Most coal-fired power plants in India are now exempt from installing technology to reduce sulphur dioxide emissions.

NEW DELHI – On 11 July, the Indian government changed its own rules, exempting most coal-fired power plants from installing technology to reduce sulphur dioxide (SO2) emissions. 

This reverses a key environmental policy launched in 2015 to cut SO2 emissions. It means that about 78% of India’s 537 or so thermal power plant units do not have to install machinery to reduce SO2 emissions called Flue Gas Desulfurization systems (FDGs).

India is the largest SO2 emitter, mostly from such plants. The gas is an air pollutant linked to respiratory disorders and other health impacts, as well as ecological impacts such as acid rain. 

While the move has been questioned by experts, the government has hit back by denying that it is reversing the policy.

In an X post, India’s environment ministry described criticism of the change as a “gross misinterpretation”, adding: “The revised sulphur dioxide emission policy is not a rollback” and that it remains “fully committed” to science-based air quality management:

Referring to an unnamed media report, the ministry added that it is “not aligned with empirical evidence, exaggerates the health and air quality impacts of sulphur dioxide, and underestimates the trade-offs of large-scale FGD implementation.”

However, the near-total reversal of the policy “weakens pollution control efforts and endangers public health,” according to the Centre for Science and Environment, an environmental think tank.

The new policy divides the thermal power plants into three categories. Of the 537 units which were supposed to get FGDs, now only 65 units (12%) must have these in category A. 

In the case of a further 66 units, category B,  officials will determine on a case-by-case basis whether they need to install FGDs . The remaining 406 units, category C,  are now exempted. 

This categorisation can be problematic. Similar pollution sources now have “different” environmental standards within India, points out an editorial in The Hindu newspaper. When the emission cuts were ordered in 2015, there was no such differentiation. All coal-fired power plants had to implement it. 

Herein, researchers point out, lies another significant dilution. Of the 36 coal-fired power units around Delhi, many have been shut down in the past during peak pollution times. However, 22 of them are now exempt from installing FGDs. 

 

Delays, postponement and now reversal

In 2015, shortly after the landmark Paris Conference on climate, India ordered all thermal power plants to reduce their sulphur dioxide emissions within two years. This was to be mainly done by installing FGD units in old and new plants. 

The policy’s clear goal was to curb air pollution. In 2014, Delhi replaced Beijing as the world’s most polluted city, a shock to many in India. 

But within two years, the pushback from India’s power ministry and various power firms began. Then the reasons ranged from the likelihood of increased costs to consumers, cost effectiveness as there were few FGD vendors in India, and, after 2020, disruption due to the COVID-19 pandemic. 

The highest costs for implementation would be borne by privately owned plants (over 45%), followed by state-owned (32%), and centrally-owned plants (24%), a study at the time estimated. 

The ten years of delays, postponements and finally the reversal of 2015 policy.

Government’s rationale for reversal

The decision has been a long time in coming. Over the past year and more, government-backed institutes of science have produced reports contending that there is no “notable” difference in ambient air SO2 concentrations between cities which have thermal power plants (TPPs) with the emission-reducing FGDs, and those cities where TPPs don’t have this. 

The rationale includes that most of the coal used has low sulphur content, that SO2 emissions are well within Indian air quality standards because of mandatory height of smokestacks (220 metres) and “Indian climatic conditions,” and that acid rain was not a significant issue.

By numbers: Lives and money

The government says sulphates (what SO2 turns into in the atmosphere) contribute only 0.96% to 5.21% of PM 2.5 in cities near TPPs. However, researchers point out that this approach is selective at best both in terms of the number of cities covered and the time period for the testing. 

“As highlighted, the estimated 5% sulfate contribution, derived from data in 18 non-attainment cities, may not fully represent the national air quality scenario. Limitations such as the short three-month sampling period and exclusion of rural areas suggest the need for broader, year-round assessments to inform effective policy,” points out Dr Manoj Kumar, analyst at Centre for Research on Energy and Clean Air (CREA).

Other studies have shown that pollution from burning coal can contribute between 15% to 20% of India’s PM2.5. 

If FGDs are installed in all coal-fired power plants throughout the country, this could reduce PM2.5 by 8%, says a paper by authors from Harvard and IIT Hyderabad. This would significantly reduce the gap between India’s annual PM2.5 average of 50.6 micrograms/m3 last year and the national acceptable standard of 40. The study estimates that near the coal-fired power plants, PM2.5 pollution would be reduced by 7-28%, and potentially avoid 48,000 premature deaths. 

FGD benefits are worth four times the investment

Since the environment ministry says it has weighed fresh scientific evidence versus the economics of imposing standards, it is useful to look at the numbers. 

Installing FGDs across the country would cost over INR 2,540 billion ($29,5 billion), the government has stated. But doing so would benefit India by an estimated INR 9,622 billion ($112 billion). This means for every rupee invested, the benefit could be about INR 3.79, a return of almost four times. 

Over 90% of that is from preventing premature deaths by 2030. Ironically, this was in a 2018 study, by Bengaluru-based CSTEP, done on the premise that the rollout, not rollback – would be done by this year 2025!

Benefits to India’s GDP after a full rollout of FGD are approximately $18.1–$604 billion per year, which is equivalent to ~ 0.44 to 10% of India’s GDP, according to the IIT-Hyderabad and Harvard study. 

However, the ministry posted that the July 11 decision reversing the requirement weighs the “disproportionate resource and environmental costs of indiscriminate FGD mandates.” 

SO2 emissions: India up 50%, China down 75%

Since the early 2000s, China has reduced its SO2 emissions by 75%, whereas India’s emissions grew by 50% during the same time, according to NASA analysis. This has been attributed to strict policies and pollution control measures by Beijing. 

Source: Newslaundry, Centre for Research on Clean Energy and Air (CREA)

SO2 is not typically a greenhouse gas. On the contrary, it can block some of the sunlight and cause a cooling effect. But this is a short-term outcome and blurs the effects of rising global warming. However, this was cited by India’s Power Minister, Manohar Lal Khattar. 

“The sulphate aerosols from these coal plants aren’t to the extent that they affect human health…it is less than 5%. On the contrary, it is necessary that some of it remain in the atmosphere. If it is too less, it can increase warming,” Khattar said.

While the environment ministry did not echo this in its rebuttal post on X, it described the new regulation as climate coherent. One of the government’s arguments has been that FGD technology would increase carbon emissions. However, researchers say this is marginal, benefits outweigh the climate cost, and that this amount would anyway be exceeded by India’s increasing coal consumption. 

Image Credits: Ella Ivanescu/ Unsplash.

PAHO director Jarbas Barbosa da Silva (centre).

Massive economic losses are ahead for South America if it fails to address non-communicable diseases, according to a report launched on Tuesday by the Pan American Health Organization (PAHO).

“Between 2020 and 2050, non-communicable diseases (NCDs) and mental health conditions are projected to cost South America more than $7.3 trillion in lost productivity and healthcare spending that is primarily due to premature deaths, disability and reduced workforce participation,” PAHO director Jarbas Barbosa da Silva told a media briefing.

“To put it in perspective, that is equivalent to the entire annual GDP of Latin America and the Caribbean lost to preventable and treatable conditions.”

To reach these figures, Harvard University researchers developed an analytical model over the period 2020–2050 in 10 South American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela. 

The report projects “massive economic losses for countries ranging from $88 billion in Uruguay to $3.7 trillion in Brazil”, said Barbosa, who described this as a “alarm bell situation”. 

“This is not just another health crisis. The escalated burden of NCDs and mental health conditions has become an economic emergency, perhaps the worst economic disaster in health, and people living with cardiovascular diseases, cancer, diabetes and chronic respiratory conditions are at the heart of this storm.”

Nearly six million people died of NCDs in the region in 2021, with 40% of deaths in people under the age of 70. Cardiovascular diseases and cancer accounted for more than half of those deaths. 

Barbosa blamed the increase on NCDs on ageing and risk factors including tobacco use, unhealthy diets, lack of physical activity, harmful alcohol use and pollution.

Around 60% of adults in the region are overweight in comparison to the global average of 43.5%. Diabetes is rising, and an estimated 43 million people do not have access to the treatment they need, said Barbosa. 

Thirty-nine percent of the energy in the region is generated from fossil fuels, which has increased air pollution. In 2020, exposure to harmful outdoor air particulate matter (PM2.5) such as from exposure to biomass smoke, resulted in approximately 37 000 deaths in South America.

Harvard’s Professor David Bloom said that policy makers in South America and beyond have, in many cases, tended to undervalue health.

The report is aimed at “helping economics ministers make grounded and judicious decisions about health sector budgets”, said Bloom.

The report encourages policymakers to take urgent action, including “prevention, universal health care, long-term care reform, the overhauling of healthcare systems, more rigorous health technology assessment and innovation, and responsive healthcare policy”.

Sand and dust storms affect about 330 million people across 150 countries in 2024.

In 2024, sand and dust storms affected 330 million people across 150 countries taking a toll on health and economies, according to a new report by the World Meteorological Organization (WMO).

While the annual mean dust surface concentrations was slightly lower in 2024 when compared to 2023, there were big regional variations. In the most affected areas, the surface dust concentration in 2024 was higher than the long-term 1981-2010 average.

WMO estimates that between 2018–2022 around 3.8 billion people or nearly half the world’s population were exposed to dust levels exceeding World Health Organization’s (WHO) annual safety threshold for PM10.

“Sand and dust storms do not just mean dirty windows and hazy skies. They harm the health and quality of life of millions of people and cost many millions of dollars through disruption to air and ground transport, agriculture and solar energy production,” WMO Secretary-General Celeste Saulo said.

Overall, dust storms are worsened by poor land and water management, including urban sprawl and deforestation, which removes vital ground cover in arid or semi-arid areas, as well as drought. With climate change exerting pressure on all of these areas, WMO has underlined the need to improve monitoring, forecast and early warnings.

Increasing exposure trends

Difference in average population-weighted days when exposure to desert dust was higher than 45 μg/m3, comparing 2018–22 with 2003–07. On average, more people were exposed to sand and dust storms between 2018–22 than between 2003–07.

WMO estimates that every year, around 2,000 million tons of sand and dust enters the atmosphere –  equivalent to 307 Great Pyramids of Giza. Over 80% of this originates from the North African and Middle Eastern deserts, and can be transported across continents and oceans.

While much of this is a natural process, poor water and land management, drought and environmental degradation are increasingly to blame.

A new sand and dust storm indicator developed by WMO and the WHO shows that 3.8 billion people were exposed to dust levels exceeding WHO’s annual safety threshold for PM10 between 2018–2022. This represents a 31% increase from 2.9 billion people during 2003–2007.

This exposure varied widely from only a few days in relatively unaffected areas to more than 87% of days – equivalent to over 1,600 days in five years – in the most dust-prone regions of the world, including Africa’s Sahara, and Asia’s Gobi and Taklamakan Deserts.

Health impacts of sand and dust storms

Sand and dust storms contribute directly to air pollution, even in areas far from the source.

Health impacts of sand and dust include respiratory and cardiovascular issues.

However, sand and dust particles from natural sources tend to be larger than the PM2.5 particles produced by combustion and industrial sources, which penetrate deeper into the lungs and into the cardiovascular system, causing impacts such as hypertension and cancer, as well as respiratory impacts.

Even so, natural dust sources may also carry with them dust from industrial sources such as urban construction and dust kicked up by road traffic, which may include benzene and diesel components as well as tire wear and tear. In addition, there are significant threats to health when mineral dust, including a range of toxic compounds, is lifted from ploughed or bare fields. And this can occur in temperate or even humid climates, according to the WHO.

Apart from this, there are the socio-economic impacts. For instance, Iraq, Kuwait, Qatar, and the Arabian Peninsula were struck by an exceptional winter dust storm in December 2024. It led to widespread flight cancellations, school closures, and the postponement of public events.

“This Bulletin shows how health risks and economic costs are rising – and how investments in dust early warnings and mitigation and control would reap large returns,” Saulo said. “This is why sand and dust storms are one of the priorities of the Early Warnings for All initiative,” she added.

The WMO Sand and Dust Storm Warning Advisory and Assessment System coordinates international sand and dust research and has operational regional centres.

Geographical distribution of sand and dust storms

Dust storms in 2024 relative to the 1981–2010 mean. The image shows the geographical distribution of dust storms and their intensity.

For 2024, the central African nation of Chad saw the highest annual average dust concentrations. Chad is home to the Bodélé Depression, a mountain-rimmed valley, which is one of the key dust emission sources of the Sahara desert.

In the southern hemisphere, annual average dust concentrations were highest in parts of central Australia and the west coast of South Africa.

In 2024, sand and dust concentrations were lower than what they normally are in many of the main source areas but higher in areas where the dust blowed to. The transatlantic transport of African dust invaded the parts of Caribbean Sea region.

The regions that are most vulnerable to long-range transport of dust are: the northern tropical Atlantic Ocean between West Africa and the Caribbean; South America; the Mediterranean Sea; the Arabian Sea; the Bay of Bengal; central-eastern China.

Economic costs of sand and dust storms

While the global economic costs of sand and dust storms are not clear there are some country-level estimates. In the US alone, dust storms and related wind erosion cost an estimated $154 billion in 2017 – more than a fourfold increase over the 1995 estimate, according to one brand-new study, published in Nature in January.

The analysis included costs to households, crops, wind and solar energy production, as well as excesss mortality from fine dust exposure, health costs due to Valley fever, and transport. The true cost of dust was much higher, since reliable national-scale evaluations of many of dust’s other economic impacts (for example, on human morbidity, the hydrological cycle, aviation and rangeland agriculture) were not available, said the study’s authors, affiliated with the University of Texas and Virginia’s George Mason Universityy.

WMO, a UN agency, has been assessing sand and dust storms since 2007. The UN has declared the 2025-2034 as ‘Decade on Combating Sand and Dust Storms.’

Image Credits: WMO, The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action, Chris Ison/WHO, China Meteorological Administration (CMA) & WMO.

Saima Wazed, daughter of deposed Bangladesh leader Sheikh Hasina, sworn in as Director of WHO’s South East Asia Region in February 2024.

Saima Wazed, the World Health Organization’s (WHO) controversial regional director for the South East Asia Regional Office (SEARO), was placed on leave Friday (11 July) – four months after Bangladesh’s Anti Corruption Commission  (ACC) filed two cases against her for fraud, forgery and misuse of power.

WHO Director General Dr Tedros Adhanom Ghebreyesus notified staff in a brief internal email that Wazed would be on leave from Friday and that former WHO Assistant Director-General Dr Catharina Boehme for External Relations would “serve as the Officer in Charge” in Wazed’s place. Boehme will arrive at the SEARO office in New Delhi on Tuesday, 15 July, Tedros added. No date was given for Wazed’s return to her position.

Some of the charges against Wazed, daughter of Bangladesh’s former Prime Minister Sheikh Hasina who fled the country last August after protests, stem from her bid to be appointed regional director.

Wazed was elected to the position by SEARO member states in November 2023, but her campaign was shadowed by claims that her influential mother used her influence to ensure her daughter’s position. Following the confirmation of her appointment by the WHO Executive Board, WHO Director Dr Tedros Adhanom Ghebreyesus formally appointed her to the position in February 2024. Only a few months later, widespread protests prompted Hasina’s resignation and flight from the country on 5 August.

In January 2025, the ACC launched an investigation into claims that she had forged documents during her campaign to become WHO regional director and misused funds collected for a foundation that she previously headed, as previously reported by Health Policy Watch.

According to formal charges filed by the ACC in March, Wazed is alleged to have provided false information about her academic record during her campaign for regional director, violating Section 468 of the Bangladesh Penal Code (forgery for the purpose of cheating) and Section 471 (forging a document).  

The ACC also alleges she misrepresented her qualifications by claiming an honorary role at Bangabandhu Sheikh Mujib Medical University, which the university disputes, to secure her WHO position. The charges were detailed  by ACC Deputy Director Akhtarul Islam.

Wazed is also accused of having misused her power and influence to collect about $2.8 million from various banks for the Shuchona Foundation, which she used to head.  

The ACC case did not provide complete details on how the money was then used. But it said that charges include: allegations of fraud and misuse of power under Sections 420 (cheating and dishonestly inducing delivery of property); as well as Section 5(2) of the Prevention of Corruption Act of 1947.

After the charges were set out, a warrant was issued for Wazed’s arrest in Bangladesh. As a result, the WHO office in Bangladesh has reportedly refused to work with her as RD, while Wazed has been unable to travel to other countries in the South-East Asia Region.

Boehme was appointed as ADG in charge of External Relations and Governance in 2023, but she was not named to any role in Tedros’ shake-up of his  leadership team, in May, which also reduced their numbers from 11 to 6.

While the reductions were supposed to save WHO funds, a number of other members of WHO’s senior leadership may have remained on in the agency’s payroll without any clear role – raising criticisms from rank-and-file staff.  Except for ADGs such as Mike Ryan who publicly announced his retirement, or Samira Asma, who left the Organization to take another position, there has so far been no clear public accounting of the positions of other remaining senior managers. In Boehme’s LinkedIn account, for instance, she still refers to herself as a WHO ADG.

*Additional reporting by Elaine Ruth Fletcher.  Updated 14.07.2025 with corrected attribution to Boehme as a former WHO ADG.  

Image Credits: WHO.

Intergovernmental Working Group (IGWG) co-chairs the UK’s Dr Mathew Harpur and Brazil’s Ambassador Tovar da Silva Nunes.

Intense negotiations lie ahead for World Health Organisation (WHO) member states to conclude the missing part of the Pandemic Agreement, after a brief respite since the agreement was adopted by the World Health Assembly in May.

A new body, the Intergovernmental Working Group (IGWG), met for the first time this week, and chose Brazil’s Ambassador Tovar da Silva Nunes and the UK’s Dr Mathew Harpur as co-chairs.

The IGWG also adopted a tight schedule to achieve its key task: negotiating an annex to the pandemic agreement on a pathogen access and benefit sharing (PABS) system. This system will set out how information about pathogens with pandemic potential is shared in a safe, transparent and accountable manner, and how those who share information will benefit from products that are developed as a result.

Member states have until 10 August to submit proposals on what they want to see in the annex, which will flesh out Article 12 of the agreement. 

According to Article 12,  the IGWG needs to develop provisions to govern the PABS System, “including definitions of pathogens with pandemic potential and PABS materials and sequence information, modalities, legal nature, terms and conditions, and operational dimensions”.

Aside from the PABS system annex, the IGWG will also prepare the ground for the Conference of the Parties that will govern the pandemic agreement, and the terms of reference for a coordinating financial mechanism, which will help defend countries against outbreaks and pandemics.

September meetings

An informal IGWG meeting is planned for 12 September, with the next formal meeting from 15-19 September.

The IGWG Bureau, the administrative body overseeing the talks, is also compiling a list of experts to assist with negotiations. These will also be circulated to member states.

Experts are essential for this part of the talks, which are complex given that the annex will need to harmonise with several international agreements covering intellectual property and trade, as well as the Nagoya Protocol, which determines how to share the benefits arising from the utilisation of genetic resources fairly and equitably.

Dr Mike Ryan addresses the IGWG meeting, his final pandemic negotiations meeting before he leaves WHO in September.

Speaking at the conclusion of the first IGWG meeting, WHO outgoing Assistant Director-General Dr Mike Ryan described the annex as the “core” and “engine house” of the pandemic agreement.

“You are beginning a really important process with difficult miles ahead diplomatically,” said Ryan, who revealed that the meeting was his last on the pandemic agreement negotiations as he leaves the WHO in September.

“You are constructing a platform that will save countless lives,” said Ryan, who added that he had “huge hope” that the talks would succeed – although member states will have to “go at it” to conclude by April 2026 in time for the World Health Assembly.

Earlier in the week, the Pandemic Action Network (PAN) and partners urged the IGWG negotiators to “keep up momentum and adopt a PABS Annex at the next World Health Assembly”.

They described the annex as critical “to advance equitable access to outbreak and pandemic medical countermeasures, and an essential step to advance the promise and potential of the pandemic agreement”.

They urged negotiators to bring in experts from public health and environmental, align early on priority themes and core structure, and tackle the toughest issues first.

“We appreciate the idea of a structured template to gather proposed texts, and stress that strategically timed meetings and well-used informal and intra-sessional opportunities will be essential to achieve a May 2026 deadline,” said the group in a press statement released by PAN, the Panel for a Global Public Health Convention, Spark Street Advisors and Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response.

Sugary drinks are significant drivers of obesity and diabetes.

At the 2025 Club World Cup, the world’s most celebrated footballers – from global icons to rising stars – are showcasing their elite athleticism and passion for the game. 

But as stars like Lionel Messi take center stage, there is one name that doesn’t belong anywhere near the pitch: Coca-Cola.  

Coca-Cola has partnered with global football body FIFA since 1978 and has been a ubiquitous presence at this year’s Club World Cup. FIFA’s football tournaments are a premier platform for showcasing health and fitness, while Coke is the largest global manufacturer of soft drinks, a top driver of the world’s twin epidemics: obesity and diabetes. Coca-Cola should not be sharing the spotlight with football players and using their achievements to “sportswash” away soda’s harms. 

It’s easy to see why not. Four of the five brands under Coke’s umbrella contain high levels of added sugar or artificial sweeteners. A single 20 oz bottle of Minute Maid Lemonade contains 67 grams of added sugar, over 100% of what a typical adult should consume in a day.

Liquid sugar is especially damaging. It causes dental caries, weight gain and increases many health risks. Our bodies don’t respond to liquid calories the same way as food calories: they do not make us feel full, leading us to consume more. 

Additionally, there’s increasing scientific evidence to suggest sugar is addictive: it affects the brain in a manner similar to cocaine and can lead to increasing intake, withdrawal and cravings.

The health harms of sugary drinks start young. Big Soda companies hook kids on their products through pervasive marketing tactics used in schools, during kids’ sports and on screens. As a result, over half of American children consume sugary drinks daily. And because dietary behaviors set in childhood track into adulthood, these early preferences set kids up for lifetimes of unhealthy eating. 

PepsiCo and Coca-Cola are amongst the worst plastic polluters in the world.

Big Soda also devastates our environment. Along with PepsiCo, Coke is one of the largest plastic polluters in the world. According to the University of California, per liter, soda uses 27 times more water and produces 11 times more greenhouse gas emissions than the equivalent amount of tap water.  

Yet, Big Soda has tried to frame itself as “part of the solution.” For decades, it’s promoted physical activity as a solution to obesity, ignoring data that it’s nearly impossible to out-exercise a bad diet. Beverage companies have interfered with scientific research and professional nutritional organizations, obfuscating the true health impacts of their products. And by positioning themselves as “helpful,” they have actively fought against public policies to reduce sugary drink consumption.

Along with “sports” and “health washing,” Big Soda employs “greenwashing,” or framing damaging products as helping, not harming, the environment. At the 2024 Olympic Games, where Coca-Cola was a leading sponsor, the soda giant claimed to be an environmental champion by halving the number of plastic bottles used at previous Olympics.

 While seemingly offering nine million drinks in reuseable, returnable eco-cups, 75% of these drinks came from plastic bottles poured into eco-cups. At best, this type of “greenwashing” is misleading to consumers and at worst, threatens to exacerbate the pollution crisis.

These companies also use emotion to push product sales. Coke’s 2022 World Cup advertisement featured people from around the world celebrating amid a flurry of confetti, which outwardly has nothing to do with soda. Coke chose to capitalize on the emotions the World Cup incites: hope, joy and a sense of social connection that is increasingly rare. It profits from this emotional appeal by selling us products that are harmful for our health and planet. 

Football is bigger than ever. The 2022 FIFA World Cup drew a cumulative audience of over 5 billion, with the final alone watched by 1.5 million people. With this massive reach comes increased responsibility to engage in ethical, transparent practices that don’t cause health and environmental harm. If we expect our athletes to play fair, so should FIFA. 

But the tide is turning. The Kick Big Soda Out of Sport campaign, led by global health advocates and organizations, is mounting an opposition to Big Soda’s sports sponsorships. As the 2025 Club World Cup games are being played across the U.S., the Kick Big Soda Out movement is demanding FIFA end its partnership with Coca-Cola. Over 350,000 people, alongside 97 health and environmental organizations have already pledged their support. 

The spotlight isn’t only on the players—it’s on FIFA too. Will it continue to hijack the global stage for profit, or will it take a stand for the health of fans, players and the planet? 

The facts are clear. It’s time to ban Big Soda in sport. 

Lindsey Smith Taillie, PhD, is an associate professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill. She is a nutrition epidemiologist focused on designing and evaluating healthy food policies.

 

Image Credits: Vital Strategies.

Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s running cost, and the HIV treatment of 3,000 people is now in jeopardy.

An additional six million new HIV infections and four million AIDS-related deaths could occur between 2025 and 2029 if US-supported HIV treatment and prevention services collapse, according to UNAIDS.

“This is not just a funding gap. It’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima at the launch of the organisation’s 2025 global AIDS update on Thursday. 

“We have seen services vanish overnight. Health workers have been sent home. And people – especially children and key populations – are being pushed out of care.” 

“Key populations” refer to people most vulnerable to HIV infection, including sex workers, men to have sex with men, people who inject drugs and young women.

Some of the immediate effects of the US withdrawal of funds since Donald Trump assumed the presidency in January include the closure of health facilities, healthworker job losses, and disrupted treatment, testing and prevention services.

Impact of aid cuts on HIV infections and deaths

The US President’s Emergency Plan for AIDS Relief (PEPFAR) had committed $4.3 billion in bilateral support in 2025 and “those services were stopped overnight when the US government shifted its foreign assistance strategies,” notes the UNAIDS report. 

PEPFAR had supported HIV testing for 84.1 million people and HIV treatment for 20.6 million people.

“Disruptions are being felt across the HIV response and pose a huge risk of increased mortality, a surge of new HIV infections, and the development of resistance to the most commonly used treatment regimens.”

In Mozambique, for example, over 30,000 health personnel have lost their jobs.

UNAIDS itself faces huge job losses, and is reducing its Geneva head office staff from 127 to a mere 19 employees, according to a report this week by Geneva Solutions.

The UN agency’s restructuring plan will cut staff by 54% globally, leaving 280 staff worldwide. 

HIV prevention programmes hit hard

Country reliance on aid for HIV prevention.

External funding financed almost 80% of HIV prevention in sub-Saharan Africa, 66% in the Caribbean and 60% in the Middle East and North Africa, according to UNAIDS.

PEPFAR alone reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services in 2024 and enabled 2.5 million people to use pre-exposure prophylaxis (PrEP). Many of these programmes have now stopped completely, according to UNAIDS. 

PrEP involves taking medication to prevent HIV infection and is usually taken by people at high risk of infection, and PEPFAR funded over 90% of PrEP initiations globally in 2024.

“Countries are reporting limited availability of PrEP and reduced activities to prevent new HIV acquisitions, including among adolescent girls and young women,” said UNAIDS.

In Nigeria, budget cuts have reduced PrEP initiation from 40,000 to 6000 people per month.

At the end of 2024, just before a sudden collapse in funding, new HIV infections had been reduced by 40% and AIDS-related deaths by 56% since 2010, Byanyima notes in the report. Countries had also reduced the annual number of children acquiring HIV from their mothers by 62% to 120,000 since 2010.

However, prevention efforts were already flatlining before the withdrawal of US aid. In 2024, there were 1.3 million new infections, which was almost the same as the year before.

“Over 210,000 girls and young women aged 15 to 24 acquired HIV in 2024 – an average of 570 new infections every day,” according to the UNAIDS report.

In 2024, 630,000 people died from AIDS-related causes, 61% of them in sub-Saharan Africa. “Community-led services, which are vital to reaching marginalised populations, are being defunded at alarming rates,” said UNAIDS.

“In early 2025, over 60% of women-led HIV organisations surveyed had lost funding or were forced to suspend services.”

Domestic budgets inadequate

Only 25 of the 60 low- and middle-income countries included in the report have increased their domestic budgets for HIV in 2026. The average increase amounts to 8%, approximately $180 million in additional domestic resources. 

“This is promising, but not sufficient to replace the scale of international funding in countries that are heavily reliant,” UNAIDS notes.

“It is important for donors to recognize that the option of increasing domestic HIV funding is not immediately or equally available to all countries,” UNAIDS notes.

“Combinations of debt distress, slow economic growth and underperforming tax systems leave many countries, notably in sub-Saharan Africa, with limited fiscal space to increase their domestic funding for HIV. “

It cites the recent International Conference on Financing for Development in Seville in Spain, as offering a way forward with “calls for debt relief, international tax cooperation and reform of international financial institutions”.

These measure would provide “the first steps towards a new economic settlement that can give countries the fiscal space needed to invest in the global HIV response”, UNAIDS notes.

“Urgent action and revived solidarity are needed to sustain the progress made and prevent a resurgence of HIV.”

Image Credits: UNAIDS.

Dr Joanne Liu, a veteran humanitarian and former international president of Médecins Sans Frontières (MSF), has seen the front lines of global health crises—from Ebola in West Africa to bombed-out hospitals in Afghanistan. But her message today is clear: “An imperfect solution is better than no solution.”

Speaking on the Global Health Matters podcast, Liu reflected on the values that shaped her career, the lessons learned during her years at MSF, and her call for renewed global solidarity.

“Young people come into my ER and tell me they don’t want to live any more,” she said. “They feel trapped in a cruel and unfair world. I want to convince them it’s better to fight than give up.”

In her new book, Ebola, Bombs, and Migrants, Liu recounts how fear and political interests often override humanitarian needs. She recalled how the world ignored West Africa’s Ebola crisis until the virus reached Europe and the U.S.

“States don’t have friends—they have interests,” she said.

Liu also discussed the devastating U.S. airstrike on MSF’s hospital in Kunduz, Afghanistan, which killed 42 people.

“We called everyone—the Pentagon, the UN—but no one stopped it,” she said.

The attack pushed MSF to campaign for stronger protections for medical missions.

Liu is now focused on shifting the power dynamics within global health.

“For every international staff member, there are nine or ten locally hired,” she said. “We need to rebalance who holds influence.”

Despite setbacks, Liu remains hopeful.

“There is beauty everywhere,” she said. “It’s action that brings hope, and hope that brings action.”

Listen to more episodes of the Global Health Matters podcast on Health Policy Watch.

Image Credits: Global Health Matters podcast.

A trial participant is prepared for a blood test as part of a trial of new TB drugs that can overcome drug resistant pathogens. Several HIV and TB trials were suspended following recent changes in US policy.

Human trials conducted outside the United States with funding from the US National Institutes of Health (NIH) halted by the Trump administration in May, may be permitted to continue.

On 1 May, the NIH outlawed US researchers from making subawards to foreign research partners, jeopardising billions of dollars of research throughout the world. As a result, some clinical trials on humans were halted midway despite dangers to trial participants and the huge waste of money.

However, the payment freeze to several NIH subawardees in South Africa was recently lifted, according the journal, Science, which reported that “an alternative payment scheme … could allow those studies to continue”.

Over the past two decades, South Africa has become a “preferred site” for HIV and tuberculosis research, both because of its high burden of HIV and TB and the excellence of its scientific community, according to Professor Ntobeko Ntusi, head of the South African Medical Research Council (SAMRC).

It has been disproportionately affected by the NIH’s change in policy towards subawards, which jeopardised at least 27 HIV trials and 20 TB trials, according to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF).

In 2024, the NIH funded about 3,600 foreign subawards worth more than $400 million, according to Science.

The NIH wants to control allocations to foreign research groups, stipulating that they will need to apply directly to NIH for grants, not go via third parties. However, it will only have the new award procedures in place by 30 September, leaving thousands of research projects in limbo.

Explaining its position in an announcement on 1 May, the NIH said that it wants to “maintain strong, productive, and secure foreign collaborations” and  “ensure it can transparently and reliably report on each dollar spent”.

As a result, NIH “is establishing a new award structure that will prohibit foreign subawards from being nested under the parent grant. This new award structure will include a prime with independent awards that are linked to the prime that will allow NIH to track the project’s funds individually,” according to the announcement.

However, it now appears to have made exceptions for clinical trials involving people in the interim. 

“Staff guidance dated 30 June maintains that grant renewal and new applications including a foreign subaward submitted after 1 May will not be reviewed until the new tracking system is in place,” according to Science.

“But the document describes an exception for human subject research in applications submitted earlier, and for ongoing human studies. As a temporary measure, NIH grants staff can convert the subawards within these projects to special ‘supplements’ to the main grant that will go directly to the foreign collaborator, the document says.”

NIH official Michelle Bulls informed grants staff in a memo on 27 June that, although no new awards can be made to South Africa, “existing subawards with clinical research can continue under the new ‘supplement’ plan… and ongoing prime awards to South African researchers, which make up about 100 of the country’s NIH grants, ‘may proceed’,” according to Science.

Prof Ian Sanne, co-principal investigator of the Wits HIV Research Group Clinical Trials Unit, earlier described navigating the US funding cuts as a “major regulatory and ethics nightmare”.

One of the studies Sanne oversaw that was terminated involved a trial of microbicide rings filled with slow-release antiretroviral medication to prevent HIV that were inserted vaginally in trial participants, many of whom were at high risk of HIV infection.

However, restarting the research is not a simple matter as, in the two-month pause in NIH payments, trial participants have dispersed and research staff have been retrenched.  In addition, there is no guarantee that current subawards will qualify for awards under the new system.

NIH targets journal fees

Meanwhile, the NIH announced this week that it was cracking down on “excessive publisher fees for publicly funded research”.

The NIH claimed that “some major publishers charge as much as $13,000 per article for immediate open access, while also collecting substantial subscription fees from government agencies. 

“For example, one publishing group reportedly receives more than $2 million annually in subscription fees from NIH, in addition to tens of millions more through exclusive article processing charges (APCs). These costs ultimately burden taxpayers who have already funded the underlying research.”

In 2026, the NIH will introduce a cap on “allowable publication costs” (APC) to ensure that  publication fees “remain reasonable across the research ecosystem”. 

“This policy marks a critical step in protecting the integrity of the scientific publishing system while ensuring that public investments in research deliver maximum public benefit,” said NIH director Dr Jay Bhattacharya.

Image Credits: TB Alliance.

A researcher collects information on pathogens during a disease outbreak. How such information is shared in a fair and equitable way is the next phase of the pandemic agreement talks.

The next – and tricky – phase of cementing the World Health Organization’s pandemic agreement resumes on Wednesday (9 July) with the first meeting of the Intergovernmental Working Group (IGWG).

The IGWG’s main task is to negotiate an annex to the pandemic agreement on a pathogen access and benefit sharing (PABS) system. This system will set out how information about pathogens with pandemic potential is shared in a safe, transparent and accountable manner, and how those who share information will benefit from products that are developed as a result.

It is a hot potato given tensions between intellectual property rights for pharmaceutical companies and wide access to affordable medical products.

In addition, the IGWG will prepare the ground for the Conference of the Parties that will govern the pandemic agreement, and the terms of reference for a coordinating financial mechanism, which will help defend countries against outbreaks and pandemics.

According to WHO legal officer Steven Solomon, the PABS annex has to be completed by 17 April 2026 to meet the deadline of submission to the World Health Assembly in May 2026.

This means that the IGWG has merely nine months and eight days to complete its work to meet the deadline.

This week’s meeting will be dedicated to electing the office-bearers, setting out timelines and modalities for engagement with relevant stakeholders.

The first item on the IGWG agenda is the election of two co-chairs and four vice-chairs – one for each of the six WHO regions. As with the Intergovernmental Negotiating Body (INB) that ran the pandemic agreement talks, the co-chairs are to reflect developing and developed countries.

IGWG co-chair contender, the UK’s Dr Mathew Harpur.
IGWG co-chair contender, Brazil’s Ambassador Tovar da Silva Nunes

Ambassador Tovar da Silva Nunes, Brazil’s Permanent Representative to the United Nations Office in Geneva, and Dr Mathew Harpur, Deputy Director for Multilateral and G7/G20 Engagement for the UK’s Department of Health and Social Care, are strong contenders for co-chairs, according to sources.

The INB co-chairs, France’s Ambassador Anne-Claire Amprou and South Africa’s Precious Matsoso, are passing the baton to new leaders, although the pandemic agreement that they oversaw contains the outline of the PABS system.

Addressing a recent meeting in Geneva, Amprou said that preparatory work for the implementation of the pandemic agreement should start as soon as possible, in parallel with negotiations on the annex.

Amprou added that she though that the annex should be a short document and that “this negotiation should be much more technical than political [as] we know the political positions of different member states”.

As with INB meetings, open sessions of the IGWG will be webcast and stake-holders in official relations with the WHO will be permitted to attend and contribute at certain times.

Image Credits: Wildlife Conservation Society .