IAS president Beatriz Grinsztejn, UNAIDS executive director Winnie Byanyima, Erika Castellanos, executive director of the Global Action for Trans Equality, Dr Joe Phaahla, South Africa’s Deputy Minister of Health, Dr Jarbas Barbosa, Director of the Pan American Health Organization (PAHO) and Dr Mariângela Simao, Brazil’s Secretary of Health and Environmental Surveillance.

RIO DE JANEIRO – Donor funding for HIV dropped by 25% in 2025 – a staggering drop of $2.1 billion – driven by the United States slashing its funding, according to analyses by KFF and the Joint UN Programme on HIV/AIDS (UNAIDS). 

This is the largest single-year drop ever, reducing funds to 2007 levels, according to the reports released shortly before the opening of the International AIDS Conference on Monday.

In 2025, US disbursements for HIV totalled $4.6 billion, down from $6.7 billion in 2024.

Although spending from HIV’s other key donors remained steady in 2025 (at $1.6 billion), they had already halved their aid since 2011 ($3.2 billion). 

The US remains the largest HIV donor to HIV in the world, and its total donor government funding for HIV has risen from 59% in 2011 to 74% in 2025 in the face of other donors’ retreating commitments. 

France, the UK, Japan, and Germany are the other major HIV donors. However, when ranked by their contributions in relation to GDP, the Netherlands ranks first, followed by the US, Denmark, Norway, and France.

Impact on prevention

Forty-one million people were living with HIV in 2025, 1.2 million of whom were infected that year.

“Every day, around 3,400 people acquire HIV around the world. Every day, around 1,600 people die from AIDS-related illnesses. The HIV pandemic is not over. Without urgent action, it could resurge,” Byanyima warned. 

The funding cuts also threaten global 2030 targets – particularly to reduce HIV infections by 90% in comparison to 2010 levels.

The impact has been felt across all programmes, but prevention services have been particularly badly affected. 

Pre-exposure prophylaxis (PrEP) programmes, antireviral medicine taken to prevent HIV transmission, and condom purchases “declined drastically and suddenly between 2024 and 2025 in some countries”, according to UNAIDS. 

“In countries with a high level of HIV, funding for condom programming declined by 93%, and funding for programmes that ensure people can reach prevention services (eg supportive laws, regulations and policy environments) reduced by 80%,” said UNAIDS.

In Cameroon, Nigeria and Zambia, the number of people receiving PrEP declined by more than 50%. 

Meanwhile, a new study estimates that over 75,000 people will become infected with HIV within a year as a consequence of full withdrawal of the US President’s Emergency Plan to Fund AIDS Relief (PEPFAR) and no additional government or international support. Zimbabwe has been unable to reach agreement with the US on new HIV funding.

“Efforts to reach the 2030 targets are threatened by converging crises, including declines in external financing, high debt burden in the countries most affected by HIV, a growing number of humanitarian crises and displacements globally, emerging epidemics such as Ebola, and a backsliding on human rights and gender equality, which all impact HIV services,” according to UNAIDS.

Domestic funding is not enough

UNAIDS indicates that around 60% of the HIV response is now funded by domestic resources. 

Dr Joe Phaahla, South Africa’s Deputy Minister of Health, said that African countries were continuing to strengthen domestic investment.

However, Phaahla warned that the 25% cut in a single year had forced African governments “to make very difficult prioritisation decisions at a very high speed”.  

The cuts have affected “the availability of medicines, commodities, pre-exposure prophylaxis and treatment commodities, and community health workers, surveillance and data systems”, he added.

“No country can replace the scale of international partnership that has driven the global HIV response for decades,” warned Phaahla. “Ending the HIV pandemic will require stronger domestic financing, sustained international support and shared responsibility.”

Decades of progress in jeopardy

This HIV treatment centre in Bahir Dar in Ethiopia has closed as a result of funding cuts.

The funding cuts threaten decades of progress, Bwanyima warned.

“Since the peak of HIV, new infections have fallen by 65% and AIDS-related deaths have fallen by 73%. More than 28.5 million lives have been saved through antiretroviral treatment. Today, 32.1 million people are receiving life-saving treatment, the highest number in history,” said Byanyima. “This is one of the greatest public health achievements of our lifetime. But let’s be clear: progress is not the same as victory.

“Last year, 1.2 million people acquired HIV, 570,000 people died from AIDS-related illnesses, and 8.9 million people with HIV are without life-saving treatment, and nearly 45% of children living with HIV are still not on treatment.”

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), described progress against HIV as “fragile”.

“We have the tools, the knowledge and the evidence to save lives and prevent new acquisitions. The challenge now is to sustain the commitment, investment and solidarity needed to reach every person who needs prevention, testing, treatment and care, and to finish the job,” said Tedros.

Swing to the right

Dr Mariângela Simao, Brazil’s Secretary of Health and Environmental Surveillance.

Dr Mariângela Simao, Brazil’s Secretary of Health and Environmental Surveillance, said the funding crisis was partly due to the “increasingly conservative world”. 

“We are seeing that conservative ways tend to criminalise or punish people that are different, [and] create problems for access to the treatment people deserve. The human health to right the right to health is a human right,” she added.

Erika Castellanos, executive director of the Global Action for Trans Equality (GATE), who has been living with HIV since 1995, supported Simao.

“I have watched medicines transform HIV from a death sentence into a manageable health condition, but I have also watched people die while those medicines existed,” said \ Castellanos.

“I have watched many of my friends die while those medicines existed. Science did not fail my friends. Science did not fail those people. Politics did. Survival is determined by a healthcare system recognising our humanity, a government considering our lives worth protecting, and a world that is willing to pay the cost of keeping us alive.”

End of UNAIDS?

UNAIDS itself faces an uncertain future amid a United Nations-wide funding crisis. As part of his UN80 reform plan, the UN Secretary-General has proposed “sunsetting” the programme by the end of this year and “mainstreaming capacity and expertise into relevant entities of the United Nations development system in 2027”.

However, International AIDS Society (IAS) president Dr Beatriz Grinsztejn said that losing UNAIDS would be a “big mess”, particularly for tracking data on HIV.

Grinsztejn acknowledged that UNAIDS would likely need to scale back further, but “we do need UNAIDS to stay in place, and we hope that this can be the final decision”. 

“We already have a big issue that most of the systems are not in place anymore for us to understand the numbers: the number of infections, the number of deaths, the number of people on treatment and on prevention.”

UNAIDS has already slashed staff by around 55%, and its Geneva head office has been massively reduced.

The UNAIDS Programme Coordinating Board (PCB) has set up a working group to develop “a plan on the further transition and integration of UNAIDS into the UN system and beyond, in coherence with the UN80 Initiative and based on a realistic financial scenario” by October.

The working group is mandated to identify “functions and units to be transferred, transformed, downsized, merged, decentralised, and/or absorbed by the UN system and other stakeholders”. 

How to preserve UNAIDS functions 

However, the PCB has stressed that UNAIDS core functions “must be preserved and safeguarded either together in a single unit or with individual UN entities”. It also directs the working group to ensure the “preservation of the role of communities and civil society”, a hallmark of UNAIDS operations.

The PCB has also tasked UNAIDS executive director Winnie Byanyima with preparing a 2027 workplan and budget “aligned with the ongoing downsizing and informed by the plan of the working group”.

Addressing the PCB earlier this month, Byanyima said: “Even in a complex global political context, UNAIDS still has that unique power to unite the world behind a shared vision to end AIDS as a public health threat by 2030.

“We will not deliver on that promise through institutions alone. We will deliver it through people, through the communities who refuse to be invisible, through the staff who carry this mission every day, through leaders in governments and partner organisations acting with courage in the face of uncertainty.”  

While the international AIDS conference has scaled back significantly in recent years, the Rio conference has still managed to attract 7,000 delegates, under the theme“rethink, rebuild, rise”, 

Image Credits: UNAIDS.

Dr Delese Mimi Darko, Director General of the African Medicines Agency.

When the African Medicines Agency became operational in Kigali in October 2025, it inherited one of the continent’s most difficult health-policy problems: how to make medicines regulation faster, more trusted and less fragmented across 55 African Union member states.

For years, African countries have relied on a patchwork of national regulators, regional harmonisation initiatives, WHO prequalification, collaborative registration procedures and external pathways such as Swissmedic’s Marketing Authorisation for Global Health Products. Those systems have helped accelerate access to some products, but they have not removed the deeper problem of fragmentation.

For Dr Delese Mimi Darko, the inaugural Director General of the African Medicines Agency (AMA), the issue is not that Africa lacks regulatory expertise. It is that the expertise is unevenly distributed and poorly coordinated.

“AMA is not there to replace any national agency,” Darko explains. “It is there to coordinate them to ensure that their impact or their strengths are magnified as a body.”

In an interview with Health Policy Watch in London on the sidelines of the Global Vaccine Manufacturing Summit, Darko discussed whether the agency is already operating, what it can offer beyond existing reliance pathways, how it is being built institutionally, whether it can function as a single continental regulatory channel, why ratification still matters, and how it is being drawn into the response to the Bundibugyo Ebola outbreak.

This interview has been edited for length and clarity.

African Union leaders sign an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in Kigali, in June 2023.

Health Policy Watch: Is AMA actually operating yet?

Darko: Yes. AMA was operationalised in October 2025, when I assumed office in Kigali. We now have 33 member states that have ratified the treaty out of 55. 

Treaty ratification is one of the main things we must ensure happens if we want the impact of having a continental agency to be felt. All 55 have to ratify. We have a ratification envoy who will be going around to encourage ratification. 

Part of what AMA is doing is that there is going to be continental approval of certain products. AMA does not do everything. AMA focuses on complex products, vaccines and products of public health importance.

If AMA is able to do a centralised approval of a new vaccine, for countries to benefit from it in the general pathway, they would have to be state parties. That means they should have signed and ratified the treaty.

The second major priority is capacity strengthening of national regulatory authorities, because at the end of the day, the product is not going to end up only in Kigali. It is going to end up in Nigeria, South Africa or wherever it is used. 

Local national regulatory authorities are the ones who must ensure that the product is of the right quality, that what was approved is what actually enters the country, and that quality, safety and supply chains are monitored.

Health Policy Watch: WHO already has collaborative registration procedures, and Swissmedic has its MAGHP process. What can AMA offer beyond those pathways?

Darko: Those pathways are important, but AMA is trying to do something different.

WHO’s collaborative registration procedure and Swissmedic’s MAGHP process are reliance and collaboration mechanisms. They allow national regulators to draw on assessments or participate in reviews involving other trusted authorities.

AMA is meant to be different because it is a treaty-based African institution built around African regulators themselves. It is not just an external pathway through which countries rely on a decision taken elsewhere.

We are building a system where African regulators are part of the process, where their expertise is used, and where the outcome strengthens the continent’s regulatory capacity.

Africa does not lack expertise. A high proportion of people who do prequalification for WHO are from the African continent. The problem is not expertise. The problem is coordination of that expertise and ensuring it is used properly.

AMA has set up a Regulatory Innovation and Market Readiness Office, where sponsors and innovators can come for early scientific advice. The idea is to bring regulators into the process earlier, before a product has reached the end of development and before regulatory questions become delays.

The aim is not to duplicate existing mechanisms, but to bring African regulators into the process earlier and more systematically.

Sketch of the architecture of the African Medicines Agency.

Health Policy Watch: How is AMA set up institutionally?

Darko: AMA has the organs set out in its treaty: the Conference of State Parties, the Governing Board, the Secretariat and Technical Committees. The Secretariat is based in Kigali. Operationally, however, our work is built around coordination with national regulatory authorities.

We have a network of the current [countries on the continent with] WHO maturity level three agencies (the second highest level in terms of regulatory agency capacity), and they are going to be the initial backbone of the work AMA does. When AMA gives a scientific opinion or a recommendation for a product to be put on the market, we will start with those agencies.

But even apart from them, there are agencies that may not have been fully assessed by WHO but have expertise in areas such as good manufacturing practice, inspections or clinical trials. We will use those as well.

AMA will also work through technical committees. These include committees for clinical trials, inspections, authorisation and safety. Those committees are made up of national regulatory authorities and focal persons from those agencies.

AMA is a coordinating body, ensuring that regulators can come together and maximise their impact.

Header of the official African Medicines Agency Treaty, adopted in Addis Ababa, Ethiopia, on 11 February 2019.

Health Policy Watch: How is AMA being financed sustainably?

Editor’s note: A detailed public breakdown of AMA’s current budget, staffing and long-term revenue mix has not yet been published. The AMA Treaty gives the Conference of State Parties responsibility for setting annual and special contributions from state parties to the agency’s budget. Public reporting has also referred to seed contributions from state parties and partner support for AMA’s operationalisation.

That leaves two related questions: how AMA sustains its own headquarters, secretariat, technical committees, digital systems and scientific review functions; and how the national regulatory authorities that AMA depends on are strengthened, because the continental agency cannot function well if national agencies remain under-resourced.

Darko: AMA is only as strong as its agencies. The stronger we make them, the better it is for us, and the more value we add.

Can AMA act like a single regulatory review channel, similar to the European Medicines Agency (EMA)?

Darko: That is the ambition, but AMA is not simply copying the EMA model. Africa has 55 member states with very different legal systems, regulatory capacity and treaty status. Some countries have ratified the AMA Treaty, some have signed but not ratified, and others have not signed.

So AMA cannot yet function as a full single channel for every country in the way some people may imagine.

The goal is that manufacturers and developers should not have to duplicate 55 separate mechanisms or go to 55 countries for approval. We are building a network so that one application can serve the continent, while still strengthening national regulators. See related content here: 

African Medicines Agency Countdown

AMA adds the most value for products where expertise is unevenly distributed across countries. If a company is making antibiotics or paracetamol, AMA does not necessarily need to get involved because there may be no added value. 

But if a company is working on vaccines, complex products, or products of public health importance such as malaria or tuberculosis tools, that is where a centralised approach can help products go quicker and reach everyone who needs them.

The central point is that AMA works with national regulators; it does not replace them. Every piece of work we do links back to the national regulatory agencies. They give us focal persons. They do the work with us. AMA’s role is to coordinate, support and strengthen.

Health Policy Watch: Some of Africa’s largest countries have been slow to sign or ratify. Why does treaty status matter?

Darko: When Covid struck, when Ebola struck, DRC was not a ratified country. The benefits of AMA are to add value to every country, so if the countries are not there, you will not feel the full impact of what AMA does. When the disease is going into a country, it doesn’t care whether it’s a ratified country or not.

If AMA wants to build capacity on the continent, AMA, by legislation, can really only work with ratified countries. So if I am building capacity and you are a country that has not ratified, you have a problem.

If you take South Africa that has not ratified, it’s a big country, it has capacity. But if South Africa manufactures a product that’s going to be available in all the countries, if you are not a ratified member, the benefits go both ways, for the country and for AMA.

It matters to us. We want to stand united as one continent.

Health Policy Watch: Some national regulators have worried that AMA might take over their authority. How are you addressing that?

Darko: Sometimes there is a fundamental thought that if AMA is there, then national agencies will no longer exist.

We have tried to create awareness by working directly with the heads of agencies. We brought them together and developed our five-year strategy with them. Our IT strategy was also developed with them.

We are not working without the agencies. That has given many of them confidence that they are part of AMA.

AMA is there to add value. We continually speak with the heads of national regulatory agencies and ask where they need impact and where AMA can add value. Many countries have not ratified not because they do not want to join, but because the process is long. It goes through parliament, legislative structures and attorneys general.

The way we convince them is by showing that AMA is built with the agencies, not above them.

Health Policy Watch: What is AMA’s current top priority?

Darko: The current top priority is to support capacity building for regulators on the continent.

AMA is only as strong as its agencies. The stronger we make them, the better it is for us, and the more value we add.

And it is the only way Africa can advance any strategy, whether it is health security, clinical trials or access to medical products.

If you have strong regulators, products move more quickly. Safety is monitored properly. Quality is monitored properly. The patient receives the right medication.

The most important thing for us now is getting national regulators together and ensuring there is more equitable capacity strengthening across the continent.

Once we do that, everything else follows.

Health Policy Watch: Has AMA been involved in the current Bundibugyo Ebola outbreak – noting the plans for the clinical trials of two antivirals, and most recently, trials of a vaccine candidate?

Darko: Yes. AMA has been involved in regulatory discussions around the outbreak, including work with the European Medicines Agency and African national regulatory authorities on clinical trial designs and medical countermeasures.

For an outbreak like Bundibugyo Ebola, where there are no authorised vaccines or treatments for that specific virus species, the regulatory pathway has to be prepared early. Regulators need to know which products are in the pipeline, what data may be needed, which clinical endpoints are appropriate, and how to balance speed with scientific rigour.

Nearly 7 tonnes of emergency medical supplies and equipment along with a team of 35 experts from WHO and the DRC Ministry of Health arrive in Bunia from Kinshasa to support frontline Ebola response in Ituri Province.

That is exactly the kind of situation where AMA can add value: bringing regulators together early so that developers and researchers are not waiting until the end of the process to find out what evidence is required.

EMA’s  Emergency Task Force is working with the AMA, African national regulatory authorities and WHO AFRO’s African Vaccines Regulatory Forum on discussions covering candidate vaccines, treatments and post-exposure prophylaxis for Bundibugyo virus disease.

For AMA, the Ebola response is an early test of whether it can coordinate African regulatory input during a fast-moving public health emergency, rather than leaving each national regulator to work separately.

Health Policy Watch: What would success look like for AMA over the next few years?

Darko: The current top priority is to support capacity building for regulators on the continent. That is the only way AMA will be strong, and it is the only way Africa can advance any strategy, whether it is health security, manufacturing, clinical trials or access to medical products.

If you have strong regulators, products move more quickly. Manufacturing is done according to the right quality. Safety is monitored correctly. Quality is monitored correctly, and the patient receives the right medication.

The most important thing for us now is getting our national regulators together and ensuring that there is more equitable capacity strengthening on the continent. Once we do that, everything else follows.

At the end of the day, everything we are doing is about the patient. We also need to ensure that all 55 member states have signed and ratified the treaty.

“If you have a strong regulator, your products go quickly,” Darko said. “Your safety is monitored correctly. Your quality is monitored correctly. The patient receives the right medication.”

Image Credits: Rwanda MoH, Rwanda Ministry of Health, African Medicines Agency , @WHO African Region.

Consumption of highly processed food is linked to rising non-communicable diseases, with low- and middle-income countries seeing the fastest increases.

A trillion-dollar food industry sues to keep prevention at bay while governments spend billions subsidising the drugs that treat what bad diets do. Meanwhile, Ebola outruns a hollowed-out WHO, and its Director-General’s legacy hangs on whether he can get a grip.

‘If all else fails, sue’

Last week’s most telling global health story was not about welfare but lawfare. A team of investigative journalists exposed the pandemic of litigation unleashed by ultra-processed food companies against the policies meant to restrain them: warning labels, junk-food taxes, marketing limitations. The companies brought 239 lawsuits across Mexico, Colombia, Brazil, US, UK, and India between 2010 and 2025.

Eight multinational corporations including Coca-Cola, PepsiCo, Mondelēz and Danone, accounted for nearly two-fifths of the cases identified by the Netherlands-based Lighthouse Reports team of journalists. Although the industry lost three-quarters of the suits concluded, litigation snarled up health ministries for a cumulative 595 years in court.

This tactic is straight out of the tobacco industry playbook, the aim being to delay, deter, and derail reforms. Including by suing, if all else fails. One Mexican bottler argued that its soft drinks were safer than local water. Colombian food-and-drink companies gave €5.85 million to political parties, two-fifths of all such donations in a year. In India, legislation mandating front-of-package labeling has been stalled since 2014, with companies suing social media influencers who post nutritional breakdowns of food products such as instant noodles and baby food. In the European Union, EU-wide food policy regulations for ultra-processed foods (UPFs) don’t adequately address their systemic health risks. But attempts by individual nations to enact more stringent regulations, taxes or front-of-package labeling rules on UPFs would face challenges under the EU’s single-market and competition rules.

The chilling effect on public health policy-making is not a by-product of strategy; it is the strategy.

A market for the cure

Walking on the beach in the fishing village of Belle Garden, Trinidad and Tobago in the Caribbean. Small island states are among the low- and middle-income nations that have seen local diets edged out by imported ultra-processed foods, fueling an epidemic of obesity.

Set that against the direction health policy is travelling – with 2026 crowned as “the year of obesity pills.” WHO issued its first global guideline on GLP-1 medicines for obesity. The US launched a Medicare GLP-1 Bridge, offering beneficiaries a month of weight-loss drugs for $50, and European health systems have opened conditional access.

The real story is around ‘money’. The global processed-food industry is valued at an annual $2.2 trillion, rising toward $3.4 trillion by 2035. The GLP-1 market stood at $79 billion in 2025 and is forecast to reach $190 billion by then. The antidote, in other words, is around one-twenty-eighth the size of the products creating the problem – a downstream market spun off from an upstream one.

Both are dwarfed by the costs of the diseases caused by unhealthy diets. Overweight and obesity will cost the world more than $4 trillion a year by 2035, over 3 percent of global GDP, comparable to the Covid-19 shock in 2020. So, the public purse is asked to subsidise the cure at the very moment efforts to mitigate the cause are litigated into paralysis.

Not a zero-sum game

Globally, WHO estimates that 22% of men and 14% of women will die prematurely (before age 70) due to a non-communicable disease (NCD), with the highest rates in Africa and Asia where timely diagnosis and treatment are harder to access.

This is not an either/or argument for prevention rather than treatment. GLP-1 drugs are genuinely transformative and widening access is a real good for the 4 billion people in 2035 – 51% of the globe who are overweight.  The drugs also have been recommended by WHO for people with type 2 diabetes – which can be linked to genetic factors as well as to lifestyle and diet.

But insofar as a large proportion of obese and overweight people also are members of lower-income socio-economic groups, at least in countries and economies where junk foods are cheaper than healthier alternatives, access to GLP-1 treatment is also highly asymmetric.

And so the injectables most often first reach higher-income groups with insurance and disposable income, while the contested warning labels and sugar taxes are no-cost tools that can protect the poorest. And it is in the latter group, mostly concentrated in low-income countries, where NCD rates are growing most rapidly and where the burden of premature death from diseases such as diabetes and cardiovascular conditions is the highest.

A world that finds billions to medicate while it will not spend political capital to prevent disease in the first place is making a choice. It is not a neutral one, let alone sensible, from the socio-economic perspective.

The reforms that didn’t reach Ituri

WHO Director-General Dr Tedros Adhanom Ghebreyesus in Ituri, Democratic Republic of Congo on May 30, at the outset of the Bundibugyo Ebola outbreak.

If that is the skewed ledger of prevention-and-cure, Congo provides the arithmetic of failure. The Bundibugyo Ebola outbreak this column tracked at 719 deaths in mid-July had, by 25 July, reached 2536 cases and 1033 deaths. The uncomfortable question is why is this outbreak expanding faster than the previous thirty outbreaks since the Ebola virus was discovered in 1976 in DRC itself?

The popular excuse is that aid cuts compromised surveillance systems and delayed detection. Then there are challenging field conditions in a large region with poor infrastructure, experiencing prolonged civil conflict, and chaotic population displacement. Also, socio-cultural resistance and mistrust of health workers, and lack of a specific vaccine against the Bundibugyo strain.

Is that sufficient justification? Many comparable factors were also present in the 2014-2016 West African outbreak that so far remains the largest to date, with 29,000 cases and 12,000 deaths. As an advisor in West Africa for the International Medical Corps (IMC), I experienced that epidemic directly on the ground – and equally noteworthy the delayed and incompetent WHO response. Bringing the epidemic under control ultimately required military assets from the US, UK, and France, and UN leadership superseding the WHO.

That episode posed an existential threat to WHO – as the world debated whether health emergency management should be taken away from the Organization to a new body. Fortunately, sense prevailed with the WHO reforms born out of the West African catastrophe. They included a beefed-up Health Emergencies Programme with new systems and a new  Contingency Fund for Emergencies – as well as the birthing of a new, and assertive Africa Centres for Disease Control (CDC) to lead the continent’s public health challenges.

Following the Covid-19 pandemic, WHO’s International Health Regulations governing member states response to health emergencies were revised and in 2025 a Pandemic Agreement was approved by the World Health Assembly.

Unanswered questions

Ebola continues to spread in eastern regions of the Democratic Republic of Congo.

The question – unanswered so far – is why these new capacities, protocols, procedures, and partnerships are not making for a more effective showing in Congo? Is it because the post-2016 reforms are not being applied by a hollowed-out WHO, or are they irrelevant to Congo’s unforgiving realities?

Or is it that the joint Africa CDC and WHO Ebola response plan launched with much fanfare in early June has diffused leadership and accountability between Geneva and Addis? When two bodies declare the same emergency, share one under-filled budget, and apportion the command-and-control of a fast-moving crisis, where do you address concerns over a faltering response?

Post-outbreak evaluations will, no doubt, provide answers. But such exercises often say more about how to win past battles than tackling future ones. Meanwhile, immediate improvements to Ebola management in Congo cannot wait.

Shaping leadership legacies

WHO Director-General Tedros Adhanom Ghebreyesus.

Recognising how history’s long arc inexorably bends should focus mindsets. Consider how the last great Ebola failure of 2014-16 in West Africa remade WHO’s leadership. It tarnished the end of the tenure of Director-General Margaret Chan, obliging her to concede that the Organization’s response “did not match” the required scale. That debacle forged a reform mandate, clearing the path for the election of WHO Director General Tedros Adhanom Ghebreyesus in 2017 as the ‘outsider-reformer’ vowing that WHO would never again be caught flat-footed by an emergency.

Now that Tedros is moving towards ending his own decade in office, what could be his legacy? The irony is sharp. A tenure that should be applauded for many achievements, including championing universal health coverage and standing up for global health through the depredations of Covid-19 and fragmented geopolitics may, instead, be remembered by his last battle.

That is because legacies in a fickle world are written more by the crisis a leader handles on the way out than by the ones they managed earlier – however competently. Unless WHO gets a grip on Congo now by bending the two-headed response into one, forcing limited available money to work better, and closing the gap between the ‘reformed’ machinery in Geneva and the struggling ground game in Ituri — the last chapter will be written not over laudatory cocktails in the Director General’s leaving parties but in Ituri’s wailing cemeteries.

It would be disappointing if the reformer who rode in on the last Ebola failure is seen out by the next.

That also raises a question for those seeking to succeed Dr Tedros next year as Director General. How can that high office allow its holder to shape events instead of being shaped by them? On the evidence of the week’s vital signs — stalling courtrooms, multi-billion drug markets, and mounting death tolls — it is fair to ask who is really in charge of our health?

Mukesh Kapila is professor emeritus of global health and humanitarian affairs at the University of Manchester, and a board member of Health Policy Watch. The opinions expressed are solely those of the author.  

 

 

 

Image Credits: Unsplash/Hamza Nouasria, WHO / Alasdair Bell, WHO/NCD Portal, X/Tedros Adhanom Ghebreyesus, X/Tedros Adhanom Ghebreyesus, X/Tedros Adhanom Ghebreyesus.

Activists disrupt the US government session on its bilateral health agreements.

RIO DE JANEIRO – The United States has conceded that the HIV epidemic cannot be stopped “unless we have services for all people at risk” at a major event on the eve of the International AIDS Conference.

Dr Rebecca Bunnell, deputy head of implementing the US President’s Emergency Plan for AIDS Relief (PEPFAR), made the remark at a US government event to explain the new “America First Global Health Strategy”.

“We can’t forget any group because if we do, we will fail,” added Deputy Assistant Secretary Bunnell, a deputy assistant secretary who is second in command to the US global AIDS coordinator.

She was responding to a question about how to include “key populations” – groups most at risk of HIV, including sex workers, men who have sex with men and people who inject drugs – who have been excluded from the new US approach to HIV, which prioritises preventing HIV in mothers and babies.

‘Key population’ exclusion

A new study released last week reported on huge disruptions to HIV treatment throughout the world following the Trump administration’s changes to PEPFAR.

Some 1,714 HIV service sites had closed, including over 1,000 public health facilities, according to the PEPFAR Pulse Study conducted by the Foundation for AIDS Research (amfAR).

“Partners were most likely to have permanently stopped providing services for key populations, the groups most vulnerable to HIV. Among partners providing HIV treatment, more than one in five (21%) had permanently stopped at least one HIV clinical care activity,” according to the International AIDS Society, which released the research.

Dr Temitope Ilori, Director General of Nigeria’s National Agency for the Control of AIDS, told the session that “the new policy” had disrupted some programmes aimed at key populations but several of these had been integrated into government programmes.

US officials Rebecca Bunnell and Jeff Graham and Dr Temitope Ilori, Director General of Nigeria’s National Agency for the Control of AIDS.

‘You lie, people die’

Earlier, the US government session had been interrupted by HIV activists blowing whistles and chanting: “You lie, people die. Restore PEPFAR now.”

“For months, there has been a public health emergency caused by your government’s deadly disruptions in PEPFAR programming and global health aid, and we will not allow this fact to be erased. We will not allow our communities to be erased by your anti-science, anti-LGBTQ, anti-participation agenda,” said HealthGAP’s Asia Russell, who had taken the microphone from Jeff Graham, the acting US global AIDS co-ordinator. 

“Today, you’re talking about memoranda of understanding with nice words like country ownership and self-reliance. But let’s be honest. These are coercive bilateral deals that expel people with HIV from the negotiating table on purpose in order to try to extract mineral wealth, to try to extract data, to extract whatever the Trump administration wants,” added Russell.

Health GAP’s Asia Russell (centre).

Graham later told the meeting that, while the MOUs had been linked to access to countries’ assets including critical minerals, “there are no critical minerals mentioned in any MOU”. 

However, some of the health MOUs – notably with the Democratic Republic of Congo (DRC) and Guinea – were signed alongside mineral deals. Meanwhile, the US MOU with Zambia reportedly fell apart as the two countries could not agree on US terms for mineral access.

All MOUs involve co-financing from partners. In Nigeria’s case, it is investing $3 billion to the US investment of $2 billion.

Graham said that while the MOUs were “non-binding”, if a country did not live up to its co-financing promises, “we will have to assess that because we’re trying to make progress together”.

He described co-investment as a positive because if countries were able to finance their own health response, that “ultimately is a good thing”.

Several of the MOUs envisage a rapid path to government self-reliance, but Graham said that a transition resilience fund would assist if countries ran into trouble.

Protesters demonstrating against global funding cuts during the opening ceremony of the International AIDS Conference 2025. This year’s conference opens on Monday amid massive budget cuts for HIV.

The African Union held a special health summit this week, primarily aimed at mobilising high-level political support for more domestic health spending – particularly on HIV, tuberculosis and maternal health.

The summit coincided with the release of two new studies reporting on the huge disruptions to HIV treatment throughout the world following the Trump administration’s changes to the US President’s Emergency Plan for AIDS Relief (PEPFAR).

Some 1,714 HIV service sites had closed, including over 1,000 public health facilities, according to the PEPFAR Pulse Study conducted by the Foundation for AIDS Research (amfAR).

AmfAR’s study, based on a survey of 166 PEPFAR implementing partners in 46 countries, found more than half had at least one grant terminated while over three-quarters had to restrict their work.

Partners reported that they were unable to obtain condoms (23%), pre-exposure prophylaxis (PrEP) to prevent HIV (22%) or antiretroviral drugs (20%).

The second study, based on an analysis of PEPFAR data for fiscal year 2025, found that 77,163 fewer children living with HIV received PEPFAR-supported treatment in comparison to 2024 – a decline of 14.2%.

The worst impact was in South Africa, which recorded a 45% drop as 30,880 fewer children received treatment support from PEPFAR. Declines were also noted in Uganda, Haiti, Zambia and Kenya.

The US has decided to cut all PEPFAR aid to South Africa by early next year due to political disagreements. 

Both studies were released by the International AIDS Society (IAS) ahead of its global HIV conference, which opens in Rio on Monday.

‘Sunsetting’ UNAIDS?

UNAIDS executive director Winnie Byanyima at the body’s recent Programme Coordinating Board (PCB) meeting.

The conference, held under the theme “rethink, rebuild, rise”, comes at an extremely difficult time for the sector and for the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Amid a massive funding crisis, the UN Secretary-General produced a UN80 strategy that proposed “sunsetting” UNAIDS by the end of this year and “mainstreaming capacity and expertise into relevant entities of the United Nations development system in 2027”.

UNAIDS has already slashed staff by around 55%, and its Geneva head office has been massively reduced.

The UNAIDS Programme Coordinating Board (PCB) has set up a working group tasked with developing “a plan on the further transition and integration of UNAIDS into the UN system and beyond, in coherence with the UN80 Initiative and based on a realistic financial scenario” by October.

The working group is mandated to identify “functions and units to be transferred, transformed, downsized, merged, decentralized, and/or absorbed by the UN system and other stakeholders”. 

However, the PCB has stressed that UNAIDS core functions “must be preserved and safeguarded either together in a single unit or with individual UN entities”. It also directs the working group to ensure the “preservation of the role of communities and civil society”, a hallmark of UNAIDS operations.

The PCB has also tasked UNAIDS executive director Winnie Byanyima with preparing a 2027 workplan and budget “aligned with the ongoing downsizing and informed by the plan of the working group”.

Addressing the PCB earlier this month, Byanyima said: “Even in a complex global political context, UNAIDS still has that unique power to unite the world behind a shared vision to end AIDS as a public health threat by 2030.

“We will not deliver on that promise through institutions alone. We will deliver it through people, through the communities who refuse to be invisible, through the staff who carry this mission every day, through leaders in governments and partner organisations acting with courage in the face of uncertainty.”  

Delivering on 25-year-old promise

Chairperson of the AU Commission, Mahmoud Ali Youssouf,

Meanwhile, leaders who addressed the AU summit urged African states to implement the Abuja Declaration decision, adopted 25 years ago, to allocate at least 15% of national budgets to health.

Deliberations focused on HIV, tuberculosis, malaria, maternal and newborn health, viral hepatitis, neglected tropical diseases (NTDs), and non-communicable diseases (NCDs).

The summit also discussed how to advance the AU Roadmap to 2030 and Beyond, which envisions ending HIV as a public health threat and sets out how to control TB, malaria, NTDs and NCDs.

AU Commission Chairperson Mahmoud Ali Youssouf called on countries to make a “decisive shift from commitments to implementation”.

“Future generations will remember this Summit not for our speeches, but for whether we changed the trajectory of health in Africa,” said Youssouf.

Speaking at the close of the two-day summit, AU Health Commissioner Amma A. Twum-Amoah urged countries to “translate the AU Roadmap and the Accra Declaration into concrete national action.

“This means strengthening primary health care, integrating services, increasing domestic investment, advancing the local production of medicines, vaccines and diagnostics, investing in the health workforce and reinforcing surveillance, laboratory and digital health systems,” she said.

Image Credits: Jean Bizimana/ IAS.

India faces a growing burden of cancer, but survivors are struggling with the cost of treatment and stigma – even after they have recovered.

Life was normal for 27-year-old Delhi-based lawyer Deeba Fariyal until six years ago when she was diagnosed with synovial sarcoma, a rare soft-tissue cancer that typically affects young adults. Since then, she has endured six relapses, leaving her with few treatment options.

All the treatments have stopped working,” she said. “My cancer is one of the rarest forms, and there are very few treatment options.” 

Two years ago, the disease left her temporarily paralysed, although she has since regained the ability to walk. Today, tumours in her lungs and spine, combined with Delhi’s worsening air pollution, make everyday life increasingly difficult.

Yet, Fariyal says the greatest burden is neither the disease nor its complications—it’s the financial cost. 

“Everything is so expensive. Treatment at a private hospital in India can easily cost between $20,000 and $30,000,” she said. 

“The targeted therapy medicine I’m taking costs more than $120. Most patients avoid government hospitals because the waiting lists are so long. If you’re diagnosed with Stage 1 cancer, by the time your appointment comes, you could be in Stage IV. If you want timely treatment in India, you need a job, and that’s nearly impossible for many people [with cancer] to keep.”

Her struggle reflects a broader challenge facing cancer survivors worldwide: surviving the disease does not always mean returning to a normal life. 

High unemployment

A 2009 study published in JAMA found that 33.8% of cancer survivors were unemployed, compared with 15.2% of people without a history of cancer. 

Experts say the financial burden has only intensified in the years since, driven by rising treatment costs and persistent gaps in access to affordable care.

India’s growing cancer burden has made the issue increasingly urgent. The country records more than one million new cancer cases each year, while improvements in diagnosis and treatment mean more people are surviving the disease. 

The latest available estimates suggest India had around 2.1 million cancer survivors in 2017-18. Globally, about 32 million people are living after a cancer diagnosis. As survivorship rises, oncologists and patient advocates say returning to work has become an increasingly overlooked challenge.

A cancer patient receives chemotherapy. Not only do Indian cancer patients face expensive treatment, but many struggle to keep or find work after they have recovered.

When cancer costs you your job

For 36-year-old Richa Rana from Saharanpur, Uttar Pradesh, surviving breast cancer was only the beginning. Returning to work proved to be another battle. 

Rana was diagnosed with breast cancer in 2022 while working in the private sector. Instead of receiving workplace support, she says her employer placed her on nearly six months of unpaid leave. 

“At first, the company didn’t take any immediate action. They just put me on unpaid leave for almost six months,” she said. “When my treatment was over, I returned to work and proved that I was healthy enough to do my job.”

But a few months later, the cancer returned. The company again granted her unpaid leave while she underwent treatment. Once doctors declared her fit to return, she informed her employer that she was ready to resume work. 

“Instead of welcoming me back, HR replied that the company wanted to separate from me,” she recalled. “I was already going through a very difficult period. My father was also undergoing a liver transplant.”

Rana wrote a lengthy email to the company’s chief executive, pleading her case. She says the human resources department acknowledged that her performance had never been a problem. 

“They admitted they had no issue with my work. I lost my job because I had taken those two medical leaves even though they were both unpaid.”

Finding another job proved equally difficult. Rana says she cleared several interviews, only to be rejected after disclosing that she was a cancer survivor. 

“The interviews would go really well, but the moment I told them I was a cancer survivor, they would reject me,” she said. “Maybe employers think I’ll need frequent leave or that my productivity will be lower. But rejecting someone without even giving them a chance isn’t justified.”

After months of searching, Rana eventually secured another job – but only by keeping her medical history private. 

“During the interview, I didn’t tell them I was a cancer survivor,” she said. “I only told my manager after I’d been in the role for more than six months and had proved myself. He said they already had an idea, but by then they had seen my work and decided to keep me. We have to do this much just to make a living.” 

Discrimination against survivors

Fariyal says she has faced similar discrimination.

“Living with Stage IV synovial sarcoma has cost me my career,” she said. “Since October 2024, I have faced continuous unemployment not because I lack merit, but because of institutional bias.

According to Fariyal, employers often praise her legal research experience and her work teaching students preparing for law entrance examinations. But once she explains the gap in her résumé, the conversation changes. 

“I tell them honestly that the gap in my CV was because I was undergoing cancer treatment,” she said. “The door is immediately shut. I’m repeatedly told that despite my qualifications, they cannot recruit me because of my health condition.”

A cancer patient is comforted during chemotherapy.

India’s labour market leaves cancer survivors particularly vulnerable, says labour economist Professor Arun Kumar.

“The country’s high unemployment allows companies to replace workers who develop serious illnesses with little consequence,” Kumar told Health Policy Watch. “From a macroeconomic perspective, spending on hospitals, medicines and doctors contributes to GDP and appears as economic growth. But this is a negative form of growth because it reflects illness rather than improvements in people’s well-being.”

Nearly 94% of India’s workforce is employed in the informal sector, where workers have little or no social protection, paid medical leave, health insurance or employment benefits, note Kumar. Even among the roughly 6% employed in the formal sector, employer-provided benefits often fall short of covering the prolonged costs of cancer treatment.

Although treatment is available free at many government hospitals, patients frequently face overcrowded facilities, long waiting lists and limited access to specialised care, making timely treatment difficult.

Calls for stronger workplace protection

For Urvashi Prasad, a public policy specialist and Stage IV cancer survivor, India needs stronger legal protections against workplace discrimination. 

“In countries such as the UK, employers cannot discriminate against someone because of a serious illness. India needs similar protections,” she said, but conceded that legislation alone will not solve the problem. 

“Even where legal protections exist, implementation remains weak,” Prasad said, pointing to India’s maternity benefit laws as an example. “Many workers still face discrimination despite the law because enforcement is inconsistent and pursuing legal action is expensive and time-consuming.”

She said many cancer survivors simply cannot afford lengthy legal battles, while government agencies often lack the resources to enforce labour protections effectively. 

“The government cannot do everything on its own,” Prasad said. “Employers also need workplace policies that support people through serious illnesses and help them return to work.” 

Kumar agrees that stronger public policy is urgently needed.

“Employers should not be allowed to terminate workers simply because they fall seriously ill,” he said. “India needs stronger provisions for medical leave and social security, particularly for workers in the informal sector, so they are protected during major illnesses not just cancer.” 

As India’s cancer survival rates continue to improve, experts say the next challenge extends beyond healthcare. Ensuring survivors can return to work without facing discrimination, financial ruin or job loss, they argue, will be critical to improving both their quality of life and long-term recovery.

Image Credits: Prashanth Pinha/Unsplash, National Cancer Institute, USA, National Cancer Institute, USA.

Animal source foods provide nutrition and food security but remain expensive in nations like Nigeria.
Grazing in Nigeria. Animals are an important source of foods rich in protein and micronutrients in many low-income countries but remain expensive.

About 43 million fewer people are undernourished today compared to a peak in 2022, during the COVID pandemic. Yet undernutrition and a lack of diet affordability still haunt more than half a billion people globally. Crises and conflicts increase risks.

Global food security improved slightly in 2025 as hunger fell to 7.8% from 8.1% in 2024, dropping the number of undernourished people to roughly 645 million. However, the fruits, vegetables, and animal-sourced foods necessary to prevent malnutrition remain inaccessible for one-third of the global population, according to a joint UN flagship report on the State of Food Security and Nutrition in the World (SOFI), released on Tuesday.

The report warns that the average global cost of a healthy diet has surged to an average of $4.28 in purchasing power, per day, up from $3.44 in 2021. Current projections indicate that up to 520 million people will still remain hungry at the end of the decade, leaving the world to fall far short of the United Nations’ 2030 Sustainable Development Goal 2, Zero Hunger.

“Healthy diets should not be a luxury. They are the foundation of health, and they should be within everyone’s reach,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the report launch. The World Health Organization co-authored the report with the Food and Agriculture Organization (FAO) and three other UN agencies.

Progress remains regionally fractured

FAO chart shows a recent decline in global hunger, though persistent risks to food security leave hundreds of millions undernourished.
The FAO chart shows a recent decline in global hunger since peaking in 2022, though persistent risks to food security leave hundreds of millions undernourished.

While Asia and Latin America reported steady gains, progress remains deeply fractured. In Africa, the percentage of hungry people remained stable, but rapid population growth means that the continent now hosts the highest absolute number of undernourished individuals worldwide, at 309 million.

Furthermore, 66.6% of Africans are entirely priced out of a healthy diet. This crisis disproportionately impacts women and children in rural areas, who face the highest levels of severe food insecurity and the lowest rates of dietary diversity globally.

Animal-sourced foods, which are an important source of protein as well as vital micronutrients in many low-income countries, constitute the most expensive dietary component across the continent. The high costs are driven by low baseline livestock productivity, animal feed expenses and insufficient veterinary services.

Because animal products as well as other highly perishable foods often travel long distances across fragmented regional supply chains, Africa’s deficit in cold chain and rural transport infrastructure leads to massive post-harvest and post-production losses. According to the UN experts, these losses can exceed 30-40% for dairy, fish, and fresh produce, inflating retail prices.

Conflicts and crises disrupt food security

Extreme weather events and armed conflict disrupt supply chains and drive up food prices in vulnerable regions.
Extreme weather events and armed conflict continue to disrupt supply chains and drive up food prices in fragile states and climate vulnerable regions.

These infrastructural gaps are compounded by extreme weather events and escalating armed conflicts. Ongoing fighting across the Sudan, South Sudan, Nigeria, and the Democratic Republic of the Congo continue to destroy agricultural livelihoods and displace millions of rural small holders who previously lived from farming or herding. The Sudan alone faces a credible risk of famine across 14 areas, as fighting blocks vital transport routes and prevents humanitarian access, the report stresses.

Beyond localised violence, broader geopolitical shocks are fracturing the global supply chains required to keep healthy diets affordable. Many African nations, which shifted from indigenous food production to cash crops decades ago incentivized by multi-national loans, investments and globalization trends, are now net importers of both fuel and basic food commodities, like cereals or grain. They therefore remain highly exposed to the macroeconomic fallout from the ongoing conflict between the United States and Iran.

The report highlights how the resulting blockade of the Strait of Hormuz has disrupted global trade routes, driving up energy and fertiliser prices worldwide. Because agricultural cold chains and transport logistics rely heavily on fuel, these macroeconomic shocks disproportionately increase the cost of highly perishable, nutrient-dense foods – like fresh produce and dairy.

Closing the agriculture finance gap

Governments historically have subsidised calorie-dense starchy staples, systematically neglecting the research and logistical support necessary for the nutrient-dense crops required to combat diet-related diseases, the report underlines. To correct this market failure, policymakers must repurpose agricultural subsidies and urgently invest in rural road networks, modern water management, and post-harvest storage.

If governments were to pivot public funding toward supply chain resilience, they could insulate local food markets from the escalating climate extremes and fragmented trade routes that inevitably trigger price spikes.

Current global investment priorities, however, do not reflect this urgent necessity. “Ending hunger and making healthy diets affordable requires political commitment, sustained investment and enabling policies,” said FAO Director-General Qu Dongyu on Tuesday in Rome.

Bridging the Nutrition Financing Gap With Private Sector Partnerships

Image Credits: DETTY IMAGES via Pexels, FAO, James Frid via Pexels.

France has enacted a sweeping youth social media ban for minors under age 15.
France has enacted a sweeping youth social media ban for minors under age 15.

France has adopted a strict youth social media ban for minors under 15, taking effect in September. But major enforcement hurdles remain, as lawmakers stripped the bill of direct platform sanctions to avoid clashing with European Union rules. The law also faces a constitutional review over the fundamental rights of children and parents.

Minors under 15 now face a strict youth social media ban in France when the law enters into force on September 1, following the adoption of new legislation on Tuesday. While new users will experience immediate restrictions, the law grants a four-month grace period for social media accounts created before that date.

The French National Assembly approved the measure with 279 votes in favour, 81 against, and 66 abstentions, mirroring overwhelming support in the Senate.

“I committed to it, it is now passed: social media will be banned for those under 15 at the start of the school year,” said French President Emmanuel Macron in a social media post after the vote.

Alongside the sweeping restriction, the legislation also extends the ban on mobile phone usage to high school premises. However, the exact rules and exceptions will be determined by each high school’s internal regulations.

French legislation follows global push for social media restrictions

The French legislation follows mounting scientific evidence, linking excessive screen time and addictive platform designs to a surge in youth mental health issues. Following the lead of countries like Australia and Spain, a growing number of governments are targeting the engagement-maximising business models of tech giants.

The French legislation follows a joint statement by Macron and WHO Director-General Dr Tedros Adhanom Ghebreyesus on 1 July, warning that poorly governed digital spaces and addictive platform features pose grave risks to the physical and mental development of youth.

Sanctions dropped to avoid EU clash

France’s youth social media ban anticipates upcoming EU measures.
France’s youth social media ban anticipates upcoming EU measures.

However, to avoid clashing with the European Union’s Digital Services Act (DSA), lawmakers deliberately stripped the bill of national sanctions against tech companies, effectively removing the teeth from any potential enforcement of the new law. The primary goal of the DSA is to establish a harmonised set of rules across the EU.

French Senate rapporteur Catherine Morin-Desailly from the centrist party Union Centriste acknowledged that the text’s normative scope is limited, acting primarily as a symbolic spur to force the EU Commission’s hand.

“Through a legal trick intended to avoid any conflict with the Digital Services Act, the ban concerns the minors themselves, without sanction,” explained Morin-Desailly during the Senate hearing.

The initial French Senate proposal favoured a two-tier system, with a blacklist of harmful platforms and parental consent for others. However, following exchanges with the Commission regarding its plans for a comprehensive EU-wide safety framework, French legislators reverted to a blanket ban to serve as a symbolic pressure tactic on Brussels.

Following a query by Health Policy Watch, the EU Commission declined to comment.

Critics warn that blanket bans often fail because teenagers rapidly find technological workarounds like VPNs, and privacy-preserving age verification systems are not yet widely implemented.

Legislation aligns with expert recommendations

The French legislation anticipates upcoming unified measures across the bloc, following recent recommendations from a special EU expert committee set up by Commission President Ursula von der Leyen.

While the EU panel recommends a harmonised EU-wide baseline prohibiting social media access for children under 13, it explicitly supports member states implementing higher precautionary age restrictions, such as age 15.

For older adolescents transitioning into “digital autonomy,” the EU experts demand harm-reduction measures requiring platforms to integrate safety-by-design defaults – such as limiting infinite scrolling and disabling addictive push notifications.

Domestic opposition and implementation realities

Opposition lawmakers warn France’s rushed social media ban is an unenforceable, window-dressing measure.
Opposition lawmakers warn France’s rushed social media ban is an unenforceable, window-dressing measure.

Domestically, the legislation faces immediate legal challenges before it can be implemented, even with very nominal enforcement. The Council of State previously warned that a general, absolute prohibition likely violates fundamental rights – specifically children’s right to access information and the exercise of parental authority – setting the stage for a review by the Constitutional Council.

Opposition lawmakers heavily criticised the government for rushing the legislation without establishing a functional, privacy-respecting age verification system. They warned that attempting to enforce such a complex technological restriction by September is a logistical impossibility.

“The final version gives the impression of a window-dressing text, without hindsight or impact study,” criticised Senator Mathilde Ollivier (Green Party) during the Senate debate.

As the government now awaits the constitutional ruling, the ultimate success of the restriction depends on whether Brussels steps in to regulate youth social media use.

See related story:

Youth Social Media Restriction Gains Critical Momentum in European Union

Image Credits: JÉSHOOTS via Pexels, Christian Lue via Pexels, Assemblée Nationale.

Although deaths from road traffic crashes have been reduced globally, six countries have recorded substantially increases – including the United States.

World leaders recommitted to reducing road traffic deaths and injuries by at least 50% by 2030 at the United Nations High-Level Meeting (HLM) on Road Safety this week – including by introducing measurable national targets, timelines and budgets. 

However, the United States voted against the UN consensus progress declaration adopted on Monday afternoon, while all the other 162 countries present voted in favour.

The US delegate claimed that the declaration was “mandate creep”, complaining that it called for road safety measures to be integrated into climate, environmental and urban policies.

“Road safety is a practical matter of engineering, sober driving and personal responsibility,” he said. “It should not be used as a backdoor vehicle to enforce global climate pacts and top-down environmental restrictions on freedom of mobility.”

Road deaths rise in US

Ironically, the US is one of only six countries in which road injury mortality has risen significantly between 2010 and 2023, according to a new study by the Institute for Health Metrics and Evaluation (IHME) published in The Lancet Public Health on Tuesday.

Globally, road traffic deaths declined by 21% between 2011 and 2025, according to new data released by the World Health Organization (WHO) on Monday.

But there were significant increases in Ghana (48.5%), Jamaica (29%), the Dominican Republic (27%), Armenia (22%), Costa Rica (16%), and the US (13.2%), according to The Lancet report, which drew on data from 204 countries and territories from 1990 to 2023.

Almost 51 million people were injured, and 1.34 million died from road injuries in 2023, which was the leading cause of death in young people aged between the ages of 10 and 39. 

Low-income death burden

More than 90% of all road deaths occur in low-income nations despite high-income countries having substantially more traffic crashes with injuries. The mortality rate in low-income countries was 43.8 deaths per 100,000 people, whereas that in high-income countries was 7.5 deaths per 100,000 – a clear indication of the standard of care available to those injured.

More than 200,000 lives could be saved each year through enhanced trauma care coverage in low- and middle-income countries, according to IHME.

“Road injury outcomes are shaped not only by crashes, but by the systems designed to prevent them and protect people when they occur,” said Dr Liane Ong, IHME senior research scientist and senior author of the study. 

Meanwhile, Dr Marie Ng, from both IHME and the National University of Singapore, said that   “road safety should be treated as a public health priority, not just a transportation issue”.

“Reducing deaths and injuries requires moving beyond individual driver behaviour and investing in systems that prevent crashes, strengthen trauma care, and implement evidence-based interventions tailored to the needs of each community,” Ng stressed.

The WHO European Region has made by far the most progress in reducing deaths (a 36% reduction between 2010 and 2021), followed by the Western Pacific Region (15% drop). In contrast, there was no change in the Americas and a 17% rise in deaths in the WHO African Region, according to WHO data.

Motorcyclists account for almost a third of deaths

Motorbike riders weave through traffic in Indonesia.

Deaths among motorcyclists now account for nearly a third of the world’s road fatalities, according to the WHO, which noted that, with the rise of ride-hailing and delivery apps, the number of motorcycles more than tripled between 2011 and 2025. 

“Motorcyclists also experienced the highest proportion of head injuries, most of which were moderate or severe traumatic brain injuries,” according to the IHME study. 

Wearing a safe motorcycle helmet reduces the risk of death in a crash by more than six times.

“New forms of mobility, including e-scooters, e-bikes and autonomous vehicles, present both challenges and opportunities for transport planners and policy-makers,” said WHO, adding that it is bringing together leading experts to find new ways to ensure all new vehicles and technologies are safe.

Almost one-third of road injury deaths were pedestrians, according to The Lancet figures. 

“More than half of all road deaths are people who aren’t even in a car – they are walking, cycling or riding a motorcycle. When roads are designed as if only car drivers matter, these people are left dangerously exposed,” said Dr Etienne Krug, WHO director of the Department of Health Determinants, Promotion and Prevention. 

“We know what works: strong laws and enforcement, safe infrastructure and vehicles with particular attention to lowering speed and addressing impaired driving. This declaration means we must all go further and faster.”

‘Strong political declaration’

WHO Director-General Dr Tedros Adhanom Ghebreyesus commended UN member states for adopting a “strong political declaration” designed to “accelerate action to ensure more roads are designed for people first, not motor vehicles, with safety as priority”. 

The declaration commits UN member states to progressively aligning speed limits, road and land-use design, traffic rules and signage, and vehicle design technologies to achieve the 2030 target, which they first committed to at an HLM in 2021.

Other commitments include “establishing lead road safety agencies, improving data collection and analysis, developing and enforcing stronger legislation, and ensuring that roads, infrastructure and vehicles meet key safety standards,” the WHO noted.

Image Credits: Anthony Maw/ Unsplash, Iqro Rinaldi/ Unsplash.

The Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement is negotiating a pathogen access and benefit-sharing (PABS) annex.

Two practical – and contrary – proposals were tabled at pandemic talks last week, detailing how information about dangerous pathogens should be shared. Health Policy Watch is sharing the two options – Africa’s Federated Model and the European Union’s Hybrid Model – to enable all interested parties to interrogate them before the next round of talks from 14-18 September.

The nitty-gritty details about a pathogen access and benefit-sharing (PABS) system – the last outstanding piece of the World Health Organization’s (WHO) Pandemic Agreement – are being hammered out in Geneva.

The PABS system, an annex to the Pandemic Agreement, will set out how dangerous pathogens are shared (access) during public health emergencies and how to share any medical products (benefits) produced as a result of manufacturers getting access to this information.

Federated model

According to the “federated model”, pathogen materials and data always stay in the hands of countries.

Each user – countries, manufacturers, etc – registers once with a central “catalogue” and receives a single identifying credential. The catalogue routes each request to the holding node – either a country or a regional node. Where a node adds its own terms, the user needs to accept them before they get any results. 

Manufacturers have to accept a data access agreement (DAA) with the country or regional node and sign a benefit-sharing contract with the World Health Organization (WHO) to gain access to the information.

The WHO contract binds the manufacturer to set aside 10% of any products it develops as a donation and 10% at cost.

The rules governing the PABS system will be set by the Conference of the Parties made up of WHO member states, not the WHO or individual countries.

“Federated access is the only route. The data stays at the sovereign node, the analysis runs in place, and only the results leave,” according to the proposal.

“We hold sovereign rights over our sequence data and our sequence materials. Custody is never surrendered. Access is granted, the resource is not.”

The European Union and others have criticised a centralised system for potentially slowing down access to pathogen information.

However, that African proposal claims that the European Genomic Data Infrastructure project operates a similar system across 22 countries and can respond to queries “in about 5 to 30 minutes depending on dataset size”. 

Hybrid model

In contrast, the “starting premise” of the hybrid model is that the PABS system is “non-exclusive”, according to the EU proposal. This acknowledges that parties can and do share pathogen information on different platforms.

However, it envisages that any pathogen materials should be shared via the WHO-Coordinated Laboratory Network (WCLN).

The hybrid model also envisages “legally binding obligations” throughout, but with different requirements depending on different user categories and whether there is a public health emergency of international concern (PHEIC) or a pandemic.

“Recent Ebola and hantavirus outbreaks show that scientists use a range of platforms to share sequence information,” Alexandra Finch, project manager for the Panel for a Global Public Health Convention, told Civicus in an interview on Monday.

She cited a range of platforms used to share sequence information, like GenBank, which allows unrestricted access without registration, the closed GISAID, platform and “newer, hybrid models, like Pathoplexus, that let scientists choose between open release and time-limited restricted use”. 

“A hybrid model reflects this reality best and could potentially draw in a wider pool of benefits,” said Finch, but added that several other conditions should come into play, including “enforceable benefit-sharing obligations”, and “persistent identifiers” to trace how the data is used.

‘Diverges from mandate’

But Sangeeta Shashikant, coordinator of the development and intellectual property programme at Third World Network, said that the hybrid model is a problem as it “diverges from the mandate established in Article 12” of the Pandemic Agreement. 

“It allows a pathway for sharing PABS materials without any benefit-sharing conditions and for sharing PABS sequence information with databases promoting anonymous access,” says Shashikant.

“In doing so, it violates the key parameters of Article 12 and fails to ensure ‘equal footing’, legal certainty and even the benefits agreed in Article 12. While the proponents of the hybrid model do not want to add conditions, they want to ensure the dilution of the terms and conditions that developing countries want to see when providing access.”

In contrast, said Shashikant, the federated model “attempts to address the capacity gaps, especially in relation to sequence-sharing infrastructure in developing countries. It requires user registration and user acceptance of benefit-sharing conditions to deliver on the requirements of Article 12”.

‘Delink equity and access’

Meanwhile, Knowledge Ecology International (KEI) has long been critical of countries linking access to PABS samples or data to the Pandemic Agreement’s equity provisions.

KEI wants negotiators to “delink the primary equity obligations from conditions attached to access to the PABS materials and data” – for two main reasons. 

“It is important for the information about the pathogens to be shared widely and quickly, and for the information to be used with other data, in a broader eco-system of databases and research tools,” KEI asserts.

“Secondly, there will be plenty of cases where researchers won’t need the PABS to get access to pathogens or their [digital sequencing information], and in those predictable cases, companies will have little or no incentive to be legally bound to the concessionary sharing of production,” KEI argues.

Instead, it proposes that the PABS annex includes an obligation on governments to “require that any manufacturer seeking to register or sell pandemic-related products provide evidence of a legally binding agreement with the WHO that addresses access to such products. 

“This agreement would be separate from any agreement they may have regarding PABS material or data. The access provisions would be consistent with Article 12, Paragraph 6, of the Pandemic Agreement.”

Five years of talks

“Finalising the annex is a critical step toward enabling countries to consider the signature and ratification of the WHO Pandemic Agreement, strengthening global health security and pandemic prevention, preparedness and response for future generations,” said the WHO in a statement on Monday as the talks reach beyond five years,

WHO Director-General Dr Tedros Adhanom Ghebreyesus commended member States for their “continued dedication to multilateralism, dialogue and to finding common ground”.

“While differences remain, those differences can be bridged if we keep our shared goal in sight: a world where pathogens and scientific information are shared rapidly, and the benefits they generate are shared fairly and equitably. The task is vital, and urgent. The next pandemic will not wait. Neither should we.”

Image Credits: WHO / Mark Nieuwenhof.