An aerial image of the earthquake damage.

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

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

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

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

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

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

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

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

Image Credits: Vantor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Opportunity to set up comprehensive monitoring

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

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

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

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

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

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

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

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

Setting up a global monitoring system

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

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

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

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

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

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

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

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

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


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

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

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

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

 

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

 

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

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

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

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

The Global Fund Executive Director nomination roadmap, obtained by Health Policy Watch.
The Global Fund Executive Director nomination roadmap.

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

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

This is where the next Executive Director will lead from: The Global Fund headquarters in Geneva.
The Global Fund headquarters in Geneva, just minutes from WHO. Its massive presence reflects its weight in global health policymaking and procurement.

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

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

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

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

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

Safe hands for the Global Fund in challenging times?

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

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

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

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

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

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

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

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

Trump appointee joins the roster

William R. Steiger demands long-term financial sustainability.
William R. Steiger demands long-term financial sustainability.

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

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

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

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

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

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

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

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

Alternative public health profile

Former NYC Health Commissioner Ashwin Vasan.
Former NYC Health Commissioner Ashwin Vasan.

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

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

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

German candidate sidelined from shortlist?

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

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

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

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

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

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

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

Former Global Fund Board Member Jirair Ratevosian calls for transparency.
Former Global Fund Board Member Jirair Ratevosian calls for transparency.

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

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

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

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

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

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

Echoes of past disastrous leadership election 

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

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

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

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

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

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

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

Funding crisis confronts renewed leadership team

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

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

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

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

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

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

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

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

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

​​Global Health Infrastructure is Changing. Why Getting it Right Matters

  • Updated 29 June 2026

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

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

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

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

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

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

Ituri Province – a zone of conflict and displacement

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

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

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

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

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

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

Resistance – a rational response to historical neglect 

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

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

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

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

Authenticity, empathy and logic as pillars of trust 

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

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

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

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

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

Empowering local structures 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Maputo Protocol commits to ending gender-based discrimination

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

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

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

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

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

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

‘Patriarchal push to dislodge human rights’

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

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

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

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

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

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

‘Human rights reframed as a foreign ideology’

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

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

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

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

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

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

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

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

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

‘Weaponising legal instruments’

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

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

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

Wildfires have evolved into a year-long threat for the European region.

As Europe sweats through the hottest week on record for June, the continent faces the looming spectre of wildfires – just one year after last year’s deadly events in Turkiye and Southern Europe.

But wildfire season is no longer episodic. It has evolved into a year-long threat, fueled by a warmer climate and its side effects. 

Increased temperatures, prolonged droughts and unpredictable weather patterns are creating more fire-prone conditions, and countries around the world are feeling the consequences, whether they are in the direct path of fires or thousands of miles away.

Anyone who has experienced a wildfire can attest to the immediate terror and heartache wildfires inflict on families, communities and economies. According to the United Nations, wildfires caused an estimated $106 billion in economic losses and $74 billion in insured losses globally between 2014 and 2023. 

But their impact spreads beyond the fire line and lingers long after they burn out. A recent report in Nature projects up to 1.4 million wildfire smoke-related premature deaths annually by the end of the century, driven by climate change, ageing populations and longer fire seasons. 

That’s nearly six times current levels. And the impacts will be experienced  unevenly around the world. Fire-related death rates in Africa, for example, are expected to increase eleven-fold.

As countries prepare for climate negotiations in Türkiye at COP31, we must act urgently to ensure wildfire smoke is treated as a climate and health agenda item, not just an economic or land management threat, and receives the coordinated response it deserves. 

If we don’t act fast enough, we will undo decades of hard-won clean air progress in the United States and Europe. The consequences carry a real human toll.

How wildfire smoke harms health

A helicopter attends to a blaze in Serbia in 2025.

Air pollution is already the second leading risk factor for premature death, with wildfire smoke contributing to its lethality. Wildfire smoke contains hazardous compounds.

Exposure to PM2.5, for example, or fine particulate matter, penetrates the lungs and bloodstream, can result in lung cancer and other respiratory diseases like asthma, cardiovascular disease and neurological diseases, all of which drive increased emergency department visits, hospitalizations, medication use, and death. 

When wildfires burn homes, office buildings and other structures, toxic compounds like lead and arsenic are mixed with fine particles.  Critically, vulnerable groups are impacted the most – children aren’t able to go to school, pregnant women are told to stay indoors for weeks, many older adults can’t open their windows in the summer, and outdoor workers who can’t stay indoors for economic reasons face some of the highest risks from long periods of breathing in smoke. 

Even without wildfire smoke, Europe already faces a severe air-quality crisis. Long-term exposure to PM2.5 above World Health Organization (WHO) recommendations was associated with an estimated 206,000 premature deaths in Europe in 2023, and nine out of 10 Europeans are exposed to air pollution at concentrations considered unsafe for human health. 

Wildfire smoke compounds the problem and its fine particles can travel thousands of kilometers across borders and into population centers far removed from the flames.

New research suggests that conventional assessments may substantially understate the specific threat posed by wildfire smoke. A 2025 Lancet Planetary Health study attributed an average of 535 deaths each year to short-term exposure to wildfire-derived PM2.5. Using a generic PM2.5 risk estimate based on different sources of pollution may result in an underestimation of health risks and understate wildfire-smoke deaths by a whopping 93%.

New era of wildfire risk in Europe

Europe’s wildfire risk for the coming week

The last few years have provided a stark preview of Europe’s future as climate change accelerates or, at the very least, continues to follow these trends. 

Southern Europe has experienced a succession of severe wildfire seasons over the past several years. In 2023, the Evros wildfire in Greece burned 93,880 hectares and killed 20 people, making it the largest single wildfire ever recorded in the European Union.  

In Portugal, the 2024 fire season was the country’s most destructive since 2017. More than 1,370 square kilometers burned, 16 people were killed and estimated damages reached €180 million. Then, in 2025, Spain experienced one of its worst fire seasons in decades. Approximately 380,000 hectares burned, making it Spain’s fifth-largest burned-area year since records began in 1961.

The scale of the 2025 fires in Spain and Portugal demonstrates how quickly extreme wildfire conditions can become a regional crisis. Consequences of fire must be tracked by more than burned areas, including fire intensity and spread. Small fires can also have large impacts on human health, economy and climate. 

Approximately 260,000 hectares burned in Portugal during the season, nearly five times the average for that point in the year. Together, fires in Spain and Portugal consumed approximately 640,000 hectares, an area equal to about 1% of the Iberian Peninsula, with most of the damage occurring within just two weeks .

Across Europe, approximately one million hectares had burned by that point in the season, the highest total since European Forest Fire Information System records began in 2006. During Portugal’s damaging 2024 season, approximately 480 square kilometers of protected areas and Natura 2000 habitats burned and a 50-square-kilometer fire entered Madeira’s laurel forest, a UNESCO World Heritage site.

Fires are not simply larger, but more frequent. A 2025 analysis found that the extreme fire-weather conditions behind the Spain and Portugal fires are now expected approximately once every 15 years. Before human-caused warming, comparable conditions would have been expected less than once every 500 years.

Wildfires are undermining air quality progress

Air quality is badly affected by wildfires.

Though many countries are making progress on reducing pollution by investing in clean transport, renewable energy and tighter controls on industrial emissions, wildfire smoke can erase these gains. According to a 2024 National Academies of Sciences Engineering and Medicine report, pollution from wildfires is actively undermining net-zero targets globally. 

In 2023, Canada’s wildfire smoke pollution was so extensive that it released enough greenhouse gases to make Canada the largest polluter of all but three countries that year: China, the US and India. In 2020, California’s wildfire season resulted in twice the pollution that was reduced from clean energy progress. 

According to estimated biomass burning emissions from the Copernicus Atmosphere Monitoring Service (CAMS), implemented by the European Centre for Medium-Range Weather Forecasts for the EU, intense fires in the Iberian Peninsula in summer 2025 resulted in Europe’s highest annual total emissions since the start of systematic monitoring in 2003. Governments simply cannot meet their clean air goals without addressing wildfire smoke.  

Strategy over silos: Coordinating the response

The solutions exist, but they require a fundamental shift from responding and reacting to, to planning for and preventing catastrophic fires.

That requires not only a strategic shift, but leveraging newly available data and coordinating clean air standards, climate mitigation plans, and fire management strategies so they work together and not in silos. Predictive science is working to identify which fires will explode into megafires and which can be managed or left to burn. 

Early detection systems can get the right response to the right fire, and air quality alerts can get people the information they need to make informed choices for their health and the health of their families. Yet few of these new tools and solutions will succeed if their use isn’t coordinated.

Across Greece, Portugal and Spain, governments have begun to move wildfire policy beyond emergency suppression toward prevention and preparedness, but the transition remains incomplete and uneven. 

Greece has adopted a National Forest Strategy for 2018–2038, launched a National Reforestation Plan for 2020–2030 and created the Ministry of Climate Crisis and Civil Protection in 2021 to improve coordination among agencies responsible for managing climate risks.  Yet the OECD concludes that Greece still lacks an overarching national wildfire-management strategy and that wildfire prevention remains divided among more than 45 agencies and public bodies. 

Portugal made a more structural shift after its catastrophic 2017 fires, creating an Integrated Rural Fire Management System and a dedicated coordinating agency to support a whole-of-government approach. It also increased its emphasis on fuel and ecosystem management, including prescribed burning and strategic fuel breaks designed to limit the spread and intensity of fires. Spain, too, has made measurable progress. 

Its average annual burned area declined substantially between 2006 and 2024, due, in part, to improved prevention measures and tougher penalties for people who start fires. But the 2025 fire season demonstrated the limits of that progress under the continued pressure of a hotter and drier climate. 

Together, these reforms show meaningful movement in the right direction, but wildfire management still tends to be divided across forest management, emergency response, climate adaptation, land-use policy and public-health protection rather than organized as a unified strategy.

Integrated fire management

A firefighter in Greece during a blaze in 2025.

Some countries and regions are already embracing a coordinated approach. The G7 Kananaskis Wildfire Charter called for integrated fire management, enhanced science and technology and international cooperation to tackle the wildfire crisis. 

Signed by over 50 countries, Brazil’s Call to Action on Integrated Fire Management and Wildfire Resilience calls for a paradigm shift in fire prevention and response. Brazil recently launched an innovative Integrated Fire Management Law, and Brazil’s new air quality law identifies integrated fire management as an air quality tool for mitigating emissions from this critical source of pollution. 

Building on these efforts, there is no more powerful platform for advancing European wildfire response than a COP hosted in Europe. 

As world leaders prepare to gather in Türkiye for COP31, key elements of the COP30 Call to Action on Integrated Fire Management can offer a foundation for this new approach: one that fully shifts from reaction to prevention. 

This approach draws on cutting-edge science that integrates climate data, fire technology and air quality and health data, innovating policy ambition to advance public health, land use and climate goals; and strengthens cross-ministerial governance structures and alignment while empowering and including local actors. 

Wildfires respect no boundaries and present grave threats to the health of people and our environment, with unsustainable costs to society. This demands a new approach to planning, prevention, and preparation; new models of governance and solutions that deliver on the triple bottom line: healthy forests, healthy environments, and healthy people.  

Angela Churie Kallhauge is the executive vice-president of impact at the Environmental Defense Fund. Prior to joining EDF, she served as head of the Secretariat of the Carbon Pricing Leadership Coalition (CPLC) at the World Bank.

Image Credits: Republic of Serbia/MUP.GOV.RS , Commons Wikimedia, Copernicus.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

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

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

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

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

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

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

‘Little miracle’

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

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

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

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

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

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

Outpacing response

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

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

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

Dangers for health workers

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

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

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

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

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

Access for those who need it?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Israel also cited the inclusion of trade issues in the 15-page declaration as one of the reasons for its vote against, but also launched a diatribe against a reference in the declaration to the 2016 Durban Declaration on HIV – which it bizarrely accused of being “anti-Semitic” without basis. The declaration, a commitment to various HIV targets, was adopted at an International AIDS Society conference held in Durban, South Africa.

‘Dubious notions’

Russia cited “at least 20 unacceptable provisions”

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

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

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

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

‘Key populations’

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

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

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

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

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

While the declaration commits to ending HIV by 2030, it identifies several gaps, including “reductions in global financing for HIV and the impact of recent disruptions on HIV services”.

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

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

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

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

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

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

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

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

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

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

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

Systemic barriers obstruct lifesaving screening

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

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

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

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

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

Sustainable state funding bridges care gap

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

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

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

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

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

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

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

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

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

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

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

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

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

Comprehensive prevention strategies 

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

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

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

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

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

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

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

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

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

Trusted voices counter misinformation

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

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

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

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

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

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

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

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

Political will and peer learning 

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

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

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

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

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

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

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

 

 

 

Image Credits: WHO/Fanjan Combrink.