Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife.

Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship –  but none required a negative blood test, as this could remain positive “for months”.

This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients.

The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands.

“We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision.

Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid.

Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases.

He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood.

“We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg.

“We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation.

Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”.

“We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia.

As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge.

“We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia.

Early phase is most dangerous

All the experts agreed that the early stages of infection were the most risky for transmission.

Zingg said that their research indicated that the infectious period is two days before the first symptoms.

Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. 

“Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown.

This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”.

Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients.

However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate.

A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak.

US evaluates home situation

Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. 

“Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet.

Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. 

“The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added.

Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine.

Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this.

Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public.

However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns.

Image Credits: BBC.

The recent Ebola outbreak serves as a grim reminder that nature does not wait for treaty negotiations on pandemic preparedness.
Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC.

Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going.

Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch.

The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan.

Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom.

“We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch.

This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya.

“We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added.

The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”.

Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries.

Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge.

Non-engagement with WHO?

WHO's Dr Roseline Belzaire (centre) and Africa CDC's Dr Yap Boum on the ground in Ituri in the DRC to address Ebola.
WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola.

The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO.

Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. 

The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees.

Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak.

“In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu.

Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response.

‘Unpredictable and unprofessional’

However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”.

“Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch.

“Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law.

“Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic.

“CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.”

Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF.

“When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded.

Image Credits: Joël Lumbala/ WHO.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. 

World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency.

This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France.

Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July.

Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. 

“The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.”

The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries.

“The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. 

“They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.”

Three steps forward

Tedros and Lula da Silva propose three urgent steps forward:

First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”.

“Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” 

Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade.

The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens,  and get swift access to tests, treatments and vaccines to address these.

“Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes.

It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty.

“Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates.

“Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.”

“Those are people who are being killed socially.”

​That is how Dr. Marcus Lacerda, Director of the WHO-hosted Special Programme for Research and Training in Tropical Diseases (TDR), describes children whose futures are shaped by repeated bouts of vivax malaria.

​

​Lacerda, who joined TDR in March 2026, has spent more than 25 years studying infectious diseases in the Brazilian Amazon. He is perhaps best known as a driving force behind tafenoquine, the first single-dose radical cure for Plasmodium vivax malaria approved in four decades.

​Speaking on the latest episode of Trailblazers with Garry, hosted by Dr. Garry Aslanyan, Lacerda reflected on the experiences that have shaped his career and the lessons he has learned over decades of work in tropical medicine.

​His path began as a young medical student when Catholic missionaries invited him to visit remote communities in the Amazon.

​”I fell in love [with] the population, I fell in love [with] the geography,” he recalled. He ultimately became convinced that his life’s calling was to practice medicine, particularly focusing on the diseases prevalent in the Amazon.

​That decision led him to focus on vivax malaria, a disease often overshadowed by more deadly infections but one that carries profound social consequences.

​One study conducted by a master’s student in the Amazon followed hundreds of children and found that those who had experienced at least one episode of vivax malaria performed worse in school than their peers.

​”Malaria sometimes kills, but sometimes it kills you in the sense of not allowing those kids to go to the university,” Lacerda said.

​Despite major advances in diagnostics, treatment and prevention, Lacerda argues that scientific innovation alone will not eliminate malaria.

​”So now we have the tools, but we don’t have the same appetite for eradication,” he said, noting that competing national priorities have pushed malaria down the global agenda.

​For Lacerda, the challenge ahead is not only developing new solutions but ensuring countries have the support and determination needed to put existing ones into practice.

Listen to the full episode >>

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Image Credits: https://www.buzzsprout.com/1632040/episodes/19280656.

“It wasn’t unusual for shells and missiles to smash through the upper floors, leaving sizeable holes. Every time we were hit, we’d wonder if we should close the hospital.”

​That is how Dr. Amani Ballour, a Syrian paediatrician and the first female director of a hospital in a Syrian war zone, recalls working in an underground medical facility during the Syrian civil war. Yet despite repeated attacks, “the people kept coming, and we kept working. We never did close the cave.”

​Speaking on the Global Health Matters “Dialogues” podcast, Ballour described six years spent treating civilians under siege in Eastern Ghouta, where hospitals became targets and medical workers struggled to provide care with dwindling resources. The underground facility known as “The Cave” cared not only for war injuries but also for children suffering from hunger, disease and a lack of basic medicines.

​Among the most traumatic moments was the August 2013 chemical attack on Ghouta. Arriving at the hospital in the middle of the night, Ballour found hundreds of victims struggling to breathe.

​”The hardest thing was to choose how to begin,” she recalled. “The people whom we will start helping will live, but other people will die. So we have to choose who’s going to live and who’s going to die.”

​The siege also created a public health catastrophe. Food, medicines and infant formula were scarce. Ballour remembered treating children whose primary complaint was hunger.

​”The first question I asked them was, ‘What are they suffering from? What they have, they said, ‘I’m hungry, I need to eat.'”

​Today, Ballour serves as Programme Advocacy Officer at the Syrian American Medical Society and continues to advocate for accountability for attacks on healthcare.

​”International humanitarian law is already protecting the health workers and the medical facilities,” she said. “There must be stronger enforcement mechanisms, like independent investigations, and real consequences for those who target healthcare.”

​For Ballour, preserving the stories of those lost remains essential.

​”Silence allows injustice to be normal,” she said. “Keeping their stories alive is a way of honoring their lives.”

Listen to the full episode >>

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Image Credits: Global Health Matters Podcast.

The Panchachuli peaks, part of the Himalaya range between India and Nepal.

Home to 1 in 4 people globally, the region should brace for “multi-hazards” and poor air quality apart from heat and water stress, according to a new report. The authors called on countries in the fractious neighbourhood to cooperate on data and form common solutions.

The monsoon season this year is likely to bring more water and heat stress, rather than relief, to South Asia, home to over two billion people – a quarter of the world’s population. 

This preliminary assessment comes from the Hindu Kush Himalaya Monsoon Outlook 2026 for June to September, which draws on global and regional climate outlooks for South Asia. 

The countries covered include Afghanistan, Bangladesh, Bhutan, China (the Xizang/Tibet Autonomous Region), India, Myanmar, Nepal, and Pakistan. Of these, much of Afghanistan and Myanmar are forecast to have a better, even above normal, monsoon in parts than the other countries. 

By contrast, the India Meteorological Department has forecast a below normal monsoon, at 92% average levels of 87 centimetres during 1971–2020 with a 5-percentage point error margin. 

The eight countries are members of the International Centre for Integrated Mountain Development (ICIMOD) based in Nepal, which produced this report; the other authors are from the Institute of Atmospheric Physics, Chinese Academy of Sciences (IAP-CAS). 

Worryingly, the ICIMOD’s report forecasts that temperatures will be about 0.5 to 2° above normal compared to a recent 15-year period, 2010-2024, which saw many of the hottest years on record. 

Threat of multi-hazards

Twin peaks of Nanda Devi, in the Himalaya range between India and Nepal.

A weaker monsoon does not reduce disaster risks, however, the report said. 

Floods account for a significant proportion of disasters in the Hindu Kush Himalaya region. The threat of floods and other water-induced hazards may be further amplified by the cascading nature of multi-hazards. 

In the HKH in particular, warmer temperatures, reduced snowfall, declining water availability, and lower river flows are likely to place additional stress on communities directly dependent on the monsoon. Erratic rainfall, especially after prolonged dry spells, can still trigger landslides and flash floods in mountain regions. 

In India, for example, between 2024 and 2025, more than 8,000 lives were lost due to disasters across Himalayan states, including Assam, Arunachal Pradesh, Himachal Pradesh, and Jammu and Kashmir.

The monsoon outlook “gives disaster management authorities a critical window to prepare,” said Navneet Yadav, Team Lead for Disaster Risk Reduction and Climate Resilience at Palladium India.

Air quality is also likely to take a hit. It is “logical” that a weaker monsoon will remove fewer pollutants from the air, the report’s authors said in response to a question from Health Policy Watch. 

“Warmer and drier conditions favour wildfires. Dust, ozone formation, et cetera,” said Saswata Sanyal, Disaster Risk Reduction Manager at ICIMOD. “So should the region be preparing for a poor air quality season, along with heat and water stress? Absolutely.”

The region is home to almost all of the world’s top 100 most polluted cities, making the waterfall effect on poor air pollution particularly dangerous. 

Impact of drier, hotter monsoon

RMC = Regional Member Countries of ICIMOD.

The impacts are likely to extend beyond the mountains. 

Increasing temperatures, both maximum temperatures and night-time temperatures, may adversely affect human health due to heat stress people may face during heatwaves, particularly when combined with higher humidity. 

Heat stress occurs when the body cannot dissipate excess heat; when that happens, the body’s core temperature rises and the heart rate increases. 

Livelihoods will also be adversely impacted, according to the report. In agriculture, for instance, higher temperatures and lower water availability can lead to heat stress in crops and livestock, reduce yields, and shorten growing seasons, particularly in already marginal mountain farming systems. 

Elevated temperatures can also intensify evapotranspiration – evaporation from water bodies and transpiration from plants – and the loss of soil moisture, further compounding the impacts of droughts. 

Hydropower generation is also likely to decline, particularly in Nepal and Bhutan, which may further exacerbate existing stresses on national and regional energy supplies.

Can South Asia work together?

The risks are high, and so are tensions among several of the countries. ICIMOD may include representatives of all the region’s countries, but it is “apolitical”. The authors acknowledge that all countries “need to be on board” for data sharing to work.  

ICIMOD says it is trying to provide a platform where data generated by a monsoon or snow outlook can be used across borders, and be a space for countries to discuss these challenges and “form common solutions”.

Given the risk of hazards intensifying through the combination of above-normal temperatures and erratic rainfall, the report calls for better coordination to share relevant information quickly with disaster management networks.

“There is always some inhibition among the countries to share data openly with each other,” Sanyal said. “Obviously, you understand there’s a lot of politics involved.” 

Image Credits: Chetan Bhattacharji.

Prevention programmes have borne the biggest brunt of the cuts, while The number of people receiving pre-exposure prophylaxis (PrEP) at least once in the year fell 38% between 2024 and 2025, the report shows. 

The global HIV response is facing its “biggest storm” since the world united against the epidemic, UNAIDS warned Friday, as it published new data showing donor funding for HIV/AID prevention and community services critical to containing infections dropped by almost one quarter last year.

The Global AIDS Brief is being published just 10 days ahead of the United Nations High-Level Meeting (HLM)  in New York City, where member states are due to adopt a new Political Declaration on ending HIV/AIDS as a public health threat by 2030.

It is the first comprehensive damage assessment of the funding shock that hit HIV response and the entire array of global health crises in 2025.

External development assistance to HIV/AIDS programmes fell by 23% last year, the sharpest drop on record, the report reveals. 

This followed on the Trump administration dismantled USAID and slashed contributions to the HIV response the United States had anchored for two decades. The result is an HIV response that is collapsing.

Most serious disruption in decades

Winnie Byanyima, UNAIDS executive director, said the disruption is unquestionably the most serious the HIV response has faced since the late 1990s, when the world came together to fight the disease with the creation of UNAIDS, followed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief (PEPFAR)  and the WHO 3×5 initiative. 

Today’s shrinking civic space and the spreading criminalization of marginalized communities is converging into “the biggest storm the HIV response has ever seen,” Byanyima warned.

Alongside malaria, HIV has been among the best-funded causes in the history of international health development, with the US pouring more than $100 billion into PEPFAR since 2003, the largest commitment ever made by one nation against a single disease.

Together with the Global Fund, US Funding channeled via PEPFAR and USAID accounted for roughly 86% of all donor financing for HIV in 2024. What was built on that money is now unravelling with it.

Some 1.2 million people acquired HIV in 2025, a dramatic 43% decline since 2010 – and reflective of the results the combined efforts have yielded on the ground.

AIDS-related deaths fell 57% over the same period to 570,000. And of the 40.9 million people living with HIV worldwide, 32.1 million were on treatment last year.

But the world missed every one of its 2025 targets, and the new numbers may be a final snapshot before the cuts register in the epidemiological record.

The report describes 2025 as “a profound shock to global health financing” that destabilized HIV responses across many countries, disrupting service delivery, supply chains and community systems. The full effects, it warns, will only become evident over the next few years.

Byanyima said the response now stands at the most perilous moment in its history, with decades of hard-won gains at risk of unravelling just as the tools to end the epidemic have finally come within reach.

Prevention programmes 80% donor dependent in disarray

The deepest cuts are in prevention which only received 11% of HIV  funding overall in 2024. In sub-Saharan Africa, prevention programmes depended on donors for 83% of their funding when the cuts hit, the UNAIDS report found.  Globally, two-thirds of prevention programmes were funded by external donors.

The number of people receiving pre-exposure prophylaxis (PrEP) at least once in the year fell 38% between 2024 and 2025 across 62 countries reporting to UNAIDS, including in countries with the highest HIV burdens.

Data from PEPFAR, the US bilateral programme, show HIV testing declined 22% in high-burden countries over the same period. Funding for condom programming fell 93%, and support for programmes ensuring people can actually reach services, such as supportive laws and policies, dropped 80%.

Every week, 3,000 adolescent girls and young women in sub-Saharan Africa acquire HIV. Incidence in this group runs three to four times higher than among their male peers, and women account for six in ten new infections in the region, according to the report data.

The HIV response collapse comes at a moment when science has delivered the most powerful prevention tools in the epidemic’s history. Lenacapavir, a twice-yearly injection that almost completely blocks HIV transmission, is a life-changing drug that isn’t reaching the people who need it most.

Lenacapavir reached just over 6,000 people across five sub-Saharan African countries by the end of March, against the 20 million people UNAIDS estimates need antiretroviral-based prevention. The gulf between the potential of the medicine and access for those who need it is one of the starkest examples in global health of how innovation and science are not solutions on their own to solving medicines access issues.

Rights in retreat

For decades, the slow drift of HIV-related law around the world moved in only one direction: toward decriminalization. That tide has now turned. For the first time since UNAIDS began tracking the data, criminalization of the marginalized populations most at risk of HIV is increasing.

Two countries introduced new criminal laws targeting same-sex sexual activity or gender expression in 2025, and one increased penalties for same-sex relations in 2026. The report does not name the countries, but Burkina Faso criminalized same-sex relations for the first time in its history last September, with sentences of two to five years in prison plus fines, while Trinidad and Tobago’s Court of Appeal reinstated its colonial-era buggery laws in March 2025. Neighbouring Mali had criminalized homosexuality months earlier, in its December 2024 penal code.

Just seven of 193 countries do not criminalize at least one of same-sex sexual activity, sex work, possession of small amounts of drugs, transgender people, or HIV non-disclosure, exposure or transmission. Outside Chile, Colombia, the Netherlands, Paraguay, Slovenia, Uruguay and Venezuela, at least one of the populations most at risk of HIV lives on the wrong side of the law everywhere on Earth.

Sex work is criminalized in 168 countries and drug possession in 152. Same-sex sexual activity is illegal in 66 countries, more than half of them in Africa, where penalties range from heavy fines to 14-year sentences in Nigeria, Kenya and Malawi, life imprisonment in Tanzania, Zambia, Sierra Leone and The Gambia, and the death penalty for “aggravated homosexuality” under Uganda’s 2023 law.

Epidemics accelerate wherever human rights protections collapse, Byanyima warned, describing the global rollback of rights and civic space as organized, political, and devastating for public health.

When people fear arrest or discrimination, they do not test and do not seek care. CIVICUS, the civil society monitor, found civic space narrowed, obstructed, repressed or closed in 159 of 198 countries and territories in 2025, leaving just 7% of the world’s population living in countries where civic space is open or relatively open.

“No country seems immune from this deeply worrying trend,” said Mandeep Tiwana, CIVICUS secretary general, presenting the findings in December.

The last declaration before the SDG 2030 deadline

Next week’s UN High-Level Meeting will produce the final Political Declaration before the 2030 deadline that world leaders set under the Sustainable Development Goals to end AIDS as a public health threat. 

The goal is not actual eradication of the virus, but reducing new infections and deaths by 90% compared to 2010, shrinking the epidemic to a scale health systems can manage.

This year’s declaration will set new targets drawn from the Global AIDS Strategy 2026-2031: 

  • 40 million people on ARV treatment 
  • 20 million accessing antiretroviral prevention, 
  • and HIV services free of stigma and discrimination for all.

Meeting those targets would avert 3.2 million new infections and 1.2 million deaths by 2030, according to UNAIDS modelling. See related story. 

Fighting for its own survival 

The declaration will be negotiated around an agency fighting for its own survival. UN Secretary-General António Guterres proposed sunsetting UNAIDS by the end of 2026 in his UN80 reform plan last September, triggering an outcry from member states and more than 1,000 civil society organizations, as Health Policy Watch reported in October.  See related story.

https://healthpolicy-watch.news/with-future-of-unaids-in-question-top-official-says-very-difficult-to-envision-2026-shutdown/

UNAIDS is already cutting its secretariat staff by 54% and consolidating country offices from 85 to 54 under its own board-approved restructuring.

“I’m seeing death, real people dying,” Byanyima told the World Health Summit in Berlin last October, as UNAIDS modelling projected the funding collapse could cause an additional 6.6 million new HIV infections and 4.2 million AIDS-related deaths by 2029 if services are not restored.

The world has the science, the medicines and the experience to end AIDS by 2030, Byanyima said. What remains, she argued, is a political choice for the leaders gathering in New York: invest in finishing the job, or retreat and watch it come undone.

Image Credits: Wikimedia Foundation.

The blood collection drape, an inexpensive plastic sheet with a pouch at its base that hangs off the end of the delivery table and collects and measures blood lost by women during and after labour.

Every year, around 27 million women bleed excessively after giving birth, and almost 43,000 die – yet there are new ways for this to be detected and treated.

This is according to a series on maternal health published in The Lancet on Friday by the United Nations Special Programme of Research, Development and Research Training in Human Reproduction (HRP), the World Health Organisation (WHO) and Oxford University.

Post-partum haemorrhage (PPH) is the leading cause of maternal mortality, and it can also result in “severe anaemia, hysterectomy, organ failure, and long-term psychological trauma”. The global economic burden of PPH is estimated at $10·4 billion.

Babies whose mothers die in childbirth also have a significantly higher chance of dying than their peers, according to studies conducted in Ethiopia and rural Tanzania.

“Women who are most likely to die from PPH are those who have home births; those with anaemia or pre-existing medical problems; those who have a caesarean birth, particularly an emergency caesarean at full cervical dilation; and those delivering in health-care settings with staffing challenges,” according to the first paper in the series.

Substandard clinical care is “a root cause” of PPH deaths, presenting as “missed or delayed PPH diagnosis, slow and fragmented delivery of treatment interventions, and agonisingly late escalation of care”. 

Identifying haemorrhaging

Health workers can save women’s lives by applying the latest guidelines on treating PPH without waiting for expert intervention, the series asserts.

If PPH is not recognised and treated early, a woman can deteriorate very quickly and die, according to the researchers.

A woman should be treated for PPH as soon as she has lost 300ml of blood – slightly more than a cup – and shows abnormal vital signs, or if she has lost 500ml of blood – whichever comes first, according to the series.

This definition is the result of several studies and consultations after the WHO found the definition of PPH varied widely across the world.

In the past, health workers visually estimated blood loss – but the researchers describe this as so “grossly inaccurate” that it missed half of PPH cases.

Now, blood loss can be measured by a “blood collection drape” – an inexpensive plastic sheet with a pouch at its base that hangs off the end of the delivery table and collects and measures blood. 

The series promotes a simple first-response treatment bundle, known as E-MOTIVE, with each letter representing an intervention – Early detection of PPH, uterine Massage, Oxytocic drugs, Tranexamic acid, intraVenous fluids, and Examination of the genital tract.

E-MOTIVE, the intervention steps that can save lives.

By using E-MOTIVE, health workers can reduce the progression to life-threatening haemorrhage by up to 60%.

But managing life-threatening PPH requires” the immediate attendance of the emergency team, which should include senior obstetricians and anaesthetists”, the series notes. 

“The immediate priority is to assess and resuscitate the woman through management of her circulation, airway, and breathing. Bleeding should be controlled, and transfusion of blood and blood products should be done if required.”

Achievable goals

The series describes the steps to reduce PPH as “achievable goals that could transform PPH outcomes globally”.

“The essential knowledge and tools to substantially reduce PPH-related morbidity and mortality now exist; the primary challenge lies in translating this evidence into consistent clinical practice across diverse health-care settings,” the series concludes. 

“Success will demand sustained commitment from policy makers and health-care leaders, adequate resource allocation, and continuous quality improvement efforts.”

Dr Wahome Ngare, who accused the Gates Foundation and CEPI of ‘genocide’.

Ghana’s parliament invited a vociferously anti-vaccine Kenyan and a conservative Dutch activist campaigning to curtail the World Health Organization (WHO) to address visiting MPs on “health sovereignty” last week.

Ghanaian President John Mahama – who is championing African “health sovereignty” via an initiative called the Accra Reset – was a keynote speaker at the WHO’s World Health Assembly last month, and is drumming up international support for the initiative.

Yet Ghanaian Speaker of Parliament Alban Bagbin, a leader in Mahama’s National Democratic Congress, hosted Dr Wahome Ngare and Wilmer Hak, from ultra-conservative Christian Council International (CCI), and sat back as they made inflammatory and wild claims about the WHO, the Gates Foundation and other health initiatives during their speeches.

Describing COVID-19 vaccines as an “assault”, Ngare accused the Gates Foundation and the Coalition for Epidemic Preparedness Innovations (CEPI) of “genocide” for “gain-of-function” research – erroneously claiming that they are manufacturing viruses to infect humans so they can develop and profit from vaccines.

In the past, Ngare has also denounced numerous routine childhood vaccines, claiming that they lead to infertility and ill-health, despite evidence that vaccines have halved African babies’ deaths over the past 50 years, according to a recent Lancet study.

Ngare also claimed that the WHO was trying to use pandemics to grab power through the International Health Regulations, which set out rules to contain epidemics. He heads a largely dormant group called the African Sovereignty Coalition, and also chairs the Kenya Christian Professionals Forum. 

He also denounced the WHO definition of health as being “godless”, said people with “same-sex attraction” had been sexually abused as children and suffered from “a very serious mental illness called post-traumatic stress disorder”, and called for “single parents” to be referred to as “absent spouse families”.

Wilmer Hak, policy director of the ultra-conservative Christian Council International (CCI).

Meanwhile, Hak said that the WHO is financed largely by private companies and the pharmaceutical industry, which is why it was focused on fundraising for pandemics – as this would ensure that these groups profited.

Hak also claimed that the WHO Pandemic Agreement aims to centralise power during global health emergencies – which is false as  the Pandemic Agreement explicitly states that the WHO will not have any authority to direct or alter a country’s laws or policies, or require measures such as lockdowns, travel restrictions or vaccination mandates.

Hak also claimed incorrectly that the WHO and various international human rights mechanisms have “intensified their calls for universal access to sexual and reproductive health and rights (SRHR) without any limitations”. The WHO is member-state-led so it cannot adopt policies at odds with the majority of its members, all 193 countries in the world except the United States.

Hak said that the WHO should work towards “progressive redundancy, as national capacities mature”, and referred MPs to the right-wing think-tank, the Brownstone Institute’s International Health Reform Project – an anti-WHO initiative. The Brownstone Institute was a signifiant source of anti-vaccine messages during the COVID-19 pandemic.

‘Family values’ charter

Delegates at the fourth annual meeting of the Inter-parliamentary Conference on Family, Sovereignty and Values, hosted by Ghana’s parliament.

The pair’s speeches were part of the fourth annual meeting of the Inter-parliamentary Conference on Family, Sovereignty and Values, a conservative initiative that has been campaigning against sexual and reproductive health rights for several years – with the backing of US and European conservative Christian groups, including Hak’s CCI and Family Watch International, a US group that has lobbying African politicians for two decades to oppose SRHR, LGBTQ rights and sex education in schools.

The conference is developing a draft “Charter on Family, Sovereignty and Values” that it aims to present to the African Union for adoption. 

However, the draft treaty already contradicts several continental human rights-based treaties – including the African Charter on Human and Peoples’ Rights (ACHPR), the Maputo Protocol, and the African Charter on the Rights and Welfare of the Child (ACRWC).

Felix Kwakye Ofosu, Ghana’s Minister of State in Charge of Government Communications, failed to respond to Health Policy Watch’s queries about why Ngare and Hak were invited and whether their views on health sovereignty reflect those of the Ghanaian government.

However, Health Policy Watch first reported on an alliance between anti-rights groups opposing sexual and reproductive health rights and anti-vaxxers in 2024, at the second meeting of the Inter-parliamentary Conference on Family, Sovereignty and Values in Entebbe, Uganda.

Ngare also addressed that conference, where he claimed that several vaccines caused infertility, and also attacked the WHO. He was supported by Shabnam Mohamed, executive director of the Africa Chapter of Children’s Health Defense, the anti-vaccine group started by current US Health Secretary Robert F Kennedy Jr.

This alliance mirrors developments in the United States, where conservative Christians opposed to abortion and LGBTQ rights have united with Kennedy’s ‘Make America Healthy Again’, which is led by several anti-vaccine activists, to maximise their power in the Republican Party.

Last week’s conference was held shortly after the Ghanaian parliament passed one of the most repressive anti-LGBTQ laws in the world, following a similar pattern to Uganda, which also tightened up its anti-LGBTQ law before hosting the conference in 2024.

Burkina Faso is due to host the next conference in 2027, and MPs attending last week’s meeting were urged to drum up support for the Charter in the next year.

However, South Africa’s delegate told the conference that her country would not adopt such a charter as it “contradicts our Constitution and … does not align with the regional and international laws that we believe in”.

Dr Jean Kaseya addresses the media briefing.

Only around 12% of the contacts of Ebola patients in Ituri province in the Democratic Republic of Congo (DRC) have been reached, posing a “huge risk” for community transmission, Dr Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention told a media briefing on Thursday.

Ituri is the epicentre of the current outbreak, accounting for 600 of the 635 confirmed cases by 9 June. 

Around 4,955 contacts have been recorded, but Kaseya said that in high-density urban areas, such as the mining towns in Ituri, each patient would have been in contact with around 40 people.

This would mean 24,000 contacts. As less than 60% of the current contacts had been traced so far, Kaseya said this meant that only around 12% of case contacts had been found and tested.

“If we don’t know these people, if we don’t have them on the [contact] list, if we don’t follow up, it means there is a huge risk of transmission to be sustained in the community,” he said, adding that some confirmed cases had still not been admitted to hospitals. 

Obstacles to contact tracing include “the rapid geographic expansion [of the outbreak], delayed detection, high mobility, insecurity and community resistance”, said Kaseya. 

“We saw that people attacked health workers today in Beni [in northern Kivu]. People  destroyed an isolation centre, they destroyed a treatment centre.”

Unlike the DRC, Uganda has followed up 91% of contacts of its 19 Ebola cases, there is no community transmission, and the country is “doing very well”, said Kaseya, adding that it is “totally wrong” to impose travel restrictions on the country. 

Conflict in the outbreak zones is also hampering the response, with new clashes between the DRC and M23 rebels in Beni.

“We cannot respond to this outbreak when we are facing insecurity, and this is why we are calling to our leaders to give us access to people and, as the EU requested, we really to have the ceasefire, otherwise this outbreak will continue,” said Kaseya.

There are also “huge” resource gaps. The reponse needs 540 staff yet only 84 are available, and 98 ambulances but it has to make do with seven.

So far, the current outbreak is the third biggest in the history of the past 20 Ebola outbreaks. Some 27 health zones in the DRC now report Ebola cases, more than double the 14 affected zones 10 days ago.

Young people aged 15 to 44 years of age make up 62% of all cases. However, the outbreak is particularly deadly, with a 44% case fatality rate in young children up to the age of four.

Risk to health workers

Professor Salim Abdul Karim, chair of Africa CDC’s Emergency Consultative Group, addressed the media briefing from Bunia, a town in Ituri.

Of the 22 Ebola patients currently in the local hospital, five are health workers, said Abdul Karim.

“That gives you some idea of the risk frontline health workers are facing,” he said. “Frontline healthcare workers are always at higher stress because they are the ones who are dealing with the patient’s blood and the patient’s secretions, and they are the ones who are directly involved in the care of the patients.”

“These are hospitals not specifically designed to deal with haemorrhagic fevers. Patients are presenting initially with a range of symptoms that can easily be mistaken for other common conditions like malaria, so it’s those early stages that we need better triage systems.”

So far, 34 health workers have been infected in the outbreak, and five have died.