Joe Biden pledged $500 million to assist the continent with mpox and other outbreaks with $385 million committed. 

Kaseya said that Africa CDC was negotiating to “see this commitment become real money”, but that talks were ongoing. 

Since the funds freeze announced on 20 January when Donald Trump assumed office, China and South Korea have pledged $4 million and Morocco has also pledged $2 million –  but this makes up a teeny percentage of US aid to the continent. 

Kaseya said that Africa CDC had engaged with US officials immediately after Trump announced the freeze a month ago, and claimed some credit securing the US waiver on life-saving humanitarian expenditure.

However, despite the waiver, numerous health projects are still in limbo as they wait for official waiver letters.

In addition, “all HIV prevention activities were excluded from the waiver, except for those aimed at preventing mother-to-child transmission”, according to amFar this week. 

“To date, few implementers have been approved to restart services under the waiver, leaving all activities, including treatment, still paused.” 

Mpox tech transfer deal with African company

While there are no accurate mpox figures from the DRC, the epidemic is growing in Uganda, Congo Brazzaville and Zambia, which has shown a huge jump in figures from 16 to 700 cases.

However, in a glimmer of good news mpox vaccine manufacturer Bavaria Nordic has “95%” concluded a technology transfer deal with an African company to enable the vaccine to be produced on the continent.

This transfer will be a “fill and finish” deal rather than the more comprehensive drug substance transfer.

Dr Ngashi Ngongo, head of Africa CDC’s Incident Management Support Team, said he was working on creating demand for the mpox vaccine including the creation of a continental stockpile to ensure that countries would buy the locally manufactured vaccine.

Image Credits: Ley Uwera/ International Committe of the Red Cross.

In October 2024, the final phase of the polio vaccine campaign in Gaza’s northernmost neighborhoods was never fully completed due to intense fighting. Now, after discovering more poliovirus in Gaza wasteater, WHO and UNICEF are launching a third vaccination round.

A third mass polio vaccination campaign will be carried out next week in the embattled Gaza Strip, following the further detection of poliovirus in wastewater samples, WHO and UNICEF said in a surprise, joint announcement on Wednesday.

“This campaign follows the recent detection of poliovirus in wastewater samples in Gaza, signaling ongoing circulation in the environment, putting children at risk,” the agencies declared.

The new round follows two successful vaccine rounds last autumn, including one carried out during a brief pause from the height of bitter fighting in northern Gaza.  But while those succeeded in reaching over 95% of children 10 and under who were targeted, it apparently was not enough to wipe out the virus entirely. During the second round, in October, WHO also warned that the inability of vaccine teams to reach children in the northernmost neighborhoods of Gaza such as Jabalia, to which Israel had blocked healthworker access while heavy fighting raged, could create future pockets of vulnerability.

“Pockets of individuals with low or no immunity provide the virus an opportunity to continue spreading and potentially cause disease,” WHO and UNICEF said in the statement. ” The current environment in Gaza, including overcrowding in shelters and severely damaged water, sanitation, and hygiene infrastructure, which facilitates fecal-oral transmission, create ideal conditions for further spread of poliovirus. Extensive population movement consequent to the current ceasefire is likely to exacerbate the spread of poliovirus infection.”

Most of Gaza’s sewage infrastructure – along with homes, schools and other infrastructure, have been destroyed during Israel’s invasion of Gaza and 16 months of fighting with Hamas that followed the bloody Hamas raids 7 October into Israeli communities near the Gaza enclave, that led to 1200 deaths and the capture of some 250 hostages. Over 46,000 Gaza Palestinians have been killed by Israel in the ensuing war.

“No additional polio cases have been reported since a ten-month-old child was paralyzed in August 2024,” the agencies said.  “But the new environmental samples from Deir al Balah and Khan Younis, collected in December 2024 and January 2025, confirm poliovirus transmission. The strain detected is genetically linked to the poliovirus detected in the Gaza Strip in July 2024.”

Cease fire creates better access to areas missed

Health workers leaving Kamal Adwan Hospital in December after months of fierce fighting in Gaza’s northern communities – which also impeded polio vaccination.

The six week Israel-Hamas ceasefire, that began on 19 January, has also created a much better opportunity for vaccination teams to reach areas that were missed during the October round.

“In 2024, health workers faced significant challenges accessing certain areas of central, north and south Gaza, which required special coordination to enter during the conflict,” the WHO/UNICEF statement noted. “In inaccessible areas such as Jabalia, Beit Lahiya, and Beit Hanoun where humanitarian pauses for the vaccination campaign were not assured, approximately 7,000 children missed vaccination during the second round. The recent ceasefire means health workers have considerably better access now. ”

It’s also clear that the UN health agencies are moving quickly in order to seize the moment of relative calm. The first six-week ceasefire period ends next weekend.

And it almost fell apart last week when Hamas momentarily said it was pausing release of the next three Israeli hostages – before finally going ahead with their release on Saturday, 15 February, as planned.  This Saturday, Hamas has even speeded up the pace, saying it will release the last of the six living Israeli hostages set to be released in this phase of the deal – instead of the three to which it was committed by the agreement.  The bodies of eight deceased Israeli hostages are also to be released before the initial six-week period of calm ends on March 1 next weekend.  Although the two parties have pledged to preserve the peace as long as negotiations for a second phase are continuing, those talks are expected to be even more complex than the first stage agreement, which took months to reach.

All in all, some 33 Israeli hostages are due to be released in the six-week cease-fire. In exchange for each Israeli released, Israel has been releasing some 30–50 Palestinians held in Israeli jails. Israel has also pulled its forces back from the Netzarim corridor that blocked Palestinian movement from southern to northern Gaza, last autumn, as well as from Gaza’s Rafah cross with Egypt, and allowed a surge of humanitarian aid into Gaza.

Doron Steinbrecher, among the first three, of 33 Israeli hostages to be released during the current cease-fire deal, was turned over to the Red Cross on Sunday, January 19.

However, big question marks remain over the future of the present truce.  After the the next pending hostage releases are completed, Hamas will continue to hold over 58 Israelis, young civilian men and soldiers, less than half of whom may really be alive.  Those remaining hostages will only be released as part of a permanent ceasefire deal. At the same time, Israel’s government has said that it won’t agree to a permanent arrangement that leaves Hamas in power in Gaza – although neither Israel nor Arab mediators have so far come up with an alternative governance plan.

And while there is wide support among the Israeli public for the continuation of the ceasefire so that all hostages are released, government hardliners are pressing for a return to war. To complicate negotiations on a second phase even more, United States President Donald Trump has shocked and alienated both Palestinians and the Arab world with his recent declarations that Gazans should be evacuated so that the area can be turned into a “Riviera” under US control – something that would be illegal under international law.

Against this very uncertain future, next week’s polio campaign will unroll. WHO said all Gaza children under 10 years of age will be targeted with a second, or even a third, polio vaccine:  “The upcoming vaccination campaign aims to reach all children under 10 years of age, including those previously missed, to close immunity gaps and end the outbreak. The use of the oral polio vaccine will help end this outbreak by preventing the spread of the virus. An additional polio vaccination round is planned to be implemented in April.”

It added that “there is no maximum number of times a child should be vaccinated. Each dose gives additional protection which is needed during an active polio outbreak.”

Image Credits: WHO, Middle East Eye , @nabilajamal.

Callie Weber, Dr Jackson Otieno, Amref’s Dr Mercy Mwangangi and Reach52’s Ben Kamarck

KIGALI, Rwanda – Confronted by a huge and growing burden of non-communicable diseases (NCDs), governments worldwide are under pressure to devote more of their domestic budgets to these illnesses.

Patients carry the burden of both the diseases and an estimated 60% of the cost of treating these, which include cardiovascular disease, cancer and diabetes.

Yet the sheer range of diseases, the high cost of NCD medicines and treatment and an apparent lack of donor interest in NCDs are daunting obstacles. (Only around 3% of official development assistance goes to NCDs.)

Ahead of the United Nations High-Level Meeting (HLM) on NCDs in September, NCD advocates want governments to commit to concrete implementation targets in whatever declaration is adopted.

Civil society organisations meeting at the NCD Alliance Forum in Kigali last week discussed various options for governments to increase domestic resources for NCDs, which are responsible for almost three-quarters deaths each year. 

Despite Africa’s youthful population, 37% of deaths on the continent are due to NCDs – and this is growing annually. Cardiovascular diseases such as strokes and heart attacks have overtaken tuberculosis and respiratory infections as the biggest killer on the continent.

Various possibilities exist for bolstering countries’ domestic resources for NCDs, including excise taxes, pooled procurement with other countries to bring down medicine prices and incentives to encourage the private sector to invest in NCDs.

Excise taxes are a win-win

If the excise taxes currently imposed on tobacco, alcohol and sugary drinks are increased by 50%, this would save 50 million lives over the next 50 years, said Vital Strategies CEO Mary-Ann Etiebet, quoting research from the Task Force on Fiscal Policy for Health.

Aside from deterring people from consuming these unhealthy products, these taxes could raise over $3.5 trillion in five years which could be ploughed back into NCD prevention, treatment and care.

Many governments have not embraced these taxes thanks to intense lobbying by the tobacco, alcohol and junk food companies.

Removing government subsidies for harmful products such as oil or sugar can also improve the overall pool of financing available for health, said Kimberly Green, PATH’s global director of primary health care and part of the Coalition for NCDs Access to Medicinces and Products (Coalition4NCDs).

But this too faces huge industry pushback.

Forecasting demand

For Green, “one of the fundamental challenges is demand forecasting”. Governments need to identify their priority NCDs and project how many people will be affected over the next five to 10 years.

“Without this, it is impossible to know how much medicine they will need. This is a fundamental gap yet demand forecasting has been very well done in HIV, TB and malaria,” said Green.

The Coalition4NCDs has developed a forecasting tool that it has shared with some parliamentarians to enable them to increase the budget for NCDs

But Rwanda’s Dr Evode Nyibizi warned that accurate data alone is not enough.

His country’s health system is fully digitised, so financial decisions are based on data fed from all tiers of the health system.

“In 2023, we were only utilising around 10% of the data that we collected on daily basis. So we established the National Health Intelligence Centre, which is helping us to draw insights from the data that we collect,” said Nyibizi, who heads the centre.

“The centre tells you what the problems are and where you need to invest your money,” Nyibizi explained.

Particularly in light of the global health financing crisis experienced by the withdrawal of United States aid, many countries need to reprioritizing where “the small amount of money left goes”, he added.

PATH’s Kimberly Green and MedAccess’s Mayank Anand

Creating demand

But even before demand forecasting, Ben Kamark’s organisation, Reach52, works to generate demand for essential health products to reach the 52% of the world who don’t have access to these.

“Out-of-pocket markets have peculiar market dynamics. They get stuck in a vicious cycle. Every distributor, every seller of pharmaceutical products, is incentivized to sell less products at a higher price,” explained Kamarck. 

“So they come into the market with a higher price, expecting a lower demand. But a higher price leads to lower demand, which also importantly, leads to lack of investment.”

Insulin is an example of a product for which the price is higher than it should be because demand is lower than it should be, he explained.

“Then the market doesn’t move. We believe that the only way to actually intervene in an out-of-pocket market is to be a market participant.”

And it takes a lot of risks. Reach52 launch medicines at prices that “would make sense in high volumes, even when there aren’t high volumes”, said Kamarck. 

They register products “that no one’s asking for and no one’s wanted, because we know there’s a need for them”.

Then Reach52 runs “hyper-targeted public health interventions and healthcare provider engagement” to create demand and drive sales of essential medicines.

“That’s a hard choice to make for a lot of private sector companies,” admitted Kamarck.

Reach52 runs “hyper-targeted public health interventions and healthcare provider engagement” to create demand and drive sales of essential medicines.

Reducing risks

Mayank Anand works for MedAccess, a social finance company established in 2017 with the support of donors, health advocacy organisations and pharmaceutical companies. 

Its aim is to reduce the risks in the NCD treatment supply chain for suppliers and procurers through volume guarantees, procurement guarantees, and concessionary loans.

“We’ve has done 11 guarantees so far across areas such as TB, HIV, malaria, syphilis, and COVID-19 with range of partners such as the Clinton Health Access Initiative (CHAI),” he explained.

“A volume guarantee is a backstop agreement between ourselves and supplier where we assure sales volumes over a period of two to six years in return for the supplier bringing the price down to an affordable price, but also making commitments to accelerate registration in markets,” said Anand.

The 11 deals done so far has enabled half a billion people to get access to medicines.

Another public-private partnership is the Financing Accelerator Network for NCDs (FAN), a new initiative started by Access Accelerated, the World Bank, and Results for Development (R4D), aimed at building sustainable health financing systems for NCDs.

Leadership is at the centre

Amref Health Africa’s Dr Mercy Mwangangi injected come realism into discussions by pointing out that almost 80% of the $9.8 trillion spent annually on health is spent in the global North.

In Kenya, where she is based, the per capita expenditure is $90 whereas in the US, it is $14,000.

“How do we ensure that drugs are available to the American who is spending $14,000 are also available to the Kenyan, where there’s a $90 spent every year?” she asks.

Aside from lack of finances, health systems also have to be ready to roll out medicines should innovative finances make them available, she adds.

Can a country screen for cancer? Does it have a national registry of the burden of disease?  Do supply chains work so that citizens can access care? Are the legal and regulatory frameworks amendable to access to medicines? 

To spell out the challenges, Mwangangi gave a rundown of Amref’s engagements with pharmaceutical company Roche to enable Kenyans to get access to the breast cancer drug, Herceptin.

“From the initiation of those conversations to having patients access these commodities took about two years of back-to-back conversations with government players, procuring agencies and with repayment systems,” she said.

Despite this energy investment, the programme has stalled because facilities are not able to pay the procuring agency for the medicine that they have been issued with.

“Leadership and governance is at the centre of innovative financing,” stressed Mwangangi.

Image Credits: Reach52.

Dr Tedros Adhanom Ghebreyesus (right) opens the 13th round of the pandemic talks, flanked by co-chair Anne-Claire Amaprou

“It’s now or never,” World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyussus told the start of the 13th round of talks on a pandemic agreement on Monday morning.

Five days of talks are scheduled this week with another five days scheduled in April. Thereafter, the plan is for an agreement to be presented at the World Health Assembly in May.

Those close to the process said that the “stock take” this Friday will be an important gauge of whether the talks will succeed.

Negotiators’ failure to reach agreement may mean the end of the road for the global endeavour to pandemic-proof the world. Energy and interest in the talks have waned considerably over the four-plus years of talks.

“I’m confident that you will choose ‘now’, because you know what is at stake. You remember the hard-won lessons of COVID-19, which left an estimated 20 million of our brothers and sisters dead,” said Tedros.

“We know that the next pandemic is a matter of when, not if. There are reminders all around us – Ebola, Marburg, measles, mpox, influenza and the threat of the next Disease X,” he added.

“No country can protect itself by itself. Bilateral agreements will only get you so far. Prevention is the responsibility of all countries. Preparedness is the responsibility of all countries, and response is the responsibility of all countries.” 

The US, although still technically part of the WHO until next January, informed the WHO last Friday (14th) that it would not take part in the Intergovernmental Negotiating Body (INB) overseeing the talks.

Trump’s executive order withdrawing the US from WHO explicitly states that “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.” 

“Like the [US] decision to withdraw from WHO, we regret this decision and we hope the US will reconsider,” Tedros told the INB.

Moving away from grandstanding?

INB co-chairs Precious Matsoso (left) and Anne-Claire Amprou.

INB co-chair Precious Matsoso told the meeting that the Bureau, which co-ordinates the talks, had taken heed of countries’ request to “propose text for all the outstanding work”.

“We did just that, and we’re hoping that, with what we’ve presented before you, to be able to move as fast as possible because we’ve got only 10 [negotiating] days left before we present the pandemic agreement to the World Health Assembly,” said Matsoso.

The latest draft of the pandemic agreement reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points. 

Matsoso also urged member states at the opening to confine their comments to the text at hand rather than making general comments – and for the first time, the open session was not dominated by repetitive grandstanding. 

With only Iran using the opening to make a general point, member states’ restraint is a positive indication that countries may finally be moving away from rigidly held positions.

Equity and solidarity

Stakeholders, who are not allowed into the negotiations, used their time slots during the open session to appeal for the deal to be struck, for equity to remain a cornerstone and to advocate for technology transfer to prepare for pandemics.

“Do not walk away from this vital mission,” urged the Pandemic Action Network’s Rafael Garcia Aceves.

“Bank and build on the promising consensus agreed thus far. Continue to advance a pandemic agreement that can lay the essential groundwork for equitable collective preparedness and response in 2025, which can be made stronger and more detail added in future through protocols.”

Ellen ‘t Hoen of Medicines Law and Policy.

Ellen ‘t Hoen of Medicines Law and Policy said that “more than ever, the world needs a signal that multilateralism works, that solidarity is at the core of the pandemic agreement and that no country will be left alone to deal with pandemics, either current or future ones”.

“That is not the predominant spirit in Geneva – or the world for that matter – at the moment, but you can bring it back.”

Spark Street senior researcher Elliot Hannon warned that “the world has changed immeasurably” since the last negotiating session in December before US President Donald Trump took over.

“The global multilateral system is under siege, threatening the very institutions developed to promote and protect health around the world,” said Hannon.

“The pandemic agreement is a concrete action against this great dismantling. Its completion would not only make the world safer but affirm the commitment to equity, integrity and solidarity,” said Hannon, adding that trying to perfect every aspect of the agreement was an unaffordable luxury.

The South Centre stated that, “without legal commitments to enhance sharing of technology and know how, and surge financing, it will not be possible to ensure timely global production of and equitable access to effective vaccines during pandemics, as during COVID-19.

The South Centre said that a “democratic vote” was the way forward to settle “divergencies” rather than “continuously” watering down the text down “to find consensus”, deferring  decisions “to uncertain future negotiations or decisions by the Conference of the Parties”.

Jamie Love

Knowledge Ecology International’s Jamie Love pointed out that the agreement’s definition of “technology transfer” was weaker than that permitted by US and European law, while, Oxfam’s Mogha Kamal-Yanni called for the agreement to contain “legal obligations” to share technology and remove intellectual property barriers.

This round of talks ends on Friday evening.

Dr. Sania Nishtar, Chief Executive Officer, Gavi, in Cairo.

In a breakthrough moment for Africa’s vaccine independence, two landmark deals could help put the continent on a path to becoming a producer, not just a buyer, of life-saving vaccines.

For the first time, an end-to-end mRNA vaccine production platform will be built in Africa, with plans to manufacture 100 million doses annually. A separate cross-continental partnership is advancing homegrown mRNA technology. These landmark agreements, signed in Cairo, are backed by a $1.2 billion investment from Gavi, The Vaccine Alliance. They aim to ensure vaccines are made by Africa, for Africa, and set the stage for expanded local vaccine production and cross-continental collaboration.

The first deal, signed in Cairo on the sidelines of the 2nd Vaccine & Other Health Products Manufacturing Forum, brings together EVA Pharma (Egypt) and European biotech firms DNA Script (France), Quantoom Biosciences (Belgium), and Unizima (Belgium) to establish Africa’s first “digital-to-biologics” end-to-end mRNA vaccine production platform. The facility is expected to produce up to 100 million vaccine doses annually, a significant boost for Africa’s ability to respond rapidly to infectious disease outbreaks and strengthen routine immunization programs.

2nd Vaccine Manufacturing Forum

In a second agreement, Biogeneric Pharma (Egypt) and Afrigen (South Africa) will expand their collaboration on mRNA vaccine technology development, reinforcing cross-continental expertise in cutting-edge mRNA vaccine applications to new diseases that have a high burden in Africa. 

“These agreements are proof that Africa is no longer just a buyer of vaccines—we are becoming producers,” said Dr. Jean Kaseya, Director-General of Africa CDC, at the conference’s closing ceremony. “This is the future of health security on the continent.”

Gavi’s $1.2 Billion Investment to Drive Manufacturing Growth

Afrigen’s mRNA hub in Cape Town, launched in February 2022, and now set to expand.

The two deals were announced alongside a broader effort to accelerate vaccine manufacturing in Africa, backed by a $1.2 billion investment from Gavi, the Vaccine Alliance.

The catalytic investments, recruited for Gavi’s newly formed African Vaccine Manufacturing Accelerator (AVMA), launched in June 2024, will be deployed over the next ten years to incentivize African manufacturers to produce priority vaccines, such as cholera and mRNA-based immunizations. AVMA leverages Gavi’s role as one of the world’s largest purchaser of vaccines to promote local manufacturing in Africa. Crucially, Gavi’s financial model ensures that licenses are held by African manufacturers, keeping intellectual property and production capacity on the continent.

“This is about building a sustainable vaccine ecosystem in Africa,” said David Kinder, Director of Development Finance at Gavi. “We are using our market power to drive investment where it’s most needed—ensuring Africa can produce its own vaccines, for its own people.”

Securing Demand and Regulatory Readiness

BioNTech’s modular mRNA vaccine manufacturing opened in Rwanda in 2023.

At present, while demand for vaccines in Africa is valued at over US$ 1 billion annually – Africa’s vaccine industry provides only around 0.1% of global supply. The African Union has set a target for the continent to produce 60% of the vaccines it needs by 2040.

While some new investments in vaccine production were made on the wave of interest created by the COVID pandemic, such as the Afrigen mRNA research hub, launched with WHO support in 2022, and BioNTech’s modular mRNA vaccine facility, in Rwanda, African manufacturers still face a major challenge: securing stable demand. Historically, global health agencies and African governments have sourced vaccines from long-established manufacturers in the Global North, leaving local producers struggling to compete.

To address this, officials at the Cairo summit called for a continent-wide pooled procurement mechanism, modeled after Egypt’s Unified Procurement Authority (UPA). Egypt’s system has successfully lowered costs and stabilized supply chains, and experts believe a similar approach at the African Union level could ensure consistent demand for vaccines produced within Africa.

“We must ensure that African-made vaccines have a guaranteed market,” said Dr. Khaled Abdel Ghaffar, Egypt’s Minister of Health and Population. “A pooled procurement system could be a game-changer, ensuring fair pricing and sustainability.”

Another critical issue discussed at the forum was Africa’s regulatory capacity. While manufacturing is expanding, vaccines must meet strict international quality standards to be used across the continent and beyond.

In December 2024, Egypt achieved WHO’s Maturity Level 3 in terms of the quality of its national regulation of vaccines and medicines – following South Africa, which reached that milestone in 2022.  The African Medicines Agency (AMA) , still in the process of establishment, is supposed to lead effort to harmonize regulatory approvals across Africa, making it easier for locally made vaccines to reach wider markets. See related stories here:

African Medicines Agency Countdown

Gavi’s Replenishment and Africa’s Push for Funding

The investments in African manufacturing come at a pivotal moment for Gavi, which is seeking $9 billion in new funding for 2026-2030 to sustain its work in Africa and beyond.

At the Cairo forum, African leaders threw their support behind Gavi’s replenishment effort, pushing for global donors to meet the funding target.

“We need a well-funded Gavi,” said Dr. Kaseya, who pledged to push for African leaders to back Gavi’s funding request at the upcoming African Union Assembly.

Momentum for local vaccine production will continue in June 2025, when Africa’s first annual vaccine and biopharmaceutical manufacturing exhibition, Africa Excon, will be held in Egypt. The event will showcase progress in local production and attract investment, ensuring Africa’s vaccine ambitions continue to gain traction.

Despite the challenges, leaders at the Cairo summit were optimistic about the future. “We are no longer just talking about vaccine sovereignty,” Dr. Kaseya said in his closing remarks. “We are making it happen.”

Image Credits: Rodger Bosch for MPP/WHO, BioNTech.

A tuberculosis patient in Mozambique who completed treatment thanks to a USAID-supported health worker. USAID administers all US bilateral aid for fighting TB.

A coalition of American non-profit, legal and small business groups welcomed a federal judge’s temporary restraining order (TRO) halting the Trump Administration’s executive order freezing virtually all USAID activities – followed by a “stop work” order on the agency by new US Secretary of State Marco Rubio. 

The ruling Thursday evening in a Washington DC District Court came in response to a lawsuit filed by the Global Health Council, the Small Business Association for International Companies, HIAS, the Jewish-American refugee aid agency; and the American Bar Association.

“This ruling is a vital first step toward restoring U.S. foreign assistance programs,” said Elisha Dunn-Georgiou, President of the Global Health Council, a member based body. “It clears the path for organizations to resume their life saving work, showcasing the best of American values: compassion, leadership, and a commitment to global health, stability, and shared prosperity.”

In their suit, the groups contended that by attempting to dismantle an independent agency established by Congress, the Trump Administration was “unlawfully withholding billions” in foreign aid. 

“The Administration has forced businesses large and small to shutter programs and lay off employees. These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support,” the charged the plaintiffs in the suit, which included Management Sciences for Health, Chemonics International, DAI Global, and Democracy International – non-profit and for-profit groups that are major USAID subcontractors.

Impacts and ongoing uncertainties 

MANA Nutrition Factory in Fitzgerald, Georgia, which produces specialized nutritious foods to treat acute malnutrition. Among the thousands of US businesses affected by the USAID freeze.

On paper, the TRO blocks the government from taking actions that would disrupt U.S. foreign assistance programs including:

  • Suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or
  • Issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.

However, with USAID personnel around the world on forced furloughs, budget systems frozen, and grain donations rotting in US ports, it remained unclear if a temporary order, on its own, could rapidly reboot the massive $40 billion-a year apparatus  – including $8.5 billion in global health assistance. 

“Despite the restraining order, much of the damage to US foreign assistance and to our agencies and humanitarian workers is already done. Within a matter of weeks, the President has succeeded in all but decimating USAID and has perhaps irreparably damaged the goodwill and reputation of the United States,” said Lawrence Gostin of Georgetown University.

“It is hard to describe the chaos at USAID, with funds frozen, staff let go, and partners all over the world feeling shattered. Even foreign aid programs that have received a waiver from the freeze cannot carry out their functions. This has caused enormous human suffering and hardship, with children starving and at risk of stunting, persons living with HIV unable to access their medications, and humanitarian assistance at a grinding halt,” he added, citing a recent article in the peer-reviewed journal Health Affairs.

Gostin, who heads a WHO Collaborating Center on law and global health policy, was pessimistic about the possibility of legal action changing policies in the long-term, saying, “no matter what the courts ultimately do, the harms will be real and palpable. And in the end, the President will probably prevail in the courts. He may be forced to actually follow a logical process and not be arbitrary and capricious. He may have to unfreeze funds until he can get Congress to join him in decimating USAID. But the president has a highly compliant Supreme Court that seems to back him on almost anything consequential.”

Pressure growing on  Trump administration 

At the same time, the pushback, coming from multiple corners could help swing the pendulum back over time.  “Some push back is good and in the end things will not be as bad as first thought,” one USAID insider, speaking confidentially, told Health Policy Watch. 

Pressures are building, for instance, from farmers in so-called “Red” or Republican states, who sell hundreds of millions of dollars in grain to USAID and, via USAID, to the World Food Programme (WFP) every year, to feed hungry people around the world. Ambassadors, who see USAID as a vital form of “soft power” for the US in the geopolitical competition with China, Russia and Islamic extremists, are also likely to protest quietly.

“I have been waiting for the agriculture sector to weigh in. They will take a big hit from the President’s actions,” Gostin said. While WFP said on Tuesday that its deliveries of food aid stuck in US ports were allowed to resume on 11 February, the Trump-ordered pause in new food aid purchases and stop work orders on new WFP purchases has remained in effect.

Biggest provider of global health foreign aid

“By attempting to dismantle an independent agency established by Congress and unlawfully withholding billions in foreign-assistance funding, the Administration has forced businesses large and small to shutter programs and lay off employees,” said the Global Health Council in its statement on the temporary restraining order.

“These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support.”  

USAID implements most US global health funding.

With a global health budget of $8.5 billion annually, USAID is the largest US provider of global health assistance, far outpacing the Department of Health and Human Services, and PEPFAR, the President’s Emergency Plan for AIDS Relief.  In fact, USAID implements most US bilateral global health funding, including 60% of  PEPFAR’s $4.2 billion budget for HIV/AIDS in 2023. 

Along with the already well-reported impacts of USAID’s collapse in battles against infectious diseases like polio, HIV/AIDS, influenza, malaria, marburg and Ebola, there has been a ripple effect to an even broader range of activities related to global health security,  health services, and nutrition, the GHC noted in a briefing note issued last week. Some of those include: 

  • A halt to the flow in over $1 billion in pharmaceutical donations, including HIV drug supplies; as well as USAID facilitated global biotech and research partnerships with US companies; 
  • Interruption in the services of thosuands of maternal and child nutrition centers; care for pregnant women and orphans; in conflict zones and the world’s poorest countries.
  • A halt to USAID support for thousands of frontline health clinics in vulnerable countries and conflict zones, including: Afghanistan, Ethiopia, Myanmar, the Democratic Republic of Congo; Guatemala and Honduras.

For maternal and child health and TB, USAID was the implementer of all US bilateral support in 2023. It also managed 99% of family planning and reproductive health funds and 96% of funds for malaria control efforts.

CDC finally reports on avian flu spread   

CDC finds vets working with dairy cattle unknowingly exposed to H5N1 avian flu.

In other developments, the US Centers for Disease Control, finally issued an update on Avian flu to its Morbidity and Mortality Weekly Report (MMWR), which showed that some veterinarians working with cattle were unknowingly infected with the H5N1 (avian flu) virus last year.

The report is the latest to indicate that the outbreak in dairy cattle is spreading further under the wire. The CDC report was one of several MMWR reports on avian flu that were to have been released three weeks ago. 

Inother report published this week, the CDC cited new USDA data on the rapid spread of H5N1 bird flu in poultry, showing some 157 million birds have so far been affected, since the first detections in 2022. The outbreak has caught the attention of the US public as the price of eggs soars to a 50-year high. 

Avian flu continues to spread amongst US poultry flocks.

States can opt out of testing dairy cattle for avian flu 

As for the dairy herds, USDA tables and maps showing trends in the spread of the highly pathogenic virus in dairy herds, across different states, which typically linked to the MMWR reports were no longer visible on the web page.  The USDA pages have not been updated since 17 January.  

But even that data, when available, was incomplete since federal law allows states to opt out of testing dairy cattle, noted Kay Russo, a dairy and poultry veterinarian.  He said the new CDC report on the silent spread of the virus among veterinarians underscores an urgent need for more routine monitoring of animals in agriculture.

“The frequency may be insufficient to proactively warn and safeguard workers,” Russo told the Washington Post. 

“This is a critical worker safety issue for farm and processing plant workers,” said Russo, who has worked on the outbreak since last March. “I can’t help but feel we’re missing huge pieces of the puzzle at this time.”

–Updated 16 February, 2024

Image Credits: Arnaldo Salomão Banze, ADPP Mozambique, USAID, KFF , US CDC , US CDC .

INB negotiations underway in Geneva for a pandemic agreement

Civil society groups have urged World Health Organization (WHO) member states to “continue to advance a pandemic agreement that can lay the essential groundwork for equitable, collective preparedness and response” ahead of the 13th meeting of the negotiating forum on Monday  (17 February). 

Only 10 negotiating days are left until the World Health Assembly in May, which is due to adopt the pandemic agreement. 

“Despite geopolitical and policy challenges, do not walk away from this vital mission. We urge Member States to stay focused on the end goal. Bank and build on the promising consensus agreed thus far,” urged the Pandemic Action Network, Panel for a Global Public Health Convention, Spark Street Advisors and The Independent Panel for Pandemic Preparedness and Response in a statement.

The latest draft of the pandemic agreement (from INB12, 6 December) reflects that pathogen access and benefits sharing (PABS) and One Health remain sticking points as countries struggle to devise a global plan to advance pandemic prevention, preparedness, and response. 

However, the new draft also contains more detail about what is expected from each member state to prevent outbreaks from becoming pandemics – which is an anxiety for poorer nations who fear this might mean more onerous financial commitments.

Since the last meeting of the Independent Negotiating Body (INB) in December, “we have witnessed deepening outbreaks of mpox and H5N1 and new outbreaks of Sudan Ebola and Marburg viruses. Any one of these threats risks spreading further without strong and decisive leadership and action,” the groups note.

“The finish line is in sight. Pandemic threats remain. The world needs member states to agree to a historic pandemic agreement and demonstrate the solidarity essential to keep us all safer. We are counting on you to pull together and get the agreement done.”

While the US and Argentina have given notice that they intend to withdraw from the WHO,  the US has to give a year’s notice so it technically remains part of all WHO member state bodies. At the recent WHO Executive Board meeting, the US was represented by technical officers at the US Geneva Mission. But US delegates to the EB made just one statement, on Taiwan, along with voting on geopolitically charged issues, such as an Israeli motion to combine the annual debates on two resolutions related to the health situation in the Occupied Palestinian Territories, into the agenda of WHO’s broader emergency work – a motion which lost.

However, sources told Health Policy Watch that US diplomats would not attend the INB negotiations at all. In fact, the Trump executive order withdrawing from WHO explicitly states that the “while the withdrawal is in process, the US will cease negotiations on the WHO Pandemic Agreement and the amendments to the International Health Regulations [IHR], and actions taken to effectuate such agreement and amendments will have no binding force on the United States.”  Amendments to the IHR, intended to provide for faster notice by countries to WHO and more efficient global response on epidemic threats, were approved in fact at the 2024 World Health Assembly, so it’s unclear if the US can retroactively declare that those have no binding force.  See related story.

‘The World Has Won’: New International Regulations to Protect Against Pandemics Finally Approved

As for Argentina, there is in fact no process for members states besides the US to withdraw without first obtaining agreement of the World Health Assembly – remaining in WHO as an “inactive” member is an option a few member states have used in the past, said Chief Legal Counsel Steve Solomon in a WHO press briefing Wednesday.

Solomon explained that when the United States first joined the WHO in 1948, it did so with a condition that it was entitled to withdraw if it chose to do so, but no other member state made that a provision of their original membership.

Robert F Kennedy Jr, Trump’s pick for US Health Secretary, was confirmed Thursday morning after weeks of contentious debate.

WASHINGTON, DC – The US Senate on Thursday voted to confirm Robert F Kennedy Jr as the next Secretary of Health and Human Services – with most Republicans setting aside concerns about his long record of vaccine hesitancy as well as skepticism of scientific research on infectious diseases. 

Republic Senator Mitch McConnell, himself a polio survivor, cast the sole Republic vote against Kennedy, a former Democrat, turned independent who then aligned himself with Donald Trump in the final stages of his campaign. Some 47 other senators –all Democrats – voted against his confirmation.

Kennedy, an environmental lawyer, has for decades been the face of a vocal anti-vaxxer movement claiming that even the polio vaccine had killed more people than it had saved. 

But in the past months, he has re-entered America’s political consciousness with his promise “to make America healthy again (MAHA).” After a failed bid for president as an independent, Kennedy joined Donald Trump’s campaign. President Trump vowed to let Kennedy “go wild” on healthcare. 

With his MAHA refrain, Kennedy quickly gained his own national following with his vow to “put the health of Americans back on track,” citing America’s growing chronic disease rates.  During Senate confirmation  hearings last month, he did not entirely renounce his anti-vax views, but said that he would not curtail Americans’ access to vaccines. 

While many of Kennedy’s critics have said that while his interest in addressing the triple American crises of obesity, mental health and substance abuse, is welcome, his reluctance to apply scientific solutions to infectious diseases could threaten Americans’ health very immediately – particularly if a virus like H5N1 avian flu, which has infected millions of poultry and dairy cattle across the United States, spins out of control.

Schumer kennedy debate
Senate Minority leader Chuck Schumer (D-NY), called Kennedy “of the least qualified people” to ensure America’s health.

Speaking just before the vote on Thursday, Senate Minority leader Chuck Schumer (D-NY), called Kennedy “of the least qualified people” to ensure America’s health. In his final appeal to colleagues, Senator Ron Wyden (D-OR) also warned that a vote for Kennedy could spell the end of Medicare for older Americans and healthcare coverage for American children – as the Kennedy would not stand in the way of Trump administration plans to slash funding for long standing entitlement programs.

Overseeing a $1.7 trillion agency 

As head of HHS, Kennedy would oversee a $1.7 trillion agency that manages domestic Medicare and Medicaid programs, as well as the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and the National Institutes of Health (NIH).

The latter three not only manage public health but also play a major role in funding and supporting scientific research that has made the US a leader worldwide in the development of new treatments, medicines and vaccines for a range of conditions. 

That leadership role is now threatened with a string of recent Trump administration actions that have seen the muzzling of CDC domestic and foreign scientific exchanges as well as public health communications, and just last week, an order imposing severe cuts on NIH grants. 

Kennedy, has nonetheless pledged to cut the NIH workforce by some 600 people– while turning his attention to chronic diseases.

“I’m gonna say to NIH scientists: God bless you all,” Kennedy said in 2023 to a crowd of supporters during his presidential bid. “Thank you for public service. We’re going to give infectious disease a break for about eight years.”

Days of grueling hearings 

Robert F Kennedy Jr (RFK Jr) day 2 confirmation hearing
Robert F Kennedy Jr on Day 2 of his Senate Confirmation hearings for the nomination of Secretary of Health and Human Services.

Kennedy’s confirmation came after a series of grueling Senate hearings last week, and on Wednesday, a late-night debate over Kennedy’s controversial statements on vaccines, abortion, and other issues.  

In Wednesday’s debate, a long lineup of senate Democrats implored their fellow Republicans on the other side of the aisle to vote ‘no’ on the nomination, which they said could set Americans’ public health back generations. 

“I don’t know if this is going to mark one of the most important public health moments in American history, but I can’t think of another time where we actually have the technology, we have the medicine, we have the science, we have the distribution system. We have the public infrastructure to keep people safe, and we just decide by a vote of 53 to 47 to make people unsafe,” said Brian Schatz, Democrat from Hawaii, speaking about how Kennedy’s anti-vaccine activism in Samoa in 2019 led to the deaths of 83 children from a measles epidemic.

RFK JR kennedy senate debate 2025
Brian Schatz, of Hawai’i, notes that 83 children died of measles in Samoa after vaccine hesitancy swept the island.

“He’s not talking about whether or not it’s appropriate to require masks in public – which  Democrats and Republicans are still arguing about. He’s talking about stuff like, if you’re a parent, and now you don’t know whether when your kid goes to school, they’ve reached herd immunity stuff that goes way, way, generations back,” he said, referring to measles, polio and other vaccine-preventable diseases. “So if you think it’s a good idea to leave all of these diseases in the rear view mirror, then this is a very very bad person to be running the Department of HHS.”

Cervical cancer vaccine at risk 

Ron Wyden, D-Oregon, pointed to Kennedy’s refusal to renounce past statements questioning the safety of the HPV vaccine that protects women against cervical cancer – as well as his financial interest in ongoing litigation over the vaccine’s side effects, as just one example of Kennedy’s “concerning” stances. 

The vaccine, “has become routine for young people about 20 years ago,  and since then, it has successfully cut cervical cancer rates into just a fraction of what they were before the drug came to market,” Wyden noted. 

But when queried about his stake in the lawsuits during the first Senate hearings in late January,  “he refused to answer questions about his 10% stake in any settlement agreements – instead passing them off to his son.  He refused to recuse himself from taking any actions that might affect his family’s financial interest,” Wyden said. 

At the hearings, Kennedy said he’d give up his 10% share in the litigation to his son.

 “All of this adds up to a future HHS secretary who stands to profit off undermining this vaccine, and the result raised cervical cancer rates, to quote my Republican colleague, Senator Cassidy, a physician, Mr. Kennedy is financially vested in finding fault with vaccines.”

Research support in question

Kennedy debates
Heinrich Martin (D-NM) lamented the loss of millions of dollars of research funding should the Trump administration’s budget cuts go through.

Other Democrats expressed concerns about how Kennedy’s appointment would affect the US biomedical research – as well as public health. 

“HHS plays a critical role in overseeing Medicare, overseeing Medicaid and the Affordable Care Act,” said Martin Heinrich, D-New Mexico.

“But HHS also supports the medical research that helps us to develop the next vaccine, prevent the next pandemic and find cures to cancer and chronic diseases like diabetes. We have already seen President Trump, Elon Musk and his DOGE minions target scientific and medical research at agencies like the National Institutes of Health. 

“Just last week, we saw them announce an estimated $4 billion cut for health research at universities across the nation, including an estimated $17 million impact at the University of New Mexico alone. And just like many of the unilateral and illegal actions of this emboldened Trump administration. This one received a temporary halt from the federal judge. 

“But whether this particular attack holds up in court or not, the Trump administration’s intention is clear, dramatic cuts to medical research into treatment cures that countless Americans are depending on to save their lives. Mr. Kennedy plans to lead this effort and even to expand on it.”

Kennedy floats different vaccine schedule for African Americans

Kennedy black children vaccines statement
“Black children already have lower vaccinations than their peers,” noted Angela Alsobrooks (D-MD), calling Kennedy’s views. “dangerous.”

Angela Alsobrooks, D-Maryland also expressed alarm at Kennedy’s remarks to the effect that Black Americans needed a different vaccine schedule than their White counterparts – a contention that she noted had been debunked by the very scientists that Kennedy had cited in support of his claims. 

“Just three years ago, Kennedy said, and I quote, ‘we should not be giving black people the  same vaccine schedule that’s given to whites because their immune system is better than ours. 

“When I asked him this question, Mr. Kennedy referenced a study…. he assured me….  that, indeed, certain races required a different vaccine schedule. That was a lie. In fact, the study’s own authors stated the data doesn’t support a change in vaccine schedule based on race. Mr. Kennedy’s response was damning and his response was dangerous.

“Black children already have lower vaccinations than their peers,” noted Alsobrooks. “That is why I said, your claims on this issue were dangerous.”

Polio survivor lone Republican to vote ‘nay’

While a number of leading Republican senators pushed back on Kennedy’s anti-vax and anti-research statements in the lead-up to today’s vote, 52 Republicans voted for the nominee, including Senators Susan Collins (R-ME) and Bill Cassidy (R-LA). 

John Fetterman, a Democrat for Pennsylvania, who earlier had spoke favorably about Kennedy’s views on chronic disease, sided with party colleagues against the nominee. 

The sole exception was Senator Mitch McConnell, who had spoken out against Kennedy’s claims about the side effects of the polio vaccine earlier in the confirmation process. McConnells’  childhood battle against polio before the development of the vaccine made him particularly sensitive to Kennedy’s debunked rhetoric claiming that vaccines cause autism. 

McConnell released a statement after the vote, saying “I’m a survivor of childhood polio. In my lifetime, I’ve watched vaccines save millions of lives from devastating diseases across America and around the world. I will not condone the re-litigation of proven cures, and neither will millions of Americans who credit their survival and quality of life to scientific miracles.

“Individuals, parents, and families have a right to push for a healthier nation and demand the best possible scientific guidance on preventing and treating illness. But a record of trafficking in dangerous conspiracy theories and eroding trust in public health institutions does not entitle Mr. Kennedy to lead these important efforts.

Opening statements centered on healthcare access

Senate vote for RFK Jr
52 senators voted for RFK Jr, confirming his appointment as HHS Secretary.

Thursday’s final statements centered on healthcare access. 

“On issue after issue, Mr. Kennedy has demonstrated a profound lack of knowledge at best, and deeply dangerous views at worst,” said Senator Wyden (R-OR) in opening statements. “Mr. Kennedy was given ample opportunity to share how he would improve these programs [Medicare and Medicaid], lower costs, save taxpayers money, and improve care. Instead, he showed a complete lack of basic understanding of Medicare and how it functions.”

“Republicans, with Donald Trump at the helm, are steering this country towards a healthcare cliff.” Wyden then accused Republican colleagues of plans to take away Medicare and Medicaid.

Mike Crapo (R-ID) countered that the Senate debates late last night were about securing the border, not about taking away Medicare. He defended Kennedy’s past anti-vaccine statements, saying that the secretary “just wants to see that the research on them [vaccines] is done, and done well.”

Republicans praise his emphasis on chronic diseases 

Throughout the two week confirmation process, Senate Republicans praised Kennedy’s  emphasis on addressing the chronic disease burden in the US, and expanding rural health care access. “Mr Kennedy, you represent a voice for an inspiring coalition of Americans who are deeply committed to improving the health and well-being of our nation,” said committee chair Senator Mike Crapo (R-Idaho). Crapo continued his praise for Kennedy in the opening statements prior to the vote.  

But others questioned his shifting stance on abortion, vaccines, and food policy, accusing Kennedy of switching his views for political and monetary gain.

As founder of the non-profit Children’s Health Defense, Kennedy has repeatedly cast doubt on the safety and efficacy of childhood vaccinations, and his organization continues to push the debunked claim that vaccines cause autism. 

Even so, Kennedy insisted in the hearings that he was not “anti-vaccine”, and that he merely supports more testing and safety studies.

“News reports have claimed that I am anti-vaccine or anti-industry. Well, I am neither; I am pro-safety … All of my kids are vaccinated, and I believe vaccines have a critical role in healthcare,” said Kennedy in his opening statement in Senate hearings in late January. 

A chance to “make America healthy again”

At the same time, he said he’d find new ways to tackle high drug prices, and address the root causes of America’s obesity and addiction epidemics with healthier foods and more mental health services – messages that clearly resonated with many senators.

As part of that, he has also pledged  to tackle unhealthy processed foods to “make America healthy again” – as well as confronting big Pharma and high drug prices – messages that clearly resonated with many senators.

Kennedy also described how his experience as an environmental lawyer working with hunters,  fisherman and farmers along the Hudson River had sensitized him to the health impacts of pesticides and environmental pollutants early in his career. 

“Something is poisoning the American people and we know that the primary culprits are our changing food supply, highly processed foods,” he said, citing the unusually high proportion of obese people in the US in comparison to other developed nations, something that he called an “existential threat”.

He stressed that the government needed to support a transition away from agriculture dependent on heavy chemical inputs to “regenerative” agriculture to support healthier food production.

But it’s unclear how much leeway he’d really have to move such a massive agenda in the new Trump administration – which is deeply indebted to big food and the pharma industry for supporting Trump’s election campaign.

Last updated 13 February 2025.

Image Credits: Associated Press, Economic Times.