WHO Director-General Dr Tedros Adhanom Ghebreyesus

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

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

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

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

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

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

‘Little miracle’

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

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

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

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

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

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

Outpacing response

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

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

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

Dangers for health workers

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

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

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

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

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

Access for those who need it?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Israel also cited the inclusion of trade issues in the 15-page declaration as one of the reasons for its vote against, but also launched a diatribe against a reference to the 2016 Durban Declaration on HIV – which it accused of being “anti-Semitic” without basis.

‘Dubious notions’

Russia cited “at least 20 unacceptable provisions”

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

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

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

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

‘Key populations’

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

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

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

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

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

While the declaration commits to ending HIV by 2039, it identifies several gaps, including “reductions in global financing for HIV and the impact of recent disruptions on HIV services”.

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

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

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

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

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

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

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

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

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

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

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

Systemic barriers obstruct lifesaving screening

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

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

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

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

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

Sustainable state funding bridges care gap

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

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

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

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

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

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

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

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

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

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

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

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

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

Comprehensive prevention strategies 

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

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

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

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

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

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

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

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

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

Trusted voices counter misinformation

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

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

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

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

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

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

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

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

Political will and peer learning 

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

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

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

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

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

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

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

 

 

 

Image Credits: WHO/Fanjan Combrink.

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

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

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

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

Africa is unhappy with political declaration

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

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

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

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

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

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

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

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

HIV is ‘the story of multilateralism’ 

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

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

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

UN Deputy Secretary General Amina Mohammed.

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

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

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

Financial crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Review of nicotine

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

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

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

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

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

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

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

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

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

 

Image Credits: Government of Palau.

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

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

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

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

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

EU tobacco tax misses WHO benchmark

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

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

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

Surging new products target youth

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

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

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

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

Divided Council to decide later this year

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

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

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

Image Credits: Felix Sassmannshausen/HPW.

Dr Faustin Ntirenganya (left) and surgeon trainee Dr Victoire Mukamitari.

Where a person is born should not determine whether they survive, whether they live with dignity, or whether they are forced to endure years of preventable suffering while waiting for surgical care that may never come.

Yet, across large parts of Africa, this remains the reality.

At this year’s 79th World Health Assembly (WHA79) in Geneva, world leaders gathered to discuss the future of global health, healthcare equity and international responsibility. Despite the scale of these conversations, one essential component of healthcare continues to receive far too little global attention: access to safe surgery in general, and plastic and reconstructive surgical care in particular.

For millions of patients, plastic and reconstructive surgery is not cosmetic. It is not optional. It is essential healthcare that restores function, mobility, independence and dignity.

It allows burn survivors to use their hands again. It enables children born with craniofacial malformations to attend school without stigma. It gives patients living with traumatic injuries, cancers or congenital defects the possibility of participating fully in life once more. These surgeries are lifesaving.

However, in many regions, access to plastic and reconstructive surgery is effectively denied.

Non-existent access to surgeons

For more than a decade, I was one of only two plastic and reconstructive surgeons serving Rwanda’s 14 million people. In some parts of the world, highly specialized surgeons are everywhere. In others, they are almost non-existent. When there is less than one trained surgeon for hundreds of thousands – or even millions – of people, the consequences are devastating.

In Rwanda, I regularly travel to hospitals where hundreds of patients arrive seeking care in a single day. Many have already waited years for surgery. Some live with severe burns that have left their limbs contracted and immobile. 

Others endure untreated injuries or tumors that continue to shape every aspect of their life. Some patients travel extraordinary distances only for us to tell them they must continue waiting because the system is already stretched beyond its limits.

What is most painful is knowing that many of these patients continue suffering or their conditions worsen to the point of becoming untreatable while waiting for care – not because treatment does not exist, but because access to trained specialists remains critically limited, there is too little infrastructure and too few resources available to meet the overwhelming demand.

Dr Faustin examines a 19-month-old child in rural Rwanda with a congenital tumour that will need a 10-12-hour operation to remove.

Sustained investment

Behind every surgical waiting list, there is a human life suspended in uncertainty. This is not merely a surgical issue; it is a global health issue. Healthcare systems cannot adequately

respond to trauma, burns, maternal health complications, cancer reconstruction or congenital conditions without sustained investment in surgical capacity.

And still, surgery continues to be treated in many international conversations as secondary rather than foundational to healthcare equity.

A documentary has been made about my team, which follows us as we work in remote hospitals in Rwanda and confront the daily realities of providing care within a system under immense strain. 

Our local work includes efforts to train the next generation of African surgeons, fighting to increase regional access to surgical care for the future.

Dr Victoire Mukamitari is a young surgical trainee navigating the immense pressures of training within a male-dominated field while carrying the hopes of becoming part of a new generation of plastic and reconstructive surgeons.

Dr Victoire Mukamitari is a young surgical trainee in Rwanda.

Unbearable pressure

There are days when the pressure feels unbearable. Days when electricity becomes unreliable in the operating room. Days when resources force impossible decisions. Days when a surgeon carries the knowledge that help arrived too late.

There is exhaustion, responsibility, grief and the emotional burden of carrying more patients than one healthcare system was ever designed to support.

But there is also extraordinary hope and immense pride to serve and contribute to something bigger than us.

Several years ago, I realized that no individual surgeon – no matter how committed – could ever meet this level of need alone. My response was to help build a training program capable of preparing the next generation of plastic and reconstructive surgeons across the region. 

My goal is to help train 30 new surgeons by 2030 so that no surgeon in Rwanda or neighboring regions will ever again have to carry this burden alone.

This mission is not about one doctor, one hospital or one documentary. It is about building sustainable healthcare systems capable of serving future generations with dignity and consistency, creating a multiplier effect.

And this work cannot happen through temporary interventions alone. It requires a holistic approach with long-term investment in surgical education, healthcare infrastructure, equipment, researchpartnerships and healthcare systems designed not only to respond to crisis, but to endure.

Most importantly, it requires the international community to finally recognize that access to surgical care is not optional within global health. It is essential, a fundamental human right.

The patients waiting for care deserve healthcare systems capable of treating them safely, compassionately and without years of preventable suffering.

The next generation of surgeons is ready to lead if the world is willing to invest in them. This should be a collective responsibility.

Dr Faustin Ntirenganya is a consultant, General and Onco-Plastic and Breast surgeon, at University Teaching Hospital of Kigali and Head of Department of Surgery at the School of Medicine and Pharmacy. The documentary, Making of a Surgeon: Fighting Africa’s Hidden Crisis, explores these realities and the growing effort to expand plastic and reconstructive surgical care across Africa. 

 

COP31 co-Presidents Türkiye and Australia used the Bonn climate talks to launch three flagship goals for November’s summit in Antalya. The targets chart a path to cut emissions from energy, buildings and waste, but steer clear of the fossil fuels and the finance fights that sank the last two COPs.

The stepping-stone meetings on the road to COP31 in Antalya unfolding in Bonn this week brought the first real clarity on what the incoming presidency wants the next UN climate summit to deliver on: electrification, reducing waste, and the energy efficiency of buildings and construction.

The three headline targets call for electricity to meet 35% of final energy demand by 2035, up from just over 20% today, a goal the presidency calls “35 by 35”. The second would halve the growth in global waste by the same date, and the third would cut the energy intensity of buildings by at least a quarter.

Together, they chart a course around sectors that are among the largest sources of global greenhouse gas emissions; the buildings sector alone accounts for around 37% of the global total.

As buildings, energy use and production and waste are also among the world’s leading contributors to air pollution that kills around 7 millon people annually, real reductions in emissions from the three sectors would also translate into near-term gains for health.  And progress on the targets would help reduce superpollutants, like methane and black carbon, that exacerbate warming as well as harming health. See related story:

Reducing Emissions of ‘Super Pollutants’ Would Slam Emergency Brake on Global Warming

But the agenda deliberately omits any reference to reducing or phasing out fossil-fuels in the process.  It is thus built to dodge the political torpedoes that sank the last two COPs, in Brazil and Azerbaijan.

The presidency has cast the package as the practical core of an “implementation COP”, echoing Brazil’s framing of COP30 a year ago.

“We need this COP to be a COP of implementation and acceleration,” said Chris Bowen, Australia’s climate minister and COP31’s president of negotiations, calling the agenda “an impressive blueprint to help us do that.”

Money missing from agenda

Low-carbon hospital in Alberton, South Africa, with solar energy, natural lighting, on-site grey water treatment and recycling – which opened in 2022.

Yet money — the other perennial battleground of recent UN climate summits, and the thing that makes any implementation possible — is also absent from the core agenda.

Beyond the three headline goals, the presidency’s ten-theme Action Agenda spans food security, oceans, green industrialisation, youth and education, and, of significant note for the health community, a pillar on resilient health systems.

The core targets, like the rest of the Action Agenda, are set by the presidency and are political objectives, not guaranteed outcomes. Countries must choose to take them up on their own in Antalya during formal negotiations to transform targets into binding commitments.

And the political momentum pushed by a presidency is not always enough to get a deal over the line. Hosting last year’s summit in the heart of the Amazon, a setting meant to put the critical role of rainforests in balancing the global climate at the centre of the talks, Brazil threw its weight behind a roadmap to halt and reverse deforestation, backed by more than 90 countries. It never made the final text, with over 100 nations declining to support the roadmaps Brazil’s presidency championed.

“What the world needs today is not another round of promises,” COP31 President-Designate Murat Kurum told delegates in Bonn. “It needs to see existing commitments delivered.”

1.5°C’s life or death moment

Planet on Course to Permanently Breach 1.5°C Limit by 2030

The new targets for Antalya land as the planet closes in on the 1.5°C limit UN climate negotiations are intended to defend.

While the presidency lists protecting that threshold in its official targets, the latest science shows the planet is on course to breach it permanently around 2030.

The electrification target is explicitly designed to hold the world on a 1.5°C path, based on International Renewable Energy Agency (IRENA) modelling. But with the fossil fuels behind roughly 70% of global emissions absent from the agenda, the presidency’s strategy looks more like pragmatic damage control than a course correction.

Human-caused warming reached 1.37°C last year, and global emissions hit a record 56.8 billion tonnes of CO2-equivalent in 2024, according to the annual Indicators of Global Climate Change report, published last week.

A separate analysis released in Bonn on Tuesday by Climate Analytics found that fossil fuel use must halve by 2035 to keep 1.5°C within reach. The growth in CO2 emissions has begun to slow, but emissions are still climbing, not falling.

“Fossil fuels are still pouring oil on the climate fire,” said Neil Grant, a senior mitigation expert at Climate Analytics. “We need to cut fossil fuel use sharply this decade, halve it by 2035, and drive it down to real zero by 2070.”

“The safer route is a rapid, planned phase-out of fossil fuels, powered by clean electrification,” said Bill Hare, the group’s chief executive.

The other key battleground of every COP since Paris – money – is not addressed in the presidency agenda either. A concept note circulated in Bonn unveiled a “Global Implementation Accelerator” and a “Climate Implementation Bridge” to speed climate solutions to the ground.

Both are coordination structures. Neither is a fund, and the presidency specifies that no new money is attached.

A target for an electric age

The COP31 Presidency’s target for electrification would reduce air pollution in cities, as well as climate emissions – but only if the electricity is produced sustainably.

The electrification goal draws on analysis from IRENA, whose latest roadmap finds electricity must rise from around 23% of final energy use today to 35% by 2035, and above 50% by 2050, to stay on a 1.5°C-compatible path.

The co-presidents frame the pitch as a move towards energy security as much as climate action. The protection renewables can offer from fossil fuel price shocks is drawing fresh attention as the war in the Middle East drives up oil and gas prices, forcing low- and middle-income countries to dig into their treasuries to afford the basic functions of government.

Electrification can be a hedge: cheaper, home-grown power that shields households, central banks and economies from volatile global markets and the geopolitical shocks that move them.

“The good news is that the answer to improved energy reliability and energy sovereignty is also the answer for emissions reduction – that is more electrification, more renewable energy, sovereign and reliable forms of energy, which is also cheap and is also the best for the climate,” Bowen said.

“Accelerating the energy transition will ease shocks to our energy systems, better protect our economies and households from high costs, and help keep bending the curve of emissions downwards,” he added, describing electrification as “the key to transitioning away from fossil fuels.”

But more electricity only cuts emissions if the power behind it is clean. While broadly welcoming the strategy, environmental groups warned it must be matched with investment in expanding renewables.

“More electricity alone is not the answer if it is still powered by coal, oil and gas,” said Fernanda de Carvalho, global climate and policy head at WWF. “Developing countries will also need finance and technology support to make this transition fair and effective.”

The targets released in Bonn do not specify how the extra electricity should be produced.

“Electrification can only deliver meaningful climate benefits if the power comes from renewables, not fossil fuels,” said Duygu Kutluay, a campaigner at Beyond Fossil Fuels.

Simon Stiell, the UN climate chief, who has thrown his weight behind the electrification push, urged delegates not to backslide.

“We don’t have time to re-open past debates or renegotiate commitments already made,” Stiell told the Bonn summit. “Tackling the global climate crisis is the hardest, but most important, thing humanity has ever tried to do together. It is worth doing, because we have no choice.”

What kind of waste?

Burning plastic e-waste to recuperate metal wiring: the COP 31 targets fail to address the generation of plastic waste upstream.

The second target takes aim at the climate impact of the world’s waste. The presidency wants to halve the growth in global waste by 2035, notably, not halve waste generation itself.

The world already generates around 2.1 billion tonnes of solid waste a year, a figure the UN Environment Programme (UNEP) projects will climb to 3.8 billion tonnes by 2050 in a business-as-usual scenario.

Mounting piles of trash and landfills are also a growing climate problem, with organic waste rotting in dumps one of the largest human sources of methane, a major accelerator of global warming.

Methane is responsible for nearly 30% of the rise in global temperatures since the Industrial Revolution. Food waste alone accounts for around 10% of global emissions, much of it as methane, a gas roughly 80 times more potent than carbon dioxide over the short term.

Yet because methane breaks down in the atmosphere within about 12 years, against centuries for carbon dioxide, cutting it is prized in climate diplomacy as a vital “emergency brake” on near-term warming. Reducing waste-related methane emissions, and along with that, waste incineration in low- and middle-income countries would also improve air quality directly and indirectly since methane is an important precursor of ground-level ozone.

What the presidency’s target actually means is also hard to define – particularly since the target makes no reference to a baseline year and does not specify what kinds of waste would be covered.

That ambiguity matters, as some waste streams, plastics above all, are politically explosive enough to derail a negotiation.

The missing piece: plastics

UN Plastics Treaty Talks Fail Again After Overnight Deadlock

While the target’s climate aspirations are positive, sidestepping plastics production could prove a gift to petrostates in the long run. A downstream focus on managing and recycling waste, rather than capping production, is exactly what petrostates fought to protect when global plastics treaty talks collapsed in Geneva last year.

A bloc led by Saudi Arabia, Russia and Iran, with the United States aligned, blocked any binding limit on production. More than 100 countries, unwilling to leave the upstream untouched, ultimately walked rather than accept a weak deal.

With less than a tenth of the world’s plastic recycled and production on track to triple by 2060, the same production-versus-waste-management fight could resurface at COP31.

The cause is also a signature of Türkiye’s first lady, Emine Erdoğan, who chairs the UN High-Level Advisory Board on Zero Waste, established by Secretary-General António Guterres in 2023 after a Türkiye-led resolution declared 30 March the International Day of Zero Waste.

A Zero Waste forum in Istanbul this month, organised by the foundation she heads, drew Guterres, UNEP chief Inger Andersen and Stiell, but produced no new commitments, even as it set up zero waste to be a central feature of the Antalya agenda.

The building target that quietly shrank

The third goal aims to reduce the energy intensity of the buildings sector by at least 25% by 2035.

Buildings and construction are heavyweight emitters, responsible for around 37% of global emissions and nearly half of all raw material extraction, from the sand, gravel and cement that go into concrete to the steel that frames it.

Roughly half the buildings that will stand in 2050 have yet to be built, most of them in fast-growing economies in Asia and Africa, according to UNEP.

How those millions of structures are built will lock in emissions for decades. A wave of poorly insulated, fossil-powered construction would commit the world to rising energy demand for the lifespan of every structure.

Despite the sector’s importance, the target was watered down hours after it landed, Climate Home News reported, another sign the presidency’s politically careful agenda may face serious headwinds once negotiations begin.

An initial presidency statement set a goal of a 25% increase in energy efficiency. A “small update” issued a day later swapped it for a 25% cut in energy consumption intensity. No reason was given.

The two metrics are not the same. Energy intensity measures the energy used per square metre, and can be brought down through superficial steps such as dimming lights or adjusting how a building is run, leaving structures untouched.

An efficiency target would force the costly structural work that delivers lasting cuts: insulation, heat pumps and retrofitted building envelopes. Recast as an intensity goal, the target can be met by operational tinkering while the deep renovations the sector needs are put off.

The fight the agenda leaves out

The shape of the COP31 agenda emerges as a pragmatic political choice to build the summit around problems less divisive than the fossil fuel and finance fights that tanked the last two COPs.

At COP30 in Belém last November, a bloc of petrostates led by Saudi Arabia drew more than half the nations present to its side and stripped every reference to fossil fuels from the final text, killing a phase-out roadmap that some 80 countries had backed.

Under the UN’s consensus rules, a single nation can veto language, even against majority support. With Saudi Arabia, Russia and the United States flanked by other major petrostates set to be in the room, any text dealing with fossil fuel phase-out will be dead on arrival.

The concession is a pragmatic but significant moment in the world’s fight against the climate crisis: the fossil fuels driving it are no longer seen as worth fighting over, a reality the joint presidency is conceding before talks begin.

That deadlock has forced the fossil fuel question to splinter off into a diplomatic track of its own. Frustrated by the inability of the core UN climate talks to move forward, 57 governments convened in Santa Marta, Colombia, in April for the first summit dedicated to phasing out oil, gas and coal, declaring the transition “past its point of no return.”

While the coalition’s power is limited, its creation signals a new shift in the phase-out fight. The Santa Marta countries account for about a fifth of global fossil fuel production, and include sizeable producers such as Norway, Canada, Australia, the United Kingdom, Brazil, Nigeria and host Colombia.

The world’s five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – stayed away from the talks.

For now, the higher-ambition camp is left to build toward a phase-out on its own, while the UN process moves on around it. The coalition will meet again in 2027 on the Pacific island of Tuvalu, co-hosted by Ireland.

The money that isn’t there

Achieving the presidency’s three targets, despite their limitations, would be a major achievement in the fight against the climate crisis.

But the question of who will pay to make them real, and how much – the defining fight of every COP in recent years as the world shifts from diplomatic documents to delivery – stands to derail the agenda altogether.

As of today, the world is paying a tiny fraction of the true costs of the three agenda items alone.

Meeting the electrification pathway requires global grid investment to roughly double, to about $1.2 trillion a year, IRENA estimates.

Investment in building energy efficiency must more than double to $5.9 trillion by 2030, according to UNEP’s Global Status Report for Buildings and Construction. The direct cost of managing the world’s waste, around $252 billion in 2020, is set to nearly double by mid-century, according to UNEP’s Global Waste Management Outlook.

The headline goal agreed at COP29 in Baku commits developed countries to mobilise “at least” $300 billion a year for the developing world by 2035, a figure the Global South denounced as a “betrayal”, alongside an aspirational, all-sources target of $1.3 trillion.

On the current trajectory, analysts estimate the flows covered by that goal will reach barely $427 billion a year by 2035, less than a third of the target.

Developing economies received around $196 billion in climate finance in 2023, with more than half of it arriving as loans rather than grants, deepening the debt of countries already crumbling under foreign repayment loads.

Even the institutions meant to deliver the “billions to trillions” now say it isn’t possible. World Bank President Ajay Banga has called the formula unrealistic, and the bank’s chief economist, Indermit Gill, has branded it a “fantasy.”

“Climate finance commitments to small island developing states are facing systemic collapse,” Anne Rasmussen, lead negotiator for the Alliance of Small Island States, told a Bonn press conference on Tuesday.

“Developed partners are defaulting on their legal obligations under the Paris Agreement, and key financial mechanisms are being crippled. SIDS are effectively being blocked from implementing vital climate priorities. It leads us to question whether the implementation of the NCQG is dead on arrival, unless these breaches of legal duty are immediately reversed.”

The presidency’s new instruments take no steps to close that gap. Kurum has described the Climate Implementation Bridge as a way to turn national climate plans into “investable project portfolios” and help finance reach the ground faster, not as a new source of cash.

A wider finance crisis

Global Health Leaders Urge Fewer Agencies Amid Funding Crisis

The shortfall is part of a wider crisis across the development aid world. Developing countries need an estimated $4.3 trillion a year to meet the Sustainable Development Goals, including $1.8 trillion for climate, according to UN Trade and Development.

The OECD warns the overall financing gap, having grown 60% to $4 trillion, could reach $6.4 trillion by 2030 without reform. This year’s Financing for Sustainable Development Report concluded the shortfall “risks reversing decades of progress.”

Climate is competing for that money with everything else falling short. Humanitarian appeals drew their lowest funding in a decade in 2025, while food programmes, global health budgets and the finances of the UN itself buckle under simultaneous cuts, led by the United States’ retreat from much of the aid system.

As at every COP before it, the fate of Antalya is likely to rest less on the ambition of its targets than on whether anyone agrees to pay for them.

“Public finance is not a preference for us, it is an oxygen for us,” said Isatu Kamara, climate finance coordinator for the Least Developed Countries group.

Image Credits: Netcare-Alberton Hospital, UNFCCC, https://www.netcare.co.za/News-Hub/Articles/environmental-sustainability-at-the-heart-of-new-hospital-design, Ernest Ojeh/ Unsplash, WHO,2021.

Africa CDC epidemiologist Dr Wessam Mankoula

The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday.

This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing.

The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain.

Ebola outbreak size at four weeks

Where’s the money?

Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said.

On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda.

The meeting mobilised $910 million in pledges, including $80 million from African member states.  However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added.

The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. 

The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination.

“The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC.

Case fatality, contact tracing

The six key obstacles hampering the response.

Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected.

The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. 

There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks.

“Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula.

Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient.

Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked.

However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak.