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Dear Colleagues,
This issue will first focus on the IMF/World Bank Spring meetings in Washington DC(21-26 April).For obvious reasons, a key question this year was “whether — and how — the U.S. plans to stay engaged with the World Bank and IMF.” Both institutions have been trying to keep “low profile” versus Trump 2.0 so far, while tweaking a bit their rhetoric and key aims (eg: more on jobs (not wrong), less climate (very wrong)). Over here in Europe, at WTO headquarters in Geneva, some are also wondering whether the organisation can survive Trump 2.0. So it’s a “popular” question, clearly (sigh). On Wednesday, the Trump administration made it known (via the US Treasury Secretary) that they will stay engaged with the World Bank and IMF but “want to tackle their ‘mission creep’”. (on a side note: speaking of ‘creeps’, I think the US are currently being run by a bunch)
From some of the discussions in Washington it’s a relatively small step to the Vatican. Indeed, earlier this year, Pope Francis made global debt relief and new processes to aid the poor the focus of the Jubilee year — a mission that “will continue as the central themes despite his death”, according to Eric LeCompte, executive director of Jubilee USA. Sadly, in this Jubilee Year, we’re increasingly being confronted with JD Vance’s ‘post-liberal Catholicism’ ( motto: “Let’s trample the downtrodden even further, while pretending to help them”). It’s a far cry from the other side of the spectrum, Pope Francis’ social justice version of Catholicism. (ps: in an op-ed earlier this week, N Tocci called Francis, correctly, “perhaps the Global South’s most powerful voice, as well as a principled one’”). In any case, if we want to make the world ‘safer, stronger and more prosperous’, I doubt “post-liberal Catholicism” has many answers. On how we can end up in hell on the other hand…. (though Vance & co would probably label it “a Riviera of sorts”).
So let’s hope international and regional organisations find themselves on Francis’ part of the continuum in the coming years, if only to make up a bit for an ever nastier ‘Might is Right’ world. The question shouldn’t be: can we (/they) survive Trump? No, rather – how can we – at last – do what’s needed? As you know, many of these international organisations have had a rather ambiguous track record in recent decades, in spite of their lofty aims & rhetoric. The upcoming Fourth International Conference on Financing for Development in Sevilla, end of June, is perhaps a key occasion to change tack? (Given my catholic upbringing I almost said ‘fingers crossed’)
Meanwhile, far away in Kuala Lumpur, 100+ experts got together for an International Symposium to address the growing influence of Private Actors in Global Health – or Powerful Private Actors (PPAs). In a BMJ Feature article, Ilona Kickbusch singled out the Big Tech sector more in particular as one to watch (and regulate). And not too far away from Malaysia, in Delhi, theregional World Health Summit meeting (25-27 April) has just kicked off. Let’s just hope JD Vance is not in the neighbourhood.
This week is also World Immunization week (24-30 April) – the messaging from international organisations was dire. This newsletter issue also offers a few more takes on the Pandemic Accord of last week, among others the (recommended) BMJ News Analysis, Pandemic accord: global health game changer or empty promises? Somewhere in between, it seems.
Finally, on Earth Day (22 April), The Guardian joined forces with dozens of newsrooms around the world to launch a year-long exploration of the ‘silent majority’ of people who want to fight climate change. “The collaboration builds on a slate of recent scientific studies finding that between 80-89% of the world’s population want stronger climate action. This overwhelming global majority, however, does not realize that they are a majority; most think their fellow citizens don’t agree. Experts agree breaking this “spiral of silence” could be pivotal to spurring critical climate action.” They have all my support, even if I think that’s only part of the answer. (#onwardstoasocialtippingpoint)
In the meantime, it was good to see that at least some “World leaders rall[ied] for ‘full-speed’ climate action ahead of COP30” in a virtual meeting on Wednesday. Here’s to hoping that the silent majority can egg them on, as I doubt every leader present interprets ‘full speed climate action’ the way Guterres does.
Enjoy your reading.
Kristof Decoster
“Agencies call for sustained investments in immunization efforts amidst looming funding cuts.”
“Immunization efforts are under growing threat as misinformation, population growth, humanitarian crises and funding cuts jeopardize progress and leave millions of children, adolescents and adults at risk, warn WHO, UNICEF, and Gavi during World Immunization Week, 24–30 April.”
“Outbreaks of vaccine-preventable diseases such as measles, meningitis and yellow fever are rising globally, and diseases like diphtheria, that have long been held at bay or virtually disappeared in many countries, are at risk of re-emerging. In response, the agencies are calling for urgent and sustained political attention and investment to strengthen immunization programmes and protect significant progress achieved in reducing child mortality over the past 50 years…..”
· Related coverage via UN News –Largely eradicated diseases at risk of returning due to budget cuts.
“Cuts to global health funding are leading to a rise in outbreaks of diseases that vaccines had nearly wiped out, the UN health agency, WHO, is warning on Thursday.”
“In Africa’s “meningitis belt”, which spans parts of sub-Saharan Africa, vaccination campaigns had successfully eliminated meningitis A. Similarly, improved routine immunization and emergency vaccine stockpiles drastically reduced cases of yellow fever and related deaths. But this progress is now at risk. “Funding cuts to global health have put these hard-won gains in jeopardy,” warned Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization…..”
“In 2023, measles cases were estimated at more than 10.3 million – a 20 per cent increase compared to 2022. WHO, UN Children’s Fund UNICEF and their partners warned in a statement marking the beginning of World Immunization Week that this upward trend is expected to continue into 2025…..”
PS: Earlier this month, a WHO review across 108 countries found that nearly half are experiencing moderate to severe disruptions to vaccination campaigns, routine immunisations, and supply chains due to falling donor support.
· And a tweet by dr Tedros:
“Since the 1970s, immunization has saved more than 150 million lives, from diseases like measles, diphtheria, pertussis, and polio. That's more than 4 million lives per year. “
· Link via GAVI - Vaccination progress helps save millions of lives in African region
https://www.who.int/news/item/24-04-2025-who-calls-for-revitalized-efforts-to-end-malaria
“Strong global collaboration has been critical in saving nearly 13 million lives since 2000.”
“On World Malaria Day, the World Health Organization (WHO) is calling for revitalized efforts at all levels, from global policy to community action, to accelerate progress towards malaria elimination. …. …. World Malaria Day 2025 - under the theme, “Malaria ends with us: reinvest, reimagine, reignite” - is calling for stepped up political and financial commitment to protect the hard-won gains against malaria…..”
See also UN News coverage - More action needed to beat malaria for good, says UN
PS: “….On World Malaria Day, Mali will join 19 other African countries in introducing malaria vaccines, representing a vital step towards protecting young children from one of the deadliest diseases on the continent. It is expected that the large-scale rollout of malaria vaccines in Africa will save tens of thousands of young lives every year….”
· And a link: HPW - Malaria’s Gender Divide: Why Women Bear the Brunt of a Global Health Crisis
https://www.devex.com/news/there-s-no-going-back-pope-francis-global-development-legacy-109916
“Issues central to global development, including economic and climate justice, migration, and elevating those on the peripheries were core tenets of the late Pope Francis’ 12-year papacy.”
“…. His approach to development was defined by a radical critique of the global economic system, a belief in the interconnectedness of people and planet, and a drive to empower those at the margins…..”
“But as head of an infamously conservative institution, this liberalism only went so far, and he found himself at odds with the mainstream development agenda when it came to LGBTQ+ and reproductive rights…..”
https://www.devex.com/news/what-to-watch-at-the-2025-world-bank-imf-spring-meetings-109896
Primer published ahead of the Spring Meetings. “The U.S. relationship, funding questions (re IDA), climate tensions, a new energy policy, and the impact of global economic uncertainty.” Some excerpts:
“The biggest question at the meetings? Whether — and how — the U.S. plans to stay engaged with the World Bank and IMF.”
“The official theme of the meetings is job creation.” Eg the World Bank’s Banga: “He’s frequently pointed out that 1.2 billion young people will enter the workforce in the next decade, but the forecast is that only 400 million jobs will be created….”
PS: “Despite political headwinds from Washington, the World Bank is pressing ahead with its climate finance commitments — even as the Trump administration cracks down on climate-related language and funding at U.S.-backed institutions. The bank recently reaffirmed its target of directing 45% of its financing toward climate-related projects, an increase from previous years. Banga emphasized at the press conference that this financing doesn’t come at the expense of core development goals such as education or health, but rather is part of an integrated strategy that treats climate and development as inseparable.”
PS: re Debt and tariffs: “…One area where it might be more difficult to avoid a direct discussion of Trump’s policies is tariffs and trade policy. While the U.S. has instituted and reversed or paused tariffs several times, the unpredictable back-and-forth trade policies will have direct and indirect impacts, from increasing the prices of imported goods and fueling inflation to driving up exchange rates, which increases the cost of loan repayments. The uncertainty also triggers capital flight from low-income countries as investors seek to transfer assets to safer investments. At the same time that debt repayments are getting more expensive as a result of the global economic uncertainty, the prospects for debt restructuring agreements under the Group of 20 leading economies “just seem close to zero at this point,” McNair (ONE Campaign) said. “The idea that we have these formal processes at the G7, G20, U.N., to solve these problems is rapidly disappearing,” he said. “A structured route for finding resolutions to these things is more complex.”….”
“The IMF is likely to acknowledge a growing debt crisis and the G20 is likely to continue discussions on improving the Common Framework for Debt Relief, though it’s not expected to announce anything at these meetings. However, the G20 is close to an agreement on expanding the number of countries that can apply to the Common Framework and for a debt payment standstill, said a debt expert who asked for anonymity to relay private discussions. “There is a lot more internal, behind-doors work on the low-income countries on the sustainability framework review,” the expert said, but they cautioned that most debt-related proposals have stalled — though a new debt playbook to help guide countries facing debt challenges is expected to be released shortly.” “ The tariffs and global instability could push countries into debt default and will certainly lead to reductions of public spending in areas such as health care and education, the debt expert said…..”
https://www.devex.com/news/the-world-bank-is-focused-on-jobs-what-does-that-mean-109898
“Job creation is the new “north star,” but orienting the bank around the mission is a work in progress.”
“The bank’s messaging on climate represents a delicate balancing act between the institution and the U.S., its largest shareholder.”
· And via Devex: Fission quest
“The World Bank is inching toward a major policy shift: lifting its long-standing ban on nuclear energy. Banga wants to include nuclear power as part of a broader strategy aimed at expanding energy access and supporting economic growth, particularly in low-income countries — including in Africa, where 600 million people still lack power…..” “Nuclear is seen as a way to deliver reliable, low-carbon energy — especially for energy-hungry sectors such as data centers and AI — while also helping the United States and its allies compete with Russia and China, which currently dominate the market…..”
“The US president’s economic agenda collides with fragile financial systems, triggering market fears, investor flight and developing nation chaos.”
“The IMF’s latest Global Financial Stability Report sees the danger in Mr Trump’s trade policies, especially his “liberation day” announcements, which have pushed up America’s effective tariff rate to the highest in over 100 years.”
“The IMF put investors on notice that Trumpian volatility was taking place as US debt and equities – especially tech stocks – were overvalued. It cautions that hedge funds have made huge bets that have gone sour, requiring them to sell US treasuries for cash and potentially deepening the chaos in bond markets. Ominously, the IMF draws the comparison, first made by the analyst Nathan Tankus, with the “dash for cash” in March 2020 during Covid, when the Federal Reserve rescued US treasury markets directly. Developing nations, already grappling with the highest real borrowing costs in a decade, may now be forced to take on even more expensive debt – the IMF warns – just to cushion the blow from Mr Trump’s new tariffs, risking a dreaded “sudden stop” in capital flows….”
https://www.devex.com/news/us-treasury-secretary-us-will-stay-engaged-with-world-bank-imf-109921
“The institutions have let “mission creep” push them off course but the U.S. will push them to get back to their core mission and make some reforms.”
The US Treasury Secretary, Bessent: “The IMF should focus on global monetary policy and fiscal stability and the World Bank should hone-in on poverty alleviation and economic growth, he said.”
For more detail, check out then what Bessent said he wants to see (happen) at the World Bank and IMF.
https://www.theguardian.com/business/2025/apr/24/imf-chief-us-trade-deals-global-economy
“Kristalina Georgieva calls for trade policy settlement and says tariff wars have ‘spiked uncertainty off the charts’. MF managing director Kristalina Georgieva has urged the US to strike trade deals urgently to limit the damage to the global economy from Donald Trump’s tariff policies.”
“Speaking at a press conference at the IMF’s spring meetings in Washington, Georgieva declined to criticise the US administration directly; but warned that what she called “major trade policy shifts” had “spiked uncertainty off the charts”. “A trade policy settlement among the main players is essential, and we are urging them to do it swiftly, because uncertainty is very costly,” she said…..”
Launched at the Spring meetings. “The final report of the Expert Review presents a suite of policy recommendations aimed at helping countries break free of the ‘triple crisis’ of escalating debt burdens, climate change and nature loss. The recommendations provide practical proposals on how to unlock finance for sustainable development - a task made even more urgent by the recent geopolitical events…..”
· Related op-ed in Project Syndicate: Climate Action Requires Debt Relief (by V Songwe et al)
“….Over the past year, we have co-chaired the Expert Review on Debt, Nature, and Climate – an initiative launched by the governments of Colombia, Kenya, France, and Germany. In our final report, “Healthy Debt on a Healthy Planet,” we outline several steps that emerging and developing economies can take to break free from the debt-climate trap and move toward a virtuous cycle of low-carbon, climate-resilient, and nature-positive growth……”
“The uncertainty surrounding potential tariffs may be more damaging than the tariffs themselves, drying up liquidity and forcing painful choices for indebted nations, experts say.”
Some excerpts from this neat analysis:
“... Low- to middle-income countries’ debt levels have more than doubled since 2009, according to an analysis by the One Campaign, and the cost of servicing that debt has grown with it. Outside of China, Russia, and Ukraine, low- to middle-income countries paid $311 billion in debt service in 2023. The Trump administration’s tariff war could make it worse. Uncertainty caused by the tariffs is likely to decrease the amount of money available in the market, which lowers the chance that creditors — which include financial institutions such as banks or credit unions, companies, governments, multilateral development banks or bondholders — will allow countries to refinance their debt, a process that experts say is fundamental to debt-distressed countries. …. … The tariffs will also decrease exports, therefore reducing countries’ access to foreign currencies, which they need to pay back their external debt…..”
“While the global debt crisis wasn’t at the top of the World Bank and IMF Spring Meetings agenda, on Wednesday, world leaders proposed a new “playbook” that outlines the process for indebted countries to restructure their debt. … The playbook guides countries on how to assess debt sustainability, whom to hire on legal and financial issues, and how to engage early with creditors….. In the meantime, the IMF has said that cuts in development aid, trade tensions, and possible rising inflation in some countries will push more countries into deeper debt crises.”
PS: “… Experts also say it’s time for low- and middle-income countries and continents to bolster their own monetary institutions. “We’re the only continent without a monetary fund,” said Hannah Ryder, CEO of Development Reimagined and a Kenyan native, adding that the African Union has been working on the idea of a continental fund since 2019. …..”
PS: “…. Comprehensive debt cancellation is unlikely to be popular among creditors, and many fear it will lead to higher interest rates when low-income countries borrow in the future. The emphasis is largely on African nations, which account for 11 of the 17 countries currently dedicating at least 15% of their revenue to external debt repayments, according to Catherine Mithia, policy research and advocacy officer at the African Forum and Network on Debt and Development, or AFRODAD. Some experts based in Africa say that this is a moment to push the development of a financial system and debt agenda that better represents African countries……” “ “This situation highlights the urgent need for a transformative debt agenda and a debt workout mechanism under the United Nations that enhances the voice and representation of African countries in decision-making processes concerning international financial flows,” said Mithia…..” “ Ryder said that this is likely to increase the importance of African financial institutions such as the African Development Bank…..”
· See also Winnie Byanyima - African leaders are rising to challenge of aid cuts, but debt holds them back (22 April)
Among others on the need for urgent debt relief. “…. Of Africa's 54 countries, 34 now spend more on debt than on healthcare……”
And: “….Third, African governments must ramp up efforts to increase revenues through progressive taxation. Africa loses $89 billion every year to illicit financial flows, mostly aggressive tax planning enabled by tax incentives, exemptions, and loopholes. Health levies on tobacco, alcohol, and sugary beverages pose an opportunity to generate short-term revenue, while helping to curb unhealthy behaviours. But the richest should shoulder the greatest burden, and that can only be achieved through taxing wealth, corporate profits, inheritance, and capital gains.”
A Larok (ActionAid International) https://www.thenewhumanitarian.org/opinion/2025/04/22/want-change-aid-system-start-justice-not-charity
“If countries are going to suffer from the sudden disappearance of aid, at least they should not spend large parts of their revenue servicing old and often illegitimate debts.”
Debt & taxes are key.
Excerpt: “…Aid budgets should be defended, but people should also demand effective uses of that aid. This is why we’re also supporting calls for a new UN Convention on International Development Cooperation, which aims to democratise the concept of development and help move aid away from charity towards justice…..” “ People and governments should support an overhaul of the international financial architecture – especially with a new debt convention. If low-income countries are going to suffer from the sudden disappearance of aid, at least they should not spend large parts of their national revenue on servicing old and often illegitimate debts that arise from an outdated and unfair system….”
https://data.one.org/analysis/net-financing-flows-remain-low
Deep Dive analysis (18 April). “Aid and concessional loans have propped up net financing flows to developing countries. With looming aid cuts, those countries face a challenging financial future.”
“With aid cuts of more than 20%, developing countries will struggle to manage debt….”
Joseph E. Stiglitz; https://www.project-syndicate.org/commentary/america-becoming-largest-tax-haven-under-trump-by-joseph-e-stiglitz-2025-04
“In a world where capital and rich individuals can cross borders freely, only international cooperation can ensure that multinational corporations and the superrich are fairly taxed. That's why US President Donald Trump rejects it, and also why his administration has embraced crypto.”
“…. Donald Trump is quickly turning the United States into the greatest tax haven in history. One need only note the Treasury Department’s mandate to withdraw from the transparency regime that shares the real identities of company owners; the administration’s withdrawal from negotiations to establish a UN Framework Convention on International Tax Cooperation; its refusal to enforce the Foreign Corrupt Practices Act; and massive crypto de-regulation…..”
“…. In a world where capital and rich individuals can cross borders freely, international cooperation is the only way for governments to ensure that multinational corporations and the ultra-rich are fairly taxed. In this context, halting the enforcement of beneficial-ownership data collection, tolerating anonymity-enhancing crypto markets, and abandoning the process to conclude a new UN tax convention and a global minimum tax reveal a deliberate pattern: dismantling multilateral frameworks designed to combat tax avoidance and money laundering. The “pausing” of enforcement of the Foreign Corrupt Practices Act indicates that the US no longer minds even bribery and graft. What we are witnessing is an apparent attempt by Trump, Musk, and their billionaire cronies to forge a kind of capitalism modeled after the lawless zones of the offshore world. It’s not just a tax revolt; it’s an all-out assault on any law that threatens the extreme accumulation of wealth and power…..”
“Nowhere is this more evident than in their embrace of crypto. The explosion of underregulated crypto exchanges, online casinos, and betting platforms has boosted the global illicit economy…. …. ….Cryptocurrencies are about one thing: secrecy. We have perfectly good currencies in the dollar, the yen, the euro, and others. And we have efficient trading platforms for buying goods and services. Demand for cryptocurrencies comes from the desire to hide money. People involved in nefarious activities, including money laundering and tax avoidance and evasion, don’t want what they do to be easily traceable. …. … The rest of the world cannot stand by and watch. We’ve seen that global cooperation can work, as shown by the global 15% minimum tax on the profits of multinationals, which more than 50 countries are now introducing. Within the G20, the consensus forged last year under Brazil’s leadership calls for the superrich to pay their fair share. The US has distanced itself from international agreements but, paradoxically, the absence of its diplomacy may help strengthen multilateral negotiations to deliver a more ambitious outcome. In the past, the US would demand that an agreement be weakened (typically to benefit one special interest or another), but in the end, would refuse to sign. This is what happened during the OECD negotiations for the taxation of multinational corporations. Now, the rest of the world can get on with the task of designing a fair and efficient global tax architecture. Addressing extreme inequality through international cooperation and inclusive institutions is the real alternative to rising authoritarianism. America’s self-isolation creates an opportunity to rebuild globalization on truly multilateral grounds – a G-minus-one for the twenty-first century.”
“A new, and near final iteration of WHO’s reorganization will shrink its programme divisions even further than previous drafts – from 10 to only four – with health systems emerging as one key pillar of the revamped organization. “ “ At the same time, disease control departments and preventive health teams – such as health promotion and environment, climate and health, will all fall under one division – for the first time in years, according to a copy of the plan, obtained by Health Policy Watch. This is in contrast to a previous “straw draft” that that had etched out five divisions, including health systems and health workforce rolled into a division with environment and health promotion. …”
“….The new plan for WHO’s headquarters, which boasts 34 departments as compared to nearly 60 now, was presented by WHO Director General Dr Tedros Adhanom Ghebreyesus to both WHO staff as well as to WHO member states at separate, closed sessions on Tuesday…..”
PS: “The new reorganisation, while seemingly radical, would in fact bring the agency’s core functions back to a template similar to the one that was left by WHO’s previous Director General Dr Margaret Chan, when she finished her 10-year tenure as head of the agency in July 2017. But with senior leadership at headquarters being reduced from 11 to just six officials, not including the Director General, the next big question looming in the minds of WHO staff, member states and observers is who will remain? ….”
· See also Devex – WHO to slash senior leadership and departments by nearly half
“In a briefing to member states, WHO Director-General Tedros Adhanom Ghebreyesus said the senior leadership team will be reduced from 12 to seven. WHO departments will also significantly downsize from 76 to 34.”
PS: “….Tedros told member states that while WHO faces a salary gap between $560 million and $650 million for 2026-2027, which represents 25% of staff costs in the current biennium, it “doesn’t necessarily mean a 25% cut in the number of positions.” That will depend on grade and duty station, he said. Some functions are also expected to be relocated to other countries…..”
· And via Geneva Solutions - WHO’s elusive plans to scale back fray nerves
https://www.bmj.com/content/389/bmj.r764
“The political scientist tells The BMJ how WHO can adapt to a world without US funding—and how health systems must change in a tech dominated era.”
Re “The tech industry’s role is interesting”: “This is the area I think will expand most that we are least prepared for and where we would need a strong normative regulatory body that can deal with it. Tech is the big new health industry, and over the next five to 10 years we will see the pharmaceutical industry fall into the shadows compared with that power. The difficulty is, as with some parts of the pharmaceuticals industry, that there are enormous positive benefits for health and health systems in this development of technology and AI—but at the same time there’s a tremendous power grab, privatisation, and many, many harms. The tech industry’s influence is set to surpass that of many countries. With their vast resources and innovative capacities, tech companies are driving advancements in health data analytics, telemedicine, and personalised medicine, fundamentally reshaping healthcare delivery and policy. It’s imperative for WHO to engage proactively with tech companies, establishing frameworks for collaboration that ensure that technological advancements align with public health goals and ethical standards. This includes addressing data privacy concerns and ensuring equitable access to technology driven health solutions….”
https://www.ft.com/content/9c52723a-0da5-459c-9be6-0039b2316058
“Gavi says continued support would help American industry as well as save over 1mn lives.”
“Gavi, the international vaccine alliance, is trying to convince President Donald Trump’s administration to maintain vital funding for the body by arguing that a donation would boost the US vaccine industry, as it seeks to raise $9bn by later this year. Gavi chief executive Sania Nishtar said the organisation had recently held meetings with the administration, and with members of Congress, to argue that the US should continue to contribute 13 per cent of its funds, despite Trump’s efforts to cut foreign aid. She said Gavi was trying to align with the administration’s three priorities of making the US “safer, stronger, and more prosperous”, including by stressing how investment in global health could stop the spread of diseases before they reached America’s shores. ….”
PS: “…. During their meetings with lawmakers in the capital, they had not encountered any overt anti-vaccine sentiment. Robert F Kennedy Jr, secretary of health and human services, has frequently questioned the safety and efficacy of vaccines. She noted that it would be “very difficult” for any other donor to fill the gap that would be left if the US withdrew, even though they had fresh pledges from, among others, the EU, Canada and Indonesia — a new donor that had previously been a recipient of funds — ahead of the agency’s next “replenishment round” which culminates on June 25. “If there’s a shortfall the board will have to make some very tough trade-off decisions.” Gavi’s current aspiration is to vaccinate 500mn children over the next five years, “which is twice as fast as what the trend has been in the past”. If the US contribution was taken out of the equation, “it means we will not be able to vaccinate 75mn children. That translates into about 1.3mn deaths. That’s what the stakes are, which is why we continue to reach out to the US administration,” she added…..”
Antoine de Bengy Puyvallée, Simon Ruston et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-025-01112-9
« ….Using publicly available data, the article analyses the Gates Foundation’s strategic engagement in Europe, focusing on its bureaucratic presence, government relations, and grant-making in its three European focus countries: the United Kingdom (UK), Germany and France. It highlights that, since 2010, the Gates Foundation has built a bureaucratic infrastructure akin to a diplomatic service, establishing country offices in London and Berlin alongside representation in Paris, Brussels and Stockholm. Through regular engagement with elected officials and bureaucrats in these nations, the Foundation has forged many strategic partnerships, effectively leveraging European states’ diplomatic power in wider political forums and alliances. Moreover, the Foundation has disbursed billions in grants to recipients in the UK, Germany, and France to advance research and innovation on its priority health issues, implement programs in poor countries, and develop policy and advocacy related to global health and development. Combined, these efforts have contributed to securing substantial and recurrent government co-investment in Gates-supported initiatives. The article proposes that the Foundation exercises a form of ‘network diplomacy’ that entails building and maintaining wide networks across European societies with the aim of aligning donor governments’ overseas development assistance and policies with the Foundation’s strategic objectives in global health and development. »
“The independent evaluation of the Global Financing Facility (GFF), published in April 2025, offers a unique opportunity to reflect on ten years of work at the intersection of health financing, equity, and systems strengthening. ….”
“… We went through the report’s 400+ pages and read about the success stories and the main challenges. While it highlights several important achievements, it also points to strategic blind spots – particularly around blended finance and the support to the private sector in providing healthcare. Below, we reflect on key takeaways, lessons learned and suggest future directions for the GFF.....”
“…. One of the GFF’s most tangible contributions has been its support for domestic resource mobilization. The evaluation confirms that in countries such as Tanzania and Nigeria, the GFF helped improve public financial management, enabling ministries of health to track spending, advocate for increased allocations, and align domestic resources with health priorities….”
PS: “Looking ahead: our suggestions for the next GFF strategy: The GFF will now work on its strategy 2026-2030, drawing from the lessons from this evaluation. The next phase should be guided by the principles of the Lusaka Agenda, in particular strengthening primary health care, promoting equity and advancing local manufacturing….”
“In a strong act of continental solidarity, His Excellency João Lourenço, President of the Republic of Angola and Chairperson of the African Union, announced a landmark voluntary contribution of USD 5 million to the Africa Centres for Disease Control and Prevention (Africa CDC), reaffirming Angola’s leadership and enduring commitment to strengthening regional health security and sustainable health financing……”
Heba Aly, Nilima Gulrajani, Jessica Pudussery; https://odi.org/en/publications/dialogue-2-using-this-moment-of-disruption-to-transform-development-cooperation/
Recommended. “This second dialogue, held in Brussels in February 2025, brought together over 40 leading thinkers and practitioners from donor agencies, multilateral organisations, research institutes and civil society groups. Together, they tackled a provocative question: In this moment of disruption, how can we catalyse the long-overdue changes needed in development cooperation? This publication summarises the conversations and ideas shared, offering a snapshot of the shifts in mindset, emerging tensions, and new possibilities that defined the dialogue. From surprising scepticism about aid’s future—voiced by both Northern taxpayers and Southern civil society actors—to the urgent need for a new development paradigm, the dialogue laid bare a crucial truth: defending the status quo is no longer enough….”
“Responding to the first draft of the Financing for Development outcome document, this brief puts forward recommendations for ten priority areas of domestic resource mobilisation.”
https://g20.org/track-news/second-g20-health-working-group/
Short report on the meeting in South-Africa (25-28 March).
PS: “The outcomes of this technical working group meeting will inform the discussions at the G20 Health Ministers’ Meeting and Declaration later in the year. The Third HWG meeting will be held virtually from 8 to 9 May 2025.”
R Glennerster et al ; https://www.cgdev.org/blog/radical-simplification-practical-way-get-more-out-limited-foreign-assistance-budgets
Making the following case: “…. now is the time to radically simplify. By choosing a few highly cost-effective interventions and doing them at large scale in multiple countries, we would ensure aid funds are spent on highly effective projects; we benefit from the substantial economies of scale seen in development; a much higher proportion of aid money goes to recipient countries, with less spent on consultants; and politicians and the public can more easily understand what aid is being spent on, helping build support for aid….”
So arguing for radically simpler projects, fewer interventions and fewer countries.
By Masood Ahmed and Minouche Shafik; https://www.cgdev.org/blog/case-health-taxes
“Developing economies face mounting fiscal pressure from slowing global growth, crippling debt service, and steep cuts to international aid budgets. Higher taxes on tobacco, alcohol, and sugary drinks may be part of the solution. Often implemented to improve public health, these taxes have significant fiscal benefits too. They can raise revenue for cash-strapped governments and reduce reliance on foreign donors while lowering health care costs by cutting cases of noncommunicable diseases such as cancer, diabetes, and stroke….”
“A 50 percent increase in the price of tobacco, alcohol, and sugary drinks through tax increases could raise $2.1 trillion for low- and middle-income countries over five years, according to the Task Force on Fiscal Policy for Health, of which we are both members. That’s equivalent to 40 percent of their public health spending and far exceeds official development assistance, which currently amounts to about $223 billion a year…..”
UNU-IIGH press release: https://unu.edu/iigh/press-release/international-symposium-addresses-growing-influence-private-actors-global-health
“International Symposium Addresses Growing Influence of Private Actors in Global Health. The symposium concluded with a powerful call for accountability in the system of global health governance.”
“Convened by the United Nations University International Institute for Global Health (UNU-IIGH) and the Malaysia-based Third World Network, the symposium, titled “Strengthening Global Health Governance: Defending the Public Interest and Holding Powerful Private Actors Accountable,” included over 100 health experts from across the world. Sessions addressed urgent challenges such as the role of transnational corporations in undermining access to essential medicines and the impact of financialization on health service delivery in low- and middle-income countries. …”
“The symposium, co-sponsored by the World Health Organization, Oxfam, and the University of Oslo’s Collective on the Political Determinants of Health, also discussed the rising global concentration of private wealth and its influence on governance and public-interest policy. ….”
Some coverage via Health Policy Watch. A few excerpts on the debates:
“The healthcare sector in India produced 32 billionaires in 2022 – more than any other sector in an extraordinary demonstration of corporatisation, according to Abhay Shukla, co-convenor of Jan Swasthya Abhinyan, the People’s Health Movement in India. Massive investment in healthcare by private companies since the 1990s, particularly in “corporate, profit-driven hospitals”, has sent non-essential procedures and treatments skyrocketing. ….”
“…. “Looking at powerful private actors in global health governance and accountability is both important and necessary,” stressed conference co-convenor Dr David McCoy of UNU-IIGH. “Many people working in global health will perhaps find it odd that we’re looking at powerful private actors and accountability. They’re more used to having conferences that talk about HIV or universal health coverage, or global health financing. “But what you’ll be hearing throughout this symposium is the evidence that demonstrates the link between concentrated power and wealth and its impacts on health and health governance,” stressed McCoy ….” “ “Whether it’s about the unethical and deceitful marketing of commercial milk formula or challenging the abuse of intellectual property rights to keep essential medicines out of the reach of millions of people with HIV, or the truth around the causal relationship between fossil fuels and global warming, there is a long history of public health having to engage with the politics of the world,” said McCoy…..”
“The growing influence of private actors, including big philanthropy, on the UN and its organisations was also raised. “The extreme concentration of wealth in the hands of so few in today’s global economy is itself an existential threat to good global health governance,” said Oxfam’s Anna Marriott. She pointed out that taxing the ultra-wealthy appropriately would provide enough money to address global health and poverty needs. … “This much wealth and power in the hands of so few is intolerable,” Marriott stressed, urging participants to support “global movements’ and multilateral efforts from the global South to tax extreme wealth to raise urgently needed revenue for health”.”
“The symposium concluded with a powerful call for accountability in the system of global health governance, demanding that systems be established to prioritise public interest and hold powerful private actors responsible for their impact on health. Suggestions include greater transparency, stronger regulatory frameworks, more monitoring of private actors and greater collaboration between governments, civil society, and international organisations. “
· For more coverage, see Devex (Andrew Green) - The rise of private global health actors sparks calls for accountability
What are PPAs ? : “They include the range of private foundations, financial institutions, and corporations that are increasingly shaping health outcomes for people around the world. And as they come into focus, so does a growing effort to hold them accountable when they undermine people’s health.”
A few more excerpts:
“…. The discussion comes as it is “likely that the global health system is going to become more dependent and reliant on private funding, both in absolute and relative terms for the coming years,” particularly with Washington’s rapid retreat from global aid and the drawdown of other major donors, David McCoy, a professor of global public health at UNU and one of the symposium organizers, explained at the outset. So the organizers decided to jumpstart global discussions to map out exactly what influence PPAs (Powerful Private Actors) actually have and what, if anything, should or can be done about it….”
“…. At the same time, participants said that development finance institutions, such as the International Finance Corporation, are leading efforts to privatize domestic health care. That has paved the way for private equity firms to buy up hospitals and pharmaceutical companies as part of a broader financialization of health systems……”
“… The point the symposium organizers endeavored to make is not that all of these interventions are bad. Private foundations, for instance, are shoring up lifesaving global health interventions at a moment when donor nations are retreating. But PPA efforts do need to be evaluated to make sure that they are actually improving health services. “We have to start with this big picture, to wrestle with this complexity,” McCoy said. And then, participants agreed to start thinking about how to hold PPAs accountable in instances where they actually do harm. While the academics and activists who gathered in Kuala Lumpur could raise the issue and suggest some guidelines, accountability “ultimately boils down to a question of governance,” McCoy said…..”
L Taylor; https://www.bmj.com/content/389/bmj.r787
Recommended and balanced read. With quotes from Arush Lal, Nina Schwalbe and others. The truth is indeed somewhere in between ‘GH game changer’ & ‘empty promises’, it appears.
PS: “... as the weary national representatives took the floor one by one to give their final discourse, their enthusiasm was more measured. Particularly for lower income nations, any celebration was prefaced by caveats, cautious optimism, and a sense that perhaps the world had not quite reached the transformative treaty many had hoped for…..”
S Shashikant & N Ramakrishnan; https://www.twn.my/title2/health.info/2025/hi250409.htm
“As World Health Organization negotiations on the main text of the Pandemic Agreement conclude, one of the most glaring shortcomings is the failure to secure binding commitments from manufacturers to make vaccines, therapeutics, and diagnostics (VTDs) available during a public health emergency of international concern (PHEIC) or to respond to early outbreaks. This undermines a core objective of the Agreement: the prevention of pandemics. Equally concerning is the absence of any clear obligation on manufacturers to license production of VTDs to developing country manufacturers, an essential measure for expanding global supply and addressing the recurring shortages observed during past PHEICs and pandemics…..”
“.... On the night of 10 April 2025, towards the end of the resumed negotiations on the Pandemic Agreement, general, vague, and non-binding language on the abovementioned elements in paragraphs 7 and 8 of Article 12 on the Pathogen Access and Benefit-Sharing System PABS) was “greened” effectively deferring these critical issues to future negotiations on the PABS system, which will be addressed in an annex after the Pandemic Agreement is adopted at the forthcoming World Health Assembly in May…..”
https://healthpolicy-watch.news/uganda-to-end-ebola-emergency-africa-cdc-may-follow-suit-with-mpox/
With coverage of yesterday’s Africa CDC press briefing.
“Uganda is set to declare an end to its Ebola outbreak on April 26 if no new cases emerge, Africa’s top public health agency announced Thursday. The country’s 83% recovery rate among confirmed cases significantly exceeds the typical 30-40% survival rate for Ebola outbreaks, with Uganda managing to contain the disease while simultaneously responding to mpox cases. ….”
“Boum, who delivered the briefing on behalf of Africa CDC Director John Kaseya, who was attending IMF-World Bank Spring meetings in Washington, also reported “promising news” on mpox, citing declining cases in several countries despite the disease’s continued spread…..”
PS: “….As the continent slowly gets mpox under control, Africa CDC’s Emergency Committee will meet on May 17 to evaluate whether to maintain the Public Health Emergency of Continental Security declaration for mpox that was issued in August 2024…..”
More or less chronologically.
https://www.science.org/content/article/nih-halts-more-collaborations-south-africa-hiv-aids-trials
“International networks told not to start new studies or enroll new trial participants in the country.”
“The U.S. National Institutes of Health (NIH) has now restricted South Africa from participating in clinical trial networks that study new medicines to prevent and treat HIV—compounding the damage to the country’s HIV efforts from President Donald Trump’s administration’s earlier foreign research funding cuts and its dismantling of the U.S. Agency for International Development…..”
“Each coffin was meant to represent 100,000 lives at risk due to cuts to the President's Emergency Plan for AIDS Relief.”
https://www.devex.com/news/philanthropies-fear-trump-will-target-their-tax-exempt-status-109892
(18 April) “Nonprofits and philanthropies brace for executive orders that could revoke tax exemptions for organizations supporting climate and immigration programs.”
“U.S. President Donald Trump made remarks on Thursday that his administration will be investigating the tax-exempt status of groups that contribute to climate projects. Though details have yet to emerge, such a move could have vast implications for U.S.-based philanthropies and nonprofits whose programs target climate change in particular. … Multiple sources told Devex that they have heard speculation about executive orders coming on Monday or Tuesday that could revoke the 501(c)(3) tax-exempt status of foundations that support programming on climate and immigration, and even target foundations that give to organizations overseas. Though unconfirmed, some organizations are already bracing themselves, with one Gates Foundation-affiliated charity removing “climate” and “climate change” from its programming and moving its money out of the U.S. Another organization is considering delaying the launch of its climate initiative. These foundations spoke on condition of anonymity….”
“The Council on Foundations, a nonprofit association, told Devex that there is a “high chance” that philanthropies “will be attacked by the current administration or Congress.”….”
“The draft executive order that could be signed by President Trump would eliminate Africa operations and shut down bureaus working on democracy, human rights and refugee issues.”
“A draft of a Trump administration executive order proposes a drastic restructuring of the State Department, including eliminating almost all of its Africa operations and shutting down embassies and consulates across the continent. The draft also calls for cutting offices at State Department headquarters that address climate change and refugee issues, as well as democracy and human rights concerns. The purpose of the executive order, which could be signed soon by President Trump, is to impose “a disciplined reorganization” of the State Department and “streamline mission delivery” while cutting “waste, fraud and abuse,” according to a copy of the 16-page draft order obtained by The New York Times. The department is supposed to make the changes by Oct. 1.”
“… One of the most drastic proposed changes would be eliminating the bureau of African affairs, which oversees policy in sub-Saharan Africa. It would be replaced by a much smaller special envoy office for African affairs that would report to the White House National Security Council. The office would focus on a handful of issues, including “coordinated counterterrorism operations” and “strategic extraction and trade of critical natural resources.”….”
PS: Rubio dismissed this as ‘fake news’.
https://www.devex.com/news/state-department-releases-new-america-first-reorganization-plan-109913
“To deliver on President Trump’s America First foreign policy, we must make the State Department Great Again,” Secretary of State Marco Rubio said on Tuesday. “
“…This is far from the first reorganization plan centered on the State Department, which now hosts the little left of USAID. But this blueprint is starkly different from the one Rubio’s team sent to Congress late last month — featuring a shuffling of bureaus, offices, and leadership across five undersecretaries and one new, “reimagined” Office of the Coordinator of Foreign and Humanitarian Affairs….”
“That foreign aid office would be referred to as the F Bureau, just like its predecessor. And while it would be responsible for high-level coordination, the majority of foreign aid would be channeled through regional bureaus, an internal document states — with each regional team administering and managing foreign aid themselves…..”
PS: “ In an earlier reorganization plan, the offices of Global Health Security and Diplomacy and Global Food Security — both of which still exist on the latest blueprint — were slated to take on some of USAID’s programming. USAID’s remaining humanitarian work, for example, had been folded into the Office of Global Food Security; the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, for another, had been brought beneath the Office of Global Health Security. But in both cases, those teams now fall beneath the Under Secretary for Economic Growth, Energy and Environment — not the F Bureau. And in both cases, there’s no indication that the State Department is still planning to fold USAID’s programs into the mix. “All non-security foreign assistance will be consolidated in regional bureaus charged with implementing U.S. foreign policy in specific geographic areas,” Rubio wrote in a State Department Substack post, which was published on Tuesday. “If something concerns Africa, the bureau of African Affairs will handle it.” “
“For many USAID staffers who spoke with Devex, that change is cause for concern. …. “Gone is any kind of civil society strengthening, systems strengthening, disease surveillance, disaster risk reduction, or any of the highly efficient initiatives that USAID used to have,” added another former USAID staff member, who requested anonymity to speak freely. “State/PRM does not have the staff to adequately manage and oversee even a much-reduced portfolio of USAID’s humanitarian and development work.”….”
· See also Devex: Diplomats in, experts out
“U.S. Secretary of State Marco Rubio has dropped a sweeping plan to revamp the State Department into an “America First State Department” that will “make the State Department Great Again.” The reorganization cuts 17% of offices, shuffles leadership, and sidelines what’s left of USAID. The biggest shake-up? A new Office of U.S. Foreign Assistance, aka F bureau, to coordinate foreign aid, but most funding decisions would shift to regional bureaus. Critics say that will gut development expertise. “We will have diplomats making deals and signing checks,” says former USAID official Rob Jenkins……”
“An interim U.S. attorney is demanding information about the selection of research articles and the role of N.I.H. Experts worry this will have a chilling effect on publications.”
· Related : Stat Plus - New England Journal of Medicine gets swept up in U.S. attorney inquiry into alleged bias (gated)
“Targeting of prestigious publication — and perhaps others — could signal a coming clash between journals and the Trump administration.”
“…. Last week, at least one scientific journal received a letter from a top U.S. attorney asking it to respond to alleged bias. Now, one of the world’s leading medical journals, has received a similar inquiry as well. The New England Journal of Medicine’s editor in chief, Eric Rubin, received a letter from the interim U.S. attorney for the District of Columbia, Edward R. Martin Jr. in recent days in which the prosecutor asked six questions, largely about alleged bias in the decision to publish unspecified content. The journal told STAT it responded by affirming its commitment to evidence-based recommendations and editorial independence…..”
“In his first public remarks, Bhattacharya emphasizes his overall support for agency.”
““Jayanta “Jay” Bhattacharya, the new director of the National Institutes of Health (NIH), told biomedical researchers in his first public remarks today that he’s pushing to “restore regular order” to the agency after funding cuts and delays, firings, leadership purges, and other upheaval imposed by the administration of President Donald Trump. But he defended several of those changes, such as the cancellation of diversity-related grants and clinical research in South Africa. NIH’s priority now is “the health of the American people,” he said, and supporting Secretary of Health and Human Services Robert F. Kennedy Jr.’s Make America Healthy Again (MAHA) agenda, which means focusing “limited resources” directly on chronic diseases…..”
“The food industry will remove synthetic dyes from the U.S. food supply by the end of 2026, the United States Department of Health and Human Services announced Tuesday, in one of the first, significant moves by new Health and Human Services Secretary (HHS) Robert F. Kennedy Jr. to address an epidemic of chronic diseases in his “Make America Healthy Again” (MAHA) movement. The HHS moves on foods came a day after an announcement that the new US administration would slash funding to the Women’s Health Initiative, supported by the National Institutes of Health. Since 1991, the Initiative has been responsible for a range of landmark studies such as the 2002 findings that hormone replacement therapy was associated with a higher risk of breast cancer. ….”
“While the exact future is uncertain, staff and programs will be cut, maybe nearly entirely, sources say.”
· Related: CGD (blog) - The Impact of Shuttering the Millennium Challenge Corporation (by C Kenny)
“A White House budget proposal for the HHS seen by Devex shows funding for programs that help investigate outbreaks globally and provides research training to U.S. and foreign scientists working in low- and middle-income countries are being eliminated.”
“….. A document outlining the White House’s Office of Management and Budget proposal for the HHS seen by Devex also shows funding for programs such as the Centers for Disease Control and Prevention’s Global Health Center — which helps investigate outbreaks globally — and the National Institutes of Health’s Fogarty International Center — which provides research training to U.S. and foreign scientists working in low- and middle-income countries — are also being eliminated.”
“….One key concern is the impact of the proposed funding cut for the Global Health Center and the lack of clarity on how some of its functions, particularly its work implementing the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, activities, will continue. J Ratevosian said about 30% of PEPFAR implementation, which translates to over $1 billion, happens through HHS, and the center plays a majority role in it. “It's very concerning, because the offices are eliminated, and there’s nothing described that would replace or reorganize them in any other way,” he said. This adds to uncertainties surrounding the future of PEPFAR, the biggest bilateral assistance program for the HIV response, whose future is currently being debated by lawmakers. An internal memo highlighting recommendations from the OMB on foreign aid also recommends slashing PEPFAR’s funding by more than half for 2026…..”
https://www.statnews.com/2025/04/24/vaccine-integrity-project-cidrap-health-secretary-rfk-jr/
“New effort is aimed at safeguarding policy and government information in extraordinary times.”
“Some key public health figures are taking an extraordinary step to try to shore up U.S. vaccination policy, feared to be under threat from Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine critic. The “Vaccine Integrity Project,” which was publicly launched Thursday by the University of Minnesota’s Center for Infectious Disease Research and Policy, will be aimed at assessing the best ways for vaccine proponents to safeguard vaccination policy and information, should government recommendations and information sources become “corrupted,” Michael Osterholm, director of the center, said during a press conference….”
· See also Science Insider - Vaccine experts band together to counter U.S. government misinformation
By Charles Kenny and Justin Sandefur; https://www.cgdev.org/blog/future-delivery-problem-facing-us-foreign-assistance
‘We’ve previously looked at the sectoral and geographic impact of the proposed USAID award cuts. But for those who want to see US foreign assistance back on its feet, it is also worth looking at the impact on awardees—the firms, nonprofits, and international organizations that implement USAID projects. The cuts have shuttered a number of sub-grantees and will likely do the same to prime award recipients. They have further concentrated delivery amongst a few large contractors and set back efforts to localize assistance….. “
Marina Romanello et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00777-9/fulltext
Concluding: “…As the opportunities to prevent the worst impacts of climate change fade, the world stands at a tipping point. The indiscriminate attacks on climate action and dismissal of scientific evidence by the USA presents an unprecedented threat to human survival. The countries responsible for the remaining 89% of greenhouse gas emissions can put the world back on track. United efforts by governments, international organisations, and the scientific community are urgently needed to enable a healthy future for all.”
State of affairs as of 21 April. “….The following administration actions have had a significant impact on U.S. GHS programs:….”
As of 21 April as well.
“As the Trump administration and Congress look to reform PEPFAR, and other U.S. global health programs, in part to ensure that aid does not continue forever, one potential approach is the use of a graduation policy and criteria – that is, metrics for determining when a country is ready to transition away from U.S. support. To inform such efforts, this policy brief reviews the graduation policies of five institutions and programs. Overall, the review identifies the following graduation approaches and components: The use of country-income to target graduation process and threshold; The use of other (non-income based) criteria to target graduation process and threshold; Timeframes that allow for scale-down and predictability; Allowing for re-eligibility for assistance; Accommodating exceptions and emergencies; Continue to monitor countries after graduation.”
“Aid in the Global South - and in Africa, in particular - has at times functioned as a mechanism of control, entrenching asymmetries under the guise of assistance. Now is the time for an unwavering commitment to shift power. Obinna Onyekwena, Deputy Director at the Bill & Melinda Gates Foundation, writes in his personal capacity.”
Wesam Mansour, David Bishai, Irene Torres, Shehla Zaidi, Valéry Ridde, Tiago Correia; https://onlinelibrary.wiley.com/doi/10.1002/hpm.3936
“….This editorial examines the cascading consequences of these shifts, particularly for low- and middle-income countries (LMICs). The U.S. withdrawal is not just a budgetary adjustment, but a significant political disruption with unforeseen effects on global inequities. It also redirects research priorities towards security-driven agendas and undermines capacity-building efforts in LMICs. As the U.S. steps back, new actors will try to fill the vacuum, but the direction of this transition remains uncertain. Whether it paves the way for a more decentralised and equitable global health research ecosystem will depend on how global health stakeholders respond. Crucially, LMICs must seize this moment not only to replace lost funding, but to assert greater autonomy, reimagine health systems financing and build more sustainable, locally led models of research and policy leadership. This editorial calls for urgent diversification of funding sources, strengthened South-South collaborations and increased autonomy for LMICs in setting their own research priorities.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00814-1/fulltext
This week’s Editorial.
“The Lancet stands with CHEST and the other medical journals that are being intimidated by the Trump administration…..”
“The harassment of journals comes amid wider radical dismantling of the USA's scientific infrastructure. …. …. The CDC budget could be slashed from $9·2 billion to about $5·2 billion—a 44% reduction. Although the new proposal says the CDC will focus on “emerging and infectious disease surveillance, outbreak investigations, preparedness and response and maintaining the nation's infrastructure”, the budget eliminates the Global Health Center, which oversees the CDC's global health mission, including the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative, global polio eradication, and outbreaks. How will the CDC maintain its leadership in global health?....”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00818-9/abstract
“Six countries, including China, have been banned from key data repositories. Bryant Furlow reports.”
· And some links:
· Stat report - NIH grants plummeted $2.3 billion in Trump’s first months, as federal-academia partnership crumbles
“Funding of research on infectious diseases and biological systems hit hardest, STAT analysis shows”.
PS: As you will note, the distinction with above ‘Global Health Governance and Financing’ section is not clear, for at least some of below reads. Indeed, there are many obvious links these days between the two sections.
“African countries can break aid dependency by simply capturing the full value of their mineral resources.”
“…. Our continent sits atop some of the world’s largest reserves of the very minerals that will power the future, yet we remain trapped in cycles of aid dependency. It is time to change that….. More than just rocks and metals, these are the keys to the global clean energy transition. Every electric vehicle, solar panel, and wind turbine depends on minerals that Africa has in abundance….”
“Yet here we are, still exporting raw materials like colonial-era vassals while begging for aid from the same countries that profit from our resources. The math is infuriating: We sell raw cobalt for $26-30 per kg (2.2lb), while battery-grade processed materials fetch $150-200. We’re giving away more than 80 percent of the value chain to foreign processors and manufacturers. This isn’t just bad business – it’s economic malpractice……”
S O Oti et al; https://collections.unu.edu/eserv/UNU:10163/Trust-based_decolonial_feminist_philanthropy.pdf
“…. Progress towards gender equality, as envisioned in Sustainable Development Goal (SDG) 5 on gender, has stalled or reversed in many countries because of factors collectively referred to as the “global polycrisis”. These factors include the rise of the anti-gender movement, threats to and assaults on liberal democracy, and the disproportionately gendered impacts of climate change, armed conflict, and forced displacement, among others. Achieving SDG3 – good health and well-being – is unattainable without addressing gender inequalities, which are relevant to at least eight of the 13 targets under SDG3. This paper argues that power imbalances in global health philanthropy perpetuate and exacerbate gender inequalities by systematically excluding women and gender-diverse people from leadership positions and ignoring their voices in policy, programme, and intervention design and implementation. It asserts that global health philanthropy must transition to trust-based decolonial feminist philanthropy.”
Nadia Tagoe, Seye Abimbola, Davide Bilardi, Dorcas Kamuya, Lucy Gilson, Kui Muraya, Sassy Molyneux & Caesar Atuire; https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-025-12566-3
“…. This paper promotes reflexive consideration of health research practices using a decolonisation lens. We propose both incremental and more radical action in five domains: knowledge production, funding and programmes, dissemination, uptake, and education and training. We suggest four steps towards transformation and share a reflexive tool to operationalise these steps.”
“… Our work, as a multidisciplinary Decolonisation and Global Health Research Exchange Network, has broadly focused on unpacking decolonisation debates in health research and broader knowledge practices to contribute to a research and action agenda for positive transformation in the field….”
https://hgpi.org/en/lecture/column-58.html
“…. This policy column revisits the importance of health financing in achieving UHC and introduces several international databases that help monitor and assess its progress. It provides an overview of their respective features, strengths, and limitations. These databases serve as powerful tools for policymakers and researchers to evaluate the sustainability and effectiveness of health systems and act as crucial starting points for global dialogue on UHC…..”
William E Rosa et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00678-6/fulltext
« Just over a decade ago, the World Health Assembly unanimously resolved that palliative care is an ethical responsibility of health systems; however, access to palliative care remains abysmal in low-income and middle-income countries (LMICs). More than 73 million people worldwide experience serious health-related suffering (SHS) each year that is amenable to palliative care—a figure projected to grow exponentially. Yet, only about 12% of all people and 2% of children with SHS receive palliative care, and most of them are in high-income countries; people in LMICs account for over 80% of the global need. Although calls for more and better palliative care policies, education, research, and funding have been repeated, effective implementation strategies to drive access improvements in the next decade are urgently needed. In this Comment, people with lived experience of serious illness, representatives from global and regional palliative care organisations and relevant Lancet Commissions, among other key actors, provide guidance to substantially increase palliative care access by implementing innovations and expanding partnerships across professions and specialties in preparation for the 2025 World Health Assembly, and thereby to measurably relieve suffering in the decade ahead. ….»
R J Lilford et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00537-0/fulltext
Comment related to a new series of two papers on primary care in LMIC cities.
“…In the second Paper in this Series, we argue that shaping the primary care market is likely to provide larger returns to scale than individual quality improvement initiatives….”
“In a bid to tackle the leading cause of death globally among 15–19-year-old girls, the World Health Organization (WHO) today released a new guideline aimed at preventing adolescent pregnancy and its significant related health complications. Among other strategies, the guideline urges rapid action to end child marriage, extend girls’ schooling, and improve access to sexual and reproductive health services and information – all critical factors for reducing early pregnancies among teenagers around the world…..”
PS: “More than 21 million adolescent girls become pregnant each year in low and middle-income countries, around half of which are unintended. With impacts on girls’ education, social connection and future employment prospects, early pregnancy can create cycles of intergenerational poverty that become difficult to break. It also brings serious health risks, including relatively higher rates of infections and preterm births as well as complications from unsafe abortions – linked to particular challenges in accessing safe and respectful care…..”
· Related UN News coverage – Stopping child marriage is key to curbing deadly teen pregnancies: WHO
“Teenage pregnancy remains the leading cause of death for girls aged 15 to 19, which countries could help prevent by allowing them to remain in school and ending child marriage, the UN World Health Organization (WHO) said on Wednesday. Each year, more than 21 million adolescent girls in low and middle-income countries become pregnant. About half of these pregnancies are unintended. Nine in 10 adolescent births occur among girls who were married before turning 18.”
https://www.nature.com/articles/d41586-025-01237-2
“The international community has a golden opportunity to start reining in the escalating, mostly ignored global burden of chronic kidney disease.”
The upcoming World Health Assembly “…. presents an opportunity to reduce the global burden of non-communicable diseases (NCDs), in line with United Nations Sustainable Development Goal 3.4, and it should be seized. Specifically, the assembly should support a resolution that calls for the WHO to recognize kidney disease as a major cause of death and disability globally, and to include it in the organization’s influential list of priority NCDs, alongside cancer, cardiovascular disease, diabetes and respiratory disease. “
“Led by Guatemala, co-sponsored by 19 other countries and supported by the WHO Executive Board, the resolution has widespread backing from researchers and clinicians. ….
PS: “….Kidney disease has a staggering global prevalence — the 2021 Global Burden of Disease study estimated that some 674 million people, or around 8.5% of the global population, have chronic kidney disease (see go.nature.com/42ur6qh). It is one of the fastest-growing causes of premature death globally and is projected to become the fifth leading cause of years of life lost by 2040….”
“…. The WHO resolution needs to succeed. If kidney disease were included on the priority list, the move would signal to national health systems and research funders that they, too, must prioritize it. That would unlock more attention and, ultimately, avoid many, many preventable deaths. So far, few high-income countries are openly supporting the resolution. Some are citing the WHO’s financial crisis as a reason not to back it: it is estimated that around US$16 million is needed to begin putting the resolution into action over a 7-year period. Yet, high-income member states must surely realize that this modest amount will then unlock more funding for diagnosis, treatment and research should kidney disease be included on the WHO’s priority list for NCDs. …”
Hollie Sarah Richards et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00059-2/fulltext
“Burns are a global issue that can result in lifelong multimorbidities and disproportionately affect people in low-resource settings. Prioritising research of importance to patients and health-care professionals improves evidence-based care. This prioritisation setting partnership was undertaken in global burn care (focusing on thermal non-electrical burns) by establishing a James Lind Alliance research priority setting partnership. … …. A short-list of 19 research priorities were ranked at an online workshop attended by 28 participants (14 health-care professionals, ten burn survivors, and four carers or advocates) from 15 countries to produce the final top ten research priorities. These priorities provide opportunities for researchers, funders, and clinicians to shape the future of burns research and improve burns care globally.”
Øystein Bakke & Sally Casswell; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-025-01117-4
“Alcohol is a global health issue with a high level of controversy. After being absent from World Health Organization (WHO) global governing body discussions for about 20 years, alcohol re-entered the agenda in 2005. The expression ‘harmful use of alcohol’ became the compromise language after hard negotiations, an example of ‘adopted language” that has remained for almost 20 years. This article analyses the background and use of the expression 'harmful use of alcohol' in the context of WHO governing bodies, current challenges and implications for public health…..”
https://www.statnews.com/2025/04/21/ireland-pharma-industry-manufacturing-trump-tariffs/
“As the country braces for possible investment losses, drugmakers see their own reasons for concern.”
“…President Trump is less fond of the industry’s operations in Ireland. As he seeks to impose tariffs on goods worldwide, part of a bid to bring companies back to the U.S. and generate jobs, he has specifically called out pharma manufacturing in this country and pledged to announce new levies on drugmakers. In his view, the U.S. trade imbalance with Ireland — one largely driven by pharmaceutical exports — is a particular injustice. As a result, the industry is now caught in his crosshairs, anxiously awaiting details from the administration….”
“…. Over the last fifty years, Ireland has become an unlikely global capital for the pharmaceutical industry, thanks to generous tax policies and a concerted effort to build up a local pharma workforce. Employment in some towns has boomed thanks to the presence of companies like Eli Lilly, which just spent $800 million expanding a countryside campus to meet burgeoning demand for diabetes and obesity medicines. Now, the future of that medicinal engine is in doubt, …. Lilly, Johnson & Johnson, Novartis and AstraZeneca have now announced manufacturing investments in the U.S., trying to convince the administration there’s no need for tariffs. In Ireland, local leaders are hoping they can send the same message…”
“Government health officials told source they were exploring an international reference pricing policy. U.S. pays nearly three times more than other developed countries for drugs. The policy is more concerning to the pharmaceuticals industry than tariffs, sources say.”
“ In 2023, the World Health Organization updated its recommendation for malaria vaccines to include both the RTS,S/AS01 and R21/Matrix-M vaccines, representing a historic landmark in malaria prevention with the potential to save tens of thousands of young lives every year. However, to fully realize this potential, vaccine implementation must be accelerated and optimized to ensure access for the patients who need them most, particularly in settings where malaria transmission is highly seasonal. To respond to this urgent need, eight European and African institutions have partnered with 14 Central and West African countries at various stages of malaria vaccine implementation to form the Optimising Malaria Vaccine Uptake (OPT-MVAC) consortium.”
“Making concerned people aware their views are far from alone could unlock the change so urgently needed.” “ The Guardian is joining forces with dozens of newsrooms around the world to launch the 89% project—and highlight the fact that the vast majority of the world’s population wants climate action….
· For more, see the Guardian: ‘Spiral of silence’: climate action is very popular, so why don’t people realise it?
“Remarks by António Guterres follow virtual meeting with world leaders including China’s Xi Jinping.”
“No government or fossil fuel interest can hold the world back from pursuing a clean energy future, the UN secretary general has said, after a key meeting with the president of China. António Guterres held a closed-door virtual meeting with Xi Jinping of China on Wednesday, along with Brazil’s president, Luiz Inácio Lula da Silva; the EU commission president, Ursula von der Leyen, and about a dozen other heads of state and government, to discuss the climate crisis…..”
· See also UN News – World leaders rally for ‘full-speed’ climate action ahead of COP30
“At a high stakes virtual summit on Wednesday, UN Secretary-General António Guterres and Brazilian President Luiz Inácio Lula da Silva brought together 17 national leaders from major economies and climate-vulnerable countries. The goal was to accelerate global climate ambition ahead of COP30, which will be hosted in Brazil. The meeting was part of a joint mobilisation strategy by the two leaders to strengthen global action under the Paris Agreement and build momentum for stronger national climate plans to be announced in 2025. The two-hour session held behind closed doors included China, the European Union, the African Union, the Association of Southeast Asian Nations, and small island developing States…..”
PS: “Guterres called on countries to deliver a credible roadmap to mobilise $1.3 trillion per year for developing nations by 2035, double adaptation finance to $40 billion this year, and increase contributions to the new Loss and Damage Fund created at COP28…..”
· And via Climate Change News - Xi commits China to full climate plan but emissions-cutting ambition still unclear
“The Chinese president told fellow global leaders that the country’s updated climate plan would cover all economic sectors and greenhouse gases.”
https://news.un.org/en/story/2025/04/1162601
“As the planet heats up and the push to decarbonise gathers pace, Indigenous Peoples – long among the world’s most effective environmental stewards – are once again being left behind, a new UN report reveals.”
“Launched on Thursday, The State of the World’s Indigenous Peoples exposes a stark imbalance: while Indigenous Peoples make up just six per cent of the global population, they safeguard 80 per cent of the planet’s remaining biodiversity – yet receive less than one per cent of international climate funding.”
Chunghong Sheng et al; https://www.thinkglobalhealth.org/article/chinas-integrated-policies-climate-change-and-health
“China is addressing health threats that climate change poses but faces challenges that require policy reforms.”
“As a major player in climate change and global health governance, China has advanced the integration of climate change and health policies at the international, national, and local levels. Those efforts are progressing, but growing challenges highlight that China should consider policy reforms that strengthen health resilience to climate change at home and abroad. ….”
Excerpts: “…. China attaches great importance to promoting climate-health resilience as part of its commitment to improving global health governance. In 2024, the Chinese government made advancing health adaptation to climate change a global priority. China is strengthening its support for climate change capacity-building and health infrastructure development through cooperation with developing countries in the Global South and the Belt and Road Initiative (BRI). China has, for example, provided grants and low-interest loans to help build climate-resilient health systems, enabling vulnerable nations to better address the health impacts of climate change. Since 2016, China has mobilized more than 177 billion renminbi ($24 billion) in climate funding for low- and middle-income countries…..”
Re China's National Policy on Climate Change and Health: “Under its National Strategy for Climate Change Adaptation 2035, China released its National Action Plan for Health Adaptation to Climate Change (2024–2030). The action plan is China's first policy on climate-health synergies and implements the commitment it made at the twenty-eighth conference of the parties (COP28) to the United Nations Framework Convention on Climate Change through the COP28 Declaration on Climate and Health. ….”
“… China is also integrating climate change and health policies at the local level….”
“… China's rise as a pivotal actor in global governance has intensified international expectations for its role in bridging climate and health agendas. Those expectations collide with complex challenges rooted in resource constraints and institutional fragmentation. … China's climate-health integration efforts require urgent, coordinated reforms across global, national, and local dimensions. China should leverage multilateral platforms, including the BRI and the WHO to institutionalize climate-health synergies. Creating a Global Climate-Health Fund under the BRI could enhance transparent governance and resource mobilization while aligning with the WHO's One Health agenda to address interconnected risks. ….”
“This Earth Day, the Lancet Countdown is delighted to announce the launch of its Africa Regional Centre, which will be led by Professor Tafadzwa Mabhaudhi as its newly appointed Director. “
“Headquartered at University of Pretoria, the centre will engage academic researchers in Africa to deliver locally-led, insightful scientific assessments of health and climate change in this region, including the unique impacts, challenges, and responses being pursued…..”
https://news.un.org/en/story/2025/04/1162461
“Without urgent action, climate change could be linked to one in every ten cases of intimate partner violence by the end of the century.” “ That is the warning from a new report by the UN Spotlight Initiative, which finds that climate change is intensifying the social and economic stresses that are fuelling increased levels of violence against women and girls.”
“The report finds that extreme weather, displacement, food insecurity, and economic instability are key factors increasing the prevalence and severity of gender-based violence. These impacts hit hardest in fragile communities, where women already face entrenched inequalities and are more vulnerable to assault…..”
“Every 1°C rise in global temperature is associated with a 4.7 per cent increase in intimate partner violence (IPV), the study finds. In a 2°C warming scenario, 40 million more women and girls are likely to experience IPV each year by 2090. In a 3.5°C scenario, that number more than doubles….”
V Dzau et al ; https://www.nejm.org/doi/full/10.1056/NEJMsb2504599
“Recognizing the urgent need to advance understanding, inform policy and practice, and protect human health in a changing climate, the National Academy of Medicine (NAM), in collaboration with Kaiser Permanente, has developed a Research Agenda to Protect Human Health and Build Resilience in the Face of a Changing Climate. This research agenda is designed to fill critical knowledge gaps, synthesize existing evidence, and make information more accessible and digestible for decision makers. Critically, the research agenda aims to advance understanding, guide policy and practice, and ultimately protect and improve human health in the face of a changing climate…..”
“This agenda identifies four key domains, which emphasize the need for interdisciplinary, equity-centered research to inform policy and practice…..” (cfr Table 1).
https://news.un.org/en/story/2025/04/1162561
“Billions of people around the world are living in fear of job loss or struggling to find work, as economic instability, conflict, and climate shocks combine to erode global security, a new UN report has warned.”
“According to the World Social Report 2025 launched on Thursday, the sobering sentiment indicates a widespread lack of confidence in the future. Despite people living longer, being better educated and more connected than ever before, many believe that life today is worse than it was 50 years ago…..”
https://news.un.org/en/story/2025/04/1162451
“Asia’s sprawling megacities – which are driving economic growth – face an uncertain future as rising temperatures, aging populations and unplanned urban development tests their resilience.”
“Seven of the ten most populous cities in the world are in Asia, with Tokyo, Delhi, Shanghai and Dhaka topping the list. These urban giants, long seen as symbols of opportunity and progress, are now in danger of dragging economies backwards. In a new report, the UN’s regional development arm, ESCAP, warns that without urgent and inclusive action, these stresses could widen inequality, overstretch public services, and deepen social and environmental tensions.”
“In response, Armida Salsiah Alisjahbana, ESCAP’s Executive Secretary, is calling for a new urban model that prioritises equity and resilience. “The road to the 2030 Agenda for Sustainable Development runs through cities and across the entirety of human settlements,” she wrote in a foreword to the report, stressing the need for decisive and inclusive action….”
https://www.nature.com/articles/s41591-025-03590-1
“Prevention research aims to understand, mitigate and ultimately avert the onset and progression of disease and the spillover of pathogens. Such research includes the analysis of risk factors and fundamental mechanisms of disease emergence, early detection and screening, stratification into risk groups, and the development and evaluation of preventive interventions. In the face of population aging and escalating planetary health challenges, such as the climate crisis, prevention research is crucial in mitigating the burden of both non-communicable and communicable diseases.”
“In recognition of the importance of shifting from reactive medicine to preventative approaches, Helmholtz Health has put together a strategic task force dedicated to prevention research. The Helmholtz Association is the largest scientific organization in Germany and, with an annual budget of €5 billion, one of the leading intramural research programs in Europe …. …. The task force has been tasked with outlining a strategic roadmap for strengthening prevention research and its translation globally…..”
https://www.ft.com/content/85d132ea-5501-4a83-991a-b53be9d06a5e
As you know, we have a soft spot for (featuring) Klaus Schwab in this newsletter : )
“A whistleblower claimed Klaus Schwab manipulated the group's Global Competitiveness Report to curry favour with governments, allegations he denied and called 'character assassination'.”
See also the Guardian - WEF launches investigation into founder Klaus Schwab
PS: “…. The accusations prompted Schwab’s resignation as the WEF executive chair on Monday after its board of high-profile trustees – which includes the BlackRock chief, Larry Fink; the IMF managing director, Kristalina Georgieva; the former US vice-president Al Gore and cellist Yo-Yo Ma – held an emergency meeting to look into the claims on Sunday…..”
B M Meier et al ; (gated) Journal of Law, Medicine & Ethics;
“The field of global health law encompasses both “hard” law treaties and “soft” law policies that shape global health norms. Transitioning from “international health law” to “global health law and policy,” global health policymakers have increasingly looked to soft law instruments to address public health needs in a rapidly globalizing world – within the World Health Organization and across global health governance. Yet, as policymakers have expanded the landscape of soft law policy instruments to advance global health across state and non-state actors, the COVID-19 response revealed the limitations of this soft law approach to global health threats, with states now seeking hard law reforms to strengthen global health governance. As hard and soft law can provide complementary approaches to preventing disease and promoting health, future research must conceptualize how these normative frameworks interact in advancing global health.”
https://genevasolutions.news/sustainable-business-finance/keep-calm-can-the-wto-survive-trump
“Countries hit by Trump's impending “reciprocal” tariffs face a dilemma – between cutting bilateral deals or standing firm and saving the multilateral trading system.”
Minouche Shafik; https://www.project-syndicate.org/onpoint/aid-cuts-call-for-new-development-framework-by-minouche-shafik-2025-04
PS: As you might recall, Shafik’s ‘track record’ at Columbia wasn’t exactly a slam dunk.
“As major donors like the United States and the United Kingdom slash aid budgets, developing countries are scrambling to fill massive funding gaps amid rising debt distress. New conditions call for a new global development architecture based on humanitarian assistance, shared public goods, multilateral finance, and a positive-sum mindset.”
“….. what will the future of aid look like? I believe that, moving forward, development will rest on four pillars: humanitarian assistance, global public goods, multilateral financing, and bilateral aid for a smaller subset of countries, driven by a variety of motives…..”
“… While development can continue with reduced international aid – albeit more slowly – real progress is impossible without collective effort. Even in a world increasingly shaped by “might makes right” tactics and negative-sum mindsets, we must continue to uphold and champion the positive-sum logic of international cooperation on trade, financial flows, security, and climate change. Emphasizing the mutual benefits of cooperation could help political leaders make the case for development assistance and pave the way for new kinds of partnerships with developing countries in a multipolar world…..”
Brian L Wong, A Nordström et al ; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004488
“Health diplomacy traditionally relies on consensus-building across nations, yet the accelerating integration of artificial intelligence (AI) into health systems poses new governance challenges. Rapidly changing geopolitical conditions—exemplified by shifts in U.S. global health funding and the expansion of AI beyond national boundaries—underscore the urgency of rethinking traditional approaches. This paper, based on insights from the Prince Mahidol Award Conference 2025 side meeting on “Navigating the Future: AI & Global Health Diplomacy,” examines how AI can reshape the practice of health diplomacy, both empowering and unsettling global health objectives. “
Some key messages: “…Global health is navigating a rapidly changing geopolitical landscape, in which shifts in funding and policy demand agile approaches to AI governance. AI can accelerate progress toward universal health coverage but risks widening inequities if not developed and deployed responsibly. Diplomacy must evolve beyond traditional forums, requiring new technical fluency and ethical guardrails to manage the impacts of AI on health. Effective AI implementation depends on building trust, promoting transparency, and coordinating across multiple sectors and levels of governance. Climate considerations must be integrated into AI strategies to ensure that innovations do not undermine planetary health.”
https://www.nature.com/articles/s41746-025-01618-x
“The Global Initiative on Artificial Intelligence for Health (GI-AI4H), established by the World Health Organization, serves to harmonize governance standards for artificial intelligence (AI). The GI-AI4H spearheads novel on-the-ground efforts, especially in low- and middle-income countries, to advance ethical, regulatory, implementation, and operational dimensions of global governance for health AI. The GI-AI4H’s efforts across the United Nations drives safe, ethical, equitable, and sustainable health AI use for the global community.”
“This paper highlights the four strategic priorities of GI-AI4H’s global governance framework for health AI and the innovative on-the-ground efforts that drive countries towards safe, ethical, equitable, and sustainable AI use….”
https://www.globalpolicy.org/en/publication/future-financing-development-what-role-un
“Monitoring, review, norm setting and coordination.”
“The 4th International Conference on Financing for Development (FfD4) is due to take place in Seville, Spain from 30 June to 3 July 2025. According to the United Nations (UN) Member States, the conference is designed to assess progress and obstacles in implementing the outcomes of the three previous FfD conferences in Monterrey (2002), Doha (2008) and Addis Ababa (2015), as well as agreeing on measures and initiatives to overcome obstacles and address new challenges in the face of global crises. The main aim is to accelerate implementation of the 2030 Agenda and its Sustainable Development Goals (SDGs) and to support the reform of the international financial architecture. “
“… This briefing describes the institutional framework through which the outcomes of previous FfD conferences have been monitored and further developed at the UN level. It also examines current proposals for the monitoring and follow-up of the forthcoming FfD4 conference, highlights good practices from other policy areas and explores which UN bodies and processes could play a role in shaping the international financial architecture following the Seville conference…..”
Rightly authored by Daniel Cash 😊.
A Tabarrok; https://link.springer.com/article/10.1007/s11127-025-01277-2
“….Rather than blaming individual actors or assuming better leadership would have prevented disaster, I examine how standard political incentives—myopic voters, bureaucratic gridlock, and fear of blame—predictably produced an inadequate pandemic response. The analysis rejects romantic calls for institutional reform and instead proposes pragmatic solutions that work within existing political constraints: wastewater surveillance, prediction markets, pre-developed vaccine libraries, human challenge trials, a dedicated Pandemic Trust Fund, and temporary public–private partnerships. …”
L Rosenzweig et al; https://www.cgdev.org/blog/vaccines-approval-high-stakes-bet-middle-income-countries-must-make-next-pandemic
“….. middle-income countries (MICs) ….. occupy a precarious middle group in the global health security architecture: too wealthy to qualify for substantial donor aid yet lacking the fiscal capacity of high-income countries (HICs). Investing in at-risk procurement involves navigating fiscal constraints, political risks associated with spending domestic finances on unproven vaccines, and complex domestic and international legal barriers around procurement. Previously, we suggested five steps multilateral development banks (MDBs) can take to enable at-risk purchasing ahead of the next pandemic. However, one question often arises: would middle-income countries seek at-risk financing, given competing budget priorities?”
“Estimates from the COVID-19 pandemic indicate that the cost of at-risk investment during the COVID-19 pandemic would have been significantly lower than what many countries spent on social benefits while awaiting vaccines. Given these fiscal costs, the broader economic toll of pandemics, and the value of the early action, MICs have compelling economic reasons to plan for at-risk investments, and the MDBs should actively facilitate these preparations ahead of future pandemics…..”
With examples from Peru and the Philippines.
Alessio Ciullo et al; https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000564
“Anthropogenic global warming affects all aspects of ecosystems and human life. Thus far, most climate impact studies have mainly focused on local impacts because climate-driven hazards – e.g., floods, storms, heat waves – occur locally. However, as the occurrence of past events has already shown, local climate impacts cascade across sectors, regions and scales, possibly leading to systemic risks. Here we highlight the main (4) transmission channels of climate-driven systemic risks, and outline how they can challenge the achievement of the sustainable development goals. We argue for more research into integrated modeling frameworks, understanding and modeling of transmission pathways and systemic climate risk governance approaches.”
Cole King; https://www.tandfonline.com/doi/full/10.1080/17441692.2025.2492234?src=
“The world’s population is rapidly urbanising, especially in low- to middle-income countries. However, urban living is associated with an increased risk of neurodevelopmental disorders (NDD) like autism spectrum disorders (ASD) and schizophrenia. Exposure to urban air pollutants like particulate matter has been positively associated with both ASD and schizophrenia diagnosis rates. Mechanistic studies have shown that particulate matter exposure leads to brain inflammation and white matter pathologies consistent with these disorders. Children are especially susceptible to these effects due to their rapidly developing nervous systems. Despite this, few reviews on the subject recommend future steps to mitigate the teratogenic effects of particulate air pollution. This commentary both synthesises evidence and recommends research and policy goals to protect children, both present and future, from the neurodevelopmental consequences of particulate air pollution. These steps include further study of the relationship between air pollution and equitable resource distribution to address the coming global rises in NDD. ….”
“The world’s coral reefs have been pushed into “uncharted territory” by the worst global bleaching event on record that has now hit more than 80% of the planet’s reefs, scientists have warned. Reefs in at least 82 countries and territories have been exposed to enough heat to turn corals white since the global event started in January 2023, the latest data from the US government’s Coral Reef Watch shows.”
“Coral reefs are known as the rainforests of the sea because of their high concentration of biodiversity that supports about a third of all marine species and a billion people. But record high ocean temperatures have spread like an underwater wildfire over corals across the Pacific, Atlantic and Indian oceans, damaging and killing countless corals. The fact that so many reef areas have been impacted ... suggests that ocean warming has reached a level where there is no longer any safe harbour….” “…. The 84% of reefs exposed to bleaching-level heat in this ongoing fourth event compares with 68% during the third event, which lasted from 2014 to 2017, 37% in 2010 and 21% in the first event in 1998….”
“Blocking sunlight could temporarily slow the climate crisis but the technologies remain highly controversial.”
https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.70015
By Joshua B. Horton, Wake Smith, David W. Keith.
“Approach might help plaintiffs win compensation from top emitters.”
“In a paper appearing today in Nature, the researchers spell out a method for quantifying how much the emissions from a particular polluter contributed to a given heat wave. For instance, the authors say they can attribute hundreds of millions of dollars in damages from an extreme event to a single major fossil fuel company…..”
“Much-disputed idea that Covid-19 originated in Chinese lab now dominates Covid.gov.”
V Haine et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00096-8/fulltext
« RTS,S/AS01E has been successfully administered to over two million children since 2019 through the Malaria Vaccine Implementation Programme (MVIP). In this Article, we report the safety results of a study evaluating RTS,S/AS01E safety and effectiveness in real-world settings….”
“….We found no evidence of vaccination being associated with an increased risk of meningitis, cerebral malaria, or mortality among vaccinated children, and no new safety risks were identified…..”
Symon M Kariuki et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00122-6/fulltext
“Brain infections are important causes of non-traumatic coma, particularly in low-resource areas of Africa and Asia. The WHO Intersectoral Global Action Plan on Epilepsy and Neurological Disorders incorporates neuroinfections (eg, meningitis, encephalitis, HIV, cerebral malaria) in their strategic objectives including “to provide effective, timely and responsive diagnosis, treatment and care”. These aspirations are advocated upon well by the two Articles by Stephen Ray and colleagues, published in The Lancet Global Health, which are timely and of public health importance. The Articles are complementary. The systematic review synthesises evidence on the morbidity and mortality associated with non-traumatic coma and illustrates the need to invest in advanced tools for diagnosis to optimise treatment and improve outcomes. These gaps in diagnosis and characterisation of features and outcomes of non-traumatic coma are addressed in a real-world scenario in the prospective cohort study conducted in Queen Elizabeth Central Hospital in Blantyre, Malawi…..”
Related:
https://www.bmj.com/collections/malaria-control-china
“…. China's certification as malaria-free by WHO in 2021 marked a historic milestone, the result of decades of dedicated efforts. A key factor in this success was its stratified vector control strategy. Has it been sustained and what lessons are there for other countries pursuing malaria elimination, especially those in Africa where over 90% of cases and deaths occur? This BMJ Collection, in collaboration with the Chinese Center for Disease Control and Prevention, Beijing, outlines China’s vector control strategies, offering insights for global malaria control and elimination efforts. A tailored approach was undertaken, adapted to regional economic and social development, malaria epidemic intensity, vector diversity, and climatic, geographical, and cross-border conditions. By highlighting China’s strategies, techniques, and lessons learned, this Collection serves as a resource for other countries, helping to inform policy, strengthen vector control approaches, and support international malaria control initiatives.”
“A new modeling study highlights the potential threat that human antibiotic use may pose to global waterways, researchers reported yesterday in the journal PNAS Nexus.”
Independent - What is Type 5 diabetes? New form of disease
“Recognised after decades of debate; This form of diabetes is rare and inherited by birth.”
“A new type of diabetes that’s linked not to obesity but to malnutrition has been officially recognised, decades after it was first observed in developing countries. The International Diabetes Federation (IDF) this month officially recognised the disease as "Type 5 diabetes" or Maturity Onset Diabetes of the Young (Mody). The rare form of diabetes is believed to affect about 25 million people globally, and is caused by malnutrition-induced low insulin production among lean and malnourished teenagers and young adults in low and middle-income households, according to reports…..”
“The new disease, distinct from Type 1 and 2 diabetes, was officially recognised through a vote on 8 April at the IDF's World Diabetes Congress in Bangkok, Thailand following years of debate over its identification……”
“Researchers say mutations more often found in younger patients’ tumours caused by toxin secreted by E coli strains.”
“…. The scientists found that hallmark genetic mutations caused by colibactin, a toxin secreted by some harmful strains of E coli, were more than three times as common in tumours removed from patients under the age of 40 than in those from patients over 70. The same signature mutations were also more common in countries with the highest rates of early-onset bowel cancer, according to the study, which has been published in Nature…..”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004398
By L Drown et al.
https://www.bmj.com/content/389/bmj.r782
“We need to understand more about how susceptibility to misinformation is socially patterned so that it doesn’t deepen health inequalities, say Simon Williams and Sander van der Linden.”
By Mathilde de Jeu and Irene van den Berg, The Investigative Desk; Geneva Health Files;
How Big Food Profits from Health Hype: “Large food manufacturers are also positioning themselves as 'health companies'. Not by making their chocolate, sauces, and desserts less unhealthy, but by capitalizing on the increased demand for dietary supplements and medications caused by all that unhealthy food. Recent years have seen unprecedented investments in health products by food companies. Global interest in weight-loss drugs is adding to the trend. In 2024, the WHO called on governments and health organizations to take action against the health-undermining tactics of the food industry…..”
“It’s an invasive practice that has been tackled by court rulings and government action. So why is it still going on?” “….. the Bureau of Investigative Journalism (TBIJ) can reveal that schools in some African countries are continuing the practice in breach of national guidelines or legal judgments.”
S Lee et al; https://www.nature.com/articles/s41591-025-03624-8
“Systematic analysis from the GBD study reported that, despite improvements from 1990 to 2021, dietary iron deficiency-associated disease burden remains high in women, children and residents in low socio-demografic index countries. “
Etienne V. Langlois, Giulia Gasparri, Rajat Khosla ; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004519
« The world is facing unprecedented threats to global health and international development. The decrease in international financing for health, the rising geopolitical tensions and threats to multilateralism, the increasing number of conflicts, and the intensifying threats of climate change all pose a growing concern for the health and well-being of the most vulnerable populations. Newborns and children are always the most affected by these compounding crises, which risk washing away decades of progress in newborn and child health….”
The WHO Risk Stratification Working Group (WHO-RSWG) https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00045-2/fulltext
“We aimed to identify readily assessable child-level characteristics that can predict mortality risk in a range of community and health-care settings in high-burden settings…..”
· Related Lancet GH Comment: Every baby counts: eliminating all preventable child deaths
“….In The Lancet Global Health, the WHO Risk Stratification Working Group (WHO-RSWG) sought to identify infants and children younger than 5 years at high risk of mortality to improve current preventive strategies. WHO-RSWG's analyses aimed to identify factors that could inform guidelines for providers regarding which children are likely to be at higher risk of death and thus require additional health-care resources. Conversely, they also sought to determine those for whom less intensive care or fewer follow-up visits might be needed, which theoretically could free up resources to focus on children at high risk……”
“A new study suggests repeated antibiotic use in early childhood is linked to a host of chronic conditions in children. The study, published this week in the Journal of Infectious Diseases, found that antibiotic exposure before age 2 years was positively associated with asthma, food allergy, hay fever, and intellectual disability, with stronger associations observed following multiple antibiotic courses. ….”
“The findings add to a growing body of evidence that early exposure to antibiotics—which are the most commonly prescribed medication in young children and frequently overused—is associated with increased risk of childhood-onset diseases and neurodevelopmental conditions. Other studies have found links to a higher risk of obesity. The hypothesis is that these conditions may be occurring because of the way antibiotics disrupt the gut microbiome, which is still in development in infants. The study authors say the results highlight the need to limit unnecessary antibiotic use in young children…..”
Rose Weeks et al; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004473
“Despite the well-documented life-saving potential of pneumococcal conjugate vaccines (PCV) and global efforts to widen vaccine availability, access to PCV in middle-income countries (MICs) has remained suboptimal due, in part, to vaccine pricing and limited external funding opportunities. To understand gaps and opportunities for improving vaccine equality, this qualitative study engaged leaders from governments, medical institutions, and health agencies who were based in MICs that did not currently have PCV in their national immunization programs to explore their perspectives on decision-making contexts and constraints related to PCV introduction…..”
https://www.cidrap.umn.edu/tuberculosis/global-drug-facility-cuts-price-critical-drug-resistant-tb
“The Stop TB Partnership's Global Drug Facility (GDF) has cut the price of a key component of multidrug-resistant tuberculosis (MDR-TB) treatment regimens by 25%.”
“The reduction, announced last week, cuts the price of pretomanid produced by generic drugmaker Lupin to $169 per treatment course when purchased through the GDF, down from $224 in October 2024. Developed by the TB Alliance, pretomanid is part of two shorter, all-oral treatment regimens recommended by the World Health Organization for treating MDR-TB—BPaL (bedaquiline, pretomanid, and linezolid) and BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin).”
“The Stop TB Partnership, which created the GDF in 2001 to promote equitable access to TB drugs and diagnostics, says the price reduction will save its clients upwards of $3 million per year. In addition, it establishes a reference price that high-burden TB countries can use in price negotiations when they are procuring pretomanid directly from suppliers. Combined with recent price reductions for bedaquiline, linezolid, and moxifloxacin, the price of a 6-month BPaLM treatment course has now been reduced by 47%, an amount the Stop TB Partnership says will save national TB programs roughly $37 million a year…..”
· See also Lancet Infectious Diseases (Newsdesk) - Price cut for drug-resistant tuberculosis medicines
https://www.ft.com/content/b5ed8bf5-fdd2-462b-a92c-96f0d985a685
“Vast majority of drugs prescribed in America are off-patent generics made in lower-cost countries.”
“Health unions across Pakistan's most populous state, Punjab, have launched widespread protests under the umbrella of Grand Health Alliance (GHA). The provincial government has decided to privatise public health services, including essential primary healthcare facilities. The unions are demanding roll back of the decision and a seat on the table to work towards pro-worker and pro-people alternatives…..”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004234
By Beatriz Barreto-Duarte et al.
https://www.tandfonline.com/doi/full/10.1080/17441692.2025.2480646
By Hansjörg Dilger et al.
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00103-2/fulltext
By E K Tannor et al.
https://www.economist.com/briefing/2025/04/24/emigration-from-africa-will-change-the-world
“As other countries age, they will need African youth.”
The Briefing ends on the following note: “….Africans need jobs; the rest of the world needs workers. That confluence of interests is a massive opportunity, if only both sides have the good sense to seize it.”
Jonathan Kanter et al; https://jamanetwork.com/journals/jama/article-abstract/2832535?widget=personalizedcontent&previousarticle=186937
“For the past decade, antitrust enforcement and policy have focused on the growing size and power of big tech platforms. Enforcers have homed in on the expansive reach and influence that technology platforms have over our lives and how the growing scale and size of platforms have blocked out smaller rivals, created outsized negotiating leverage, and raised barriers for new and innovative companies. In this article, we argue that a smaller number of massive health care conglomerate platforms exhibit many of the same concerning characteristics as big tech platforms and that similar antitrust attention and action may be necessary. We argue that policymakers and stakeholders should look beyond the individual services that each platform offers and consider the power and influence created by the conglomeration of services and formation of multisided platforms that function as essential health care intermediaries.”
https://www.thelancet.com/journals/langlo/issue/current
· Editorial: Renewing our commitment to maternal and newborn survival
Check out the full issue!
Yafei Si et al; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004551
Among the findings: “We analyzed data from 1990 to 2021 to measure ASEAN’s progress toward health targets in nutrition, maternal and child health, infectious and non-communicable chronic diseases, environment health, universal health coverage, and road injuries. Overall, countries improved in nutrition, maternal and child health, and universal health coverage, but they struggled to reduce infectious diseases, non-communicable chronic diseases, environmental risks, and road injuries. Singapore and Brunei are likely to achieve most targets by 2030, whereas countries like Laos, Philippines, and Cambodia face significant challenges….”
Adalsteinn Brown, Robert J. Reid; https://onlinelibrary.wiley.com/doi/10.1002/lrh2.70008
“... Despite the attractiveness of the LHS (Learning Health Systems) vision, progress on adoption by systems remains slow. In this commentary, we consider one potential reason, namely politics, or the ways in which government bodies, interest groups, and political ideas shape structures and policies.”
https://academic.oup.com/oocc/article/5/1/kgaf014/8108829?login=true
By Amanda V Quintana , Susannah H Mayhew , Sari Kovats & Lucy Gilson.
“Deeply saddened about the passing of His Holiness Pope Francis. His was a humble yet powerful voice of wisdom and humanity. I had the honour to meet with him several times - each time I felt personally inspired by his humility. Our troubled world needs more leaders like His Holiness — to champion peace and put the poorest and most vulnerable first. He will be greatly missed.”
“Somehow a medieval theocracy created one of the most progressive leaders in Europe. I’ll miss Pope Francis.”
“Sometimes good decent people die within hours of meeting nasty evil people. It’s coincidence.”
““The level of urban starvation in Gaza has not been seen since the Dutch Hunger Winter and the siege of Leningrad during the Second World War.””
Quote related to Alex De Waal in the London Review of Books : How to Measure Famine (on the classification of catastrophe in Gaza)
“Would be very happy if I never again heard a high-income government official talk about “self-reliance” or “self sufficiency” in global health. It is global North that depends on the global South for net funding inflows. There’s plenty of mone;y for health, it just isn’t where the people are.”
“Not sure what the point of words is any more. We are witnessing pure evil, and even worse, we are witnessing the full-throated support of that evil among all our institutions, from governments to political parties to media organisations to judiciary. It's a masks off moment.”