Members of the Coalition for Health Justice speaking with Health Policy Watch. From left: Dr Puspita Wijayanti, Dr Irma Hidayana, Prof Teddy Prasetyono and Prof Zainal Muttaqin.
Members of the Indonesian Coalition for Health Justice speaking with Health Policy Watch. From left: Dr Puspita Wijayanti, Dr Irma Hidayana, Prof Teddy Prasetyono and Prof Zainal Muttaqin.

A coalition of senior medical professors and anti-corruption watchdogs from Indonesia has formally petitioned the World Health Organization’s Executive Board to reject Indonesian Health Minister Budi Gunadi Sadikin’s candidacy for Director-General.

As health minister since 2020, Sadikin has pursued “a pattern of actions that have marginalized or penalized physicians, academics and health professionals who expressed legitimate criticism of government health policies,” the group alleged in a 12-page dossier dated 4 November, and obtained by Health Policy Watch. The seven point appeal, also alleges that under Sadikin’s governance, Indonesia has seen: 

  • “The weakening of the independence of scientific and professional medical bodies;”
  • “Increasing centralization and commercialization of the health system;”
  • “Erosion of meaningful stakeholder participation;”
  • “Serious concerns regarding the governance, oversight, transparency and benefit-sharing arrangements surrounding collection and use of genomic data;” and
  • “Policies that have contributed to widening health inequities.”

The coalition concluded that “Sadikin is not an appropriate candidate to lead the World Health Organization,” arguing his domestic governance record violates basic principles of scientific independence and administrative transparency.

The appeal, delivered to all WHO Executive Board members and Geneva diplomatic missions by the Coalition for Health Justice (Koalisi Keadilan Kesehatan), which includes a dozen civil society organizations and academic bodies, marks the first grassroots challenge to an official nominee seeking to succeed Dr Tedros Adhanom Ghebreyesus. 

Signatories include the Council of Professors of Medicine of Indonesia (MGBKI), Transparency International Indonesia, Indonesia Corruption Watch, the Center of Economic and Law Studies (Celios), and BPJS Watch.

The dossier was also sent to Indonesian President Prabowo Subianto, parliamentary leaders, the National Human Rights Commission, and the UN Special Rapporteur on the Right to Health.

Contacted by Health Policy Watch on Tuesday for a comment on the allegations, the Indonesian Ministry of Health and the Permanent Mission of Indonesia in Geneva did not respond. 

Sadikin’s campaign also declined to respond by Wednesday’s publication deadline, saying that they would deliver a reply by Thursday – which Health Policy Watch will print in full, once it is made available.

Diplomatic push meets domestic headwinds

The preliminary hearing in Indonesia’s Constitutional Court in December 2023 of a petition by five leading health professional organizations against a new law championed by Minister Budi Sadikin, which transferred authority for professional standards and training from the associations to the government.

Much of the domestic pushback to Sadikin’s candidacy lies in a 2023 omnibus health law championed by the health minister, under which key training, competency, and ethics standards previously managed by independent medical, nursing, and health worker associations were placed under a health ministry-backed Health Council and thus government oversight. 

The move triggered fierce resistance from the country’s medical establishment, sparking a protracted constitutional battle.

“The government, through the leadership of the current minister, has moved into controlling professional ethics and standards,” said Dr Teddy Prasetyono, a plastic surgeon and member of the Council of Professors of Medicine of Indonesia (MGBKI). Prasetyono, a lead signatory to the petition, and several other coalition members spoke with Health Policy Watch on Wednesday.

Professor Teddy Prasetyono, plastic surgeon and member of the Council of Professors of Medicine of Indonesia (MGBKI).
Professor Teddy Prasetyono.

“This is one of the most alarming policies we have ever faced, where disciplinary actions and ethical oversight that belong exclusively to independent professional societies have been taken over by the state.”

Meanwhile, a court-mandated deadline for the government to dismantle key elements of the centralised regulatory apparatus expires in late January 2027, coinciding directly with the WHO Executive Board’s candidate shortlisting session in Geneva

In rulings issued on 30 January 2026, Indonesia’s Constitutional Court held that the Collegia, the academic bodies that set specialist competency and training standards, must carry out their role independently. The court also ruled that the Indonesian Health Council should remain independent, answering only to the President, rather than to the health minister. 

It also limited the minister’s role in setting professional standards to administrative sign-off. That reversed many elements of the 2023 reform that Sadikin had led.

Still a formidable contender 

Indonesian Health Minister Budi Gunadi Sadikin in Geneva in May during this years' WHA.
Indonesian health minister Budi Gunadi Sadikin on the podium of the Geneva Graduate Institute in May during this year’s World Health Assembly.

Not everyone sees such reforms as a bad thing.

In many countries, professional societies wield outsized power. But in developing countries with weak health systems, that independence can sometimes be a mixed bag, reinforcing vested interests rather than public health, one longtime Geneva-based global health expert told Health Policy Watch.

“Health reforms that strengthen government leadership and bring professional societies under appropriate public oversight should be welcomed and celebrated, as the ultimate responsibility for safeguarding the health and well-being of citizens rests with the government,” observed the expert, who requested anonymity.

By anyone’s count, Sadikin remains a formidable contender backed by the support of the Indonesian state, and bolstered by major administrative achievements. 

According to some reports, Indonesian President Prabowo Subianto personally asked him to run. Subianto himself is, however, currently facing a wave of criticism over his management of the air pollution emergency that has overcome the country and broader region over the past several months. 

The Indonesian Chamber of Commerce also has reportedly mobilized to campaign for the candidacy of Sadikin – a former CEO in Indonesia’s largest bank.

During his tenure as health minister, Sadikin directed the distribution of 453 million COVID-19 vaccine doses, oversaw a reduction in childhood stunting from 24.4% in 2021 to 19.8% in 2024, and helped establish the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, hosted by the World Bank. He is also one of the four co-chairs of the Accra Reset’s High-Level Panel on global health architecture, an initiative led by Ghana’s President John Mahama to give Global South governments a greater say in how global health is governed and financed. 

Jakarta has also recently increased voluntary contributions to the WHO, pledging $30 million in additional funding to the budget-strapped organization in July, a move celebrated by current WHO Director General Tedros Adhanom Ghebreyesus.

Unfolding environmental health disaster

Real-time wildfire locations and fire activity in Indonesia • as of November 12, 2026

Sadikin’s campaign is also unfolding against domestic and regional public backlash over Jakarta’s weak environmental health response to a months-long emergency. 

Toxic haze from wildfires in Sumatra and Borneo, driven by slash-and-burn deforestation to make way for farming, has spurred an epidemic of acute respiratory illness in the archipelago nation – with the haze spreading as far as Singapore and the Philippines. 

The crisis has also added fuel to the fire of criticism from civil society over inadequate state protection for vulnerable populations.

 

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In the months leading up to the wildfire crisis, Indonesia had also been wracked by spates of toxic air, including microplastics, wafting from burning landfills in a country where waste management is out of control. According to the UN, the country is the second-largest producer of mismanaged plastic waste after China. 

While Sadikin, as health minister, advised Indonesians to wear masks during such air pollution emergencies, his campaign has had little to say about how he, as the world’s top health official, might address the tsunami of changes sweeping across low-income countries – from air pollution and climate change to ultra-processed foods – leaving an epidemic of chronic disease in their wake. 

“As health minister, my job is to fix the downstream side at the end of the tunnel,”  he told Health Policy Watch in an interview last month. 

Court overturns doctor’s removal amid faculty revolt

Dr Piprim Basarah Yanuarso, thrown out of his post at a leading Jakarta hospital after he criticized new government measures, tells his story to the media.

The coalition argues that member states must evaluate Sadikin’s administrative track-record alongside his lack of clinical credentials and contentious domestic methods that have landed the health ministry in the country’s highest courts over its treatment of dissenting medical leaders.

Senior clinicians and heads of professional associations report intense personal and professional pressure. In one such case, Dr Piprim Basarah Yanuarso, president of the Indonesian Paediatric Society, was reassigned by the Health Ministry from his post as paediatric cardiologist at Indonesia’s national referral hospital, Dr Cipto Mangunkusumo National General Hospital in Jakarta to Fatmawati General Hospital.

The transfer came after Yanuarso consistently opposed government moves to place the independent medical collegium under direct ministerial control. Yanuarso was then terminated after he refused to take up the new post.

The Indonesian Supreme Court later annulled the ministerial transfer decree in September. Government officials have argued, however, that the Supreme Court ruling applies only to the initial reassignment order, while Yanuarso’s subsequent civil service termination, due to 28 consecutive days of absence from the new post, still stands.

Coalition alleges broader pattern of retaliation

372 Indonesian Professors of Medicine Deliver Statement on National Health Governance Policies on 12 June 2025.

Yanuarso’s case reflects a broader pattern of government retaliation against medical professionals and other healthcare workers who have criticized Sadikin or the Ministry, coalition members argued in their interview with Health Policy Watch.

The country’s five leading professional associations – the Indonesian Medical Association (IDI), the Indonesian National Nurses Association (PPNI), the Indonesian Dental Association (PDGI), the Indonesian Midwives Association (IBI) and the Indonesian Pharmacists Association (IAI) – had fiercely opposed the 2023 reforms from the outset. In a collective challenge to the new law in Indonesia’s Constitutional Court, they contended that the omnibus law dismantled the country’s architecture of professional independence and self-regulation.

When the Constitutional Court upheld the initial legislation in early 2024, the legal battle shifted to fresh legal challenges against its provisions on medical councils and collegia and an escalating faculty rebellion. 

The tensions escalated sharply in June 2025, when 372 medical professors issued a joint declaration of no confidence after Sadikin bypassed university faculties to launch hospital-based specialist training under ministry control.

The January 2026 Constitutional Court ruling was more favourable to the professional associations – preserving the independent role of the collegia to establish and oversee specialist competency and training standards. Health ministry officials have meanwhile maintained that senior faculty had refused repeated invitations to resolve curriculum standards through dialogue.

Major professional associations stay on the sidelines

Puspita Wijayanti, a physician and representative of the Coalition for Health Justice.
Dr Puspita Wijayanti, Coalition for Health Justice.

Notably, two frontline associations that led the 2023 constitutional challenge – the Indonesian Medical Association and the Indonesian National Nurses Association – did not sign the current appeal against Sadikin’s WHO candidacy.

Coalition leaders claim that established professional bodies have been cowed into silence after being stripped of many of their statutory authorities.

“We are fully aware that speaking publicly carries professional risks, especially for those working within the public healthcare system,” said Dr Puspita Wijayanti, a physician and coalition representative, in an interview with Health Policy Watch. 

“But we believe that remaining silent carries a greater risk, particularly for patients and healthcare workers whose concerns are not being heard.”

Indonesia’s genomic initiative and Geneva’s pathogen access and benefit sharing 

BGSI promoting the initiative on LinkedIn

Beyond domestic courtroom battles, Sadikin’s opponents say their petition also has relevance to the negotiations underway in Geneva over the proposed Pathogen Access and Benefit Sharing (PABS) Annex to the WHO Pandemic Agreement, currently deadlocked in negotiations between developed and developing nations. 

Under Sadikin’s tenure as health minister, Indonesia launched the Biomedical and Genome Science Initiative (BGSi). The mission aims to integrate genomic sequencing, biobanking, and clinical registries into routine public health and precision medicine across Indonesia. 

However, his civil society critics argue that the initiative massively expanded genomic sample collection in collaboration with a number of multinational health and tech companies, without sufficient statutory guardrails governing data ownership or benefit-sharing from health products produced using the vast data repositories. 

The companies collaborating in the initiative include BGI Group, a China-based genomics company, the UK-based Oxford Nanopore Technologies, a sequencing technology firm, G42 Healthcare, an Abu Dhabi-based AI and cloud health technology company, and the US-based gene-sequencing entity Illumina.

The Ministry of Health has in the past countered the criticism, stating that BGSi sequencing and analysis are carried out in Indonesia, that no samples are sent abroad, and that genomic data is stored in cooperation with the National Cyber and Crypto Agency (BSSN). 

Commercial hospital targets draw fire

While Sadikin is being widely hailed as a financial expert capable of steering the WHO through stormy fiscal waters, the petition challenges his market-oriented approach to public health financing. A 2024 ministry directive imposed corporate performance metrics on public referral hospitals, requiring state facilities to develop revenue targets and generate a revenue surplus, where possible.

“His target was creating all the hospitals not for servicing the people’s health, but as revenue centres, forcing hospital directors to meet targeted incomes or face being fired. It is changing public hospitals into private businesses, using sick people as the objects of business,” said Zainal Muttaqin, a senior neurosurgeon and prominent coalition member whose hospital contract was terminated after criticising ministry policies, in Wednesday’s interview with Health Policy Watch.

Sadikin has defended the targets as fiscal pragmatism, arguing that private executive wards generate commercial revenue needed to cross-subsidise universal healthcare patients under the national insurance scheme (BPJS Kesehatan).

Patient advocacy groups counter that the push to commercialise public healthcare services has strained frontline care. The coalition cites the death of a patient following an eight-hour wait for an inpatient bed. At the time of that event, Sadikin publicly conceded he felt he had failed.

The dispute also extends to drug affordability. While Sadikin publicly acknowledged that domestic retail medicine prices run up to six times higher than international benchmarks, he said in June that prices could rise by 10% to 20% this year because of the weakened rupiah, the local currency.

The coalition argues these commercial policies, alongside broader lapses in emergency coordination, conflict directly with WHO’s foundational commitment to universal and equitable healthcare access.

Contest turns on two conflicting views of Sadikin’s tenure 

The WHO Executive Board meeting in 2025. The next EB meeting in January 2027 will select the three finalists for the WHO Director General for the World Health Assembly election in May.

The civil society petition culminates in a direct challenge to Sadikin’s eligibility under WHO criteria, arguing his non-medical background and courtroom defeats disqualify him from global public health leadership. Sadikin has consistently dismissed that critique, pointing to his executive management of more than 100,000 personnel and his willingness to confront institutional resistance as proof of decisive capability.

Having received no formal acknowledgement from Jakarta or Geneva, the coalition confirmed to Health Policy Watch that it is escalating its campaign ahead of January. 

Planned steps include lobbying foreign ambassadors in Jakarta, requesting an urgent intervention from the UN Special Rapporteur on the Right to Health, and appealing directly to Dr Tedros to press for institutional engagement – even though the Director-General holds no constitutional authority over the member-state-led election process.

“If frontline professionals are afraid to speak, policymakers will never hear where the system is failing,” Wijayanti emphasised. “A future WHO Director-General must be able to listen to the people who see the failures of a health system first: healthcare workers and their patients.”

Ultimately, the contest turns on two conflicting views of Sadikin’s tenure as health minister: a necessary disruption of an entrenched medical guild during a doctor shortage, or an executive overreach that alienated the health workforce.

“Whoever leads WHO next will inherit a global health agenda that cannot be delivered without a strong, valued health workforce,” Howard Catton, chief executive of the International Council of Nurses – which represents more than 30 million nurses worldwide – told Health Policy Watch. 

Emphasising that frontline workers must be treated as “equal partners,” Catton warned that clinical trust requires “safeguarding professional ethics and ensuring health professionals can raise concerns about patient safety without fear of reprisal.”

For Board members reviewing Sadikin’s candidacy in January, the question is whether his executive track record represents decisive reform or a breach of the consultative leadership required of WHO’s top diplomat.

See more about the WHO DG election on our microsite:

WHO DG Elections 2027

Image Credits: WHO, Felix Sassmannshausen/HPW, MKRI/Ilham W.M./Indonesia Constitutional Court , IQAIR, Devandra Abi Prasetyo/Detikcom , LinkedIn/BGSI.

“Starting next year, I will no longer be Secretary-General. But you can count on this. I will not stop telling the truth, and I will not stop fighting for it,” Guterres told COP31.

In his last climate summit address as UN secretary-general, António Guterres accused fossil fuel interests of “making a killing while killing our planet”, and warned that a world set to blow past 1.5°C of warming was on a “path to mutually assured destruction.”

“Fossil fuels must go the way of the dinosaurs,” Guterres told the leaders. “But that won’t happen on its own. The dinosaurs did not have a lobby. But fossil fuels do.”

The nine largest oil companies made $95 billion in profit last quarter alone, he noted, while the fund launched at COP28 in Dubai in 2023 to pay for losses from climate disasters has received around $600 million, roughly what those companies earn in 14 hours.

“The brutal truth is that the climate crisis is outrunning us,” Guterres said. “It’s time for governments to tax these windfall profits and use them to help vulnerable countries recover. Polluters must pay.”

Speaking as more than 70 world leaders gathered in Antalya for two days of speeches, Guterres appealed for unity at a time of deep divisions over war, debt and who should pay for the costs of a warming planet.

“We do not need countries to agree on everything,” Guterres said. “But we do need to cooperate on the things no country can solve alone, and the climate process itself must evolve. Negotiations matter, but success must be measured on the ground.”

Leaders of the three biggest emitters stay home

Brazilian President Luiz Inácio Lula da Silva told the summit governments are “talking more about weapons and tariffs than the survival of future generations.”

The leaders’ summit marks the point where COP31 turns from procedural wrangling to politics, before the talks close on 20 November. After a year dominated by war, inflation and an oil price shock, the path to a true breakthrough in Antalya looks steep.

“Chaos in global energy markets and climate disasters are supercharging inflation,” UN climate chief Simon Stiell told leaders. “The political costs of fossil fuel dependency are unforgiving.”

A procession of heads of state, from Australian Prime Minister Anthony Albanese to European Commission President Ursula von der Leyen, accepted that warming can no longer be held below the Paris Agreement’s 1.5°C limit, the north star of COP negotiations for the past decade.

Despite the accelerating crisis, heads of state from many of the world’s largest economies – and the three top emitters in China, India and the US – are skipping the summit.

Leaders who stayed home included China’s Xi Jinping and India’s Narendra Modi, who lead the world’s largest and third-largest emitters, as well as France’s Emmanuel Macron and Germany’s Friedrich Merz. The United States, the second-largest emitter, sent no official delegation for the second year running.

“It is a disgrace that only one G7 head of state and a handful of G20 leaders are attending the summit,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. “The world’s biggest economies should be leading the response to the climate crisis, not leaving it to others.”

A White House official told Spectrum News the summit “rejects reality by failing to acknowledge that extremist climate policies are destroying countries around the world.”

“This concern turned into silence,” Brazilian President Luiz Inácio Lula da Silva said of climate’s place at G7 and G20 summits. “We started talking more about weapons and tariffs than the survival of future generations.”

‘Fight harder’

The window to hold global warming below 1.5ºC has closed, and greenhouse gas emissions must nearly halve within a decade to keep the chance of limiting peak warming to 1.8C in reach, the UN Environment Programme said ahead of COP31.

“Science tells us an overshoot above [1.5°C] is now inevitable,” Guterres said. “But science is not telling us to surrender. It’s telling us to fight harder. The truth is that we have the power to determine how high, how long and how devastating that overshoot will be.”

The World Meteorological Organization put the global average temperature from January to September at 1.47°C above pre-industrial levels in its latest update. An El Niño forecast to reach record strength by December will push that higher, giving a “new meaning to the phrase off the charts,” WMO Secretary-General Celeste Saulo said on Monday.

Hilda Heine, president of the Marshall Islands, whose atolls average about two metres above sea level, told leaders the global response to overshoot must be “overwhelming, or the world we know is over.”

“Overshoot means waves eating away our shores, flooding that destroys towns, schools, hospitals,” she said. “In July, I went to my home island. I saw coral, bright and lush beneath the water, as it has been throughout my life. I returned just a few months later, to find half [of it] white from bleaching.”

Most countries want the Intergovernmental Panel on Climate Change (IPCC), the UN body that assesses climate science, to finish its next reports in time for the 2028 global review of climate progress, known as the global stocktake. Oil exporters Saudi Arabia and Russia have pushed back, along with India.

“We have seen efforts to undermine the IPCC and to [block] its reports informing the next global stocktake,” Heine said. “Our Pacific scientists tell us the work can and should be completed on time.”

Trillion-dollar hurdle 

Ethiopian Prime Minister Abiy Ahmed addressing the COP31 plenary.

“Developing countries pay nearly $1 trillion in interest on public debt,” said Ethiopian Prime Minister Abiy Ahmed, whose country hosts COP32 next year. “[Early action] should begin here, with every pledge of finance answering three questions: how much, by when, on what terms.”

The UN trade and development agency, UNCTAD, puts the 2025 bill for developing nation interest payments at $995 billion and counts 3.7 billion people living in countries that spend more on interest than on either health or education.

Australian Climate Change and Energy Minister Chris Bowen, who is leading the negotiations, told leaders that just 0.2% of climate finance goes to small island developing states to help them adapt to climate change. “This must change,” he said.

“We cannot demand that countries transform their economies while denying them the means to do so,” Guterres said. “Emerging and developing economies outside China are home to nearly two-thirds of humanity, yet they receive less than one-fifth of global clean-energy investment.”

Stiell said the talks would focus on “delivering, and improving access to finance – without reopening previous agreements,” leaving untouched the Baku target. Developing countries went into the 2024 talks in Baku seeking $1.3 trillion a year and left with a pledge under which developed countries agreed to mobilise $300 billion a year by 2035. The latest OECD figures show they provided and mobilised $136.7 billion in 2024, less than half that sum.

On opening day, developing countries won a dedicated agenda item on whether rich nations are meeting their legal duty to provide finance, over EU objections.

The dinosaur lobby is in the room

“Their strategy is simple,” Guterres said of the fossil fuel lobby. “Distort the science. Delay the policy. Delay the action. Delay the accountability.”

On Monday, the day COP31 opened, Turkish President Recep Tayyip Erdoğan announced that Türkiye’s Gabar region now produces about 84,000 barrels of oil a day from 184 wells, and unveiled two new fields. Türkiye’s emissions rose by 24.4 million tonnes in 2025, the second-largest increase of any country after the United States, UNEP reported last month.

“Every new oil well drilled, every piece of coal extracted, is a threat to my country’s future,” Heine said. “The discovery of new fossil fuel resources is not something to celebrate, but something to fear.”

The presidency’s flagship pledge, to raise electricity’s share of global energy use to 35% by 2035, does not require that extra power to come from clean sources. “Electrification is important,” Heine added, “but must be linked to renewable generation.”

In a fiery address in which the Turkish president declared that “unnecessarily cutting down a healthy tree is, in fact, equal to killing a person”, Erdoğan told leaders that developed countries “that have historically consumed the global carbon budget should assume greater responsibility for emissions reductions and financing,” reopening one of the oldest fault lines in climate talks: who counts as a donor.

No new donors 

Russia’s COP31 pavilion showcasing the power of its nuclear-powered icebreaker fleet.

The 1992 UN climate convention puts the duty to provide climate finance on a list of wealthy nations known as Annex II: the United States, Japan, Germany and 20 other countries that belonged to the OECD in 1992, plus the European Union.

Russia, China and the Gulf states were never on the Annex II list. Despite decades of growth that have made China the world’s second-largest economy and Qatar and the United Arab Emirates among the richest countries per person, they insist they are not donors and will not become ones.

The Paris Agreement only encourages other countries to contribute voluntarily, which some do on their own terms: China says it has provided and mobilized more than 177 billion yuan, about $24.5 billion, for other developing countries since 2016, and the UAE launched a $30 billion climate investment fund when it hosted the 2023 summit in Dubai.

In an interview with Russian state media Interfax before the summit, Russia’s top climate envoy drew a red line reflecting non-donor states’ attitude.

“There are issues, if not ‘red lines,’ that we do not support,” Ruslan Edelgeriev, President Vladimir Putin’s special representative for climate said. “The first is the rapid abandonment of hydrocarbons. The second issue is that they are trying to force Russia to become a ‘donor’ … we are not donors; this is purely voluntary.”

At Russia’s pavilion, an exhibit on its fleet of nuclear-powered icebreakers showcases how the country stands to profit from a warming planet, as melting sea ice opens the Northern Sea Route, an Arctic shortcut to Asia.

Russia’s long-term climate strategy, filed with the UN, says climate change “creates new opportunities” for the country’s trade and economy, including “an increase in the navigation period” on the route.

Image Credits: UNFCCC.

Former US Secretary of State John Kerry, who signed the Paris Agreement for the United States, speaks at COP31 in Antalya on Tuesday.

ANTALYA – In a tale of America at a crossroads, former US Secretary of State John Kerry declared at COP31 on Tuesday that the country would soon return to a leadership role in the global response to the climate crisis, as a new report found President Donald Trump’s war on Iran had inadvertently tipped global fossil fuel emissions into decline.

“After two years of pulling back from international cooperation, after attacking clean energy and weakening our climate [protections], especially the [Environmental Protection Agency], after mocking renewables and showing scorn for science,” Kerry said.

“The US election offers powerful proof that, given a choice between denial and delay on the one side and innovation and common sense on the other, Americans are committed to taking back their future, and we will build and rebuild our partnerships as we do that.”

Soaring oil prices and the closure of the Strait of Hormuz are set to push global emissions from coal, oil and gas down 0.4% this year, to 38.2 billion tonnes of carbon dioxide (CO2), according to the annual Global Carbon Budget report, compiled by more than 140 scientists and presented at COP31. It is the first drop since the COVID-19 pandemic, led by a 1.9% fall in emissions from oil.

IEA forecasts for 2026 have swung from a 281 million tonne rise in global fossil fuel CO2 emissions before the Iran war to a 191 million tonne fall, as sharp cuts in oil and gas demand outweigh a rebound in coal. Source: Carbon Brief analysis of IEA forecasts.

“The price of petrol and supply chain disruptions are clearly a cause of the decrease in global fossil CO2 emissions in 2026,” said Corinne Le Quéré of the University of East Anglia, who led a companion study published in Nature Climate Change.

Adding to the irony, the war waged by the president who took the US out of the Paris Agreement is also speeding the world’s turn away from fossil fuels. With the world in its second war-driven oil shock in under five years, after Russia’s invasion of Ukraine, energy security has overtaken environmental concern as the main driver of renewables growth, the International Energy Agency (IEA) found last week.

“No country can block the sun from shining. No one can block any wind from blowing,” Kerry said. “Clean energy is not just a climate strategy; it is a national security strategy, an economic strategy, and a way to give countries much greater control over their own futures.”

The blue wave reaches Antalya

John Kerry and UN Secretary-General Antonio Guterres exchange words at COP31.

New optimism around the future political direction of the United States follows a sweeping Democratic victory in last week’s midterm elections, in which the party took both chambers of Congress and won races in long-time Republican strongholds including Texas, Kansas, Iowa and Ohio.

That same victory has inspired hope for renewed focus on health and environmental regulation gutted under the Trump administration. Democrats have pledged to restore withheld research funding, repeal deep Medicaid cuts and call in Environmental Protection Agency chief Lee Zeldin for questioning over the rollback of pollution rules, Health Policy Watch reported on Monday.

For now, the US is not in the room in Antalya. Washington formally left the Paris Agreement in January, has sent no official delegation to a COP for the second year running, and in February will become the first country ever to quit the UN climate convention itself. In 2025, Trump’s first year back in office, the US posted the largest emissions increase of any country, the UN Environment Programme found last month.

Anyone who still calls climate change a hoax, Kerry said, “should not be serving in public office.”

A dip, not a peak

The US posted the largest emissions increase of any country in 2025, adding 133 million tonnes of CO2 equivalent as electricity demand, driven in part by mass data centre expansion to fuel the AI boom, rose and coal power rebounded, with the Trump administration using emergency orders to delay coal plant closures.

Yet the Iran war was not the only factor in dropping fossil fuel emissions, and the dip may not last, scientists behind the report warned.

Solar, wind and electric vehicles met about two-thirds of this year’s rise in energy demand, Le Quéré said, with the oil shock accounting for the rest. Total CO2 emissions still rose, from 42.8 billion to 43.3 billion tonnes, as peat fires and forest degradation in Southeast Asia drove up emissions from land use.

“A decline in fossil CO2 emissions is encouraging,” said Pierre Friedlingstein of the University of Exeter, who led the study. “But a reduction driven partly by geopolitical shocks is not a sustainable climate solution.”

The world can emit just 150 billion more tonnes of CO2 before warming passes 1.5°C, less than four years of emissions at current rates. Holding the 1.5C line would mean taking emissions to zero within a decade, Friedlingstein told reporters, “which is extremely unlikely to happen.”

Kerry, who signed the Paris Agreement as secretary of state and later served as President Joe Biden’s special envoy for climate, conceded that the world had agreed “1.5 degrees was the target, and we have not delivered.”

“This is what makes it so damn frustrating,” Kerry said. “Solving this challenge is not a mystery. We know what to do.”

‘A second round of suffering’

Least Developed Countries Group chair Ambassador Adão Soares Barbosa of Timor-Leste addresses reporters on Tuesday.

The people paying for that failure live in the 44 least developed countries (LDCs), which have done the least to cause the crisis.

“For the LDCs, 1.5 is not just a number,” Ambassador Adão Soares Barbosa of Timor-Leste, who chairs the group, told reporters in Antalya. “Every fraction increase imposes a greater threat to our people’s homes, livelihoods, food and water security, and ability to recover from disasters.”

At a press conference setting out the bloc’s demands for COP31, Barbosa said the LDCs back Türkiye’s flagship 35% electrification target by 2035 but cannot reach it without money, technology and training from developed countries.

“That target is clear,” he said. “But then, how can we move together?” The biggest emitters must move off fossil fuels first, Barbosa said, and any support for LDCs must come as grants.

Repayments on climate loans to developing countries nearly tripled between 2020 and 2024 and could overtake new lending by 2036 if lending stays at current levels, a CARE analysis found. Some 3 billion people already live in countries whose governments spend more on debt interest than on health and education combined, according to the UN.

“It’s not loans,” he told reporters. “If we have loans… we will lose something. We don’t want to have a second round of suffering.”

Fossil fuels off the COP agenda

Delegates gather for the opening ceremony of COP31.

Three years after nearly 200 countries agreed in Dubai to transition away from fossil fuels, the issue is not formally on the agenda in Antalya.

Co-hosts Türkiye and Australia deliberately left it off after the fight over a fossil fuel roadmap torpedoed last year’s talks in Belém, Brazil, instead staking the summit instead on voluntary targets for electrification, waste and building efficiency.

On Tuesday, Brazil’s COP30 presidency tried to put the issue back before governments, presenting a voluntary roadmap for transitioning away from fossil fuels that it drafted after Belém ended without one.

The document is a toolkit rather than a plan, setting no deadlines or targets, leaving each country to assess its own dependence on coal, oil and gas and choose from a menu of measures. Those include scrapping fossil fuel subsidies and halting new fossil fuel power plants to cutting the flaring and venting of gas at oil and gas sites.

The transition away from fossil fuels, the roadmap concludes, is “urgent, inevitable and yet possible.”

No new backers were announced, and some fossil fuel producers are expected to resist any mention of the roadmap in the summit’s final decision.

“We have to make sure that we really do a roadmap,” Kerry said, “and we’ll find all kinds of ways to pressure and pull those CEOs to the table who are slow to move their companies.”

Host Türkiye charts path to more fossil fuels

COP31 President Murat Kurum of Türkiye addresses the plenary.

The host, meanwhile, is heading the other way. On opening day, President Recep Tayyip Erdoğan announced two new oil fields in Türkiye’s southeastern Gabar region holding an estimated 135 million barrels. State oil company TPAO is projected to nearly triple its gas output by 2035, according to a Global Witness analysis.

“The message from Türkiye could not be more contradictory,” said Jeni Miller, executive director of the Global Climate and Health Alliance, a network of more than 300 health organisations. “How can a country host the world’s most important climate conference… and on the same day announce plans to expand production of the fossil fuels driving that crisis?”

Türkiye’s flagship electrification pledge, championed by the presidency at Tuesday’s Electrification Forum, calls for lifting electricity’s share of final energy use from about 23% to 35% by 2035, but sets no requirement that the extra power be clean. Coal supplied 34% of Türkiye’s own electricity last year, according to the energy think tank Ember. Electrification “only limits overshoot if the electricity is cleanly generated,” said Samuel Guéret of Climate Analytics, a Berlin-based climate science and policy institute.

The EU, which co-hosted the first Electrification Forum on Tuesday, wants the target at the heart of the summit’s outcome but frames its own push as “clean electrification.”

“Expectations are low,” EU climate chief Wopke Hoekstra told reporters on Tuesday, pointing to a string of “underwhelming” COPs. “That’s just a reflection of reality.”

No list of backers has been published, and none is expected this week, Climate Home News reported. India has said it will not sign.

“We think this is not yet [the peak],” Le Quéré said of this year’s dip, “but the further acceleration of renewable energy and electric vehicle deployment is needed to really secure… a peak and decline afterwards.”

Image Credits: UNFCCC, UNFCCC, UNFCCC.

The blue cartridge contains three sputum specimens, which are being tested together using a GeneXpert machine. If the result is positive, each sample will then be tested separately. If the cartridge is negative, none have to be individually tested.

At a laboratory in Cameroon, technicians receive sputum samples from people suspected of having tuberculosis (TB). Until recently, each person’s sample required a separate test cartridge to detect the bacteria that causes TB. But when cartridges become scarce, the country’s National TB Program found a way to make existing resources go further: testing samples from several people together, using a single cartridge.

The approach, known as pooled testing, is helping laboratories process more samples with fewer cartridges, reducing costs and allowing more people to access TB diagnostics.

For Ngono, a 14-year-old girl in rural Cameroon, this change made a critical difference. After developing a persistent cough, she waited three months for a TB diagnosis. The nearest laboratory with GeneXpert – the main molecular test for diagnosing TB in children recommended by the World Health Organization (WHO) – was 16 km away. 

But for her, distance wasn’t the greatest barrier: when her sputum (phlegm) sample reached the lab, a backlog of samples and shortages of testing cartridges further delayed her diagnosis. 

When Cameroon introduced pooled testing, the laboratory was finally able to process her sample, confirming her TB diagnosis and allowing her to start treatment. Ngono’s experience illustrates how making better use of existing resources can help overcome barriers that might otherwise prevent people from receiving a timely diagnosis, sometimes with life-threatening consequences. 

Smarter delivery can lower costs

An estimated one in four people with TB globally are still undiagnosed and untreated. WHO recommends that everyone with signs and symptoms of TB receive a rapid molecular test as their initial diagnostic, yet only 54% currently do, largely because these tests remain costly for health systems and therefore out of reach for many.

Pooled testing addresses this gap: by testing multiple samples together, it stretches limited resources further, allowing more people to access testing using the same platforms that can detect TB and drug resistance within hours rather than weeks.

This challenge is becoming more pressing as global health enters a new era of constrained financing. The decline in donor funding underscores the need for increased domestic funding and greater national ownership of health programs. But this shift will not happen overnight. In the meantime, across countries, fewer people are being reached with essential services, and progress against diseases like TB is at risk of being reversed. Millions continue to face stark barriers to access the diagnosis, treatment and care they need. 

As funding tightens, it is essential for governments, funders and global health partners to continue investing in research, development and innovation, because diseases do not slow down when funding does: they continue to evolve, spread, and adapt. 

Meeting the challenge in today’s constrained financial environment will require a broader view of innovation, one that goes beyond developing new technologies to include smarter ways of delivering existing technologies.

How pooled testing works

 

Normally, diagnosing TB requires each person to provide a sputum sample, with one test used per individual. Pooled testing changes that: samples from up to four people are combined and tested together with a single test cartridge. 

If the pooled sample is negative, everyone in the group receives a negative test result. If it tests positive, samples that made up the pool are retested individually to identify who has TB. The potential is significant: fewer tests used, freeing up resources that can be reinvested to reach more people.

In Cameroon, this approach emerged out of necessity, in response to a cartridge shortage that had pushed the country’s TB testing capacity to a breaking point. By pooling samples at selected laboratories, the National TB Program reduced cartridge use by around 65%, lowering the estimated cost of molecular testing from about $8 to $2.80 per person. 

With the same resources, nearly 39,000 people accessed molecular TB testing, compared with just over 21,000 with individual testing – a nearly 85% increase in diagnostic coverage. 

By testing multiple samples together, pooled testing stretches limited resources further, allowing more people to access testing using existing platforms that can detect TB and drug resistance within hours rather than weeks.

In early 2026, the WHO issued new recommendations that endorsed pooled testing as a cost-effective strategy to increase TB screening. 

These recommendations draw on evidence from multi-country studies funded by Unitaid and led by the Liverpool School of Tropical Medicine and the Stop TB Partnership, with eight partners across seven countries (Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria and Viet Nam), and reflect a broader shift toward decentralized testing approaches that address longstanding access barriers. 

In Cameroon, the National TB Program is already demonstrating what this looks like in practice.

By rethinking how existing tools, infrastructure, and resources are used, rather than just introducing new technologies, the country has demonstrated what smarter delivery can achieve. This kind of practical, real-world innovation can increase access, improve efficiency, and transform the impact of global health investments. 

Sputum samples are being prepared to be tested in one GeneXpert cartridge.

Turning efficiencies into a global health priority

 Cameroon’s experience illustrates an important lesson: in today’s health financing environment, how health innovations are delivered is just as critical to health outcomes as developing new technologies. 

Efficient approaches like pooled testing ensure that resource constraints do not translate into reduced testing coverage. Instead, they have the potential to vastly increase the number of people who can be tested with the same resources – a critical step toward finding the “missed millions” and moving closer to ending TB. 

Unlike many new technologies that might require new devices or extensive training, pooled testing is ready to be implemented. It uses existing infrastructure and resources, and requires minimal additional training for laboratory technicians. 

For people seeking care, nothing changes in how they give a sample or get results, except they are more likely to be tested on time. Countries do not have to wait years to benefit. Because pooled testing builds on existing laboratory equipment, implementation can begin quickly, and results can be seen within months – expanding testing coverage, reaching more people, and reducing costs for national TB programs.

But access to these efficient approaches is not automatic. Even when evidence exists and tools are available, they can only be brought to scale through deliberate, coordinated action.

The health financing crisis makes this urgent. Innovating in the way we deliver existing tools is not just about efficiency: it is the most effective way of expanding access while enabling countries to transition toward more sustainable, nationally-owned health responses, even as external funding declines. But realizing this potential requires moving beyond fragmented individual efforts to collective global action.

This means three things: First, making it easier for countries to scale proven approaches now through coordinated technical support, clear and practical implementation guidance, including how-to videos, and alignment among partners to accelerate adoption. 

Second, investing in identifying where delivery innovation can be applied across other disease areas or for multi-disease testing and treatment. This means strengthening operational research, cross-disease learning, and evidence generation. 

And third, aligning countries, donors, and partners to scale what works. Without stronger coordination, even the most effective innovations risk remaining underused.

Developing new tools will remain essential, particularly as we face new and emerging health threats. But Cameroon’s experience with pooled testing demonstrates that optimizing delivery can unlock enormous gains – expanding access, improving equity, strengthening health systems, and contributing to finding the missed millions with TB. 

As global health enters a new era, the question is not whether innovation remains essential, but whether the global health community will prioritize both technological discovery and smarter use of existing tools – and act collectively, and with urgency to bring both to scale. 

Dr Noah Appolonie is the Cameroon National TB Program coordinator.

Dr Philippe Duneton is Unitaid’s outgoing executive director.

Dr Lucica Ditiu is executive director at Stop TB Partnership.

Dr Tom Wingfield is the deputy director of the Centre for Tuberculosis Research at the Liverpool School of Tropical Medicine (LSTM).

 

Image Credits: Stop TB Partnership.

Attendees flood in on the opening day of COP31 in Antalya, Türkiye.

ANTALYA – The 31st United Nations (UN) climate conference, COP31, got underway on Monday in the Turkish coastal city of Antalya, where some 100,000 people, including more than 90 heads of state and hundreds of ministers from nearly 200 countries, will gather over the next two weeks to decide what the world will or will not do to protect the future of the planet.

As has become routine, the summit follows a year of record-setting heat, floods, wildfires and drought across the globe. It is also the first since the UN Environment Programme (UNEP) concluded that the chance of holding warming to 1.5°C, the Paris Agreement’s landmark limit, “has been lost.”

On arrival at the sprawling Antalya Expo Centre, attendees who had not collected their badges the night before met a level of disorganisation reminiscent of the state of the negotiations themselves. This reporter’s wait to enter the venue lasted three hours, 21 minutes and 20 seconds, while others, stuck in highway traffic or unable to board the few buses, shuttles and trams to the venue, fared far worse.

For those brave enough to make it inside, the national pavilion halls play out like a world’s fair. Tajikistan’s is adorned with glaciers, a reminder of the Himalayan glacier collapse accelerated by climate change that killed more than 1,300 people in Nepal in August. Brazil’s is a rainforest, Oman’s a desert.

Across the hall, the UK pavilion honours the man who has arguably done more than anyone to protect the ecosystems the pavilions celebrate, the 100-year-old Sir David Attenborough.

UK Pavilion at COP31.

From the moment planes land to when buses and trams pull into the Expo Centre grounds, COP31-themed slogans blanket the city. Some play on time (“Protecting tomorrow is today’s work”), others on public transit (“Next stop: a better future,” painted on the COP31 tram). Some are classic UN jargon (“Dialogue. Consensus. Action.”), while others are just silly (“Let’s COP!”).

Yet one in particular best captures what the hosts, delegates, civil society and attendees in Antalya hope the summit will deliver: “Where dialogue becomes action.”

“COP31 must help close the gap between commitment and delivery,” said Australian climate minister Chris Bowen, who presides over the negotiations under a power-sharing deal with Türkiye. He has made finance, electrification and the ocean his priorities, and advocates: “We must turn climate ambition into real-world outcomes.”

So can the world deliver?

“The success of the next two weeks of talks will be judged by two things. The appetite to deliver on the promises we have made, and the ability to move beyond the culture of declarations that has sullied previous conferences,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa.

Let’s COP!

A large animated dome sitting atop the food court flips through animations of the globe, COP31 logos and the Turkish flag.

In hallowed COP tradition, the opening ceremony began an hour and a half late. The talks ran into Sunday night, stumbling over developing countries’ demands to put climate finance on the official agenda. Still, by previous years’ standards, this was a relatively short stalemate.

While the overtime talks secured an agenda item on climate finance, a two-year work programme agreed in Belém on how rich countries meet their obligation under the Paris Agreement to fund climate action in developing ones, it came at a compromise.

An African Group request for a separate item on tripling adaptation finance, the money that helps countries cope with heat, floods and failed harvests, was withdrawn after late-night talks and will be taken up under other items instead, according to Climate Home News and AFP.

Adaptation finance was a key target of civil society and developing nations alike in the run-up to COP31 because of the confusion in the text agreed last year. At COP30 in Belém, countries pledged to “at least triple” adaptation finance by 2035, but never agreed on a baseline year to triple from, or a dollar figure.

As it stands, depending on how it is measured, the pledge would cover just 20% to 29% of the roughly $420 billion a year, adjusted for inflation, that developing countries will need by 2035 to adapt to a fast-accelerating climate crisis, UNEP found in its annual Adaptation Gap Report last week.

An interactive map charting the flight paths and emissions of COP attendees.

As money continues to fall short and warming accelerates, the 44 least developed countries (LDCs) called the looming overshoot of 1.5°C “a grave betrayal of our countries who have contributed least to this crisis” in their opening-day statement.

“COP31 cannot be another exercise in deferring difficult decisions,” said the group’s chair, Ambassador Adão Soares Barbosa of Timor-Leste. “It must deliver urgent emissions reductions, address temperature overshoot, access finance and tangible protection for those most at risk.”

‘Pandemic proportions’

Top health and climate officials gather at a high-level ministerial meeting on COP31’s Health Day.

Türkiye opened COP31 with a Health Day, and health ministers and global health leaders from Geneva to the Pacific came to Antalya to argue that the health consequences of climate change have reached catastrophic proportions.

“No health system can be made resilient to an endlessly warming world,” Simon Stiell, the UN’s climate chief, told health ministers. “We must drive the transition away from fossil fuels fast and fairly.”

Stiell added that a health system can falter by degree: “A ward grows hotter. The power flickers. A refrigerator holding medicines fails. Floodwater enters a well. A mother in labor finds the road to the clinic cut off.”

At a separate press briefing on Monday, Stiell said the climate crisis is now “a global health crisis of pandemic proportions.”

Heat was linked to a record 710,000 deaths in 2023, almost three-quarters of them caused by climate change, the Lancet Countdown found last month. Air pollution from burning fossil fuels killed another 2.78 million people that year, and The Lancet authors argued that WHO should create a new category of public health emergency to classify the climate crisis.

“We can say that most heat deaths around the world are caused by climate change,” said Diarmid Campbell-Lendrum, who leads WHO’s climate and health work. “They’re climate change deaths.”

Money for war and death

Opening plenary of COP31 in session.

But as dire warnings of health threats echoed around the room, for a third consecutive COP, following Brazil and Baku, governments did not announce any new investment or financing.

“Let me be direct,” said Brazil’s Health Minister, Alexandre Padilha. “Financing for health adaptation is insufficient and is falling down.”

International public commitments for health adaptation fell from about $3.2 billion in 2022 to $2.2 billion in 2024, just 5% of all international public adaptation finance, Padilha said.

Development aid fell 23% in 2025, its largest drop on record, according to OECD figures he cited, while global military spending has risen 41% in a decade to $2.9 trillion.

“Why [is there] always so much money for war and death,” he asked, “and so little for health, environment, and life?”

‘Declarations do not protect people’

Bridge to COP31 stretches over a highway, with Antalya’s surrounding mountains in the backdrop.

Dr Tedros Adhanom Ghebreyesus, at his last COP as WHO Director-General before his term ends next August, traced health’s climb up the climate agenda, from pledges on climate-resilient health systems in Glasgow in 2021 to the first COP Health Day in Dubai and the Belém Health Action Plan last year.

“Each of those steps was driven by health ministers, but declarations do not protect people,” he said. “Implementation does.”

Tuvalu Health Minister Tuafafa Latasi said he spoke “from the front line of an immediate clinical and public health emergency,” with three of his country’s nine islands at high risk from cyclones, rising seas and salt seeping into groundwater.

“Protecting health in Tuvalu is a test of our shared humanity,” he said. “Our call at COP31 is simple: match strong climate commitment with practical support.”

In a WHO survey last year, more than 90% of countries named insufficient finance as a top barrier to their health and climate plans, Tedros said. Yet health has no item of its own in the formal talks, where climate finance is negotiated.

Resilient health systems are one of 10 priorities on Türkiye’s voluntary action agenda but, unlike electrification or waste, they have no numerical targets for 2035.

“Health is the human face of climate change,” Tedros told ministers. “It belongs in the negotiated text. It should be an explicit eligibility area for climate finance and its share should grow as adaptation finance grows.”

New ‘initiative’ launched

The headline launch from Health Day came with Türkiye and WHO’s announcement of what is known as the Antalya Initiative for Resilient Health Systems (AIR).

It is a voluntary scheme through which countries document what has worked in protecting health from climate shocks, what has not and what it cost, and share those lessons. In short, a shared feedback platform. But no countries announced their participation in the initiative as of Monday night.

“We want a successful solution developed in one country to be able to save lives in another,” said Türkiye’s Health Minister Kemal Memişoğlu. “We want to ensure that no country has to waste time reinventing solutions for the same problems.”

The initiative is designed to complement WHO’s Alliance for Transformative Action on Climate and Health (ATACH), a network of more than 100 countries that will hold their own summit on Tuesday at the COP31 health pavilion.

No funding, staff or list of participating countries has been published. Eighteen health organisations, led by Health Care Without Harm, have asked for the initiative to include a dedicated pillar for health workers.

Belém funding framework

WHO Director-General Dr Tedros Adhanom Ghebreyesus speaks at COP30 in Belém. The summit saw the launch of the Belém Health Action Plan, a Brazilian-led initiative that aligns with the WHO’s broader Global Action Plan on Climate Change and Health.
At COP30 in Belém, Director-General Tedros Adhanom Ghebreyesus called the formalising of Belém Health Action Plan a historic shift in the role health plays in climate talks. One year later, it has 40 signatories.

Brazil, meanwhile, launched a financing framework for the Belém Health Action Plan, a voluntary list of about 60 non-binding measures now endorsed by 40 countries since it was launched last year.

Drawn up with Wellcome and the Rockefeller Foundation, it sets out for each measure which kinds of money could pay for it, from climate funds and development banks to philanthropy and national budgets, along with likely partners and examples of where it has worked.

“I wish to make it very clear: this is not a new fund,” Padilha said. “It’s a map to help countries make better use of the mechanisms that already exist.”

Much of what the plan covers, such as disease surveillance, early warning systems and training health workers, generates little or no revenue, Padilha said, yet countries are being asked to take on debt to pay for it. The framework is meant to steer those measures toward grants and public money instead, with progress to be reported by COP33 in 2028.

“With the financing framework, we have the map,” he said. “Now we need the investment.”

Alan Dangour, Wellcome’s director of climate and health, announced that the Climate and Health Funders Coalition, which pledged $300 million in Belém, had awarded more than $225 million in its first year and attracted $150 million in new commitments.

“We should approach climate negotiations as though people’s lives depend on them,” Dangour said, “because they do.”

‘Off the charts’

Earth’s energy imbalance (EEI) from 1960 to 2025 as estimated from ocean heat
content.

The past 12 years are the 12 warmest on record, and the past four are the warmest of all, the WMO said in its report. Global temperatures from January to September averaged about 1.47°C above pre-industrial levels, and are likely to climb further as El Niño, forecast to be the strongest on record by December, takes hold.

“El Niño and indeed the state of the global climate in 2026 gives new meaning to the phrase off the charts,” said WMO Secretary-General Celeste Saulo. “El Niño doesn’t add new heat to the planet. It releases heat from the ocean, which is the warmest ever measured.”

Saulo told reporters to “prepare for another record-breaking year in 2027.” Europe’s heatwaves, drought and wildfires this year caused more than 30,000 excess deaths by preliminary estimates, the report found.

For the first time, WHO has classified El Niño’s expected health impacts as a health emergency, according to WMO. The Lancet Countdown has urged WHO to go further and create a new instrument recognising climate change itself as a global health emergency.

Three in four national weather services send health information to their countries’ health ministries, Saulo said, but only one in four ministries treats it as relevant to their decisions.

“Early warnings help save lives. Early warnings for heat, for floods, for droughts,” she said. “But they cannot be just headlines. They need to be translated into action.”

Image Credits: WHO/PAHO/Karina Zambrana .

Capitol building
Democrats swept into power during the US midterm elections, promising to restore funding to health programs and scientific research, and to increase oversight of the Trump administration’s policies.

November’s US midterm elections swept Democrats into power in both the House and Senate, marking a shift in congressional leadership on key health policies. This comes as a former Trump administration official and a founder of the “Make America Healthy Again” (MAHA) movement accused the administration of catering to industry interests over the health of Americans. 

WASHINGTON – The “blue wave” that swept the US delivered a stark rebuke of the Trump administration’s unprecedented health policies. Voters registered their disapproval of steep Medicaid and food assistance cuts, MAHA-vaccine policy upheavals, and MAHA messaging that has failed to resonate in a year of high inflation and fuel costs. 

As of 9 November, the Democratic Party held the Senate majority with 54 seats and the House of Representatives with 254 members. Democrats also won in state-level and gubernatorial elections to the surprise of seasoned pollsters – including in deep red states like Texas, Kansas, Iowa, and Ohio. Several races are yet to be called but will not change the cemented Democratic majority.  

The election – held halfway into President Trump’s second term – sent a strong signal that Americans are unhappy with, among other policies, the incumbent Republican agenda of deep health care cuts, about-face MAHA policies on pesticides and environmental protections, and turmoil in public health preparedness as the measles virus has sickened over 5,000 Americans this year alone. 

The results set the Democrats to reshape health policies come January – and exert their oversight powers through investigations of key administration officials.

Over three-quarters of voters stated government corruption was a top issue in exit polling.

Congressional leadership change

Means Saunders Vaccines
Senator Bernie Saunders (I-VT), who caucuses with Democrats, is poised to chair the Senate health committee. Democrats won control of both the House and Senate.

Democratic victories netted the party at least seven seats in the Senate and more than 40 in the House, securing control of both chambers when the 120th Congress convenes in January 2027. 

With these changes, the party will control powerful congressional committees, including the Senate Health, Education, Labor, and Pensions (HELP) Committee, which oversees legislation and policy relating to public health, health care, and biomedical research. Senator Bernie Sanders (I-VT), who caucuses with Democrats, is poised to chair the HELP Committee. 

Notably, the HELP Committee oversaw all confirmation hearings for health agency leaders in the first two years of the Trump administration, including for Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. 

HELP chair and doctor Senator Bill Cassidy (R-LA) lost his seat, as did another HELP member, Senator Susan Collins (R-ME), who was known for championing biomedical research funding. 

The Senate Appropriations Committee will also change hands, giving Democrats greater influence over federal spending priorities, including funding for the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and other research agencies.

US Midterm elections Nov 2026
The US Senate midterm elections results. As of 9 November, the Democratic party holds the chamber with a majority of 54 seats.

In the House, committees on Appropriations, Energy and Commerce, and Ways and Means will also come under Democratic leadership. The Energy and Commerce Committee is particularly consequential for science and health policy, given its jurisdiction over the NIH, FDA, public health, and environmental quality. Frank Pallone (D-NJ) is seeking the chairmanship, while Rosa DeLauro (D-CT) is expected to lead Appropriations and Richard Neal (D-MA) to lead Ways and Means. 

The Democrats will be able to influence the kinds of bills introduced and prioritized by leadership, and call in administration officials for questioning.

Although the party holds a Senate majority, it lacks the 60 votes generally needed to overcome a filibuster, as well as the two-thirds majority needed to override a presidential veto.

‘First 100 hours’ vows to undo Trump cuts

Medicaid funding cuts
Under the “One Big Beautiful Bill,” millions of Americans lost health care due to changes to ACA premium tax credits and Medicaid cuts.

A health policy agenda circulated prior to the elections by House minority leader Hakeem Jeffries (D-NY) outlined immediate, ambitious action in the first 100 hours and 100 days of the legislative session. 

The plan includes a repeal of the steep 2025 Medicaid coverage cuts in the “Big Beautiful Bill” (HR1), restoring supplemental nutrition assistance program (SNAP) coverage, and reinstating healthcare tax credits for the Affordable Care Act. The expired tax credits left millions of Americans facing higher health insurance costs. 

US voters midterm election sentiments on health policies
US midterm voters rejected the Trump administration’s health policies, including those that tackled fraud and costs.

The plan also aims to release National Institutes of Health (NIH) funding withheld by the Trump administration. Last year’s “catastrophic” cuts to the premier research funding agency led to thousands of NIH grants being paused, frozen, or terminated mid-project – including cancer and HIV/AIDS clinical trials. 

“Scientists researching new cancer cures are neither culture warriors nor campus protesters. But so far, the biggest financial blows against academia have been borne by biomedical research,” wrote David Cutler and Edward Glaeser, professors at Harvard University, in a JAMA 2025 editorial.

Nearly two dozen Democratic candidates with science or medical backgrounds used this rhetoric to decry the Trump administration’s upheaval of the US scientific research enterprise. 

Dr Jasmine Clark
Dr Jasmine Clark, a microbiologist from Georgia, made restoring research funding a top priority during her campaign for Congress.

Dr Jasmine Clark of Georgia, a microbiologist who will be the first woman to hold a STEM PhD in Congress, ran on a platform that would restore funding to the CDC and NIH, calling the cuts “unsustainable.” 

“Years of research on life-changing issues like asthma and air pollution, cancer treatments, measles-rubella, and HIV, have been lost due to attacks on science,” she said.

New cohort of physicians and scientists to focus on affordability 

Annie Andrews pediatrician South Carolina
Dr Annie Andrews, a pediatrician from South Carolina, will represent her state in the Senate. She joins several other health professionals in the incoming Congress.

The incoming Congress features a near-record number of physicians and health scientists. Aside from Clark, pediatrician Annie Andrews of South Carolina and epidemiologist Abdul El-Sayed of Michigan are incoming senators who have promised to deliver on Democratic promises of expanded healthcare. El-Sayed especially leaned hard into “Medicare-for-All” messaging. 

US midterm elections health care affordability
Health care affordability was top of mind for US voters in November’s midterm elections.

According to analysis from KFF, health care affordability was a leading issue for voters, with six in 10 voters saying they were “very concerned” about the costs. Their polling also revealed broad discontent with two pillars of Republican health policies: government health program fraud crackdowns and making America healthy again. A majority of voters said the administration made both worse.

“Most midterm voters appear to reject the idea that the Trump administration’s policies have made America healthier,” KFF analysts said in their report of election sentiment data.

MAHA agenda failed to win voters

Pesticides
Crop applications in Illinois. MAHA candidates fared poorly in agricultural states as voters rebuked the administration’s policies that favored industry over health.

These sentiments extended beyond health care costs. The MAHA coalition that propelled Kennedy into his prominent role have united against what they perceived to be the most insidious health threats to Americans: pesticides, ultra-processed foods, vaccines, and even public water fluorination. 

Many of these policies focused on tackling the industries that drive poor health, including Big agriculture, pharmaceuticals, and food. 

While the administration revamped dietary guidelines that focused more on protein, it failed to regulate ultra-processed foods, including offering a definition of what ultra-processed food is.

Calley Means, a senior advisor to Kennedy who resigned shortly before the Midterms, said over the weekend that the MAHA agenda had failed due to the Trump administration’s industry interests.

“Underneath Trump’s nose…you had a group of former lobbyists, catering to the vaping industry, catering to the ultra-processed food industry, catering to the pharmaceutical industry, catering to the pesticide industry and doing their bidding with an excuse that we need their money for the midterms and [need] to go against what voters said,” Means told CBS in an interview that aired Sunday. 

Means also accused several Trump administration officials of undermining the MAHA agenda, telling CBS that these advisers were “taking money from the industries we ran on fighting against.”

Calley Means
Calley Means, a top MAHA advisor, accused the Trump administration of catering to industry interests following the November midterm elections.

MAHA supporters also felt betrayed when the Trump administration issued an executive order boosting the production of glyphosate, a pesticide banned in many countries for its adverse health and ecological effects. 

The Republican candidates’ failure to strike a resonant chord with voters in the elections could reshape the MAHA coalition’s alignment with MAGA Republicans in favor of Democrats. 

Several Democratic members of Congress have stated their support of MAHA tenets such as fixing the US food supply and protecting environmental health. 

Rep Chellie Pingree (D-ME) launched a “Fix Our Food Caucus” and has long worked on popular MAHA issues.

“If RFK survives all this, I hope we can get the focus back on healthier foods, food is medicine, and straighten out the CDC and vaccine side of it,” Pingree said in an interview.

But she also said she would “absolutely” call in the Environmental Protection Agency’s director, Lee Zeldin, for questioning on the unprecedented deregulation of pollution, pesticides, and environmental protections.

Measles crisis bungled, calls for Kennedy’s impeachment 

Measles case map US Nov 2026
Measles cases have topped 5,000 in the US as vaccination rates have slipped.

Congressional Democrats are looking to exert their oversight authority on Kennedy through subpoenas, investigations, hearings, and even removal from office. 

“I want to hold RFK Jr accountable for the damage that he has done to America’s public health system,” Andrews said in an interview following her election. “He is the reason that Spartanburg County, South Carolina, had a measles outbreak just last year.”

Measles cases in the US have surpassed 5,000 – the highest number of infections since the 1990s. The virus, which can cause severe and permanent complications such as severe pneumonias and brain infections, is vaccine-preventable. Several states have reported their first measles deaths in over three decades.

RFK Jr testimony day 1 Jan 2025
RFK Jr. testified before the US Senate Finance Committee during his two-day confirmation hearing schedule. He is expected to be called to testify with greater frequency now that the Democratic Party controls the chamber.

Kennedy has become a divisive figure in vaccine policy, backing a reduction in the number of recommended childhood vaccines and casting doubt on the efficacy of vaccines.

US public health agencies like the CDC and FDA have also seen massive workforce reductions in the past two years. 

Sanders was asked whether he agreed with Andrews that RFK Jr should be removed from his role as HHS secretary. 

“I am absolutely open to that,” Sanders said. “The bottom line is we need a secretary of HHS who is concerned about the health and well-being of our kids and all Americans, not involved in crazy conspiracy theories.”

Sen. Ralph Warnock (D-GA) went further. “Unless RFK Jr. is interested in spending the next two years in front of Congressional committees, he should go ahead and resign now,” he said in a social media post. 

Image Credits: Unsplash, HELP Committee, AP, Statista, KFF, Jasmine4GA, drannieandrews, James Baltz, CIDRAP, CDC, CSPAN.

WHO Director-General Dr Tedros Adhanom Ghebreyesus met with Sadikin at WHO headquarters in July 2026.
WHO Director-General Dr Tedros Adhanom Ghebreyesus met with Sadikin at WHO headquarters in July 2026.

Budi Sadikin, Indonesia’s Minister of Health and the country’s nominee for WHO Director-General, has in fact spent most of his career in finance –  as a top executive at Indonesia’s largest bank, PT Bank Mandiri TBk.

“Before, my job was to make my clients wealthy; now my job is to make my people healthy,” says Sadikin with a smile. Sadikin, who also holds an undergraduate degree in physics, believes his executive experience will help him tackle WHO reform, even as the organization suffers big cuts in donor funding.

But he is also a firm believer in health equity, telling us that during a global pandemic, emergency treatments “should become global public goods.”  The good relations he enjoys with the United States, politically and personally (he did several executive education stints at places like Wharton, Harvard and UC Berkeley), could also help pave the way for Washington to rejoin the WHO, he suggests.

But he also has a warning for Washington, saying: “If any country believes it can safeguard its population on its own during the next pandemic, that is scientifically and practically impossible.”

Listen to the full podcast:

The podcast series with candidates is being co-produced by the SwissInfo media platform with the Geneva Graduate Institute’s Global Health Centre, as part of a collaboration covering the upcoming WHO election – also supported by Health Policy Watch.

See more about the candidates on Health Policy Watch’s special WHO election website.

WHO DG Elections 2027

UN Resident Coordinator in Zimbabwe, Dr Rosemary Kalapurakal, and health workers at the solar power installation at Victoria Falls District Hospital earlier this year.

HARARE, Zimbabwe – As she opened and shut the doors of four giant refrigerators inside a dispensary at Budiriro Polyclinic in the capital of Harare, the nurse beamed.

Since the clinic became linked to solar power, critical medicines that need refrigeration are no longer at risk of spoiling when the national power grid is unavailable.

While the rest of the world is moving towards solar as a clean energy option, Zimbabwe turned to it out of sheer survival to keep its health clinics from operating in the dark. 

Run by the United Nations Development Programme (UNDP) and the Global Fund, in active collaboration with the government of Zimbabwe, the country’s “solar-for-health” program was launched in 2015.

Budiriro Polyclinic was one of the first beneficiaries. At the time, Zimbabwe experienced power cuts of up to 18 hours a day as drought sapped away water from dams and lakes, heavily impacting hydro-electricity.

By August this year, over 1,263 health facilities and medical warehouses across Zimbabwe had solar energy systems, driven by a partnership between the UNDP, the Global Fund, and the government. 

These installations power maternity wards, such as the ones at Budiriro Polyclinic, as well as vaccine cold chains and emergency operating rooms at hospitals during lengthy periods of power blackouts. 

In 2024, to shield medical drugs from the incessant power blackouts, the UNDP  donated a state-of-the-art 450 kWp solar system to Zimbabwe’s Ministry of Health and Child Care and the National Pharmaceutical Company (NatPharm). 

Solar pride

In Harare, where a 500-kW hybrid solar-battery system was installed at Parirenyatwa Group of Hospitals, Zimbabwe’s biggest referral hospital, the transition to clean, reliable solar energy has brought relief to healthcare workers and patients previously plagued by blackouts.

“Before the coming of solar here, as nurses, we would order expecting mothers to buy candles and torches for lighting because power outages were severe. We no longer do that because solar has made our lives better,” a nurse at Parirenyatwa Hospital told Health Policy Watch. 

“I’m so happy because there is solar power here now. In the past, each time I would be admitted here, there would be total darkness with no alternative when power went off. But with solar now, that is no more,” said Neliet Magosvongwe, a hypertension patient.

In 2024, the Global Fund’s Linden Morrison, Zimbabwean Health Minister Dr Douglas Mombeshora, and UNDP’s Dr Ayodele Odusola at a ceremony to hand over the 450kW solar system to the National Pharmaceuticals Company (NatPharm).

Solar plants increase

Zimbabwe is steadily scaling its healthcare grid, marked by a continuous rise in solar-powered clinics.

Such is the case at the United Bulawayo Hospitals (UBH), a central referral hospital west of the country which serves five provinces. UBH now has a 350kW solar plant that became fully operational in February.

“The solar plant here has massively consolidated power reliability while it has also resulted in a cut in costs that have often been incurred by the hospital through the use of diesel while powering generators for energy supplies,” said a staffer at UBH.

Patients upbeat

Miriam Matshona from Budiriro is expecting her third child. In 2018, Matshona had her second child at the clinic when a solar plant had just been installed. When power cuts hit the clinic then, the lights remained on, so she is confident that this will be the case for her next birth. 

Nurses no longer dread nocturnal deliveries, when they battled to monitor women’s labour by candlelight.

“Before solar came, when power went off, we would turn to candles or the diesel generator, but that was noisy, smoky and not fit for use around patients. But now we have solar, which provides clean energy,” said a nurse at Budiriro Polyclinic.

Approximately 25% of healthcare facilities in Sub-Saharan Africa (SSA) have no access to electricity, while a further 28% do not have reliable access to power and experience frequent outages that have often affected the continuity and quality of health care, according to UNDP. 

 

Image Credits: UNDP, UNDP.

Zainab Shinkafi-Bagudu and Khaled Ghanem
Zainab Shinkafi-Bagudu and Khaled Ghanem

A child diagnosed with cancer in a wealthy country has more than an 80 percent chance of surviving. In Syria, one hospital has managed to bring survival rates to 76 percent, despite years of war and severe shortages, while in parts of Nigeria, survival remains around 30%.

For Dr. Khaled Ghanem, a pediatric oncologist who directs a cancer unit in Damascus, the difference is not necessarily the disease itself, but whether children can access the treatment they need.

“A curable disease is dependent on the health system available,” Ghanem said.

Speaking on the latest episode of Global Health Matters, Ghanem joined Dr. Zainab Shinkafi-Bagudu, founder of Nigeria’s Medicaid Cancer Foundation and president-elect of the Union for International Cancer Control, to discuss how partnerships, early diagnosis and financial support can improve childhood cancer survival in resource-limited settings.

Ghanem’s unit, operated in partnership with the non-profit BASMA, treats approximately 400 children annually, working with international partners to secure medicines, specialised diagnostics and training. He said the programme operates on an annual budget of approximately $1.5 million.

In northern Nigeria, Shinkafi-Bagudu described a different set of challenges, including late diagnosis, limited access to hospitals and treatment costs that can force families to sell their homes or farmland.

“I have seen children that move from stage two to metastatic and even palliative care stages simply because they’re not able to access that care,” she said.

She also warned that many families and healthcare workers still do not recognise childhood cancer as a possibility, delaying diagnosis until treatment becomes more difficult.

Both experts emphasised that improving survival requires more than medicines, including stronger health systems, partnerships and practical support that allows families to complete treatment.

“We can cure it; it’s one of those with a good outcome,” Shinkafi-Bagudu said.

Watch more episodes on Health Policy Watch >> 

Image Credits: Global Health Matters.

Regional development bank headquarters in Lomé, Togo, representing the institutional shift toward loan-based health financing as grant aid contracts.
West African Development Bank headquarters in Lomé, Togo, representing the institutional shift toward loan-based health financing as grant aid contracts.

Multilateral development banks (MDBs) are moving to centre stage in global health financing, driven by collapsing bilateral aid and political momentum from initiatives like the Accra Reset. Experts see the shift as an opportunity to deliver the predictable, large-scale investment needed to strengthen domestic health systems, provided governments and lenders can ensure transparent terms that safeguard sovereign solvency.

Peter Piot, co-chair of the Accra Reset High-Level Panel and professor of global health at LSHTM.
Peter Piot, co-chair of the Accra Reset High-Level Panel and professor of global health at LSHTM.

“Multilateral development banks will probably become the major external source of funding, just like in high-income countries where we go to banks,” explained Peter Piot, professor of global health at the London School of Hygiene and Tropical Medicine, in an interview with Health Policy Watch at the World Health Summit in Berlin.

A veteran negotiator who represented the United Nations (UN) in establishing the Global Fund, Piot co-led the Accra Reset High-Level Panel work stream on governance and institutional reform.

According to the panel, integrating MDBs into national health budgets is inevitable as domestic tax revenues fall short of mounting post-pandemic healthcare demands. Unlike short-term, disease-specific donor grants, development bank loans offer multi-year, scalable capital designed to finance foundational health infrastructure, digital systems, and workforce expansion.

Bilateral aid declines, development bank financing steps in

Regional development bank funding surged by 32% as traditional grant channels and UN agencies faced steep, widespread contractions.
Regional development bank funding surged by 32% as traditional grant channels and UN agencies faced steep cuts.

Recent preliminary data from the Institute for Health Metrics and Evaluation (IHME), published by Think Global Health, underscores the volatility of this pivot. Development assistance for health from regional development banks grew by an estimated 32% ($270 million) between 2025 and 2026 – alongside a 2% ($91 million) increase from the World Bank.

This rebound follows a 48% contraction the previous year as pandemic-era emergency disbursements unwound. But bank lending falls far short of replacing the billions lost in bilateral and multilateral grant cuts, demonstrating that development banks are being pulled into a primary role by default as traditional grant streams recede.

Overall, global health grant aid contracted by 12% in 2025 and a further 5% in 2026. External health funding to sub-Saharan Africa alone fell by nearly 70% between 2021 and 2025 following the expiration of emergency COVID-19 facilities, according to the Accra Reset High-Level Panel report.

Although low-income nations increased government health spending by an average of 8% per year between 2024 and 2026 to cushion these losses, budget constraints and mounting external interest burdens meant total per capita health spending still fell by 3% annually.

Sharp cutbacks from major donors – led by the United Kingdom slashing assistance by 37% ($891 million) and the United States by 8% ($668 million) – were compounded by parallel declines across multilateral grant channels, including an 18% drop for UN agencies and a 15% drop for Gavi.

Disbursements from the Global Fund to Fight AIDS, Tuberculosis and Malaria contracted by 25% between 2024 and 2025, followed by another 2% drop in 2026, as emergency funding unwound. This comes as the organisation registered an unprecedented $5.32 billion shortfall in its Eighth Replenishment.

Blended finance: the Global Fund-Islamic Development Bank deal

Bridging grants and loans: Headquarters of the Islamic Development Bank in Jeddah (left) and the Global Fund in Geneva (right).
Bridging grants and loans: Headquarters of the Islamic Development Bank in Jeddah (left) and the Global Fund in Geneva (right).

To bridge this widening fiscal gap, traditional global health funds are turning to financial engineering, using grant dollars to stretch capital through blended finance. In October, the Global Fund and the Islamic Development Bank (IsDB) signed a partnership agreement mirroring the new fiscal realities.

This institutional framework blends Global Fund grant capital and technical expertise with IsDB’s concessional lending portfolio and implementation scale to fund public health priorities, including integrated primary healthcare, supply chains, and health workforce development.

The partnership focuses on a major shared territory: 43% of the Global Fund’s country grants (roughly $4.5 billion) go to nations that are also IsDB member states, enabling the two institutions to coordinate joint and blended financing streams.

Responding to queries from Health Policy Watch, the Global Fund explained that the agreement forms part of a broader strategic effort to collaborate with MDBs – including parallel arrangements with the World Bank and Asian Development Bank – to stretch capital. A spokesperson cautioned that these bank co-investments mobilise complementary capital and cannot replace continued donor grant commitments or domestic health allocations.

However, the organisation confirmed that the precise financial terms and interest structures of its co-investment arrangements remain undisclosed to the public – leaving public watchdogs unable to assess the ultimate repayment liabilities being incurred.

Concerns over health equity trade-offs

Mariska Meurs, Senior Global Health Advocate at Wemos.
Mariska Meurs, Senior Global Health Advocate at Wemos.

While critical of the sparse published partnership details, Mariska Meurs, global health expert at Dutch civil society advocacy organisation Wemos, sees potential in these new financing instruments. Co-investing through global health initiatives offers the advantage of directing MDB capital into public systems rather than commercial ventures.

However, she stresses that it is essential to distinguish public bank borrowing from private-sector de-risking when evaluating health equity. Public MDB concessional loans expand state budget capacity; by contrast, blended models engineered to de-risk private commercial investment tend to channel funds toward profitable medical services rather than non-profit public healthcare for high-need populations.

Over-relying on MDB borrowing also risks distracting global health advocates from systemic fiscal solutions, including progressive national and international tax justice and sovereign debt cancellation.

“To solve the health financing gap, the global health community should rally behind campaigns for debt and tax justice,” Meurs urged, highlighting public-sector initiatives like the WHO-EIB-IsDB Health Impact Investment Platform (HIIP) focused directly on primary healthcare.

Financing experts warn of growing debt risks

Rapidly rising public debt across developing countries severely constrains the fiscal space required to fund essential public healthcare.
Rapidly rising public debt across developing countries severely constrains the fiscal space required to fund essential public healthcare.
Bodo Ellmers, Director of Financing for Development at Global Policy Forum Europe.
Bodo Ellmers, Director of Financing for Development at Global Policy Forum Europe.

While closer coordination between global health funds and multilateral development banks reduces donor fragmentation, analysts warn that converting grant streams into debt risks locking vulnerable nations into an escalating debt spiral.

“A trend toward blended finance must be treated with caution, as it means more loans and thus more debt for the Global South,” warned Bodo Ellmers, director of financing for development at the German NGO, Global Policy Forum Europe, in response to a query by Health Policy Watch.

“The Global Fund has historically disbursed almost exclusively grants, and that should remain the case, as many developing nations are already groaning under an unsustainable debt burden.”

This warning comes against a broader backdrop of mounting fiscal distress across the Global South. Developing nations face an escalating sovereign debt crisis, with interest payments on external public debt across developing countries (excluding China) outstripping net new lending since 2022, according to UN Trade and Development (UNCTAD) data. This systemic interest burden leaves borrowing governments under severe fiscal constraints precisely as grant aid recedes.

Debt swaps offer fiscal space alongside bank capital

Panelists discuss the Accra Reset roadmap for health sovereignty at the World Health Summit in Berlin. Pictured (from left to right): Shingai Machingaidze (Accra Reset), Peter Piot (LSHTM), Priscila Ferraz (Fiocruz), Elhadj As Sy (Kofi Annan Foundation), and Catherine Kyobutungi (APHRC).
Panellists discuss the Accra Reset roadmap for health sovereignty at the World Health Summit in Berlin. Pictured (from left to right): Shingai Machingaidze (Accra Reset), Peter Piot (LSHTM), Priscila Ferraz (Fiocruz), Elhadj As Sy (Kofi Annan Foundation), and Catherine Kyobutungi (APHRC).
Elhadj As Sy, Co-Chair of the Accra Reset High-Level Panel and Chair of the Kofi Annan Foundation Board.
Elhadj As Sy, Co-Chair of the Accra Reset High-Level Panel and Chair of the Kofi Annan Foundation Board.

To create the fiscal room needed to absorb development bank capital without triggering defaults, Accra Reset leaders argue that new loans must be paired with debt relief mechanisms, such as debt-for-health swaps. Through these swaps, creditors forgive or restructure sovereign debt on the condition that saved interest payments are redirected into national health budgets.

“The discussion going on is to create more fiscal space – that is, debt swaps for health – and bring the International Finance Corporation and the private sector along so that we can have a more critical combination,” explained Elhadj As Sy, chair of the board of the Kofi Annan Foundation and co-chair of the Accra Reset High-Level Panel, during an interview with Health Policy Watch in Berlin.

In As Sy’s view, pairing debt restructuring with development bank loans and private capital is intended to create the structural headroom necessary for countries in the Global South to build self-reliant health systems anchored in domestic resources.

Reform agenda maps pathway to health sovereignty

The African Union headquarters in Addis Ababa, where head-of-state leadership anchors the Accra Reset roadmap for continental health sovereignty.
The African Union headquarters in Addis Ababa, where head-of-state leadership anchors the Accra Reset roadmap for continental health sovereignty.

Translating health sovereignty into practice requires overhauling how external capital enters recipient nations. Rather than allowing lenders to impose parallel application and reporting processes, the Accra Reset urges MDBs and global health funds to channel financing through a single country interface aligned behind one national health plan – a model demonstrated in Indonesia, where four development banks harmonised $4 billion in capital.

Shingai Machingaidze, Advisor to the Accra Reset Secretariat.
Shingai Machingaidze, advisor to the Accra Reset Secretariat.

This structural alignment is critical because development bank borrowing requires formal approval from Ministries of Finance managing tight sovereign debt ceilings.

To ensure fiscal discipline without sidelining healthcare, the Accra Reset mandates that national health investment plans be jointly co-signed at the cabinet level by ministers of finance, health, and planning, with external lenders relying on national audit offices rather than duplicative reporting tracks.

Reflecting on previous reform initiatives – including the 2023 Lusaka Agenda – Shingai Machingaidze, advisor to the Accra Reset Secretariat, noted in an interview with Health Policy Watch that earlier frameworks correctly identified the systemic flaws of donor-driven aid but struggled to compel change through voluntary compliance.

“Everything said in those previous analyses remains valid today,” Machingaidze explained. “If we continue to rely on voluntary implementation, we should expect the same results – the difference with the Accra Reset is that it is anchored at the Head-of-State level, providing a direct political pathway to practical implementation.”

Ultimately, whether this new financial architecture succeeds will depend on converting Head-of-State political momentum into resilient, self-reliant health systems that safeguard national sovereignty long after grant aid recedes.

See related story:

Accra Reset’s Plan for Health Sovereignty Includes Closing Some Global Health Bodies

Image Credits: mtcurado via Canva, Think Global Health / CFR, Suzanne Blanchard Photograhy, UNCTAD, Global Policy Forum Europe, Felix Sassmannshausen/HPW, derejeb via Canva.