The official WHO DG election cycle for 2026–2027 traces the path from the initial call for nominations in April 2026 to the final appointment in May 2027.
The proposed WHO Director-General election cycle for 2026–2027 lays out the path from the initial call for nominations in April 2026 to the final appointment in May 2027.

As the campaign to elect a new World Health Organization Director-General officially opens, a timeline and guidelines for the process have been published by outgoing DG Dr Tedros Adhanom Ghebreyesus for consideration by member states at next week’s World Health Assembly and the upcoming Executive Board. While these aim to promote a transparent and level playing field, structural loopholes remain.

With the call for nominations for the next World Health Organization (WHO) Director-General officially underway, the global health community is bracing for an intense, year-long campaign season. The upcoming 2026/2027 WHO DG election cycle marks a definitive departure from the previous race in 2021, which unfolded amidst the COVID-19 pandemic, featured an incumbent, and relied heavily on remote adaptations.

The current contest expects a full return to “normal” physical in-person campaigning at regional committee sessions. However, a “new normal” is also unfolding under complex conditions, as the WHO grapples with a sharply polarized body of member states and a drastically reduced budget following the United States’ withdrawal last year, forcing it to implement massive, ongoing workforce reductions.

To maintain fairness in this highly pressured, post-pandemic landscape, WHO has published a draft set of guidelines that would help create a firewall between candidates’ campaign activities and official organisation business – rules that will be particularly important for candidates that emerge from within WHO’s ranks.

The Director-General’s recommendations on the election process, to be reviewed by Member States at the upcoming World Health Assembly and Executive Board, aim to reinforce established parameters from the previous election cycle. But enforcement still relies mostly on ‘good faith’ as compared to legally binding measures.

WHO staff members who join the race will have to go on leave – but Regional Directors may be exempt

Current WHO staff members entering the competition face the election’s strictest internal guardrails, according to the newly published guidelines. To prevent conflicts of interest between campaigning and official business, they will be immediately placed on annual leave. Once their annual leave allowance is exhausted, they would be placed on mandatory special leave with half pay leading up to the January 2027 Executive Board nominations. If they survive this initial selection process and make the final shortlist, their full salary would be restored for the remainder of the race.

Yet, past precedent has explicitly exempted WHO Regional Directors from this rule – due to their status as WHO officials elected by member states. This means that potential candidates such as Hanan Balkhy, Regional Director of WHO’s Eastern Mediterranean Region, or Hans Kluge, European Regional Director, could theoretically campaign while remaining in their positions – while other potential candidates such as Assistant Director-General Jeremy Farrar, would have to spend months on leave in order to compete, at a sharp inherent professional and financial disadvantage.

Prospective candidates also must not conduct campaign activities as part of WHO regional committees’ official programmes. Reaffirming the standing rules, candidates will not be given speaking time during official meetings to promote their campaigns, and must instead restrict their promotional events strictly to the margins of these meetings.

The guidelines also set forth a proposed timeline – following the Director-General’s invitation to member states to nominate candidates, which was delivered by letter to Geneva’s UN missions on 24 April. After nominations close on 24 September, contenders would participate in a live candidates’ forum, with a proposed date of November 18. The field would then be narrowed to up to three finalists during the 160th Executive Board session, preliminarily set for 25 January-2 February 2027. After a second interactive forum, tentatively set for 15 March 2027, member states will vote at the May 2027 World Health Assembly, with the winner taking office in August 2027.

A gauntlet of public appearances

Economy Class in an airplane.
Economy-class travel remains the standard for WHO candidates, underscoring the organisation’s push for financial equity.

The framework further aims to create a gauntlet of public scrutiny for the election process. During the first live candidates’ forum, contenders will face structured 60-minute interviews. To ensure the question and answer process is not rigged, member states will drop colour-coded tokens into receptacles, which the Chair of the Executive Board will draw by lot to determine exactly who gets the opportunity to ask the candidates a question.

To curb the potential for opaque backroom deals, the WHO relies on a Code of Conduct to oversee activities on the physical campaign trail. Originally adopted by the World Health Assembly in 2013 and most recently amended in November 2020, this framework was specifically designed to promote an open, fair, equitable, and transparent election process.

Additionally, previous World Health Assembly decisions and WHO Secretariat practices guarantee financial travel support. Specifically, this involves provision of an economy-class airline ticket and a daily per diem for every candidate participating in both of the two live public forums that will be sponsored by WHO, and, upon request, for their interviews at the 160th session of the Executive Board.

This logistical support aims to ensure prospective leaders from lower-income regions receive a genuinely fair opportunity without relying entirely on massive domestic or private funding.

Guardrails built on ‘good faith’ – no binding enforcement

Newly elected WHO Director-General Dr Tedros Adhanom Ghebreyesus receives congratulations from members of the Executive Board after the previous WHO DG election.
Outgoing Director-General Tedros’s 2022 pandemic-era election gives way to a high-stakes, in-person 2026 WHO DG election cycle.

While these guidelines aim to promote a transparent and level playing field, structural loopholes remain. A closer reading of the WHO’s rulebook reveals that the Code of Conduct is not legally binding. The framework openly acknowledges it is merely a “political understanding” that recommends “desirable behaviour”, relying on the good faith of candidates and member states to honour its contents.

This lack of binding enforcement mechanisms leaves critical transparency measures vulnerable. For instance, candidates and member states are instructed to promptly disclose all campaign activities and funding sources to the Secretariat for public posting. But this system relies on self-reporting without independent audits.

Furthermore, while the regulations state that campaign-related travel should be “limited” to prevent financial inequality, and that using official technical meetings as a guise for electoral promotion “should be avoided”, these vague parameters leave vast room for interpretation.

Ultimately, as the mandate of Dr Tedros Adhanom Ghebreyesus approaches its expiration after the end of the upcoming election cycle, the focus will inevitably shift from the rules of the campaign trail to the monumental task awaiting his successor. Whoever emerges victorious from this highly scrutinised election must not only navigate deep geopolitical divides and restore internal trust, but also prepare the global health body for future crises.

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Image Credits: WHO/Christopher Black , Felix Sassmannshausen/HPW, Alexander Schimmeck via unsplash.

Evacuation of passengers from MV Hondius, the ship hit by hantavirus, continue.

Hantavirus has been confirmed in a French citizen evacuated from the MV Hondius cruise ship on Sunday, while two tests on a  US citizen turned up one “weakly positive” and one negative result – but it is still unclear how the virus is being transmitted.

The evacuation of passengers from the ship, now docked in Tenerife in the Canary Islands, continued on Monday under the supervision of health officials from Spain, assisted by the World Health Organization (WHO) and several other European countries. Passengers were only allowed to disembark to board chartered flights arranged by their countries.

However, countries differ on how they plan to treat citizens who do not test positive for the virus right away, given that it can take up to 42 days before symptoms appear.

Quarantine

Spain, the UK, and Australia will require citizens to quarantine in designated government facilities for varying periods.

The six Australians will spend up to 42 days in a government quarantine facility while undergoing PCR testing, according to Health Minister Mark Butler.

US health officials – many vehemently against lockdown measures to contain COVID-19 – have suggested that asymptomatic citizens will be allowed to return home.

Sixteen of the 18 US evacuated passengers are currently being assessed in a regional emerging special pathogen (RESPTC) treatment centre in Omaha, Nebraska. Two others, including the person with the weakly positive test, are being assessed in Atlanta. 

John Knox, deputy secretary for Strategic Preparedness and Response at the Department of Health and Human Services (HHS), told a media briefing on Monday afternoon that asymptomatic passengers may be able to complete 42 days of isolation at home if they remain without symptoms and have the necessary support.

On Sunday, Dr Jay Bhattacharya, acting director of the US Centers for Disease Control and Prevention (CDC), told CNN that asymptomatic passengers could not spread the virus.

However, Nebraska Governor Jim Pillen told Monday’s media briefing that “no one who poses a risk to public health is walking out the front door”.

How close is ‘close contact’?

Although most transmission is from rats, human-to-human transmission of the Andes virus, the hantavirus species affecting the ship, has previously been documented in Argentina in 2018. 

Genome sequencing of the current outbreak has shown it to be 99% similar to that outbreak, where the index patient attended a concert, subsequently infecting 34 people.


Human-to-human transmission is possible with “close contact”, according to the World Health Organization (WHO). 

However, there is some debate about the nature of this “close contact”. Professor Joseph Allen from Harvard’s Department of Exposure Assessment Science, said in a weekend TV interview that a doctor on board the ship had told him that some infected passengers had little interaction with the first three patients identified with the virus. These are a Dutch couple (now deceased), and a British man, currently making a slow recovery in South Africa.

The International Hantavirus Society and members of the international hantavirus research and clinical community have also warned against various “simplified conclusions”, including that the Andes virus (ANDV) has “minimal or negligible human-to-human transmission potential” and that only symptomatic patients are infectious.

Are asymptomatic people infectious?

The experts warned in a statement last week that “the precise timing of infectiousness remains incompletely defined”. 

“While symptomatic patients are likely to represent the highest-risk group, available outbreak reconstructions do not support overly categorical statements that transmission can occur only after clear symptom onset,” they said. 

“Transmission potential during prodromal, early symptomatic or minimally symptomatic phases, should be considered when designing contact tracing, testing and quarantine strategies.”

They stated that this is “particularly relevant in closed settings such as a cruise vessel where ANDV-exposed individuals may still be within the incubation period”.

Infectious disease specialist Dr Jeremy Faust, writing in his substack, on Monday said that “it remains possible that an animal on the ship spread [Andes virus] to multiple people, or that the infected people visited the same place on land where the virus was waiting for them”.

But, Faustus added, “given that human-to-human superspreader events of the Andes hantavirus have been documented, I’d bet that human-to-human transmission did occur here”, adding that the ship’s doctor also got infected.

WHO professional gender parity rises as more men depart, even as overall staff representation slightly declines.
WHO professional gender parity has risen as more men depart, even as overall staff representation slightly declines.

A dramatically shrinking World Health Organization (WHO) has seen a slight decline in gender parity amidst restructuring. Strict recruitment policies and targeted job cuts have actively boosted female representation within the organisation’s professional ranks. But deep regional disparities in gender representation remain unresolved, with men holding the overwhelming majority of staff posts in the African, South-East Asian and Eastern Mediterranean regions.

Amid sweeping job cuts triggered by the US withdrawal and a massive budget crisis, the World Health Organization (WHO) claims that “gender parity has been achieved” among its remaining 8,569 staff members in the Director General’s annual report, for WHO member states at next week’s World Health Assembly.

However, WHO human resources data for 2025, released on 1 May, reveals this to be slightly misleading: women actually lost their 50.1% majority from 2024, dropping slightly to 49.7% by the end of 2025.

Despite this broader decline, progress was made within the professional and higher categories, where female representation successfully rose from 47.9% in December 2024 to 48.5% by December 2025. While the absolute numbers for both genders shrank during the restructuring phase, a larger number of male professionals left the organisation than women (105 men compared to 67 women).

This progress is not solely the result of the ongoing downsizing but reflects an intentional, long-term policy shift: targeted recruitment measures introduced in 2023 to achieve the gender parity mandate that job openings must be reopened if the applicant pool is less than 30% female or if shortlists lack at least two women.

These strict policies, which remain in place until parity is reached in under-represented grades, helped drive the percentage of female applicants up from 31.4% to 32.1% over the past four years.

Gender parity by region: a tale of two organisations

WHO regional gender disparities persist, with stark contrasts between female-majority Western offices and male-dominated Eastern regions.
WHO regional gender disparities persist.

While the WHO’s official designation points to overall gender parity on a global scale, examining the workforce data for 2025 reveals a starkly divided WHO. True gender balance remains elusive, with distinct female-majority and male-majority regions painting a complex picture of international representation.

The Western Pacific Region currently boasts the highest overall female representation at 65.2%, followed closely by headquarters and global shared services at 63.5%, and the European Region at 59.2%. Conversely, male staff retain a dominant majority in the African Region (65.5% male), the Eastern Mediterranean Region (59.2% male), and the South-East Asia Region (57.4% male).

However, a more in-depth look at the data reveals that majorities are characterised by a concentration of women in administrative and clerical roles. In both headquarters and the Western Pacific, the high overall female representation is heavily driven by the ‘general service’ category, where women make up 79.5% and 74.3% of the staff, respectively.

In contrast, the male-dominated regions exhibit male majorities across nearly all job categories: in the African Region, for example, men hold 67.8% of the general service roles and dominate the professional ranks. Data on the WHO Region of the Americas, which has its own governing body, budget and HR processes, is not included in the global HR report.

Uneven gains in field and senior leadership

WHO’s glass ceiling remains intact as female representation thins significantly at the highest director levels.
WHO’s glass ceiling remains intact as female representation thins significantly at the highest director levels.

These regional disparities become even more pronounced when examining crucial leadership roles. While women are increasingly securing top diplomatic and operational roles, these leadership gains remain highly uneven across the globe. The South-East Asia Region leads the agency in field leadership, successfully achieving exact gender parity, with 50% of its country offices now headed by women.

In stark contrast, female leadership in the field lags severely in other regions. In the African Region, only 25.5% of country offices are headed by women, and the Eastern Mediterranean Region reports a similarly low 26.3%.

A similar divide exists within the highest echelons of senior management at the D1 and D2 grades – the WHO’s top director-level roles. The European Region has the highest percentage of women in these senior leadership positions at 40%, followed by Headquarters at 36%. Meanwhile, the lowest senior female representation is found in the South-East Asia Region (23.1%) and the African Region (24.1%).

In the DG’s annual human resources report, the organisation openly acknowledges that the greatest remaining gaps in global gender parity exist exactly at this glass ceiling: the uppermost D2 (director) level is only 24.5% female, and the P6/D1 (senior leadership) levels stand at 37.3% female.

Staff decline tracks toward June projections

WHO aims to slash 25% of its workforce by June 2026, shifting focus to country offices.
WHO aims to slash nearly 25% of its workforce by June 2026, shifting the focus to country offices.

The DG’s human resources report also confirms the scale of the ongoing departures. By December 2025, the WHO counted a steep 9.4% decrease in regular staff members, down to 8,569 from the 9,463 staff recorded at the end of 2024, or the 9,401 employed as of 1 January 2025.

The data on end-of-year departures indicate that the health agency is well on its way to reaching its previously announced target of slashing nearly 25% of its global workforce by mid-2026.  According to the latest projections before WHA, only 7,283 regular WHO staff will remain by 30 June, about 23% less than the 9,401 employed as of 1 January 2025.

By 30 June 2026, WHO’s global staff count is projected to decline to 7283 ‒ roughly 23% less than 1 January 2025 (9401).

Meanwhile, the number of non-staff affiliates decreased by 23% in 2025, down to 5,844 full-time equivalent positions across three non-staff categories as compared to 7,582 in 2024. These categories include professionals and general service staff working under “Agreement for Performance of Work” contracts for specific, time-limited tasks, “Consultants” for more ongoing roles, and Special Service Agreements (SSAs), a type of non-staff category common in Africa and South-East Asia.

Non-staff ‘affiliates’ in 2025 as compared to 2024 in terms of numbers of contracts and full-time equivalent posts. SSA positions are typically full-time.

Headquarters is bearing the heaviest burden of the realignment. Official projections indicate that Geneva and Global Shared Services will shrink by 29% by June 2026, losing over 800 staff members. Meanwhile, the proportion of personnel based in country offices has increased to nearly 46% of the remaining global workforce.

This deliberate geographic shift reflects a strategic institutional goal to build a significantly leaner administrative headquarters while vigorously protecting country-level health delivery. “The development aid era is over. WHO Geneva needs to be much smaller,” as diplomatic sources who spoke to Health Policy Watch framed it.

Financing the restructuring

The missing US flag at WHO headquarters reflects the deep budget crisis and ongoing workforce restructuring.
The missing US flag at WHO headquarters – Washington’s departure triggered a deep budget crisis and workforce restructuring, which is still ongoing.

The WHO currently faces a funding gap of approximately $630 million, representing roughly 15% of its $4.2 billion base budget for the upcoming 2026-2027 biennium. Officials have managed to shrink this deficit through aggressive reprioritisation, extensive staff cuts, and a 50% reduction in travel costs.

This represents a massive reduction from the initial projected deficit of $1.7 billion, which was catalysed by the geopolitical earthquake of the US withdrawal from the global health agency, announced in January 2025 when President Donald Trump took office.

To finance the sweeping realignment, the 78th World Health Assembly in 2025 authorised the temporary use of up to $410 million from Programme Support Costs reserve funds to cover unavoidable indemnities and salary gaps. Yet, the organisation has successfully minimised its reliance on these reserves.

To date, the projected utilisation of the reserve funds stands at $206.2 million, roughly half of the authorised amount, according to the Human Resources report focusing on “WHO’s prioritisation and realignment process.

Senior management says they achieved this by prioritising “preventive measures” to manage the downsizing. Approximately 51% of all global separations were managed through natural attrition, the expiration of fixed-term contracts, and a voluntary early retirement package, completely sparing the agency from paying out costly forced termination indemnities for those individuals.

As attention turns to the next WHA and the election process for a new Director-General, the incoming leader will inherit a downsized organisation that has stronger female representation in its professional ranks in some regions, with more work to achieve parity in others, but that remains fundamentally fractured by severe budget constraints and glaring regional disparities.

Image Credits: WHO/Christopher Black , Felix Sassmannshausen/HPW, WHO/Human Resources – Prioritization and Realignment Process , WHO Human Resources Update, 31 December 2025.

Schools have to been directed  to build gender-segregated toilets and to keep stocks of menstrual hygiene products by India’s Supreme Court .

In January, India’s Supreme Court has ruled that menstrual health is a fundamental right, directing states and schools to take measures to facilitate menstrual health and sanitation.

The laws of the world’s most populous country are now in line with the United Nations (UN) stand on menstrual health taken in 2024, and one that is also echoed by the World Health Organization. 

India’s Supreme Court directed state governments and schools in the country to build gender segregated toilets, hold menstrual health awareness sessions for both boys and girls, and stock schools with menstrual hygiene products.  

After the ruling, Megha Desai, president of the Desai Foundation,  said she and her team jumped for joy. The foundation works across eight states in India on menstrual health and hygiene awareness, 

“Up until this ruling came through, the responsibility of managing menstruation was left to a 12-year-old girl,” said Desai. “With the Supreme Court ruling, what it has done is shifted that responsibility to the community, and in this case, the infrastructure of the school.”

Megha Desai, president of the Desai Foundation, that works on menstrual health.

The court relied on research that showed only half of the girls surveyed were aware of menstruation before puberty, toilets were scarce, and menstruation led to a high level of absenteeism. 

The issue is not restricted to India alone. A 2021 survey by global children’s non-profit Plan International done in the United Kingdom found that 64% of girls aged 14-21 missed part or a full day of school due to their period, and 13% of girls missed an entire day of school at least once a month.

The UN children’s organisation, UNICEF, has long raised the issue of girls staying out of school due to their monthly periods in several continents, such as Africa, apart from Asia.

Precedent for the developing world?

A community open session on menstrual health and hygiene in Jahelipatti village of Bihar state in India conducted by World Neighbors’ partner Ghoghardiha Prakhand Swarajya Vikas Sangh.

In many parts of the world, especially in rural areas, menstruation is still a taboo subject. Women can be labelled “unclean” and subjected to social isolation. Blood stains due to the periods are perceived to be shameful. 

“This is a very bold move by the Indian government, and I really hope other countries learn from that and decide to do more about it,” said Rannia Elsayed, regional portfolio director for South Asia, the Middle East, and North Africa at Pathfinder International, a non-profit that focuses on women’s health.

Elsayed, who is based in Egypt, said that talking about menstruation is taboo in many rural parts of Egypt and Jordan. 

India may have set a precedent in the developing world with its court ruling.

“In Kenya, there’s been a ruling that mandates free sanitary pads for public schools. Again, but there’s no constitutional rights framing for it,” she said. 

The ruling comes at a time when climate change is making heatwaves more intense and changing rainfall patterns in India as well as the rest of the world. A policy like this will help girls become more resilient to the impact of climate change on menstrual health, Elsayed said.  

Also read: Climate Change Driving India’s Unseasonably Severe Heat Wave

Slew of recent measures to improve health

India has built millions of new toilets in the past decade.


Over the past decade, the Indian government’s Swachh Bharat Mission has focused on building millions of new toilets in the country with an eye on improving health, sanitation, and women’s lives. 

Despite this, less than half of the schools researchers surveyed in India have gender segregated toilets. The Indian government  claims that 100 million toilets were built by 2019, but the reality is more complex than that. 

“In some of the schools I’ve seen [that the] toilet is there but no water, or the situation of toilets is in such a pathetic condition that you wouldn’t step in,” said Srijana Karki, who oversees the projects in India and Nepal for the international development organisation, World Neighbors.

But in communities where access to toilets has improved, this has also translated into increased mobility of women as they feel more confident about managing their periods, she added.

More toilets are just one of the many requirements to improve menstrual equity, however.

“You have to have awareness [on menstrual health], you have to be educated, and there has to be a functional toilet, not just a toilet, but a functional toilet… clean, have enough water, and then use of sanitary napkins or clean cloths, and knowledge about how to safely dispose the napkins or safely reuse the cotton cloths,” Karki said. 

But the Indian government’s campaign to build more toilets has started a conversation about the relationship between more toilets and improved women’s health. It has also created an appetite for such infrastructure among families, especially from women who are now pushing for it from within families.

“That wonderful campaign with beautiful intentions did change the mindset of communities and community leaders,” Desai said. 

Impact depends on implementation

A menstrual health awareness session in progress in India’s Tamil Nadu, organized by the Desai Foundation.

The immediate impact of the ruling is to provide impetus for development organizations working in this area to speed up their work. 

“Having the support of a ruling allows us to eliminate the debate. So, for me, I can tell you that time is now being saved on the ground where I am now saying, okay, now that we all agree that this is the way forward, let’s work together for the best way to implement,” Desai said. 

She also said that the government can play a big role in the implementation by supporting new infrastructure, and that it is likely that we will see more girls finish school as a result of this ruling.

The ruling has been welcomed by development organizations working in the region, while the non-profit International Planned Parenthood Federation’s South Asia team has called for such a ruling to be extended to workplaces.  

If India does get the implementation part right in the coming years, it could set an example for the rest of the developing world, Desai said.   

Image Credits: Desai Foundation, Yogendra Singh/ Unsplash, World Neighbors, Ignas Kukenys/ Openverse/ Flick.

Woman standing in front of formula options
Nestlé is the largest transnational food corporation in the world, and a documented violator of the International Code of Marketing of Breast-milk Substitutes.

The United Nations University Institute for Water, Environment and Health (UNU-INWEH) announced a “strategic partnership” with Nestlé to establish the World Food Academy 4 Sustainable Food Systems on 26 March. 

The arrangement incorporates Nestlé’s science and technology seminars, which reached around 7,000 students across over 300 academic institutions in more than 90 countries last year, and will be extended through a joint symposium later in 2026. 

The World Food Academy targets students, early-career researchers, and young professionals “particularly from priority regions in the Global South.”

Within days, an open letter coordinated by the International Baby Food Action Network (IBFAN) and authored by Phillip Baker of the University of Sydney began circulating. It carries nearly 500 signatures from public health researchers, nutritionists, lawyers, and civil society organisations around the world. It calls on UNU-INWEH to terminate the partnership immediately. Its reasoning is grounded in the UN’s own published standards for engagement with the private sector.

Nestlé is the largest transnational food corporation in the world. It is a documented and persistent violator of the International Code of Marketing of Breast-milk Substitutes – the 1981 World Health Assembly instrument created, in substantial part, in response to the company’s marketing practices. 

It is among the largest global manufacturers of ultra-processed foods, identified by the 2025 Lancet series on ultra-processed food as a principal commercial determinant of diet-related chronic disease. 

Distorting nutrition science

It is also documented as a major actor in the broader pattern by which large food and beverage corporations distort nutrition science – funding research designed to produce favourable findings, sponsoring professional societies, and undermining the independence of the evidence base that public health policy depends on. 

It participates in industry associations that lobby against public health regulation of food marketing and against the breastmilk code. 

Nestlé’s UN-system footprint expanded sharply between December 2025 and March 2026. A UNFPA coalition membership on women’s health, the UNU-INWEH academy, and a new ILO partnership on labour rights in coffee supply chains were announced within five days of the academy. 

None of these partnerships, nor their concentration in a single four-month window, has been the subject of any published UN-system review.

Criminal investigation

The contradiction is sharpest at the level of UNU-INWEH itself. Nestlé’s water-related conduct is the subject of an ongoing criminal investigation in France, regulatory action in the United States, and decades of Indigenous-led litigation across the Americas over aquifer depletion, over-extraction, and unauthorised treatments. 

A water institute lending its name to a company whose water practices are themselves the subject of regulatory and judicial proceedings is the textbook case of reputation washing.

The UN system has spent two decades building rules of engagement for this kind of oppositional arrangement. The 2015 UN Guidelines on Cooperation between the UN and the Business Sector require that partnerships advance UN aims and that partners demonstrate commitment to human rights and Global Compact principles. 

The 2017 UN Sustainable Development Group Common Approach to Due Diligence requires documented scrutiny where there is public brand association, exchange of assets, or promotion of a business-led initiative – all three of which this partnership involves. 

UNDP has translated these principles into a detailed operational policy with exclusionary criteria, risk-tiered due diligence pathways, and decision-making separated from initiating staff. 

Breach of due diligence policy

UNU has its own due diligence policy, promulgated by the rector in September 2024, with comparable exclusionary criteria and a requirement that high-risk business-sector partnerships be escalated to institute directors in consultation with the office of the rector.

A more specific layer applies to the food and nutrition sector. UNICEF’s 2023 guidance states categorically that it will avoid all partnerships with Code violators and with ultra-processed food manufacturers. 

WHO’s Framework of Engagement with Non-State Actors (FENSA) identifies the conferral of UN legitimacy on corporate actors as a foundational risk. World Health Assembly Resolution 69.9 of 2016 calls on academic institutions not to allow companies marketing foods for infants and young children to sponsor meetings or enter promotional partnerships. 

In 2024, WHO and UNICEF jointly reaffirmed the principle of avoiding all partnerships with Code violators. Beyond these frameworks, an open-ended intergovernmental working group is negotiating, under Human Rights Council Resolution 26/9, a legally binding instrument to give the voluntary 2011 UN Guiding Principles on Business and Human Rights binding force.

The Nestlé partnership is a breach of these provisions. The accountability failure is not procedural. It is categorical: the partnership is of a kind the UN system’s own frameworks identify as one to avoid, and UNU’s own Due Diligence Policy provides the mechanism that would have caught it. That mechanism does not appear to have been applied.

Levels of harm

Mothers and babies are harmed by the marketing of infant formula in place of breastfeeding.

The harm operates on two levels. The first and most fundamental is to children, mothers, and parents whose feeding choices, nutrition, and health are shaped by the marketing practices and product environments the Code exists to regulate. 

The second is to the UN system itself, and to the institutions whose work the partnership undermines – among them WHO, UNICEF, and UNU’s own International Institute for Global Health (UNU-IIGH).

UNU-IIGH, in Kuala Lumpur, hosts a ‘power and accountability’ research programme covering, among other things: accountability deficits of the world’s largest food and beverage, pharmaceutical, and financial corporations; the political economy of commercial milk formula marketing; aggressive tax avoidance by transnational corporations that drains public fiscal capacity in the Global South; and governance capture of inter-governmental institutions. 

Among the programme’s recent outputs is a Lancet article on the inadequacy of current efforts to hold corporations accountable. The Nestlé partnership undermines this work.

Publicly funded research products are lost, inter-agency collaborations disrupted, and the institutional voice of researchers working on commercial determinants of health is structurally weakened. Three years of work is now shadowed by an arrangement the work itself would have recommended against.

The case is not isolated. In late 2025, the Pan American Health Organization (PAHO), the WHO Regional Office for the Americas, signed a three-year Framework Agreement with Ferrero International to support initiatives for “children, adolescents, and families in vulnerable conditions.” 

Researchers, civil society, and the BMJ raised the same concerns that the IBFAN letter raises now: a UN agency lending its name to a major ultra-processed food manufacturer in the very policy domain where the company’s interests run against the public health evidence. On 15 April 2026, PAHO terminated the agreement.

Private funding filling gaps

Two cases, two UN agencies. The pattern is not accidental. The UN’s financial architecture – assessed contributions are now a small proportion of operating budgets, with voluntary earmarked private funding filling the gap – rewards arrangements with well-resourced private partners and penalises institutes that decline them. 

Reinforcing this is the multi-stakeholder model that the World Economic Forum and the World Health Summit have promoted for two decades as the standard architecture of global governance – framing corporations, philanthropies, and states as equivalent partners, weakening public responsibility and intergovernmental accountability. Without active central enforcement of the UN’s own frameworks, the pressure runs one way.

The UN is a global public institution. Its founding Charter establishes it as an institution designed to serve the peoples of the world. It derives its mandate and legitimacy from member states acting through intergovernmental bodies: the World Health Assembly, the General Assembly, and the governing councils of the specialised agencies. 

Its authority rests on the premise that it represents collective public interest, not the interests of particular donors or sectors. Each partnership of this kind erodes public trust in the multilateral system itself, at a moment of declining public confidence in international institutions. 

Within this system, UNU institutes occupy a particular role: an academic and rigorous think tank governed by an independent academic council, providing space for constructive critique while operating in accordance with UN principles. 

Enforcing existing guidelines

When UNU lends its name to a company whose practices the UN has spent decades regulating against, the exchange is clear: the corporation gains legitimacy and access to the next generation of food and nutrition professionals. The UN loses its legitimacy as the arbiter of the standards it exists to uphold.

What is required is not new guidelines. They exist. What is required is enforcement –  transparently, with documented risk-benefit analyses, with decision-makers separated from the staff initiating partnerships, with published exclusionary criteria actually applied. 

UNDP has done this; UNU has the equivalent on paper but appears not to have applied it here. Direct correspondence with the UNU rector and the directors of UNU-INWEH and UNU-IIGH, raising these concerns, has to date received no response. 

Under UNU’s own due diligence policy, a business-sector partnership of this scale would require enhanced due diligence with the direct involvement of the institute director and consultation with the office of the rector. Whether that consultation occurred, and what it concluded, is now the central question.

Three steps must follow. First, UNU-INWEH should terminate the partnership and publish the due-diligence record that preceded its announcement. 

Second, UNU should apply its existing due diligence policy to the Nestlé case and expand its exclusionary criteria to align with the food and nutrition sector frameworks the broader UN system has already adopted – including ultra-processed food manufacturers and Code violators alongside the tobacco and weapons categories the policy already names. 

Third, the United Nations must take enforcement of its own engagement frameworks more seriously, including review by the UN Sustainable Development Group of concentrated patterns of corporate engagement, such as Nestlé’s recent clustering of partnerships across UN agencies, and active management of conflicts of interest, including the instrumentalisation of UN legitimacy by private actors.

The credibility of the UN system depends on the clear separation of its public mandate from the commercial interests its work often contests. Once that line is blurred, it becomes very difficult to draw again.

Dr Unni Karunakara is a Senior Fellow at the Global Health Justice Partnership at Yale Law School in the US; the Richard von Weizsäcker Fellow at the Robert Bosch Academy in Berlin, and a visiting professor at Manipal University, India. He was the interim director of the United Nations University International Institute for Global Health (UNU-IIGH)  in 2024-2025.  and international president of Médecins Sans Frontières (MSF) from 2010-2013. He has held various academic and research fellowships at universities in South Africa, Zimbabwe, Uganda, Germany and the United Kingdom, focusing on forced migration, and healthcare delivery to neglected populations affected by conflict, disasters and epidemics. 

Image Credits: FDA, WHO.

White and blue labelled COVID-19 vaccine
This week’s BioNTech factory closures raise critical concerns over European vaccine supply chains.

This week’s announcement of BioNTech factory closures in Germany marks an end to the country’s pandemic-era COVID-19 vaccine production boom. The Mainz-based pioneer announced that it will manufacture its final batches of the vaccine domestically later this year, transferring all future production to its American partner, Pfizer.

This strategic retreat from Germany – which includes the shuttering of facilities in Marburg, Idar-Oberstein, and the recently acquired CureVac site in Tübingen – is scheduled for completion by the end of 2027, according to German media reports. In total, the company plans to cut up to 1,860 jobs across production sites in Germany, as well as in Singapore.

The company’s leadership attributed the restructuring to plummeting global demand for pandemic products and a necessary pivot toward funding a high-stakes oncology pipeline. BioNTech reported a net loss of €531.9 million in the first quarter of 2026, a sharp decline from previous years.

Closures prompt calls for industrial policy

Modern glass building with European Union flags
The EU Commission recently authorized mCombriax, the first combined mRNA flu-COVID vaccine.

Economic experts warn that relying on volatile corporate and geopolitical developments to maintain vaccine supplies threatens European health security.

“We have seen in the COVID pandemic that a purely business-driven choice of production sites for vaccines can lead to supply bottlenecks in a crisis,” Professor Sebastian Dullien, scientific director at the Macroeconomic Policy Institute, warned in an interview with Reuters.

To prevent future shortages, he urged the government to take stock of vaccine production capacities and implement industrial policies, such as state subsidies or “Buy European” regulations for health insurance companies, to maintain vital production capacities across the continent.

The German federal government dismissed warnings of supply bottlenecks, maintaining that the country’s vaccine supply remains secure and other manufacturers will compensate for the shortfall.

Indeed, foreign manufacturers are stepping in to fill the void, with US pharma company Pfizer likely to utilise its established manufacturing facilities in Europe to absorb BioNTech’s production in the EU. Further underscoring this transatlantic market shift, European regulators recently authorised mCombriax, a new messenger RNA vaccine produced by US rival Moderna that protects adults aged 50 and older against both COVID-19 and seasonal influenza.

US trade policies and EU legislation to reshape global markets

While the approval of foreign products like mCombriax addresses immediate health needs, this deepens EU reliance on American imports, underscoring the fragility of Europe’s supply lines, currently exacerbated by a trade conflict with the US.

The BioNTech factory closures unfold against the backdrop of a recent US Presidential Proclamation imposing up to 100% tariffs on pharmaceutical imports. Although a preferential 15% rate exists for products from the European Union (EU) and Japan, alongside a 10% rate for the United Kingdom, the overarching threat of a trade war leaves European governments scrambling.

To counter its dependency on US imports and to secure local manufacturers, the EU is currently advancing the Critical Medicines Act and the European Biotech Act. These measures aim to incentivise domestic production through public procurement, streamlined regulatory pathways, state subsidies, and “Buy European” rules to shield European health security from global trade ruptures.

Image Credits: Spencer Davis via unsplash, Paws and Prints via unsplash.

Dr Abdi Mahamud, WHO’s director for Health Emergency Alert and Response Operations.

The first person suspected of contracting hantavirus outside of passengers on the Hondius cruise ship is currently in a Dutch hospital.

She is a flight attendant who came into contact with a former passenger who briefly boarded a KLM flight in Johannesburg, South Africa, but was prevented by airline staff from flying to Amsterdam as she was too sick. 

The woman died shortly afterwards in a Johannesburg hospital. Her husband had died on board the ship on 11 April, the first casualty in the ship’s hantavirus outbreak. She had left the ship at St Helena Island on 24 April to accompany his body home.

Cabo Verde permitted the medical evacuation of three patients, but denied permission for passengers to disembark. The ship has since sailed for Tenerife in the Canary Islands. It is expected to arrive by 11 May, where it is hoped that Spanish authorities will assist passengers to return home. 

However, the President of the Canary Islands, an autonomous community of Spain, has said he will not allow the ship to dock – although the Spanish President has assured the World Health Organization (WHO) that passengers will be able to leave the ship.

Cruise operator Oceanwide Expeditions said that two Dutch infectious disease doctors had joined the cruise to “ensure that optimal medical care can be provided if necessary, during the next stage of this evolving situation”.

The WHO has advised that “all passengers stay in their cabins. The cabins are being disinfected, and anyone who shows symptoms will be isolated immediately”, WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

A WHO expert and an expert from the European Centre for Disease Prevention and Control (ECDC) have also joined the ship.

Together with the two Dutch doctors, they are “conducting a medical assessment of everyone on board and gathering information to assess their risk of infection”, said Tedros.

“WHO is developing a step-by-step, operational guidance for the safe and respectful disembarkation and onward travel journey for all passengers when they arrive in the Canary Islands,” he added.

Tedros thanked Spanish President Pedro Sanchez for his “generosity and solidarity” for agreeing to accept the ship in the Canary Islands, describing the risk to the islands as low.

Dr Tedros thanked Spanish President Pedro Sanchez for agreeing to accept the cruise ship in the Canary Islands.

Eighth patient in Switzerland

Oceanwide Expeditions confirmed that all 30 passengers who disembarked at St Helena on 24 April have been contacted. One, a Swiss national with mild symptoms, is currently in a Zurich hospital.

“The Swiss Federal Office of Public Health (FOPH) has confirmed that a passenger who travelled on the first leg of the voyage has tested positive for hantavirus and is currently being treated at the University Hospital Zurich. His wife, who accompanied him, has not shown symptoms but is self-isolating as a precaution,” the company said in a statement

So far, eight passengers are suspected of hantavirus infection. Three have died, one is in hospital in Johannesburg, three were evacuated from Cabo Verde to undisclosed European hospitals – and the eighth is the Swiss man.

“Five of the eight cases have been confirmed as hantavirus, and the other three are suspected,” said Tedros.

“Hantaviruses are a group of viruses carried by rodents that can cause severe disease in humans. People are usually infected through contact with infected rodents or their urine, droppings or saliva. The species of antivirus involved in this case is the Andes Virus, which is found in Latin America and is the only species known to be capable of limited transmission between humans,” he added.

Collaboration with US

Dr Abdi Mahamud, WHO’s director for Health Emergency Alert and Response Operations, said that each country is responsible for repatriating citizens from the ship and tracing any citizens who may have had contact with those exposed to the virus.

Although the US decided to leave the WHO, it has citizens on board the ship and Mahamud said that collaboration with the US CDC is “going very well on a technical level”.

US CDC officials have joined meetings of the Global Outbreak Alert and Response Network (GOARN) “so the information flow is there, transparent and frank, and information sharing”, he added.

The US remains party to the International Health Regulations (IHR), which stipulates the conduct of countries in the event of disease outbreaks, and was receiving formal communication on the outbreak through that.

“This outbreak shows why the world needs a global entity that coordinates,” added Mahamud, also commending Argentina – which also quit the WHO – for coming forward with information, as the cruise started in that country.

Dr Anais Legand, WHO technical lead on viral haemorrhagic fevers, described “excellent collaboration” with her counterpart at US CDC, including sharing of technical assessments almost every day.

Dr Anais Legand, WHO technical lead on viral haemorrhagic fevers.

Long incubation

Mahamud confirmed that the incubation period for the virus is up to six weeks, but that only confirmed cases needed to isolate. 

Contacts of cases need “active monitoring”, which was up to host countries to define, he added.

At this stage, PCR testing by South African and Senegalese scientists had confirmed the Andes virus, a species of hantavirus found mostly in Argentina – which is where the cruise started.

Scientists are currently engaged in genome sequencing of the virus to see whether it was the same as that from an Argentinian outbreak in 2018, which affected 34 people, said Mahamud.

This is the only other known instance of human-to-human transmission. That outbreak evolved from an infected person who attended a concert.

Dr Maria Van Kerkhove, WHO’s Director of Epidemic and Pandemic Management. stressed the importance of “global solidarity”, adding that the WHO has “pulled together all of the global experts related to hantaviruses, in particular the Andes Virus”, to assist in managing the outbreak.

Image Credits: 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

Vials of Pfizer´s COVID-19 vaccine. Recent studies showing vaccine’s safety and effectiveness blocked by US FDA.

Officials at the Food and Drug Administration have blocked publication of two studies supporting the safety of widely used vaccines against Covid-19 and other safety studies on shingles in recent months, a spokesperson at the US Department of Health and Human Services confirmed.

In October, 2025 FDA scientists were directed to withdraw two Covid-19 vaccine studies that had been accepted for publication in medical journals, the New York Times reported on Tuesday. Then in February, top F.D.A. officials refused to sign off on the submission of abstracts of studies of Shingrix, a shingles vaccine, to a major drug safety conference,

The withdrawn FDA studies on COVID vaccines involved the use of massive 2023 and 2024 vaccine data sets by agency scientists, compiled and analyzed with outside data firms. Pre-prints and abstracts of the studies that have been made public have largely confirmed the vaccines’ safety.

One study, which examined the Covid vaccine in people older than 65, was posted on the prestigious preprint server Medrxiv.org. The study reviewed the records of about 7.5 million Medicare beneficiaries who got the vaccine, in the first six weeks after their jab. Among 14 health outcomes potentially caused by the vaccine, including heart attacks, strokes and Guillain-Barré syndrome (an auto-immune disorder), researchers found only outcome of concern, anaphylaxis, a severe allergic reaction affecting about 1 in a million people to get the Pfizer COVID vaccine.

“No other statistically significant elevations in risk were observed,” the researchers reported. The study was withdrawn under pressure from FDA officials after it had been accepted by the peer reviewed journal Drug Safety, according to the New York Times report.

An abstract of a second COVID safety study was published at the August 2025 conference of the International Society of Pharmacoepidemiology (ISPE), where it remains online. The study monitored the safety of three leading COVID-19 vaccines, produced by Pfizer-BioNTech, Moderna, and Novavax, among individuals aged 6 months–64 years who received the shots in 2023-24. The researchers found evidence of rare, adverse events, previously reported, primarily fever-related seizures and myocarditis (inflammation of the heart muscle). But no new elevated risks were identified among the 4.2 million vaccine recipients analyzed.

“Given the available evidence, F.D.A. continues to conclude the benefits of vaccination outweigh the risks,” the study’s abstract concludes. Withdrawal of that FDA study from submission to the peer-reviewed journal, Vaccine, was first reported by STAT News.

Shingrix vaccine study also blocked by FDA – outside of agency’s purview

In the case of the Shingrix vaccine against shingles, FDA officials in February failed to sign off for scientific staff to submit abstracts on two studies to a drug safety conference. One study found the vaccine’s efficacy to be in line with findings from the clinical trials done before agency approval. A second safety study also aligned with what was known, finding an elevated but low risk for Guillain-Barré syndrome, an autoimmune disease already noted in the vaccine’s label, the New York Times reported.

Asked about the withdrawal of the Covid vaccine safety studies, Andrew Nixon, a spokesman for the Department of Health and Human Services, was quoted saying: “The studies were withdrawn because the authors drew broad conclusions that were not supported by the underlying data. The F.D.A. acted to protect the integrity of its scientific process and ensure that any work associated with the agency meets its high standards.”

Regarding the blocked shingles vaccine research, he said, “The design of that study fell outside the agency’s purview.”

A senior administration official told the New York Times that the decisions about the research had not reached Dr. Marty Makary, the F.D.A. commissioner, or Health Secretary Robert F. Kennedy Jr. Dr. Vinay Prasad, head of the FDA. vaccine office at the time, did not respond to requests for comment.

In recent weeks, Dr. Jay Bhattacharya, who was serving as interim leader of the US Centers for Disease Control and Prevention (CDC) also canceled the publication of a report concluding that the COVID vaccine sharply cut the odds of hospitalizations and emergency room visits last winter, claiming that the study had limitations.

The current US Administration, under the leadership of HHS Secretary Robert F Kennedy Jr, has dramatically cut research funding for vaccine development and cast doubt on multiple aspects of vaccine effectiveness and safety. It has also frozen vaccine funding to Gavi, the Vaccine Alliance, over alleged safety issues related to the use of thimerosal, as a preservative in some vaccines most often used in low- and middle-income countries where cold chain remains a problem. Those are concerns that WHO, backed by leading vaccine experts, has said are long resolved. See related story:

https://healthpolicy-watch.news/us-freezes-all-funds-to-gavi-over-vaccine-preservative-thimerosal/

Image Credits: Mat Napo/Unsplash.

Wonder, a healthy 8-month-old with his mother, Naomi. He was one of the first infants to receive Coartem® Baby when he was hospitalised at 3-months in The Methodist Hospital, Muwasi, Ghana.

The World Health Organization has ‘pre-qualified’ Coartem® Baby, the first-ever malaria treatment for young infants of 4.5 kilograms or less.

The combination treatment, now being rolled out in Ghana, aims to fill a longstanding gap in treatments available for children under the age of 5, who constitute three quarters of the estimated 610,000 malaria deaths worldwide. 

Until now, infants with malaria have been treated with formulations intended for older children, which increase the risk of dosing errors, side effects and toxicity.” said WHO Director General Dr Tedros Adhanom Ghebreyesus speaking to reporters last week.  

“This new formulation of artemether-lumefantrine helps to close a long-standing treatment gap for some 30 million babies born each year in malaria-endemic areas of Africa.”

The artemisinin-based combination treatment, developed by Novartis together with Medicines for Malaria Venture (MMV), can be used on newborns and infants as small as 2kg.  

It was approved by the Swiss drug regulatory agency, Swissmedic in July 2025.  Since being introduced in Ghana through a combination of pubic and private sector procurement, thousands of infants have been treated with the formula in a response exceeding expectations. 

WHO Pre-qualification paves way for mass procurement

But WHO’s ‘prequalification’, announced last week, is a critical step in paving the way for bulk procurement of the treatment by international agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria for distribution in low-income countries at concessionary prices, said Pierre Hugo, MMV Vice President of Access and Product Management. 

Prequalification is WHO’s ‘stamp of approval’ assuring the quality, safety and efficacy of vaccines and medicines for major diseases like malaria, HIV/AIDS and tuberculosis. WHO’s list of prequalified products is used by UNICEF, the Global Fund, and other agencies procuring products in bulk, to inform their choices about drug and vaccine purchases. 

 “WHO prequalification is a critical milestone because it enables procurement by major global health funders… While specific procurement volumes have not yet been announced, this step paves the way for large-scale access in malaria-endemic countries,” said Hugo.

“This [prequalification] decision takes us one step closer to ensuring that the tiniest babies have access to the first antimalarial designed specifically for them,” said Novartis’ Lutz Hegemann, President of Global Health.

Eight other African countries joined in the Swissmedic “Marketing Authorisation for Global Health Products” (MAGHP)  process for approving the new malaria formulation, including Burkina Faso, Côte d’Ivoire, Kenya, Malawi, Mozambique, Nigeria, Uganda and Tanzania.  

The process aims to support the national regulatory agencies of low-income countries in the Swissmedic assessment, building trust and confidence that can help fast-track national marketing authorisations following Swissmedic’s approval.

Incorporating into WHO treatment guidelines next step for mass rollout 

The next important milestone will be for the medicine to be added to the WHO treatment guidelines, Hugo said, expected in mid-2026. This is another requirement for Global Fund bulk procurement of new medicines and vaccines, along with registration of the treatment in national regulatory systems.  

“Coartem® Baby represents a breakthrough not just in science, but in equity, closing a long-standing treatment gap for the smallest and most vulnerable malaria patients. With WHO prequalification now secured, the focus shifts from innovation to access, ensuring that this life-saving treatment can reach newborns across malaria-endemic regions.”

Earlier this month, WHO also prequalified three new rapid diagnostic tests that can detect strains of malaria that older tests miss.

Said Tedros, “Together with vaccines, new diagnostics and next-generation mosquito nets, it’s another step towards a malaria-free world”. 

Image Credits: Novartis.