People typically think of pandemics in terms of their biological consequences, but science journalist Laura Spinney argues that their impact is shaped just as much by human behaviour and language.

On a recent episode of “Dialogues,” part of the Global Health Matters podcast series, Spinney joined host Garry Aslanyan to discuss the lessons of the 1918 influenza pandemic. Spinney is the author of Pale Rider: The Spanish Flu of 1918 and How it Changed the World.

She argues that despite its global ramifications, the so-called “Spanish flu” remains largely absent from collective memory. Its impact extended far beyond Europe and North America, with countries like India suffering some of the worst losses, and it influenced the course of major wars, independence movements, and even the arts.

“The 1918 pandemic accelerated the pace of change in the first half of the 20th century and helped shape our modern world,” Spinney said.

Central to this understanding is the role of language. The way a pandemic is named shapes how it is perceived, and the term “Spanish flu” is, in hindsight, a misnomer that obscures its global nature.

Naming informs how people assign blame, assess risk, and respond to a crisis. Early in the HIV epidemic, for instance, labelling the disease as “gay-related” distorted public understanding and fueled stigma.

As Spinney explains “When there is an outbreak of [infectious] disease somewhere, it has to be named quite quickly because you can’t respond to it if you can’t talk about it.”

At the same time, she suggests global health must move toward a more inclusive linguistic approach. While English dominates international discourse, relying on a single language poses significant risks in managing health crises in a multilingual world.

Listen to the full episode >>

Read more about Global Health Matters podcasts on Health Policy Watch >>

Image Credits: Global Health Matters Podcast.

The proposed elimination of “disease-specific account” is likely to mean the end of the US President’s Emergency Plan for AIDS Relife (PEPFAR).

US President Donald Trump wants to eliminate $4.3 billion from the US government’s global health budget, including all funding for the Pan-American Health Organization (PAHO), the World Health Organization’s (WHO) regional organisation for the Americas.

His proposed budget for 2027, which needs to be approved by the US Congress, includes a 42% increase – some $445 billion – for defence, including “$1.1 trillion in base discretionary budget authority” for the Department of War.

In contrast to the lavish military budget, deep cuts are proposed to domestic health programmes, with an overall 12,5% reduction in the Department of Health and Human Services (HHS) budget.

Domestic cuts include $923 million less for HIV/AIDS, $561 million less for maternal and child health, a $576 million cut to mental health (including suicide prevention, substance use prevention and treatment) and a $872 million cut to health workforce programs.

The Centers for Disease Control and Prevention (CDC) is allocated $663.8 million, the same amount as previously and the budget claims that CDC “will play a key role in implementing an America First approach to global health to replace the functions of the World Health Organization.”

Driving these cuts is Russell Vought, head of the White House Office of Management and Budget. Vought, former vice-president of the right-wing think tank Heritage Foundation, co-authored Project 2025, the conservative blueprint for governance being followed by the Trump administration.

No money for ‘corrupt’ PAHO

When Trump announced that the US would leave the WHO on his first day in office in January 2025, he made no mention of PAHO, and US officials have continued to interact with the other 34 member states in the regional body.

However, the US has not paid its membership fees (called assessed contributions) to PAHO since 2024, and owes the body over $134 million.

In his latest budget ask, Trump describes the WHO and PAHO as “corrupt organizations [that] have shown no independence from inappropriate political influences, such as when the WHO aided in the COVID-19 coverup.”

In February, PAHO projected a 19% reduction in its 2026/27 budget, and is cutting 17% of staff. Its 2024/24 budget was $820 million, which means a $155 million cut. Measles and dengue are surging in the region, while health services in the Caribbean have been badly affected by extreme weather events.

Oropouche mosquito monitoring
WHO staff in the Americas region (PAHO) researching mosquitos to better understand the distribution of disease-carrying species.

No more disease-specific aid

In a death knell for the US President’s Emergency Plan for AIDS Relief (PEPFAR), the proposed budget for the US State Department will “eliminate disease-specific accounts”.

The reason given is that this will “provide the Department crucial agility to address the actual needs of each recipient country—across HIV/AIDS and other infectious diseases such as malaria, tuberculosis, and polio—to strengthen global health security and protect Americans from disease.

PEPFAR, started by Republican President George W Bush, is the US government’s most successful aid programme, credited with saving 25 million lives and preventing millions of new HIV infections.

However, the Trump budget claims 60% of its funds were “wasted”. It also makes the misleading claim that “PEPFAR funded health workers who performed over 21 abortions in Mozambique”. 

The US has not allowed its foreign aid to be used to fund or lobby for abortions since it enacted the Helms Amendment in 1974.

Four Mozambican nurses, whose salaries were partly covered by PEPFAR, did not know that they could not provide abortions (which are legal in Mozambique) if they received PEPFAR funding, as previously reported by Health Policy Watch.

PEPFAR’s own compliance mechanisms identified the violation, and it took “immediate corrective action with the partner”, including ensuring that Mozambique repaid PEPFAR for the nurses’ salaries, the plan said in a statement. 

Anti-contraception bias

There is no funding ask for contraception or reproductive health. The budget also contains several disparaging references to contraception, something that Project 2025 also takes issue with, preferring “natural contraception”.

The proposed budget disparages PEPFAR for “promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana.”

“The Budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance.” according to proposal.

“The United States should not pay for the world’s birth control and therapy.”

New ‘America First Global Health Strategy’ bilaterals

DRC Health Minister Dr Roger Kamba, US Charge D’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the bilateral health MOU

Included in the State Department Budget is $5.1 billion to “execute” its America First Global Health Strategy (AFGHS), the bilateral Memorandums of Understanding (MOUs) with individual countries.

“The President’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” according to the budget. 

By 10 April, the State Department had signed 30 bilateral global health agreements. The latest is with the Philippines, signed on 9 April (no details available, including the amount involved). 

It follows an MOU with Cambodia, the first in Asia, signed on 6 April. The US will provide $30.8 million over five years for infectious disease prevention and response capabilities, including “accurately identify pathogens of epidemic and pandemic potential before they spread internationally” and “a robust network of laboratories” aimed at eliminating malaria in Cambodia.

A day before this, a bilateral was signed with Tajikistan, the first in the South and Central Asia region, involving $38 million in US aid over the next five years to “support Tajikistan’s efforts to combat HIV/AIDS and tuberculosis, while bolstering disease surveillance and outbreak response.”

Way forward

The US Congress still needs to approve the budget and may well authorise more money, particularly for domestic health. 

In February, Congress approved a $50 billion Foreign Affairs Bill, including $9.4 billion for global health for the fiscal year 2026, almost three times larger than Trump’s request for $3.8 billion.

White House budget head Vought will testify before the House budget committee on Trump’s request next Wednesday.

Image Credits: Gage Skidmore, International AIDS Society, PAHO/WHO.

Five major economic powers - led by the US - drove nearly 96% of 2025's global aid funding reduction.
Five major economic powers – led by the US – drove nearly 96% of 2025’s global aid funding reduction.

Historic declines in Official Development Assistance (ODA) have set international aid back a decade, prompting civil society warnings that the ODA cuts will further devastate funding for global health, education and social protection.

The Organisation for Economic Co-operation and Development (OECD) released preliminary data showing total global aid fell by 23.1% in real terms during 2025, marking the most severe single-year contraction ever recorded.

“It’s deeply concerning to see this huge drop in ODA in 2025, due to dramatic cuts among the very top donors,” Carsten Staur, chair of the OECD Development Assistance Committee (DAC), said in a press statement.

While a few countries exceed the United Nations target of allocating 0.7% of their gross national income to foreign aid, the world’s major economic powers have abruptly withdrawn their support. This collective retreat was highly concentrated, with five top nations driving 95.7% of the total global reduction.

German Development Minister Reem Alabali Radovan emphasizes Germany's continued international responsibility despite significant ODA cuts.
German Development Minister Reem Alabali Radovan.

The United States alone accounted for three-quarters of the overall drop after slashing its budget by nearly 57%. Germany, France, the United Kingdom and Japan all reported significant decreases alongside the US, marking the first time these top providers simultaneously shrank their budgets.

This collective retreat resulted in Germany becoming the single largest global provider for the very first time, despite reducing its own overall aid by over 17%.

“Despite painful cuts, we stand by our international responsibility,” Reem Alabali Radovan, Germany’s development minister, said. “This is existential for millions of people in light of extreme global challenges, crises and wars.”

Core development and humanitarian aid slashed 

Drastic ODA cuts threaten the basic survival and essential infrastructure of the world's most vulnerable.
Drastic ODA cuts threaten the basic survival and essential infrastructure of the world’s most vulnerable.

Beneath the headline figures, the OECD data highlights severe structural shifts that are draining funds from vulnerable countries precisely when their economic burdens are mounting.

“Fiscal pressures on developing countries are growing, and the ongoing conflict in the Middle East represents a significant risk for global growth and food security,” OECD Secretary-General Mathias Cormann said during the data launch.

According to the OECD data, vital humanitarian aid plunged by almost 36%, accelerating the reversal of a five-year growth trend, while bilateral assistance to sub-Saharan Africa fell by 26.3%. Core development programming also suffered its largest historical contraction, dropping by over 26%.

Multilateral contributions similarly faced severe constraints, declining by 12.7% overall across the international landscape. Core funding to the United Nations (UN) system experienced a 27% decline, marking the largest annual drop on record for the global body.

Global health advocates warn these broader funding contractions arrive just as major initiatives, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, face critical cuts.

Geostrategic and economic pivot reshapes aid

EU humanitarian supplies face uncertainty as European institutions pivot funding toward regional security and domestic interests.
EU humanitarian supplies face uncertainty as European institutions pivot funding toward regional security and domestic interests.

The recent ODA cuts expose a stark geostrategic pivot, as major donors increasingly prioritise immediate regional security and domestic economic interests over broad human development. Beyond the massive volume drops from individual nations, European Union (EU) institutions accelerated this downward trajectory by reducing their overall assistance by 13.8%.

Adding to the shifting landscape, bilateral funding to Ukraine fell by 38.2%, yet when including EU institutional funds, total assistance to the nation still exceeded the combined aid given to all Least Developed Countries.

Civil society organisations warn that these institutional funding choices will inflict direct damage on fragile communities and dilute the core purpose of international cooperation.

“Though framed as part of the ‘paradigm shift’, EU Institutions and EU Member States have already been cutting grants to those who need them the most,” Mafalda Infante from Plataforma Portuguesa das ONGD said in a joint press release by Concord, a European confederation of development NGOs.

Critics argue this controversial policy shift toward mutual interests heavily disadvantages vulnerable states by increasingly designing cooperation to benefit European companies.

“In order to support the reduction of poverty and inequalities the EU should dedicate more ODA to sectors like health, education and social protection, but today’s figures show another path being taken,” the NGOs stated.

Projections remain grim

OECD projections indicate a continued decline in global aid through 2026, extending a historic downward trend.
OECD projections indicate a continued decline in global aid through 2026, extending a historic downward trend.

Despite the gloomy overarching narrative, several nations have demonstrated a steadfast commitment to sustaining international development. Eight member countries actually increased their assistance in 2025, resisting the broader fiscal pressures that drove the global reductions.

Notably, Denmark, Luxembourg, Norway and Sweden continued to exceed the UN target of allocating 0.7% of their gross national income to foreign aid. Additionally, 12 non-DAC countries increased their collective development finance by 4.5% to reach $13.3 billion.

However, these non-DAC providers shifted their direct funding from multilateral contributions to country-to-country assistance. Nations like Qatar and the United Arab Emirates drove this growth, with the UAE specifically directing its bilateral funds to immediate regional development and humanitarian crises in the West Bank and Gaza Strip.

Looking ahead, the OECD projects an additional 5.8% decline in global aid for 2026, raising alarms over the international community’s ability to respond to future shocks.

“I can only plead that DAC donors reverse this negative trend and start again to increase their ODA,” DAC Chair Staur said.

Drastic UK Aid Cuts Hit Fragile African Health Systems

Image Credits: ‪Salah Darwish via Unsplash, Felix Sassmannshausen/HPW, Bundesregierung/Steffen Kugler, European Union, OECD.

WHO Director General Tedros Adhanom Ghebreyesus addressing the 158th session of WHO’s Executive Board in Geneva in February. His term ends in August 2027.

Several WHO member states about to join the Executive Board have dubious human rights records, but they will shortlist Director General candidates at the Organization’s most consequential period in a generation.

The World Health Organization (WHO) Executive Board does not make headlines. It should. This is the body that screens Director General candidates, whittles the field down to three, and presents them to the World Health Assembly (WHA) for confirmation.

Whoever is confirmed to the board at this year’s WHA in Geneva in May will have an outsized say in who leads the world’s most important health organization at arguably its most precarious moment. And precarious is putting it kindly. Member states are fleeing, including the historically largest donor, the United States, which said it had officially completed its withdrawal in January. 

Right now, across all six WHO regions, the deals are being done to determine who fills the rotating seats on the board’s 34-member roster, with 10 members rotating out in 2026 and 10 new ones taking their place.

EB will select three DG candidates 

So why does any of this matter? The countries entering the Executive Board in 2026 will screen the Director General (DG) candidates and narrow the field to three finalists before the full WHA makes its final call in 2027. 

That process begins this year. Any serious candidate already knows it. As Health Policy Watch reported in February, those with their eye on the top job are already touring capitals, working the conference circuit, and calling in favors – with exactly the countries now taking their seats on this board. 

They still need the golden ticket: a formal nomination from their own Ministry of Foreign Affairs, and that clock starts the moment Tedros issues his call for candidates, anticipated later this month.

The question is whether the incoming countries will have the mettle to reverse the damage done to the organization, or whether they will simply provide fresh cover for an institution that is at risk – budget-wise and politically – before a new DG even gets the chance to restore some credibility. 

China in the new EB line-up

So who do we have? Up first is the Western Pacific Region (WPRO). At the 76th session of the WPRO, held behind closed doors in Nadi, Fiji, in October 2025, member states made a little-publicized decision to nominate China to WHA 2026, replacing Australia, whose term expires next month.

The closed-door nature of the proceedings suggests this was contentious, a reading reinforced by the chair’s report, which notes that the equitable distribution of seats within WPRO will be revisited for a final decision sometime in 2026. 

What exactly happened in that room? The context matters. Former WPRO Regional Director Takeshi Kasai was terminated following allegations of misconduct, leaving the region reeling and lacking leadership. 

One could reasonably assume that both Indonesia, which recently and controversially opted to depart WHO’s South East Asia Region (SEARO) for WPRO, and New Zealand, had their own ambitions for a board seat.

The internal turmoil is likely to have done little to smooth the path to consensus on China’s nomination.

China described the US withdrawal from the WHO as a lack of leadership at the WHO Executive Board in February.

European region

Then we head to the European Region, where Georgia and the United Kingdom have been allocated Executive Board seats beginning May 2026. Yes, the UK is still in WHO’s far-flung European Region of 53 member states, which extends from Iceland eastward to the Russian Federation and Central Asian republics. The UK and Georgia will replace Switzerland and Ukraine whose terms end this month. 

You really have to read the fine print to find this, and scratch around in Georgian news to confirm it. The UK’s inclusion is unsurprising. Based on Resolution EUR/RC53/R1, permanent members of the UN Security Council within the European Region are entitled to Executive Board membership for three out of every six years. 

France, on the same basis, is already confirmed to follow in 2027. Worth noting too that Ukraine loses its board seat while its medical facilities and civilian infrastructure continue to be bombed by Russia, a detail that speaks for itself. Reports indicate that Russia stood as a competing candidate for the seat ultimately won by Georgia, meaning it was not afforded the same rotating privileges extended to the United Kingdom and France.

African and Eastern Mediterranean Regions

Over in the African Region, four out, four in: Cote d’Ivoire, Guinea, Mozambique, and South Sudan replace Togo, Cameroon, Comoros, and Lesotho respectively, with Cote d’Ivoire also tapped to serve as Vice-Chair of the Executive Board from the 159th session onwards.

From the Eastern Mediterranean Region (EMRO), Qatar completes its term at the close of the 79th World Health Assembly in 2026, with Kuwait set to take its seat through to May 2029.

Question marks in South East Asia and Americas

All four regions – Africa, EMRO, EURO and WPRO – have now published their nominations, though they are buried deep inside the archives of WHO’s never-ending pile of papers. 

Two question marks remain. First, who will replace the Democratic People’s Republic of Korea (DPRK)  from SEARO? Given the region’s smaller size, the list of viable candidates is short. Replacing one pariah with another in the form of Myanmar seems unlikely. The Maldives has limited diplomatic capacity. That leaves India, Sri Lanka, or Bangladesh, given Nepal and Thailand still have time left on their existing terms. 

If India is paying attention, and it almost certainly is, it may well calculate that with China joining the board, it cannot afford to remain aloof. The cold diplomatic war between the two countries, and their competing claims to the title of pharmacy of the world, gives India every reason to want influence over an organization that can directly shape that designation.

Second, the Americas. With Barbados going out, logic suggests another Caribbean nation could come in, but no reporting has yet confirmed a nomination. Jamaica or Trinidad and Tobago would both have the diplomatic capacity to make a push and represent the region credibly. And notably, the United States will not be at the table, given their recent exit from the WHO.

The board that emerges from Geneva in May will be imperfect. Based on historical precedent, including the DPRK being confirmed to the board three years ago despite its status as a global health pariah, it is hard to see any of the proposed names being rejected.

That said, several of the countries to be represented have human rights records that would raise eyebrows anywhere else. But they will help decide who leads WHO through its most consequential period in a generation. The world will be watching. One can only hope they set politics aside and do what the role demands: govern.

Following WHA 2026, the Executive Board is expected to be composed of the following Member States:

Staying on (continuing terms):

  •   AFRO: Cabo Verde (2025-2028), Central African Republic (2025-2028), Zimbabwe (2024-2027)
  •   AMRO/ PAHO: Chile (2024-2027), Costa Rica (2024-2027), El Salvador (2025-2028), Haiti (2025-2028), Panama (2025-2028)
  •   SEARO: Nepal (2025-2028), Thailand (2024-2027)
  •   EURO: Bulgaria (2024-2027), Israel (2024-2027), Norway (2024-2027), Poland (2024-2027), Serbia (2025-2028), Spain (2025-2028)
  •   EMRO: Egypt (2025-2028), Lebanon (2024-2027), Saudi Arabia (2025-2028), Somalia (2024-2027)
  •   WPRO: Brunei Darussalam (2024-2027), Japan (2025-2028), Republic of Korea (2024-2027), Solomon Islands (2025-2028)

Rotating in from May 2026:

  •   AFRO: Cote d’Ivoire, Guinea, Mozambique, South Sudan
  •   AMRO: TBC (replacing Barbados)
  •   SEARO: TBC (replacing DPRK)
  •   EURO: United Kingdom, Georgia (replacing Switzerland, Ukraine)
  •   EMRO: Kuwait (replacing Qatar)
  •   WPRO: China (replacing Australia).

Image Credits: WHO/X.

Exposure to air pollution, particularly in the long term, is associated with an increased risk of diabetes.

Air pollution increases the risk of diabetes, particularly when exposure is long-term, according to emerging evidence.

A 2025 study from China involving 18,606 middle-aged and elderly adults found that long-term exposure to air pollution – both indoor and outdoor – significantly increased their risk of metabolic disorders like diabetes.

“This national cohort study shows that outdoor air pollution -– particularly PM1, PM2.5, and their chemical components – is an important environmental factor contributing to GMDs [glycolipid metabolic disorders],” according to the study, published in the World Journal of Diabetes.

Long-term exposure results in higher toxicity than short-term exposure.

This is one of a series of studies on the association between diabetes and air pollution produced in the past decade.

But researchers need to factor in several variables that could affect the results, such as sugar consumption, genetics and socio-economic conditions, Arindam Roy, climate science advisor at the Clean Air Fund, told Health Policy Watch.

“It’s difficult in terms of getting the data right, because you need to have a substantial amount of air quality monitors, or by any means, you need air quality information at a very high resolution. You also need health information at a very high resolution,” Roy said.

A 2022 study published in The Lancet concluded that, “in 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure.”

While type 1 diabetes is an autoimmune condition where the body attacks the insulin-producing cells, type 2 diabetes is influenced by environmental factors, diet and exercise.

Solid fuel not linked to higher diabetes risk

Using solid fuels does worsen indoor air pollution, but research does not show any association with metabolic disorders like diabetes.

The 2025 study from China looked at air pollution as a result of various particle sizes ranging from PM1, PM2.5 and PM10. It studied the health impact over a five-year (long-term) and one-year (short-term) period.

Researchers found that while any kind of exposure to air pollution increases the risk of developing diabetes, the impact of long-term exposure was strongest.

The terms short-term and long-term are not very well defined, but short-term usually refers to episodic high exposure around events like wildfire or a season of high exposure. Long-term duration is usually measured in a timeline of years.

The use of solid fuels for cooking, which is known to push up indoor air pollution, did not appear to increase the risk of developing diabetes in the China study.

The researchers concluded that the lack of any association with air pollution from solid fuels and metabolic disorders like diabetes “underscores the urgent need for targeted interventions to improve outdoor air quality and reduce metabolic risks at the population level.”

This result is also in line with another four-year multi-country trial, the Household Air Pollution Intervention Network (HAPIN), which studied 3,200 households in Guatemala, India, Peru, and Rwanda. Study participants switched from cooking on solid stoves to LPG but did not see any significant health gains – a result that surprised the study’s researchers.

Also read: Switching from Biomass to LPG Failed to Show Health Gains in Four-Country Study of Household Air Pollution

Lack of adequate ground monitors is getting in the way

A 2022 study from Denmark that studied 1.9 million people found that exposure to all air pollutants was associated with a higher risk of diabetes.

Studying the health impacts of air pollution requires two sets of data – one on air pollution, and the other on health. Currently, very few countries have both these datasets at hand.

Air pollution data requires better monitoring on the ground using ground monitors.

“We do have satellite-based or modelled air quality data, which are very high resolution, like one kilometre or so. But again, you need ground-based monitors to validate the data in those particular areas to give you more confidence in your research,” Roy said.

Sharing health data is also often fraught with ethical challenges, apart from the fact that institutions in many countries might not even have them in digital format. Then there is the issue of both health and environmental researchers working in silos.

Evidence is lagging in most parts of the world

High-quality evidence on air pollution’s impact on health is available only in some countries and regions, such as the US, UK, and Europe.

“China is one example of a country where AQ (air quality) data has been improved during the recent past. There are other countries as well where accessibility has improved,” Roy said.

Africa in particular, and much of the developing world in general, suffers from the lack of evidence, researchers told HPW.

“The monitoring is not nationwide. A lot of the monitoring is centered in urban areas, and especially in the capital cities. Most of this monitoring is not national government activities,” said Gordon Dakuu, a Ghana-based analyst with Clean Air Fund.

“These are mostly project-based initiatives using Low-Cost Air Quality Sensors with a few Reference Grid monitoring. So, in Kenya, it is just Nairobi. In South Africa, it is Johannesburg, then when you come to Ghana, [it] is just Accra.”

The US administration’s cuts to the budget of its Environmental Protection Agency (EPA) have further disrupted air quality monitoring in several global locations.

Currently, the awareness of the air pollution-diabetes connection is also low.

“We tried engaging [people] on how air pollution can lead to some of these conditions. And you see, people’s perception of the linkages between air pollution and diabetes is still very weird,” Dakuu said.

“They think diabetes has to do with eating sugar, especially white sugar. So, I think there is still a lot for us to do as far as public health sensitization of people is concerned about the risk factors.”

Image Credits: isensusa/Unsplash, hailegebrael Berhanu/Unsplash.

Thousands of Somalis escaping drought and conflict have been arriving every month in sprawling settlements on the outskirts of towns, like this one in Baidoa, south-central Somalia, pictured in August 2022. The World Food Programme is the largest humanitarian organisation operating in the country.

The Trump administration has put forward Luke J Lindberg, the US Department of Agriculture trade and foreign agricultural affairs under secretary, as its pick for executive director of the United Nations World Food Programme (WFP). 

Lindberg would succeed Cindy McCain, who announced her resignation in October due to health issues. 

“Throughout his career, Under Secretary Lindberg has demonstrated the strategic vision, geopolitical insight, and focus on accountability that are necessary to lead WFP in delivering emergency food assistance,” the State Department said in its media note.

The WFP, founded in 1961, is the largest humanitarian organization in the world, offering emergency food relief, direct cash assistance, and technical and development assistance.

The programme is overseen by an executive director, who is appointed jointly by the UN Secretary General, and the Food and Agricultural Organization (FAO) Director-General.

The US is the single largest WFP donor, and has chosen its executive director for each five-year term since 1992. Under the first Trump Administration, WFP head David Beasly, the former South Carolina governor, oversaw the agency raising  $55 billion in funding and a Nobel Peace Prize.

From trade to aid

USAID and WFP channelled American-grown food to countries in need.

Prior to serving as USDA under secretary, Lindberg founded South Dakota Trade, an association that assists Midwestern businesses in accessing international markets. Lindberg has also held roles at the Export-Import Bank of the United States, where he served as chief of staff and chief strategy officer; and at Sanford World Clinic, a Sioux Falls-based health system.

Lindberg is also a fellow at the America First Policy Institute, a conservative think tank founded by Trump administration officials in 2021, and a member of the Council on Foreign Relations. 

The State Department pointed to Lindberg’s experience overseeing the McGovern-Dole Food for Education Program, Food for Progress program, and the Food for Peace program as demonstrating “proven operational excellence at the scale required for WFP leadership.”

World Food Programme in crisis

Grain shipment in SudanWorld Food Programme
The prolonged conflict in Sudan is hindering key humanitarian aid, including the World Food Programme’s work.

Lindberg’s nomination comes at a fraught time for the UN agency. Under the second Trump administration, WFP saw its funding slashed in half following the shuttering of the US Agency for International Development (USAID).

The loss of $2.6 billion in US funding triggered the layoff of a third of its staff – and a surge in malnutrition in some of the most fragile humanitarian states. 

WFP has issued emergency appeals to aid Sudanese refugees, Afghan families, and Ukrainians – some of the 103 million people supported by the agency in 2023.

The war in the Middle East further complicates WFP’s mission of providing life-saving aid. “If this conflict continues, it will send shockwaves across the globe, and families who already cannot afford their next meal will be hit the hardest,” said Carl Skau, WFP deputy executive director and chief operating officer in a press statement. “Without an adequately funded humanitarian response, it could spell catastrophe for millions already on the edge.”

“The more consequential question is whether Trump’s pick will rebuild WFP’s lifesaving mission, or continue dismantling an enterprise awarded the Nobel Peace Prize just six years ago,” wrote Sam Vigersky, an international affairs fellow at the Council on Foreign Relations in a March opinion piece. “Humanitarian aid is no longer billed as a needs-based charity, but an explicit lever of statecraft.”

Vigersky argued that the UN Secretary General is likely to green-light Trump’s pick, given the tense status of US-UN relations and the US stake in its financing.

With the State Department and USDA now channelling money back into the WFP, it remains to be seen whether WFP under Lindberg’s leadership will recover its funding and its impact.

The State Department reiterated its stance: “Our support for Luke J Lindberg’s candidacy demonstrates the U.S. commitment to keeping the WFP focused on its core mission: feeding those in need.”

Image Credits: Mercy Corp/ TNH, WFP/Abubakar Garelnabei.

Displaced people sleeping on the street in Beruit’s ​​Ain El Mreisseh, Lebanon, last month.

The World Health Organization (WHO) has only mobilised 37% of the funds it needs for the Eastern Mediterranean Region (EMRO) amid a “deteriorating health situation”, regional director Dr Hanan Balkhy told a media briefing on Wednesday.

Welcoming the two-week ceasefire between Iran and the United States-Israel, Balkhy called for the “permanent cessation of hostilities”, warning that the damage from the regional wars would take generations to address. She also called for the ceasefire to apply to Lebanon, which Israel claims is not covered.

Fourteen countries in EMRO are affected by wars, and over 4.3 million people have been displaced as a result. The damage in the region ranges from physical and psychological trauma to destroyed health facilities, and missed targets on maternal and child health and non-communicable diseases (NCDs), she explained.

“Stability is on a knife-edge across the region,” said Balkhy. “Public health risks are rising. Displacement is increasing the threat of outbreaks. Essential services are being disrupted, and environmental hazards are raising serious concerns about safe drinking water, air pollution and longer-term health impacts. 

Aside from violent conflict large parts of the region, a recent 5.8 magnitude earthquake in Afghanistan has also affected health services.

“Even before this escalation of hostilities, emergency operations were critically underfunded,” Balkhy said. “Of the $689 million required for 2026, only 37% has been secured. This week, the WHO launched a $30.3 million flash appeal to support the health response in Lebanon, Iran, Iraq, Syria and Jordan.” 

The flash appeal includes almost $7 million to provide trauma response and basic health services in Lebanon, and $5.2 million to provide the same in Iran.

Environmental concerns

Balkhy also warned of the environmental impact of the war, particularly on water and energy supplies, and air pollution.

“The Middle East is among the most water-stressed regions globally. The Gulf hosts approximately 400 desalination plants producing 40% of the world’s desalinated water. Several countries rely on desalination for up to 90% of their municipal water supply,” she added.

One of Iran’s desalination plants is inoperable after being bombed, while there have been “near misses or debris damage” near plants in Bahrain, Kuwait and the United Arab Emirates (UAE), Balkhy said.

She also warned of respiratory illnesses from degraded air quality.

“We cannot live without water and oxygen. We need both of them. The damage that’s happening to the environment could contaminate the water and the air.” 

Nuclear fears

“We are also extremely concerned about the increasing risk of radiological or nuclear incidents,” said Balkhy.

The International Atomic Energy Agency (IAEA) has notified the WHO of eight strikes in the vicinity of Iranian nuclear facilities, “marking an alarming pattern”, she noted. 

One of the strikes hit 75 metres from the perimeter of a nuclear site, according to the IAEA.

“Any strike near a nuclear facility could have severe and far-reaching consequences for public health and the environment.”

The WHO is working with national authorities and partners to strengthen preparedness and response measures for potential chemical, biological, radiological or nuclear (CBRN) incidents, she added.

“Continued military activity near an operating plant with large amounts of nuclear fuel could have severe consequences for people and the environment in Iran and beyond.”

While WHO has expertise in dealing with health crises, “when it comes to CBRN, when it comes to radiological and nuclear incidents, the level of expertise becomes thinner and thinner. 

“WHO’s job is to keep health systems prepared for exactly that kind of low probability, high impact event. But it is not easy, and the best way out of this is to sustain the ceasefire and the peace .”

Global impact of health system collapse

Following the US-Israeli attack on Iran on 28 February, hostilities between Israel and the Lebanese-based Hezbollah have escalated and Israel has sent ground troops into the country last month.

Dr Abanisar AbuBaker, WHO Representative in Lebanon, said that “So far, six hospitals have been closed, 200 hospitals have been damaged, and 51 primary healthcare centres are closed.”

One in five people – around a million – have been displaced in Lebanon, nearly 5000 have been injured, and more than 1500 have died.

Since 1 April, WHO has mobilised over 187 metric tonnes of medical supplies valued at more than $3.1 million for high priority settings. 

In Lebanon, a convoy has delivered 22 tonnes of supplies, supporting 50,000 patients. A 22.2 tonne convoy is currently on its way to Gaza, with enough supplies for 110,000 patients, while a 78.5 tonne air shipment to Afghanistan is underway, aimed at reaching over five million people in need. 

“In a region already carrying half of global humanitarian needs, health system collapse will not stay contained. That is a very unfortunate situation. It will have regional and global consequences,” Balkhy warned.

“At the same time, other crises continue to unfold, from Sudan’s massive humanitarian emergency to the recent 5.8 magnitude earthquake in Afghanistan, further stretching already overwhelmed systems.

“Even before this escalation of hostilities, emergency operations were critically underfunded.”

Image Credits: World Food Programme .

French President Emmanuel Macron opening the One Health Summit in Lyon, France.

The European Commission announced that it will contribute €700 million to the next funding cycle of the Global Fund to Fight AIDS, Tuberculosis and Malaria at the G7 One Health Summit in Lyon on Tuesday.

This was one of several pledges made at the summit, as the World Bank, vaccine alliance Gavi, governments, philanthropies and private companies made commitments to improve the health of humans, animals and plants.

Jozef Síkela, European Commissioner for International Partnerships, told the summit that Europe was able to commit €185 million to the Global Fund for the first year to kickstart the €700 million allocation. 

The Commission had been expected to announce its commitment at the Fund’s executive board meeting in February, but is facing intense pressure from its members amid the worsening global security situation.

Síkela also announced a €46.5 million commitment to health security in Africa and Europe, involving a partnership between the European Centre for Disease Control and Prevention (ECDC), Africa CDC and the European Food Safety Authority.

The European Commission is also investing €30 million in research and development (R&D) to combat antimicrobial resistance, and €20 million in R&D for new dengue treatments.

Jozef Síkela, European Commissioner for International Partnerships.

The World Bank intends to invest $750 million for One Health activities, its vice-president for development finance, Akihiko Nishio, told the summit.

The Bank will also strengthen the One Health implementation of regional health programmes in West and Central Africa.

Boost for vaccine development

Gavi executive director Dr Sania Nishtar told the summit she would ask her board to approve up to $200 million for upstream support to boost African vaccine manufacturing at its July meeting. 

Gavi has already pledged $1 billion to the African Vaccine Manufacturing Accelerator (AVMA) to promote commercial vaccine manufacturing on the continent. 

Gavi is also allocating $380 million to a “resilience mechanism to ensure that immunisation is at the heart of the response to crises in fragile settings”, Nishtar added.

Later in the summit, the South African generic drug company, Aspen, announced that it intends to prequalify two childhood vaccines, the hexavalent and pneumococcal vaccines, and start to manufacture these for the continent by the end of the year.

Aspen’s Dr Stavros Nicolaou said that his company would also start producing human insulin with Novo Nordisk by May to address the “sinister” explosion of type 2 diabetes.

Dr Sania Nishtar, Executive Director of Gavi, the Vaccine Alliance

Climate change

Opening the summit, co-chair French President Emmanuel Macron reminded delegates that “75% of emerging infectious diseases come from animals and that figure is sufficient justification for this meeting”.

The COVID-19 pandemic “became a global phenomenon in just the space of a few weeks,” he added, urging collaboration and a convergence of global and country-based strategies to address One Health.

“Progress must be based on science, which is free, open and independent,” Macron stressed.

Ghana’s President, John Mahama, co-chair of the summit.

Co-chair President John Dramani Mahama of Ghana told the summit that there is an “overwhelming surge of health threats across borders.”

 “Every species is in the crosshairs – animals, humans and plants. And the environmental catastrophe confronting us is in the waves of the sea. It’s in the glaciers. It’s in the rainforests. It’s in the desert storms. 

“In Ghana, a blight of disease and pests affects smallholder cocoa farmers, threatening millions of households. Illegal gold mining leads to forest degradation and pollution of our water bodies, threatening the survival of precious populations of birds and insects critical to our biodiversity. And the foundation of all these crises is the phenomenon of climate change.”

Mahama stressed that “everything is interconnected, from the outbreak of infectious diseases to antimicrobial resistance, and from climate-related disruptions to food systems.”

However, these risks are converging and intensifying in “frequency, complexity and severity” more than at any time in human history. 

“The One Health approach is thus a practical matter for us. In Africa, we traditionally lived our lives in lockstep with nature. We’re an integral part of nature. More than 50% of our population relies on herbs and other natural forest resources for their medicines,” he said.

“Our lived experience leads us to accept without question that human survival, animal wellbeing and plant health and environmental care form a single interconnected system.”

Echoing Mahama’s experience, Botswana’s President Duma Gideon Boko, also warned of the impact of climate change: “We’ve now begun to experience floods even in areas that were desert. It’s very strange, and it has undermined our climate-resilient infrastructure.” 

Role of philanthropy

Wellcome Trust CEO John-Arne Røttingen.

Wellcome Trust CEO John-Arne Røttingen told the summit that several philanthropic organisations had developed a declaration on One Health based on three pillars.

The first is to sustain investment in product development. The second is applying a One Health lens to this, particularly in the context of climate change.

Third, while philanthropies “are really proud to play a role in the system that’s dear to our heart… our role is only catalytic, complementary and driving collaborations”, said Røttingen.

“We are, as philanthropy, committed to partnerships, to collaborate. We need to tackle climate change. We need to tackle the infectious disease threats that are linked to climate change and to the One Health agenda, but we can only do it in partnership; in collaboration with governments, with industry, and civil society.”

Friends and colleagues at funeral of Majdi Aslan, a WHO driver, killed after Israel targeted the vehicle as it was driving on a main street in Khan Yunis.

The World Health Organization said it was “investigating” the circumstances around the Israeli shooting of a WHO contractor driving a vehicle in the southern Gaza city of Khan Yunis on Monday. Speaking at a UN press briefing in Geneva on Tuesday, a WHO spokesperson refused to confirm or deny Israeli military claims that the vehicle had been unmarked when it was targeted by nearby soldiers.  

“WHO is devastated to confirm that a person contracted to provide services to the organization in Gaza was killed yesterday during a security incident,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post, on Monday. 

Israel’s UN Mission in Geneva issued a statement saying that an unmarked vehicle had approached  a group of soldiers, who first fired warning shots, and then after it accelerated, shot and killed  the contractor, reportedly the vehicle’s driver. The incident was being investigated by the Israeli army, the statement added. 

Palestinian media reports named the victim as 54-year-old Majdi Aslan. Some reports contended that he was driving a clearly marked vehicle at the time he was shot on Salah-a-Din street a busy street in  eastern Khan Yunis near Israeli troop positions. Others said he was in driving a commercial vehicle while a second WHO staff vehicle accompanied the convoy.

WHO cannot confirm if the vehicle was marked

Speaking at the press briefing WHO spokesperson Christian Lindmeier said he could not confirm or deny the Israeli reports that the vehicle was not carrying standard WHO or UN markings. 

“I have no further information, so I can neither confirm nor deny what the vehicle is. Typically they would be who marked vehicles. But again, I do not have further information at this point,” Lindmeier said.

Following the incident, WHO said it had suspended until further notice  medical evacuation of patients from Gaza via Rafa to Egypt. Khan Yunis, in southern Gaza, lies just north of Gaza’s Rafah governorate, which borders Egypt and serves as an important crossing point both for humanitarian supplies and medical evacuations. 

Al Jazeera rendition of the “Yellow Line” on a satellite image with red dots showing positions of Israeli military outposts following the cease-fire.

The Khan Yunis area itself is bisected by the “Yellow Line” drawn at the 10 October 2025 cease-fire, which separates Israeli from Hamas-controlled areas of the 365 square kilometer enclave. Most of the governate remains under Israeli military control, with nearly a dozen Israeli army positions situated near or along the Yellow Line. 

Since the cease-fire took effect in October 2025, Israeli troops have continued to carry out targeted assassinations against alleged militant Hamas figures throughout Gaza –  killing some 713 people in total according to Gaza Ministry of Health. That is the death toll cited by the UN Office for the Coordination of Humanitarian Affairs in its latest, 2 April report.  Although the Gaza MOH data makes no distinction between civilian and military casualties, a significant number have been civilians, including women and children, UN and eyewitness reports. 

Attacks on health facilities in Lebanon

At the briefing, Lindmeier also detailed the situation in Lebanon where, according to WHO reports, there have been some 92 attacks on health facilities, since Hezbollah entered the war on 2 March, launching heavy missile fire against northern and central Israel. 

Some 53 Lebanese health workers have been killed in subsequent Israeli attacks, mostly in southern Lebanon, according to the WHO reports. Around 51 primary health facilities and six hospitals are now closed in the south, Lindmeier said.

That followed an Israeli order demanding the mass evacuation of  Lebanese civilians living in the border region south of the Litani river as Israel seeks to limit, so far unsuccessfully, Hezbollah’s range of fire into northern Israeli communities.

Limited humanitarian access to southern Lebanon 

Displaced people sleep in the coastal area of ​​Ain El Mreisseh in Beirut on 11 March 2026.

Humanitarian access to southern Lebanon where an estimated 150,000 people have chosen to remain “continues to be a major logistical and security issue,” Lindmeier said.  Throughout the country, Lebanon’s Ministry of Health has reported at least 1461 deaths, including  129 children, and over 4,400 injuries, he said. Israel claims that about 1000 Hezbollah fighters have been killed during the conflict. 

“Displacement [in Lebanon] remains massive, with over 1 million self-registered internally displaced people, with some nearly 140,000 hosted in 674 collective shelters placing significant pressure on services, particularly Beirut and Mount Lebanon,” Lindmeier added. 

“Displacement is driving rising risks of infectious diseases, including measles, hepatitis A and acute diarrheal diseases, particularly in overcrowded shelter situations.” Women and children make up the majority of those displaced and are disproportionately affected.”

Thousands of Israelis have also abandoned their homes along the country’s northern border with Lebanon as the war grinds on with dozens of Hezbollah missiles still being fired into their communities every day.

Thirty-nine Israelis, including 27 civilians, have so far died since the war began on 28 February from combined Iranian, Hezbollah and Yemenite Houthi missile and rocket fire.  Some 7500 Israelis, including over 1000 children,  have been injured  in the war, according to Israel’s Ministry of Health. 

Four West Bank Palestinians were also killed by an Iranian missile in March, while Israeli settlers have taken advantage of the war to ransack and terrorize West Bank Palestinian communities, killing at least 10 civilians, and injuring more than 215, according to one Israeli civil rights group.  In mid-March, undercover Israeli soldiers killed two young Palestinian children along with their parents as they were driving back from shopping for Ramadan to their West Bank home late one night. 

Iran: mounting death toll and massive displacement 

Photos of missile damage in Tehran shared by WHO in an X post last week denouncing on the destruction of Iran’s Pasteur Institute.

In Iran, meanwhile, numbers of Iranian casualties remain unclear with official Iranian figures putting the figure at a little over 2000, while a recent report by a  Iranian human rights group talks about the death of about 3600 people, including about 1,600 civilians, with the latter toll mounting. Israeli and US media reports have claimed that more than 6,000 military personnel have been killed.   

Some 3.2 million people have been displaced internally as Iranians flee Tehran and other major cities that have become targets in the joint US-Israeli campaign. 

There have been some 23 attacks on Iranian health facilities or health personnel during the US-Israeli war on Iran, resulting in nine deaths, according to the WHO dashboard tracking such incidents. 

That included an attack last week on Tehran’s Pasteur Institute, which was called out by WHO Director General Tedros in an X post, which was reposted by Iranian Foreign Minister Abbas Araghchi.    

Some observers, however, contend that the Pasteur Istitute had also become engaged  in biological weapons research, citing reports such as one from the UK-based Royal United Services Institute (RUSI).  Asked to respond, WHO did not comment.    

Protective gear for a chemical or biological incident – which can be as dangerous to health as a nuclear one.

Attack on Kuwait water desalination facilities

In another post last week, Tedros also denounced an Iranian attack on two water desalination facilities, noting that “damage to desalination facilities jeopardizes hospitals, health‑care services, and the well‑being of the entire population.” Some 32 civilians in Gulf countries have died in Iranian missile attacks, according to media reports. 

Regarding targeting of Kuwait’s water supplies, Israel’s Ministry of Foreign affairs criticized the WHO DG for failing to name Iran as the attacker – he has called out Israel in other posts related to the war. 

Asked whether WHO was indeed being selective in terms of military aggressors that it names – and it does not, a WHO spokesperson told Health Policy Watch the following: 

“”Health facilities, workers and patients must not be attacked nor used for military purposes, and the principles of precaution, distinction and proportionality are absolute and always apply. 

“Health care depends on the facilities and workers that deliver it; attacking them destroys lives, health systems and, of great potential importance, the paths that lead to post war peace and reconciliation.” 

 

Image Credits: @AlJarmaq News, cc/Al Jazeera , World Food Programme , @DrTedros /X, RUSI.

Smaller pharmaceutical companies and those outside countries with trade deals with the US will bear the brunt of President Donald Trump’s 100% tariff on imported patented pharmaceuticals and their active ingredients announced last week.

The tariff will be imposed on large companies 120 days from the announcement, and in 180 days for smaller ones.

Pharmaceutical companies from the European Union, Japan, the Republic of Korea, Switzerland and Liechtenstein will pay a 10% tariff and UK pharma companies are exempt from tariffs, thanks to earlier deals with the US.

Meanwhile, 16 big pharma companies, including Pfizer, Novo Nordisk, Eli Lilly and Johnson & Johnson, will also escape the 100% tariff as they reached “onshoring agreements” with the US Department of Commerce last year. Some of these companies also entered into “Most Favored Nation (MFN) pricing agreements with the US Department of Health and Human Services (HHS)”.

Companies that have both onshoring and MFN agreements will pay no tariffs, while those with onshoring agreements only face a 20% tariff.

However, commentators warn that many smaller pharma companies don’t have the flexibility or capital to make such deals.

Swiss pharma warning

The Swiss pharma association, Interpharm, warned last week that the tariffs “endanger global production and supply chains for pharmaceuticals, hinder research and development and ultimately harm patients worldwide.”

“Even if those companies that have concluded a deal with the USA are to be exempted, this decision may have an impact on security of supply,” said Interpharm, which represents all the major research-based pharmaceutical companies in Switzerland.

It also “demanded” that Switzerland secures an agreement with the US similar to that of the UK, and implements “extensive reforms” to ensure that the country “remains attractive for investment in research and development of innovative medicines in the future.”

Interpharm’s members include Johnson & Johnson, Novartis, Roche, AbbVie,, AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Lilly, Merck, Pfizer and Sanofi.

Making his announcement, Trump said that, in 2025, approximately 53% of patented pharmaceutical products and 15% of APIs distributed in the US were imported.  

Last year, the US imported $274 billion in pharma and medical products, but 80% of these were from the EU, Japan, South Korea, Switzerland and the UK.

Meanwhile, companies supplying an estimated two-thirds of branded medicines had already made deals with the US.

This means that only around $12 billion of imported medicines will be taxed at 100%.

Generic and animal medicines and biosimilars are exempt from tariffs, but this policy will be reviewed in a year’s time.

‘Jeopardise investment’

Stephen Ubl, CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), warned that the tariffs “on cutting-edge medicines will increase costs and could jeopardise billions in US investments announced in the last year.”

“Every dollar spent on tariffs is a dollar that can’t be invested in communities across the country,” said Ubl. 

“The innovative biopharmaceutical sector has a robust US manufacturing footprint. In fact, two-thirds of the medicines that are consumed in the US. are made in America. And when innovative medicines or their inputs are sourced from other countries, these products overwhelmingly come from reliable US allies, like Europe and Japan.”