Children from El Fasher refugee families at village school in Tawila, North Darfur. The desert town’s population has swelled to 650,000 due to the war.

The World Food Programme (WFP) is warning of a rapidly deteriorating humanitarian emergency in Sudan on Friday, with conditions in the besieged city of El Fasher in Sudan’s Darfour region described as “beyond horrific.” 

Speaking at a briefing to UN reporters in Geneva, Ross Smith, WFP’s Director of Emergency Preparedness, said “anywhere between 70 and 100,000 people” are believed to be trapped inside the city,  amid “network blackouts” and “mass killings.”

The Rapid Support Forces (RSF, overran the city, the strategic capital of North Darfur, in October 2024 with little or no access by outside groups in recent months. 

Satellite images and survivor accounts, portray “the city as a crime scene with the mass killings, with burned bodies, with abandoned markets,” and WFP has “no partners left on the ground,” Smith added, saying that he had “no verified reports… that any of the community kitchens are operating.”

World Food Programme’s Ross Smith, speaking at a UN press briefing Friday in Geneva.

Attempting to flee is also extremely dangerous. “The city and its surrounding roads are littered with mines [and] unexploded ordnance,” he said. Those who escape face “robbery, looting and gender-based violence,” and must often pay “extraordinary amounts for transport.” Many arrive in surrounding areas “under the open sky without medicine and shelter.”

Smith said WFP continues to call for “unimpeded access into El Fasher,” noting that the agency now has “agreement in principle with the Rapid Support Forces that control the area for a set of minimum conditions to enter the city.” 

But after more than a year and a half under siege, he said, “the essentials for survival have been completely obliterated.” WFP has food and trucks ready to move “once that safe passage is secured.”

A massive displacement crisis in Tawila

Red dotted line denotes the Tawila district near North Darfur’s strategic capital of El Fasher, the latter beseiged by the RSF for over a year.

Sudan is the world’s largest displacement crisis with more than 12 million people uprooted inside and outside the country.

In the Darfur region, one of the worst affected, Smith highlighted the extreme strain on Tawila, once a small desert town which has now swelled into a massive IDP holding more than 650,000 people. Families fleeing famine, atrocities, and recent fighting in El Fasher and Zamzam camp are now living in “very negative structures, grass, straw structures, etc.” He warned that “cholera and disease outbreak is widespread,” and that while WFP can deliver food to Tawila, “there’s very limited health care, sanitation, clean water and other… support.”

Across Sudan, WFP is reaching “over 4 million people per month,” and “half a million people in and around Tawila” were assisted in November. But escalating violence against aid workers—including an incident in which “one of our trucks was hit… and [a] driver is seriously injured”—continues to disrupt operations.

Smith warned that shifting battle lines are putting new communities at “grave risk,” including in nearby Kordofan, where the UN Refugee Agency, UNHCR reported on further deterioration over  the past two weeks. After a week of heavy fighting, the RSF reportedly seized control of a Sudanese Armed Forces base in Babanusa, West Kordofan.

In South Kordofan, “civilians remain trapped in besieged cities such as Kadugli and Dilling, and as women, children, and the elderly find ways to escape, men and youth are often left behind due to specific high risks they face along flight routes such as detention by armed groups for perceived affiliation with parties to the conflict,” UNHCR said.

Preventing the devastation seen in El Fasher from being repeated “must be a top priority for all of us,” said Smith.  

He added that WFP faces imminent funding shortfalls, Smith also said: “Pipeline breaks are right in front of us,” and assistance will require “almost $ 700 million” over the next six months.

Gaza: Winter storm deepens suffering 

As thousands of displaced Gazans’ tents were flooded by Storm Byron, mounds of debris and waste were the only stormwalls.

Meanwhile, in Gaza, humanitarian and health conditions remain dire – with a massive storm Byron leaving thousands of tents flooded, increasing disease risks and leaving families homeless once again. 

Speaking to reporters from Gaza, WHO representative Rick Peeperkorn to the Occupied Palestinian Territory (OPT), described the widespread infrastructure destruction he had witnessed and the growing public-health crisis aggravated by Storm Byron, the massive winter storm that swept through the region this week. 

“The storm environment struck Gaza with force,” Peeperkorn said. “The deplorable conditions, especially shelter conditions, are deepening the suffering of already displaced families. 

He described how high ocean waves had hit particularly hard at the thousands of families sheltering in “low lying and debris-studded coastal areas with no drainage or protective barriers, simply the heaps of garbage everywhere along the roads. 

“And we’ve seen, of course, winter conditions, combined with poor water and sanitation causing a surge in acute respiratory infections, including influenza –  as well as hepatitis, diarrhoeal diseases, etc,” Peeperkorn said.

Hospitals only partly functional 

WHO’s early warning system has recorded 1.47 million acute respiratory infections and over 670,000 acute diarrheal cases since being established in January 2024. But that’s only partial data insofar as diagnosis and testing are severely constrained by a shortage of clinics, laboratories and diagnostic equipment, Peeperkorn added. 

Only about half of Gaza’s 36 hospitals are functioning, along with 46 primary health care centers, while another 84 clinics out of a total of 195 are partly functional. 

Rik Peeperkorn, WHO Representative to the Occupied Palestinian Territory (OPT) speaking with reporters Friday from Gaza.

North Gaza remains the most severely underserved, with tens of thousands of displaced people and almost no functioning medical facilities within the “Yellow Line” that demarcates Israeli-controlled areas from areas controlled by Palestinians – where the militant Hamas group has largely reasserted itself. 

Among the roughly 650 essential medicines on WHO’s list, “50% of them are zero, or close to zero, stock.” Peeperkorn said the Shifa Hospital director “was almost crying,” as major hospitals operate “without CT, without MRI, without proper X-ray, without proper ultrasound equipment.”

Despite immense shortages, he observed creative reconstruction efforts, where clinic and hospital reconstruction teams are managing to rebuild using repurposed materials salvaged from destroyed buildings.

Critical need for medical evacuations

Peeperkorn called on Israel again to reopen the traditional medical evacuation route from Gaza to West Bank and East Jerusalem Palestinian hospitals, saying: “There’s no reason why this… cannot be reopened.” WHO is prepared to facilitate daily evacuations once access resumes, he said.  

While WHO and partners have managed to evacuate some 10,645 people since the war began in October 2023 to third countries in Europe, the Middle East or elsewhere, there are still some 18,500 patients awaiting medical evacuation, including 4096 children. And over 1000 patients have died while waiting. 

Call for sustained ceasefire and rehabilitation 

Peeperkorn meanwhile warned that makeshift shelters, widespread debris, and deteriorating sanitation pose long-term threats,  especially for children and the elderly. 

“There’s an enormous amount of garbage and debris everywhere, it’s an environmental health disaster,” he said. 

And while formal reconstruction processes remain on hold, pending further negotiations between Israel and Hamas, mediated by the US and Arab brokers, the situation on the ground is not static, Peeperkorn warned. 

“The 2.2 million people of Gaza cannot wait before we renegotiate again, those materials need to get in now.”

Image Credits: UNICEF/Mohammed Jamal, Google Maps , IOM .

From left to right: the two negotiators for the European Parliament Tiemo Wölken (Socialists and Democrats, DE) and Dolors Montserrat (European People’s Party, ES) with the chair of the EP Committee on Public Health Adam Jarubas (European People’s Party, PL) at the presentation of the new EU pharma package on Thursday.

Following eleven hours of intense negotiations overnight, the European Union (EU) clinched a landmark agreement on the most significant pharma reform of its medicines market in over 20 years on Thursday.  Reached in the final moments of the Danish EU Presidency’s mandate, the deal aims to strike a critical balance stimulating pharma innovation, particularly for critical new antibiotics and rare disease drugs, but also speeding the development of generics to ensure more affordable treatment in all 27 member states.

“The deal demonstrates the EU’s commitment to innovation and ensuring that patients in Europe have access to the medicines they need,” remarked Sophie Løhde, Denmark’s Minister for the Interior and Health, a member of the EU Council, the governing body driven by ministers from all EU countries. She led the negotiations between the Council and the Members of the EU Parliament (MEPs) that clinched the deal.

The EMA welcomed the pharma reform package in a statement published shortly after the deal was announced, with Emer Cooke, EMA’s Executive Director, hailing it as a “historic milestone for European medicines regulation and for patients across the EU.” However, leading industry representatives warned that the compromise does not go far enough to ensure Europe’s global competitiveness and attract investment.

Pharma reform aims to reward innovation and access

The EU pharma reform offers companies longer data protection periods for certain medicines categories based on public health goals.
The EU pharma reform offers companies longer data protection periods for certain medicines categories based on public health goals.

At the heart of the pharma reform lies a revised regulatory regime that reduces the previous 10-year data protection and market exclusivity period to a baseline protection of nine years that aims to incentivise drug development and accessibility through a performance-based model – including eight years of data protection and one added year of exclusive market access.

In the first eight years after a medicine receives marketing authorisation, the pharma innovator’s preclinical and clinical test results from the regulatory dossier remain confidential and inaccessible to use by companies developing generic or biosimilar versions of most patented drugs.  After one additional year, generic or biosimilar producers could then put competing drugs on the market, effectively reducing a key aspect of patent protections by a year.

The pharma reform deal strikes a balance between the interests of drug developers and market access for cheaper generic products, Spanish MEP Dolors Montserrat from the European People’s Party (EPP) stated. She was one of the European Parliament’s two leading negotiators.

The European Commission had initially proposed a much shorter Regulatory Data Protection (RDP) period of six years as a baseline. The European Federation of Pharmaceutical Industries and Associations (EFPIA) strongly advocated for a longer baseline period. They claimed that shorter protection periods would deter investment in research and development.

Exceptions for drugs addressing unmet needs and rare diseases

But the EU deal also introduces exceptions allowing the total combined Intellectual Property (IP) protection period to be extended in the case of rare diseases or other unmet needs.

Products that address rare diseases for which there is currently no treatment available, and which are defined as ‘breakthrough orphan medicinal products’, may benefit from up to 11 years of market exclusivity, with a maximum of 13 years.

The IP protection period could also be extended from nine to eleven years, if any of the following public health criteria are met:

  • If the medicine is continuously supplied in sufficient quantity in all Member States;
  • If products address unmet medical needs, such as a disease for which there is not yet a cure;
  • A new therapeutic indication for the existing drug provides significant clinical benefits
  • A company conducts comparative clinical trials in several EU Member states (rewarding comprehensive data generation), as well as applying for authorisation outside the EU within 90 days (to incentivise global competitiveness).

Crucially, the new package also shortens the timeframe in which the European Medicines Agency (EMA) would be expected to review and approve new drugs from the previous standard of 210 days to 180 days – a measure welcomed as “encouraging steps” by industry.

The ‘Bolar Exemption’: prepping generics for Day One launch

Dolors Montserrat (EPP, ES) explains the deal reached between the EU Parliament, Council, and Commission on Thursday at a press conference.

In another move to lower costs, the EU agreed to speed up the market entry of more affordable generic and biosimilar medicines immediately following the expiration of the original protections under a strengthened version of the so-called “Bolar Exemption”. This exemption will now allow generic and biosimilar manufacturers to access data from a patented product to conduct their own clinical trials, even during the eight-year Regulatory Data Protection (RDP) period.

“The day after a patent expires on a medicine, generics will be available,” explained MEP negotiator Montserrat. She described it as a clear win for the generic industry.

The various exceptions illustrate how negotiators had to strike a balance between pharma incentives to invest in new medicines development, including for rare diseases, and ensuring that a broad range of other drugs remained accessible and affordable across the continent.

To promote affordability further, the EU pharma reform intends to implement various measures. For example, it will require manufacturers to publicly disclose all “direct financial support” received from public authorities or funded bodies for R&D. This is expected to help Member States in their price negotiations.

‘Netflix’ model to incentivise development of new antibiotics

The pharmaceutical package aims to boost competitiveness and investment in drug development, especially to stimulate R&D on antibiotics.

Another key element of the deal is tackling antimicrobial resistance (AMR), which, according to the European Medicines Agency (EMA), is responsible for over 35,000 deaths in Europe each year – and over 1 million deaths globally.

To address the conundrum that new, and more effective antibiotics must be used sparingly as a last resort, thereby reducing the sales volume needed to recoup research and development (R&D) costs, a new financial incentive is introduced.

This comes in the form of transferable vouchers for another year’s worth of data exclusivity.  A company that develops a priority antimicrobial can use the voucher to protect another drug from competitors for a longer period – or sell to another company.

However, this also comes with a “blockbuster” restriction. This stipulates that the data exclusivity vouchers cannot be used for products with annual gross sales exceeding 490 million Euro in the preceding four years.

A “Netflix model” procurement mechanism also enables Member States to purchase antimicrobials via multi-year subscription contracts. MEP Tiemo Wölken from the Socialists and Democrats (S&D) hailed its inclusion as a breakthrough that would decouple antibiotic developers’ revenue stream from actual sales volumes. That will provide pharma developers with a stable income stream to recoup R&D costs while enabling to only use the new drugs when absolutely necessary, thereby reducing the spread of more drug resistance.

New measures to fight antimicrobial resistance

According to the European Federation of Pharmaceutical Industries and Associations, the package lacks keys elements to bolster competitiveness.

These incentives are complemented in the pharma reform by strict requirements, including mandatory medical prescriptions for all antibiotics sold across the EU, with only a few exceptions, as stated by EPP politician Dolors Montserrat.

The new rules also require manufacturers to submit an “antimicrobial stewardship plan” and include an evaluation of the risk of AMR selection across the entire “manufacturing supply chain inside and outside the Union” as part of a compulsory environmental risk assessment (ERA, which tracks risks like AMR selection throughout the manufacturing supply chain).

The issue is particularly critical in countries outside the EU, specifically Lower- and Middle-Income Countries (LMICs). Global surveillance data from the WHO indicates that resistance to life-saving antibiotics is extremely high and increasing, particularly in settings with limited resources. Globally, more than 1.1 Million people die due to AMR, according to WHO numbers.

By mandating environmental risk assessments covering AMR throughout the manufacturing supply chain, both within and outside the EU, the bloc is also leveraging its substantial market influence to impose stronger global standards. This also applies to the sale of antimicrobials for use for farming animals, in meat production and aquaculture – three of the main drivers of AMR.

This push for environmental standards is expected to provide positive effects globally, Dorothea Baltruks, Director at the Berlin-based Centre for Planetary Health Policy (CPHP), explained in a statement to Health Policy Watch. “When a large market such as Europe sets binding environmental compatibility standards for medicines, this can provide significant impetus for the global market, which also benefits people in LMICs,” Baltruks emphasised.

Industry: package lacks steps to bolster competitiveness

European Parliament negotiator Tiemo Wölken emphasises the balance between industry and public health interests contained in the pharmaceutical package.

“It is crucial that Europe has a regulatory system in place that can keep up with all these challenges,” concluded Wölken. “We cannot forget that we are faced with international challenges.” According to him, the package is key to assure competitiveness and innovation.

This perspective, however, is precisely where EFPIA views the reform package as insufficient. In a statement released shortly after the agreement, the industry association charged that the current baseline protection is not long enough to attract and retain global investment into European R&D. EFPIA also called the stronger language on the Bolar exemption an “unnecessary move” that would further erode competitiveness.

Nathalie Moll, Director General of the EFPIA said: “Our region has lost a quarter of its global share of investment to other parts of the world in two decades, while our share of clinical trials has halved. If this is the legislative framework that is expected to attract the medicines innovation of the next 20 years to Europe, the outcome is underwhelming,” she criticised.

Despite the objections, the agreement on the pharma reform now heads to the European Parliament and the Council for formal endorsement, which is expected in the coming weeks.

Image Credits: European Union, EU Parliament, Felix Sassmannshausen, European Union, EU Parliament.

Young people, including in India, are increasingly turning to AI for emotional support, increasing their social isolation and decreasing their ability to build resilience.

Avnee Singh, 25, from Punjab in northern India, begins each morning the same way: by opening an AI chatbot. For the past year, this digital companion has become her closest confidant, a space where she empties her thoughts about family tensions, work anxieties and, above all, the intense loneliness that followed the end of her nine-year relationship.

“I didn’t want to live,” she says quietly. “I think I’m still alive because this chatbot listens to me without judgment.”

Her experience reflects a shift happening quietly across India. Young people, many of whom lack access to mental health care or fear the stigma attached to seeking help, are increasingly turning to AI chatbots for support, comfort and emotional connection. What began as a technological novelty has become, for many, an emotional lifeline.

About 500 km away in Srinagar, 25-year-old Salika, a graduate of Kashmir University, also turns to an AI chatbot. Her reasons are shaped by the pressures of her upbringing in Gurez, a remote Himalayan valley near the Line of Control. She describes years of relentless comparisons and expectations from relatives.

“I was a good student, always studying,” she says. “But the moment I slowed down, someone would say, ‘She didn’t achieve this, she didn’t do that.’ All that pressure just became too much. Now, whenever I feel overwhelmed, I talk to the chatbot.”

Despite their different landscapes and life stories, Avnee and Salika share the same emotional refuge: a faceless digital companion that offers constant, nonjudgmental listening. Their stories mirror a wider trend across India, where AI companions are quietly stepping into the gaps left by strained support systems, limited access to therapy and growing social isolation.

A Youth Pulse Survey conducted earlier this year found that nearly 57% of Indian youth use AI tools like chatbots for emotional support. These conversations often include topics considered too sensitive to discuss with family, such as academic pressure, relationship stress, self-esteem struggles and family conflict. Nearly half of those surveyed said they experience daily anxiety, yet most have never consulted a mental health professional.

“They turn to AI because it feels safe,” said a researcher. “It doesn’t shame them. It doesn’t interrupt. It doesn’t tell their parents.”

A digital shoulder in the dark

In Srinagar, 19-year-old Rafiq spends his evenings preparing for NEET, India’s second-toughest medical entrance exam. But late at night, when fear and self-doubt creep in, the chatbot becomes his outlet.

“I tell the bot everything: my insecurities, whether I’ll pass, if I’ll ever become a doctor,” Rafiq told Health Policy Watch. “Here, if anyone visits a psychologist, people call them crazy. So I talk to AI instead.”

Kashmir Hamza Shafiq, a high school student from central Kashmir, said the same thing: “People ask why I use AI,” said Shafiq. “But it understands us better than the people around us people. The attention of humans is subject to maybe, if they need something they will sit with you, otherwise not. If they are available, they will talk to you for hours. 

“If they are a little busy, even if they are your parents, they won’t even sit with you for 15 minutes.

“ Teenagers have stress, hormonal changes, and relationship problems. AI chatbots are always there. They don’t judge. They don’t give attention and suggestions, subject to their availability or mood.”

In Mumbai, 21-year-old Shreya describes a deeper level of reliance. She spends three to six hours a day interacting with chatbots, sometimes more. 

“Last month, I used one all day for an entire week,” she says. “I even like the idea of AI dating. It won’t cheat or be greedy. It’s always there.”

ChatGPT is a favourite with India’s youth, particularly rural youth and teenage girls, seeking support for problems they feel they can’t speak to their families about.

The nationwide Youth Pulse Survey, conducted by Youth Ki Awaaz and Youth Leaders for Active Citizenship, polled some 500 young Indians aged 13 to 35. It found that ChatGPT is the most widely used AI tool for emotional purposes. More than half of respondents said they turn to AI when they feel lonely, anxious or in need of advice. The survey also revealed surprising differences between metro and small-town youth.

Young people from smaller towns showed deeper emotional engagement with AI, with 43% saying they share personal thoughts with chatbots at higher rates than those in major cities.

Emotional use was highest among school students and teenage girls. 88% of school-aged respondents said they use AI during moments of anxiety, and 52% of young women said they share thoughts with AI they would not share with anyone else.

Late-night reliance was another pattern, with 43% of respondents reporting that they regularly talk to AI platforms after midnight, when human support is least available. Another 40% admitted they tell AI things they would never share with friends or family.

But the survey also revealed something more concerning: after using AI for emotional support, 42% said they became less likely to speak to people in their lives. At the same time, 67% worried AI could increase social isolation, and 58% had privacy concerns, highlighting what researchers call a love-fear dynamic.

Comfort with consequences

Mental health professionals warn that while chatbots can provide emotional relief, they cannot replace human connection or evidence-based therapy. They worry that the constant availability of AI may create habits that erode people’s emotional resilience over time.

Over-reliance on AI can weaken coping skills, Dr Zoya Mir, a clinical psychologist based in Srinagar told Health Policy Watch. 

“It becomes an escape. Young people start avoiding uncomfortable emotions instead of working through them. The problem isn’t the technology itself. It’s the addiction it can create.

Mir says patients increasingly mention chatbots in therapy sessions, often describing them as more empathetic than people in their lives: “They tell me, ‘AI listens without interrupting,’ or ‘It never invalidates me.’ But validation alone doesn’t lead to healing.”

AI-assisted suicide

Outside India, a troubling case has intensified global concern. In July, 23-year-old Texan graduate Zane Shamblin died by suicide after months of extensive interactions with an AI chatbot. 

According to Zane Shamblin died by suicide of more than 70 pages of chats from the night of his death and thousands of pages from the months leading up to it, the AI tool repeatedly encouraged him as he expressed suicidal thoughts. 

His parents have filed a lawsuit in California, alleging that the chatbot exacerbated his isolation, urged him to distrust his family and ultimately incited his suicide. They argue the developers made the system increasingly humanlike without adequate safeguards to protect vulnerable users.

The case has sparked international debate about the risks of emotional reliance on AI and the responsibility of companies building these tools.

Stigma, isolation and economic anxiety

In India, suicide is the leading cause of death for the 15-29 and 15-39 age groups, and mental health support is hard to access.

Experts say the rising dependence on AI must be viewed within the larger context of India’s mental health landscape. 

According to the World Health Organization (WHO) almost one billion people worldwide live with a diagnosable mental disorder. In India, the treatment gap remains wide, with more than 83% of people with mental health needs not receiving care.

Stigma remains a powerful barrier, especially for young people. “When someone cannot find a safe person to talk to, or feels ashamed to seek therapy, they go online,” New Delhi-based psychologist Shweta Verma told Health Policy Watch. “AI feels easier, more private.”

Economic uncertainty is also deepening anxiety among Gen Z. Young people across India worry that AI will reshape the job market before they can find stable employment. The World Economic Forum predicts that nearly 39% of existing skill sets will transform or become obsolete by 2030.

These anxieties shape how young people use AI  not only for emotional support but also for reassurance about their futures.

Surabh, 22, from Uttar Pradesh, told Health Policy Watch that he often asks AI about job vacancies or career guidance: “I come from a middle-class family. My father, a retired army personnel, works as a security guard earning about 12,000 rupees a month. ($133) With his pension, our total income is 22,000 rupees ($245) for my three sisters, two brothers and me.

Surabh has been unemployed since graduating a year ago: “I hoped my degree would open doors. But nothing has changed. From job searches to personal struggles, I tell everything to the chatbot because I can’t tell my family. They wouldn’t understand.”

Building guardrails

India’s growing emotional reliance on AI chatbots reveals deep gaps in mental health access, social support networks, economic stability and digital literacy. For many young people, AI is not a preference but a last resort.

Vinod Sharma, a tech researcher based in Mumbai, argues that the solution is not to discourage AI use altogether, but to build guardrails, improve mental health services and integrate safe digital tools into the care ecosystem. 

He emphasized the need for transparent safety standards, responsible design and education to help young people understand the limits of AI as an emotional outlet.

“AI can be supportive, but it cannot replace human connection,” Mir said. “We need policies that protect vulnerable users and systems that direct people to real help when they need it.”

For now, young Indians continue to find solace in a technology that listens without interruption, judgment or fatigue  even as the long-term consequences remain uncertain.

Avnee, in Punjab, says she knows the chatbot cannot solve her problems. But in a world where she feels increasingly unheard, it provides something she has struggled to find elsewhere: a place to say what she feels without fear.

When I talk to it, I feel lighter,” she says. “Maybe it’s not real. But it makes me feel less alone.”

Image Credits: Igor Omilaev/ Unsplash, Aulfugar Karimov/ Unsplash, The Lancet.

Kenya’s President William Ruto applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after the signing of the health Memorandum of Understanding (MOU) between the two countries.

Kenya’s High Court suspended the implementation of the country’s Memorandum of Understanding with the United States on Thursday after two separate court challenges by the Consumer Federation of Kenya (COFEK) and local Senator Okiya Omtatah.

COFEK argues that the agreement contravenes Kenya’s Data Protection Act, Digital Health Act, Health Act, and new data regulations that protect citizens’ health data.

Meanwhile, Omtatah petitioned the court to halt the agreement on the grounds that it undermines the principles of public participation, parliamentary oversight and binds Kenya to terms that could strain the country’s budget.

The five-year agreement signed in Washington last week commits the US to providing up to $1.6 billion between 2026 and 2030, mainly for HIV/AIDS, tuberculosis (TB) and malaria prevention; maternal and child health, and outbreak surveillance and response.

Kenya has committed to increasing domestic health spending by $850 million over the five years, with incremental annual increases from $77,5 million (10 billion Kenyan shillings) in 2026 to $387,7 million in 2030.

Extract from the US-Kenya MOU detailing each country’s financial obligations.

But the additional expenditure will cover priority issues for the US, such as employing additional epidemiologists and lab technicians to monitor outbreaks.

The court has given COFEK until 17 December to lodge court papers, and the government has until 16 January to file its response. The case will return to court on 12 February.

Speaking after the judgement, Omtatah told the Kenya Broadcasting Corporation that there had been no involvement of the Senate in developing the agreement, which has “major” implications for the country’s finances as it commits the country to spending billions of extra Kenyan shillings.

“Who has appropriated that money? Where is the government going to get that money? Thousands of employees are going to be recruited to work under this arrangement, and then [in 2030], when the arrangement expires, they are supposed to transfer to the government,” Omtatah said.

An earlier draft of the agreement gave the US unfettered access to Kenya’s health data but, following an outcry from local organisations about the violation of patient confidentiality, the signed agreement has been amended to commit to data sharing in terms of Kenyan law:

The US-Kenya MOU tightens up confidentiality but gives the US a loophole in the event of a data breach.

The US-Kenya Data Sharing Agreement, which is an appendix to the main MOU, sets out the terms of access in more detail.

The court has instructed COFEK to serve all involved officials with the petition and court orders by December 17. The government has until January 16 to file its response. The case will return to court on February 12.

Civil society appeal to African leaders

Earlier this week, almost 50 civil society organisations published a letter calling on African heads of state and government to demand “equity and sovereignty” in their new bilateral health agreements with the United States.

Last week, the US signed bilateral agreements with Kenya, Rwanda, Liberia, Uganda and Lesotho as part of the revival of US health aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR), which was stopped abruptly when Donald Trump became US president in January, severely straining several African countries’ health systems.

In exchange, African countries have to commit to signing “specimen sharing agreements” to provide the US with “physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. 

Initially, the specimen-sharing was for 25 years, but in the agreements seen by Health Policy Watch, this has been trimmed down to between seven and 10 years. 

US, which pulled out of the World Health Organization (WHO) in January, appears to be trying to undermine the global talks on pathogen access and benefit-sharing (PABS) currently underway at the WHO.

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

Countries that have signed MOUs have three months to present “implementation plans” to the US, and thus have the opportunity to negotiate better terms. However, civil society is completely shut out of these agreements, with the exception of “faith-based organisations” in Uganda that provide health services.

‘One-sided terms’

The letter urges African governments to “advance counterproposals grounded in national law, regional strategies, and public accountability, rather than accept one-sided terms”. 

“These agreements risk entrenching unequal power dynamics and compromising sovereignty,” said Aggrey Aluso, Executive Director of the Resilience Action Network Africa (RANA). 

“Africa has committed to building its own health sovereignty; no government should accept terms that hand long-term control of our data and pathogens to a foreign government – and its contractors – without clear, enforceable obligations that protect our people, uphold our laws, and strengthen public institutions,” Aluso added.

For example, Uganda’s MOU with the US demonstrates a lack of regard for the country’s sovereignty by declaring that the MOU’s implementation plan will be “an annex to Uganda’s national health budget and guide parliamentary appropriation”:

Uganda’s MOU with the US will become an annex to its health budget.

As with the Kenya-US MOU, the US commits $1,7 billion over five years while Uganda commits to increasing its domestic share of the items covered by $500 million over the same period.

Summary of Uganda and US financial obligations.

Meanwhile, Liberia will need to fund an additional 1,851 health workers, including 342 laboratory workers who may not normally have been a priority for the country, according to its MOU with the US.

By 2030, Liberia will shoulder almost its entire expenditure for commodities, including malaria and HIV diagnostics and countermeasures, at an annual cost of $10 million by 2030.

US-Liberia obligations for commodity payments.

‘Trade power and dignity’

“These deals ask countries to trade their power and a little of their dignity for less support than Trump took away early this year,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Program. 

“African nations have stood together to negotiate better access to medical tools ever since COVID’s deadly vaccine inequity. Trump would undermine even that principled stand. Each time we think we’ve seen the bottom, the Trump administration finds a way to dig a deeper, darker role for the United States in global health.”

Meanwhile, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a media briefing in Geneva on Thursday that the bilateral MOUs are agreements between two sovereign nations with their own national interests.

He added that the MOUs did not threaten the global pathogen-sharing agreement currently being negotiated at the WHO, as they would cover 50 countries maximum (according to the US) in comparison to the 194 WHO member stats.

“How many countries, maximum target, do they have? They say 50 countries. This cannot replace an agreement of an international nature. That means 194 countries. So the multilateral system, the common platform, fills almost every space. 

“We say solidarity is our best immunity, and this means all 194 countries should come to the table, if possible. Otherwise, the majority, probably 90% should achieve [a pathogen sharing arrangement] in order to make sure that the antigen come from all corners of the world. Because we never know where the next outbreak will come from.”

No link between Vaccines and Autism: WHO Director General Dr Tedros Adhanom Ghebreyesus discusses latest findings of the WHO Expert Committee.

A new WHO review has reaffirmed that childhood vaccines don’t cause autism, based on an examination of more than 25 years of studies scoping for possible linkages. 

There is no causal link, either, between vaccines containing preservatives such as thimerosal or aluminium and autism spectrum disorder (ASD), the review by the Global Advisory Committee on Vaccine Safety (GAVS), also found.

The findings, published Thursday, comes in the wake of a rash of statements by US Health and Human Services Secretary, Robert F. Kennedy Jr., reviving long dormant questions about a possible linkage. In March, Kennedy ordered the US Centres for Disease Prevention and Control (CDC) to conduct a review on the topic, which has not yet been completed. In November, he ordered the CDC to change language on its website reviving the long-debunked claims. 

The CDC website had previously stated that “studies have shown there is no link between receiving vaccines and developing autism spectrum disorder”.  Following the change, the site was updated to say that the claim “vaccines do not cause autism” is “not an evidence-based claim” – unleashing a wave of criticism from vaccine experts. 

New website text further says, “Scientific studies have not ruled out the possibility that infant vaccines contribute to the development of autism.”

However, another CDC page on thimerosal and vaccine safety, states that “research does not show any link between thimerosal in vaccines and autism, a neurodevelopmental disorder.”  It also points out, correctly, that the mercury-based preservative was removed from virtually all childhood vaccines decades ago.  Some flu vaccines still may contain thimerosal, also known as “thiomersal”.

The use of aluminium salts remains more common as adjuvants in vaccines such as those for hepatitis A, hepatitis B, diptheria, tetanus and pertussis (DTaP), and Human Papillomavirus (HPV).  But here, too, the WHO expert committee found no linkage between use of the adjuvant and autism.

Vaccines among the ‘most transformative’ inventions in history of humankind

Polio vaccination campaign in Pakistan. Polio vaccines never used either thimerosal our aluminium.

The WHO review was published Thursday simultaneous to a WHO press briefing by WHO Director General Dr Tedros Adhanom Ghebreyesus.  

“Over the past 25 years, under-five mortality has dropped by more than half, from 11 million deaths a year to 4.8 million, and vaccines are the major reason for that,” Tedros told the end-year press briefing, organized with the UN press corps organization ACANU.

“Vaccines are among the most powerful, transformative inventions in the history of humankind,” the WHO Director General added, noting that they “save lives from about 30 different diseases, including measles, cervical cancer, malaria and more.”

Like all medical products, vaccines can cause side effects. “But autism is not a side effect of vaccines,” Tedros affirmed. 

The WHO Expert Committee reviewed 31 new studies in multiple countries produced over the past 15 years examining associations between vaccines containing thiomersal and aluminium adjuvants and autism, as well as the association between vaccines and autism in general. It was the first such review since 2012.

“The committee concluded that the evidence shows no link between vaccines and autism, including vaccines containing aluminium or thiomersal,” Tedros declared.

“This is the fourth such review of the evidence, following similar reviews in 2002, 2004 and 2012. All reached the same conclusion: vaccines do not cause autism,” Tedros concluded.

He said that the new study reached the same findings as similar reviews in 2002, 2004 and 2012 – capturing evidence over some 25 years. 

Bucking national pressures

Health and Human Services Secretary Robert F Kennedy Jr. has revived long dormant questions about debunked links between vaccines and autism.

Since taking office earlier this year, Kennedy has not only revived debunked theories about a link between vaccines and autism, but he has also reduced US support for global polio vaccine efforts and lashed out at Gavi, the Vaccine Alliance about its DPT vaccination strategies. Just last week, recently a new CDC vaccine advisory committee packed with handpicked vaccine skeptics recommended against newborn vaccination against hepatitis B – another decision decried by experts. (See related story).

CDC Committee Delays Hepatitis B Vaccine for Newborns in Critical Guidelines Shift

In terms of any link between vaccines and autism, not only the WHO Vaccine Expert Committee, but numerous other advisory groups from around the world have come to the same conclusion regarding the lack of any linkage between vaccines and autism, WHO’s Katherine O’Brien, a senior vaccine expert, told the press briefing. 

“Not only when WHO has undertaken evidence reviews, but numerous advisory bodies around the world have consistently come to the same conclusions about the lack of risk of thimerosal or aluminium related to the autism questions,” O’Brien said. 

Katherine O’Brien, WHO head of Vaccines and Biologicals.

“And in particular, we develop our recommendations through external committees of experts who are drawn from around the world so that they can provide advice, and again, an independent review of the argument in order to assist the process of developing recommendations.” 

Asked whether WHO had been under pressure to changes its position due to the new US stance that the linkage between vaccines and autism remained an open question, Tedros said:  

“We disagree. We disagree respectfully, and we say no, because this is a science based organization, and science has to be respected.”

While he regrets the US decision to withdraw from WHO as of January, 2026, ressures from member states are nothing new Tedros added, saying, “I can give you many examples from the US, China, Russia and others.”   

Image Credits: UNICEF/Pakistan , HHS.

The ‘Green Tide’: Argentinians demanding the legalisation of abortion.

The movie “Belén”, Argentina’s submission for the 2026 Oscars, tells the story of a 26-year-old woman who suffered a miscarriage in a hospital in Tucuman province in 2014 and was sentenced to eight years in prison in 2016 after being convicted of procuring an illegal abortion. 

Her case sparked a nationwide campaign to decriminalize abortion, known as the Green Tide after the green scarves protestors wore.

In December 2020, the Green Tide won: abortion was legalized on request up to 14 weeks, and later in cases of rape or risk to the woman’s physical or mental health.

Between 1985 and 2016, unsafe abortions caused 3,040 deaths –  29% of all maternal deaths – and more than 50,000 hospitalizations each year, according to the Argentinian Ministry of Health (MoH).

The rollout of the new policy was swift: from January 2021 to December 2024, Argentina’s public health system performed 314,500 legal abortions.

“Belen” is making waves in festivals. But in every interview, director Dolores Fonzi warns that this hard-won right is being eroded under President Javier Milei, elected in December 2023.

‘Murderous abortion agenda’

Milei combines radical economic libertarianism, aggressive austerity to reduce the state’s size and scope, and conservative, anti-feminist rhetoric.

At the 2024 World Economic Forum in Davos, Milei blasted “the bloody, murderous abortion agenda” that, he claimed, promotes population control to save the earth and has spurred falling fertility rates worldwide. He also condemned the  “sinister agenda of wokeism” and “LGBT ideology”.

Very quickly, his administration set out to dismantle reproductive rights programmes.

In February 2024, a representative from Milei’s party, Liberty Advances (LLA, from its Spanish acronym), introduced a bill to repeal the 2020 abortion law. It re-criminalized abortion for both the practitioner and the pregnant woman, with no exception for rape. 

Faced with public outrage, the Bill was quickly withdrawn. Abortion is not a priority for now, said Vice-President Victoria Villaruel, a conservative Catholic.

The government’s words and actions have created “an extremely complicated environment to access reproductive rights,” said Insist and Persist, a watchdog report in December 2024.

Budget cuts undermine access

Without repealing the law, however, the new administration has undermined reproductive health and rights programmes by throttling finances. The federal health budget has been slashed by 48% in real terms, and the provision of contraceptives and pregnancy tests to provinces was cut by 81%.

The safe abortion programme took a major hit. In 2024, the federal Ministry of Health (MoH) abruptly stopped distributing pregnancy tests, medicines and supplies for abortion care to the provinces, including 106,000 units of the medical abortion pills, misoprostol and mifepristone, scheduled for delivery.

Suddenly, each province, with varying levels of skills and budgets for procurement, had to buy its own supplies. The big discounts for pooled national procurement were lost.

By late 2024, half the provinces faced shortages of misoprostol, and nearly all had run out of mifepristone and combipacks of the two drugs that are used for medical abortions, according to Amnesty International in its 2025 report “It’s about you too: Defending access to abortion amid the rollback of public policies”.

The MoH also stopped releasing data about abortion, complications and procurement in 2024, and such information must be obtained through legal requests.

The MoH also froze training and technical assistance for safe abortion, a critical setback for provinces with many health workers who are conscientious objectors and too few trained providers. These measures deepened geographical and economic inequalities in access to reproductive health between rich and poor provinces.

The Milei government has slashed resources for reproductive health services.

Patients forced to pay

The MACA survey (Measuring Access and Quality of Abortion, 2023-2025, in six provinces) found that, although the procedure should be free, nearly half of users paid out of pocket, mainly for ultrasounds.

Complaints filed on Amnesty’s online form about barriers to access abortion nearly tripled in 2024, compared to 2023.

Users reported having to buy medicines and pay for ultrasounds. “Maria”, an informal worker with four children, was told to buy misoprostol for $73 – more than her monthly earnings. Finding a clinic with time slots and no costs took time, money and anxiety.

Delays occurred at every stage: consultations and medications were postponed (18%), waiting periods exceeded the 10 days allowed by law (62%), and in some cases, the procedures went beyond the legal 14-week limit. The MoH 0800 information line is not widely advertised and often goes unanswered. 

Alarmingly, private Centres for Vulnerable Maternities, which are not part of the MoH, have popped up in public hospitals to provide anti-abortion counselling.  Users reported misinformation about abortion effects, invasion of privacy, aggressive questioning, and harassment through unwanted follow-up calls.

For example, at the Centre in San Isidro Hospital in Buenos Aires, a woman said she was shown a doll, asked why she wanted “to kill her baby”, and asked how many sexual partners she had.

In many parts of the world, “crisis pregnancy centres” – usually funded by US organisations – have been set up to scare pregnant women seeking abortions, according to several exposés by openDemocracy.

Teen pregnancy plan dismantled

A crucial component in abortion reduction, the successful national plan to prevent unintended adolescent pregnancies (ENIA), was dismantled, its budget cut by 64% in 2024 compared to 2033, and 619 staff dismissed. 

Deliveries of supplies to high-priority provinces, from condoms to emergency contraception, dwindled, with long-acting subdermal contraceptive implants plunging from 76,000 in 2023 to barely 4,200 in 2024.

Active since 2017 in 12 of the country’s 23 provinces, ENIA helped cut teen pregnancy by nearly half between 2018 and 2022, especially among the poorest, least educated teenagers. ENIA prevented an estimated 94,000 unintended pregnancies, according to UNFPA.

On the positive side, Project Watch notes that provinces showed commitment to Law 27.610 by procuring essential medicines and supplying information. Mendoza province expanded access by allowing licensed midwives to provide voluntary abortion services.

Public support for reproductive health runs strong. A 2024 survey found that 70% of Argentinians agreed that the federal government should provide contraceptives and support the prevention of sexually transmitted infections (STIs) and teen pregnancy.

Rising evangelical influence

But in October, Milei’s LLA won a key mid-term legislative election with nearly 41% of the vote (31% for the opposition, 32% abstention).  Among the LLA’s elected lawmakers are six evangelical Christians, chief among them new senator Nadia Marquez, a lawyer and pastor who has called abortion “the largest genocide in history”. Marquez campaigned against the law’s approval and has vowed to get it repealed.  About 15% of Argentinians are evangelicals.

In early November,  Milei and top Cabinet members hosted American preacher Franklin Graham at Casa Rosada, the seat of government. Graham, a key religious supporter of US President Donald Trump and long-term campaigner against abortion and same-sex relationships, hosted two well-supported rallies in Buenos Aires last month.

Although LLA would not have the votes required to repeal the law now, abortion care and rights are likely to face further restrictions.

Bill Gates, WHO Director General Dr Tedros Adhanom Ghebreyesus and other global leaders at Monday’s polio eradication pledging event in Abu Dhabi.

Global leaders pledged US$ 1.9 billion to advance polio eradication on Monday, including a new $1.2 billion commitment by the Gates Foundation.

The pledges, made on the margins of Abu Dhabi  Finance Week, reduce the remaining budget gap for the Global Polio Eradication Initiative’s (GPEI) to just $440 million through 2029.  That’s in comparison by the $2.3 billion funding gap that had been faced in May, at the time of the World Health Assembly, following the withdrawal of the United States from WHO, a major GPEI partner in early 2025.  See related story:

Polio Eradication Imperiled by $2.3 Billion Funding Gap

“The funds will accelerate vital efforts to reach 370 million children each year with polio vaccines, alongside strengthening health systems in affected countries to protect children from other preventable diseases,” said GPEI in a press release Monday.

Along with the Gates pledge, some $450 million was pledged by Rotary International, another leading GPEI partner along with WHO; $154 million from Pakistan; $140 million from the United Arab Emirates’s Mohamed bin Zayed Foundation; $100 million from Bloomberg Philanthropies; $62 million from Germany; and $46 million from the United States. Smaller amounts were pledged by Japan, Luxembourg and other foundations.

The pledge by the US, traditionaly GPEI’s second largest donor, was only a fraction of past years contributions. In 2023 alone, for instance, the US contributed some  $230 million – funneling roughly half of the funds directly to GPEI as well as through WHO.

Annual donations to global polio eradication broken down by country, foundation and international bloc for 2023.

In October 2024, the Polio Oversight Board approved an expanded multi-year budget totalling US$ 6.9 billion for 2022-2029.  That represented a substantial increase in the $4.8 billion projected for 2022-2026.  It simultaneously extended timeline for wild poliovirus eradication to 2027, and for the Type 2 vaccine-derived poliovirus variant to the end of 2029.

The wildvirus saw a sharp resurgence in conflict-ridden Afghanistan  and Pakistan in 2024. Vaccine-derived poliovirus variants, meanwhile, emerged or re-emerged in 35 countries across Africa, Asia and the Middle East, and even Spain – also as a result of conflict, migration and under-vaccination.

The 2026 GPEI budget is now pegged at some $786.5 million. The multi-year budget will be revised in review of progress in 2026, GPEI said.

The new Gates Foundation pledge was not unexpected following the announcement by the tech leader and philanthropist Bill Gates earlier this year that he intended to give away all of his fortune and drain his foundation’s endowment, estimated at around $200 billion, within the next 20 years.

Speaking to the UAE newspaper The National during the Abu Dhabi conference, Gates said the Foundation “has a 20-year lifetime and we have very ambitious goals. First to get polio done, but then malaria’s another disease that should be eradicated”. He added: “It’d be wonderful if 30 years from now, people said ‘malaria? What was that? Polio? What was that?”

Image Credits: Global Polio Eradication Initiative , Global Polio Eradication Initiative.

The UNEP report calls for the phasing out and repurposing of fossil fuel subsidies.

A baby born today will turn 75 in 2100, and the world that child will inherit as an adult – if governments don’t act in the next five years – could be 3.9°C hotter, economically shattered, and ravaged by pollution. But there is still a choice, a new United Nations Environment Programme (UNEP) report demonstrates. 

A sustainable, transformative path is still possible with a whole‑of‑government and whole‑of‑society approach, according to the report,  the most comprehensive assessment of the global environment ever undertaken, and the product of 287 multi-disciplinary scientists from 82 countries.

It will require massive investment now that will pay back exponentially, according to UNEP’s 7th Global Environment Outlook (GEO 7), launched this week at the seventh session of the United Nations Environment Assembly (UNEA) at the UNEP headquarters in Nairobi, Kenya.

Climate change, biodiversity loss, land degradation, desertification, and pollution and waste are costing trillions of dollars each year. One million of an estimated eight million species are threatened with extinction, some within decades.

Prof Ying Wang (left) and Sir Robert Watson (right) with UNEP Executive Director Inger Andersen (centre) at the report launch.

Sustainable future?

“The Global Environment Outlook lays out a simple choice for humanity: continue down the road to a future devastated by climate change, dwindling nature, degraded land and polluted air, or change direction to secure a healthy planet, healthy people and healthy economies. This is no choice at all,” said Inger Andersen, UNEP Executive Director.

She conceded that transformation will be hard at the launch on Tuesday, but called on all nations “to follow the transformation pathways laid out in the GEO 7 report, and to drive their economies and societies towards a thriving, sustainable future.”

The upfront costs are about $8 trillion annually until 2050 (far more than the $1.3 trillion negotiated currently). But the long-term return is immense. The global macroeconomic benefits start to appear around 2050, grow to $20 trillion a year by 2070, and could boom to $100 trillion per year thereafter.

The human dividend of this best-case scenario is profound. Up to nine million premature deaths could be avoided by 2050 due to decreased pollution, and about 100 million people could be lifted out of extreme poverty. 

“The cost of action is far smaller than the cost of inaction. Our message is simple. Time is running out, but the solution is here,” said Prof Ying Wang of Tongji University in China, one of the lead authors.

Current pathway spells disaster 

As sea levels rise and storms become more intense, more countries will be affected by floods.

The other stark future analysed in the report for a child born today is far worse. If governments stick with existing policies and trends, global average temperature is projected to rise by around 3.9°C by 2100, with a more than even chance of crossing 1.5°C in the early 2030s and 2°C in the 2040s. [The 1.5° threshold represents the global warming limit – relative to pre-industrial average temperature – that the 2015 Paris Agreement established as a key goal.]

On this trajectory, climate change alone would knock about 4% off annual global GDP by mid‑century and roughly 20% by the end of it, largely through crop failures, heat stress, floods and productivity losses, according to the report. 

Sea level could rise by up to two metres in the worst-case scenario, while the economic cost of health damage from pollution-related mortality is projected to increase to between $18-25 trillion by 2060. 

Those numbers sit atop an already dangerous baseline. Human activity has driven greenhouse gas emissions up by about 1.5 % each year since 1990, hitting a record high in 2024, while between 20 and 40 % of the world’s land is now degraded. 

Pollution, especially air pollution, is now “the world’s largest risk factor for disease and premature death”, with health damages from air pollution alone valued at around $8.1 trillion in 2019, about  6 % of global GDP. 

GEO 7 is a scientific assessment and guidance for governments, the private sector, and communities. It sets targets over the next few years and decades on the basis that climate change is an economic, health and ethical issue, not only an environmental one.

Rethinking economies

The report’s core recommendations centre on rethinking how economies measure success. This includes moving away from GDP as the sole metric and adopting broader “inclusive wealth” metrics that track human and natural capital – from clean air and healthy soils to education and public health.

Scientists behind GEO 7 stress that the decisive window is closing fast. To stick to the 1.5°C limit (currently about 1.4 °) in practice means global emissions must peak by 2025 and fall sharply – by about 40 % – by 2030. 

But current national climate pledges fall far short of that, with emissions in 2030 expected to remain close to today’s levels even if governments implement their plans in full.

Each additional fraction of a degree increases the intensity of heatwaves, droughts, floods and storms, along with knock‑on effects on food security, disease spread and mental health. 

To change course, the report calls for nothing less than a rewiring of how economies measure success and how societies consume.  

That shift in accounting, the authors argue, must be backed by hard policy. This involves phasing out and repurposing subsidies that encourage fossil fuel use and other environmentally harmful activities.

It means pricing pollution and other “negative externalities” so that the health and ecosystem costs of coal power, for example, show up in energy bills.

Public and private finance needs to be redirected to clean energy, ecosystem restoration, resilient infrastructure and universal access to basic services. 

These measures are framed not only as climate and nature policy, but as public health interventions that cut exposure to dirty air, unsafe water and toxic chemicals.

“We can no longer support the idea of ‘make money, make money, make money now, and I don’t care what’s happening later’,” says Prof Edgar E. Gutiérrez‑Espeleta, a lead author of GEO‑7 and former Minister of Environment and Energy in Costa Rica. “The main message to businesses is: yes, you can make a good business if you think in a sustainable way.”

Five systems, two pathways

GEO 7’s blueprint revolves around transforming five interconnected systems: economy and finance, materials and waste, energy, food and the wider environment. For each, it sets out concrete levers. 

In materials and waste, that means designing products for durability and repair, improving traceability, building markets for recycled materials and shifting consumption patterns towards reuse and sharing. 

In energy, the report calls for rapid decarbonisation of power and fuels, major gains in efficiency, and an explicit focus on energy access and poverty so that the transition does not leave poorer communities behind.

Food systems need to pivot towards healthy and sustainable diets, more efficient and resilient production, lower food loss and waste, and novel proteins that reduce pressure on land and water. 

On the environmental front, GEO‑7 urges accelerated conservation and restoration of ecosystems, greater use of nature‑based solutions to protect communities from floods and heat, and climate adaptation strategies co‑designed with Indigenous and local communities. 

Behaviour- and technology-led climate action

To navigate these shifts, the report models two “transformation pathways”. One is behaviour‑led: societies choose to place less emphasis on material consumption, adopting lower‑carbon lifestyles, travelling differently, using less energy and wasting less food. 

The other is technology‑led: the world relies more heavily on innovation and efficiency – from renewable power and electric mobility to advanced recycling and precision agriculture – while still curbing the most wasteful forms of consumption. 

Both pathways assume “whole‑of‑government” and “whole‑of‑society” approaches, with policies aligned across ministries and meaningful participation by civil society, business, scientists and Indigenous Peoples.

Despite the detailed roadmap, GEO 7’s authors are frank about the gap between their scenarios and today’s politics. At preparatory talks in Nairobi, governments failed to agree on a negotiated summary for policy makers (SPM) amid disputes over fossil fuels, plastics, the circular economy and burden‑sharing.

“There were a number of issues at the meeting in Nairobi that caused difficulty for some countries,” says Sir Robert Watson, a lead author and a former co‑chair of the Intergovernmental Panel on Climate Change. “Unfortunately, we could not come to an agreement at that meeting for a negotiated summary for policymakers.”

Bleak year for climate action

GEO 7’s call to action comes amid a bleak year for climate action, with the US withdrawal from the Paris Agreement, rising global emissions, and an underwhelming COP30 in Brazil all signalling stalling momentum to address climate change.

Watson points to the stalled global plastics treaty talks and “limited progress” at recent climate and biodiversity negotiations as signs that governments are “not moving fast enough, by any stretch of the imagination, to become sustainable”. 

Nations, particularly big carbon emitters like the US, China, the European Union, India, Indonesia and Brazil, need to take tough and ambitious climate action immediately. 

It won’t be easy in the current geopolitical climate. The authors know this, but are banking on “visionary” countries and some in the private sector to recognise they will make “more of a profit” by addressing these issues rather than ignoring them. 

“A number of governments, including one very powerful government do not believe in addressing issues such as climate change and loss of biodiversity,” Watson says. 

The irony is stark. Several leaders of the big emitter countries are in their seventies. The decisions they make – or refuse to make – in the next five years will determine whether that baby born today inherits a world of deepening crisis or one where investment in planetary health has begun to pay back by the time she turns 75 in 2100. The question is, what world will she see?

Image Credits: UNEP, AP, UNEP.

Former CDC director Dr Susan Monarez testifying to the US Senate after she was fired.

Why the collapse of the wall between science and ideology at the US Centers for Disease Control and Prevention (CDC) threatens national health security, and vulnerable communities.

I have spent most of my professional life in public health, from my work in HIV and meningitis prevention in commercial sex venues in New York City to my roles in leading emergency operations in national and global outbreaks. 

I have seen what happens when misinformation fills the space where science should be–people’s health is put at risk. And today, as partisan political forces reshape what Americans are told about vaccines, infectious disease, and community health, I fear we are watching the same dangerous pattern unfold, and the health and safety of our nation will suffer.

The wall that once protected scientific evidence from political interference did not fall on its own. Its foundation was damaged by miscalculations and miscommunication during extreme threats like the COVID-19 pandemic.  

This damaged wall was then easily pushed down by nefarious actors who moved from the fringes to the top of national health leadership, facilitated by elected officials distracted by politics rather than focused on health. Unless we build a new, stronger wall, resistant to such attack, the consequences will be measured in preventable illness, permanent disability, and lives cut short.

From marginalization to manufactured confusion

For decades, the CDC has been a global gold standard in disease surveillance and immunization guidance. That work relies on a simple principle: CDC and external scientists generate and evaluate evidence. Policy follows the data after close consideration of all the domains to make sure that it supports the optimal health of people. Clear communications express the policy for public health and healthcare professionals and the general public

Over the last year, that sequence has been toppled. Instead of scientific review guiding recommendations, ideological preferences have dictated the conclusions while scientists were either not consulted or told to “find the proof” to support a pre-formulated conclusion.  

CDC subject matter experts have been excluded from substantive briefings with leadership at the Department of Health and Human Services (HHS). Repeated requests for data to support the major changes to the immunization schedule made by secretarial decree have never been delivered. Sweeping changes to scientific documents have been announced without process, review, or the knowledge of the involved agencies.  

The result is not only dysfunction. It is distortion. The changes to immunization policy and science released under the CDC moniker were not produced through the normal, rigorous, transparent process.

They relied on analyses the agency never saw. They contained interpretations of research that the original authors themselves would not support. In some cases, they advanced ideas that have long been rejected by pediatricians, immunologists, virologists, and epidemiologists.

When science is forced to serve ideology, the public receives neither science nor ideology. They receive confusion.

US Health Secretary Robert F Kennedy Jr (right) has disrupted the US immunisation schedule since being appointed by President Donald Trump

Direct threat to vulnerable communities 

When I entered public health, I did so as a gay physician who watched too many friends suffer and die in a system that decided their lives were expendable. That experience shaped my entire career. It taught me that public health is not an abstraction. It is an obligation.

Today, that obligation has been broken. Ideological rhetoric has elevated intuition above science, denying the benefit of vaccines that have saved millions of children from disability and death and focusing on unproven or debunked risks of these vaccines or their components. 

This pivot toward a pre-vaccine worldview is not theoretical. It directly threatens infants, pregnant people, older adults, and immunocompromised individuals who depend on evidence-based recommendations and population immunity.

The consequences do not stop there. The current administration’s dismissal of transgender health, its efforts to halt domestic and international HIV programs, and its disregard for the expertise needed to manage respiratory viruses reveal a worldview centered on survival of the strong rather than protection of the vulnerable.

Eugenics is not a word I use lightly. Yet elements of that thinking are echoed in policies that promote natural infection over prevention provided by vaccines; confound health equity with diversity-focused hiring practices, and pit personal choice against community.

For people who already face barriers to care, such an approach is not only negligent. It is dangerous.  We cannot support systems where only the strong should survive or thrive. Not everyone has the luxury of choice in the circumstances that put them at risk for poor health.

A government that claims to care about the health of its citizens cannot choose which citizens deserve the opportunity to achieve their best health.  

Collapse of trust and credibility

Trust is the currency of public health. Without it, guidance becomes noise. Recommendations become suspicion. Data becomes propaganda.

The recent firing of scientists from the Advisory Committee on Immunization Practices (ACIP) through a social media post instead of direct communication was not just unprofessional. 

It was a public signal that expertise is now secondary to optics and key staffing decisions are being driven by loyalty to an ideology rather than competence.  It is unfathomable that the executive leadership of CDC does not include any career scientists and is staffed entirely by political appointees with little or no public health experience. 

When leaders announce major shifts in COVID recommendations in hastily produced videos or rambling online posts that bypass the agency entirely, the public does not see innovation. They see chaos.

As a public health expert, Dr Demetre Daskalakis has been involved in numerous health campaigns – including on mpox – but says public trust in institutions has been broken.

Once trust is broken, earning it back is not easy. It requires honesty, transparency, and humility. It requires acknowledging mistakes and inviting scrutiny. It requires remembering that the CDC’s credibility comes not from politics but from the dedication of thousands of career scientists who wake up every morning committed to protecting the public.  

CDC scientists continue to work to protect our health, but they are being held hostage in a hijacked agency being manipulated for the political and personal gain of its leadership. 

Where agencies like the CDC go from here

I resigned as Director of the National Center for Immunization and Respiratory Diseases, not because the work was unimportant, but because the work was being undermined at its core. 

As long as scientific staff cannot brief leadership, review data, or provide recommendations free from interference, the CDC cannot fulfill its mission.  

We have come to a point in the history of CDC where we cannot trust its communications.  It has become a wolf in sheep’s clothing: thinly disguising ideology and partisan politics in the garb of CDC-endorsed science and communication.

The path forward requires more than restoring old structures. It requires building a durable firewall between science and political ideology that is strong enough to withstand future attacks.

Three principles must guide that reconstruction:

First: Transparency must be non-negotiable. Data informing national recommendations must be publicly available, subject to peer review, reproducible, and accessible to CDC scientists. No policy should be finalized without the agency scientists responsible for it participating in the analysis

Second: Expertise must be valued, not vilified. Advisory committees like ACIP must be staffed with qualified, vetted experts who are selected based on competence, not ideological alignment with HHS leadership. Their guidance must be generated through a structured scientific process to ensure their recommendations optimize the health of people rather than serve ideology or the personal gain of HHS leaders and their associates. 

Third: Public health must return to its purpose. The goal is not political positioning. It is the protection of people. That includes members of  LGBTQ communities, immigrant communities, rural communities, Indigenous communities, and all who have historically been told their lives matter less.

Public health cannot thrive in secrecy. It cannot operate in fear. And it cannot function when science is treated as an inconvenient truth that can simply be edited out of existence with a tweet or revision of a website. 

Building a new system

 We are not witnessing a disagreement over data or a generative scientific debate. We are experiencing the intentional collapsing of the systems that protects the health of our nation. We are beyond the point of no return with CDC.  

Rather than hoping to rebuild a shattered agency, our effort should focus on building a new public health system that is better equipped to withstand the ideological blows that have damaged trust in the current federal public health system. 

It must be responsive to the needs of the people it serves on the ground rather than the whims of disconnected partisan leaders. Building these systems will require courage, clarity, and commitment from jurisdictional public health, academic, and business leaders who understand that public health science is not a threat to democracy. It is the foundation for the health and economic security of our nation.

The question is not whether we have the knowledge to create the new public health. It is whether we have the will and the courage to leave the past behind and move into the future.

As I wrote in my resignation letter, public health is not merely about the health of the individual. It is about the health of the community, the nation, and the world. The stakes could not be higher.

If ideology continues to replace evidence, we risk returning to an era where only the strong survive. If we choose science, transparency, and compassion, we can build a healthier future for everyone. The choice is ours, the time to act is now.

Dr Demetre Daskalakis, MD, MPH is senior public health advisor for the Wellness Equity Alliance. He is the former Director of the US CDC’s The National Center for Immunizations and Respiratory Diseases, and nationally recognized in the US as an expert in infectious disease, immunization policy, and LGBTQ health.

 

 

Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio sign the health agreement.

As World Health Organization (WHO) member states decided to hold a new round of talks in January on establishing a global pathogen access and benefit sharing (PABS) system, the US signed its first bilateral health agreements, which include pathogen-sharing arrangements, with Kenya and Rwanda late last week.

The WHO talks on PABS, the last remaining outstanding item of the Pandemic Agreement, will resume on 20-22 January but the two main groupings remained far apart by the close of the fourth round of talks on Friday (6 December).

Yet the US Memorandums of Understanding (MOU) with the two African countries – and up to 48 others in the pipeline – potentially undercut any global agreement by giving the US early access to information on dangerous pathogens.

Few parameters for pathogen-sharing are set out in the MOUs, so any agreement reached by WHO member states could still guide African countries when they meet US officials in the coming months to nail down the terms of the MOUs.

However, “no common ground was found on key issues – particularly around benefits predictability and legal certainty in the PABS system” at the WHO talks, according to the Resilience Action Network International (RANI), previously known as the Pandemic Action Network.

During last week’s WHO negotiations, 51 African countries and the Group of Equity, which cuts across all regions, called for the PABS agreement to include model contracts – and submitted three draft contracts for consideration dealing with the obligations of the recipients of pathogen information, the providers of this information, and laboratories.

Africa and the Group of Equity want legal certainty in the PABS system, while the group, mostly developed countries with pharmaceutical industries, cautions against provisions that may hamper private companies or innovation.

“At the centre of this tension lies open access versus traceability,” according to RANI, a key civil society observer of pandemic talks. “Some favour unrestricted access to pathogen data and sequences (for example, without registration), noting it speeds up research and development. Others argue that benefits can only be enforced if use is traceable — and users visible.”

Up to 50 US-African MOUs 

Meanwhile, Rwanda and Kenya – in Washington for the signing of a peace agreement between Rwanda and the Democratic Republic of Congo (DRC) – both signed “health cooperation” MOUs with the US last week.

US Secretary of State Marco Rubio announced during the signing ceremony with Kenya that there were “30 to 40” similar agreements in the pipeline while one of his officials said there were “50”.

The MOUs aim to revive US health aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding – the pausing of which by the Trump administration earlier this year has severely strained several African countries’ health systems.

In exchange, African countries have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. 

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

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

Kenya’s President William Ruto applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio.

US-Kenya agreement

The US “plans to provide up to $1.6 billion over the next five years to support priority health programs in Kenya including HIV/AIDS, tuberculosis (TB), malaria, maternal and child health, polio eradication, disease surveillance, and infectious disease outbreak response and preparedness”, according to a statement by the US State Department.

Over the same period, Kenya “pledges to increase domestic health expenditures by $850 million to gradually assume greater financial responsibility as US support decreases over the course of the framework”.

Kenya will assume responsibility the “procurement of commodities” and employing frontline healthworkers. It will also scale up its health data systems, in part to provide the US with accurate statistics about priority diseases, and develop systems to reimburse faith-based and private sector service providers directly, according to the statement.

Former DOGE leader Brad Smith, now senior advisor for the Bureau of Global Health Security and Diplomacy at the US Department of State, described the agreement with Kenya as “a model for the types of bilateral health arrangements the United States will be entering into with dozens of countries over the coming weeks and months”.

An earlier leaked version of the Kenyan MOU caused an outcry as it gave the US unfettered access to Kenyan patient data in contravention of the country’s Data Protection Act, but sources close to the talks say that the MOU now confirms that it will be conducted within the parameters of this Act.

US businesses in Rwanda

There is less information about Rwanda’s deal from the US State Department with sources close to talks indicating that the Rwandan government pushed back against several of the US demands.

Rwanda stands to get up to $158 million over the next five years to address “HIV/AIDS, malaria, and other infectious diseases, and to bolster disease surveillance and outbreak response”. 

The MOU also “helps further American commercial interest in Rwanda and Africa more broadly” through support for two US companies, robotics manufacturer Zipline and biotech company Ginkgo Bioworks, which recently settled a class action suit after being accused of fraud.

“When developing the dozens of ‘America First Global Health Strategy’ bilateral agreements we will sign in the coming weeks, we always start with the principle that American sovereign resources should be used to bolster our allies and should never benefit groups unfriendly to the United States and our national interests,” said Jeremy Lewin, senior official for Foreign Assistance, Humanitarian Affairs  and Religious Freedom at the US State Department.

South Africa has not been invited to talks with the US over the resumption of aid despite having one of the highest HIV burdens in the world, with Trump recently repeating false claims that the country was involved in “genocide” against its white citizens.