Easter saw much needed peace messages from the pope and even more heart-warming ‘We all just have one home’ videos coming from Artemis II astronauts, yet on World Health Day  (7 April) the current US president thought it appropriate to tweet an apocalyptic(/genocidal) threat against an entire civilization. Meanwhile, far away in Lyon, the  One Health Summit was taking place, highlighting the ‘interdependence of human, animal, plant ànd ecosystem health’. Doubt Samuel Huntington had foreseen that scenario decades ago.  Unbelievably revolting and scary times, even if ‘One Health’ is  ostensibly “rising on the global health policy agenda”.

On a more positive note, last weekend, the  Chancery of the Accra Reset announced an 18-member High-level panel to reform global health governance, in a further effort to reposition African and Global South voices at the centre of global health decision-making. 

Jean Kaseya (Africa CDC) clearly agreed, later this week in Lyon, tweeting: “Today, I joined President @EmmanuelMacron, President @JDMahama, President Duma Gideon Boko (@duma_boko ), and global health leaders with a clear message: Africa’s sovereignty is not negotiable. We are turning a page. Africa will no longer be spoken for — we will speak with one voice through the African High-Level Ministerial Committee on the Reform of the Global Health Architecture [ which will have its inaugural meeting in the margins of the World Health Summit Regional Meeting end of April, in Nairobi  ]. … Africa will shape its own future.  ….. At Africa CDC, we are working with AU Member States and partners to align financing, strengthen institutions, and ensure that the global health architecture reflects African priorities.  The next phase of global health must be built with Africa — not for Africa.”

Later this week, Kaseya also announced that Ghana’s “President Mahama agreed to serve as Patron of the African High-Level Ministerial Committee on the Reform of the Global Health Architecture (AHLMC).  “….Our discussions focused on advancing public health across Africa and accelerating implementation of the Accra Reset through the Africa Health Security and Sovereignty (AHSS) Agenda.  … I am pleased to announce that  he will engage with Ministers during the inaugural meeting in Nairobi this April and will host the Committee in Accra in the coming months. This sends a strong signal: Africa is organizing, aligning, and leading the reform of global health — on its own terms. “

That is all great news and indeed long overdue (even if Jean Kaseya’ s middle name is ‘bullish’). With one caveat, perhaps: it’s more than time to strengthen the structural input and real influence(/power) of the next generation in all these  global health architecture/reform discussions, High-Level dialogues and ‘likeminded’ panels. After all, they are the ones who will, statistically, still spend most time on this fragile planet of ours. Not Peter Piot , Michel Sidibé, Christoph Benn  or even Bill Gates himself…  Yes, some gatherings do better than others on this front (like the one currently going on in Bangkok), but by and large, there’s much room for improvement.  Gentle reminder: in the few remaining democracies on earth, people are actually allowed to vote from the age of 18.  And run for a seat slightly after.  (and some of us also think an age limit for decision makers also makes total sense these days… #deepsigh)

As for the backdrop of this global health ecosystem reform discussion: a recent Afrobarometer publication pointed out citizens in 38 African countries nowrank health as the top policy issue they want their governments to address on average, as they are facing health systems ‘in transition’….

We do leave you with some uplifting news from the US (yes, that exists). Earlier this week, the People’s Health Platform  was launched over there, highlighting “the importance of ensuring healthcare for all, protecting and expanding sexual, reproductive, and gender-affirming healthcare, preparing for the climate crisis and the next pandemic, and taxing billionaires, among other tenets…..”  While clearly focusing on the current public health and broader predicament in the US, the 10-point platform includes plenty of stuff with also broader global (health) appeal.

Starting with point 10 (well, you know me) : )

Enjoy your reading.

Kristof Decoster

As Easter is fast approaching over here, I’ll keep the intro short this week.

Now that apparently 2-minute micro dramas (‘duanju’) are all the rage in China, with many people watching titles like ‘Saved by the sexy cowboy’ on their smartphones, I’m sure you will be pleased that over here, my wife and I are still firmly hooked on K-Drama. Lately, we’ve been watching ’Can this love be translated?’.  The concept is rock solid: it takes many, many episodes till the two protagonists, this time Joo Ho-jin and  Cha Mu-hee (+ her zombie alter ego Do Ra-mi), finally get to kiss each other passionately ( K-drama kissing is a genre in itself). Sometimes, in the few remaining episodes, things still go wrong for reasons only the scenario writers know. Not this time (spoiler!), though.

Anyway, just to let you know that like most of you, we also have a few  escapist strategies for the evening, to try to forget – briefly – the current, increasingly “zombie multilateralist” state of the world.

But back to Easter. Last week, Kamran Abbasi already zoomed in on the religious determinants of health in a BMJ Editorial. He started his reflection from Pope Leo who recently  called universal health care a moral imperative (“health cannot be a luxury for the few”). Sadly, these days, religious extremists are calling the shots in almost all world religions, certainly in political arenas – with the results we can all see on battlefields and far beyond. And so I hope the many moderates, present in all religions, will find a way to take the initiative back.  As unlike the extremists, they realize that human beings aren’t all that different, and that what unites us is far more important than what differentiates us. 

Enjoy your reading.

Kristof Decoster

It was a rather busy week in global health, with among others World TB Day on Monday (this year with quite some focus on diagnostics innovations), the Global Maternal and Newborn Health conference in Nairobi (including a push for a “New Deal” on Maternal and Child Health in Africa ),  a  looming deadline for the bilateral health agreements between the US and African countries (detailed implementation plans normally have to be ready by 31 March …  ), but most of all, of course, the  PABS Annex negotiations  in Geneva. As the last round was about to start (23 March), the Bureau draft text looked – with an understatement – badly “out of balance”. Let’s see whether that improves by tomorrow. The draft ( quickly discarded on Monday), was certainly  a far cry from the lofty ‘No one is safe till everyone is safe’  EU rhetoric from the old Covid days. This week, so far only  ‘incremental progress’  was spotted…  

Along somewhat similar lines, the latest (2025) State of Global Climate report emphasized Earth is increasingly ‘out of balance’ , as more heat is trapped in the atmosphere, driving global warming.   Quoted in the NYT, J Rockström, put it like this: “Taken together, we see the first signs of a planet that is losing resilience, or losing strength to buffer heat stress. The consequence of such loss of resilience will be increased rate of warming.”   And we all know what that means, in terms of increased risk of tipping points and the like.

This, by the way, is the main issue I have with the (excellent) Wellcome Trust synthesis report of regional dialogues,   “From rethinking to reform: the way forward for the global health system” and the ( far less convincing)   ‘call for evidence on the upcoming EU Global Health Resilience initiative’.   Indeed, how “on earth” can one discuss global health resilience and/or reform in the year 2026, without linking a lot more prominently with planetary boundaries and resilience?

Let’s start perhaps from the quote, in the intro of the Wellcome synthesis report, by J-A Röttingen: “If we get this right, history will mark 2026 as the beginning of a positive new era for global health.”    

Well, with that lofty goal in mind, the ‘climate-health intersection’ idea, which is lurking in the backdrop of many contemporary global health reports (as compared to the planetary emergency we’re really facing), won’t cut it.  The benign view of this would be that, as mankind has now clearly squandered the opportunity for a more gradual and planned transition to a more sustainable and fairer global economic system,  and an era of cascading shocks has started (spurred on by old, fascist,  and/or dumb Sapiens specimen), global health experts and elites perhaps hope: “Maybe things will just work out in the end, at least with the transition to a more sustainable global economy?”   Could be (there are some positive signals and ‘green transition’ silver linings imaginable, including from Gulf War III),  but it would be rather unwise to count on it.

Related to this: with some exceptions (eg: some in the Global Public Investment Community), mainstream global health elites still don’t seem ready to push the Overton Window on billionaires, including the role of philanthropies (or at the very least, their governance), even if Gates himself gave them a ‘slam dunk’ opportunity in the Epstein files lately. Which is a major mistake on multiple fronts, as Robeyns    (and many others) have argued in the past. Or as somebody put it more bluntly on Bluesky (just focusing on the ecological implications):  “Billionairism is incompatible with life on Earth” .  I happen to agree. And I bet, deep in your heart, you do too,  J-A Röttingen. So let’s start saying it also in the Global Health community. A billionaire-driven global economy is incompatible with global health as well. For plenty of reasons.

The sooner ‘Global Health’ gets this, the better.  As only then, “… history will mark 2026 as the beginning of a positive new era for global health”   and “…fit for purpose”.  If not, we better all become ‘preppers’. True, that’s also a ‘resilience’ of sorts. (#huh)

PS: in a way, D Krugman has said it all before, even if his seminal paper dates from a few years ago. He would surely describe at least some of the current Global Health ecosystem reform processes as mostly about ‘changing Global Health’, rather than ‘changing ‘global health’    (cfr table 1 in Krugman’s paper).  So let’s get that balance better. Fast.  For example, at the WHO-hosted process, which is about to be kicked off in earnest with a document (from what we heard yesterday at a HEAR CSO webinar).  

After all, even if the times feel rather different nowadays,  ‘No one will be safe till all are safe’ : )

Enjoy your reading.

Kristof Decoster

Just back from some short holidays, so this newsletter issue will be a bit, ahum, shorter than usual. Starting with the intro.

(Consider this as my present for World Happiness Day, celebrated on 20 March)  : )

Enjoy your reading.

Kristof Decoster

With  ‘end of world beliefs’ increasingly common according to new research, local bible groups diligently reading up on the Book of Revelation and the rest of us starting to wonder what Nostradamus actually “foresaw” on the demise of the “rules-based order” back in his time (now that religious nutcases are mostly in charge in the US, Israel and Iran), on top of it all, it’s Friday the 13^th again!  In other words: time for your weekly IHP read : )

After International Women’s Day  (celebrated last Sunday), (mostly) men continued to f**k up the planet for the remainder of the week.  Pentagon figures put the cost of the third Gulf Warat  1 billion a day, an  underestimate it turned out so far. That’s awful enough, but no doubt the many complexity thinkers among you already saw a plethora of ‘ripple effects’ coming long before “God’s instrument” Donald & his luminary ‘Minister of War’ did so. Egged on by Gulf War 3, the polycrisis is clearly on speed now. (hint for Adam Tooze: time to update the term ‘polycrisis’, it sounds a bit benign for the current scary times, and also doesn’t take the ‘agency’ of some of the dumber Sapiens leaders enough into account, I feel)

In this week’s issue, we also pay plenty of attention to the Commission on the Status of Women in New York (where among others the merger of UNFPA and UN Women is being discussed, and Trump & co already suffered an ‘Epic Defeat’). In Geneva, it’s increasingly  crunch time for the  PABS annex discussion, with the forthcoming formal negotiations scheduled for March 23rd-28th.  And in Addis, a landmark summit on fungal diseases took place.  

End of last week, the US State department alsolaunched a new umbrella (global health) funding platform,  a “supplemental framework through which the Department of State may identify and support projects that complement, extend, and/or fill identified gaps in the implementation of … bilateral MOUs. “   We also already want to flag here Gavi’s first-ever vaccine budgets.    

Tim Schwab posted yet another Substack post on the Gates/Epstein links, “How Epstein & Gates harmed public health and global security”. Commenting on a previous post by Schwab, Matthew Canfield nailed it (on LinkedIn): “How can a foundation that claims to “empower women and girls” be so deeply entangled with Epstein? As CEOs step down, and royals, former diplomats, and other collaborators are arrested, the silence about Gates is shocking.“     

MostGlobal health big hitters indeed remain “soundly asleep”  on the issue. Perhaps it’s the age. Well, let’s hope they stop napping now that Jocalyn Clark  argues  in the BMJ that “… the Epstein files should no longer be ignored by those of us in the global health community…”. Clark puts things also in broader (global health re-imagining) perspective:  “…   “… The [Epstein] saga raises a broader need: for critical debate about the role and influence of powerful financiers in global health, especially now as traditional sources of support dwindle. Billionaire philanthropists are one group in need of scrutiny, but so too are the tech robber barons, petro-states, and human rights abusing regimes that will increasingly be looked to for support and patronage—and all too willing to oblige—as the fledgling global health architecture is reimagined….”  

In other dire news, a 2026 AMR Benchmark report warned that so far “growth of drug resistance is outpacing industry-wide efforts”. And on the planetary health front, new research showed climate change is speeding up   ( with the planet now warming at a rate of around 0.35 ºC per decade). You probably already noticed. Another study pointed out that “Extreme heat already affects one in three people, globally” “… making it hard even for young, healthy people to safely do normal physical tasks in many regions”.  Chances are the rising temperatures will further jeopardize global physical inactivity, which, by the way, has remained stubbornly ‘high and unchanged for the past two decades’ (see Nature Health).   

In short, maybe Pete Hegseth is the “Call of Duty” Nostradamus of our times, after all. At least if we paraphrase him a bit: could it be that mankind is “Toast and (increasingly) we know it”?   

Though from a more upbeat angle, as somebody put it on X: what is currently going on in the Strait of Hormuz is probably ‘the best advertisement for green energy the world has ever seen’.

Sadly, that’s about the only silver lining I can discern.  Meanwhile, the horror in the Middle East continues, with no end in sight.

PS: Today’s Featured article on Mali (in French, see below) is a new contribution by researchers from the International Health Policy Research Network (IHP Res Net).   

And do check out also the 6  IHP correspondents  for this year: Duha Shellah, Eunice Lobo, Pratistha Singh, Relindis Ma-gang Tapang, Sabu K U and Shubham Gupta.  We’re looking forward to their contributions this year!

Enjoy your reading.

Kristof Decoster

I’m feeling slightly nostalgic these days for the times, not so long ago, where one could still read about a fairytale “Grand Global health convergence by 2035” in a top medical journal or other merry “cosmopolitan moments”  on the horizon. In the year 2026, things feel slightly different.  Earlier this week, an EV alumna put it aptly on Whatsapp:  “Since some time, I’ve been wondering whether this is how people lived before WW II. Living ‘normal lives’ and keep doing regular things while the global craziness just keeps increasing. Something happens and then I think, “Well, this is the worst that can happen. But global super powers surprise me over and over again.”    And not in a good way, obviously.

Indeed, whenever you think we’ve reached rock bottom, Darth Donald and some of the other people currently in charge ‘trump’ it again in the new and largely lawless ‘Age of Resource Competition’.  Americans in particular must have felt super proud of their political system earlier this week, when during a war press conference, their ‘Commander in Chief’ was waxing about the “lovely drapes” in the “very, very beautiful new White House ballroom” in the making, just as his wife Melania was addressing the Security Council (apparently ‘Championing Peace Through Education”), and all while  Christian nationalists seem to have taken over a fair bit of the US military. Egged on by Pete “American Psycho“ Hegseth (the US ‘minister of War’), they seem rather keen on speeding up biblical end times  these days. Downright chilling.

When people later analyze what happened over the past few years (well, if we still get the chance), they’ll probably acknowledge that in addition to the raw & lawless power used by fascist leaders (Putin, Trump, Netanyahu, and yes, certainly also Khamenei…) and extremist movements, it was also the blatant double standards by most European and “like-minded” hapless leaders that killed the  (already heavily flawed) post-WWII ‘rules-based order’.  Where this will end? Nowadays, I’m just hoping not in “the Rapture”.

But as this is still a global health policy & governance newsletter, let us come back one last time on Gates and the Epstein files. Yes, you might think “this is  last week’s news”, but then again, you would be wrong. Let me briefly explain why, bullet-point style.

• When it comes to Gates’ individual behaviour, there’s certainly no ‘smoking gun’ – at least as far as we know. Dodgy, perhaps, yes (of the kind that breaks marriages), but not illegal.  (Or, in line with this week’s theme, in more or less Christian terms – at least the Christianity I remember from my catholic upbringing: “Whoever has never done anything dodgy, can throw the first stone.” )
• However, when it comes to the more structural links between Gates and Epstein (as well as by his Foundation), there’s more than enough in the Epstein files to warrant an independent investigation.  Tim Schwab already made that case convincingly in a few recent posts.  In his words: ““…Jeffrey Epstein presents a rare opportunity to hold Bill Gates accountable, and to finally have a larger public debate about extreme wealth and billionaire philanthropy—the common ground that initially brought Epstein and Gates together.”   This week, further news broke on Epstein’s involvement in  the polio eradication campaign in Pakistan (via Dropsite). Also timing wise, Gates is in far bigger trouble than Bill Clinton (who seems to have had no relationship with Epstein anymore after the latter’s conviction).
• You might well argue, there’s no ‘hard evidence’ yet, it’s mainly news reports etc. That’s right but the truth is: we will only know for sure if there’s actually an independent investigation (as compared to Gates interviews in “friendly” mainstream media and Gates foundation press statements). 
• And let’s not forget: usually global health can’t stop lamenting ‘conspiracy theories’ and misinformation jeopardizing public health. How on earth would you like to stop conspiracy theories re Gates & Epstein if you don’t set up an independent investigation?    By way of example, quoting the last sentence in the abovementioned Dropsite article: “…Now this entire Epstein saga will just give more oxygen to anti-vaccine hysteria and put millions of Pakistani children at risk. Just the thought of Gates and Epstein ‘helping’ children is enough to give any parent nightmares.””

• And so: whoever is currently  ‘reimagining’  global health, but decides to look away from this major governance problem in the global health architecture, might as well close shop.   As then clearly, they’re not doing their job: last time I checked, the Gates Foundation was part and parcel of the Global Health architecture. (#doublestandards?) So maybe, ahum, the ‘reimaginers’ should “refocus on their core mandate”?  

In any case, it’s now up to Helen, Anders, Peter P and all the others to do what’s needed. And yes, I know there’s one mitigating factor: that at this dire point in time, global health can’t do without the Gates billions. But I’m afraid that argument doesn’t suffice. More, I bet many Gates Foundation staff and grantees  agree.   Time to clean up the governance of the Gates foundation. But that won’t happen if global health’s Big Shots aren’t starting to push for it. 

Perhaps International Women’s Day   (8 March) is a good time to boldly set up a ‘Friends of an independent investigation of the Gates foundation’? : )

Enjoy your reading.

Kristof Decoster

Given all that’s happening in the world and in the global health community these days, you will have noticed that it’s next to impossible to provide a brief overview of ‘what’s up this week’ in the intro. And that’s not even going into everything that is being published. So let me just flag a few things that caught my attention this week.

First of all, the news on  Zimbabwe having walked away from a proposed $350 million health funding agreement with the United States ( only reported now), as well as the  double argumentation for doing so, will most likely also “inspire” other African countries involved in similar negotiations. Even if a strategic leak might have played a role in all the frenzy. Already a few days later, the Zambia government seemed to follow suit. Lately, Jean Kaseya is also sounding a bit more concerned on the US bilateral health agreements, although – Jon Bon Jovi style   – he did reassure African countries, “if you want Africa CDC to be there, we’ll be there (for you) ”.  

On the new ‘transactional era’ (where Rwanda seems to have some of the ‘best cards’  in ‘Trump speak’ ), we find Nelson Aghogho Evaborhene’s analyses very insightful, whether in Global Policy (“Global Health: Nigeria and the Pathology of the Hostage State in an Era of Fragmentation “), Lancet Global Health  or anywhere else.  But there are quite a few others – certainly including Emily Bass (this week linking Trump’s global health strategy with ‘Project Vault’).  Meanwhile, yesterday, DRC was the latest country to  sign a health agreement   with the US.

Increasingly, although  it’s not altogether clear mankind will get there, some are already thinking about the post-2030 era. We certainly want to draw your attention here to a new paper by Mulumba   et al, arguing for reparative justice as overall lens: “… A post-2030 Global Social Contract must impose enforceable obligations on former colonial powers, embed structural restitution through debt and tax justice, and democratise health governance under the principle of Common but Differentiated Responsibilities….”   (ps: I would suggest, for obvious reasons, to mainly try ‘find’ the reparations among the global 0.00001 %, currently rather busy causing ever more stuff to ‘repair’, worldwide).   A quote from Mulumba et al that resonated with me: “…Ultimately, the SDGs operate as a neocolonial placebo -soothing global conscience without treating the root causes of injustice.”  

From there to the ongoing ‘Global Health Reimagining & reform’ debate is a relatively small step. We agree with others that mental health should get more prominence in these discussions (and not just because materialist psycho-analysis theories seem to be “in vogue” again  to explain the behaviour of Trump, Macron & co : ) ).  

A bit closer to home, in Geneva, at the opening of the UN Human Rights Council, “President of the UN General Assembly Annalena Baerbock insisted that human rights were “not a spectator sport” for Members of the Council, ambassadors, ministers or UN officials, for whom “silence is a choice…and it has consequences”.”  Adding:   “History teaches us that large systems rarely collapse in one dramatic moment; they erode slowly, rule by rule, commitment by commitment, with those who should defend them rather staying silent. Until one day, what seemed permanent simply vanishes.”

“ … In her opening comments, she highlighted the ongoing plight of Afghan women who under a new Taliban edict can reportedly be beaten by their husbands, so long as there are no visible marks…”

And then, finally, a few words on Epstein and Gates. On Wednesday it was reported that “Bill Gates ‘took responsibility’ over Epstein ties in a staff meeting”. I guess among others investigative journalist Tim Schwab’s hard-hitting Substack post from earlier this week pushed Bill to come with an updated official statement, realizing this issue wasn’t just going to vanish “into thin air” by largely ignoring it. However, (at least for me)  Schwab really hit home with his second Substack post of the week (so, after Gates’ apology): Gates’s responds to Epstein, digs hole deeper. Do read it and judge for yourself.  A quote: “At a certain point, we all need to accept that Gates knew, or should have known, what a monster Epstein was. Given that, and given the many open questions about the nature and scope of the Epstein-Gates affair, should Bill Gates be allowed to remain in charge of a philanthropy that boasts a multi-billion-dollar portfolio of work empowering women and girls?”

Earlier this week (before Gates’ apology), I suggested a few ways forward in an ultra-short blog post (“While awaiting Global Health’s “All Stars” to shed their light on the issue …  ), and I still think they remain ‘no brainers’. After all, if even the World Economic Forum (!) can launch an “independent investigation”, why not the global health community?  

More in general, of course, I agree with Schwab’s stance that ‘the entire field of elite philantropy is long due for a major overhaul“. Which, as mentioned before numerous times, in my view also implies philanthropies of ‘a few hundred million’ to spend maximum, not ‘200 billion by 2045’. Whoever is currently busy ‘reimagining’ global health, and still thinks the latter is a good idea should think twice.  GPGs need to be structurally financed in another way, and should not depend to this extent on the whims of billionaires.

From a somewhat different angle, but still related to Epstein, we  recommend BMJ’s  Jocalyn Clark (‘Doctors were complicit in Epstein’s abuse, survivors must now be our priority’)  andKatri Bertram ‘s articles on the Epstein files and beyond. As Bertram puts it, “Don’t sanitize. Don’t normalize. And don’t ever, ever look away or stop listening.” 

Which somehow brings me back to the ‘spectator sport’ from the title…

Enjoy your reading.

Kristof Decoster

In this issue, we first cover the health sovereignty related news from the latest (39^th) African Union summit in Addis. A quote via Africa CDC set the scene: “Countries must lead, regions must coordinate, and the global level must support.”  That principle guided a high-level dialogue on reforming the global health architecture, convened by Africa CDC, South Africa and Ghana on the margins of the summit.

We also come back on the latest PABS round and Global Fund Board meeting, both in Geneva. Some days ago, France’s heavy cut of funding to the Global Fund came as another major shock. Still in the Swiss diplomatic capital, Health Policy Watch more or less kicked off the WHO DG race, with an analysis of the current (rumoured) crop of candidates. There are quite a few. Apparently, the organization needs a “unicorn”, “someone with the political skill to navigate a fractured world but the technical discipline to focus the agency’s ambitious mandate.”   In other words, the opposite of the current White House occupant. Shouldn’t be too difficult.

In the Global Health Reimagining & Reform debate, this week we feature quite some interesting contributions on the ‘missing ingredients & blindspots’ so far. Meanwhile, sadly, the Trump administration continues to have its own ideas on how to “Re-imagine global health”, now even considering a more expensive replacement of WHO  to duplicate  its global disease surveillance and outbreak functions. Sounds like a ‘Big Beautiful Deal’ (#deepsigh).

We also pay some more attention to the health/bio-security & development related debates at the Munich Security summit. With among others, the rise of ‘maluse of AI’ as a global threat, also flagged by a new CEPI global plan.  The Lancet Commission on global health threats for the 21^st century wasn’t launched yet in the end, even if there was  a related IHME event – maybe they went back to the drawing board after learning about the increasing likelihood of a ‘hothouse Earth’ scenario ( see last week )?  Meanwhile, the World Health Summit tried to get the following message across in Munich, at a side event: “Health security is a cornerstone of national security”. We agree. But as Scott Greer put it aptly (on Bluesky),   “The European response to the enormous cuts to US global health investment over the last year has pretty consistently been… enormous cuts to their own global health investment.”   It’s not much different elsewhere in the world, with defense funding trumping investment in global public goods big time.  

Recently, we also started an AI & health section. This week, among others, with some news from Delhi. You might want to check out the new acronym EVAH.

As for some of the publications of this week, we already want to flag here a very rich Lancet Global Health (March) issue (also with some health policy articles), and a few must-reads by Seye Abimbola  “The evidence of things not seen”, and  Aku Kwamie et al (Alliance for HPSR);Advancing health policy and systems research and analysis: new frontiers, renewed relevance. And oh yes, there are quite some interesting  Global Health “substacks”   and LinkedIn newsletters   these days – which we try to feature as well in our curated compilation (well, as long as they don’t pander to the MAGA crowd : )).

Finally, as you probably also know by now, we have entered the Chinese  ‘year of the (Fire) horse’.  Clearly the world is paying more attention than a decade ago, when the Chinese kick off “their” year. The year is said “to represent optimism and opportunity, following the year of the snake, a period that represents [resilience and ] transformation akin to the reptile’s habit of shedding skins.” 

Now that we have shed the skin of a disastrous first Trump 2.0 year in global health, let’s “get on our horses” and make this a better world before the nazis take over altogether. And humanoid robots : )

Enjoy your reading.

Kristof Decoster

We are not going to make a habit of it, but for obvious reasons  Benito Antonio Martínez Ocasio (better known as “Bad Bunny”) pops up for the second week in a row in the intro.  You probably had your fair share of analyses of his performance at the Superbowl halftime break by now, so we won’t add to that. In our spare time, however, we also engage a bit in ‘capacity strengthening’ for young (and not so young?) researchers. From that point of view, Steven Nelson  totally nailed it :  “…If Bad Bunny can cover the history of Puerto Rico, colonialism, transatlantic slavery, hemispheric consciousness, as well as contemporary life and politics in under 14 minutes, you can do your 15- or 20-minute conference presentation with time to spare.” : )   On a related note, we do think Latin dance skills should become a compulsory part of a  “GRIPP package fit for our dire polycrisis times”: you never know you end up on a stage at the Superbowl half time event, with only one goal on your mind: ‘Constructive disruption’ (and we actually happen to have a  colleague with hips like Elvis who would make a great coach!).

On a more serious note, Bad Bunny was no doubt also a good antidote for the multitude of commercial “health” ads  with financial ties to the beef or dairy industries,  Big Pharma and other “MAHA centers”. “Capitalism still rules the world”, and the US in particular.  It’s a stunning success from what we can tell.

Which brings us to the rest of a rather busy global health policy week.  

This newsletter features among others, coverage & analysis on another round of PABS negotiations in Geneva; final analysis of WHO’s 158^th Executive Board meeting; and some health (sovereignty) reads related to the African Union summit (ongoing, Addis). One of the key targets: to tackle the “$43-per-person health deficit” ( with increased Africa CDC calls for efficiency among the ways forward). There’s also the Global Fund Board meeting (11-13 Feb),  a  Global Coalition for WHO Action on Gun Violence, and much more.

This weekend, the Munich Security conference also takes place in, you guessed it, Munich. The annual report, themed this year “Under destruction” sounds like a nice Friday 13^th read. It describes, accurately, how “the world has entered a period of wrecking-ball politics”. The Lancet Commission on 21st Century Global Threats to Health (dubbed the “Commission of Commissions”) will also be launched in Munich. The 21^st century looks full of global threats to health, some even ‘existential’. Earlier this week, other researchers pointed to the increasing likelihood of a  ‘hothouse Earth’ scenario.  And a new BMJ call for papers  aims to zoom in on the geopolitical determinants of health. Timely call.

Let me leave you, however, with my idiosyncratic silver lining of the week:  coffee has been linked to slower brain ageing!  Even better, cognitive health in later life is also ‘strongly influenced’  by  “lifelong exposure to intellectually stimulating environments”  (reading & writing, and learning a language or two). Music to my ageing ears. (and hope scanning IHP also qualifies as an ‘intellectually stimulating’ thing for you guys : ))

PS: Today’s Featured article (see below) was produced by researchers from the International Health Policy Research Network (IHP Res Net) – a collaborative health policy research network that was launched in October 2025. The network plans to evaluate the impacts and appropriateness of a range of international health policies across different LMIC contexts.   Do check out their first contribution!

Enjoy your reading.

Kristof Decoster

With the 158^th WHO Executive Board meeting (2-7 Feb) still ongoing in Geneva, it’s obvious a lot of our attention will go to this vital global health event. As usual, the agenda was chock-full. Let’s hope the participants also had some time for a few ‘exercise snacks’   during the breaks – otherwise known as “vigorous intermittent lifestyle physical activity (VILPA)”   : ) After all, Jeremy Farrar is spot on when he claims “NCDs will be one of the “defining concerns” of the 21st century” , so people might want to set a good example at the EB meeting. Even more so as World Cancer day took place on Thursday, with prevention as a key focus.  

We also noted “WHO’s superpower”in Tedros’ opening address:  its convening power. Let’s hope that will also be the case for the ongoing ‘reimagining global health’ discussion which WHO aims to host.

Speaking of ‘convening power’ (ahum), the release of still more Epstein related files sparked global commotion this week. For once, the sick reality seems to have been even worse than conspiracy theorists could have imagined. There’s no need to go into some of the stuff that showed up in the (even in ordinary times nutcase) “For you” category in X, some of it also more or less ‘global health related’, I can only hope that only half of it is true. On the broader picture, Bernie Sanders nailed it, though: “What should alarm us about the Epstein files isn’t just the appalling details. It is the degree to which enormously wealthy and powerful people live by their own rules — and continue to get away with it. It’s a club where the rules and the law don’t apply…. ” From that angle, anybody who thinks still more financialization of global health is a good idea, ‘fit for our times’, should think twice. Katri Bertram even pushed it further,  tweeting “Any organization taking funds from these billionaires should seriously consider whether they are abiding to their ethical funding guidelines”…

In planetary health related news, researchers stumbled upon another “inconvenient truth” – it turns out you can’t “bail out” the planet. Oops.  And by the way, how on earth did we go so quickly from ‘the right to health’ (even if it was an ideal) to ‘de-healthification’ – “ a systematized regime that transforms health from a protected public good into a field of coercion” (cfr People’s Dispatch), in Gaza and ever more places?

All roads lead to Rome, it’s often said. By now, from so many different angles, it’s blatantly obvious we need to end the ‘rule of billionaires’ sooner rather than later. As if mankind (or perhaps ‘humanity’ is a better word), fails to stop Bezos, Musk & other Thiels in the coming years, the whole ‘reimagining global health’ enterprise will be more like re-arranging the deck chairs on the Titanic. Though perhaps this time not with “the orchestra still playing” but with Bad Bunny. 

When it comes to ending the ‘rule of billionaires’, I guess the Global Health community knows where to start. Let’s hope we’re up for it.

And so sing along with me, “If not now, then when?”  : )

Enjoy your reading.

Kristof Decoster

We’re a few weeks into 2026, and with a somewhat revamped newsletter (thanks to my colleagues from Communications), we think this is a good time to draw your attention again to how you can make best use of this newsletter & knowledge management tool.  Also with a view on the new subscribers.

True, as IHP aims for (some) comprehensiveness, this will never be the most flashy knowledge management tool – also because our pockets aren’t as deep as Bill’s or Elon’s (and so our team has its constraints) : ) We didn’t change the  “double” structure   of the newsletter, but some of the changes should make navigation a bit easier. Over the past few weeks, we already experimented with a few, as you might have noticed, eg. ‘Structure of Highlights’ (which comes right after the Feat article section, and gives you an idea on the main content). Links in the Table of Contents in the intro should also work now.

The Highlights section (which you find after the introduction & Feat article) remains a curated compilation of the key global health policy/governance/events of the week, as well as some high-profile reports and publications. The idea is that ideally, if you have some time, you scan this section. Later on, you can then still read some publications and news more in detail if you want. In our view, the ‘Highlights section’ is the “weekly stop”. Arguably, even scanning it takes a bit of time:).

The extra sections, on the other hand, are only relevant if you’re interested in these specific areas, and mostly contain extra (peer reviewed) papers. Regular readers will have noticed that in some global health areas, this extra section is more comprehensive than in others (after all, we’re human).

At the top of this email, in addition to the pdf-version of the newsletter, you normally also find translations in French, Spanish, Portuguese (still considering hindi & Chinese … ).

Importantly, as we realize that some of you have very little time, since a few months we also offer a short (4-page) AI summary of the Highlights section, plus 20-30 key reads of the week, selected by AI in the HL section (& respective URL links).  Of course, such an AI summary can never substitute for the ‘full experience’ (ahum), and the selection certainly has its limits, being largely AI-driven, but if you want to have some idea on the main global health policy headlines of the week in 10-15 minutes, then perhaps this option is for you. #workinprogress (you also find the AI summary at the top of this email)

In addition, the weekly newsletter is also published on the IHP website: https://www.internationalhealthpolicies.org/newsletter/  (whether you need VPN or not : ) #tailoringIHPtoyourpoliticalregime)

Finally, if you think this weekly newsletter is a good resource, we hope you recommend it to your colleagues and friends. They can self-subscribe here.  Would be much appreciated!

Enjoy your reading.

Kristof Decoster

As you might have noticed, it’s been quite a week (deep sigh).

As Tedros was taking part in a – presumably important – discussion on “the Dawning of the New Global Health Architecture” at the WEF Annual Meeting in Davos (check the picture on the participants), the dawn of a new world (dis)order  was in full display. As well as the Dawn of a new Davos, even worse than the previous one it seems. You find much more about Davos in this newsletter (from a global & planetary health, and development/taxation angle mostly). 

While global health reimaginers are boldly aiming “to Leap where no one has Leaped before”, I still hope they start the reform towards a new global health ecosystem  from a rather simple assessment –  as compared to burying it somewhere in the all but last paragraph. That is, the one Oxfam comes up with, every year, ahead of Davos. A few telling stats from this year’s report:  the 12 richest billionaires now have more wealth than half the world’s population (4 billion people). And “billionaire wealth grows 3 times faster than ever before”. The 2026 edition also had a fancy accompanying new ‘billionaire ticker’  (billionaires are making $80,700/second …).   

In the Guardian, Monbiot set the scene ahead of Davos in a similar way,   “At the root of all our problems stands one travesty: politicians’ surrender to the super-rich” .  That might be a bit exaggerated, but only a bit. Wish high-powered global health “trendwatchers” like Carsten Schicker (CEO WHS))  would also get that, by the way.

Every year the Oxfam report points in the same direction, but so far nothing really changes – except, that clearly the world is now in a far worse state than when they first started doing so. One tiny silver lining perhaps:  the huge political influence from billionaires, the key theme of this year’s report, is now obvious for almost everybody. 

And so, now that Schwab’s “stakeholder capitalism” and vision on Davos as the ‘conscience of global capitalism’   are well and truly dead ( having been ‘fake news’ for decades), I hope that at last the many global health “stakeholders” will also connect some dots.   A bit like it “dawned upon” European and other Western leaders in Davos earlier this week, one year into Trump 2.0, that maybe a change of tack is needed ( and let’s hope it lasts for more than just a few days).  

Meanwhile, in spite of one of the 5 themes at Davos, “How can we build prosperity withing planetary boundaries”,  “… analysis commissioned by environmental charity Greenpeace before the meeting,  “Davos in the sky”, found the number of private jet flights associated with Davos more than tripled between the 2023 and 2025 meetings, highlighting the climate impact of the annual shindig …”   All while the world is  entering a new era of “global water bankruptcy”, among others.

Over to Tedros, Nishtar & co – before the world turns altogether into ‘Dawn of the Planet of the Apes’. Or rather, maybe we do need a global health “Caesar”  to lead a global movement of citizens who still believe human beings are better than what we’ve seen coming from the White House’s Nero lately?  Such a “Caesar” would no doubt be laser-focused on the blatant injustice found in Oxfam’s annual reports. Bet plenty of precarious “apes” would be willing to follow him/her (whether Caesar wears Top Gun glasses or not). Then, at last, the world would smell the “Dawn of a New Global Health Architecture”.  

PS: among the publications of this week, make sure you also check out the new Lancet Commission A Citizen-Centred Health System for India, launched in Delhi this week.

Enjoy your reading.

Kristof Decoster

With much of the world on fire, and every week bringing new horrors, the global health community is gearing up for a number of meetings, discussions and negotiations in the coming weeks, also starting 2026 in earnest.

Next week, the PABS discussions  pick up again  in Geneva (20-22 January). The 158^th WHO Executive Board meeting is  scheduled for 2-7 Feb, with a rather full agenda as you can imagine given the state of the planet. And of course, the “Davos community” also has its yearly snowy “get-together” (19-23 January), this time in “A Spirit of Dialogue”. In Davos speak, “at a pivotal moment for global cooperation”, moreover (ahum).  Still in this part of the world, at the Munich security conference, the ‘Commission of Commissions’ (Lancet Commission on 21^st century global threats to health) will be launched in February (we do recommend the CSIS podcast ‘sneak preview’).

WHO published two reports on health taxes this week, “urging governments to unlock health taxes on sugary drinks and alcohol in order to save lives and raise revenue. “  EU chief diplomat Kallas didn’t really get the hint, joking that “ the World’s woes mean it’s time to start drinking” (can’t say I  blame her).

Obviously, this week’s issue features again a big amount of global health governance & financing/funding updates & analyses (including some encouraging global health related news from the US Congress). Meanwhile, the global health (& broader) “re-imagining” saga continues. Nobody still dares to use the old mantra to ‘Build Back Better’, though.  

While the Elders are warning against a return to  a might-is-right world   (for a damned good reason), our knowledge on the fifty shades of ‘optimism’ (vital skill for our times) also increased further this week. Bill Gates expressed his “Optimism with footnotes”  (which for some reason made me think back of a now retired colleague known for his endless footnotes : ) ), while Habib Benzian reflected on  “optimism washing” in a rather cool political analysis of the latest WHO report on UHC. They both nicely complement  ‘Hopeless pessimism’   (recommended read from a few weeks ago in this IHP intro).

Having said that, I absolutely agree with the president of the UN General Assembly that “the UN is worth fighting for”.  As well as a bunch of other things that the many creeps and ‘degenerated buffoons’ in power (quoting Adam Tooze here, one of the main “crisis whisperers”  of our times) want to get rid of. And the time is now. Unless you’re into ‘apocalyptic mindfulness’ (increasingly a thing, I heard).

Speaking of which, you might want to look into a new  report with a rather fancy title – ‘Parasol Lost’.

Enjoy your reading.

Kristof Decoster

We start this week’s issue with a final reminder for the IHP call for correspondents 2026. Deadline: 15 January.  (and in case you missed last week’s first issue of the year (2 Jan), see  here)

Over to the – official – first week of this year then. And boy, what a week that was.

Last weekend, many people involved in the abundant ‘re-imagining global health’ processes probably soon realized that Trump’s “special operation” in Venezuela is what one might call in global health speak “a gamechanger”.   True, since the pandemic ended, the world has seen its share of mindless violence, brutality and even genocides in an increasing number of settings, but after the Venezuela “intervention”, terms like ‘the new age of impunity’,an “increasingly anarchic world”, the ‘New Global Disorder’   or   “age of chaos” are all over the place. And for good reason, as last weekend the US joined the ranks of “rogue states” ( Israel, Russia, … and I can think of quite a few others these days). They crossed the Rubi(o)con (or is it ‘Miller-con’?).

Unfortunately, they happen to be a “rogue superpower”, led by a leader increasingly turning into an unhinged 21^st century Nero (his Caligula days are probably behind him, no matter how much aspirin he takes).  In a NYT essay, ‘The Great Unraveling has begun’,  O A Hathaway put it like this: “President Trump’s decision to launch a secretive predawn military operation in Venezuela to grab President Nicolás Maduro is a blatant assault on the international legal order. The action threatens to end an era of historic peace and return us to a world in which might makes right. “

We’re not quite yet at a  “ No-Rules International Order”  but clearly well on our way. By now, a few things should be obvious for everybody in global health, however. Certainly for the ones arguing (as I read in a document earlier this week) that  “The goal of global health architecture reform is to sustainably and efficiently deliver improved health outcomes for all.”  From that lofty angle, it was bad enough that the US under Trump 2.0 early on in 2025 got rid of the SDG agenda in its entirety (‘way too woke’ and ‘not in line with American values and interests’) and retreated from multilateralism. But how on earth can global health stakeholders and entities (Boards, …) continue to work with a country that has now turned clearly into a rogue superpower? Also, in an age in which African states rightly claim health sovereignty, when negotiating bilateral health agreements with the current US government, they better keep in mind that Trump 2.0 sees ‘sovereignty’ as a concept that only applies to the US. The supersized version of it, moreover.  

While (1) I’m well aware that the world is complex with plenty of constraints and trade-offs to make (eg. for European leaders, there’s the fact that we’re still not ready to defend the EU (let alone Ukraine) without US weapons & intelligence for a few years at least, or for many African leaders, the continued need for health support, at least during a transition period), and (2) you never know that at some point American “checks & balances” begin to function a little bit again, I hope that 2026 will be the year that at last, ‘coalitions of the willing’ will start saying, enough is enough. It’s high time to show a bit of spine, even if I don’t fully share the analysis of a  ‘The World-Minus-One-moment’. Building on a recent blog from Andrew Harmer, maybe the global health community could start by setting up a  ‘Friends of anybody who feels like telling Trump & his kind to just bugger off’, inviting all ‘likeminded countries & organisations’ to join?  

But clearly, it’s not just  global health (that) needs leaders with backbone. For once, though, Global Health leaders could actually show the way to other leaders?

Enjoy your reading.

Kristof Decoster

Like you, we arrived more or less “in one piece” on the other side of the year end, and so we celebrate this with the first IHP issue of 2026!  This issue will update you on the past two weeks – certainly the journals didn’t take a long break, as you’ll notice.

As is our habit, we capitalized on the winter break to enjoy a bit of spirituality (first episode of season 5 of ‘Emily in Paris’ : “total emptiness” : ) ), some wisdom from Habib Benzian (whose global health related Substack posts we recommend very much, eg. When Generosity Has a Calendar  – on what seasonal giving reveals about how we manage inequality), heck, we even stumbled upon a philosophy book fit for our dire times. ‘Hopeful pessimism’   (by Mara van der Lugt) was quite a discovery.  Written mainly with the planetary emergency in mind, but with ancient roots and old & new role models like Albert Camus and Greta Thunberg, it’s perhaps not everybody’s cup of tea. Yet, many of us can benefit from it, we bet, certainly in dark moments. And not just with respect to the climate emergency.   

We also want to remind you of the 2026 IHP call for correspondents. Deadline: 15 January!

PS: Finally, if you enjoy this newsletter – even if we know it takes some effort – do inform your colleagues and friends. To subscribe to the weekly knowledge management tool: https://www.internationalhealthpolicies.org/

Enjoy your reading.

Kristof Decoster

Like many other people in this part of the world, I tend to get a bit cheesy as Christmas approaches. And so, with this being the last newsletter of the year, I came up with something slightly different for this week’s intro. Adapted from you-know-whom : )

Reimagine

Imagine there’s no Gates or Bloomberg
It’s easy if you try
No Vlad, Donald, Netanyahu or Hamas in front of us

Let alone, Elon Musk.

Imagine all the global health people

Truly reimagining “Health for All” for our permacrisis times… 

A-h!

Imagine there’s no “likeminded” countries or global health “usual suspects”
It isn’t hard to do

No consultants helping with ‘prioritizing’ or billionaires to chase money from
And no blended finance, ‘strategy meetings’ or success cartel too

Imagine all the global health people

just invite Greta to their – abundant – reimagining processes…

Yu-huh

You may say I’m a global health dreamer
But I’m not the only one
I hope someday you’ll join us
And the global health world will be as one!

Imagine “reimagining capitalism”
I wonder if you can
No need anymore to head for “high-level breakfasts”
Just a brotherhood of  woke Sapiens,

Imagine all the global health people working towards a rights-based economy

“blending” planetary boundaries & Robeyns’ limitarianism…

Yu-huh!

You may say I’m a global health dreamer
But I’m far from the only re-imaginer
I hope someday you’ll join the “new narrative”,
And the global health world will – at last – live as one!

With that, if all goes well, we hope to see you again in 2026!   (tentative date for the next issue: 2 Jan)

PS: As a reminder, also with a view on 2026: the primary purpose of a Rights-Based Economy is “to guarantee the material, social and environmental conditions necessary for all people to live with dignity on a flourishing planet”.

Enjoy your reading.

Kristof Decoster

We start this week’s intro with the Call for IHP correspondents 2026. If you fit the criteria, we hope you apply! Deadline: 15 January.

The global health week started with the UHC High-Level Forum in Tokyo (6 Dec),  featuring among others the launch of a UHC knowledge hub and a bunch of  national health compacts. The day before, however, all eyes had been on the 2026 World Cup Football draw ceremony in Washington DC, where FIFA’s Gianni Infantino handed the inaugural “FIFA peace prize”  to Trump. While some observers were slightly carried away, claiming “The world comes together and fútbol is a ‘bridge to peace’”, we reckon WHO staff must by now be “super proud” of the WHO-FIFA partnership.  

Also end of last week, the new US national security strategy  was launched, painting Europe as weak and facing ‘civilisational erasure’.  Brought back some memories of that cheerful Tiffany song  from the 80s, “I think we’re alone now…” : )  Anyway, I don’t want to spend too much time on the Donald, the way things are going with him, I guess we increasingly have to get ready for the Vance era (could turn out even more creepy, in my opinion). If Republicans can still stretch it, perhaps just after the midterms?

In this week’s issue, we naturally also pay quite some attention to the first US-Africa bilateral health deals (four so far) and come back on last week’s PABS round in Geneva.  Speaking of the latter, after going through some top-notch investigative reporting by Geneva Health Files, we’ll probably never look again with the same eyes at the swans in Lake Geneva: “… “Anyone familiar with Lake Geneva will also know the white swans that dot the shores. These birds are deceptively calm. They are dry on the outside but are really furiously paddling underneath. And sometimes they can be aggressive. The mood in Geneva at the PABS talks brought these birds to mind.” … “   

On Monday, an Abu Dhabi Summit on polio eradication  led to some nightmarish visions of a “reimagined” global health ecosystem in the not too distant future, mainly comprising philanthropic foundations (including a few from shady regimes), some peanut “catalytic” commitments from former donor countries (increasingly ‘like-minded’ in this respect)  and for the rest ‘blended finance till we drop’ (with no doubt some ‘agile’ Boston Consulting Group staff lurking in the backdrop).  We ain’t there yet, but a quote from Kelley Lee’s recent blog on the Collective certainly came to mind: “… Global Health is now seen by many as a rarified world occupied by elites …“. As a way forward to rebuild public trust in global health, Lee argues, correctly, “ … Global Health scholars should … play an important role, not only in advancing our own research agendas among policymakers, but in advocating for good governance as a starting point for rebuilding public trust.”   

By the way, if global health wants to do something about this ‘elite’ perception, the ongoing, apparently ever expanding ‘Reimagining’ exercises better have a proper look at the latest World Inequality report.   As whoever thinks global health can be ‘re-imagined’ while continuing to allow “just 0.001% to hold three times the wealth of the poorest half of humanity” should probably think again.  

On the planetary health front, UNEP’s latest Global Environment Outlook report (GEO7), ‘A Future we choose’, argued “the accelerating climate crisis is now a major driver of global instability”. By the way, gone are the days that UN reports would lay out the road towards ‘sustainable development’. For several years now, framing has been rather ‘the SDGs are off track’, and increasingly, it’s about the ‘risk of collapse’, no less.   

Finally, today (12 Dec) is UHC Day.  The theme this year: “Unaffordable health costs? We’re sick of it!” The latest UHC monitoring report, which in spite of the updated indicators was  not all that different from the previous ones (ahum), provides some of the backdrop.  

But let me end with a small suggestion. Although the health community rightly pays a lot more attention to the climate-health intersection than a few years ago, including in power corridors, I think the mantra “health security & UHC are two sides of the same coin” needs an update in times of planetary emergency, permacrisis and ‘hyper-prioritized’ crises.  As while I won’t deny some positive trends ten years after the Paris agreement, the coin is increasingly melting.  In some ways, the new Lancet Commission on improving population health post-COVID-19 also hints at this this morning.

Over to you, speechwriter of Tedros! : )

Enjoy your reading.

Kristof Decoster

In this week’s newsletter we first come back on World AIDS Day (1 Dec), and linked HIV discussions and publications (including a Lancet Global Health/Lancet HIV Series on Sustainable HIV prevention in Africa, launched at the ICASA conference). The theme of this year’s World AIDS Day was “Overcoming disruption, transforming the AIDS response.” Easier said than done in the current cold world. With the polycrisis worsening, “Equity in decline: fair distribution in a worse-off world” (a read from 2023) feels  ever more urgent. 

The fourth meeting of the Intergovernmental Working Group (IGWG) on the Pandemic Agreement   took place in Geneva this week (1-5 Dec), with the ongoing US bilateral negotiations on MoU as the worrying backdrop. The first deal was signed yesterday in Kenya. In total, Marco Rubio plans “50 planned bilateral agreements with partner countries in the coming weeks”. Also in Geneva,  WHO issued its first guideline on the use of GLP-1 medicines in treating obesity. In the words of Tedros:  “The new guidance recognizes that obesity is a chronic disease that can be treated with comprehensive and lifelong care…” … .“While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”

This issue will also feature a number of global health governance & financing reads, including continued ‘re-imagining’ exercises of global health, development and health systems (research). Speaking of reimagining, this year’s stark Gates Foundation Goalkeepers report    “…urges Global Leaders to Target Scarce Resources Where They Save the Most Lives”. By the way, I have some “free” advice for the new senior communications strategy people  about to be hired by the Gates Foundation: tell your bosses Gates & Suzman to please stop talking about ‘rich countries’ that need to fund global public goods for health, and instead zoom in on ultra-rich people, multinationals & the financial industry. Trust me, a big part of the answer to try turn around the current negative trend in public opinion on ‘global solidarity’ lies there. And you better hurry up.  Moreover, the last one to lecture the world  ‘we should do more with less’   is probably somebody with 200 billion to be spent by 2045 : )

Anyway. We also already want to flag here the announcement of a new Lancet Commission on Health Systems Performance Assessment.  Keeping in mind what happened last time (when a ranking was published), I can’t wait till this one comes out.

Last but not least, tomorrow (6 December), the UHC Global Monitoring report 2025 will be launched at the UHC High-Level Forum (5-6 Dec) in Tokyo. The forum is hosted by the Government of Japan, the WB Group and WHO and will also celebrate the official launch of the UHC Knowledge Hub.  “Health Works”  seems to be one of the new mantras of the World Bank & partners. Great timing, now that the new Japanese prime minister confessed her deep love for   “work, work, work, work, and work”    

Enjoy your reading.

Kristof Decoster

Last week(end) three major global events were concluded: the Global Fund Replenishment, the G20 summit and COP 30, respectively in South Africa and Brazil – all with major global health implications. We come back on them in this newsletter, trying to explore where they are situated on the vast continuum between ‘empty multilateralism’  and a ‘victory for multilateralism’  (ps: arguably, the Global Fund replenishment is a bit different from the others, due to the somewhat unexpected continued US contribution, not exactly a multilateralism-minded powerhouse these days). As you know, for the pandemic treaty, a similar discussion is possible, to a great extent depending on whether negotiators will manage to secure a fair PABS annex or not in the coming months. Whereby I tend to agree with the ones arguing that  ‘holding the line in the current geopolitical environment’  is already a feat in itself, unfortunately.

In most abovementioned cases, the picture is rather blurred. Yes, of course, progress was/is anything but sufficient, overall outcomes were disappointing, and “voluntary initiatives” as always far too dominant. From that ‘glass half empty’ angle, it’s extremely important that some people continue to tell it like it is, cutting through all the PR (like J Rockström on the disappointing COP outcomes & what’s really needed with respect to the roadmap idea on the phaseout of fossil fuels; or check out a hard-hitting letter on the danger of  ‘toxic positivity’ at the COP; or the Global Fund Observer warning for ‘health austerity’   in Africa,  plain and simple).   Yet, all three events also provided some positives. Just flagging one here for example for the COP: it seems likely the roadmap idea will dominate future COPs. Better late than never, I hear you say.

Overall, given the multiple & intersecting emergencies the world is facing on a number of fronts (planetary, geopolitical/military, inequality, … and let’s not forget the societal/security impact of AI in a few years from now), we tend to agree with RANI that  ‘resilience’ will be the overarching lens in power corridors all around the world (well, at least, the ones still trying to align somewhat with science). Not that we particularly like the concept, and neither do we like the sound much of what Carsten Schicker (CEO World Health Summit) calls ‘resilience returns’ in an interview earlier this week, stating that ‘ …By 2035, the defining shift in global health will be mainstreamed ‘resilience returns’, where governments and partners treat health spending as a strategic investment that safeguards stability, growth, and peace…”.   But as we’re too dumb as a species for degrowth, ecosocialism and the like, “resilience” will be the name of the game in the coming decades at all levels, I’m afraid. (whereby ‘boosting resilience’ at global & other levels will probably be as makeshift as how a rusty fiftysomething tries to get through his/her days : ) )

In this issue, we also come back on the AU-EU summit in Luanda, Angola (24-25 Nov), well-attended by EU leaders (featuring both “Jupiter” and the more provincial types). The theme: “Promoting peace and prosperity through effective multilateralism”.  

In the run-up to World AIDS day, UNAIDS published a dire report,  Overcoming Disruption, Transforming the AIDS Response. We also pay some more attention to AMR Awareness week, among others in the extra AMR section and with a featured article from Cesar Vargas.

Finally, we want to flag the Emerging Voices for Global Health call for 2026 (linked to the Dubai HSR symposium). Check it out here!  

Enjoy your reading.

Kristof Decoster

The world (minus the US) is gearing up for the G20 Leaders summit in South-Africa this weekend (22-23 Nov). Ahead of the summit, the Global Fund Replenishment is scheduled(for today in Johannesburg, more in particular). Things look rather gloomy on that front.

The backdrop is also a bit odd, with on the one hand Africa CDC’s new Health Security and Sovereignty agenda (see Jean Kaseya in the Lancet this week),  egged on by the Decolonizing Global Health movement and the vaccine apartheid during the pandemic, and on the other hand more and more instances of blatant neocolonialism and attacks on multilateralism. Not quite sure where the new US Global Health Strategy is situated in this respect, now that  bilateral health agreements are moving full speed ahead, but it seems likely it will have a bit of both (and I’m rather worried about the “proportion”, frankly). The ‘trickle-down’ start of the roll-out of Lenacapavir in a few sub-Saharan countries  (but not yet in South-Africa) seems to be a case in point.

More in general, it will be an interesting G20 summit though, the first one taking place in Africa, with an  agenda more than usual focusing on some of the continent’s concerns. (On a side note, I personally certainly wouldn’t mind an  “IPCC on inequality”, sooner rather than later. Not that I expect it to happen soon … )

From the IPCC, it’s relatively small step towards the COP30 in Belém – which we’ll continue to cover (second week now), focusing first of all on the climate-health nexus,but also broader. In Geneva, the Conference of the Parties ( COP 11 ) to the WHO Framework Convention on Tobacco Control (FCTC) is ongoing (17-22 Nov). On the commercial determinants of health front, we also want to flag  an important Lancet series on UPF and human health, yet another public health emergency.  Earlier this week, the global health world celebrated the 1^st  World Prematurity Day and the 1^st World Cervical Cancer Elimination day. And oh yes, it’s alsoWorld AMR Awareness Week. By now, we all know how important that is.

Last week, Health Systems Global (HSG) launched its call for abstracts for the 2026 symposium  in Dubai. Given that one of the subthemes is ‘Politics and Polycrises’, I hope to read soon an HSG Board statement on the UAE’s weapons deliveries in Sudan, as well as Western countries’ involvement in these – as data from the Stockholm International Peace Research Institute indicate.    

We leave you with a few final news snippets. Larry “global health champion” Summers is at last  resigning from his role as neoliberal public intellectual (three decades late, but still). The same goes for a bunch of other commitments – among others, Larry  was also chair of CGD’s Board. Unfortunately, Klaus Schwab is still very much “alive”, however, having just published a new book, “Thriving and Leading in the Intelligent Age: Mastering Change with Purpose.” Bet you’re all running to the virtual bookshop now to get a copy for under the Christmas tree.

Enjoy your reading.

Kristof Decoster