The IQ of Indian children exposed to high levels of air pollution was lower than children in areas with low air pollution.

Air pollution not only affects lung health but also brain development in children, according to two studies presented at the World Conference on Lung Health (WCLH) held in Denmark recently.

One study from India found that children living in highly polluted areas scored nearly 20 points lower on the intelligence quotient (IQ) than their peers in cleaner environments, immediately limiting their educational potential and life opportunities.

These findings highlight air pollution as not merely an environmental issue but a global health emergency that threatens children’s futures and severely worsens existing lung disease.

Air quality lowers IQ in children

Zeroing in on the link between airborne particulate matter and cognitive ability, new findings from the Kalinga Institute of Industrial Technology (KIIT) in India suggest a significant and close association between children’s IQ development and long-term exposure to ambient air pollution.

The KIIT study, published in the WCLH abstract book, examined the impact of particulate matter PM2.5 and PM10 (particulate matter with a diameter of 2.5 and 10 micrometres) on the cognitive development of children aged 6-8 in the state of Odisha in India. While the effects of air pollution on lung and cardiovascular health are well documented, this research represents a pioneeringl look into its potential to disrupt cognitive development in children.

Setting up a comparative analytical study, researchers assessed two sites between July and December 2022: one with high pollution levels (PM10 above 60 micrograms per cubic metre and PM2.5 above 40 micrograms) and one with low pollution. Children who had lived within a 1.5 km radius of air quality monitoring stations for six years were tested, using Malin’s Intelligence Scale for Indian Children, which measures full-scale, verbal, and performance IQ.

The results were stark. Mean Full-Scale IQ in high-pollution areas was 80.33 compared to 98.12 in low-pollution areas. Children from high-pollution areas had a verbal IQ of 81.60 compared to 99.68 in low-pollution areas, and a performance IQ of 79.02 compared to 96.55 in cleaner areas.

The authors conclude that long-term exposure to air pollution is closely linked to poorer cognitive development in children. The report further suggested that the child’s age and weight, poor kitchen ventilation, maternal education, and family income also made an impact on full-scale IQ, painting a picture of multiple interacting risk factors.

Air pollution affects the poorest the most

“The burden of air pollution and climate change on health is one which sadly continues to grow. And, as with many other determinants of health, it is the world’s poorest who are the most affected,” said Professor Guy Marks, president of the International Union Against Tuberculosis and Lung Disease (The Union).

“New strategies are urgently needed globally to ensure no one’s future is limited simply because of the air they breathe.”

The Union was established in 1920 as the world’s first global health organisation and works towards a world free of tuberculosis and lung disease. Its members, staff, and consultants work in more than 140 countries globally. 

Asthma attacks increase in West Africa

Separately, a direct link between air pollution and the severity of asthmatic conditions in adolescents has been reported in a new study by the Centre Hospitalier et Universitaire de Pneumo-Phtisiologie (CNHUPPC) in Cotonou, Benin, in West Africa.

In Cotonou, where air pollution systematically exceeds World Health Organisation (WHO) thresholds for all pollutants, researchers followed a cohort of 730 asthmatic adolescents over 36 months. The study reported that over one-third 37% of the adolescents experienced at least one respiratory event or asthma attack.

Measuring individual exposure via portable air quality sensors carried in backpacks and fixed sensors in schools and homes, the researchers determined that the adolescents with frequent respiratory events had higher levels of exposure to several pollutants, including nitrogen dioxide, PM1, PM2.5 and PM10. 

The study also noted that asthma symptoms occurred 2.5 times more during the seasonal harmattan period when a cool, dry and dusty wind blows, usually between December and March. This highlights the compounding effect of climate-related atmospheric changes. 

“Fine particulate air pollution remains very high in West Africa and poses a serious risk to the respiratory health of adolescents with asthma who are chronically exposed,” said Dr Attannon Arnauld Fiogbé, chest physician and clinical researcher at CNHUPPC. He suggested that strengthening responses by combining air quality alerts with therapeutic education could significantly improve respiratory health.

Air purifiers in schools 

Proposing a tangible solution to mitigate some of the exposure, Professor Anant Sudarshan from the University of Warwick in the UK, advocates for targeted intervention in schools, especially for low-income communities. 

“Introducing appropriately sized air purifiers in all government schools may be a good policy. Children spend a significant share of their day in classrooms, and any reduction in pollution exposure can have large health benefits,” Sudarshan told Health Policy Watch. 

“This is most important for the poor who cannot afford to purify air at home or who live close to traffic or industry,” Sudarshan added.

Sudarshan explained that children spend roughly one-third of their day at school for two-thirds of the year – around 17% of their lives – so cleaning up the air just in schools could cut a child’s annual pollution exposure by approximately 17%.

This reduction is considered vital because PM2.5 has been shown to have similar effects on cognitive behaviour and productivity as CO2 buildup, impacting both short-term alertness and long-term development. 

For policymakers grappling with this crisis, the evidence is now clear: the fight for lung health must integrate immediate, robust action to protect the cognitive and life-long potential of the world’s children.

Image Credits: Akshar Dave/ Unsplash.

A technician at the Biomedical Research Institute in South Africa, which is training African scientists. Investing in regional health systems is essential to ensure global development.

As the world navigates a pivotal moment in global health and development, one of the most critical pathways to sustainable development is through regional public health. Investing in regional health systems and production capacity of public health goods isn’t just a moral responsibility; it is an economic imperative. 

A 2020 McKinsey & Company report revealed that every $1 spent on health in developing countries can yield a return of $2 to $4, underlining the impact of strategic investments in health. 

When the COVID-19 pandemic brought the world to a standstill, it not only revealed critical failures and fragilities in the global response to public health crises but also highlighted the inextricable link between health and development. 

It caused the first rise in global poverty in a generation, triggered the deepest global recession since the end of World War II, and widened inequalities within and across countries, particularly for the most vulnerable. 

The unequal access and distribution of medical countermeasures between wealthy nations and low- and middle-income countries left millions around the world without life-saving vaccines, overwhelmed healthcare systems, and led to the loss of lives. 

Over-centralized, top-down response

Beyond the human and economic costs, the pandemic exposed a troubling reality: An overly centralized, top-down global response is inadequate when crises arise. The failure of initiatives like the COVID-19 Vaccines Global Access (COVAX) to ensure equitable vaccine access for poorer nations exemplified these weaknesses. 

In response, regional institutions stepped up. The Caribbean Public Health Agency (CARPHA) mobilized resources to support member states in their COVAX participation. Similarly, the Association of Southeast Asian Nations (ASEAN) launched the Vaccine Security and Self-Reliance initiative to boost regional procurement and stockpiling. 

In Africa, the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) created the African Vaccine Acquisition Task Team, securing enough doses to cover a third of the continent’s population. 

Historically, public health outbreaks like HIV, TB, malaria, Ebola, SARS, dengue, Zika, mpox, and COVID-19 have demonstrated that public health threats do not respect borders. When a nation or region cannot adequately prepare for, prevent, or respond to these threats, it poses significant risks for the rest of the global community. 

Around the world, regional agencies like the Africa CDC, CARPHA, the European Centre for Disease Prevention and Control (ECDC), the Gulf CDC and the, yet to be established, ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), are emerging as powerful models for tackling cross-border health challenges and fostering regional countries’ cooperation and a platform for future south-south collaboration – through shared responsibilities, knowledge exchange, data-sharing, and pooled resources. 

In the face of recent disruptions, regional bodies continue to show their indispensable role in shaping a more resilient and coordinated global response. 

The Africa CDC’s declaration of the 2024 mpox outbreak as a Public Health Emergency of Continental Security before the World Health Organisation (WHO) – making it the first of its kind in the agency’s history – illustrates the power of regional leadership. 

This catalyzed the rapid mobilization of resources, collective will, and interventions to contain the outbreak and protect vulnerable populations.

 Likewise, ASEAN convened and activated regional action quickly during its 2024 mpox outbreak, while in 2021, the European Union (EU) established the Health Emergency Preparedness and Response Authority, bolstering regional capacity to respond to health emergencies and ensuring access to vaccines, diagnostics, and therapeutics. 

Together, these highlight the transformative potential of regionally anchored strategies, and the crucial need for them as central players – not just in crisis response, but in ongoing efforts to coordinate, respond, and sustain recovery – not as mere beneficiaries but as essential actors. 

Equity and resilience

Strong regional public health mechanisms should be the key engines for equity and resilience. Although the world has taken a significant step forward with the adoption of the Pandemic Agreement to improve coordination, transparency, and equity, it is not enough. 

Challenges persist, especially the power dynamics that favor wealthier countries in decision-making and in controlling vaccine rights and distribution. By contrast, empowering regional health systems to produce vaccines, therapeutics, and diagnostics locally can help address these inequities. Such efforts can create ripple effects – enhancing human capital, creating jobs, and stimulating economic growth.

The African Vaccine Manufacturing Accelerator (AVMA) financing initiative, designed to unlock up to $1.2 billion over the next decade, reinforces this shift toward self-reliance. 

Moreover, regional institutions are vital for advancing equity by increasing the negotiating leverage of marginalized or less powerful states in global health governance. 

For instance, the Pandemic Agreement’s provision and voting rights for regional organisations such as ASEAN, the AU and the EU illustrate the importance of regional voices. 

The Africa CDC’s role in galvanizing a unified African position during the negotiations emphasizes how regional bodies strengthen collective influence. 

The lesson is clear: Robust regional public health systems not only promote equitable representation on the global stage but also serve as mediums for self-sufficiency and health sovereignty. 

These qualities are key to building resilient health systems capable of weathering overlapping global shocks and shifting geopolitical priorities. Given these promising developments, there is a compelling argument for establishing a Latin American CDC to enhance the region’s capacity to coordinate and respond to outbreaks effectively – a proposal worth exploring. 

Public health is a public good, and it must be viewed not as charity but as a strategic investment in our shared future. Building resilient, equitable, and well-resourced regional health systems, backed by strong political will, is essential for stability and shared prosperity. 

By prioritizing this approach, we take a step toward transforming the global health architecture and creating a more equitable and healthier future.  

Michael Weinstein is the president and co-founder of the AIDS Healthcare Foundation (AHF), the largest AIDS health organization in the world, whose mission is to provide cutting-edge medicine and advocacy regardless of ability to pay.

Mehdi Jomaa is the former Prime Minister of Tunisia (2014-2015) and a member of Club de Madrid, a forum of former democratic presidents and prime ministers who leverage their experience and global reach to strengthen inclusive democratic practice and improve the well-being of people around the world.

Image Credits: Kerry Cullinan.

The Zimbabwean delegate at the Intergovernmental Working Group (IGWG)’s fourth meeting, speaking for Africa and the Group of Equity.

African countries affirmed their commitment to a global agreement to share information about pathogens that may cause pandemics on Monday – yet several of these countries are also in talks with the United States to conclude conflicting bilateral deals on pathogen access in exchange for the resumption of US health aid.

The onerous US demands on countries may even face court challenges, with a legal opinion from Kenya describing that country’s draft Memorandum of Understanding (MOU) with the US as “not legally compliant, [posing] critical constitutional and sovereignty risks”.

Zimbabwe, speaking for 51 of the 54 African countries, told the resumption of negotiations on a pathogen access and benefit-sharing (PABS) system at the World Health Organisation (WHO) headquarters in Geneva that this week’s talks should start to reach consensus on the draft PABS text.

The PABS system, the last outstanding issue in the Pandemic Agreement, will govern both how information about dangerous pathogens should be shared (the access part) and how countries that share this information should be rewarded (the benefits).

Developing countries feel strongly that they need to benefit from any vaccines, therapeutics or diagnostics that are developed from the pathogen information that they share. 

This is a particularly sensitive issue for African countries in light of how the continent struggled to get access to COVID-19 vaccines despite South Africa being the first country to share the Omicron variant sequencing globally. More recently, African countries worst affected by mpox outbreaks had very limited access to vaccines while the US could offer them to any of its citizens who felt they were at risk.

The fourth meeting of WHO Intergovernmental Working Group (IGWG) charged with developing a PABS system, started on Monday and runs for the entire week.

The fourth meeting of the IGWG negotiating a pathogen access and benefit-sharing (PABS) system started in Geneva on Monday.

US ‘specimen-sharing’ demands ‘illegal’?

Yet Zimbabwe itself and several other African states are also in talks with the US government over its resumption of health aid, including new US President’s Emergency Plan on AIDS Relief (PEPFAR) agreements. 

The US is seeking MOUs with developing countries that make its health aid contingent on recipient countries agreeing to provide the US with rapid access to information about dangerous pathogens, as well as access to the countries’ health data.

Attached to each MOU is a “Specimen-Sharing Agreement” that details the “rapid sharing of specimens, samples, sequencing data, and any other associated data related to novel and emerging infectious diseases with epidemic or pandemic potential”.

African countries have five days to share this information with the US government, and are required to give the US permission to share it with up to 10 entities that can “assist in developing diagnostics and/or medical countermeasures”. 

In other words, they are required to agree to the US sharing the information with select pharmaceutical companies without any obligations on these companies to share the products that they might develop as a result. The “America First” orientation of the Trump administration means that US companies will receive privileged access to this information.

There is a vague promise that countries that share the information will be second in line – after the US – to receive “medical countermeasures”. But this is “subject to the availability of funds and applicable law”. 

The agreement adds that the US will “make best efforts to make such medical countermeasure available … at prices equal to or below those paid by the US government” – but the pharmaceutical companies, not the US government, set these prices.

MOUs undermine Pandemic Agreement

According to Article 4 of the specimen-sharing agreement: “Each Party affirms that its participation in any multilateral agreement or arrangement, including surveillance and laboratory networks, governing access and benefit sharing of human and zoonotic specimens and related data shall not prejudice its compliance with this agreement.”

In other words, countries’ agreements with the US will, at a minimum, be on a par with the global Pandemic Agreement and its PABS annex. The US withdrew from the WHO on 20 January, the day Donald Trump assumed the presidency.

The clause that allows the US to share information with select pharmaceutical companies undermines the PABS system’s endeavour to hold “participating manufacturers” to annual subscription fees and contracts outlining their rights and responsibilities.

Furthermore, “the transfer, use, management and control of specimens and related data shared under this [specimen agreement] will be carried out consistent with applicable laws of the United States”.

PABS talks to include contracts?

The Ugandan delegate at IGWG

Nonetheless, Zimbabwe, supported by Zambia and Uganda, made a strong call for the PABS negotiations to include “standardised contracts” on Monday.  

These would cover the “details of benefit-sharing obligations” and “the rights and responsibilities of providers of PABS materials and sequence information, as well as users of the PABS system, including terms of access and terms of use”.

“This important work cannot be deferred to the Conference of the Parties,” said the Zimbabwean delegate, who also spoke on behalf of the Group of Equity, 80-plus countries across all WHO regions.

She added that “entering into PABS contracts will, of course, be voluntary, but access to PABS materials would be granted only upon acceptance of terms and conditions in the contracts”.

“This is key to ensuring respect to countries’ sovereign rights over their genetic resources, preventing free riders and building a trusted ecosystem in which all actors understand and uphold their obligations,” she concluded.

However, the 10 pharma companies that the US could share the pathogen information with could well be “free riders”.

Zambia also urged IGWG to negotiate the contracts, adding that it will “will spare no effort to negotiate in good faith and exercise wisdom and engage in collaborative efforts to help us reach consensus and to bring this process to a successful conclusion”.

Uganda also called for “the standard material transfer agreements” to be finalised by IGWG.

“Without clear, standardised and legally binding contracts, we risk a fragmented and inconsistent system that undermines predictability and confidence for all member states,” said Uganda.

However, Zimbabwe, Zambia, Uganda, Eswatini, Ghana, Kenya, Lesotho, Malawi and Rwanda are among countries known to have begun negotiations with US government officials on the new MOUs – and many lack the agency to push back against US demands as their health systems have been severely affected by the suspension of US aid.

The current MOU templates give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information.

South Africa, previously a significant PEPFAR beneficiary, has been excluded from talks with the US  amid political tension between the two countries.

MOU is ‘unconstitutional and unlawful’

Allowing the US access to countries’ patient data may be illegal.

The legal opinion submitted by Dr Mugambi Laibuta, a Kenyan advocate and data governance expert, to his government argues that its draft MOU with the US violates both the country’s Constitution and various laws and it must be “significantly renegotiated before Kenya can lawfully sign or operationalise it”.

The MOU’s data-sharing obligations grant the US government “extensive and intrusive privileges, including real-time access to Kenya’s national health data systems” and “may directly expose sensitive personal health data” in violation of Article 31(c) of the Kenyan Constitution, argues Laibuta.

Granting foreign governments “real-time access” to the country’s health information systems “significantly heightens national cybersecurity vulnerabilities, exposes strategic population-level data, and creates risks of data manipulation, extraction, or misuse”, he adds, noting that this violates Kenya’s Data Protection Act.

The MOU also violates Kenya’s Health Act, which “declares all health records confidential” and “restricts disclosure to third parties except where consent has been obtained or where a specific legal mandate exists, and requires that any authorised use of such information be clearly justified”. 

It also violates Kenya’s Digital Health Act, which “prohibits unregulated or unauthorised access to health data” 

The MOU is also “construed in accordance with US federal law”, which subordinates Kenya’s Constitution and law to a foreign legal system” – “an arrangement that is unconstitutional and cannot validly govern activities taking place within Kenya”, Laibuta contends. 

Other countries may well face similar legal problems with their MOUs, most of which are expected to be signed by the end of this year in order for grants to start being disbursed in April 2026.

Dr Gitau Mburu, first author of the new WHO guidance on infertility.

One in six people of reproductive age will be affected by infertility, yet health services to address this are “severely limited” and largely funded out-of-pocket, according to the first ever global guideline  on the issue by the World Health Organization (WHO).

“In some settings, even a single round of in vitro fertilization (IVF) can cost double the average annual household income,” WHO notes.

“Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Millions face this journey alone — priced out of care, pushed toward cheaper but unproven treatments, or forced to choose between their hopes of having children and their financial security. “

Tedros encouraged countries to adopt the guideline, giving “more people the possibility to access affordable, respectful, and science-based care”.

Basic prevention

The guideline includes 40 recommendations, starting with “basic prevention first” then advancing to more expensive options, scientist Dr Gitau Mburu, first author of the report, told a media briefing.

The starting point is basic education sessions at the primary health care level about issues that can affect fertility, including age, untreated sexually transmitted infections, alcohol and tobacco consumption.

“Informing people about fertility and infertility early can assist them in making reproductive plans,” the WHO notes in a media release.

Much of the guideline outlines the clinical pathways to diagnose and treat common biological causes of male and female infertility. 

“It provides guidance about how to progressively advance treatment options from simpler management strategies – where clinicians first provide advice on fertile periods and fertility promotion without active treatment – to more complex treatment courses such as intrauterine insemination or IVF,” according to the WHO media release.

The guidance also recognises that infertility can lead to depression, anxiety and social isolation, recommending ongoing psychosocial support for all those affected.

The report is based on information from 95 countries, only half of which have policies on infertility, Mburu said.

The recommendations address male and female infertility, Mburu said, adding that men are responsible for 45.1% of infertility. 

However, in many cultures, women are blamed if they don’t fall pregnant – and 36% of women with infertility face intimate partner violence. 

Dr Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing.

“The prevention and treatment of infertility must be grounded in gender equality and reproductive rights,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing.

“Empowering people to make informed choices about their reproductive lives is a health imperative and a matter of social justice.”

She stressed that people delaying having children should not be equated with infertility, which the WHO defines as the “failure to achieve pregnancy” after 12 months or more of regular, unprotected sex.

A health worker vaccinates a young child against measles

Although global immunisation efforts have led to an 88% drop in measles deaths in the past 25 years, measles cases are surging worldwide, according to a new report from the World Health Organization (WHO).

Last year, 59 countries reported large or disruptive measles outbreaks – almost triple that in  2021 and the highest since the onset of the COVID-19 pandemic.

There were an estimated 11 million infections in 2024, which is nearly 800,000 more than pre-pandemic levels in 2019.

The measles cases increased by 86% in the WHO Eastern Mediterranean region, 47% in the European Region, and 42% in the South-East Asian Region in 2024, when compared with 2019. 

However, the African Region experienced a 40% decline in cases and 50% decline in deaths over this period, partly due to increased immunisation.

“All regions except the Americas had at least one country experiencing a large outbreak in 2024. The situation changed in 2025 with numerous countries in the Americas battling outbreaks,” according to the WHO media release.

The WHO also highlighted that “deep funding cuts” to country immunisation programmes and the Global Measles and Rubella Laboratory Network (GMRLN), which tests samples, may “drive further outbreaks in the coming year”.

More than 30 million children were under-protected against measles in 2024 – three-quarters of them in the African and Eastern Mediterranean regions, often in fragile, conflict-affected or vulnerable settings.

Around 84% of children received their first dose of the measles vaccine last year, and only 76% received the second, according to estimates by the WHO and UNICEF.

At least 95% coverage with two measles vaccine doses is required to stop transmission and protect communities from outbreaks.

“Measles has resurged in recent years, even in high-income countries that once eliminated it, because immunization rates have dropped below the 95% threshold,” according to the WHO.

“Even when overall coverage is high nationally, pockets of unvaccinated communities with lower coverage rates can leave people at risk and result in outbreaks and ongoing transmission.

“To achieve measles elimination, strong political commitment and sustained investment is

needed to ensure all children receive two doses of the measles vaccine and surveillance systems.”

The Immunization Agenda 2030 (IA2030) Mid-Term Review, also released on Friday, stresses that measles is often the first disease to resurge when vaccination coverage drops.

Growing measles outbreaks are exposing weaknesses in immunization programmes and health systems globally, and threatening progress towards IA2030 targets, including measles elimination.

By the end of 2024, 81 countries (42%) had eliminated measles. In 2025, 96 countries had eleiminated measles with the addition of Pacific island countries, Cabo Verde, Mauritius and Seychelles. 

While the Region of the Americas regained measles elimination status in 2024, it lost this status again in November 2025 due to ongoing transmission in Canada.

Image Credits: WHO/John Kisimir.

Ambassadors Caroline Bwanali-Mussa of Malawi, Leslie Ramsammy of Guyana and Matthew Wilson of Barbados.

Millions of girls miss school each month when they menstruate, as their families cannot afford sanitary pads or tampons – something that a Geneva-based diplomatic effort is seeking to address.

Ambassador Matthew Wilson of Barbados described improving access to menstrual as a “global moral imperative” at a meeting of diplomats this week. 

“[Caribbean] surveys show that one in four girls have missed school due to lot of menstrual products, and over 30% of low-income households struggle to purchase them regularly,” Wilson told the meeting, hosted by the Permanent Missions of Barbados, Canada, and Malawi to the United Nations in Geneva, the Sanitation and Hygiene Fund (SHF), and the Global Center for Health Diplomacy and Inclusion (CeHDI).

“The unmet need for menstrual hygiene products in Africa is very high,“ said Zimbabwe’s  Ambassador Ever Mlilo, quoting recent research which showed that almost 75% of women and girls lacked access to these products in Burkina Faso, 70% in Ethiopia, and 65% in Uganda. 

Tax codes

Demonstration against taxes on period products in Ghana.

One of the first steps towards ensuring affordable and accessible menstrual hygiene products is getting a separate tax code for these products.

Currently, menstrual products are lumped with disposable nappies and other products deemed luxury items, which has made it difficult to implement tax breaks, speakers told the meeting.

The World Customs Organization (WCO) assigns Harmonized System (HS) codes to goods, enabling tracking of their use as well as any taxes and tariffs levied.

“Menstrual products don’t have a dedicated HS category. Single-use products are grouped together with diapers, wipes and other tissues, making it very difficult to even understand the types of tarriffs that these products are subject to, because they’re not classified,” said the  Sanitation and Hygiene Fund’s Adrian Douglas.

The WCO meets every five years to revise the HS classification, with a meeting planned for next year, and the Canadian government has been leading efforts to get an HS code for menstrual products.

International standards

Distributing free period products to teens.

Another avenue for diplomatic pressure is ensuring that the International Organization for Standardization (ISO) sets standards for menstrual products. 

“Menstrual products do not have an ISO standard yet, and it’s caused all kinds of challenges  in importation, challenges in ensuring quality, and it’s been one of the barriers that has prevented new innovations from reaching users,” said Douglas.

“There are heavy metals present in nearly all the menstrual products that are on the market today,” he added, pointing out that getting ISO standards on these products was expected by 2027.

“Today, in low and middle income countries alone, the annual value of the menstrual product market is $28 billion. So there’s a lot of convincing arguments to be made to include private sector to attract the additional investment.”

Afripads, a social enterprise based in Uganda that is making and distributing sanitary products, has reached seven million women and girls across 40 countries in the last 15 years, Afripads CEO Michelle Tjeenk Willink told the meeting.

“One of our main focuses is that if you tackle menstrual health, girls miss far less school and are more likely to graduate, more likely to continue to be financially active, economically active in work. So we always track [impact] in terms of school days, and we’ve given back more than 20 million school days to girls,” said Tjeenk Willink.

Import tariffs

Demonstration in Malawi- elimination of taxes on menstrual products ‘didn’t immediately translate into lower prices.’

“The Caribbean is extremely import dependent, particularly for menstrual hygiene products,” Wilson said. 

“Any shifts in global trade dynamics, production costs, and supply chain disruptions have immediate and significant consequences on the affordability and access of these products in our region. 

“So when import costs rise due to tariffs elsewhere, due to factors entirely outside of our control, prices increase at the community level, potentially undermining years of progress that have been made to reduce period poverty.”

While Barbados, Guyana, St Lucia and Trinidad and Tobago have removed VAT or reduced taxes on menstrual products, this has not been enough to guarantee lower prices.

“While VAT is being removed in many countries, not all taxes are removed. There are other kinds of taxes, like excise taxes, that are still applied,” said Ambassador Leslie Ramsammy of Guyana.

Earlier this year, Guyana removed all taxes on feminine hygiene products, but the country is still affected by tariffs and import taxes.

Wilson urged his diplomatic colleagues to engage WCO, the World Trade Organization (WTO) and other multilateral forums “to ensure that menstrual products are clearly delineated, have clear HS codes ascribed to them, are included as essential goods and that they’re considered for exemption from escalating tariffs.

“This is critical, not just for our region, but for millions of women and girls cannot afford to bear the burden of trade policies beyond their control.”

Malawi’s Ambassador Caroline Bwanali-Mussa agreed that “some tax reforms alone have not been enough”. 

In 2022, Malawi eliminated import duties and excise taxes (VAT) on pads and menstrual cups but this “did not immediately translate into lower prices”, she said.

Instead, Bwanali-Mussa said that “harmonised trade systems can unlock dignified, affordable access to menstrual products for all who need them”.

She also reminded the meeting of a 2024 United Nations Human Rights Council resolution which called on member states to ensure universal access to affordable menstrual products, including by “eliminating or reducine all taxes on menstrual products” and supporting those “living in economic vulnerability with free or affordable options”.

Image Credits: Teenn4Teens, CeHDI, Teens4Teens, Teens4teens, Afripads.com.

G20 leaders met in South Africa over he past weekend.

For the first time, the G20 Leaders’ Declaration explicitly references the Lusaka Agenda  – a significant milestone for developing countries that have long called for a fairer global health architecture. This acknowledgement gives political weight to an agenda that places integrated health systems, universal health coverage, and national leadership at the center of global health reform.

But a reference alone is not enough. Commitments must translate into action. With donor funding in decline and health needs growing more complex, G20 countries – and other nations – must deliver on the Lusaka Agenda: strengthen primary health care, secure sustainable domestic financing, and build resilient systems that protect the most vulnerable. Health is not a cost – it is the smartest investment. G20 countries have both the responsibility and the capacity to act together.

We stand at a pivotal moment in global health. The era of fragmented, disease-specific programs has shown its limitations. People live with multiple conditions, and health needs are increasingly interconnected.

Most low- and middle-income countries are ready and capable of taking greater responsibility for their populations’ health. But fragile states and those affected by conflict face unique challenges that demand global solidarity. These countries must remain a priority in efforts to strengthen health systems and ensure access for all.

We cannot afford to repeat the mistakes of the past. Fragmentation has left millions underserved. Today,  countries must act together to protect the most vulnerable and champion integration over division.

The Lusaka Agenda: A blueprint for change

The Lusaka Agenda is the result of a country-led process initiated in Africa and endorsed globally. It was developed through consultations with governments, regional bodies such as the African Union and Africa CDC, and global health partners, and was formally launched at the Conference on Public Health in Africa (CPHIA) in Lusaka in November 2023. Since then, it has been recognized by WHO, supported by Gavi and the Global Fund, and now referenced in the G20 Leaders’ Declaration—a milestone that gives it political weight and global legitimacy.

The Agenda calls for a fundamental shift in how global health is organized. 

First, it urges countries and partners to prioritize primary health care as the foundation of health systems, ensuring that essential services are accessible to all and integrated across disease areas. 

Second, it emphasizes the need to strengthen resilient and integrated health systems, moving away from fragmented, vertical programs toward approaches that respond to people’s real needs rather than donor-driven priorities. 

Third, it calls for sustainable domestic financing, encouraging countries to increase public health spending and embed health as a core investment in national budgets. 

Finally, it seeks to foster coherence across global health initiatives, reducing duplication and aligning efforts under a unified vision for universal health coverage.

The essence of the Lusake Agenda

At its core, the Lusaka Agenda is a call for equity, self-reliance in the production of medical products, and nationally led health systems—both in Africa and globally. Countries in the Global South are already leading this transformation, supported by regional institutions like the African Union and Africa CDC. 

They bring ownership, political will, and a young, dynamic population ready for change. But leadership must be matched with investment.

Examples from around the world show this is possible: the Philippines funds universal health coverage through health taxes on tobacco and alcohol; Rwanda has embedded cancer screening into primary care; and Jordan integrates non-communicable disease care with infectious disease treatment for refugees. These points demonstrate that integration works – and that reform cannot wait.

Why reform cannot wait

Global health has achieved extraordinary gains. Child mortality has halved since 2000. Millions of lives have been saved through vaccines, infectious disease treatment, and stronger health systems. Norway has been proud to contribute, through Gavi, the Global Fund, the Global Financing Facility, and other funds and initiatives.

But success has come at a cost. Vertical programs have created fragmentation. While HIV, TB, and malaria patients often receive quality care, millions with chronic diseases die undiagnosed. Every year, hundreds of thousands of children die from preventable conditions like asthma, pneumonia, diarrhoea and diabetes. 

Air pollution alone claims eight million deaths annually, more than half a million of them children. These are not inevitable tragedies; they are failures of access. The treatments exist. They are affordable. Yet they do not reach those who need them most. This is not inefficiency – it is injustice.

Shared leadership: Norway and South Africa

South Africa, through its G20 Presidency under the theme “Solidarity, Equality, Sustainability”, has elevated priorities that matter: universal health coverage, primary health care, and non-communicable diseases. 

Norway, as a G20 guest country this year, stands firmly alongside South Africa in these efforts. Both nations share a commitment to sexual and reproductive health and rights (SRHR), a cornerstone of equity and resilience. Together, we champion integrated health systems that protect the most vulnerable and deliver care for all.

South Africa’s leadership also extends to health sovereignty. The Johannesburg Process – supported by Norway, the World Health Organization (WHO), Gavi, and others – is strengthening local production of vaccines and medicines, including the mRNA technology transfer hub in Cape Town. 

For Norway, this is about more than technology; it is about resilience, preparedness, fairness and economic growth. By investing in regional manufacturing capacity, we help ensure that lifesaving tools reach those who need them most, when they need them. Investment in production creates jobs and revenues for States to build their own sustainable societies.

Driving reform and building resilience

Norway contributed to building the global health system we have today, investing billions in vaccines, disease control, and maternal and child health. But we also helped shape a system that became too vertical and fragmented. Now it’s time to reform this system towards the future. 

As Minister of International Development Åsmund Aukrust stated at the Oslo seminar in September: “Norway will continue delivering on our promise of 1% of GNI to official development assistance. Public health and strengthening health systems remain a priority. We will work to ensure universal health coverage in low-income countries, where we protect the vulnerable and marginalized—especially children and youth.”

Norway’s leadership is not only financial. It is political and strategic. We will champion integration and equity, support WHO’s coordination role, fund country-led priorities, and ensure that children and vulnerable populations come first.

As the world moves from negotiation to implementation of the Pandemic Agreement, Norway is proud to have helped secure this landmark deal. Together with partners, we are now focused on turning commitments into action, strengthening preparedness, building surge capacity, and ensuring equitable access to countermeasures. 

The Pandemic Fund, which came out of G20 and Norway supports, is a critical instrument for financing readiness and response. These efforts are not separate from health systems. They are part of making them stronger, more resilient, and better able to protect future generations.

 Smarter, fairer health financing

We need systems that make smarter, transparent and evidence-based decisions about resource allocation. It is unsustainable to overspend on one disease while ignoring others that kill just as many – or more. Inequality in spending must be addressed. Children and youth must come first. The most vulnerable must be shielded, not only from illness but from financial ruin caused by health costs. Universal Health Coverage (UHC) is not just a moral imperative. It is an economic one.

For many countries, the costs of strengthening health systems are rising as chronic, non-communicable diseases become more prevalent. These illnesses not only strain health budgets but also impose heavy social and economic burdens: parents unable to work because they care for chronically ill children, and adults sidelined from the workforce due to long-term conditions. This is a drag on productivity and national development.

Strengthening domestic resource mobilization, through good budgeting practices, improved tax systems and a broader tax base, is essential for sustainable health financing. 

Fiscal measures such as taxes on tobacco, alcohol, sugary drinks, and pollution are powerful tools to fund health and promote healthier societies. At the same time, initiatives like the Johannesburg Process contribute directly to strengthening local production and pandemic preparedness. These are investments in sovereignty and resilience.

WHO should coordinate

The WHO is uniquely positioned to play a central coordinating role in this transformation. As the only global health body with a constitutional mandate to coordinate international health work, WHO should guide the implementation of the Lusaka Agenda. 

This includes helping align global health initiatives with country priorities, developing practical tools for integration, and supporting national systems to deliver care based on real needs. WHO should act as a convener and facilitator—championing equity, integration, and country ownership across all levels of the global health architecture.

Call to action

The G20 has a unique role in shaping global health priorities and mobilizing resources. Its collective influence can drive reforms and keep health at the center of sustainable development.

However, words alone are not enough. At the G20 Health Ministers’ meeting in Polokwane earlier this month, a joint declaration could not be agreed on because two countries opposed the text. 

Yet all other G20 members and invited countries supported it—a strong indication of consensus and momentum. Now, that momentum must translate into action.

As the Norwegian Minister of Health and Care Services stated in Polokwane: “We need bold action: we must move from a Lusaka Agenda to Lusaka Deliverables, Lusaka Timeline, Lusaka KPIs—and most important: Lusaka Results.”

Acting together is essential. We must put the health of the most vulnerable first. The tools exist. Resources exist. What is needed now is political will—and the courage to act.

Stine Håheim is Norway’s State Secretary for International Development. She has also served as Deputy Minister in the Ministry of Foreign Affairs, and as a Member of Parliament (2013-2017). She trained as a teacher.

Usman Mushtaq is Norway’s State Secretary for Health and Care Services. A medical doctor by training, Mushtaq was preciously the Vice Mayor for Labour, Integration, and Social Services in Oslo.

 

AI tools will help drug discovery researchers like Cláudia Fançony, principle investigator at Centro de Investigação em Saúde de Angola (CISA).

Artificial intelligence could compress years of drug discovery into months – helping to overcome growing drug resistance to existing treatments for malaria and other vector-borne diseases. But scientists in low-income countries are often left behind. Jeremy Burrows, Medicines for Malaria Venture (MMV) vice president, head of drug discovery, explains how a new open-access, AI-powered drug discovery tool co-developed by MMV aims to level the playing field. 

Given the growing role of Artificial Intelligence (AI) in healthcare, what concrete contributions can the new technology offer in the fight against malaria?

Jeremy Burrows: At MMV, we are focused on the mission to discover, develop, and deliver new antimalarials. Along the entire value chain, from the point where you first come up with a possible molecule all the way to the end, to delivering a medicine, there are huge opportunities for AI to have an impact.

I work in the early stages of drug discovery. It is particularly in these phases where AI can play a major role in terms of helping us to identify new starting points, optimize these molecules toward candidate drugs, and then actually profile these compounds to ultimately be the medicines of the future.

Jeremy Burrows, MMV vice president, head of drug discovery.

AI is best at analysing large amounts of data. How do you make use of that?

Burrows: Since our foundation in 1999, MMV has worked with about two dozen pharmaceutical partners around the world, screening millions of compounds that can target the world’s deadliest and most prevalent malaria parasite, Plasmodium falciparum, which gives us extensive data. 

We’ve modelled that data and created an open-access machine learning model malaria inhibitor prediction platform (MAIP), available for free. Anyone can go there, enter a virtual chemical structure, and receive a prediction of whether that compound is likely to be active against malaria. Through validation exercises, this approach gives a tenfold increase in hit rate, which is substantial for making choices about what compounds we acquire and work on. However, our major focus is actually using AI to help optimize the medicinal chemistry design of new compounds — that is the deliberate design of compounds in a process called generative design.

A 3D model of the cofolded structure prediction of a Malaria Libre compound inhibiting Plasmodium cytochrome.

So, your goal is to increase efficiency and accessibility?

Burrows: Yes, we are working with the Gates Foundation and a London-based company called deepmirror to deliver a tool called Drug Design for Global Health (referred to as dd4gh). This tool will be delivered in March 2026 and will be available for free only for scientists working in global health.

It allows a scientist to upload their chemistry and biology data, where everything is modelled. Scientists also have access to all models built on public domain data, hosted in the MMV network. With dd4gh, they can do generative design, creating virtual chemical structures that can be scored against the models to predict which ones will be good. We can boil down thousands of options to maybe 20 compounds to synthesize and test in an iterative design cycle. 

This process, called model-informed active learning, in which the models improve with each design cycle, can potentially reduce the number of cycle times required to deliver a candidate drug. Regarding accessibility, many tools like this are currently prohibitively expensive. Delivering dd4gh is therefore democratizing AI for scientists in lower- and middle-income countries to fight malaria.

The dd4gh learning loop to improve compound design.

You speak of democratisation. What are the main challenges of applying these AI-driven tools in low-resource settings?

Burrows: There is clear inequity in access to these technologies. The investments needed are beyond the scope of most academic groups in lower- and middle-income countries. However, there are excellent scientists in Africa, and often good internet connectivity exists – even if the data centres running the algorithms will likely not be in Africa, all the ingredients are there. 

A major challenge in drug discovery in Africa is the logistics: how long it takes to order and receive components to make a compound. We are tackling this directly by encoding DD4GH with information about the local availability of building blocks so that it would prioritize compounds to make that can be accessed quickly. Our strategy involves free access to a high-end tool, training, and co-creation together.

Jeremy Burrows presenting advances in AI at the MMV symposium in Geneva.

Does your tool rely on a proprietary algorithm? And how is data-sharing organized amongst partners?

Burrows: MMV, with the help of the Gates Foundation, has secured a licence that ensures long-term access. Critically, AI allows us to share information confidentially between partners so that it can be modelled without actually sharing data. In our recent MMV workshop where the tool was discussed, we asked participants if they would contribute their data into such a tool, and the response was unanimously positive.

What other opportunities do you see for AI in drug discovery?

Burrows: AI is opening up many new opportunities in drug discovery and MMV has multiple projects underway, including developing better models of how the immune system fights malaria and how drugs interact with the human body. We are partnering with some leaders in this field so we are excited to see what it can do.

There is widespread scepticism regarding AI. What advice do you have for drug discovery scientists facing this new reality?

The future of AI is promising but requires a healthy degree of scepticism. While there are many bold claims, it’s essential to validate new models and understand their limits. Human oversight remains critical. AI should be used as a tool to enhance, not replace, human judgment.

Continuous learning, openness to outside expertise, and adapting to new ways of working will be key. Ultimately, AI has the potential to transform how we use data, democratize technology for scientists worldwide, and co-create tools that change the way we work, especially in global health.

See related story: Looming Malaria Drug Resistance Spurs Global Search for New Treatments

Burrows spoke with Health Policy Watch on the margins of the recent MMV Science of malaria medicine symposium in Geneva.

Image Credits: Supplied by Cláudia Fançony, Violaine Martin/ MMV, DD4GH, Jeremy Burrows.

Khalilou, second from left, disguises himself as a woman to compete in a beauty pageant and challenge norms about skin colour in Timpi Tampa.

“Why is it always those who have light skin that win,” asks a young Senegalese man tasked with handing out flyers for a local beauty pageant.

The setting is Dakar, where the newly-released film Timpi Tampa tells the story of a young man, Khalilou, whose mother is diagnosed with cancer, potentially from using skin-lightening products contaminated with mercury. He disguises himself as a woman named Leila to join a beauty pageant dominated by light‐skin standards, with the intent to challenge that system.

The film highlights how global efforts to remove mercury from cosmetics – still widely used in whiteners – need to go hand-in-hand with changes in social attitudes that combat “colourism” – that is the still prevalent idea that whiter skin has inherently greater beauty than darker brown and black colours. 

The film was aired in an unusual evening at the intersection of art and environmental policy on the margins of the recently concluded COP6 Conference of Parties to the Minamata Convention. The latest COP, which aims to eliminate harmful uses mercury, a highly toxic metal for both health and the environment, ended on 7 November with a decision to step up advocacy and action around the cosmetics issue.

The side-event was organized by the Global Health Platform and Global Health Centre of the Geneva Graduate Institute. It was co-hosted by the United Nations Environment Programme; World Health Organization; Global Mercury Partnership; Biodiversity Research Institute, and the Global Environment Facility. 

Many cheap skin lightening products contain toxic mercury and its compounds that are harmful to human health.

While mercury is banned in cosmetics, it continues to be used widely, especially in poor-quality and artisanal products commonly used for skin lightening. At the recent COP-6, countries committed to clamping down further on the availability of mercury-containing cosmetics as well as cross-border trade. 

Mercury’s toxic compounds can have a range of impacts on human health affecting nervous, digestive, immune systems and also on lungs, kidneys, skin and eyes, according to the World Health Organization (WHO). For the next COP7, scheduled in 2027, the WHO has also been invited to prepare a strategy advising countries about measures to prevent the use, manufacture, import and export of mercury-contaminated cosmetics.

See related story: Dental Amalgam Set to Be Phased out by 2034 to Reduce Toxic Mercury Exposures

Growing market for skin-lightening products

“For us in Geneva, it might not be so obvious, but skin-lightening products are a growing market. The estimated figure was $9.2 billion in 2023 and it’s expected to almost double to 16 million in 2032 with Asia Pacific dominating the market for the production and end use,” said Ludovic Bernaudat, Senior Programme Management Officer at Chemicals and Health Branch, United Nations Environment Programme (UNEP). “People use these products because in many societies lighter skin means better job, better prospect of marriage, and means beauty or status.”  

Skin-lightening cosmetics represent one of the fastest-growing parts of the beauty industry, with the Asia-Pacifiic region having a market share of over 50%.

Skin whitening products with mercury easy to access

Side-event in Geneva earlier this month at the Geneva Graduate Institute discussed the beauty ideals that allow cosmetics with mercury to stay in the market. From left to right: Ludovic Bernaudat of UNEP, Serge Molly Allo’o Allo’o of WHO, Ellen Rosskam of International Geneva Global Health Platform and
Angélica Dass of project Humanae.

In poor communities in Gabon, like other places in West Africa, people often resort to cosmetic bleaching as a way to lighten their skin, said Serge Molly Allo’o Allo’o, Project Coordinator working on eliminating mercury from skin-lightening products at WHO’s Gabon office.

“When you go to the market, you have cosmetic bleaching [is] everywhere, everywhere. And that is very cheap. But that is why in Gabon, we set up a regulatory framework to ban this kind of importation, most of which is informal,” he said.

The problem is not just in Africa. Skin bleaching is also widespread in Asia and Latin America. Most of these countries still linger under a colonial legacy where whiter skin was the standard of beauty. This standard remains embedded in large segments of the population, experts said.

UNEP is developing a project with 13 countries in Africa as well as with five countries in Asia, Latin America and the Caribbean to address regulations around mercury-containing cosmetics, said Bernaudat, adding that the agency hopes to gradually expand that footprint “so that we can make a difference at the global level.”

Using art to leverage awareness

Khalilou in a poster of Timpi Tampa, which addresses colourism as a driver of consumption of cosmetics that contain mercury and other toxics.

While regulation is critical to limiting the availability and movement of mercury-contaminated cosmetics, consumer preferences need to change to address the root problem – why these products are purchased in the first place.

And art can help ‘detoxify’ such perceptions of beauty. 

In Timpi Tampa, a film by Senegalese director Adama Bineta Sow, social pressures around “colourism” are discussed through the story of Khalilou, who finds out that skin bleaching caused his mother’s skin cancer. He disguises himself as a young woman, Leila, and enters a beauty contest to encourage women with dark skin to be proud of their colour

“Now, most of [the] women in my country… have light skin. It’s not the[ir] natural skin. And I’ve always wanted to go to each of them and to tell them you were already beautiful the way you were before,” Sow said during the interaction following the screening of her movie at the event.

Sow said she wrote the movie out of her experiences growing up in Senegal. Although she never tried lightening cosmetics herself, she witnessed first-hand the harmful beauty standards and social pressures that can lead many teenage girls and women to use such products – including ones that may contain mercury.

Portraits taken by photographer Angélica Dass as part of her project Humanae.

“When we are not able to talk with each other, when words are not enough… I think that art speak[s] clear, loud,” said Angélica Dass.  

Dass is the creator of the exhibit Humanae, which also addresses the topic of colourism.  As a part of her project Dass took 5,000 portraits across 39 cities and 20 countries capturing her subjects’ bare shoulders, skin and hair, in natural, unadorned poses. 

“The most important information that you find about these people is exactly the lack of information. Anything that you put in these people just belongs to your own stereotypes,” said Dass, who also participated in the evening panel discussion.   

And changing the colour of ones skin or hair doesn’t provide an authentic escape from the related social prejudices of race and ethnicity, Dass pointed out. For instance, when a curly-haired girl in the picture uses skin whitening, her identity still remains that of a black girl, Dass observed, suggesting that identity needs to be embraced rather than modified superficially.

The key is to teach new generations to understand and celebrate who they are.  The amount of melanin someone has in their skin should never be a dehumanizing factor.

Tackling colourism an important human rights issue

Mercury and its compounds can cause immense damage to human health.

While the government can enact laws and regulations, artists like Dass and Sow can impact deeply perceptions of beauty and thus contribute to behavioural change, Bernaudat said, adding that looking at the issue of mercury in cosmetics through the lens of human rights can also help address the issue.

“People need to have the same chance, wherever they look like, whatever gender they are, etc, and that’s where we need to start. And I think from this we need to change behaviours,” he said. 

At the same time, legislation, when well crafted, can help with accelerating this behavioural change, He pointed out, citing UNEP’s work with The Minamata Convention on Mercury as one such example.

“That is an extraordinary international treaty that UNEP pushed through with an entire health component,” said Ellen Rosskam, Coordinator, International Geneva Global Health Platform and the Global Health Centre, who moderated the conversation.

“And that is something really exceptional.”

Image Credits: Timpi Tampa trailer , By arrangement, Global Health Centre, Geneva Graduate Institute, IMDB, Angélica Dass.

Many prevention campaigns, such as this by Alliance Côte d’Ivoire, have been cut for due to lack of funds.

Abrupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world, according to the 2025 UNAIDS report released on Tuesday.

“People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available,” notes the UNAIDS report, aptly called Overcoming Disruption: Transforming the AIDS response.

“Over two million adolescent girls and young women have been deprived of essential health services, and community-led organisations have been devastated, with many being forced to close their doors.”

The UN agency has been forced to slash staff by more than half as it too has been defunded by the US government since the Trump administration took charge in January and froze all foreign aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR). 

“It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS. 

“Before, we had places to go, people to talk to, and we knew someone cared. I felt supported when there were peer groups and community counsellors.”

A South African sex worker and mother of three who lost access to antiretroviral (ARV) therapy for four months told the agency: “The only thing I could think of was my kids, and that I am going to die.” 

Immaculate Bazare Owomugisha, of the International Community of Women Living with HIV based in Uganda, said that “community structures that supported people to remain engaged in care and come in for testing have been phased out” and her organisation had to retrench more than 30 people who did community-based monitoring.

PEPFAR supported 20 million people living with HIV in 55 countries, including 222,000 people on ARVs and 190,000 healthcare workers, according to the PEPFAR Program Impact Tracker. It estimates that the funding freeze has caused 132,933 adult deaths and 14,150 child deaths (by 25 November).

Long-lasting effects of disruptions

Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients has been in jeopardy.

Although funding for some PEPFAR-supported HIV programmes has restarted, “service disruptions associated with these and other funding cuts are having long-lasting effects on almost all areas of the HIV response”, according to the report.

Access to treatment for many people with HIV in West and Central Africa was disrupted as donors cover 90% of the costs for antiretroviral (ARV) medicine.

In eastern and southern Africa, this figure is 38%. In Eswatini, which has the highest HIV prevalence in the world (23% of adults aged 15- 49 years), the HIV programme lost 20% of its funding.

In Ghana, 29% fewer pregnant women with HIV received ARVs to prevent HIV transmission to their babies during the first six months of 2025 

Vital tests – CD4 counts and viral loads which gauge whether ARV treatment is working – have plummeted in several countries.

Some people didn’t get ARVs because funding cuts affected procurement and supply-chain management systems, resulting in stock-outs of HIV medicines in the Democratic Republic of the Congo, Ethiopia and Kenya.

But even quantifying the disruptions is difficult, as data capturers have lost their jobs and community-led monitoring has been disrupted.

However, the report identifies the most vulnerable areas as being HIV testing, prevention and care; data collection; community-led responses; services for “key populations” and human rights and gender equality. 

Collapse of services for key populations 

“Key populations” refers to groups most vulnerable to HIV and where the virus is hardest to eliminate – often because these groups are heavily stigmatised. 

These include adolescent girls and young women, men who have sex with men (MSM), sex workers, people who inject drugs, transgender people and prisoners.

“Donor funding accounts for most of the funding (100% in western and central Africa) for tailored HIV testing services in settings focusing on key populations,” according to the report.

In Zimbabwe, for example, many HIV services for sex workers and other key populations have “effectively collapsed” this year. Most key population clinics in Kenya and at least five in Nigeria have closed.

Over three-quarters (77%) of harm reduction programmes and other HIV services for people who inject drugs had been “severely disrupted by funding cuts”, according to a UNAIDS survey in April.

Prevention disrupted

Getting an HIV/AIDS test at Witkoppen Clinic in Gauteng, among many in South Africa highly dependent on US funding prior to the dismantling of USAID.

Funding cuts have substantially affected access to pre-exposure prophylaxis (PrEP), antiretroviral therapy to prevent HIV infection, usually also targeted at groups at the highest risk of HIV. 

When the US government resumed funding via bridging agreements in October, it made it confined several services, including PrEP, to pregnant and breastfeeding women only.

By mid-October, the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people have lost access PrEP this year. This includes 64% of people in Burundi, 38% in Uganda and 21% in Viet Nam.

Meanwhile, male condom distribution fell by 55% in Nigeria between December 2024 and March 2025, 

The number of HIV tests performed declined by 43% in Cameroon from January through July.

Community outreach ‘eliminated’

Community-led organisations play an important role in HIV prevention, testing, care and treatment services, including direct provision of these services – particularly for “key populations”.

“Community outreach services have been reduced or eliminated in Angola and Eswatini due to funding cuts’” the report notes.

“Over 60% of women-led HIV organisations have lost funding or been forced to suspend essential programmes, leaving entire communities without access to vital services”, while a survey of 45 youth organisations found that 60% had experienced a sudden and significant loss of resources.

Community-led organisations of men who have sex with men in Kenya, Mozambique and Viet Nam reduced staffing by at least one-third.

African solutions

Increasing domestic financing for HIV is essential, but tricky for many countries in western and central Africa, where public debt service is on average 5.5 times greater than public health allocations.

However, UNAIDS estimates that it is feasible for the domestic share of HIV financing to rise from 52% in 2024 to two-thirds by 2030. 

This year, Nigeria approved a $200 million increase in its health budget. Uganda is taking steps to double its domestic spending on health, while Côte d’Ivoire and South Africa have increased their domestic investments to help mitigate the effects of reduced donor support.

Twenty-six of the 61 countries reporting to UNAIDS stated they expect to increase their domestic public HIV budgets.

African leaders adopted the Accra Reset earlier this year, calling for “a new era of health sovereignty rooted in national ownership, investment and leadership”.

Meanwhile, an extraordinary session of the African Union Assembly is being convened in next month to secure support for the implementation of the African Union’s roadmap on “sustaining the AIDS response, ensuring systems strengthening and health security for the development of Africa”.

African leaders have also committed to strengthening local manufacturing of medical products, and the vaccine alliance, Gavi, has committed $ 1.2 billion to the Africa Vaccine Manufacturing Accelerator initiative.

The report also introduces the new Global AIDS Strategy (2026–2031), to be adopted by the UNAIDS Programme Coordinating Board in December.

The new strategy is “person-centred and has fewer focused targets”. It focusses on integrating HIV services into national programmes, reducing stigma, and securing sustainable financing.

UNAIDS estimates that $21.9 billion will be needed annually until 2030 to achieve global HIV targets in low- and middle-income countries.

“HIV programmes are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services and the organisations that support those communities are being decimated,” the report notes.

“There is hope, however, as seen through the political will and the resilience that both communities and countries have demonstrated in the past months. The world has come a very long way already on this journey and now is not the time to pause or step back. Now is the time to keep the promise and end AIDS by 2030.”

Image Credits: JB Russel/ The Global Fund/ Panos, UNAIDS, Witkoppen Clinic.