01/07/2026 Kerry Cullinan

Health workers contain the highly fatal Marburg virus during an outbreak.

An outbreak of Marburg, a highly infectious haemorrhagic fever, has been reported in western Uganda.

The outbreak was discovered after a child died, according to Reuters, while Stat reports that two cases of Marburg were reported to the World Health Organization (WHO) this week.

Uganda is already trying to contain an outbreak of Ebola Bundibugyo Virus, which is also a viral haemorrhagic fever.

The US Embassy in Uganda noted reports of Marburg on Monday and urged caution. The US issued a level four “do not travel” alert for Uganda on 4 June, citing “crime, health, terrorism, and unrest”. This came in the wake of the declaration of Ebola Bundibugyo as a public health of international concern by the WHO on 17 May.

The Africa Centres for Disease Control and Prevention confirmed the Marburg outbreak, which Uganda is obliged to report in terms of the International Health Regulations, in Kyegegwa district involving an 18-month-old child who had died.

Meanwhile, Uganda has reported 20 cases of Ebola Bundibugyo, the majority from the outbreak in the Democratic Republic of Congo (DRC).

While Africa CDC said that all the country’s Ebola cases stem from the DRC, a local newspaper, Monitor, reports that five of the cases involved local transmission.

Marburg is usually transmitted from animals to humans, with Egyptian Rousettus bats being a key carrier of the virus.

Image Credits: WHO.

The Climate-Health Crisis Needs Money, Not More Declarations

01/07/2026 Stefan Anderson

Climate change is one of the WHO’s top six health priorities, but there are few funds to address it.

On the day France recorded its hottest temperature on record, a coalition of health ministers, officials and advocates huddled in a sweaty, half-full auditorium in Paris to take stock of a campaign they have spent a decade waging: the fight to put human health at the centre of the world’s response to climate change.

The meeting was a high-level gathering of the Alliance for Transformative Action on Climate and Health (ATACH), the WHO-hosted network of 106 countries launched at COP26 in Glasgow in 2021.

Convened under France’s G7 presidency, the summit’s task was to look ahead to COP31 in Antalya in Türkiye in November, to gauge what fights the health community should place at the top of its agenda.

For a movement that began with a handful of officials struggling to be heard, ATACH has grown almost faster than it can handle. “We’ve accidentally been too successful,” said Nick Watts, director of the Centre for Sustainable Medicine at the National University of Singapore, who has tracked the alliance since its creation.

While part of the meeting carried the air of a victory lap, it was also a reckoning with the one thing recognition has not delivered: money.

“Finance is the weakest one, and I think this is a key point for this meeting,” said Elena Villalobos Prats, the WHO official who built much of ATACH’s architecture.

“It’s not just a plea for external support to come to countries,” Prats added. “It’s really about making sure that ministries of health, that now understand what the problem is, have the capacity and the resources to do something about it.”

Winning recognition

Dubai’s COP28 produced the first health and climate declaration.

ATACH was itself a creation of UN climate talks, among the first concrete health commitments to come out of the climate COP process when it launched in Glasgow in 2021. The milestones – in terms of words on paper, if not finance – have piled up from there.

Dubai’s COP28 produced a health declaration signed by more than 140 countries, unveiled at an event thick with fanfare and celebrity guests like Bill Gates. The following year, in a windowless room in the underground levels of Baku’s football stadium, COP29 created a coalition that committed future presidencies to keep health on the agenda, securing a formal recognition health leaders had sought for decades.

Then COP30 in Brazil delivered the Belém Health Action Plan, a voluntary framework of 60 measures to ready health systems for climate shocks, and the clearest sign yet that health had secured a permanent place on the UN climate agenda.

“I think we don’t need to tell everyone anymore. I think this is very clear,” said Agnes Soares da Silva of Brazil’s health ministry, who helped write the Belém plan. Real-world action, however, “has not been at the same level”, she added.

The health community has hailed each declaration and framework as a breakthrough. Yet none is binding, all are voluntary, and none sits inside the formal UN negotiations where targets are set, international legal obligations are made, and money is committed.

And the money required is astronomical. The World Bank estimates climate change could cause up to 15.6 million additional deaths between 2026 and 2050 and inflict $8.6 trillion to $15.4 trillion in health costs by mid-century. WHO calls it “the greatest single risk to humanity.”

“Even if we stop our emissions now, we still need to adapt,” Soares da Silva said. WHO’s director-general had made the same point in reverse. “We must adapt our health systems,” Dr Tedros Adhanom Ghebreyesus said, “but we must also mitigate the cause of climate change by drastically reducing emissions, including from the health sector.”

With the fight for attention successfully won, the hard part begins – getting into the rooms that can fund the response to the worsening climate-health crisis.

The evidence is settled

Twelve of 20 climate-health indicators are now at catastrophic levels, including a sharp rise in heat-related deaths globally.

The science underpinning the campaign is no longer seriously contested. Diarmid Campbell-Lendrum, who leads WHO’s climate and health work, told the room that extreme heat “kills over half a million people each year,” and that researchers had seen it coming for generations.

“We told you so,” he said, relaying the message of the scientists who first described the greenhouse effect two centuries ago.

That figure comes from the latest Lancet Countdown, which counted around 546,000 heat deaths a year, roughly one a minute, alongside 2.52 million deaths from air pollution caused by burning fossil fuels. Thirteen of its 20 health indicators stood at record highs.

Those effects reach further than hospitals and heatwaves, down to the chemistry of the medicines themselves. Vincent Breton of Unitaid traced the climate exposure of a single product, the HIV treatment taken by 24 million people. In a Kenyan clinic, he said, women were swallowing their pills every day yet still showing high viral loads, because they had been storing the medicine in the kitchen, the hottest room in the house, where it degrades in the heat.

“Climate crisis is a health crisis, not hypothetically in the future, but here and now,” WHO Director-General Tedros Adhanom Ghebreyesus told the meeting by video, kept away by an Ebola outbreak in the Democratic Republic of Congo.

“Responding to climate change is a key strategic objective for WHO, and ATACH is our most powerful tool to take action against this existential threat.”

There have been over 1,300 excess deaths since the start of the record-breaking heatwave in Europe on 21 June, according to Tedros.

Europe is the fastest-warming continent on Earth, heating at twice the global average. Right now 150 million people are living under extreme heat, hundreds have died, schools are shut, grids are buckling.

Driven by climate change and global warming, the phenomenon of the…

— Tedros Adhanom Ghebreyesus (@DrTedros) June 28, 2026

WHO now ranks climate change as the first of six priorities in its current programme of work, and its officials insist the economics are settled too. “At an absolute minimum, every dollar that you invest gets you $4 back,” Campbell-Lendrum said.

The economics also run the other way. The ingredients of that same HIV treatment trace back to oil, some of it routed through the Strait of Hormuz, leaving the medicine’s price exposed to crude markets and to what Breton called “the current geopolitical context.”

In a study his team will soon publish, every 10% rise in the oil price translated into a 3% rise in the drug’s price. “How do you avoid being exposed to this risk?” he asked. “Simple answer: decarbonization.”

A movement wide but shallow

COP30 in Brazil’s Belém adopted a health plan, a voluntary framework of 60 measures that countries can adopt to prepare for climate shocks.

ATACH currently counts 106 member countries, more than half the nations that turn up to the climate talks, but membership demands little and delivers less.

Joining requires little more than a statement of intent. Endorsing the Belém plan, the concrete commitment the alliance now wants implemented, takes a signature, and fewer than three dozen countries have so far provided one.

Completing the work the plan describes is rarer still. As of last year, only three members, France, Japan and the United Kingdom, had completed all four assessments that ATACH asks of them.

There is no penalty for members that do nothing, and, as Health Policy Watch reported from Baku, no mechanism to verify whether commitments translate into action on the ground.

Watts, presenting a new ATACH strategy for 2026 to 2028, was blunt about the habit of the alliance’s members of substituting documents for delivery.

“I have read the same five-page policy brief on climate change and health genuinely, maybe 1000 times,” he said. “They’ve said the same thing for the last two decades. Let’s move on.”

The new strategy leans on regional hubs, a modest catalyst fund and what the alliance calls “implementation clinics,” all meant to drag members from writing plans toward building things.

Another COP, another building block

Türkiye, which holds the COP31 presidency, used the meeting to lay out what it wants from Antalya. Rather than a departure from the pattern, it plans to attach health more firmly to the summit’s action agenda, the voluntary track that runs alongside the negotiations proper.

“We aim to focus on designing the healthcare system we need by adding a new building block to the Belem action plan,” a senior official from Türkiye’s health ministry told the meeting.

That building block, published as a COP31 priority titled “Dynamic and Resilient Health Systems,” runs to seven goals spanning resilient infrastructure, disease surveillance, early-warning systems, artificial intelligence, a trained workforce, cross-sector coordination and “sustainable financing.” It sets no targets, attaches no figures, fixes no timeline and names no mechanism to deliver any of it.

The priorities largely restate the pillars of the Belém plan, which in turn restated the Baku and Dubai declarations before it. The proposal to build further on Belém also sits uneasily against the plan’s thin support, given that most ATACH members have yet to endorse the document it would extend.

As Türkiye and Australia’s joint presidency angle to strategically side-step the issue of fossil fuels that torpedoed the previous two COPs in Belém and Baku, the COP31 health priority – like the Belém plan it is building on – makes no mention of the role of fossil fuels in the climate crisis.

“If we don’t have the personnel, and if we don’t have the funds, then it’s just a paper that may be sitting on the shelves,” Zimbabwean Health Minister Douglas Mombeshora, told the meeting.

Still no money

The French Development Agency puts the cost of adapting the world’s health systems to climate change at $22 billion. The UN climate body’s estimate runs higher, at $26.8 billion to $29.4 billion a year by 2050.

At COP29, wealthy nations agreed to provide $300 billion a year by 2035, against the $1.3 trillion the developing world said it needed. Health receives a fraction of a fraction of that, capturing roughly 2% of adaptation funding and 0.5% of multilateral climate finance, a share that has not moved since Glasgow.

The collapse of aid budgets, led by the United States, has tightened the squeeze. “The world just feels a little bit meaner,” Watts said. “We’re entering into a bit of a rough patch. It’s going to last for a couple of years, and everyone knows what it feels like in their own national context.”

The only fresh money announced at COP30 came from philanthropy, with a $300 million commitment from the Gates Foundation, Wellcome and the Rockefeller Foundation. None has been added since.

“That is a drop in the ocean,” said Aarti Artwell of the Wellcome Trust, an anchor of the funders’ coalition.

Part of the trouble, she said, is that health falls between two budgets. “We’re either talking about climate finance or we’re talking about health finance, and actually that ambiguity slows everything down.”

Campbell-Lendrum was blunt that the failure is one of will rather than knowledge. “We’re coming up with a plan, we’re still not investing, or not investing enough,” he said. “If anything, it’s got worse; we’re not prioritising this around the world.”

Tamer Samah Rabie of the World Bank located the deeper problem in chronically starved health budgets: “Low- and middle-income countries pay about $8 per person per year on a basic package of services, when in fact they should have been spending about 60 to $80 per person per year.”

The total cost of carrying on at this level of underinvestment would reach “$21 trillion” by 2050, Rabie said.

“Let’s stop talking about putting together another report, another plan for how we bring in more sources of finance,” he said. “Let’s be a lot more operational.”

The fund WHO just unlocked

Green Climate Fund Director Dr Oyun Sanjaasuren.

In March, WHO became an accredited entity of the Green Climate Fund, the world’s largest climate fund, having already been approved as an implementing entity of the smaller Adaptation Fund.

The status lets WHO write and manage health funding proposals directly, rather than merely helping countries apply for small preparatory grants. Accreditation is a licence to compete for funding – and so far, health has been virtually absent from the GCF portfolio.

As of COP29, the Green Climate Fund had financed a single health project, in Malawi, and Health Policy Watch reported at the time that the country’s own climate minister did not know it existed.

The fund was designed to let developing-country institutions draw cash down directly, yet the bar has proved too high for most. Of 62 national entities accredited for direct access, 42 have never received any funding from GCF, and only about a fifth of approved projects flow through them. The rest is routed through international bodies such as the World Bank and the UN.

“We absolutely need to simplify access to finance, and for me it remains a major barrier, because the financing landscape still is really complex, really fragmented,” said Camille Perron, deputy head of the Health and Social Protection Division at the French Development Agency.

Co-financing a single climate and health project through the agency, he added, “sometimes takes from two to sometimes three years to land on the project preparations and be able to commit an investment to our board.”

WHO’s new role does nothing to lower that bar for health ministries, but does add a potential ally in another international middleman, even as WHO contends with an existential budget crisis of its own.

The WHO’s new status will not unlock enough money to shift the needle on the climate crisis, but it can help individual communities. Yet the difficulty of the bureaucracy of the fund means even that may take time.

An analysis of the fund’s first five years found that projects for the poorest countries took 20 to 22 months on average just to win approval, with the slowest taking nearly five, and that least-developed countries had received less than 9% of the money approved for them after more than five years.

The Adaptation Fund, with a single-country cap of $25 million and roughly $1.6 billion committed since 2010, deals in sums that electrify a clinic or buy a cold-chain freezer, not money that rebuilds a health system.

“It’s wonderful that WHO are now implementing partners for the GCF. This is what is needed, the technical capacity and expertise,” Wellcome’s Artwell said. “The scale of the challenge isn’t enough for just philanthropy to try and do.”

Image Credits: WMO, Felix Sassmannshausen, X/@Cop30noBrasil.

RFK Jr Changes Terms for US Vaccine Committee as Email Leak Reveals Sustained Political Interference in Vaccine Policy

30/06/2026 Kerry Cullinan

Robert F Kennedy Jr

US Health Secretary Robert F Kennedy Jr has broadened the terms of the country’s vaccine advisory committee in an apparent move to circumvent a judge’s ruling that his appointees lacked the requisite experience to serve as the country’s immunisation advisors.

The new charter for the Advisory Committee on Immunization Practices (ACIP) was published on the Centers for Disease Control and Prevention’s (CDC) website last week.

Instead of requiring vaccine-related expertise, the new terms simply require that “members shall collectively represent a balanced range of scientific, clinical, and public health expertise relevant to the committee’s mission”.

A day earlier, US Senator Bernie Sanders released 253 pages of emails showing how Kennedy’s Health and Human Services (HHS) staff pressured CDC officials to influence the country’s vaccine policies. ACIP advises the CDC on vaccines.

One of the emails from Matthew Buckham, Kennedy’s chief of staff (19 August 2025), to then CDC Director Susan Monarez stated “the absolute need for political review of major decisions at CDC”.

Email from HHS Chief of Staff Matthew Buckham to then CDC Director Susan Monarez (19 August 2025).

An email from CDC staffer Nicole Coffin (14 February 2025) reveals that HHS communications director Andrew Nixon “asked that we pull out of circulation all campaign ad buys related to flu or anything encouraging shots or vaccinations. He said this request came directly from the secretary.”

An email from CDC staffer Nicole Coffin (14 February 2025) reveals that HHS communications director Andrew Nixon

The emails also reveal Kennedy’s influence over ACIP, including his removal of members without the required consultation with the CDC and his control over the committee’s agenda, particularly to review hepatitis B and multi-dose flu vaccines for pregnant women and children, the reintroduction of a seven-year review and biannual report on vaccines, and review of the definition of vaccines (19 May 2025).

Email from HHS to CDC (19 May 2026)

In March, US District Judge Brian Murphy ruled that the January changes to the vaccination schedule and Kennedy’s firing of all 17 ACIP members are likely to have violated the Administrative Procedure Act.

Murphy also issued three temporary stays: on Kennedy’s appointment of 13 new ACIP members, mostly vaccine sceptics; changes to the vaccination schedule, and all decisions of the Kennedy-appointed ACIP. These stays will be in place until Murphy can rule on a lawsuit brought by the American Academy of Pediatrics (AAP) and other medical organisations against Kennedy’s “unilateral changes” to vaccinations for children and pregnant women.

Tighter control over science

Meanwhile, the Trump administration also plans to further tighten its control over scientific grants, placing them under the control of politicians and their appointees.

The proposed changes to US government support for scientific research is being pushed by the White House Office of Management and Budget (OMB), which is headed by former Heritage Foundation leader Russell Vought.

According to the proposed rule change, politicians and their appointees will be able to decide on funding without the advice of scientists, stop it at will and limit or prevent partnerships with other countries.

In a note explaining the proposed change, the OMB claims that “far-left activists hijacked the critical work done by the US President’s Emergency Plan for AIDS Relief (PEPFAR), which was established to respond to the AIDS crisis in Africa. Due to wasteful spending, PEPFAR became a left-wing foreign aid entitlement that attempted to promote abortion and gender ideology”.

However, the editors of the New England Journal of Medicine noted in a recent editorial: “Giving political appointees ultimate authority to determine federal grant funding, as proposed by the OMB, would politicise and weaken biomedical research.

“Expert, independent peer review of grant applications is essential for directing NIH dollars to research that has the greatest potential for advancing science and improving health. Selecting the most promising research is an enormously complex and challenging undertaking, but over the past 70 years, scientific advances achieved with rigorous methods in clinical trials have improved quality of life, transformed human health, and extended life expectancies.”

The proposal is open for public comment until 13 July, and the OMB intends to issue a final rule by 1 October.

Image Credits: HHS.

London Climate Week: Improving Air Quality Starts With City-Level Actions

30/06/2026 Amanda Magnani

Cecilia Vaca Jones, Executive Director of Breathe Cities.

LONDON – “Cleaner air is possible when there’s political will,” said Cecilia Vaca Jones, executive director of Breathe Cities, told a panel during London Climate Action Week.

Britain’s capital is the poster child for that statement. In 2019, less than a decade after more stringent national air quality targets were first introduced, some experts estimated it could take the city 193 years to meet the target to reduce some pollutants, such as nitrogen dioxide (NO2), which both harms lung development and is a risk factor in asthma.

But five years later, that goal had already been achieved.

London’s success inspired and connected cities around the globe. It also inspired a whole-day Clean Air Hub on 24 June convened by the Clean Air Fund, where speakers from governments, civil society, business and philanthropy explored practical action on clean air and climate.

Climate Week involved more than 1,000 events, attracting over 75,000 people to the city from around the world.

‘London is cooking’

London’s Climate Action Week coincided with record-breaking heat – and the audience used fans to mitigate the heat.

The week coincided with a record-breaking heat wave in Europe and the UK, with United Nations (UN) Secretary-General António Guterres remarking in a special address: “London isn’t just calling – it’s cooking.”

Attendees felt it on their skin. Amid red alerts of life-endangering high temperatures, the ceiling fans weren’t enough to mitigate the heat inside the un-airconditioned room of the National Theatre.

The organisers were fully aware: ahead of the event, a mass email redirected the audience to a link with tips for staying safe in the heat and reassured them there would be chilled water, ice and handheld fans available. Still, the morning started with a room packed with people whose bravery in the face of the heat was commended by most panelists.

Throughout Climate Action Week, the city embodied the climate agenda defined by Guterres in his address as “the best of times and the worst of times”, a phrase from the Charles Dickens novel, A Tale of Two Cities.

And if the heatwave depicted the worst of times, the event at the Clean Air Hub signaled the best of times, with speakers sharing experiences that reinforced Jones’ point that improving air quality is possible if there is political will.

London’s success story

On 29 June, air pollution in all of London was below the concentration of 5 μg/m3, the limit set by the WHO.

This year marks the 70th anniversary of the first national Clean Air Act, introduced after the Great London Smog of 1952, when five days of extreme smoke from uncontrolled stove and industrial emissions during a cold, windless period led to thousands of air pollution-related deaths.

Many decades later, human-made air pollution still claims roughly 30,000 lives every year in the UK, and costs the country more than £500 million ($662 million) a week in medical expenses.

But London is proof that things can be different. Between 2019 and 2024, the city saw a 40% drop in deaths linked to air pollution.

Mayor Sadiq Khan attributed the results to the Ultra Low Emission Zone (Ulez), an area where vehicles that fail to meet minimum emissions standards must pay a daily fee or a fine. Created in 2019, the zone was expanded to include the entire City of London and all of its boroughs in 2023, making it the world’s largest clean air zone.

Had the Ulez not been introduced, experts estimate air pollution would be 27% higher than current levels.

“This is real information that shows that the air pollution has improved as a result of that one policy,” Phoebe Stockton, senior policy and officer at the Greater London Authority, told the Clean Air Hub.

Through the Air Quality Fund, the city has already distributed £27 million ($36 million) to over 100 projects that helped boroughs cut pollution. In honor of the Clean Air Act’s 70th anniversary, another £6 million ($8 million) was awarded.

But for Stockton, that’s still not enough: “We need to go further. We’ve met legal limits, now we need to strive towards the World Health Organization (WHO) guidelines.”

Multi-city ripple effect

In 2025, Bogotá was announced as the winner of the ‘clean our air’ category of the 2025 Earthshot Prize.

In 2018, Mayor Khan launched Breathe London, in collaboration with the joint WHO-UN Environment Programme’s BreatheLife initiative, which linked nearly 80 cities and regions around the world in ambitious clean air and climate commitments. ‘Breathe London’ aimed to improve measurement of air quality across the city and engage with communities to act.

Then in 2021, at COP26, the UN climate conference in Glasgow, Khan called for the creation of an initiative to invest in cities around the world to clean their air and enhance public health. That helped to spark the Breathe Cities initiative supported by Bloomberg Philanthropies, the Clean Air Fund and C40 Cities.

Breathe Cities now includes a network of 16 cities that aim to replicate the success of Breathe London. The cities have received financing commitments totaling $75 million from its sponsors, including $45 million announced at London Climate Week.

The initiative provides equipment and technical support for cities to expand air quality monitoring; develop their own Clean Air and Reduced Emissions zones; restrict highly polluting vehicles; support cleaner household heating solutions; and build public awareness.

Bogota, Rio de Janeiro and Mexico City share experiences

In 2024, Rio de Janeiro launched the ‘Breathe Rio de Janeiro’ initiative to enhance air quality monitoring, raise public awareness, and implement targeted actions to reduce air pollution.

Representatives from cities such as Bogota, Mexico City and Rio de Janeiro told Climate Week about the progress made and challenges they still face in reducing air pollution to levels now common in London.

Around a third of London’s bus fleet is now based on zero-emission electric vehicles. Mexico City is redesigning an existing taxi repatriation programme to accelerate the transition to electric cars.

Meanwhile, much like in London’s Ulez, Bogota is working on measuring and reporting the impact of its own clean air zones, the Zumas, and Rio de Janeiro has recently created Brazil’s first Low Emission District.

“We have learned a lot from other cities,” said Teresa Borges, head of international relations for Rio de Janeiro. “Now we will have to expand the use of the hyperlocal data to inform policies and reiterate public awareness – which is vital for the program’s growth.”

Multifaceted approaches to change

Clean Air Fund CEO Jane Burston (centre) and panelists at the Clean Air Hub.

The problem is multifaceted, and so is Breath Cities’ approach. As a blueprint for all localities, the initiative combines data and research, technical policy assistance, community engagement and, most importantly, lesson sharing.

“Air quality isn’t an isolated issue,” said Alejandra Ucrós, director of programs at the Colombian organization, Movilizatorio. “It lands in neighborhoods where people are also navigating insecurity, unemployment and inadequate health care.”

She said Colombia’s capital, Bogotá, has much to learn from London, particularly in terms of institutional continuity and the creation of sustained participation mechanisms that go beyond the government in turn.

But the learning process goes both ways. “We do see the importance of community participation and ensuring that the work that we do truly translates,” said Veronica Awuzudike, principal consultant in the research, evaluation and learning team at The Social Innovation Partnership in the UK. And that’s something she wants to learn more about from colleagues in Bogota.

Making the link between air pollution and health

Andrzej Guła, Co-Founder of the advocacy group Polish Smog Alert

As Ucrós mentioned, the same gaps can be seen across many of the urban centers in the Breathe Cities network: knowledge and technical expertise are available. But tools and approaches for meaningful engagement remain elusive.

“How do you involve citizens in highly technical processes that are difficult to understand and communicate?” Ucrós asked.

For Dr Ian Mudway, senior lecturer in the School of Public Health at Imperial College, air pollution “is not concretely linked to health in the public’s mind.” A link that, he and other panelists agreed, must be made visible.

“But scientific knowledge is not so well translated,” said Alice de Morais Amorim, program director for the COP 30 Presidency. “And we won’t win the fight against super pollutants if we don’t communicate in different and much more creative ways.”

That’s exactly what Polish Smog Alert did through its “See What You Breathe” campaign. For four months, giant “breathing” lung installations toured the country. As days went by, the white semi-permeable fabric the lungs were made of got darker and darker, as air pollutants deposited on the material.

“It shows people what they breathe and it’s really, really impactful,” said Polish Smog Alert’s co-founder Andrzej Guła. “It is a very visible campaign.”

In Bogotá, what Ucrós found to be most impactful was making people feel heard: “Local leaders know which streets flood, which intersections choke with fumes at school, run times whose health is already compromised, and that knowledge makes solutions better,” she said.

“People participate when they understand how something affects their everyday lives and when they believe their voice can actually change something,” Ucrós added.

Air pollution’s economic costs are ‘not invisible’

Areli Carreón is a founder member of Mexican organization Bicitekas.

“There are lots of things in the world that have hidden economic costs. Air pollution isn’t one of them,” said Valerie Hickey, the World Bank Group’s director of environment.

According to the World Bank, air pollution causes global economic damage of $6 trillion a year, roughly 5% of the world’s GDP.

But many governments are grappling with a constant stream of short-term, urgent economic problems and struggle to make mid- or long-term investments in clean energy and clean air solutions.

“There’s a set amount of money, and they’re dealing with crisis after crisis,” Hickey said.

In this context, panelists agreed the private sector has an important role to play, and the $45 million Bloomberg Philanthropies announced to Breathe Cities the day before the event can go a long way in helping cities in low- and middle-income countries to develop solutions.

Grassroots organizations are well-placed to make the most of funding opportunities. One example is Bicitekas, a nonprofit that promotes cycling in Mexico City through riding events, workshops, seminars and political action.

Areli Carreón, one of its founders, said funders need to realize the impact of allocating resources in a more decentralized and horizontal way. “We can do a lot with very little money,” she said.

Data paving the way to awareness

The lack of data, which also feeds awareness, remains the other major obstacle in the fight for cleaner air.

“If you want to hide the damage that air pollution is doing to the population, the way to do it is to not make measurements,” said Imperial College’s Mudway.

Data has been critical to the successful expansion of London’s Ultra-Low Emission Zone, said Deputy Mayor of London for Environment and Energy, Mete Coban.

Good data allows you “to go out there and make the case”, winning over myths and disinformation. “Without that knowledge base, there’s no way that we could have achieved what we did,” he asserted.

But Coban knows the work is far from over. Air quality has improved in the city as a whole, but there are still “pockets of London” that need improvement. Notably, those are most often a feature in lower-income areas.

By tackling air pollution, the city can simultaneously tackle “a big social and racial justice issue, he said.

Those changes need to be made at an accelerating rate, he stressed, due to the fast pace of climate change, whose impacts “you can literally see” this week in the city.

But to be successful, changes also need to be co-produced and co-designed by communities that have to live with the consequences. In the end, Coban says, it all boils down to one question: “What type of cities do we want to live in?”

As Guterres said: “This is our moment of choice. Our moment of truth. Our moment of opportunity.”

Image Credits: Amanda Magnani.

Despite Wildfires, Europe’s 2025 Air Quality Improves as Regulation and Tech Advances Pay Off

30/06/2026 Disha Shetty

Europe’s air quality has improved substantially since 2015.

Decades of environmental policies, advances in technology, and cleaner approaches to industry and transportation in Europe have paid off, resulting in a steady decrease in the emission of major air pollutants.

Despite the challenge of wildfires, Europe’s air quality improved in 2025, according to the latest data released by Copernicus, the European Union’s (EU) Earth Observation unit.

“Europe continues to make steady progress in improving air quality thanks to sustained efforts to reduce emissions from transport, industry, residential heating, and other key sectors,” said Laurence Rouil, director of the Copernicus Atmosphere Monitoring Service (CAMS).

Air quality has improved every year since 2015 as regulated air pollutants have declined, the agency’s latest report has found.

Parts of Europe continue to experience localised air pollution, often driven by summer heatwaves, extreme cold, and temperature inversions in winter, when warm air settles over cooler air. Such periodic weather fluctuations have led to situations where the air pollution levels have temporarily exceeded the environment and health limits that were set.

“Our report highlights and explains situations when the combination of emissions and meteorological conditions can still trigger significant large-scale episodes with exceedances of the limit values set for health and environment protection,” Rouil explained.

The report shows that, despite increased economic activity, emissions are increasingly becoming decoupled from industrial production and transport demand.

Major air pollutants saw a decline in Europe since 2015.The report draws on data from monitoring stations across Europe for major air pollutants like ozone, nitrogen dioxide (NO2) and particulate matter PM10 and PM2.5 to present the latest assessment of Europe’s air quality for 2025.

Since 2015, emissions of sulphur oxides (SOx) and nitrogen oxides (NOx) have fallen by approximately 3–5% per year across the EU, with the most significant reductions achieved in industry and road transport.

Industrial emissions of SOx have fallen by 59%, while NOx emissions from industry have declined by 39%. Road transport emissions have also fallen substantially, with reductions of 40% for NOx and 34% for PM2.5.

All the pollutants monitored are known to pose a risk to human and environmental health.

Number of days when the PM2.5 concentrations were above the EU limit.While emissions are falling, rising temperature extremes like heat and cold waves also affect air quality and are becoming important factors.

The year 2025 was also the third warmest in Europe, according to the European State of the Climate 2025 report.

High temperatures, intense sunlight and stagnant atmospheric conditions create favourable conditions for ozone formation during summer. Prolonged dry conditions contribute to severe wildfire activity in parts of southern Europe that also worsen regional air quality.

Colder-than-average conditions contribute to elevated particulate matter concentrations during winter, largely as a result of emissions from heating systems.

Significant air pollution episodes in 2025

The report looked at significant air pollution events in 2025.

The report also looked at four major pollution episodes that occurred in 2025. In February 2025, colder-than-average conditions in parts of Europe contributed to elevated PM2.5 concentrations and exceedances of air quality health thresholds.

Residential heating emissions played a dominant role in the episode, particularly in eastern Europe, while emissions from transport, agriculture and industry also contributed to elevated pollution levels.

Elevated concentrations of ozone – which can irritate lungs, worsen asthma, and even impact vegetation and ecosystems, reducing crop yields – were recorded during heatwave periods in June and August. High temperatures, intense sunlight and stagnant atmospheric conditions created favourable conditions for ozone formation across large parts of the continent.

Record wildfires in August affected Portugal and Spain, and led to widespread exceedances of daily PM2.5 limit values across parts of the Iberian Peninsula.

“In addition to elevating the levels of particulate matter at the surface level, the fire plumes also contributed to the increase in surface ozone levels in northern Portugal and Spain, because the release of significant amount of ozone precursors, which react in sunlight as the smoke travels,” said Paul Hamer, senior scientist at the Norwegian climate research institute, Nilu, and main author of the report.

Image Credits: Unsplash/Xenia Bunina, CAMS Assessment Report on European Air Quality.

Hopes Fade for Survivors of Venezuela Earthquakes

29/06/2026 Kerry Cullinan

An aerial image of the earthquake damage.

The official death toll from Venezuela’s twin earthquakes last week was 1,450 by Sunday, but over 50,000 people are still missing, and hopes of reaching them alive are fading fast.

The first 72 hours are critical for earthquake rescue efforts before injuries, suffocation and dehydration take their toll, according to rescue experts.

“Critical infrastructure remains severely disrupted, including electricity, water, telecommunications, and transport, with Maiquetía International Airport still closed due to damage. Hospitals continue to operate under mass casualty protocols, and shelters have been established for displaced families,” the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported on Monday.

The two earthquakes, measuring 7.2 and 7.5 on the Richter scale, struck just one minute apart last Wednesday (24 June), near the capital of Caracas.

The quakes affected densely populated and economically important areas, including Caracas, and the states of La Guaira, Carabobo, Miranda, Yaracuy, and Aragua. Almost a third of the buildings in Catia La Mar in La Guaira state, one of the hardest-hit areas assessed so far, were damaged.

Around $6.7 billion in direct physical damage – around 6% of the country’s GDP – has been caused, according to a satellite-based Rapid Digital Assessment (RAPIDA) by the United Nations Development Programme (UNDP).

UNDP estimates that 1.7 million structures have been damaged. Meanwhile, UNICEF estimates that 1.8 million people, including 680,000 children, need humanitarian assistance.

Venezuela is situated on the boundary between two of the world’s tectonic plates, the South American and the Caribbean plates. As they slide past each other, these plates can stick, building up resistance that can generate an earthquake.

Image Credits: Vantor.

UN Member States Have an Unmissable Responsibility to Better Protect Us Against Outbreaks and Pandemics

29/06/2026 Helen Clark, Victor Dzau, Joy Phumaphi & Shingai Machingaidze

Health staff at an Ebola treatment centre at Elikya hospital in Ituri province, Democratic Republic of Congo.

This is a fact: a new pandemic threat is not a question of if, but when.

Armed with this knowledge, all leaders must ask themselves: Are we ready, and what more must be done to protect our people and avoid an Ebola- or COVID-sized catastrophe?

Over the last decade, outbreak and pandemic monitoring bodies and tools have been activated in the wake of crises. Many perform much-needed functions. But the approach has led to a fragmented system characterised by gaps and overlaps. Important information is available, but often it does not reach the right people at the right time, and it too seldom informs plans and investments to strengthen essential systems. (see figure 1, below)

The result is a monitoring landscape that provides a patchwork of siloed information, rather than timely, actionable insights and a cohesive roadmap.

On 18 May, during the 79th World Health Assembly (WHA) in Geneva, senior representatives from member states, international organizations, and expert institutions came together to consider how pandemic prevention, preparedness and response (PPPR) monitoring can better inform action and investment.

Is there enough financing in the outbreak and pandemic ecosystem? Absolutely not, but political leaders and policymakers can’t pinpoint how much more we need, who needs to provide it and where it should be spent.

Are WHO, UN agencies and key international and regional institutions well equipped to manage the next epidemic or pandemic threat? We don’t know for certain. Nationally, are we investing in communities to participate in outbreak readiness? In some places, yes. But the list of unknowns is too long. And fundamentally, what threats should we be preparing for, which pathogens should we be targeting, and are we investing in the right capacities to address them?

Figure 1: Overview of outbreak and pandemic monitoring bodies and mechanisms since the West Africa Ebola Outbreak 2014- 2016

Two of the key global monitoring bodies providing important insights, The Global Preparedness Monitoring Board (GPMB) and The International Pandemic Preparedness Secretariat (IPPS), are set to close soon as their mandates come to an end.

This will add to widening holes in our knowledge and in our collective safety. Without action, these closures risk setting back global monitoring efforts at a time when they are needed most.

The GPMB was established in 2018 following the devastating West Africa Ebola epidemic and comprises senior leaders and experts. It provides an annual assessment of the world’s preparedness.

In 2023, it published the first proposal for a comprehensive, multisectoral framework for monitoring epidemic and pandemic risk. It recently published its last assessment. The blunt message? Our collective readiness to manage pandemic threats is not keeping pace with the risks.

The GPMB will cease to exist later this year. Building on its eight years of experience and insights, it has made strong recommendations to establish a robust, comprehensive monitoring mechanism. Unless the UN General Assembly (UNGA) and WHA act, there is a risk nothing will replace it.

The IPPS – which tracks progress towards the 100 Days Mission for diagnostics, therapeutics and vaccines – is transitioning towards closure in early 2027, after the publication of its sixth and final major implementation report.

While the IPPS 100 Days Mission Scorecard will be continued by Impact Global Health, the current support is only until 2028.

Today, IPPS is providing essential real‑time insights, including its 15‑day updates on the Ebola Bundibugyo outbreak, which give countries such as the DRC and Uganda clear visibility on progress toward tests, treatments and vaccines, and maintain collective accountability for the 100 Days Mission.

Opportunity to set up comprehensive monitoring

So how do we move from what we have towards a comprehensive monitoring ecosystem that provides a full picture? Charting this path is essential to all our safety.

What if, for example, a multidisciplinary body of scientific experts had focussed on the geographically linked forested areas of the last two Bundibugyo Ebola outbreaks, and recommended heightened surveillance for that species? What if this recommendation had been supported with the requisite financing, technical support and system strengthening? It would have given us a far better chance of averting the current emergency.

In future, such a model could identify additional threats, and guide investments to avert a full pandemic.

This year, there is an opportunity to establish a comprehensive monitoring mechanism that will provide a clear overview of outbreak and pandemic risk and readiness, including through identifying risks from animal spillovers, to country, regional and global preparedness, response to health emergencies, and recovery.

Sampling dead animals in the Congo basin for zoonotic diseases that could be transmitted to humans

September’s UN High-Level Meeting on Pandemic Prevention, Preparedness and Response must provide the political mandate to establish such a mechanism. Monitoring must extend beyond health ministries and embrace a whole-of-government and whole-of-society approach, reflecting the reality that pandemic threats emerge at the intersection of human, animal and environmental health, and that preparedness depends on many sectors.

Monitoring cannot be reduced to a box-ticking exercise, nor a process where those with money are scrutinizing those without. It’s about identifying collective gaps in PPR which require collective action.

A publication by GPMB leadership in the Lancet described the principles of effective and coordinated monitoring. A recent brief by The Independent Panel highlights the need to shift to a mutually beneficial approach: one that moves from blind spots to understanding pandemic risk; from basic data collection to actionable insight; from a top-down imbalance to a federated system driven by national priorities, and from compliance to mutual trust and accountability.

Setting up a global monitoring system

What should this global monitoring system look like? For one, it needs to be independent and objective so that the information is trusted by all. Organizations, for example, cannot monitor themselves.

Second, it needs to make information easily accessible, but based on evidence and deep dives. A risk science-based body would need to be well resourced and detailed, but its main messages must be clear to political leaders, policymakers, and the public as part of a big picture assessment.

Third, it needs to fill gaps in the system: for example, for Bundibugyo Ebola, we know what vaccines and treatments are in development, but we don’t have a clear assessment on if and how countries will eventually access them.

Fourth, it needs to be tied to funding and technical support, so that when gaps are identified, including by countries themselves, they can be prioritised and filled.

Finally, it needs legitimacy, requested by the UN, reporting to the technical body responsible for global health, the WHA and through it those who will need to act, including UNGA, relevant UN agencies, the World Bank, International Monetary Fund,, World Organisation for Animal Health, World Trade Organization, World Intellectual Property Organisation and other relevant bodies.

It should be designed to inform the amended International Health Regulations and the implementation of the Pandemic Agreement when it comes into force.

None of this requires a large new institution or a major additional burden on countries. Nor does it displace or duplicate existing valuable efforts; rather, it would seek to unify them in a coordinated manner and provide ready access to timely insights.

What it would need is a well-resourced secretariat with a sustained mandate, access to modern data tools, including AI, that can synthesise across fragmented sources, and connect to scientists, practitioners, civil society and policymakers in countries, regions and global capitals.

Most of all, monitoring should not be seen as a burden, but a reassurance. If done right, it can alert us to outbreak and pandemic threats, but also ease our minds. Because if we know where the risks lie, we can address them ahead of time

The Right Honourable Helen Clark is co-chair of The Independent Panel for Pandemic Preparedness and Response. She is the former Prime Minister of New Zealand.

Dr Victor Dzau is president of the US National Academy of Medicine. He is also Chancellor Emeritus and James B. Duke Distinguished Professor of Medicine at Duke University

Joy Phumaphi is co-chair of The Global Preparedness Monitoring Board. The former Minister of Health of Botswana, she also chairs the Rollback Malaria Partnership to End Malaria.

Shingai Machingaidze is co-chair of the Science and Technology Expert Group (STEG) at the International Pandemic Preparedness Secretariat, and is head of Africa Strategy and Engagement at the Coalition for Epidemic Preparedness Innovations (CEPI).

Image Credits: Alexis Huguet/MSF, Sebastien Assoignons/ Wildlife Conservation Society.

EXCLUSIVE: US Candidates Among Those Shortlisted in Contentious Global Fund Leadership Race

28/06/2026 Felix Sassmannshausen & Elaine Ruth Fletcher

Life-saving work of The Global Fund: distribution of anti-malarial nets, along with drugs for malaria, HIV and TB, has been a calling card since its foundation.

As the Global Fund to Fight AIDS, Tuberculosis and Malaria heads into a secretive but highly contentious election of a new Executive Director, the names of several candidates reported to be on the shortlist, all US citizens, have surfaced. They include former Global Fund Executive Director Mark Dybul, former Trump appointee William Steiger and a former NYC public health official, Ashwin Vasan. None of the candidates responded to queries by Health Policy Watch about their potential candidacies, when approached last week, three days prior to publication of this story. However on Monday evening, the US-based NGO Malaria No More denied that Steiger, who currently serves as their CEO, is in the running for the Global Fund post. What’s clear, however, is that the shortlist of candidates that was defined at at Global Fund Board meeting in early June is longer than two or three names. But the opaque selection process has left everyone guessing about who the other candidates may be.

Whoever does emerge as the Global Fund’s new ED in late October must immediately confront a $5.36 billion funding gap for the next three-year cycle. And as speculation over the shortlisted candidates mounts, some voices are calling for greater transparency in the process of finding a new leader for an agency that drives a massive pooled procurement mechanism supporting market-shaping pharma contracts for drugs and other supplies required by the world’s poorest nations.

Among them is former Global Fund board member Jirair Ratevosian. “Confidentiality is not the enemy, opacity is, and leadership selections for institutions like the Global Fund and Unitaid should not feel like papal conclaves,” he told Health Policy Watch.

The Global Fund Executive Director nomination roadmap.

Meeting behind closed doors, the Global Fund’s Executive Director Nomination Committee (EDNC) convened in the first week of June 2026 to evaluate the long-list of candidates for the top post and create an initial short list. Those candidates will be interviewed in a first-round of interviews in July, followed by a second round in September, when the “short-list” is to be narrowed to four-five candidates, according to an official Global Fund timeline. A final appointment decision, is scheduled for the Board meeting of 28-30 October.

The opaque process stands in stark comparison to the more public election of a new Director-General of the World Health Organization, set for May 2027.

The Global Fund headquarters in Geneva, just minutes from WHO. Its massive presence reflects its weight in global health policymaking and procurement.

Despite a $4 billion annual budget and a broad, multilateral scope of influence in global health policies and procurement choices, the Global Fund remains a donor-supported and governed entity with key administrative decisions shielded from public scrutiny.

The ED Nomination Committee operates under a highly restrictive framework, assisted by the executive search firm Russell Reynolds Associates. The Global Fund declined to comment on the candidates, how many are on the present shortlist, or other aspects of the process, pointing to its strict confidentiality.

So far, all the top contenders mentioned by sources familiar with the proceedings are also US citizens, and at least two of those reportedly have US government backing. Considering the importance of the US as a donor, and the Trump administration’s clear linkage between funding and political influence, support from Washington may very well turn out to be one of the most important factors in the final selection.

At the same time, the US administration is increasingly bypassing the multilateral system, and allocating its own global health aid budget largely on the basis of bilateral agreements – with over 30 signed so far. That could put any new Global Fund leader in the uncomfortable position of steering between the Global Fund’s multilateral mission and US priorities, as well as drug procurement preferences, in the coming years.

As for the three leading candidates whose names have so far surfaced, Health Policy Watch reached out to all three for comment, but did not receive a response before publication. Here’s a rundown of who they are:

Safe hands for the Global Fund in challenging times?

Mark Dybul is an experienced Global health expert (2016).

This would be a second term for Mark Dybul, who served as the Global Fund’s Executive Director from 2013-2017. With his deep institutional experience, some observers say Dybul could represent a safe pair of hands who can steady the Global Fund as the organisation navigates a precarious moment, battling massive funding shortfalls and geopolitical turmoil.

During his previous tenure as Executive Director, he took over an organisation reeling from financial uncertainty. He also oversaw a new and more flexible funding model that provides countries with up-front allocations based on disease burden and allows them to set their application timelines.

Evaluating his leadership record, supporters praise his success in lowering the prices of key commodities like insecticide-treated nets and antiretrovirals, but official reviews also challenged his administration to effectively translate its sustainability policies into practical implementation. Nevertheless, concurrent assessments by the UK government and multilateral networks awarded the institution top ratings for its financial transparency and overall organisational strength under his watch.

Dybul began his career as a young internist treating AIDS patients in San Francisco.

He acted as the principal architect for the President’s Emergency Plan for AIDS Relief (PEPFAR), and served as the United States Global AIDS Coordinator from 2006 to 2009.

Today, PEPFAR faces an uncertain future and a dramatically reduced reach following the dismantling of USAID and its absorption into the State Department under the new administration’s “America First Global Health Strategy”. The programme’s scope now focuses strictly on treating existing patients and preventing mother-to-child transmission.

Beyond his historical track record, Dybul remains an advocate for systemic reform, urging the global health community to abandon old aid models that tend to prioritise organisational self-preservation. Opening up to technological advances, he recently joined the US-based private company Redwood AI as a public safety and defence advisor to guide the application of artificial intelligence in global health preparedness.

Trump appointee joins the roster

William R. Steiger demands long-term financial sustainability.

Another name that was reported to be on the shortlist is Dr William R. Steiger, a former Trump appointee and currently the CEO of the US-based NGO Malaria No More. Steiger did not respond to a Health Policy Watch invitation sent on Thursday to comment prior to publication of this report on Sunday evening. On Monday evening however, following publication of this report, a Malaria No More spokeperson denied that he is in the running.

“Dr. Steiger is not a candidate and is not participating in the selection process,” said Megan Rabbitt, in an email to Health Policy Watch.

Steiger has, however, collaborated with the Global Fund in the past. He served on the 2017 Global Fund selection committee that chose today’s outgoing Executive Director, Peter Sands, who concludes his second four-year term this year. Steiger also advised the Global Fund’s General Manager in 2012 and acted as staff director for an independent panel that triggered wide-ranging institutional reforms in 2011.

During President Trump’s first term, Steiger served as Chief of Staff at USAID as a political appointee. He thus brings to his candidacy credentials that align with Washington’s “America First” policies. He currently serves as a Global Health Consultant at the George W. Bush Institute and as the CEO of Malaria No More.

In early 2026, Steiger co-authored a policy paper assessing the Trump Administration’s America First Global Health Strategy alongside Bush Institute Deputy Director Hannah Johnson and Deborah Birx, the former White House Coronavirus Response Coordinator. The authors supported the administration for “rightfully” pushing low- and middle-income countries toward self-reliance through the new five-year bilateral agreements intended to replace PEPFAR. However, they warned that “not all countries will be able to replace PEPFAR support” within such a tight timeframe.

To bridge this gap, the authors argued that continuing targeted, cost-effective U.S. engagement in these special cases would ultimately strengthen the broader goals of the America First strategy. They emphasised that preventing a resurgent HIV or malaria epidemic is essential to maintaining a safe environment, which in turn is required to attract risk-averse U.S. companies and build successful bilateral partnerships in key strategic industries like critical minerals, oil and gas, and pharmaceuticals.

The arguments mirror the current administration’s strategy, which clashes with the overall multilateral thrust of the WHO Pandemic Agreement in preventing and responding to emerging disease threats.

Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why

Alternative public health profile

Former NYC Health Commissioner Ashwin Vasan.

Alongside Dybul and Steiger, some sources also mentioned Dr Ashwin Vasan as a top candidate bringing significant early-career experience with the WHO. In the early 2000s, working under WHO’s Director of HIV/AIDS Dr Jim Yong Kim, Vasan helped launch the “3 by 5 Initiative” to expand antiretroviral treatment access to three million people living with AIDS across low- and middle-income countries by the year 2005. The campaign fell short of reaching the initial 2005 target date, but ultimately far exceeded the goal for getting people on ARVs in the years that followed, helping to transform the face of HIV treatment.

More recently, in 2022, Mayor Eric Adams appointed Vasan, also a mental health expert, to lead New York City out of the COVID-19 pandemic. However, Vasan unexpectedly resigned in late 2024 ostensibly to spend time with his family. He denied that his departure had any connection to the swirling federal corruption investigations targeting the mayor’s inner circle.

Before leaving, Vasan launched the ambitious “HealthyNYC” campaign. This initiative aims to extend the average life expectancy of New Yorkers to 83 years by 2030 by aggressively targeting chronic diseases, overdoses, and maternal mortality.

German candidate sidelined from shortlist?

Top six Global Fund donors, 2026–2028 (Source: The Global Fund, June 11, 2026).

As these high-profile names from the United States emerge, European member states that are also among the Global Fund’s largest donors are struggling to maintain their traditional influence in the agency’s orbit.

The ED Nominating Committee reportedly removed the only applicant endorsed by the German government from the shortlist during its early June meeting. The dismissal of the German-endorsed contender emerged as a source of intense frustration in Berlin, sources familiar with the process told Health Policy Watch.

Observers continue to perceive Europe and Germany in particular as “weak” on the global stage, with the country still struggling to translate its financial weight into executive leadership.

But the bigger issue is whether the US will have a stranglehold on the process, given its weight as a donor, while stepping back from organisations such as the WHO.

The German Federal Ministry for Economic Cooperation and Development (BMZ) declined to comment, responding to a query: “The BMZ does not comment on ongoing selection processes or confidential discussions.”

Calls for more transparent elections with public articulation of vision by candidates

Former Global Fund Board Member Jirair Ratevosian calls for transparency.

Independent of the frictions in the current nomination process, Ratevosian, a former Board member and global health policy expert at Duke University, has recently argued for a more transparent leadership selection process for the agency that wields billions of dollars in medicines procurement budgets.

“These are public-interest decisions. They should be moments to widen the tent, strengthen legitimacy, and reinvigorate the global health community,” he told Health Policy Watch.

In a Lancet article published on 23 June, he proposed creating open forums for candidates to present their visions and engage directly with Board constituencies before the field is narrowed.

Ratevosian clarified that increasing transparency does not mean turning the process into a popular election. Instead, he suggested that hosting open forums would allow civil society, recipient countries, and affected communities to evaluate the candidates’ priorities while still preserving the Board’s ultimate hiring authority.

“The case for greater openness goes beyond institutional accountability,” he added, noting that because the institution relies heavily on taxpayer dollars from donor governments, citizens have a fundamental right to understand who is selected to manage those resources.

Framing transparency as a strategic defence, Ratevosian concluded: “A more open selection process that brings candidates into public view could also help build the broader public case for global health investment at a moment when that case is under attack.”

Echoes of past disastrous leadership election

According to the nomination timeline, the Nominating Committee schedules first-round interviews from 12 to 23 July in London. Second-round interviews follow in early September, before finalists attend a Board Retreat on 1 and 2 October to conclude the race. The final appointment decision awaits the main Board meeting spanning 28 to 30 October 2026, marking a definitive end to the selection period.

Before the final decision, the board uses multiple weighted voting cycles to gradually eliminate contenders and identify a single preferred nominee.

Yet, for veteran health diplomats, the current atmosphere evokes uncomfortable memories of the organisation’s previous leadership crisis.

In 2017, the Global Fund was forced to completely scrap its Executive Director selection process after divergent political agendas created a blocking minority that made consensus impossible.

The crisis escalated when an anonymous email criticised insufficient due diligence by the executive search firm, leading finalist Helen Clark to withdraw before a leak to the New York Times ultimately poisoned the proceedings. Following the collapse of this initial search, the process was restarted and culminated in the appointment of Peter Sands as the new Executive Director in November 2017.

To prevent a repeat of the past failures, comprehensive confidentiality frameworks and robust ethical guardrails were implemented throughout the current leadership selection process.

Current political factionalism risks creating a destructive leadership deadlock, as the final candidate must secure a two-thirds majority from both the donor and implementer constituencies, which each hold 10 of the Board’s 20 voting seats. To counter this, if consensus fails, the voting threshold is gradually lowered until at least 11 votes of the full Board is obtained. This simple majority, regardless of donor or implementer blocs, would then define the winner.

Funding crisis confronts renewed leadership team

The Global Fund supports doctors and hospitals working to combat HIV/AIDS, tuberculosis, and malaria in the world’s poorest nations.

The victorious candidate will join forces with a renewed board leadership team. Former Norwegian Prime Minister Erna Solberg and global public health leader Javier Hourcade Bellocq recently secured the Chair and Vice-Chair roles, respectively. This new leadership duo also begins their three-year term in late October, meaning an entirely fresh executive trio must immediately steer the institution through challenging times.

Whoever emerges victorious from the current diplomatic friction must immediately confront severe financial constraints. The eighth replenishment cycle secured only $12.64 billion against an $18 billion target for the next three years of the fund’s life-saving work.

Consequently, the next Executive Director inherits an institution that was recently forced to manage devastating mid-cycle reductions to country grant budgets. While the most immediate, core services have been protected, looming cuts in longer-term investments threaten imminent reversals in critical disease prevention.

Simultaneously, the US administration’s 2027 budget proposal would intensify the rippling impact of its massive cuts in global health spending seen last year by eliminating disease-specific accounts entirely.

While Washington and the Global Fund recently expanded joint commitments to supply lenacapavir, the US administration is increasingly bypassing the multilateral system, relying instead on strict bilateral agreements.

These, in turn, could help drive a wave of preferential procurement deals with primarily US-based drug manufacturers. Politically-driven procurement deals that systematically prefer certain nations or manufacturers could render the Global Fund procurement mechanisms far less effective, as well as fostering a dangerous reliance on a smaller number of pharma companies, experts warn.

It might also undermine the Global Fund’s recent efforts to foster more local procurement from African manufacturers – as compared to manufacturers located largely in Asia or the Global North.

At the same time, the organisation may find itself between a rock and a hard place. Following the US announcement to withdraw from the WHO, the Global Fund now has to defend its multilateral model to a highly sceptical Washington. A shortlist featuring prominent American candidates who offer strategic overlap with the current administration’s agenda might be one way to achieve exactly that.

Global Health Infrastructure is Changing. Why Getting it Right Matters

Updated 29 June 2026

Image Credits: UNDP, The Global Fund, Felix Sassmannshausen/HPW, Guilhem Vellut via flickr, Georgetown University, George W. Bush Presidential Center, Columbia University, Milken Institue, European Union/Daniel Hayduk.

Mind the Gap on Ebola: It’s the People, Not Just the Virus

26/06/2026 Githinji Gitahi

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

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

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

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

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

Ituri Province – a zone of conflict and displacement

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

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

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

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

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

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

Resistance – a rational response to historical neglect

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

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

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

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

Authenticity, empathy and logic as pillars of trust

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

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

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

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

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

Empowering local structures

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

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

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

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

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

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

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

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

African Women’s Rights Charter Faces Challenge from Conservatives

26/06/2026 Kerry Cullinan

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

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

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

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

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

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

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

Maputo Protocol commits to ending gender-based discrimination

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

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

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

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

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

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

‘Patriarchal push to dislodge human rights’

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

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

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

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

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

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

‘Human rights reframed as a foreign ideology’

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

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

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

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

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

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

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

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

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

‘Weaponising legal instruments’

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

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

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