IGWG negotiators (clockwise from top L): Nurhafiza Hamza (Malaysia), moderator Guilherme Faviero (AIDS Health Foundation), Jean Karydakis (Brazil), Taime Sylvester (Namibia), Eirik Rodseth Bakka (Norway) and Adeel Mumtaz Khokhar (Pakistan).

Yet another negotiating session on the outstanding annex of the Pandemic Agreement begins at the World Health Organization’s (WHO) headquarters on Monday (27 April) – and developed nations have presented a “hybrid” solution in an attempt to find consensus.

The “hybrid” proposal consists of a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information.

Adeel Mumtaz Khokhar, First Secretary to the Permanent Mission of Pakistan in Geneva, confirmed that a “hybrid” proposal had been presented to developing countries by some developed countries, but declined to name them.

WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs).

The outstanding annex will set out terms for a pathogen access and benefit-sharing (PABS) system that ensures all countries have access to countermeasures to combat a pandemic or public health emergency of international concern (PHEIC) – unlike during COVID-19 when rich countries hoarded scarce vaccines.

“We have been hearing rumours about this hybrid system for the past two IGWG [Intergovernmental Working Group] meetings, and finally, some developed country negotiator took pity on us and presented it,” Khokhar told a high-level webinar hosted by the University of Miami’s Public Health Policy Lab last week.

The proposal envisages two categories for biological material, Khokhar explained.

To access one category, countries and manufacturers will “have to follow certain terms and conditions”, and these will be included in the PABS system. No terms or conditions apply to the other category of material, including benefit-sharing obligations.

However, Third World Network (TWN), a civil society alliance tracking the negotiations, says that the hybrid system proposed by developed countries also envisages a split between information sharing and benefits.

“Developed countries expect developing countries to share pathogen samples and sequence information freely, while deferring benefit-sharing to future negotiations between WHO and pharmaceutical manufacturers,” writes TWN in a recent brief.

Maintains the status quo

For Khokhar, the hybrid proposal “is essentially the status quo” as it allows parties to “share the way they want to share”. 

“So I’m not sure how fundamentally the needle is moved by this proposal. All I can understand from this proposal is that they want to retain and preserve the status quo, which, from a developing country negotiations perspective, is a disappointment.”

Nurhafiza Hamza, Minister Counsellor for Health at Malaysia’s Permanent Mission to Geneva, explained that developing countries want “a set of mandatory benefit-sharing that is acceptable to different categories of users of the PABS system” – member states and pharmaceutical companies – during health emergencies.

“If manufacturers have VTDs during a PHEIC or pandemic emergency, they should share,” said Hamza. “It is important to get some mandatory benefit sharing and not a menu of options, where manufacturers can pick and choose.”

Kicking the can down the road?

France’s Ambassador Anne-Claire Amprou, co-chair of the talks, and WHO Director-General Dr Tedros at the conclusion of the Pandemic Agreement talks.

Jean Karydakis, Counsellor in Brazil’s Mission in Geneva, acknowledged that the positions of the different groups – primarily developed countries versus developing countries – are fairly entrenched.

“We won’t change other countries’ positions at this time,” he acknowledged. “The question now is whether we can find possible creative language, also bearing in mind that we will have a Conference of the Parties (COP) later on that will need to revisit and detail further what we cannot agree right now.”

Karydakis also asserted that “90% of of the text is already agreed in the Pandemic Agreement, and the Pandemic Agreement was already adopted. “

But the PABS system was a contentious issue that evaded negotiators, who packaged it into an annex and kicked it down the road to new negotiations. This enabled the World Health Assembly to adopt the Pandemic Agreement last year, described by some observers as the Pandemic Agreement Lite precisely because it dodged the detail about PABS.

Adopting a vague PABS annex and kicking further details down the road again – this time to the COP – might save face for multilateralism. But it simply delays the adoption of the Pandemic Agreement to yet another set of talks, leaving all member states vulnerable to public health emergencies in the meantime.

Standard contracts?

Developing countries want the annex to include a standard contract to govern access to biological material and digital sequencing, including benefit-sharing obligations.

But Khokhar said that the IGWG Bureau and “other colleagues” have expressed that “a full standardised contract may not be the appropriate way”, as it is hard to predict what – if any – VTDs may be developed as a result.

“Fair enough,” he said, adding that developing countries are prepared to explore the inclusion of a “basic contract” followed by a PABS contract, if a party has developed a medical countermeasure.

“But what is their answer to this suggestion? Let’s have an open and a closed system. So, in this endeavour to try and find and create a multilateral system, we are actually going back to our national systems… What new system are we creating here? We’re creating nothing new?”

For TWN, the lack of “contractually enforceable legal obligations for recipients of PABS materials and sequence information “will add to the legal uncertainty, as benefit-sharing will depend on the WHO concluding contracts with manufacturers.

Namibian negotiator Taime Sylvester said that the funders of research in developing countries are “overwhelmingly high-income country governments and foundations”. 

They could “include PABS compliance as a condition of their grants,” said Sylvester, pointing to the example of the European Union’s Horizon Europe (2021–2027), its funding programme for research and innovation.

This requires researchers to commit to Nagoya Protocol compliance, which mandates fair benefit-sharing from the use of genetic resources.

Prospects for agreement

Norwegian Health Counsellor Eirik Rodseth Bakka acknowledged that there are “significant outstanding issues, and I think as a collective, we do need to see significant progress next week”.

However, he stressed that member states have the opportunity to “correct some of those inequities from the COVID-19 pandemic,” especially early access to vaccines for low- countries and lower-middle-income countries, and enabling “to the extent possible that there is more technology transfer and access to access to manufacturing capacity.” 

Karydakis expressed hope that “we will get this by May”, adding that talks may need to continue alongside the World Health Assembly in late May, the deadline for the annex. 

He also joked that night sessions were necessary to get people tired and hungry and “only able to leave the room when the deal is reached.”

Sylvester said that Namibia believes that “a fair, functional, legally grounded PABS system” is possible and will assist both the global south and the global north need this functional system to succeed. So we we believe it. We believe that it can happen which is above and beyond, or we’re not asking any country to stand to a higher standard. We’re asking the same standards.

Malaysia’s Hamza described the PABS system as “the litmus test for equity”.

“We will have to see whether states will come in next week and design a PABS system that would actually make an improvement in the current status quo.When the Group for Equity gets together, the first thing we will assess is whether what we have agreed on, each paragraph, is really delivering equity.”

Schwartz CDC Trump
Rear Admiral Erica Schwartz was nominated to lead the CDC. Schwartz would bring several decades of medical and public health experience in the US Navy, Public Health Service Commissioned Corps, and US Coast Guard, to an agency in turmoil. She has garnered bipartisan support for her nomination.

US Health and Human Services Secretary Robert F Kennedy Jr offered contradictory responses that the country’s new leader of the Centers for Disease Control and Prevention (CDC) would be able to make decisions independent of political interference, especially around vaccines.

The White House announced late last week its fourth pick in a year for CDC director, Dr Erica Schwartz, a medical doctor and former deputy surgeon general under the first Trump Administration.

If approved by the Senate’s Health Committee, Schwartz would replace Dr Jay Bhattacharya, the NIH director and acting CDC director. 

“If Dr Schwartz is confirmed as CDC director, will you commit on the record, today, to implement whatever vaccine guidance she issues without interference?” asked Congressman Raul Ruiz, MD (CA-25) in a House hearing. 

“I’m not going to make that kind of commitment,” Kennedy said.

“Because you probably won’t, you’ll fire her. Like you did with Dr Monarez, because you will not accept recommendations based on science,” Ruiz accused. 

Schwartz is a preventative medicine doctor and public health official with nearly three decades of service in the Navy, Public Health Commissioned Corps, the US Coast Guard.

She has garnered bipartisan support – and applause from public health experts – for her nomination as a credible and service-oriented candidate. 

Kennedy faces questions about CDC independence 

Kennedy RFK Jr Schwartz congress
HHS Secretary Robert F Kennedy Jr, responding to Senator Bill Cassidy’s concerns of political interference at the CDC.

In his first appearance before Congress in months, Kennedy defended the CDC’s efforts and its response to contain the ongoing measles outbreak, saying the US “has done the best job in the world.”

He also deflected blame for the over 2,000 measles cases in the past year across the country, saying “[i]t has nothing to do with me.”

The secretary faced questions on abortion medication availability, the cost of healthcare, and research funding cuts, which the secretary admitted were “painful.”

Senator Bill CassidyHELP committee
Senator Bill Cassidy (R-LA), a physician and chair of the Senate’s health committee has clashed with Kennedy over his vaccine stance.

Kennedy’s hearing with the Senate Health, Education, Labor, and Pensions (HELP) committee this week saw similarly tense exchanges about the CDC director nominee. 

“I applaud the CDC director,” HELP chairman Senator Bill Cassify (R-LA) said. “She seems to be a qualified person.”

But the Louisiana senator, a physician facing a tough reelection in the fall, noted that “there are currently political appointees at CDC who have worked to undermine trust and immunizations.

“Will the new director, whoever she is, have the right to make decisions independently of those of political appointees and or replace them, or otherwise reassign them so they cannot continue to actively undermine trust in immunizations?” Cassidy asked. 

“Your characterization of the political appointees is wrong,” Kennedy said. When pressed by Cassidy, who again asked whether the CDC would be able to make independent decisions, Kennedy agreed.

The Trump administration has apparently counseled Kennedy to tone down his anti-vaccine rhetoric as midterm elections approach this fall.

Service in Navy, Coast Guard, Surgeon General’s office

Schwartz USPHS CDC
Schwartz served as a member of the Uniformed Public Health Service.

Commissioned to the Navy in 1995 after receiving her medical degree, Schwartz served for 10 years with the branch before transitioning to the Coast Guard. During her tenure, she served as a Navy occupational medicine physician and head of preventative medicine at the Naval Medical Clinic in Annapolis. 

As Rear Admiral in the Coast Guard, Schwartz was responsible for the entire branches’ health care system, overseeing the Coast Guard’s “child care programs and food services delivery programs, ashore and afloat, and the Coast Guard’s Ombudsman, Substance Abuse, Health Promotion and Sexual Assault Prevention and Response programs,” according to her Coast Guard bio. 

Schwartz served under the first Trump administration as deputy surgeon general, overseeing COVID-19 vaccine deployment.

She also instituted several key infectious disease prevention programs and policies for the Coast Guard, including those for anthrax, smallpox, influenza, and HIV. The nominee also holds degrees in law and public health.

Schwartz’s focus on vaccine-preventable diseases, infectious diseases, and occupational health may put her at odds with the current HHS priorities, which have called for more research and attention for chronic diseases.

“As a well-trained and credentialed physician and former Deputy Surgeon General, Erica Schwartz possesses the medical background and public health knowledge to understand that the Centers for Disease Control and Prevention must be guided by evidence-based science,” said Dr George C Benjamin, the American Public Health Association (APHA) CEO in a press statement. 

APHA has consistently criticized the Trump Administration’s public health actions, including changes to the childhood vaccination schedule and removing clean air protections.

“Erica Schwartz is a credible CDC director. But she’ll need assurances against political interference & ongoing attacks on science and the CDC itself,” said Lawrence Gostin, distinguished professor at Georgetown University and Director of the O’Neill Institute for National and Global Health Law. 

But the global health security expert noted “the signs are not good. RFK may impose a leadership team & senior CDC officials are extreme MAHA advocates.”

Gostin alluded to past interferences between HHS and CDC leadership in the childhood vaccine schedule, which was modified late last year.

If confirmed, Schwartz would be responsible for adopting the controversial vaccine schedule recommended by the Secretary’s handpicked committee, also known as ACIP. 

Last June, Kennedy fired the entire panel of vaccine advisers, instead replacing them with vaccine skeptics. A federal judge has since blocked changes to the vaccine schedule, ruling that the removal of the original committee violated a law governing federal expert committees. 

Schwartz would also likely face pressure from Kennedy on vaccines, just as Susan Monarez, the first Senate-confirmed CDC director under the Trump administration publicly testified about. Monarez led the agency briefly in 2025, before being ousted by Kennedy Jr just 29 days into her tenure.

In Senate testimony about her firing, Monarez told the Senate Health Committee members that she refused Kennedy’s requests to “replace evidence with ideology,” in pre-approving vaccine recommendation changes and in firing career public health officials.

Mixed feelings from anti-vaccine advocates

measles elimination vaccines map US
The percentage of American kindegartners who have been vaccinated against measles has declined in the past two decades.

Some in anti-vaccine wings have expressed feelings of betrayal at Trump’s pick. 

In a social media post Nicholas Hulscher, an activist with the anti-vaccine advocacy organization the McCullough group, lamented the nomination. “Trump’s new CDC director pick, Erica Schwartz, forced smallpox, anthrax, and flu shots into our troops with threats and discipline for those who refused. She personally wrote and signed the DIRECT ORDERS making them MANDATORY for Coast Guard troops.”

Others closer to Secretary Kennedy, including his former personal attorney Aaron Siri, also criticized Schwartz’s vaccine mandates when she served as Rear Admiral in the Coast Guard.

“This agency does not need another cheerleader for industry; it needs a regulator over industry,” Siri said in a statement to Politico last week.

The administration announced several other CDC leadership changes, including Sean Slovenski, a digital health administrator, as deputy director and chief operating officer; Dr Jennifer Shuford, commissioner at the Texas public health department, as chief medical officer and deputy director; and Dr Sara Brenner, who serves as FDA principal deputy commissioner, to be a senior adviser to Kennedy. 

Image Credits: HHS, CDC.

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana.

The African Union Commission, the African Leaders Malaria Alliance (ALMA) and the RBM Partnership to End Malaria each play a distinct role in Africa’s malaria response, from continental policy direction to member state leadership and accountability, to coordination of the broader global and regional partnership. 

This World Malaria Day (25 April), we write together because the moment demands exactly that: global coordination, continental resolve, and sustained political leadership.

This joint reflection is more than symbolic. It signals a renewed commitment to stronger coordination, more effective delivery, and shared accountability for results.

This moment requires honesty. Yes, Africa has made remarkable progress against malaria, since 2000. More than 1.64 billion cases have been prevented and 12.4 million lives have been saved. 

Yet the trend is moving in the wrong direction. In 2024 alone, Africa recorded 270.8 million malaria cases and nearly 600,000 deaths. Most devastating of all, 75% of those deaths were children under five. 

The hard-won gains of the early 2000s have stalled, and with the continent is now off track to meet the targets of the African Union’s Catalytic Framework to End HIV, TB and Eliminate Malaria in Africa by 2030.

This is not a moment for incrementalism. It is a moment for renewed political commitment from member states.

An intensifying perfect storm

Africa’s malaria response is being tested by a convergence of pressures: shrinking external financing, climate change, insecticide and drug resistance, and the growing burden of humanitarian crises. 

The global health financing landscape is shifting in ways that are structural, not cyclical. This is not a temporary disruption. The global health financing landscape is changing in ways that are structural, not cyclical. The era in which malaria control could rely heavily on external funding is coming to an end.

For Africa, this is an inflection point. The question before us is clear: do we allow these changes to deepen vulnerability, or do we use them to build something stronger and more durable? Do we continue to depend on systems designed and financed elsewhere, or do we seize this moment to build a continent that controls malaria on its own terms, financed increasingly by its own resources, driven by its own institutions, and supported, rather than led, by global partners?

This is the real challenge before us. And it is also the opportunity.

Accountability for the ‘Big Push against Malaria’

Zambia started to roll out the malaria vaccine in December 2025. This baby is being vaccinated at the Lumezi Urban Clinic. The country is also rolling out a new tool to track its progress against malaria.

In response to the rising malaria cases and associated deaths, at last year’s AU Summit, African Heads of State and Government endorsed the African Union Roadmap to 2030 and Beyond.  This roadmap is not simply another declaration. It is an acceleration plan designed to get Africa back on track to meet the targets of the AU Catalytic Framework.

At the same time, the RBM Partnership is stewarding the “Big Push against Malaria”, a new approach grounded in endemic country leadership, sustainable solutions, and health sovereignty. Its purpose is to align global, regional, and national actors behind country-defined priorities and nationally owned, optimised plans.

A key shift is how we hold ourselves accountable to those commitments, especially at the national level.

In February, Zambia became the first AU Member State to roll out a new monitoring and accountability approach aligned with this effort. Building on its existing malaria scorecard management tool, the country has enhanced how it tracks progress at national and subnational levels. 

To reflect the interconnected factors that influence malaria outcomes, this new approach expands coordination across sectors, engaging Ministries beyond health, such as finance, agriculture, water and sanitation, and environment. By strengthening existing systems rather than creating parallel ones, Zambia is demonstrating how accountability can be embedded into existing governance systems and how political commitments made at higher levels can be followed through to actual delivery.

This is the kind of leadership Africa needs: practical, country-owned and measurable.

Accountability needs strong, sovereign foundations

Ghanaian President John Mahama welcoming delegates to the Africa Health Sovereignty Summit in August 2025, where countries committed more domestic finances to health.

Accountability alone, however, will not carry this agenda. We need African health sovereignty.

First, domestic financing must shift from aspiration to obligation. More than two decades after the Abuja Declaration, fewer than five countries have met the target of allocating at least 15% of annual national budgets to health. Malaria financing must be seen as an investment in national security, economic productivity and human development.

Second, Africa must reduce its dependence on imported malaria commodities, diagnostics and medicines. A continent that bears the heaviest malaria burden should not remain dependent on external supply.  We must manufacture in Africa, for Africa. The African Medicines Agency, the African Continental Free Trade Area, and Africa’s growing pharmaceutical capacity already provide a foundation. What is needed now is scale, speed and political backing.

Third, surveillance and data systems must be treated as sovereign infrastructure. No country can eliminate malaria if it does not know where transmission is happening, how patterns are changing or which interventions are working. Surveillance is not a technical add-on. It is the backbone of a credible elimination strategy. As the Africa CDC strengthens continental health intelligence systems, malaria must be central to that architecture.

Fourth, malaria elimination must also be fully integrated into primary health care. Universal health coverage and malaria elimination are not competing agendas. They reinforce one another. Every investment that strengthens local health systems, expands access to frontline services and improves continuity of care also strengthens the malaria response.

The commitments already exist through the African Union’s Catalytic Framework to End HIV, TB and Eliminate Malaria in Africa by 2030. What is now required is financing that matches ambition and political follow-through that turns declarations into delivery.

Malaria-free Africa is within reach

A malaria-free Africa is within reach. Countries such as Algeria, Cabo Verde and Egypt have demonstrated what sustained commitment, political leadership and coordinated action can deliver. The progress proves that elimination is possible on the continent.

But a malaria-free Africa is not a gift conferred by others, it is a condition created through sovereign investment, determined leadership, accountable systems and enduring institutions.

The tools exist. The science is stronger than ever. The institutions are in place. What Africa needs now is the discipline to hold itself accountable and the resolve to act with urgency.

Ending malaria is one of Africa’s greatest health opportunities. It is also one of the clearest proofs of what genuine self-determination in global health looks like.

This is the new chapter before us.

Africa must write it with accountability.
Africa must finance it with sovereignty.
And Africa must deliver it with leadership.

Ambassador Amma A Twum-Amoah is the African Union Commissioner for Health, Humanitarian Affairs and Social Development.

Dr Joy Phumaphi is executive secretary of the African Leaders Malaria Alliance (ALMA) and former Health Minister of Botswana.

Dr Michael Adekunle Charles is CEO of the RBM Partnership to End Malaria

 

Image Credits: Temwanani Mtonga/ Gavi, WHO/Fanjan Combrink.

Carrying their vaccines, a group of health workers cross a flooded area in Gonja sub-district in Northern Ghana.

The huge push to reach children who missed vaccinations during COVID-19 has largely paid off, reaching 18.3 million children – but plummeting aid and misinformation threaten future childhood immunisations.

This is according to leaders from the vaccine alliance, Gavi, the World Health Organization (WHO) and UNICEF, who reported on the “Big Catch-Up” at a media briefing on Thursday – on the eve of World Vaccination Week.

Over 100 million vaccines were delivered between 2023 and 2025, and an estimated 12.3 million of the children reached had never been vaccinated, while 15 million had never received a measles vaccine. 

Gavi CEO Dr Sania Nishtar said that, by 2021, coverage of the three-in-one diphtheria, tetanus and pertussis (DTP) vaccine had fallen to 78% in lower-income countries, erasing “years of hard-won gains”.

The Big Catch Up initiative targeted 36 countries, which accounted for 60% of the world’s zero-dose children, and these countries actively looked for children under five who had missed vaccines.

To protect communities affected by the recent floods in Mozambique, the Ministry of Health is carrying out a preventive cholera vaccination campaign in the districts most prone to cholera outbreaks.

Twelve of the countries reached more than 60% of their zero-dose children – Burkina Faso, Democratic People’s Republic of Korea, Ethiopia, Kenya, Madagascar, Mauritania, Niger, Pakistan, Somalia, Togo, Tanzania, and Zambia.

In total, catch-up reached the equivalent of “five times the number of children under five in the European Union,” said Nishtar.

Dr Kate O’Brien, WHO’s immunisation director, said that the initiative also strengthened countries’ immunisation systems, monitoring children’s immunisation status up to the age of five instead of two, and five-year-olds, and strengthening primary health care systems to track newborns.

Dr Ephrem Lemango, UNICEF’s global chief of immunization, said that maintaining vaccination momentum relies on targeting populations living in fragile and conflict situations, building trust in vaccines and increasing domestic and global financing. 

Effects of reduced aid

Vania (4) shows off her pinky finger, indicating she has received the polio vaccine during a vaccination campaign in Herat, western Afghanistan.

“The continued decline of official development assistance (ODA) and recent sharp funding cuts to global health have seriously affected the delivery of immunisation services,” Lemango warned.

ODA cuts have reduced services, including “last-mile” outreach, “because so many health workers and supply chains have been supported by these funds”.

The cuts have affected governments’ ability to provide their part of the co-financing to procure Gavi vaccines. Meanwhile, some countries received donors funds for “traditional” vaccines – such as polio, tuberculosis and DTP – and this has been “considerably disrupted”. 

ODA cuts have also affected the capacity of the WHO, UNICEF and Gavi to provide technical assistance to governments to deliver immunisation services.

O’Brien said that aid cuts have also affected countries’ and international agencies’ ability to react fast to disease outbreaks.

However, Nishtar said that the “silver lining” has been the rise in Africa of a “health sovereignty movement”, where heads of state are stressing that they need to be able to deliver basic services through domestic revenue

Undermining trust

“Trust has become a prominent predictor of vaccine uptake across countries and populations,” said Lemango. “Even brief exposure to vaccine misinformation likely reduces the willingness to vaccinate.”

“So much anti-vaccine content has its own political economy behind it, where there is financial and political backing.”

Nishtar said that, while there have “always been naysayers”, social media has driven misinformation to new heights.

“What is really troubling, and a very high concern to all of us, is that there has been ever more politicisation of vaccines and of health,” O’Brien noted.

“Politicisation of vaccines should not happen. The world of vaccines should be based on evidence and facts and should be supportive of families and children’s parents or caregivers to provide what is a life saving intervention for them.”

Image Credits: UNICEF, UNICEF.

Back to bed nets as drugs fail? Hassana Sa-adu with her children, holds a free mosquito bednet delivered to her home in Kano, Nigeria.

Resistance to a key drug used to treat malaria in Africa is spreading. Experts warn action is now urgent and any delay will cost lives and create economic misery. 

Artemisinin-based combination therapy (ACT) is the main first-line malaria treatment used in Africa and the best available option, according to the World Health Organization (WHO). 

ACT has saved millions of lives, but the parasites that give you malaria are becoming resistant to one of the two drugs in the treatment, artemisinin. 

The WHO reports that this has happened in Rwanda, Uganda, Eritrea and Tanzania. Resistance, Resistance is suspected in at least four other countries, and tests are being carried out in these and further countries as it is likely that the problem is spreading.

This is known as partial resistance to ACT because the parasites can still be killed and have not developed resistance to the other drug used with artemisinin, most often Lumefantrine.

While the early warning surveillance system is doing its job in detecting resistance,  AMDR (Antimalarial Drug Resistance) Action, which uses evidence on drug resistance in malaria to create change, told Health Policy Watch that “these signals are not consistently triggering action”. 

“Too often, the response stops at detection. Countries are left with data, but without the financing, coordination, or readiness to act on it.” 

Professor Deus Ishengoma, a malaria specialist from Ifakara Health Institute in Tanzania and professor at Kampala International University, says action is not being taken quickly enough: “We should have acted yesterday, but we haven’t. So we should act today.”

He explains that no one knows when the situation will turn from “orange to red.” Red means full treatment failure and a jump in the number of deaths.

“When you start to see the first signs, which we already saw in a good number of African countries, you start seeing some patients who do not get cured as expected. And as we move into the second stage, the third stage, the number starts building up. In the fourth stage, that’s when the drug fails completely and you get into panic mode… and more deaths,” Ishengoma told Health Policy Watch.

“In countries like West Africa, where things haven’t got worse, they should act now and prevent it. In eastern Africa, where we are now in the third stage, we should not allow it to go into the fourth stage, where the drugs will completely fail.”

AMDR Action says that Africa is at a “critical inflection point”. The group of experts say “the risk is no longer theoretical”, yet “without intervention, the region faces rising treatment failure rates and associated economic costs, increased malaria cases and mortality, escalating healthcare expenditures, and communities losing trust in curative health services.”

Some experts argue that several countries are responding well. Professor Maciej Boni, an epidemiologist at Temple University in Pennsylvania specialising in malaria, told Health Policy Watch that changing policy and drugs takes time.  

“For the seven or eight countries that have identified artemisinin-resistant parasites inside their borders, the time to act is now. For the rest of East Africa, I think they would need to act in the next year or two,” said Boni.

He praised Burkina Faso for procuring alternative drugs before resistance to ACT had been detected. 

More deaths if countries wait for the drugs to fail

Worldwide, deaths from malaria have come down over the past 25 years, and 47 countries are now malaria-free, the latest being Georgia, Suriname and Timor-Leste, in 2025. 

Yet in Africa, experts warn decades of progress are at risk. The latest figures available from the WHO (2024) show a slight rise in people dying from malaria to 610,000. 95% of those deaths were in Africa. 

Boni says in countries with high numbers of deaths from malaria, “these death counts could increase 20% over a five-year period.”

Oliver Watson, an infectious disease mathematical modeller at Imperial College London, explains that delaying action ultimately costs countries much more than if new interventions, like introducing different drugs, are funded quickly. 

Watson has modelled the impact of delayed action based on current resistant patterns in Africa. 

“The health estimates are huge, with up to half a billion additional patients where the drugs no longer clear the infection,” Watson told Health Policy Watch.

This leads to “catastrophic economic losses” for affected countries as patients living with malaria struggle to work and feed their families. 

The cost to health budgets of delaying action is also much higher than early intervention. “Taken together, the modelling suggests that the additional pressure on health systems and households could plausibly amount to well over a billion dollars over the next 15 years,” said Watson.

Diversifying drugs

The efficacy of artemisinin-based antimalarial drugs is increasingly being threatened by parasite resistance.

To deal with drug resistance, “you try to diversify the drug supply”, Boni explains. By getting multiple drugs in use, “you make it challenging for the parasite, as it jumps from person to person, to acquire resistance to all the drugs”.

There are four artemisinin combination therapies (ACTs) “realistically” available for use in Africa, according to Boni, but he adds that some are expensive and not all are available at scale. 

Two promising new drugs are in the pipeline but not available yet, including one which doesn’t use artemisinin. 

But AMDR Action told Health Policy Watch the new medicines may not be available quickly enough for those countries already affected by resistance. There, they believe drug alternatives need to be in place within six to 12 months. 

Other measures being used include vaccines, chemoprevention for those who are more vulnerable (giving a course of antimalarial drugs to prevent infection), and insecticide-treated nets to avoid being bitten in the first place. 

However, some mosquitoes (rather than the parasites they carry) are also becoming resistant to insecticide on treated nets, which is reducing their effectiveness. 

Strategies like testing before treating to ensure drugs aren’t being used when it’s not malaria, driving up resistance, are also part of the solution. 

Boni says that it “takes years” to change malaria policy, and you don’t do it quickly if you don’t have the money.”  

But funding has gone down as the costs, driven by emerging resistance, have gone up. 

For Boni, “the disappearance of funding from USAID and the US government in general has made all this more challenging.”

Ishengoma in Tanzania says countries facing resistance need help from international funders, but ultimately wants his country and others in Africa, to take the lead in their own solutions.  

‘The battle is not all lost’

Ahead of World Malaria Day (25 April), the WHO says: “With the tools and resources available today, no one should die from malaria.” 

Resistance to antimalarials like ACT was anticipated, but AMDR Action says “waiting for clear treatment failure will mean acting too late. The tools, data, and platforms to act already exist… And the warning signs are already clear. The question is whether we respond to them.”

Ishengoma, who lost two siblings to malaria, is pushing for action to prevent a return to anywhere near the scale of deaths he witnessed in the 1970s and 80s in Tanzania, “when we were growing up… and children were dying.”

“The battle is not all lost. We still can go in today and save our people.”

With support from The London School of Hygiene and Tropical Medicine

Image Credits: WHO, Global Fund, Paul Adepoju .

Brazilian children from the Yanomami indigenous community will be the first to get paediatric treatment for malaria.

Brazilian children from the Yanomami indigenous community will be the first in the world to get a single-dose paediatric treatment for relapsing malaria.

The introduction of paediatric tafenoquine, developed by Medicines for Malaria Venture (MMV) and pharmaceutical  company GSK, marks a “major step” towards closing the treatment gap for children at risk of relapsing Plasmodium vivax (P. vivax) malaria, according to MMV.

Tafenoquine only needs to be taken once, replacing older medicines taken daily for seven days. This is especially important in remote areas, where following through with longer regimens can be challenging.

Brazil incorporated a child-friendly formulation of tafenoquine into its public health system in mid-2025. It is approved for children from two years of age, and taken in combination with chloroquine to cure P. vivax malaria,  the less deadly but most widespread malaria species.

Illegal mining, deforestation drive malaria

Malaria cases in the Yanomami Indigenous Territory have surged 300% between 2016 and 2022, where illegal mining has driven deforestation and a dramatic resurgence of the disease carried by mosquitoes. The Yanomami are the largest indigenous people in the country, living in villages within the Amazon rainforest on the border of Venezuela and Brazil. 

Brazil declared malaria a public health emergency in the area in 2023.

“The rollout of paediatric tafenoquine addresses a long‑standing gap in malaria care for children, particularly in remote and underserved settings. This initiative strengthens our national elimination efforts while centring children’s health,” said Alex Vargas from Brazil’s Ministry of Health.

“Between 2019 and 2022, over 21,000 malaria cases were recorded among Yanomami children under the age of five, alongside a sevenfold increase in malaria‑related child deaths over four years,” according to MMV.

“In a population of around 30,000 people, these figures underscore the devastating impact of malaria and the urgent need for a well‑tolerated, effective treatment for the youngest and most at risk.”

 MMV CEO Dr Martin Fitchet said that, ‘for too long, younger patients have remained vulnerable to debilitating relapse simply because existing treatments were hard to complete.

“The rollout of paediatric tafenoquine among the Yanomami marks a major step toward more equitable access to effective malaria treatment.”

If someone is infected with P. vivax and does not receive liver-stage treatment, they will be at risk of repeated clinical relapses. 

But tafenoquine can cause haemolytic anaemia in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency, so G6PD testing must be performed before it is prescribed, which complicates the rollout.

Tafenoquine is the first new drug to be developed in over 60 years to treat relapsing malaria. Brazil was the first malaria-endemic country to adopt tafenoquine for adults into its public health system in 2023.

Rollout to adults began in June 2024. and by April 2025, it covered 49 municipalities from six states and nine Special Indigenous Health Districts (DSEIs).

In the first quarter of 2025, Brazil recorded a 26.8% drop in all malaria cases. Rondônia, one of the first states to introduce tafenoquine treatment, saw a 47% decrease in malaria cases during the first four months of 2025 compared to the same period the previous year, and 95% of all its malaria cases during this period were P. vivax.

Image Credits: Nathalie Brasil/ MMV.

Extreme heat waves linked to a warming planet are having a devastating impact on crops, warns WMO in its latest report.

Extreme heat threatens livelihoods, health and labour productivity for over a billion people around the world, warns the latest report from the World Meteorological Organization (WMO). Agricultural workers and the food production systems that they manage are on the frontlines.

The increased intensity and duration of climate change-related heat waves, driven largely by the indiscriminate burning of fossil fuels, poses a direct risk to crop and livestock production,  fisheries – and the health of workers who must work long hours outdoors during extreme heat to manage those systems, warned the report, published on Earth Day, observed  every April 22.

“This work highlights how extreme heat is a major risk multiplier, exerting mounting pressure on crops, livestock, fisheries and forests, and on the communities and economies that depend upon them,” said FAO Director-General QU Dongyu.

The report titled “Extreme heat and agriculture,” prepared in collaboration with Food and Agriculture Organization (FAO), assessed risks as well as adaptation options.

Among the latter, early warning systems can help farmers prepare for extreme heat, the report stresses. It also urges countries to look at options such as selective breeding of crops to prioritize more drought- and heat-resistant plants, and make those more widely accessible to farmers.

“Extreme heat is increasingly defining the conditions under which agrifood systems operate,” said WMO Secretary-General Celeste Saulo.

Risks to the agrifood systems set to soar

Agriculture workers are on the frontlines of extreme heat.

The frequency, intensity and duration of extreme heat events have risen sharply over the past half century, WMO said, leading to soaring risks.

“More than simply an isolated climatic hazard, it [heat] acts as a compounding risk factor that magnifies existing weaknesses across agricultural systems. Early warnings and climate services like seasonal outlooks are vital to help us adapt to the new reality,” WMO’s Saulo said.

Apart from its direct impacts, extreme heat when combined with droughts, wildfires, water stress, and pests has an escalating impact on production, the report cautioned.

Wide-ranging impacts – crops, fishes, livestock and humans

The impact of extreme heat on humans has received more attention in recent years – but the way in which heatwaves have also  affecting crop and fish production and therefore prices, has received less attention.

The extent of the impact of extreme heat is different relative to the context of when and where they occur.

For livestock, heat stress begins when the temperatures exceed 25°C. The threshold is even lower for chickens and pigs, as they are unable to cool themselves by sweating.

In 2025, more than 90% of the ocean’s global expanses experienced at least one marine heatwave, according to the WMO’s State of the Global Climate 2025 report. When heat rises in water bodies, it leads to a reduction in the presence of dissolved oxygen, making the fish struggle to maintain their respiration rates. As a result, they can suffer from cardiac failure, and production declines.

For most major agricultural crops, yield declines begin to occur above 30°C; but it is lower for some crops such as potatoes and barley. Evidence also points to a strong correlation between heat waves and wildfires, with longer and more intense fire seasons.

Agricultural labourers are hardest hit due to extreme heat as the number of days each year when it is simply too hot. The number of extreme heat days may soon rise to 250 per year in much of South Asia, tropical Sub-Saharan Africa and parts of Central and South America by the end of this century, according to the report.

Also read: ILO: Excessive Heat Linked to Climate Change Affects 70% of Workers

Key insights for policymakers

When heat combines with water stress or drought, the impacts compound, according to WMO report.

Along with more selective development of climate-resistant plant and animal species, the report highlighted the need for adjustments in planting windows and altered water management practices,  so that crops and agricultural activities can be sheltered from the impacts of extreme heat.

The report also urges countries to improve access to financial services like cash transfers, insurance and payment schemes, and other climate shock-resilient social protection schemes for agrifood workers.  Innovative insurance schemes are currently being tested in developing countries like India, but their effectiveness is yet to be proven.

“Protecting the future of agriculture and ensuring global food security will require not only building on-farm resilience but also exercising international solidarity and collective political will for risk sharing, and a decisive transition away from a high-emissions future,” the report says.

Image Credits: WMO, Extreme heat and agriculture report.

PEPFAR funded 80% of the running costs of Luyengo Clinic in Eswatini, and the HIV treatment of 3,000 clients was distrupted when the US froze foreign aid.

Researchers have challenged several upbeat claims made by the United States government about the continued impact of the US President’s Emergency Plan for AIDS Relief (PEPFAR). The US State Department claims that PEPFAR has sustained its impact on HIV despite the service disruptions and funding cuts introduced by the Trump administration.

In a data release covering 1 July through 31 September (the fourth quarter of the US budget cycle), the US government reports that PEPFAR supported 20,6 million people in over 50 countries on anti-retroviral (ARV) treatment. They note that this is “stable from the same FY 2024 reporting period”. 

“Three million people now receive treatment from national governments rather than external PEPFAR implementers,” with two million “successfully transitioned” during the fourth quarter alone, according to a statement from the US State Department’s Bureau of Global Health Security and Diplomacy (GHSD).

PEPFAR initiated 103,000 pregnant and breastfeeding women on pre-exposure prophylaxis (PrEP), “more than double the 43,000 from a year ago”, according to the GHSD. PrEP involves HIV negative people taking ARVs to prevent infection.

While the GHSD acknowledges a decline in the number of children on HIV treatment – from 643,627 in 2022 to 508,703 in 2025 – it attributes this to “tremendous progress” in prevention of mother-to-child transmission (PMTCT).

Historically, however, HIV positive children are hard to reach, and only slightly over half of children under the age of 15 who are living with HIV are actually on ARVs, according to UNICEF.

“The message is clear: we cut overall spending by 30% while preserving critical frontline HIV care and eliminating wasteful programs. This proves the America First Global Health Strategy works,” according to the GHSD.

‘Substantial disruptions’

But researchers – from AmFAR, the Foundation for AIDS Research, and the International AIDS Society (IAS) – argue in a preprint article that there have been “substantial disruptions across PEPFAR service areas”.

Their analysis is based on both the newly released fourth quarter figures plus ​​data from “an earlier inadvertent release [that] included all four quarters.”

It covers 31,746 facilities and community service sites, which the researchers classify according to their reporting records as “continuous” (71.3%, who submitted reports every month), “intermittent” (16.9%, submitting some reports) and “community services” (2.5%). 

They report a “modest” 0,3% decline in people accessing HIV treatment, which is similar to the State Department assertion.

But researchers Brian Honermann, Elise Lankiewicz, Jennifer Sherwood and Greg Millett  (all AmFAR) and Anna Grimsrud (from IAS) assert that this stable figure “obscures substantial changes”.

The “continuous facilities” rebounded to slightly above their 2024 level as they maintained “at least some level of support from PEPFAR and are primarily owned and operated by ministries of health”. (Around three-quarters of PEPFAR-supported facilities in 2024 were government facilities.)

They describe access to treatment as a “lagging indicator” of the overall health system performance because stable patients on treatment “already have strong routines in place for continually collecting medication.”

Decline in testing, PrEP and health workers

A Zimbabwean health worker administers an HIV test.

The drop in HIV testing portends future weaknesses. There was an overall 17% decline in HIV testing – the gateway to ensuring people with HIV are on treatment – resulting in a 16% decrease in the number of people initiated on ARV treatment.

Infant HIV testing declined by 6%, and infant diagnoses declined by 12% in the “continuous facilities”. There was a precipitous decline of 60% in testing and 31% in diagnosis in the “intermittent facilities”.

“The significant declines in HIV testing, diagnoses, treatment initiations, and treatment retention programming, however, raise serious concerns for countries’ capacity to maintain progress toward the 95-95-95 targets”,  they noted. This is a reference to the United Nations target of 95% of people with HIV knowing their status; 95% on ARVs and 95% virally suppressed, adopted by the General Assembly in 2021.

PrEP initiations declined by 33% –  largely as the Trump administration has designated PrEP for pregnant and breastfeeding women, rather than the “key populations” most at risk of HIV.

The PEPFAR-supported workforce was reduced by 22% between 2024 and 2025, a loss of some 76,051 jobs.

Instability, grant cancellation

The researchers recount the damage to PEPFAR starting from Trump’s executive order on 20 January, freezing all foreign aid disbursements.

This was followed by a stop work order on 24 January 24 for all foreign aid awards, including PEPFAR.

“Following this period, a series of waivers allowed for the partial resumption of PEPFAR programming, including a PEPFAR-specific waiver that permitted a defined subset of HIV care, treatment, and prevention of mother-to-child transmission services to continue,” they note.

But “the subsequent months were characterized by considerable instability, including cycles of award cancellations and reinstatements, legal challenges to the freeze, and the permanent dissolution of USAID, which was one of two major PEPFAR implementing agencies.”

They point to other research that has modelled the calamitous impact of these disruptions on the fight against HIV.

The last PEPFAR data?

They also acknowledge that the full implications of the foreign aid review have been “difficult to assess” as the US government has released “no official list of terminated and active awards post-review”.

However, they also note that “this is potentially the last data set PEPFAR will ever release”.

“Under the terms of the memoranda of understanding (MOUs) that the US State Department is currently signing with partner governments, public disclosure of data from those data sets is prohibited, including with external researchers, academics, or advocacy organizations,” they note.

“Without public data sets that enable national, sub-national, facility-level, and implementing mechanism level scrutiny, it is virtually impossible for external oversight and accountability to take place, whether within the US government or outside it.”

Image Credits: UNAIDS, UNICEF Zimbabwe.

German Ambassador to Ethiopia Birgitt Ory, Africa CDC Director General Dr Jean Kaseya, Jozef Síkela, European Commissioner for International Partnerships, and Ethiopian Health Minister Dr Mekdes Daba.

The African Union and the European Commission have concluded three agreements worth €100 million aimed at strengthening Africa’s health systems.

The first initiative supports the national public health institutes of 10 African countries to enhance disease surveillance, early warning systems, emergency response, research and laboratory services.

The second, announced at the One Health Summit in Leon earlier this month, involves addressing antimicrobial resistance (AMR) and developing a workforce trained in a ‘One Health’ approach to detect and prevent health threats in animals, humans and the environment.

The third involves expanding digital health solutions for pandemic preparedness and stronger primary healthcare systems in six African countries.

The initiatives were officially launched at the African Union headquarters on Tuesday by Jozef Síkela, European Commissioner for International Partnerships, and Dr Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention, which is the operational partner for the initiatives.

“Health remains at the top of the EU’s political agenda, including in the shifting geopolitical landscape. While the others are stepping away, we are stepping up,” Sikela told the launch. 

“Recent history showed us that a health crisis in one region can turn very quickly into a global emergency, an economic crisis and a security threat. Investing in global health is a strategic investment, not a gesture.”

Kaseya said that the support will assist the continent to achieve its Health Security and Sovereignty Agenda, “strengthening its capacity to build resilient health systems, improve preparedness, and reduce dependency by producing, financing and managing more of its own health priorities.”

Sikela told the launch that the EU and AU are also working on a global health resilience initiative, with the aim of launching it in May.

“This will be a powerful tool, bringing together research with medical technology and innovation programmes, knowledge transfer and systematic cooperation with regulatory agencies, health systems and highly skilled workforces,” he said.

“The aim is to equip and empower health systems worldwide so that they are in a better position to prevent and respond to future crises,” he concluded, adding that this includes European investment in the local manufacturing of vaccines and medicines “to avoid health dependency.”

Welcoming the initiatives, Ethiopian Health Minister Dr Mekdes Daba noted that “a crisis in one region can, with alarming speed, become a challenge for the continent and the world. From COVID-19 to mpox and the recent Marburg outbreak, we have learnt that preparedness cannot be deferred.”

air pollutionphilanthropies
A new report on the status of philanthropy in air pollution from the Clean Air Fund found spending on preserving air quality heavily skewed in favor of North America, which enjoys cleaner air compared to Africa and Latin America.

Less than 0.1% of all philanthropic funding has gone to the fight for clean air. Yet globally, nearly eight million deaths are attributed to the particles and gases that pollute the air – making air pollution the second biggest risk factor for premature death after high blood pressure.

“Air pollution is one of the world’s largest public health threats,” said Dr Christa Hasenkopf, senior fellow at the Clean Air Fund (CAF). “And not only do we underfund it, we’re not directing the funds available to where they’re needed most. Africa has twice the population of North America and more than twice the air pollution, yet it receives 35 times less philanthropic air quality funding.”

CAF’s report on philanthropic funding in air pollution reveals steep disparities in funding, where regions suffering from the worst polluted air receive the least amount of funding.

Worldwide, 99% of people live in environments that exceed the World Health Organization’s (WHO) air quality guidelines.

CAF found that between 2019 and 2023, philanthropic funding was heavily skewed towards North America, which received 35% of total outdoor air quality funding – yet thanks to over 50 years of clean air regulation, it broadly enjoys clean air. 

Meanwhile, Africa and Latin America received only 1% and 2% of funding, respectively. 

The lack of funding also has implications for air quality monitoring, crucial for protecting public health and guiding policies.

Hasenkopf noted that “over a third of countries still don’t monitor their air quality at all. But this is a story about opportunity, not just neglect: even modest philanthropic investments in local capacity can unlock pollution reduction for nearly a billion people.”

Philanthropies continue to play a critical role in environmental health, especially as unprecedented aid cuts rock the global aid economy. 

Africa, parts of Asia neglected

Peak air pollution levels in the Indo-Gangetic plain, which includes Nepal, Bangladesh, India, and Pakistan. South Asian countries outside of India have a fraction of air quality funds compared to India.

While North America has historically enjoyed the largest portion of philanthropic clean air investments at $165.6 million between 2019 and 2023, India and China have also received a significant share of funding- $77.9 million and $43.4 million respectively.

CAF analyzed China and India separately from the rest of the Asia region because, in doing so, their report reveals a broader imbalance within Asia.

Several Asian countries, notably Nepal, Bangladesh, and Pakistan, have faced some of the most dangerous air quality levels in the past decade. Pakistan and Bangladesh have ranked first and second for the highest levels of fine particulate matter in the world, according to the Swiss-based air quality organization, IQAir.

Yet despite this burden, Asian countries -excluding India and China – received only 7% of outdoor air quality philanthropic funding. 

iqair mapair pollution
An IQAir map highlights the scarcity of monitoring data in poor air quality regions like the African continent.

In Africa and Latin America, which are also high-need regions, funding remained “particularly low.” Four of the top 10 most air-polluted countries are in African: Chad, the DRC, Uganda, and Egypt.

While Latin America has historically enjoyed cleaner air than its regional counterparts and innovative urban design in its cities, many areas still suffer from a lack of air pollution monitoring.

The two regions received only 0.9% and 1.5% of total philanthropic outdoor air quality funding between 2019 and 2023, respectively.

air pollution funding by region
Philanthropic air quality funding by region between 2019 and 2023.

However, the report notes a positive shift in funding to the Global South. The distribution of outdoor air quality funding grew from $5.1 million to $19.8 million in Asia – excluding China and India – and from $1.5 million to $2.2 million in Africa between 2022 and 2023.

These figures are still dwarfed by the funding available in North America, although it is decreasing: from $56.2 million in 2022 to $25.1 million in 2023.

“The fact that the funds are going to North America and others, is because communities have organized and demanded clean air,” said Dr Maria Neira, WHO’s former director of the environment, in a statement to Health Policy Watch. 

“We need to ensure that philanthropies are focusing the resources to create demand from the civil society in the countries most affected,” Neira said.

Philanthropies step in to shore up funding

coal plant map clean air air pollution
A philanthropic success story: A map of the contiguous United States, depicting the efforts of the Sierra Club’s campaign to transition away from coal power plants. Retired plants shown in gray; yellow circles denote partially operating; red show fully operating.

Historic aid cuts to global health, environment, and humanitarian assistance during 2025 sent shock waves through these sectors – and have jeopardized the lives of millions.

The report acknowledges that philanthropies alone cannot fill the gaps left behind by the US and other governments, “they can ensure vital work can continue.”

In the past year, Bloomberg Philanthropies has stepped in to cover the US’s funding for the UN Climate convention, while the Skoll and MacArthur Foundations pledged to increase giving after the dismantlement of USAID.

Philanthropies are in a unique position to drive progress on clean air. These groups have the flexibility to take greater risks and fund early-stage innovations, pilots, and advocacy campaigns, the report notes – all without the debt burden typically associated with official government-given development assistance. 

Philanthropies also provide leadership in the political space through lending evidence, raising awareness of air pollution risks, and lobbying.

“While philanthropies cannot fill the entire finance gap on their own, we’ve seen the hugely impactful domino effect they create,” said CAF CEO Jane Burston. “Their investments [accelerate] public policy and catalysing public and private finance.” 

Most of these projects fall under policy and awareness efforts, though the report highlights the need for technical projects like monitoring.  

Philanthropies have catalyzed change in the air pollution space for decades. In 2002, the Sierra Club launched its Beyond Coal Campaign, one of the most “extensive, effective, and long-lasting campaigns in the history of the environmental movement.” The campaign has advocated shifting away from coal to more renewable sources.

Funding needed for other polluting sectors

recyclingwaste sector ghana
Young people trained by the Green African Youth Organization (GAYO) in Ghana, sort and divert waste from being burned.

Philanthropic funding has primarily focused on the transportation sector, with 61% of funding supporting projects such as bus electrification or protecting pedestrian walkways away from busy roads. Other polluting sectors received a far smaller share of funding, notably the energy sector, agriculture, and the waste management sector. 

“Diversifying investments across sectors can help address several sources of emissions that significantly affect both health and climate outcomes,” the report argues.

The waste management sector in particular could greatly benefit from addressing open air burning of solid waste and reducing methane and black carbon emissions. Burning waste generates toxic plumes of dioxins, furans, and heavy metals. More recent research has also pointed to the practice for releasing microplastics into the air.

Several grassroots organizations, like the Green African Youth Organization (GAYO) in Ghana, Botswana, and Uganda, have projects that aim to reduce open-air burning and deploy air quality sensors to track open-burning hotspots.

GAYO’s anti-incineration and no-burn campaign has trained more than 100 municipal officers and environmental health workers in community-level enforcement and education across Ghana. Their Zero Waste Cities initiative in Accra has recovered 50 to 75 tonnes of waste per month, diverting materials from both landfills and open burning. 

Engaging in these sectors beyond transportation – like in clean cooking and agricultural practices such as moving away from crop residue burning  –“will be critical for improving public health, reducing inequality, and accelerating progress towards cleaner air and a more sustainable future,” the report argues.

A call to increase philanthropic giving

Waste workers join protest over air pollution exposure in Delhi.

In the past several years, the rate of growth in philanthropic funding in clean air has slowed. While the raw numbers of funds invested have more than doubled between 2019 and 2023, reaching a total of $478 million, philanthropic funding for outdoor air quality is showing “signs of stagnation,” the report warns.

Between 2022 and 2023, funding grew by only 2%, from $123.1 million to $125.8 million, the report says. 

Image Credits: Igor Karimov/ Unsplash, University of Chicago , IQAir, Clean Air Fund , Sierra Club, Clean Air Fund.