The influx of people, equipment and supplies needed to respond to the Ebola virus outbreak is overwhelming for communities.

Treatment tents are burning in Ituri, burial teams are facing hostility, and suspected patients are fleeing quarantine centres, disappearing into communities.

These heartbreaking incidents are often described as obstacles to controlling the current Ebola outbreak. For the dedicated frontline workers risking their lives every day to contain the virus, these challenges are deeply frustrating. But as we reflect on how to best support these heroic efforts, we must ask a difficult question: why are people resisting those who are working so tirelessly to save them?

The answer may lie in a fundamental truth of public health: we must follow not only the path of  the virus, but people’s response to it.

The current outbreak is caused by the Bundibugyo strain, a rare Ebola variant for which there is currently no approved vaccine or treatment. With limited medical countermeasures, community trust becomes our most vital first line of defence.

Ituri Province – a zone of conflict and displacement

Médecins Sans Frontières (MSF) displacement camp in Fataki health zone of Ituri Province, DRC, which has been wracked by violence.

Consider the context of Ituri Province in the eastern Democratic Republic of Congo – a vast country roughly the size of western Europe.

Nearly five million people have lived for years amidst conflict raging in the country’s eastern region between Congolese government forces and local rebel groups; in Ituri this includes the Convention for the Popular Revolution (CRP), an ally of the better known M-23.

Ituri  province is home to vast humanitarian needs and large-scale displacement, reflecting a broader national crisis in which more than 21 million Congolese require humanitarian assistance and nearly 8 million have been forced from their homes. 

Half of the health centres in the conflict-ridden Fataki Health Zone, also now a virus hotspot, remain closed. And women struggle to access safe delivery care, as critical health surveillance funding for the region from USAID and other donors ended in March 2025. Essential health services have also been weakened by years of insecurity and chronic underinvestment.

This longstanding neglect has left treatable diseases such as malaria as one of the deadliest threats still facing communities in eastern DRC. The DRC alone accounts for approximately 11% of global malaria deaths, with children under five bearing the greatest burden. 

Resistance – a rational response to historical neglect 

Ebola treatment centre at Elikya hospital, in Bunia, Ituri province, June 2026. The tents, protective suits and Ebola protocols are overwhelming to communities accustomed to living in neglect.

When an Ebola outbreak occurs, the international community mobilises rapidly, bringing in tents, protective suits, emergency protocols, and security escorts. This response is necessary and well-intentioned. However, to a community that has endured years of everyday crises with limited support, this sudden influx of resources can feel jarring. Understandably, some might interpret this intense focus as an external priority rather than a response to their holistic needs.

This resistance is not born of ignorance. It is a rational response to historical neglect. When a health system has struggled to address daily emergencies but suddenly scales up for a single disease, communities draw their own conclusions. Trust, we know, cannot be manufactured at the moment of crisis; it must be cultivated long before the emergency arrives.

Trust rests on three pillars: authenticity, empathy, and logic. In the chaos of an emergency response, establishing these pillars is an immense challenge for even the most dedicated teams.

Authenticity, empathy and logic as pillars of trust 

Community engagement in critical prevention measures like handwashing and safe burial requires trust.

The logic of a response can be difficult for communities to grasp when it doesn’t align with their daily realities. When people see extraordinary mobilisation for Ebola but continue to lose children to malaria, malnutrition, and maternal complications, the reasoning can feel disconnected. They may wonder why such resources were not available for the threats they face every day.

Empathy is equally challenging to convey in a crisis. Frontline workers care deeply, but when people are hungry, displaced, grieving, and traumatised, a response focused solely on containment can feel clinical. When safety protocols require armed escorts for burials and prevent families from mourning their dead in traditional ways, the compassionate intent of the responders can be overshadowed by the rigid necessities of infection control.

Authenticity, too, is harder to perceive when intentions are viewed through the lens of historical trauma. Communities ask reasonable questions about the sudden arrival of numerous agencies and organisations. When the answers are complex, trust is fragile.

So, how do we bridge this gap and support the incredible work already happening on the ground? 

Empowering local structures 

Members of the Red Cross bury people who have died of Ebola in Ituri province in DRC, guarded by military personnel after attacks on a treatment facility for Ebola patients.  Experience shows that community managed burial teams have better outcomes.

The evidence suggests that empowering local structures is the key. During the 2018–2020 Ebola response in this same region, communities that were actively involved as partners achieved greater success. Trusted local leaders played a critical role in dispelling rumours, while community-managed burial teams had significantly better outcomes.

We can build on this by further supporting local leaders and family members, providing them with training and personal protective equipment so they can carry their own dead with dignity under supervision. We must continue to shift our approach so that communities are not just beneficiaries of a response, but active partners in designing and delivering it.

And looking forward, we must advocate for responding to malaria, malnutrition, and maternal health with the same urgency, so that when the next crisis hits, a foundation of trust is already in place.

Trust is built from the bottom up, household by household, village by village. It is sustained by the local nurse who is there every day, the teacher who explains prevention measures, the religious leader who helps families navigate fear, and the community representatives who understand local realities.

The crisis in Ituri will not be solved by medical interventions alone. It will be solved by supporting those who are already doing the heavy lifting and by minding the gap in trust. Because in the absence of trust, even the best-resourced outbreak response will struggle. But when trust is present, communities themselves become our strongest defence.

Dr Githinji Gitahi is the Group CEO of Amref Health Africa.

Image Credits: Direct Relief , MSF , Alexis Huguet/MSF, Médecins Sans Frontières (MSF) , AP.

Traditional dance at the opening of the Fourth Inter-parliamentary Conference on Family, Sovereignty and Values in Ghana in early June.

Human rights and legal experts have urged African governments not to buy into a draft charter being incubated by conservatives that will undermine the rights of women and girls.

Conflict, repressive laws and harmful cultural and religious practices conspire to undermine the health and safety of African women, girls and sexual minorities.

Now, one of the few continental treaties that protects women’s rights and promotes gender equality – known as the Maputo Protocol – is under threat from a conservative alliance with its roots in the Christian right-wing in the United States.

This alliance has developed a rival treaty – the draft African Charter on Family Sovereignty and Values – that it wants the African Union to adopt instead.

This draft charter was developed over four annual gatherings of conservatives. The first three in Uganda (2023, 2024 and 2025) were hosted by the Ugandan government and co-sponsored by the far-right US group, Family Watch International (FWI). The 2024 conference also received $300,000 from the Russian government, according to a Wall Street Journal exposé. 

FWI has lobbied African governments for over two decades to outlaw abortion and tighten their anti-LGBT laws despite evidence that backstreet abortions are killing women and that same-sex relationships have always been part of African life.

Maputo Protocol commits to ending gender-based discrimination

Girls and women protesting outside Gambia’s parliament in March 2024 against legislative attempts to reverse the legal ban on female genital mutilation – a form of ‘harmful’ practice outlawed by the legally-binding Maputo Protocol.  The initiative was narrowly defeated.

The Maputo Protocol, which has been ratified by 46 of the continent’s 54 countries, commits countries to eliminating “all forms of discrimination against women”, including “harmful cultural and traditional practices”. This includes female genital mutilation and child marriage.

It also allows for abortion “in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus”.

The rival draft charter, tabled at the fourth annual meeting of the Inter-parliamentary Conference on Family, Sovereignty and Values hosted by Ghana’s parliament on 3-6 June, wants “the family” – narrowly defined as a nuclear family headed by a husband – to be the foundation of all rights.

Members of Parliament from approximately 20 countries attended the conference, which has no legal status. They resolved to establish parliamentary caucuses on “family, sovereignty and values” with budgets from their parliaments, and to put their draft forward to heads of governments and the African Union for adoption.

Only the South African and Mozambican MPs declined to endorse the charter. 

‘Patriarchal push to dislodge human rights’

Dr Tlaleng Mofokeng, United Nations (UN) Special Rapporteur on the Human Right to Health

Dr Tlaleng Mofokeng, outgoing United Nations (UN) Special Rapporteur on the Human Right to Health, described the draft charter as “yet another assault on sexual and reproductive health rights and justice, as well as bodily autonomy and human rights in general”. 

It is the first continent-wide “patriarchal push to dislodge human rights”, she said, adding that the Maputo Protocol “has been playing a defining role in promoting gender equality, as well as protecting reproductive and health rights of women and girls in Africa”. 

By prioritising “family” over individual rights, the draft charter could legitimise subordination of girls, women, and gender diverse people, “wrongfully firewalling families from accountability in situations such as violence, coercion, or discrimination, making it impossible for vulnerable girls, women, and gender diverse people to seek justice where needed’, said Mofokeng.

She urged governments to “disengage with this draft Charter and instead honour and deliver on the promises they have made on gender equality and human rights to health, where no one is left behind”.

She was addressing a webinar hosted by the Centre for Health Diplomacy and Inclusion (CeHDI), International Planned Parenthood Federation (IPPF), Asian-Pacific Resource and Research Centre for Women (ARROW), Asia Pacific Media Alliance for Health, Gender and Development Justice (APCAT Media) and the media network, CNS.

‘Human rights reframed as a foreign ideology’

Sibongile Ndashe, executive director of the Initiative for Strategic Litigation in Africa.

Sibongile Ndashe, executive director of the Initiative for Strategic Litigation in Africa (ISLA), also described the draft charter as regressive. 

“Sovereignty is used to resist accountability, and family protection is used to justify exclusion,” Ndashe told the webinar. “Culture is invoked to limit equality protections, and human rights is reframed as a foreign ideology. The result is that there is a shift from rights-based governance to values-based regulation.”

Ndashe said that the charter narrowly defines “family” in terms of marriage, potentially excluding unmarried people from a range of services and inheritance.

Echoing Mofokeng, Ndashe said that the charter’s clauses “become especially dangerous where families themselves are sites of violence, coercion, discrimination, or unequal power relations. 

“Family cohesion cannot override women’s rights, children’s rights, bodily autonomy, or protection from abuse,” she stressed.

She also criticised the draft charter for expanding sovereignty to “justify extensive state control over morality, health, education, sexuality, and family life”.  ISLA has produced an extensive legal analysis of the draft charter.

Meanwhile, Famia Nkansa, communications lead at Purposeful in Sierra Leone, described the charter as dangerous “because it frames sovereignty as something that the state is entitled to versus the individual”. 

It is trying to substitute bodily autonomy, equality and dignity with “parental authority, tradition, and cultural preservation”, she added.

‘Weaponising legal instruments’

Letlhogonolo Mokgoroane, a South African legal practitioner who engages in rights-based litigation, said they have “seen up close what happens when legal instruments are weaponised against the vulnerable, and what happens when progressive instruments are dismantled or allowed to atrophy”.

Mokgoroane, who is non-binary, said the draft charter’s narrow definition of the family “excludes same-sex families, single-parent families, and chosen families from any legal recognition or protection” and its definition of gender “erases the existence of intersex and gender diverse persons”.

“The Maputo Protocol is a legally binding instrument that has been ratified by 46 of the 55 African Union member states. This is not a marginal document. This is a continental consensus on women’s rights, and the draft charter would have African governments repudiate it.”

Wildfires have evolved into a year-long threat for the European region.

As Europe sweats through the hottest week on record for June, the continent faces the looming spectre of wildfires – just one year after last year’s deadly events in Turkiye and Southern Europe.

But wildfire season is no longer episodic. It has evolved into a year-long threat, fueled by a warmer climate and its side effects. 

Increased temperatures, prolonged droughts and unpredictable weather patterns are creating more fire-prone conditions, and countries around the world are feeling the consequences, whether they are in the direct path of fires or thousands of miles away.

Anyone who has experienced a wildfire can attest to the immediate terror and heartache wildfires inflict on families, communities and economies. According to the United Nations, wildfires caused an estimated $106 billion in economic losses and $74 billion in insured losses globally between 2014 and 2023. 

But their impact spreads beyond the fire line and lingers long after they burn out. A recent report in Nature projects up to 1.4 million wildfire smoke-related premature deaths annually by the end of the century, driven by climate change, ageing populations and longer fire seasons. 

That’s nearly six times current levels. And the impacts will be experienced  unevenly around the world. Fire-related death rates in Africa, for example, are expected to increase eleven-fold.

As countries prepare for climate negotiations in Türkiye at COP31, we must act urgently to ensure wildfire smoke is treated as a climate and health agenda item, not just an economic or land management threat, and receives the coordinated response it deserves. 

If we don’t act fast enough, we will undo decades of hard-won clean air progress in the United States and Europe. The consequences carry a real human toll.

How wildfire smoke harms health

A helicopter attends to a blaze in Serbia in 2025 amid a pall of smoke.

Air pollution is already the second leading risk factor for premature death, with wildfire smoke contributing to its lethality. Wildfire smoke contains hazardous compounds.

Exposure to PM2.5, for example, or fine particulate matter, penetrates the lungs and bloodstream, can result in lung cancer and other respiratory diseases like asthma, cardiovascular disease and neurological diseases, all of which drive increased emergency department visits, hospitalizations, medication use, and death. 

When wildfires burn homes, office buildings and other structures, toxic compounds like lead and arsenic are mixed with fine particles.  Critically, vulnerable groups are impacted the most – children aren’t able to go to school, pregnant women are told to stay indoors for weeks, many older adults can’t open their windows in the summer, and outdoor workers who can’t stay indoors for economic reasons face some of the highest risks from long periods of breathing in smoke. 

Even without wildfire smoke, Europe already faces a severe air-quality crisis. Long-term exposure to PM2.5 above World Health Organization (WHO) recommendations was associated with an estimated 206,000 premature deaths in Europe in 2023, and nine out of 10 Europeans are exposed to air pollution at concentrations considered unsafe for human health. 

Wildfire smoke compounds the problem and its fine particles can travel thousands of kilometers across borders and into population centers far removed from the flames.

New research suggests that conventional assessments may substantially understate the specific threat posed by wildfire smoke. A 2025 Lancet Planetary Health study attributed an average of 535 deaths each year to short-term exposure to wildfire-derived PM2.5. Using a generic PM2.5 risk estimate based on different sources of pollution may result in an underestimation of health risks and understate wildfire-smoke deaths by a whopping 93%.

New era of wildfire risk in Europe

Europe’s wildfire risk for the coming week

The last few years have provided a stark preview of Europe’s future as climate change accelerates or, at the very least, continues to follow these trends. 

Southern Europe has experienced a succession of severe wildfire seasons over the past several years. In 2023, the Evros wildfire in Greece burned 93,880 hectares and killed 20 people, making it the largest single wildfire ever recorded in the European Union.  

In Portugal, the 2024 fire season was the country’s most destructive since 2017. More than 1,370 square kilometers burned, 16 people were killed and estimated damages reached €180 million. Then, in 2025, Spain experienced one of its worst fire seasons in decades. Approximately 380,000 hectares burned, making it Spain’s fifth-largest burned-area year since records began in 1961.

The scale of the 2025 fires in Spain and Portugal demonstrates how quickly extreme wildfire conditions can become a regional crisis. Consequences of fire must be tracked by more than burned areas, including fire intensity and spread. Small fires can also have large impacts on human health, economy and climate. 

Approximately 260,000 hectares burned in Portugal during the season, nearly five times the average for that point in the year. Together, fires in Spain and Portugal consumed approximately 640,000 hectares, an area equal to about 1% of the Iberian Peninsula, with most of the damage occurring within just two weeks .

Across Europe, approximately one million hectares had burned by that point in the season, the highest total since European Forest Fire Information System records began in 2006. During Portugal’s damaging 2024 season, approximately 480 square kilometers of protected areas and Natura 2000 habitats burned and a 50-square-kilometer fire entered Madeira’s laurel forest, a UNESCO World Heritage site.

Fires are not simply larger, but more frequent. A 2025 analysis found that the extreme fire-weather conditions behind the Spain and Portugal fires are now expected approximately once every 15 years. Before human-caused warming, comparable conditions would have been expected less than once every 500 years.

Wildfires are undermining air quality progress

Air quality is badly affected by wildfires.

Though many countries are making progress on reducing pollution by investing in clean transport, renewable energy and tighter controls on industrial emissions, wildfire smoke can erase these gains. According to a 2024 National Academies of Sciences Engineering and Medicine report, pollution from wildfires is actively undermining net-zero targets globally. 

In 2023, Canada’s wildfire smoke pollution was so extensive that it released enough greenhouse gases to make Canada the largest polluter of all but three countries that year: China, the US and India. In 2020, California’s wildfire season resulted in twice the pollution that was reduced from clean energy progress. 

According to estimated biomass burning emissions from the Copernicus Atmosphere Monitoring Service (CAMS), implemented by the European Centre for Medium-Range Weather Forecasts for the EU, intense fires in the Iberian Peninsula in summer 2025 resulted in Europe’s highest annual total emissions since the start of systematic monitoring in 2003. Governments simply cannot meet their clean air goals without addressing wildfire smoke.  

Strategy over silos: Coordinating the response

The solutions exist, but they require a fundamental shift from responding and reacting to, to planning for and preventing catastrophic fires.

That requires not only a strategic shift, but leveraging newly available data and coordinating clean air standards, climate mitigation plans, and fire management strategies so they work together and not in silos. Predictive science is working to identify which fires will explode into megafires and which can be managed or left to burn. 

Early detection systems can get the right response to the right fire, and air quality alerts can get people the information they need to make informed choices for their health and the health of their families. Yet few of these new tools and solutions will succeed if their use isn’t coordinated.

Across Greece, Portugal and Spain, governments have begun to move wildfire policy beyond emergency suppression toward prevention and preparedness, but the transition remains incomplete and uneven. 

Greece has adopted a National Forest Strategy for 2018–2038, launched a National Reforestation Plan for 2020–2030 and created the Ministry of Climate Crisis and Civil Protection in 2021 to improve coordination among agencies responsible for managing climate risks.  Yet the OECD concludes that Greece still lacks an overarching national wildfire-management strategy and that wildfire prevention remains divided among more than 45 agencies and public bodies. 

Portugal made a more structural shift after its catastrophic 2017 fires, creating an Integrated Rural Fire Management System and a dedicated coordinating agency to support a whole-of-government approach. It also increased its emphasis on fuel and ecosystem management, including prescribed burning and strategic fuel breaks designed to limit the spread and intensity of fires. Spain, too, has made measurable progress. 

Its average annual burned area declined substantially between 2006 and 2024, due, in part, to improved prevention measures and tougher penalties for people who start fires. But the 2025 fire season demonstrated the limits of that progress under the continued pressure of a hotter and drier climate. 

Together, these reforms show meaningful movement in the right direction, but wildfire management still tends to be divided across forest management, emergency response, climate adaptation, land-use policy and public-health protection rather than organized as a unified strategy.

Integrated fire management

A firefighter in Greece during a blaze in 2025.

Some countries and regions are already embracing a coordinated approach. The G7 Kananaskis Wildfire Charter called for integrated fire management, enhanced science and technology and international cooperation to tackle the wildfire crisis. 

Signed by over 50 countries, Brazil’s Call to Action on Integrated Fire Management and Wildfire Resilience calls for a paradigm shift in fire prevention and response. Brazil recently launched an innovative Integrated Fire Management Law, and Brazil’s new air quality law identifies integrated fire management as an air quality tool for mitigating emissions from this critical source of pollution. 

Building on these efforts, there is no more powerful platform for advancing European wildfire response than a COP hosted in Europe. 

As world leaders prepare to gather in Türkiye for COP31, key elements of the COP30 Call to Action on Integrated Fire Management can offer a foundation for this new approach: one that fully shifts from reaction to prevention. 

This approach draws on cutting-edge science that integrates climate data, fire technology and air quality and health data, innovating policy ambition to advance public health, land use and climate goals; and strengthens cross-ministerial governance structures and alignment while empowering and including local actors. 

Wildfires respect no boundaries and present grave threats to the health of people and our environment, with unsustainable costs to society. This demands a new approach to planning, prevention, and preparation; new models of governance and solutions that deliver on the triple bottom line: healthy forests, healthy environments, and healthy people.  

Angela Churie Kallhauge is the executive vice-president of impact at the Environmental Defense Fund. Prior to joining EDF, she served as head of the Secretariat of the Carbon Pricing Leadership Coalition (CPLC) at the World Bank.

Image Credits: BBC, Commons Wikimedia, Copernicus.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

A clinical trial of two antivirals that may be effective in treating Ebola Bundibugyo is expected to start in the Democratic Republic of Congo (DRC) next week.

“The trial will evaluate whether MVPC 134 and remdesivir can help to reduce mortality in patients with Bundibugyo virus disease, alone or in combination,” World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

The two interventions will be tested on confirmed cases of people with Bundibugyo, and the WHO estimates that it will need around 1,000 people to be enrolled to test whether the treatments are safe and effective.

There are currently 1,094 confirmed Ebola cases and 277 deaths. Two cases outside the DRC have been recorded over the past week, one each in Uganda and France.

The French Health Ministry reported on Wednesday that a doctor who had recently returned from a humanitarian mission in the DRC had tested positive, and was in a stable condition in a specialised facility.

The Ugandan case is linked to the DRC outbreak, bringing the country’s cases to 20.

‘Little miracle’

Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme,

In the past five weeks, capacity in the DRC has improved dramatically, said Tedros. Treatment beds have increased from less than 10 to over 500 in 19 health centres, while laboratory capacity has risen from 30 tests a day at the Central Laboratory in Kinshasa to over 2000 tests a day in nine labs across the three most affected provinces.

Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme, praised the DRC government for driving the response, with improvements “every day”.

“Increasingly, communities are leading this response from the front, identifying cases, and bringing them into care,” said Ihekweazu.

He described the establishment of the nine laboratories as “a little miracle”.

“It’s not just setting out equipment and a reagent. It’s providing power, security, logistics, transport, sample transportation, report notification, all of these are necessary to get a lab to work.”

Outpacing response

Dr Abdi Abdi Rahman Mahamud, WHO director of Health Emergency Alert and Response Operations,

However, Tedros warned that “the outbreak is continuing to outpace the response”, and “political advocacy and action are essential to create the conditions for increased humanitarian access and a scaled response”.

“Contact tracing is still not at the level needed. Capacity at treatment and isolation centres is insufficient. Safe and dignified burials remain a major challenge. The health system is under pressure. Border closures continue to hinder the response. Multiple security incidents have been reported, and the affected area is in the grip of a decades-long humanitarian crisis, and financial support is still insufficient,” Tedros elucidated.

Dangers for health workers

Dr Abdi Abdi Rahman Mahamud, WHO director of Health Emergency Alert and Response Operations, told the media briefing that there have been seven incidents targeting healthcare workers in the Ebola response. 

“These incidents demonstrate the real challenge and the heroism of healthcare workers,” said Mahamud, adding that 82 healthcare workers have been infected – 78 in DRC and four in Uganda. 

Mahamud also said that the WHO has a weekly call with officials from the US Centers for Disease Control and Prevention (CDC) globally, while WHO officials were in almost daily contact with the US CDC country director in the DRC.

“We are in the process of ensuring, because they are not able to go to the field, to link [up with] them, so that they can participate in the coordination,” said Mahamud.

“At the technical level, both in the field and at the global level, there’s some excellent collaborations, and hopefully this will be strengthened. I think this outbreak has shown  WHO, US CDC and the US government how critical collaborating in the field, sharing information, everything that’s required to respond is.”

Access for those who need it?

Meanwhile, the co-chairs of the Independent Panel for Pandemic Preparedness and Response have called on the WHO, Africa CDC and affected countries to develop a “transparent roadmap showing how promising vaccines, treatments and tests will move from development to delivery if they prove successful”.

“Responsibility for research, manufacturing, procurement, licensure and delivery currently appears fragmented across multiple organisations,” they note in a statement on Wednesday.

“The work to identify vaccine and treatment candidates, and to fund the next stages of development, has been rapid when compared to past Ebola emergencies,” said co-chair Ellen Johnson Sirleaf.

“However, questions remain regarding financing the full development, manufacturing, procurement, deployment and access should vaccines, treatments or tests prove successful. We also need publicly articulated guarantees that these products will reach the people who need them most.”

US Ambassador Tammy Bruce, deputy representative to the United Nations.

The United States and Russia were part of a group of eight countries that voted against the United Nations (UN) Political Declaration on HIV/AIDS, which was adopted by 149 votes at the High-Level Meeting (HLM) on Tuesday afternoon.

Israel, Burkina Faso, Burundi, North Korea, Niger and Senegal also voted against the declaration, while there were 14 abstentions, including nine from countries in the Middle East.

US Ambassador Tammy Bruce said that the declaration diverged from the 95-95-95 targets “by including divisive topics, reaffirming documents that do not enjoy consensus or which are not related to the fight against AIDS”.

The UN adopted the  95-95-95 targets, in 2021 which involve ensuring that 95% of people with HIV know their status; 95% of people with HIV are on antiretroviral (ARV) treatment, and 95% of those on ARVs are virally suppressed.

Bruce also recorded “deep concern” that the declaration included issues related to trade – a reference to clauses encouraging the transfer of technology to countries to enable them to produce their own HIV treatment.

“We have made clear our longstanding position on intellectual property protection and the need for transfer of technology to be on both voluntary and mutually agreed terms. We cannot accept references without appropriate caveats,” said Bruce.

Voting on the Political Declaration at the UN HLM on HIV/AIDS.

A last-minute oral amendment to the declaration by Malawi, on behalf of the Africa Group, removed the phrase “mutually agreed terms” in relation to technology transfer. This also incurred the disapproval of the European Union (EU), Switzerland and Canada, which dissociated themselves from these paragraphs.

However, Malawi’s Madalitso Baloyi said: “The African group believes that keeping ‘on mutually agreed terms’ in the text in connection to technology transfer undermines the key objective to access medicines, vaccines, and medical products, and to boost research and development”.

Malawi’s Madaliso Baloyi, speaking for the Africa Group.

The Africa Group has advanced the same argument during negotiations for a Pandemic Agreement, arguing that pharmaceutical companies need to be compelled to share technology during health emergencies.

Israel also cited the inclusion of trade issues in the 15-page declaration as one of the reasons for its vote against, but also launched a diatribe against a reference in the declaration to the 2016 Durban Declaration on HIV – which it bizarrely accused of being “anti-Semitic” without basis. The declaration, a commitment to various HIV targets, was adopted at an International AIDS Society conference held in Durban, South Africa.

‘Dubious notions’

Russia cited “at least 20 unacceptable provisions”

Meanwhile, Russia cited “at least 20 unacceptable provisions linked to intervention in domestic affairs of member states in combating the spread of HIV infections, imposing upon countries scientifically dubious notions”.

The declaration notes “the lack of significant progress in expanding harm reduction programmes”, and calls out “discrimination against people who use drugs, particularly those who inject drugs, through the application of restrictive laws”.

HIV in Russia is comparatively high in people who inject drugs, but Russia supports criminalisation rather than harm reduction.

Russia also accused the declaration of “the promotion of non-consensus-based language on gender”. This view was echoed by Belarus, Burundi and Senegal.

‘Key populations’

Cyprus, on behalf of the EU, succeeded in amending the declaration to include the terms “sexual and reproductive health services”, “gender-based” in relation to violence” and “key populations” – a reference to groups that are most at risk of HIV. These differ per country, but traditionally include sex workers, gay men, young women, prisoners and people who inject drugs.

“Key populations face disproportionate stigma, discrimination, and violence barriers that severely hinder access to life-saving HIV services,” said Cyprus.

“Global evidence demonstrates that these groups face HIV prevalence rates up to 25 times higher than the general population, yet they continue to encounter barriers in accessing prevention, testing, diagnostic and treatment services. 

“The European Union calls on all member states to uphold an evidence-based, inclusive, and rights-based HIV response and restore key populations to ensure no one is left behind in the fight against AIDS.”

Cyprus, for the European Union, succeeded in amending the declaration to include more human rights based language.

While the declaration commits to ending HIV by 2030, it identifies several gaps, including “reductions in global financing for HIV and the impact of recent disruptions on HIV services”.

HIV prevention programmes are at “particular risk, including community-led services, as external funding contributed almost 80% of HIV prevention in sub-Saharan Africa, 66% in the Caribbean and 60% in the Middle East and North Africa in 2024”.

Meanwhile, “high debt servicing obligations and limited domestic fiscal capacity continue to constrain sustainable investments in health and HIV responses in certain countries”.

In 2024, the HIV response was short by $3.2 billion and “there is a risk that this funding gap will widen further due to recent, sharp reductions in HIV-related development assistance”, the declaration notes.

HIV remains a “public health emergency”, and infections increased between 2010 and 2025 in three regions, namely the Middle East and North Africa (by 77%), Latin America (13%), and Eastern Europe and Central Asia (15%), according to the declaration.

However, despite the declaration being carried by a huge majority, several countries said that the short negotiating period and length of the text had complicated negotiations, which were led by Botswana and Georgia.

UNAIDS executive director Winnie Byanyima welcomed the adoption of the declaration: “A vast majority of countries have adopted a strong declaration that sets ambitious targets for the world to race to the 2030 goal of ending AIDS as a public health threat. They have kept the promise of 25 years ago.”

Newborn screening can prevent lifelong impairment, ensuring vulnerable infants receive early, critical medical care.
Newborn screening can prevent lifelong impairment, ensuring vulnerable infants receive early, critical medical care.

Universal newborn screening needs to be dramatically expanded to improve infant mortality, says the World Health Organization (WHO). Without intervention, many of the estimated eight million infants born worldwide annually with congenital anomalies face severe impairment or death, warns a new technical report.

The WHO report reflects a paradoxical landscape. As low- and middle-income countries (LMIC) successfully reduce deaths in infancy and early childhood by tackling the most deadly infectious disease, birth anomalies are now driving an increasing proportion of under-five mortality.

Between 2000 and 2023, the proportion of under-five deaths linked to birth defects surged from 1% to 4% in sub-Saharan Africa and from 3% to 11% in South Asia, according to new data. Globally, birth defects now account for almost 8% of all deaths among children under five.

“No child should miss the chance for a healthy future because a congenital condition was not detected early enough,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in a news release on Tuesday.

Systemic barriers obstruct lifesaving screening

WHO scientist Dr. Ayesha De Costa advocates for sustainable newborn screening
WHO scientist Dr. Ayesha De Costa advocates for sustainable newborn screening at a UN press briefing Tuesday.

High out-of-pocket costs and fragmented funding routinely exclude vulnerable infants from essential care. This is exacerbated as LMICs struggle to provide specialised medical care and long-term rehabilitation services that such children often require.

The new report also underlines that testing and diagnosis fail to save lives without a functional treatment pathway. Compounding this problem, inadequate emergency transport systems and severe workforce shortages frequently interrupt the continuum of care.

Without reliable data tracking systems to secure short- and long-term follow-up, early detection of treatable – and in some cases curable – conditions like sickle-cell disease, congenital hypothyroidism, and hearing loss often fails to lead to the treatment of vulnerable infants.

“Newborn screening is one of the best investments a country can make in the future of its children,” said Dr Ayesha De Costa, scientist at the WHO’s Department of Maternal, Newborn, Child and Adolescent Health and Ageing.

Sustainable state funding bridges care gap

To close these dangerous gaps, the WHO urges states to fully fund diagnostic initiatives, shielding impoverished families from catastrophic healthcare costs. For long-term sustainability, policymakers must shift from fragile donor-dependent models to tax-funded national insurance frameworks.

To begin this transition, the advisory proposes that health ministries of member states initiate targeted testing for at least one priority condition. Programmes can then expand incrementally as domestic infrastructural capacity grows.

When financially burdened governments adopt this pragmatic strategy, they can overcome initial limitations and establish effective care models. In India, for instance, a national screening programme reached well over 28 million children over three years, linking nearly 900,000 infants to treatment frameworks.

“Progress is possible even in resource-constrained settings when screening is linked to diagnosis, treatment, referral systems, and long-term care,” stated De Costa.

​​How Mentorship Is Quietly Transforming Maternal and Newborn Care in Sierra Leone

Image Credits: Photo by Visualss via Unsplash, Felix Sassmannshausen/HPW.

Ghana has combined the malaria vaccine with other proven tools, including using trusted voices to counter misinformation.

For decades, malaria has been one of Africa’s most persistent health challenges. In Ghana, it was once the leading cause of death for children under five. Bed nets and antimalarial drugs reduced deaths substantially, but by the mid-2010s, the pace of improvement had declined. 

Climate change was altering the length and intensity of transmission seasons. Resistance to the insecticides used on bed nets and to the drugs used to treat infection was spreading. The tools that had driven earlier progress were becoming less reliable. 

Then, between 2019 and 2024, under‑five malaria deaths fell by 86%. This did not happen by chance. 

With strong support from government, local leaders and technical partners, and a willingness to learn and adapt to changing needs, Ghana is showing that sustaining impact is possible.

Three things drove the decline in Ghana’s under-five malaria deaths: redesigning vaccine delivery around the needs of families in high-burden areas, activating trusted voices to counter misinformation at every level, and layering the vaccine with other proven tools rather than treating it as a standalone solution. 

Together, these approaches offer a practical model for how African countries can protect millions of children from malaria. However, across sub-Saharan Africa, progress against malaria is under threat as shrinking development budgets put life-saving programmes at risk.

Comprehensive prevention strategies 

Facing a high burden of malaria and backed by a strong pharmaco-vigilance system and robust immunisation systems, Ghana is showing what can be achieved. 

We joined the Malaria Vaccine Implementation Programme in April 2019, becoming one of the first three countries to pilot the vaccine together with Kenya and Malawi. The programme has since expanded across 11 regions in Ghana, protecting an estimated 4.8 million children.

Ghana’s results reflect the impact of combining vaccination with other proven tools, such as insecticide-treated bed nets, indoor residual spraying, and prompt diagnosis and treatment to reduce transmission and prevent deaths. 

Layering interventions protects children at multiple points – from preventing infection to reducing the severity of the disease and lowering the risk of death, especially in high-transmission settings where no single tool is enough. 

The original dosing schedule consisted of a three-dose primary series, followed by a fourth dose 18 months after the first dose, requiring additional facility visits beyond routine immunisation and wellness touchpoints. 

Many families in high-burden settings live far from primary health care centres, and many children missed the fourth dose because the system was not designed around the families it serves.

We addressed this by adjusting the malaria vaccination schedule to 6, 7, 9 and 18 months, aligning the fourth dose at 18 months alongside other Year 2 vaccines, including meningitis A and the second measles dose. 

In high-transmission districts, bed nets and vaccine boosters are also delivered at that same visit, maximising protection through a single point of contact. Co-delivery of interventions reduces the burden on families by limiting trips to health facilities, often located far away. 

It also helps health workers deliver more per contact, improving efficiency and reach. By designing primary healthcare services around families’ realities, Ghana is improving coverage and completion, especially for later doses, so more children receive maximum protection.

Trusted voices counter misinformation

Communities initially met the vaccine with curiosity and cautious optimism, alongside some hesitancy. We quickly learned that misinformation was a major challenge, and our early communications underestimated how fast rumours could spread on social media. 

Ghana Health Service (GHS) deployed teams to track and counter false and misleading narratives circulating across social and traditional media. 

At the same time, in-person feedback gathered in areas where the malaria vaccine is used provided valuable insights into community perceptions of the vaccine. Based on that information, the GHS then activated trusted voices to share clear and consistent information and address concerns directly.  

First, we trained frontline health workers to answer questions clearly and confidently during household visits and outreach sessions. 

Second, the GHS broadcast discussions on TV and radio in local languages, with live phone-in sessions that allowed community members to raise concerns and get immediate clarification from experts. In parallel, we trained radio talk show hosts and journalists to provide consistent, fact-based coverage and to invite health experts to debunk rumours live on air. 

Finally, we developed evidence-based infographics and other visual materials to counter misinformation and shared them widely across social media platforms. All this would not have been possible with a strong network that included community health workers, chiefs, religious leaders and civil society organisations.

As families began to notice fewer malaria hospitalisations and deaths, trust and demand steadily grew. This is when we expanded the anti-misinformation campaign nationwide, including in areas where rollout was phased, and reinforced confidence through robust safety monitoring with Ghana’s Food and Drugs Authority. 

The voices, channels and assets cultivated throughout the campaign played a crucial role in educating caregivers about the safety of the vaccine and countering rumours and misinformation. This effort has now been integrated into broader EPI communications activities. 

Political will and peer learning 

Sustaining progress will take political commitment and predictable financing. This is the core of the Accra Reset: African governments setting the agenda, prioritising proven tools and investing in the community workers who deliver them, with Gavi, the Global Fund and other donor mechanisms reinforcing country-led plans. 

This is no small undertaking, considering the competing priorities in health financing. Similarly, efforts such as the adoption of the Economic Community of West African States (ECOWAS) Regional Malaria Elimination Framework, which places malaria elimination at the top of regional health priorities, reflect that our leaders are committed to increasing domestic financing, strengthening accountability and supporting progress beyond donor funding.

Collaboration across countries is just as critical. Leaders should share successful delivery strategies, align supply chains and exchange lessons on community engagement and countering misinformation. 

With malaria vaccine rollout underway in more than 25 African countries, the experience exists. Now, let’s use it to move faster.

Ghana is committed to sustaining these achievements as we work toward full domestic immunisation financing by 2030. Our results show what is possible when evidence, partnerships, and community trust align. 

Every child in Africa deserves the opportunity to grow up free from the threat of malaria.

Dr Selorm A Kutsoati is a medical doctor and head of the Immunisation Programme at the Ghana Health Service. She currently leads Ghana’s malaria vaccine implementation effort, which has led Ghana’s malaria vaccine rollout since its inception in 2019.

 

 

 

Image Credits: WHO/Fanjan Combrink.

UNAIDS executive director Winnie Byanyima addressing a largely empty assembly hall at the opening of the UN High-Level Meeting on HIV/AIDS.

Despite remarkable advances against HIV over the past two decades, “let us not confuse progress with success”, warned UNAIDS head Winnie Byanyima at the start of the United Nations High-Level Meeting (HLM) on HIV in New York on Monday.

Over 40 million people are living with HIV, yet “almost nine million people are still not on treatment, and last year 1.2 million people were newly infected,” said Byanyima, her address delivered to a sea of empty chairs – symptomatic of waning interest in responding to the virus.

“This is our last High-Level Meeting before the 2030 promise to end AIDS as a public health threat. We are just four years away, and the opportunity is extraordinary.”

Africa is unhappy with political declaration

However, African countries expressed unhappiness with the political declaration due to be adopted at the end of the HLM on Tuesday. 

“The text renders the objective to end HIV and AIDS as a public threat by 2030 unachievable,” said Malawi Minister of Health Madalitso Baloyi, speaking on behalf of the continent.

“We are very disappointed with several areas in the text,” added Baloyi, listing the failure of the international community to “strengthen efforts for transfer of technology, equitable access to medicines and vaccines to developing countries”

Baloyi also highlighted the removal from the text “of a commitment to the supply of medical products,  including to countries facing unilateral coercive measures”.

Baloyi added: “The language on financing has regressed compared to the 2021 political declaration, reducing financing responsibility to mainly domestic financing and rejecting principles of equity and burden sharing.” 

Malawi’s Health Minister Madalitso Baloyi, speaking on behalf of the continent.

The European Union called for the political declaration to “serve as a pathway to accelerated and coordinated action, grounded in science, solidarity, accountability and human rights.”

The EU said that several requirements were needed to sustain the HIV response, including political will, strengthening synergies with co-infections such as tuberculosis and hepatitis; accelerated prevention, testing, and treatment, and country ownership with “stronger domestic financing”.

HIV is ‘the story of multilateralism’ 

President of the UN General Assembly, Annalena Baerbock told the HLM that “the story of HIV is a story of multilateralism itself”, and today, “reflecting the wider headwinds facing multilateralism, the HIV response stands at a crossroads again”.

“If we walk the last mile together, in the interest of all of us, we can end AIDS as a public threat. Or we can allow four decades of hard-won progress to be put at risk.”

UN Deputy General Secretary Amina Mohammed reminded the HLM of global achievements: “AIDS-related deaths have been reduced by 70% since their peak in 2004 and by 54% since 2010. HIV prevention and treatment services have reduced new infections by 40% in the same period, and today, more than 32 million people living with HIV are receiving lifesaving antiretroviral therapy.”

UN Deputy Secretary General Amina Mohammed.

She appealed to member states to “summon the political will to accelerate and finish the global HIV fight”, based on the UNAIDS Global AIDS Strategy 2026–2031, which centres “country ownership, people-centred services, and community leadership”.

In 2021, the UN adopted the  95-95-95 targets, which involve ensuring that 95% of people with HIV know their status; 95% of people with HIV are on antiretroviral (ARV) treatment, and 95% of those on ARVs are virally suppressed.

Aside from the 95-95-95 targets, UNAIDS also wants 90% of people in need of prevention to use prevention options, including lenacapavir, a twice-yearly injectable that offers almost total protection against infection.

Financial crisis

The HIV sector faces a massive loss of development aid, driven primarily by the United States, once by far the biggest HIV donor. It is winding down its President’s Emergency Plan for AIDS Relief (PEPFAR), largely substituting it with bilateral memorandums of understanding (MOUs) in terms of its American First Global Health Strategy. 

The HIV component of the US strategy is focused narrowly on preventing mother-to-child HIV infection.

South Africa, the country with the largest HIV population in the world, has not been invited to discuss an MOU with the US – and the US finally confirmed on the eve of the HLM that it intends to halt HIV support to South Africa due to political differences.

Zimbabwe, Zambia, and Ghana have also been unable to reach MOUs with the US.

The silver lining of the MOUs is the commitment by countries to incrementally increase domestic investment in their HIV response.

The UN has proposed “sunsetting” UNAIDS as part of the “UN80” cost-cutting in the face of a massive loss in funds. UNAIDS is fighting to remain, but as part of its transformation, it has already slashed staff by over 55%, including an 80% reduction in staff at its Geneva headquarters.

Meanwhile, HIV activists are campaigning for much broader access to the injectable lenacapavir, pressuring Gilead to allow generics and to reduce the price of the medicine.

President Surangel S Whipps (centre) and officials at the formal signing of the notification

The island country in the western Pacific Ocean has initiated a World Health Organization (WHO) review of nicotine in terms of the United Nations (UN) Convention on Psychotropic Substances

In 2023, I stood in a room among other Palauan mothers, school principals, teachers, and students who had come to witness the signing of Palau’s comprehensive prohibition on e-cigarettes, including their importation, distribution, sale, possession, and use. I told them I believed that if we let this industry continue unchecked, we would raise an entire generation damaged by vapes.

The prohibition was the right decision, but I knew even then how this works. The industry doesn’t stop. It continues to invent new products. We have already seen nicotine pouches appearing in Palau. Now we must develop new policies to regulate them, while, in the meantime, another generation becomes addicted.

Many of us in tobacco prevention and control have spent years focused on products – regulating what the industry sells. Yet the industry keeps creating new formats and flavors, all delivering the same addictive molecule, often targeted at young people. By the time regulation is in place, something new is already on the market. We are always one step behind.

What we see in Palau is not unique. It reflects a broader global pattern. According to our Ministry of Health and Human Services, more than half of Palau’s cancer cases are tobacco-related. 

Almost 46% of Palauan students aged 13 to 15 reported using e-cigarettes in a 2022 survey, before the prohibition of e-cigarettes in 2023. More than six in 10 of those who smoked said they wanted to stop but couldn’t. That is not a choice. That is an addiction. The addictive substance itself – nicotine – has been overlooked by the world’s regulatory systems for decades.

Review of nicotine

We realized we needed to rethink our approach. Instead of asking “Which product do we target next?” we should be asking: “Why has the molecule itself never been addressed?”

Cannabis, amphetamines, and ecstasy have been reviewed under international drug control. Yet nicotine – responsible for more than seven million deaths a year – has not. 

The molecule affects virtually every tissue and organ in the body. It damages the heart and lungs and disrupts brain development in adolescents and the unborn. Nicotine has an addictive potential comparable to cocaine and heroin. 

It drives addiction in over a billion people, most of whom began using it before they were old enough to make a choice. Globally, nine out of ten nicotine users start before the age of 18. Yet in decades of international drug control, not once had any country formally asked for a review of nicotine. 

On 10 June, Palau issued a formal notification to the UN under Article 2 of the 1971 Convention on Psychotropic Substances, requesting that the WHO Expert Committee on Drug Dependence (ECDD) conduct a critical review of nicotine. It is the first time any government has taken this step. 

Such a review will examine the evidence against the same criteria applied to every other substance on the drug control list: dependence potential, abuse risk, threat to public health, and therapeutic usefulness. We believe the evidence is clear—nicotine is a drug. It is time the world’s institutions treated it as one.

This step does not immediately change a single law in any country. It asks, formally and legally, for the first time, whether nicotine belongs under the same international framework that governs every other comparably dangerous and addictive substance.

While the mechanism has always existed, no government has used it until now. Palau invites others to follow.

Valerie Ngereblungt Remengesau Whipps, the First Lady of Palau, is a public health advocate and policy leader focused on tobacco control and preventing non-communicable disease (NCD). She chairs the Coalition for a Tobacco-Free Palau and serves on the country’s National Coordinating Mechanism for NCDs. 

 

Image Credits: Government of Palau.

EU lawmakers vote for lenient tobacco tax regulations in Strasbourg.
EU lawmakers failed to agree on tobacco tax regulations in Strasbourg this week.

The European Parliament on Wednesday defeated a proposal to freeze cigarette excise taxes at a 60% rate of retail value – throwing a final decision on tobacco and nicotine policies into the court of the European Council of Ministers. But the politically divided EU Council is unlikely to raises taxes anywhere near the bar set by the WHO’s latest recommendations for taxes on cigarettes, as well as novel nicotine and tobacco products that are surging in popularity.

A European Commission initiative, now set to go before the Council this summer, would raise cigarette excise taxes to 63% – still short of the WHO’s 70% benchmark. Meanwhile, excise taxes for e-cigarettes at low nicotine concentrations would be set at only 20%; at 40% for products with higher nicotine concentrations, and at 50% for nicotine pouches, according to the EC proposal. That’s in contrast to a WHO recommendation that excise taxes for all novel products be aligned with traditional cigarettes.

The requirement for unanimous European Council agreement on a tax package creates a major political hurdle for any initiative to raise cigarette to taxes and taxes on novel products further – in  alignment with WHO guidance. This, as the European Union records one of the world’s slowest declines in tobacco use.

The EU Commission initiative would also establish a stricter minimum tax floor of €215 per 1,000 cigarettes. The now-rejected European Parliament position had attempted to lower this floor to €200 per 1,000 cigarettes, while setting the proposed minimum excise tax on nicotine pouches to just 28% of the average retail selling price, a full 22% lower than the Commission’s original proposal.

EU tobacco tax misses WHO benchmark

WHO recommends that excise taxes – that is, taxes specific to products like tobacco and alcohol – account for at least 70% of a product’s retail price. Total taxes, including VAT and customs duties, should account for at least 75% of the retail price, according to the WHO recommendations.

Furthermore, the WHO has cautioned against differentiated taxation for novel products. Global health officials warn against creating such regulatory carve-outs, arguing that they sustain lifelong nicotine dependence.

Health advocates have meanwhile spoken out against revised tobacco taxes that make novel products highly affordable and easily accessible for young demographic groups.

Surging new products target youth

A recent WHO report highlights that retail sales of nicotine pouches surged past 23 billion units globally in 2024. Within the European Union, this market expansion is heavily driven by high consumption in Sweden, where novel pouches have become increasingly popular among young people.

WHO officials warn that these aggressively marketed products threaten to create an imminent youth addiction epidemic across the bloc if left unchecked. “The use of nicotine pouches is spreading rapidly, while regulation struggles to keep pace,” said Dr Vinayak Prasad, Unit Head of the Tobacco Free Initiative at the WHO, upon the release of the WHO global report.

According to health advocates, transnational tobacco companies are actively using Sweden’s experience to pressure other EU nations into adopting equally lenient regulatory and tax frameworks.

To attract adolescent consumers, manufacturers deploy digital influencer campaigns and candy-inspired flavours. Medical experts caution that some European brands feature extreme concentrations reaching up to 150 milligrams of nicotine per gram, significantly increasing cardiovascular risks and impairing adolescent brain development.

Divided Council to decide later this year

With the EU parliament failing to find a negotiating position, the burden now falls entirely on the EU’s Council of Ministers, including ministers from all 27 EU member states, to close the tax loopholes. The EU Council must now reach a consensus before adopting the final directive. The likelihood is that a tax increase of some kind will be approved, but it will be unlikely to even meet the level of the EU Commission’s proposal.  

The Swedish government, in particular, has been lobbying to keep tax levels low on alternative tobacco products due to its large pouch market.  Earlier this month, Sweden reportedly blocked an broad EU initiative that would have established a higher tax floor on novel products, sources told Health Policy Watch.

Nicotine Pouches: WHO Demands Strict Regulation to Prevent Looming Youth Epidemic

Image Credits: Felix Sassmannshausen/HPW.