In today’s intro, we first want to draw your attention to the following: Global 50/50 has published an open letter to the candidates for the next UN Secretary-General, asking every candidate to commit publicly to five practical priorities for advancing gender equality across the UN system: measuring it, analysing it, centring it, funding it and institutionalising it. With the Security Council straw poll expected in late July, the coming weeks are the most consequential window to hold candidates to account. The letter launches publicly on 7 July. Add your name here and please pass it on.

Let’s zoom in on this week then, flagging just a few highlights and events here (out of a week with plenty more news). 

In Geneva, formal negotiations on PABS are resuming July 6^th (with a few related anticipatory reads).  A number of Boards also met this week, among others the  UNAIDS board (which pondered an interim report on UNAIDS reform), UNITAID and  GAVI boards. Next week it’s the Global Fund’s turn. The newsletter also has an  update on the UNFPA/UN Women “merger”.  

On the planetary health front, extreme heat is now officially a public health crisis  after the past few weeks (clearly, that was already very much the case in many parts of the world, but with now also Europe being badly hit, western media can’t deny it anymore, even if the airco debate has at the same time sparked yet another ‘climate culture war’). Around  500,000 people die from severe heat every year. That’s probably an underestimate as the crisis is rapidly growing worse, exposing extreme inequality in the process.

Over to a global health event then which I managed to join on Tuesday, the European Global Health Policy Forum  in Brussels. The Forum focused this year on the recently released Global Health Resilience Initiative (GHRI). Rather interesting event, which probably warrants a blog on its own. As this is just a newsletter intro, however, I’ll just list a few things below that struck my attention. 

But first the overall background. As Martin Seychell (DG INTPA) put it in a keynote in the morning, GHRI is building on the 2022 EU Global Health Strategy (“Better Health for All in a Changing World”), and is very much a political initiative – the EU/C wants to signal in this way that ‘global health resilience’ should remain high on the political agenda. In line with another speaker in the afternoon, Seychell also mentioned GHRI aims to operationalize the GH strategy for a rather drastically changed global environment (compared with 2022, when by the way the world had already changed quite a bit…). The new environment has negatives but also some positives, he stressed. As a reminder: GHRI currently features five pillars & 9 flagship initiatives.

Overall, it was good to learn a bit more about GHRI, see how things were being framed (and occasionally distorted as well). A few points from my point of view: (1) like most of you, I’m overjoyed that a ‘global health & resilience’ tracker is in the works. The world might still be going to hell in the coming years, but at least it’ll all be properly measured & mapped. (2) For an event focused on ‘global health resilience’, it was rather odd the PABS negotiations in Geneva were barely mentioned. (3) I counted only one CSO representative in 4 panels (with 25+ speakers in total). That’s not much, in spite of the fact that the panelists kept banging on about ‘our democracies’ and (an evergreen at these sorts of HL events)  the ‘importance of communities’. True, many CSO people were in the audience, but that’s not quite the same in terms of ‘agenda setting’/gatekeeping power. With more of them present in the panels for example, I doubt the Covid pandemic would have been (mostly) framed as a ‘stunning success’ for the EU. (4) All five pillars have merits, but also possible caveats (in terms of ‘mutual interests’ for example). The fifth pillar  (“Strengthen societal resilience by fostering trust in science and countering disinformation, misinformation and FIMI”) is by far the most tricky one, however  (Ps: in case you wonder (like I did), FIMI stands for ‘Foreign Information Manipulation and Interference’.) Certainly the EEAS panelist  in the last session sounded not just like a rather convinced ‘FIMI fighter’ of sorts, at times he also came dangerously close to an “EU ‘truth’ version” of your average Trump spokesperson (though arguably, he didn’t look like a young blonde woman). It’s a minefield, in other words, this fifth pillar, even if I agree with other panelists in the fourth panel that this is indeed a major worry, and should thus be a key priority. Having said that, you wonder why some obvious stuff in that debate on countering health misinformation wasn’t mentioned (such as Von der Leyen’s notorious SMS exchanges with Pfizer’s Bourla, or the fact that Pfizer and other BioNTechs made tens of billions of dollars in a pandemic, which certainly didn’t “harm” conspiracy theories). In short: nice panel discussion on a vital issue, but not a good start for that pillar.

But enough on the Forum. (for additional reading, you might want to check out Scott Greer’s recent paper  on the EU’s ‘formal’ and ‘implicit’ global health strategy)

Far away from Brussels meanwhile, at the World Cup football, some members of ‘Team Europe’ are diligently trying to restore a bit of the tarnished soft power of this continent, aiming to make amends for the vaccine apartheid during the pandemic, or (many) EU countries’ cowardly role in the Middle East (Gaza) over the past years. They do so  by getting knocked out early in the tournament by teams from the Global South/Majority World. Like in the ongoing PABS discussions, changed power dynamics certainly also play a role, however, and for the better.  

In a first show of ‘diplomatic goodwill’, now that a  German South-North Commission has just seen the light at the Hamburg Sustainability conference, on Monday former football powerhouse Germany lost from Paraguay at the World Cup ( great start to rebuild some lost credibility but there’s still a long way to go for the Germans ).  Although usually not ‘like-minded’, the Dutch swiftly followed suit, crashing out against Morocco. Both succumbed in the ‘Last Mile’ of the football matches: the penalty shoot-outs.

This being the EU, it will not come as a surprise though that other members of Team Europe are so far not playing along though in this major “reverse FIMI” diplomatic effort.  True, my own country (Belgium) tried very hard, for 85 minutes or so, with Senegal by far the better team. In the end, though, Belgium still managed to pull through, with quite a bit of luck. England ( not really part of ‘Team Europe’ these days as you know, but somewhat on the fence ) got past the DRC in another tough match. And then there are the French, of course – who admittedly have an awesome team this time. Apparently they have a ‘higher purpose’, as a French interlocutor told me at the Forum in Brussels. The reasoning goes like this: only if they win the World cup, a radical-right presidency can perhaps still be averted.   And so, ‘Allez les Bleus’ !   

(and let’s hope we see a similarly constructive ‘Team Europe’ in the PABS discussions ahead : ) )

Enjoy your reading.

Kristof Decoster

With the World Cup football now in full swing, you will have noticed with me that WHO is keeping its partnership with FIFA  rather ‘low profile’. Among the many good reasons for doing so, just mentioning one here: while FIFA boss Infantino is doing – as usual – ‘Infantino things’ (as in: using a private jet in an attempt to watch two World Cup matches per day ), earlier this week we learnt  that Aramco, the state-owned Saudi Arabian oil and gas company, and the world’s largest corporate climate polluter, is also a top sponsor of the 2026 World Cup and has a four-year global partnership agreement with FIFA. To keep in mind next time you hear about WHO’s “climate-health agenda”. 

In the DRC, the Ebola outbreak sounds ever more worrying, one month after WHO declared an international emergency.  On Tuesday, Africa CDC’s Jean Kaseya warned during a virtual high-level meeting of African heads of state and partners  that   “the Ebola outbreak could be the worst ever”  (…. “If we don’t stop the outbreak very soon, it will be worse than what we had in West Africa and eastern ‌DRC”).  Fortunately, the Evian G7 Leaders’ summit produced a  heartwarming  “Call for a coordinated response to the Bundibugyo Ebola outbreak”.  Added benefit: now that G7 leaders have finally “seen the light”, maybe a (long awaited) PABS breakthrough might also happen in July : )   (#somewhereinthemultiversethatis)

Speaking of PABS, in this issue, we also briefly come back on the Member State Hearing for the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response in New York  (9 June). And as you can imagine, the issue also came up at the Global Health Security conference in Kuala Lumpur last week (see below for analysis in the Feat article by my colleagues Valérie & Gorik).  

We also pay some attention to World Blood Donor day (14 June), Men’s Health week (always organized around ‘Father’s day’), World Refugee Day (20 June) (with among others the launch of  The UCL–Lancet Commission on Migration and Health: review of the state of progress ), and look ahead to the UN High-Level meeting on HIV/AIDS (22-23 June).  It’s a ‘perilous moment’ for the response to HIV, UNAIDS warned last week. An understatement, sadly.

In Accra, Ghana, a three-day event (17-19 June) (called “Next Steps”) is taking place  “to advance the continent’s push for reparatory justice after the adoption of the landmark UN resolution declaring the trafficking of enslaved Africans as the gravest crime against humanity.”  Against that backdrop (but also for so many other reasons), we hope you take the time to read Tlaleng Mofokeng’s final report and dialogue, “The Right to Health as an Enabler of Dignity”.  Her mandate as the UN Special Rapporteur on the right to health ends soon. She asserts, correctly, that “… health cannot be realized without dignity, and dignity cannot flourish without health.”

With that, we have arrived at the Global Health reform discussions (& post-2030 brainstorm) and the future of international cooperation. As for tackling one of the defining challenges of the 21^st century (concentrated wealth), sadly the high-powered “ Friends of Global Health Reform“ still leave it largely to the likes of Zucman  (“The era of trillionaires will be dire for democracy. Here is how we can fight back”)  and Robeyns   “Is it bad that Elon Musk has a trillion dollars? Yes, and here’s why” (“ it starts with understanding why billionaires and trillionaires are not a sign of success, but of a dysfunctional system that is harmful to all our lives.”) to put the issue on the global agenda. No doubt because most ‘Friends of Global Health Reform’ consider themselves as ‘realists’. The picture isn’t very different among the “world’s top donors” (cfr theG7 summit in Evian), now increasingly “shifting towards investment and (mutually beneficial) partnerships” which sounds great in theory till you read  the fine print and all the caveats.  

Finally, we already want to flag here a new  UNICEF report on the impact of triple climate threats  now affecting nearly half the world’s children.  The zillionth wake-up call for all self-proclaimed ‘realists’ and others.  The ever expanding ‘planetary health & climate/health’ section in this newsletter points to the same.

Enjoy your reading.

Kristof Decoster

As we provide today’s Featured article by Rajeev B R in full – he reflects on his IHP residency from last year -, we’ll keep it short in the intro.

In this newsletter issue, you find among others updates and analysis on the ongoing Ebola emergency and related PPPR discussions and advocacy ( including a high-profile letter   to “stop the cycle of panic and neglect” ); the Bonn climate meeting    (8-18 June); the usual sections on global health governance & financing, global health reform,  etc.  In Malaysia, a Global Health Security conference takes place this week (stay tuned for analysis by colleagues next Friday), and in Brussels, The Lancet Commission: Accelerating Progress on Essential Medicines convened, in partnership with “Team Europe” (from 9-11 June).   The Commission is developing a new report to be launched in 2027, the 50th anniversary of the WHO Model List of Essential Medicines.

Early next week, Macron hosts the  G7 Leaders’ summit  in Evian, France (we’re already bracing ourselves for an inflation of fluffy ‘middle powers’ discourse). Later this month an important UN High-Level meeting on HIV/AIDS  is scheduled in New York (22-23 June) against a rather dark backdrop.    

Among the  publications of the week, later this morning a  new Lancet Series will be launched, led by WHO and  HRP researchers, and unveiling a transformative roadmap for the leading cause of maternal death worldwide, postpartum haemorrhage (PPH). 

We leave you with a short reflection for the weekend.

Back in the old days, many of us called for ‘Health for All’ – I’m sure you still vaguely remember those days. While at the time, clearly the global economic system was also cruel for hundreds of millions, perhaps billions of people, the hope was something real could be done about it.  In the year 2026, however, given all the worrying trends (in areas as diverse as climate change & planetary boundaries, AI, geopolitics, conflict trends  & nuclear weapons spending,  extreme concentrated wealth  …) the planet looks increasingly ‘Scary for All’. True, the downfall of neoliberal globalization was always going to be ugly. But with four years left till the SDG deadline, the world has become a rather frightening, dystopian place for most of us, with few being “left behind” in this respect.  At least if we dare to look carefully at many of the abovementioned trends.

Fortunately, courageous and visionary people continue to think another future is possible. They aren’t wrong. It requires, however – as they rightly claim – “changing the rules of the global economy”, no less.   While time is running out. As scary times often attract scary leaders (as I’m sure you’ve noticed lately).

Enjoy your reading.

Kristof Decoster

My week started with wasting another 3 hours of my life, watching an incredibly boring Champions League final (I blame Arsenal). Do read Branko Milanovic’s take on football’s extreme commercialization. But it’s worse than that, actually, given the game’s multiple links with unsavory authoritarian regimes, a FIFA president “BFF” with Donald Trump (and a bunch of other thugs), and of course a World Cup about to begin in a country constantly in the news for all the wrong reasons. Nevertheless, I still fancy late-capitalist football once in a while, and with a Belgium team not half as bad as many might suspect, I’ll probably go for watching matches taking place in Mexico and Canada. Hope the stadiums will be mostly empty in the US – you’d have to be nuts to go there as a fan, for so many reasons.  

Over to the more usual ‘global health policy & governance’ news then.

In Ghana, “Ghana’s LGBTQ community is living in fear after the country’s parliament approved a sweeping bill that criminalises the promotion of LGBTQ+ activities and identifying as lesbian, gay, bisexual, transgender or queer”, the Guardian reported earlier this week. The sorry bill came ahead of the fourth ‘African inter-parliamentary conference on family values and sovereignty’ in Accra (from 3-6 June), the first time the event is being held in Ghana. I trust the High-Level panel advising president Mahama on the Accra Reset will make a related ‘High-Level statement’ one of these days (Mahama has to sign the bill).  

In the DRC, meanwhile, the Ebola outbreak is raging, and the picture will no doubt remain very worrying for a long time still. On a slightly more positive note, however, on Wednesday evening, WHO officials  sounded for the first time a cautious note of optimism.  Last weekend, the  DRC’s health minister said that, based on previous experience, they aim to stop this epidemic in four to six months.  Let’s hope that’s possible.

Perhaps sparked by the new Ebola emergency, at least some people in the Trump administration seem to have second thoughts on the continued importance of multilateral Global Health these days, complementing their bilateral transactional, ahum, ‘efforts’ (see Rubio on ‘re-engaging with GAVI’  this week, in Congress). All it took was apparently one major global health security crisis to shift some of the few remaining half-sane minds in the Administration. Though you can’t rule out that concerns about the upcoming World Cup football play a role as well. In any case,  it’s certainly not a major shift yet (unlikely under this president).

Still on Ebola, in a FT op-ed  from last weekend, Africa CDC’s Jean Kaseya acknowledged the health emergency is a serious test for Africa CDC and the African Union   (  among    others ), but he also emphasized: “…I also saw something the world still fails to recognise clearly enough: an African response taking shape rapidly, under African leadership, with African professionals on the front line. International partners still play an essential role. But their support matters most when it aligns with strategies built alongside African institutions and governments…”.  

And so this newsletter has a big chunk on the Ebola emergency, as you might expect. Against that backdrop, the 2026 Virchow prize  for JJ Muyembe & P Piot comes more than timely too.

Over to the US, then, where Bill Gates is gearing up for a Congressional hearing (10 June) re the Epstein links. The Gates Foundation’s CEO, M Suzman, naturally shied away from that topic in a new Foreign Affairs  op-ed, ‘The end of foreign aid is not the end of development’. Instead, he argued ‘the world can do more with less’.  That doesn’t really seem to pertain to his own foundation, though – as it still intends to spend 200 billion over the next twenty years (and I assume his own paycheck isn’t going to change much either : ) ).  

I’m not going to deny that some of what Suzman says in the op-ed makes sense. But for a far more ambitious & convincing view of what the world (including the ‘development crowd’) should aim for, we recommend  The Global Justice Report, released on Thursday by the World Inequality Lab. The report also provides some great ideas for global health reform that actually would make a serious effort to tackle the key (interconnected) post-2030 challenges the world faces. As for all the positives the converging Global Health reform processes already brought (and there are certainly some encouraging trends), this report lays out where the reform is still found badly wanting. From where I sit (and I usually sit in this job (huh)), even if many of the ideas sound rather utopian, Piketty et al offer an alternative vision sorely needed if we still want to avert epic doom & gloom in the 21^st century. And so ‘Global health’ should side with it, unequivocally. At least if ‘Health for all’ is still somewhat on our radar. And no, you don’t need to be Gramsci material to get that.

Continuing with the publications of this week, we also already want to flag here the  Cancer workforce – Lancet Oncology Commission. (related HR hint: in case AI takes away your job, “One Direction” : )).

Finally, we hope you take the time to delve into this week’s Featured article, “Transcending Boundaries: From Inner Embodiment to Planetary Health”  (by B van Mierlo & W van de Put), who shed light on the climate-health nexus from an angle not often covered in ‘global/planetary health’. It’s a remarkable read, somewhat related perhaps also to “The Health, Equity, Peace, and Planetary Value of “Unplugging” ( on ‘Cortisol Dysregulation as a Biological “Plug-Indicator” of Immersion in Extractive Systems’) by Juan Garay.

We still remember the time when European Global Health strategies and Communications weren’t all about ‘resilience’. Juan Garay was around back then in Brussels. Good times.

With that (and perhaps Nirvana’s ‘MTV Unplugged in New York’  in the backdrop ? ), enjoy your reading!

Kristof Decoster

In this newsletter issue you’ll get an overview of the key WHA79 news since last Friday, as well as related analyses from various angles. Speaking of which, do start with today’s Featured article on the WHA (by my colleagues Rachel Hammonds & Valérie Vermeersch) which has a rights-based focus, among others.

As last week’s intro was fairly long (sorry), I’ll keep it short today (true, the weather doesn’t help : ) ).

As you know, the fast-moving and worrying Ebola epidemic – the first PHEIC to occur after the dismantling of USAID and the global health funding crisis –  is so far outpacing response efforts. Obviously, the emergency takes up a considerable chunk of this newsletter issue.

In another part of the world,  at the World Urban Forum in Baku, the global housing crisis was discussed. Housing is slowly, but steadily  rising on the global agenda. For good reason.   

As for the “global health reform” odyssey, I suggest that in order to focus minds, the  25-member taskforce that is going to lead the ‘WHO joint process’ in the coming months,  trades airconditioned (& Zoom) rooms for the harsh climatological circumstances South-Indian informal workers increasingly have to endure. Should bring them in the proper post-2030 mindset to at last come up with a reform ‘fit for polycrisis purpose’ (FFPP), even if I’m afraid that’s an oxymoron. The Global Climate & Health Alliance seems to agree, although they put it more diplomatically.  The taskforce might also want to take into account the difference between normal & singular crises  that sociologists sometimes make. 

Finally, as no doubt many of you have also noticed, last weekend pope Leo framed AI among others as a social problem in his new encyclical letter, “Magnifica Humanitas”.  Very much needed as recent books like  ‘Empire of AI’ already made clear.

Increasingly, our late-capitalist world resembles a run-of-the-mill ‘billionaire villain’ movie, in which a billionaire typically claims to try save the world, while in fact doing the exact opposite. With one difference perhaps: in the real world, it’s not one, but a bunch of billionaires that are “starring”. Almost a “Marvel-universe”.

Enjoy your reading.

Kristof Decoster

As I don’t need to tell you, following a World Health Assembly from afar is not quite the same. Fortunately, a few of my colleagues were around in Geneva this week. Today you can already read a first contribution by Valérie in the Feat article section. And stay tuned for a joint analysis (by Rachel & Valérie) next week.

This issue (read together with Tuesday’s ‘WHA79: part one’) continues the curated compilation of the great work by colleagues from Health Policy Watch, Devex, Geneva Health Files, People’s Dispatch (and let’s not forget Habib Benzian ’s incisive analyses!).

I won’t try to capture the entire WHA agenda here in the intro ( I’m not Don Quixote), so let me just briefly dwell on one issue here, that got plenty of attention this week in Geneva: the ‘Global Health reform’.

By now, WHA participants probably have a severe migraine from all this ‘rethinking global health for a changing world’, but as I concur with this year’s WHA theme, “Reshaping Global Health: A Shared Responsibility”, let me also do my bit : ) Even if my thoughts are obviously based on very limited info (including the odd hybrid panel session here and there).

While (as mentioned in ‘part one’), some  global health people with power (like  John-Arne Røttingen), argued for more ambition in the ‘joint process’, going beyond just incremental reform  (he’s damned right), I doubt that what he (and others) have in mind goes far enough. Indeed, even the most visionary global health people with power, who definitely want to go beyond the status quo, still seem to focus on ‘global health reform’ that mainly concerns part of the world (mostly LMICs). See also Kumanan Rasanathan’s take on global health reform, in an eloquent wrap-up of a Washington University panel session in hotel Intercontinental, ‘Rethinking Global Health in a Changing World’,  on Wednesday evening. While I respect both leaders very much, I honestly wonder whether that suffices in times of polycrisis, even if I agree the time for ‘health sovereignty’ is now (and in fact, long overdue).

But maybe ‘global health reform’ should (also) try to deal with the current ‘global’ (& increasingly interdependent) crises?   I know, that sounds daunting, and arguably, the reform does try to tackle some global crises (eg: pandemics, GHS in general). But it largely “omits” quite a few – vital – other crises.   

Let me provide a few examples.

First example: as CESR put it in a neat analysis,   “…The (current) credibility crisis of multilateralism is clearest in the contrast between collapsing ODA and expanding militarism.” “ …Resources are treated as scarce when it comes to care systems, climate adaptation, public services, and social protection, but politically available when directed toward militarization, border regimes, fossil fuel security, and creditor repayment…..” 

Second case in point: the Draft Strategy on the Economics of Health for All (2026–2030) was being discussed  this week in Geneva, emphasising the role of economic, fiscal, trade, labour, and social protection policies in promoting population health, reducing inequities, and supporting sustainable development.  While this is certainly progress, I noticed – multitasking during a related hybrid PHM session on Tuesday evening –  that the mood there was fairly subdued (including from a former member of the Council of the Economics of Health for all, Els Torreele).  David Mc Coy showed, for the second year in a row, a telling graph on the respective trends of private and public capital in past decades. And argued we urgently need to stop the financialization of the global economic system (which also increasingly affects ‘global health’).  I’m afraid he’s right, and not just because the current enormous inequality and ‘austerity for the many’ lead to further fascistization of our societies.  

From a slightly different angle, on X,  Kalypso Chalkidou  also pointed out policymakers face  “the fiscal version of long COVID” .  And related to the Global Partnerships conference  that took place in the UK this week, here’s a quote from the Oxfam GB CEO:  “….There is also a wider question about the global financial system itself. High levels of debt and an unfair international tax system continue to drain resources from many countries in the Global South – money that could be invested in public services, crisis response and long-term resilience. At the same time, Oxfam research shows billionaire wealth is rising at extraordinary speed: last year the world saw a record number of billionaires created, with a collective wealth of $18.3 trillion, while nearly half the world’s population continues to live in poverty. There is enough money to tackle poverty and climate breakdown, but political choices continue to protect concentrated wealth while aid budgets are cut. A genuine partnership approach should extend here too, with the UK backing Global Majority-led efforts on debt relief, fairer tax systems and reforms that keep more resources in-country.”

Last but not least: the latest Lancet Planetary Health Editorial,  “On the edge” claims, ominously but accurately,  “In weighing policy choices, we increasingly need to consider our proximity to environmental tipping points. Once considered distant future risks, these are now looking increasingly like credible mid-term scenarios that we need to understand to make informed decisions…”

On all these accounts, the current ‘global health ecosystem reform discussions’, are found wanting. At least in most power corridors. And yes, I know, it’s possible that grumpy old fascist men already end ‘mankind as we know it’ in the coming years, or that AI decides at some point to save mankind from itself (and its dumbass leaders). Nevertheless, abovementioned reasons make it painfully clear that ‘global health reform’ (even in its more “ambitious” version – already a tall order to achieve in the coming years) is not even trying to deal with the many of the (near-)existential challenges we’re facing. The envisioned reform is thus anything but ‘fit for purpose’. Rather, global health power sees these as ‘constraints’ in the brave new world, which we just have to live with. They refer to them, yes, occasionally, but apparently there’s not that much we can do about these (except becoming ever more ‘resilient’).  Oh, and I almost forgot ‘innovation’ : )

And so, no, I don’t share the ‘glass half full’ feeling that seemed to dominate at the Washington University session on Wednesday evening ( eg, Björn Kümmel – admittedly, Larry Gostin didn’t share his sentiment). Instead, I tend to side with the gloomy looking people at the PHM meeting on Tuesday evening. As if we fail to take on these challenges (and/or continue to largely look away), we’re doomed. No ‘blended bullsh*t’  (excusez le mot) is going to make up for that.

At least trying to take on these global interconnected crises should be, in my opinion, the global counterpart of the (much needed) current drive towards health sovereignty in African countries. Yes, just like for many LMICs in SSA, it might sound a bit utopian in the short term, but we owe it to the next generations to at least give it a try.

Meanwhile, against this rather dark backdrop, the WHO DG race is gaining momentum (and apparently, the list of possible contenders is getting longer and longer…). In a BMJ Feat article from earlier this week,  “Who will be the next leader of the beleaguered WHO?”,  our favourite quote came from Sophie Harman: “…The enormity of the challenge has led observers to call for a “unicorn,” but “you can’t find all these qualities in a single person and they can’t do it alone anyways,” …” , adding:  “… I would like to see less singular focus on the background of the director general herself or himself and more on their ability to bring together a strong team of public health expertise, diplomatic skill, and financial stewardship. ….”

In short, the opposite of the bunch of nasty clowns currently running the White House.

Enjoy your reading.

Kristof Decoster

With the 79^th World Health Assembly now in full swing in Geneva, for once we send you an early update on Tuesday, mostly compiling the great work of colleagues from Devex, Health Policy Watch, Geneva Health Files and many others, split between the ‘Palais’ and the WHO headquarters this year (for the official sessions), ànd also no doubt in many side events in the city. Occasionally, I watch the odd hybrid event here and there, like the Graduate institute’s pre-WHA briefing  on Sunday,   themed “Can global health (still) make progress under rupture? “,  or the Accra Reset ‘clarion call’   (with a rather vigorous ‘MC’) on Monday evening. There’s quite some buzz around the Accra Reset – and for good reason. The Ghana president, John Mahama, certainly gives the impression he means business.

You get some of the main info from these and other sessions in our curated compilation – stay tuned for the follow-up (part 2) on Friday. You will notice that in this issue, we split up the WHA79 content in a first subsection with more or less chronological focus on the ‘main highlights’ so far, and then dig a bit deeper into various agenda items (and related publications) in follow-up subsections.

By the way, we quite enjoyed Suerie Moon’s “termites in the wood” metaphor (on the impact of bilateral health agreements of the US, vs some of the multilateralism needed), at the pre-WHA briefing on Sunday, ànd it also struck us that Wellcome’s John-Arne Røttingen, usually fairly diplomatic and nuanced, grumbled  ‘bullocks’   when describing the limits to the mandate of the  Joint Process on global health reform. We agree with him ‘tinkering at the edges’ is no longer an option.

Finally, while clearly the new and worrying Ebola PHEIC gets a lot of attention at the WHA (and in this newsletter), we would also like to draw your attention here to the Pan-European Commission on Climate Change and Health, which argued we need to “Confront climate change as a catastrophic threat to human health, security, and social stability”. Among its (17) recommendations: “Declare the climate crisis a global public health emergency” (PHEIC).

Would be long overdue, moreover.

Enjoy your reading.

Kristof Decoster

On Monday, the long awaited 79^th World Health Assembly starts in Geneva, and boy, do I have FOMO : ) Fortunately, a few of my colleagues will be present – stay tuned for their updates! Ps: hope they’ll also find the time for some early morning “slow jogging” around the Lake in Geneva, which I much enjoyed last year (#WalktheTalk).  One consolation for missing the Geneva global health week: the “Sleepless Ape” (which I tend to be after a few days at the WHA) might get some more rest than usual next week : )

As you can imagine, this pre-WHA issue features a bunch of“primers” and other pre-analyses related to #WHA79. Speaking of one of these,  “ Global health reformcannot wait for a new world order. Middle powers must act now” (by I Kickbusch) is a nice read. I certainly agree global health reform can’t wait for a new world order. But I have somewhat less faith in many of these ‘middle powers’ (certainly most European ones, given their current leadership) – keeping in mindtheir track record of the past years on vaccine equity (during the Covid pandemic), the Gaza genocide, their stance in the pandemic agreement   (& PABS) negotiations, and let’s not forget their overall right-wing policies which tend to facilitate the radical-right in our countries, instead of doing the opposite.

I have my doubts whether  the European Commission’s new ( & naturally ‘bold’ )Global Health Resilience Initiative can change this. Paraphrasing K Seitz in a neat  HPW analysis, the initiative predominantly features right-wing recipes, to “boost global health resilience”. Good luck with that.

Onwards to other agenda items and issues then in Geneva. The WHO DG race will clearly get some attention in Geneva, even if it’s early days. As Priti Patnaik put it,  ❝The next WHO leader will need to be a multitasking political acrobat” . Some of the more paranoid ‘DG wannabes’ are probably already humming that first line of the U2 song, ‘Acrobat’: “Don’t believe what you hear, don’t believe what you see. If you just close your eyes, you can feel the enemy….”   

But there’s a a lot more on the agenda in Geneva, as the primers make abundantly clear. On Wednesday, the  World Health Statistics report 2026  already set the scene for #WHA79: “…while global health efforts are delivering results, progress is fragile and insufficient.” Put differently, “There’s a real threat of reversal. “  

Elsewhere, and part of the broader backdrop of the global health architecture reform discussions, there are increasing calls for a thorough development cooperation & partnerships “reset”, with a flurry of related events these weeks. In this issue, we pay some attention to an OECD meeting on the Future of Development co-operation in Paris (11-12 May)  (ahead of an OECD flagship report, scheduled for October). Next week (19-20 May) the  Global Partnerships Conference  takes place in the UK. And of course we also come back on this week’s “Africa Forward” Summit in Nairobi, Kenya (with Macron & Ruto as some of the protagonists). The Nairobi declaration will also inspire the G7 summit in Evian, France (in June).

On Tuesday International Nurses day was celebrated. As  Howard Catton put it in a HPW op-ed,  “Nurses Are Not a Cost to Health Systems. They Are the Power Holding Them Together”.   With 2 nurses among my siblings, I can only concur.

And oh yes, before I forget, on the Planetary Health front, we seem to be heading for a year in which “El Niño meets global warming”.  Better be ‘resilient’  this year : )

Enjoy your reading.

Kristof Decoster

It’s been a bit of a crazy week over here, ànd we have two Featured articles (see below), so just a few points here in the intro.

The week started with the news that the PABS negotiations  get (quite ) some ‘extra time’. That the deadline wasn’t met, didn’t come as a major surprise.  In fact, as TWN notes, among others it showed “… the limits of the argument that why WHO should conclude the WHO Pandemic Agreement negotiations and start the ratification process is the urge to show “multilateralism is working, and possibly without the US”.”    Let’s hope the coming months/year do lead to a breakthrough, though, that does go beyond the status quo.

But like Tedros and others, we’re not sure pandemics will patiently wait till then. In a fresh public health emergency  (and IHR ”stress test”, not a pandemic fortunately), the boomers among us were reminded again that a cruise can have its downsides. Even if one’s ship embarks from Ushuaia. Having said that, there’s perhaps some poetry (and consolation?) in going from ‘the end of the world’ all the way to your own end.  

In the WHO reform (and broader Global health Re-imagining) debate, Andrew Harmer thoroughly  “deconstructed” a Lancet Comment by some ‘members of the Old Boys network” (from last week). If blogs like these can see the light on a UK train, I’d say the UK rail network is vastly underrated.  The blog is also a neat curtain raiser ahead of the upcoming 79^th World Health Assembly (starting in ten days).

In the coming weeks, quite some ‘future of development cooperation’ meetings are  scheduled, starting with an OECD one in Paris next week.   Elsewhere in Europe, Friedrich Merz is one year in power ( still trying to nudge/trick a colleague of mine into writing a blog on ‘Merz from a global health angle’, but so far to no avail : ) ).

Over to some of the events of this week, then. The 2nd Africa Health Workforce Investment Forum  (6-8 May) ends today in Accra. In the same capital, a World Bank regional health strategy (  “Fit to Prosper: Investing in Health for Jobs and Development in Western and Central Africa”  ) was launched earlier this week (4 May), part of the World Bank’s ambition to reach 1.5 billion people with health services by 2030.  

In Kigali, the Global pre‑eclampsia summit, a multi‑stakeholder convening designed to accelerate progress on preventing, diagnosing, and treating pre‑eclampsia worldwide, also ends today.  Which brings us (via one of our readers) to International Day of the Midwife: “This week,  the world also marks International Day of the Midwife (5 May), celebrating the essential role midwives play in supporting women and newborns across the continuum of care. This year also serves as a call to action, as the most recent evidence points to a global gap of nearly one million midwives, leaving millions without access to essential care before, during and after pregnancy. Addressing this shortage is critical to improving health outcomes and strengthening health systems. To help drive action, the International Confederation of Midwives has launched a global petition calling on governments to invest in the midwifery workforce — we encourage readers to learn more and add their voice here: https://millionmore.org/petition/”.

Last but not least, the inaugural issue of African Journal of Health Economics, Systems and Policy was published. We don’t like the word much, but yes, it’s a “game changer”.  

Enjoy your reading.

Kristof Decoster

It’s the 1^st of May today, a holiday in my country – and an important one. Nevertheless, as I get older and perhaps a bit more rigid, I prefer to send out this newsletter on Friday morning : ) 

I still want to celebrate May 1^st properly, though, and so I suggest you read the following interview  between Dirk Holemans and Céline Marty in the Green European Journal,   “To save the planet, we must liberate time”: “…The capitalist emphasis on working hard as the key to success comfortably ignores an ugly reality: that the workforce faces worsening conditions and increasing precarity, while extractivism has brought the planet to the verge of ecological collapse. From the teachings of André Gorz to Gen Z’s quest for work-life balance, liberating time is at the centre of endeavours to achieve a better life – not just to consume freely as individuals, but to come together as a community.”   

A quote from the article: “….If we can put forward serious environmental projects that assert that the environmentally friendly way forward is working less, then that’s a very attractive idea. I think this idea of “work austerity” is one of the most appealing proposals that can be made as part of the ecological transition. It feels good when you take a break from work or work less, and that’s something we need to stand by…..”

Let’s call it our small contribution to ‘global health reimagining’ for this week : )   

But that’s the world “as it should be”. As we know from the past, in order to reach this eco-social nirvana, people have to fight, and fight really hard, in social movements and otherwise. And all this while some trends are clearly  going in the opposite direction. Just mentioning one here: what experts tend to call ‘tail-end AI scenarios’, and common people like me, “Hey, we didn’t sign up for the Matrix  ànd Black Mirror !”.

Over to ‘the week in global health’ then.

This week’s issue focuses obviously on the latest (and all-important) PABS round in Geneva. The WHO DG himself called for a ‘landing zone’  (see also last week’s issue) at the start of the round. But for some reason, that old band ‘Status Quo’   also kept popping up in my rusty brain.  Civil society and some delegations  seemed to agree by the end of the week (i.e. that Status Quo is a rubbish band).  

We also zoom in on the regional World Health Summit conference   in Nairobi. Feeling slightly under the weather recently, the ‘changemaker/thought leader’ in me (ahum) tried to follow some of the key action from a distance. Under the theme “Reimagining Africa’s Health Systems: Innovation, Integration and Interdependence,” the opening session in Nairobi already set a clear focus: moving from dialogue to coordinated, practical action. It was amilestone event, no less. You can read all about it in this newsletter.

Still in Africa, yet another country (Ghana) rejected the bilateral health agreement with the US this week, citing data concerns.  And on the way back from his tour in 4 African countries, pope Leo once again positively surprised us (though arguably, these days it’s not that hard to positively impress for an American, at least against the “benchmark” of the peculiar American blend of Benito, Louis XIV & Hermann Göring that is currently occupying the White House).

We also cover the Women Deliver conference in Melbourne,  the World Hepatitis summit in Bangkok (with a related new WHO report) and, more extensively, the Santa Marta conference in Colombia, where “the UN Deadlock and Iran Oil Shocks Push(ed) 54 Nations to Chart a Fossil Fuel Phase Out”. Santa Marta was also an interesting experiment in climate diplomacy  by the way,  excluding the nations most responsible for holding it back. “…Coincidence or not, the US, China, Russia, India and Saudi Arabia are not attending. Neither are the battalions of fossil fuel lobbyists who’ve turned Cops into networking events….”      Sounds like a brilliant idea.

And oh yes, I almost forgot: the WHO DG race has now really kicked off. Let the ‘WHOsplaining’ begin (or rather continue) : )

Enjoy your reading.

Kristof Decoster

Although the ninth meeting of the Ministers of Health of the Shanghai Cooperation Organization (SCO) member states took place in Bishkek, Kyrgyzstan this week, and Africa (CDC) & (Team) Europe announced €100 million Health Initiatives in Addis,  strengthening their health partnership, it’s clear that in the coming days/weeks, “Global Health” is really gearing up.  

Starting today and this weekend with among others,   World Malaria Day    (April 25) (WHO & partners are launching the campaign “Driven to End Malaria: Now We Can. Now We Must.“) and  World Immunization Week (April 24–30), under the motto “For every generation, vaccines work“. Good one for RFK jr, I hear you think. Early this morning, rather uplifting results  of the ‘Big Catch-Up’ were published.

The next PABS round is also scheduled for next week (27 April-1 May) in Geneva. From where I sit,it will require a fair amount of diplomats well-versed in the ‘Art of the Deal’ (ahum), as well as heaps of kerosine, to get to equitable “landing zones”  : ). 

Next week, the regional World Health Summit in Nairobi  (27-29 April) also takes place, themed “Reimagining Africa’s Health Systems: Innovation, Integration, and Interdependence”. Easier said than done, reimagining in an age of polycrisis, a new era of ‘predatory power’  and ever more “major risk multipliers’ and ‘chokepoints’. It’s as if you imagine yourself to be in a misty-eyed episode of the K-drama “Still Shining” , while in fact you happen to play in the grim late-capitalist season 2 of Beef.  

There’s also the upcoming Santa Marta Conference in Colombia (28-29 April), which convenes a climate ‘coalition of the willing’ to break the global fossil fuel deadlock. The aim: to begin the long-awaited “transition away from fossil fuels”.  The ‘billionaire death cult’   (in the words of Monbiot) isn’t helping much in this respect, but on the bright side, these days the ‘coalition of the willing’ is aided quite a bit by the current war in the Middle East – about the only advantage of the crazy global crisis sparked there. But given the existential risks of tipping points, mankind better hurries up. In case we get distracted by the neverending Trump sh**sh*w, by autumn a potentially “super El Niño” is already awaiting us.  

Meanwhile, the 79th World Health Assembly  (18-23 May) is already looming on the not too distant horizon, with a rather packed agenda. Yesterday, WHO’s Results report was published, showing some progress on the ‘triple billion targets’.  The new EU  Global Health Resilience Initiative will  probably also be launched in May (bracing myself for that one…).

You’ll find much more in this newsletter issue, including  fierce discussions  on worrying  PEPFAR impact data; a high-profile US State Department official resigning over disagreement with the Trump administration’s global health approach; andmore analysis/advocacy on the Lenacapavir rollout. We also briefly come back on the IMF/WB Spring meetings and learned about‘embedded global health solidarity’  in a webinar on Wednesday.

Finally,the Gates Foundation started – at last – an external review of the Epstein ties (though you might wonder why the ‘third-party investigators have not been publicly named’). Meanwhile, the Foundation already seems to be “working diligently on the future”. As Themrise Khan  noted on LinkedIn, ““So the Gates Foundation is now trying to court the wealthy oil rich Arab world in hopes of more funding. Specifically the Saudis. A billionaire courting other billionaires.  If no one in the #philanthropic and #globaldevelopment industries finds this disturbing, then I have truly lost all hope.”       

But maybe, ‘evidence-based’ as they are, the Foundation had anticipated the latest  billionaire trends? Yesterday, it was reported in the Guardian that according to research from the estate agent Knight Frank, “the number of billionaires is expected to grow the fastest in oil-rich Saudi Arabia.”

What could go wrong, indeed.

Enjoy your reading.

Kristof Decoster

From what I could tell, White House and GOP leaders  took up a new hobby this week –  “popesplaining”  – but no worries, unlike the Donald, Vance & co, IHP has no time for  sparring with Leo XIV.

In this week’s issue, we first focus on the IMF/World Bank Spring meetings (with among others the new  ‘Water Forward’  initiative from the World Bank, part of its recent  “shift toward mission-driven development”).  The meetings take place in ‘polycrisis times on speed’, but we’re also in the midst of a capitalist regime change since a few years.  In the margins of the meetings, there was also some good news on the Lenacapavir roll-out (at the CSIS Futures summit), and the Future of Development Cooperation Coalition met for the first time.    Meanwhile, in the WHO DG race it seems ‘the game is on’ ( with for example a rather important  visit of Tedros to Berlin  early this week).  The newsletter also features once again lots of publications and Comments related to the changing global health architecture & reform.  The debate is slowly but steadily becoming less theoretical, and more operational.

Speaking of this ‘system in transition’,  we already want to flag here an important Alliance-convened Comment  in the The Lancet that zooms in on the global health research financing emergency, arguing for earmarked domestic funds to inform health financing reforms. In the Comment, 20+ global health research leaders warn that funding cuts are threatening national health research ecosystems.  As Dr John-Arne Røttingen, CEO of the Wellcome Trust and also a Comment co-author, put it:   “Health research financing is not just a technical issue – it is about power, priorities and participation in the global knowledge economy.”  And so, “… In response to this challenge, the Alliance is launching a new programme of work focused on advancing domestic financing of health policy and systems research in LMICs. This initiative will explore practical pathways for countries to mobilize and sustain funding for health policy and systems research and strengthen national research ecosystems.”   Much needed indeed.

Last but not least, although physically incapable of ‘beaming like Ursula when pleased about something’, we were also rather happy about the ousting of Orban from power in Hungary.  Yes, the EU never ceases to disappoint on its lofty ‘values’, certainly the past years, but there’s still much worth fighting for on this continent, as many people in Hungary (including many young people)  showed us again.  Let’s hope their victory also inspires many other people and countries in the months to come, both in the EU and across the ocean.  As this was just one defeat for the radical-right  –  it’s far from ‘game over’ for them, unfortunately.

But maybe, just maybe, the ‘Wind of change’   (horrible song, I know: ) ) is starting to blow differently. If only because by now, citizens and voters have seen a few ‘case studies’ of what can actually happen when you hand the radical-right the reins of power.  

Still, every setting and battle is different. But at the very least, after last weekend, it’s game on.

Enjoy your reading.

Kristof Decoster

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