Germany’s top climate civil servant questioned a poor-country negotiator’s figure on how little climate finance reaches health. The resistance sets the stage for an uphill battle for the health world to get the urgently needed money to adapt to the climate crisis next month.

BERLIN – Germany’s top climate civil servant pushed back on Monday against a call from the world’s poorest countries for more climate finance for health. The money fight of COP31 opens officially in Antalya, Türkiye, next month. In the halls of the World Health Summit in Berlin, it’s already started.

Less than 0.5% of climate finance goes to health, Dr Sidi El Moctar, a Mauritanian health ministry official, told a World Health Summit panel. He wanted to know how the least developed countries, Mauritania included, could get more to address the health crises amplified by climate change.

“We say in French, le financement, c’est le nerf de la guerre,” said the official, who negotiates on adaptation for the Least Developed Countries group at UN climate talks. Money, as the French saying has it, is the “lifeblood of war” – a truism over three decades of UN climate summits as fights over financing dominate proceedings.

But Jochen Flasbarth, state secretary at Germany’s environment ministry, questioned the number before answering. “I would make some question marks,” he said about the figure, which the World Health Organization (WHO)  first published in 2021 and which was still being cited at COP30 in Brazil last year.

Health-specific climate finance reaching climate-vulnerable countries totals roughly $500 million to $700 million a year, about 2% of adaptation funding and the 0.5% of multilateral climate finance the negotiator cited, Health Policy Watch reported at COP30.

“Whenever we work on mitigation, it has an impact also on the health sector,” Flasbarth said. “When you narrow it down to how much money is going to the health sector, like hospitals, medical institutions and so on, then it might be smaller.”

Crunching the numbers 

Jochen Flasbarth, state secretary at Germany’s environment ministry, at the World Health Summit in Berlin on 12 October. He co-chaired mitigation talks at the pre-COP in Fiji last week.

The exchange, cut short as Flasbarth left the panel early for another engagement, previews a critical question for the health world that will return next month at COP31: will global health ever get a serious spot in the climate money conversation?

As wealthy governments count their emissions cuts as health protection, countries on the front line of the climate crisis say the clinics, cold chains and disease surveillance they need to survive heat, floods and outbreaks are unfunded. 

A special report from the WHO and Brazil, launched at COP30 in Belém last year, put the cost of direct health adaptation in those countries at more than $22 billion a year by 2035.

The case made by Flasbarth for mitigation as health spending is borne out by critical environmental threats like air pollution from burning fossil fuels, which causes about five million premature deaths a year. Cutting emissions could deliver major health gains and reduce pressure on health systems within years.

“However you quantify this, you come up with very large potential benefits in the near term, over and above the benefits of reducing the risk of dangerous climate change,” said Andrew Haines, professor of environmental change and public health at the London School of Hygiene & Tropical Medicine, who chaired the session. “Health is not just the province of the healthcare sector. So many determinants of health are social and environmental.”

COP31 will feature major battles over the future of climate financing for low-income nations. With health sitting outside the formal negotiations, the odds of securing major financing are slim.

Germany put €4.7 billion of federal budget money into international climate finance in 2025, down from €6.1 billion a year earlier and short of the €6 billion a year successive governments had promised, according to a joint release from Flasbarth’s environment ministry and the development ministry last week. The release does not mention health.

“We’re clearly not doing enough,” EU climate commissioner Wopke Hoekstra told reporters at the pre-COP meeting in Fiji last week, as Pacific leaders pressed wealthy nations for more money.

“The world is expected to cross 1.5°C of global warming above pre-industrial levels in the next few years,” Hoekstra said. “That means we’re talking about survival of the world as we know it.”

In Antalya, health will have no formal negotiating track of its own. Türkiye’s health ministry plans a Health Day on 9 November, the summit’s opening day, and “Dynamic and Resilient Health Systems” is one of 10 themes in the presidency’s action agenda, a voluntary track outside the formal talks.

“There is some progress,” the Mauritanian negotiator said of the push to bring health financing into the climate talks. “But we need more voices in these rooms.”

Fighting over the same money

Comparison of adaptation financing needs, modelled costs and international public adaptation finance flows
in developing countries, per UNEP data.

Across all of adaptation, developing countries will need $310 billion to $365 billion a year by 2035, including for the climate-resilient health systems they are asking for, the UN Environment Programme estimates. But the international public adaptation finance reaching them in 2023 was $26 billion, down from $28 billion the year before.

A string of newer funds have popped up to chase what money remains as foreign aid and development assistance collapse globally across all sectors. The Pacific Resilience Facility, which entered into force in May, set out to raise $500 million. It had commitments for less than half of that when Fiji added $10 million at the pre-COP in Nadi last week, AFP reported.

The Fund for Responding to Loss and Damage, the headline achievement of COP28 in Dubai, had $822 million in pledges by April but only $449 million paid in. The fund has yet to disburse any money, and despite that, could face “liquidity issues” as early as next year, Climate Home News reported. Campaigners put developing countries’ loss and damage needs at up to $400 billion a year.

“Climate has gone down on the agenda with governments around the world,” said Katrín Jakobsdóttir, the former Icelandic prime minister who chaired the Pan-European Commission on Climate and Health convened by WHO’s European office. “AI and conflicts around the world are higher on that agenda. That does not mean that the climate crisis has gone anywhere.”

Adding to the funding crunch, more than 90% of what development banks provide for health adaptation arrives as loans rather than grants, a major barrier for low-income governments already struggling to service their debts.

In lower-income countries the IMF rates at high risk of debt distress, governments have cut education spending by 8% and health spending by 1% since 2019, the campaign group Debt Justice found in research published on Sunday. In 113 developing countries, servicing foreign debt cost more than education in 2025, according to UNESCO.

Mauritania paid $373 million to service its public external debt in 2024, World Bank data shows. This is more than half the total available health-specific climate finance that climate-vulnerable countries receive in a year.

“In Senegal, half of our revenue goes to creditors,” said Souleymane Gueye of the Senegalese campaign group FRAPP. “Education and healthcare share barely a quarter.”

Children suffer most from lead exposure.

HARIPUR, Pakistan – Unregulated industrial pollution and lead exposure are poisoning a generation, with four in 10 children in high-risk cities carrying unsafe blood-lead levels, exacerbated by toxic smog and weak enforcement, according to a UNICEF study.

Few months ago, Malik Ayaz Ahmed, 22, took a job at a lead-processing factory in Hattar, an industrial belt outside Haripur in Khyber Pakhtunkhwa, in the northwest of Pakistan.

He started work barely a month after a national study revealed that children living near his hometown’s factories had among the highest blood-lead levels ever recorded in Pakistan.

Weeks later, Ahmed fell seriously ill and was admitted to the district headquarters hospital. A clinical test seen by Health Policy Watch put his lead level above 103 micrograms per decilitre — nearly 30 times the safe threshold reference of 3.5 µg/dl.

“It was the test case that showed whether industry had followed any safety protocols to control lead exposure. It had not,” said Tariq Mehmood, executive director of the Human Unity Movement in Haripur, who has spent years documenting the toll of the Hattar industrial zone.

In Pakistan, lead battery manufacturing units and paint factories are major sources of lead exposure, while informal recycling of lead batteries is the main lead poisoning route.

The lead batteries market volume was estimated to be worth $1.65 billion in 2026, while in the paint industry 40% of solvent-based paint samples exceeded Pakistan’s legal lead limit of 100 ppm, with a maximum of 97,000 ppm.

Alarming pattern

Ahmed’s case is an adult echo of a much larger and alarming pattern disclosed by Pakistan’s government and UNICEF earlier this year. Four in 10 children aged 12–36 months in high-risk areas of seven cities carry lead in their blood at levels that the World Health Organization (WHO) considers unsafe.

In Hattar itself, 88% of children tested had elevated blood-lead levels, compared with just 1% in nearby Islamabad, the federal capital of the country. Researchers describe this gap as one of the starkest environmental health disparities documented anywhere in South Asia.

The study, “Ending Childhood Lead Poisoning: Evidence for Policy Action,” shared exclusively with Health Policy Watch,  tested 2,175 children across 21 sites in Pakistan’s major industrial cities, including Karachi, Lahore, Peshawar, Rawalpindi, Islamabad, Quetta and Haripur.

It found a national mean blood-lead level of 3.12 µg/dl, with one child registering 107.63 µg/dl, among the highest values ever reported in the medical literature.

UNICEF estimates that 47 million Pakistani children have blood-lead levels above the WHO threshold, and warns that global modelling suggests the true toll could be far worse, with up to eight in 10 Pakistani children potentially affected. This is among the highest rates in the world. The organisation puts the economic cost of the resulting lost cognitive potential at 6–8% t of GDP, or roughly $25–35 billion a year.

“Protecting children from lead exposure is a national public health priority,” said Muhammad Aslam Ghauri, former federal secretary of the Ministry of National Health Services, Regulations and Coordination, calling for stronger surveillance and enforcement.

UNICEF Representative in Pakistan Pernille Ironside was blunt about the stakes: “There is no safe level of exposure to lead for children whose harmful effects are irreversible.”

There is no known safe level of lead exposure.

Where lead meets smog

Public health experts and environmental researchers insist that Pakistan’s lead emergency is unfolding inside one of the world’s most polluted airsheds, and the two toxins appear to interact.

“Co-exposure to air pollutants like particulate matter can significantly affect lead absorption, bioavailability and overall metabolism,” said Dr Ammara Naeem, a consultant paediatrician at Sulaiman Al Habib Hospital in Saudi Arabia.

Fine particulate matter can chemically alter how lead behaves in the body, trigger inflammation, and act as a carrier that deepens exposure, meaning a child breathing Pakistan’s smog is likely absorbing more lead, not less, than the same child in cleaner air, explained Naeem.

Islamabad-based climate policy advocate  Dr Zainab Naeem of the Sustainable Development Policy Institute points to shared sources: old paint and mining residue in Khyber Pakhtunkhwa, informal battery-recycling smoke, e-waste burning, and the open incineration of industrial waste.

“There are no safety protocols for battery recycling; this informal smoke damages [health], and there is a problem of child labour in the industry, especially in the big cities,” she said, adding that weak coordination between federal and provincial environmental agencies has let both crises fester in parallel.

The numbers bear this out. Pakistan ranked as the world’s most polluted country in IQAir’s 2025 World Air Quality Report, with an average PM2.5 concentration of 67.3 µg/m³ – 13.5 times the WHO annual guideline of 5 µg/m³.

As of mid-February 2026, IQAir’s real-time index placed Lahore as the third most polluted major city on Earth and Karachi eighth, with AQI readings above 200 recorded across the country’s urban centres.

Pakistan’s own National Environmental Quality Standards permit ambient air lead levels of up to 1.0 µg/m³ annually, but researchers and lawyers alike say enforcement of that ceiling is negligible outside a handful of monitored zones.

The World Bank has repeatedly quantified the economic toll of dirty air. Its Pakistan Country Climate and Development Report estimates air pollution imposes economic losses equivalent to roughly 6.5% of GDP annually, and health costs equivalent to roughly 9% of GDP in 2019.

The Federal Minister for Climate Change, Dr Musadik Malik, framed the two crises as inseparable: “Air pollution is a major challenge to human health,” he said, calling for reforms across industry, transport and energy, tighter monitoring and enforcement, and wider adoption of electric vehicles.

In a statement he said clean air is a basic right of every citizen, describing joint national efforts on the environment as unavoidable — language that mirrors, almost verbatim, the coordinated-action rhetoric now attached to the lead response.

A patchwork of poorly enforced laws

Pakistan is not without a legal architecture. The Pakistan Environmental Protection Act, 1997, together with the National Environmental Quality Standards, hazardous-substance rules and provincial environmental laws, gives regulators broad powers to monitor pollution, investigate violators and issue Environmental Protection Orders.

“The more significant weakness is implementation and enforcement rather than the complete absence of law,” said Advocate Bina Faraz, an environmental lawyer.

Faraz argues there is a strong case for regulating air pollution and toxic-metal contamination jointly, as industrial emissions routinely poison air, soil and water through the same smokestacks.

“Treating air pollution and toxic-metal exposure as entirely separate regulatory silos can leave gaps in accountability,” she said, calling for independent monitoring of emissions and blood-lead levels alike, and a legally binding action plan with enforceable timelines, mandatory reporting and defined penalties, rather than the largely aspirational plans Pakistan has produced to date.

Industry, for its part, does not fully dispute the picture. Malik Ashiq Awan, chair of an industries association covering the Hattar zone’s roughly 418 factories, acknowledged there are “health issues because of industry,” including from lead-battery units, alongside ongoing air pollution and water contamination.

He said filtration systems needed to curb emissions are prohibitively expensive to install and operate, but added: “I support it should be checked.”

Haripur’s District Health Officer, Dr Mohsin Turabi, confirmed that his department took part in the sampling, and that affected workers and children were treated if lead was detected – a response he called a step toward a broader government policy to curb exposure, although he acknowledged children were harmed in the first place because safety protocols were never implemented.

Children pay the most

The health data from the UNICEF study reads as a cascade of compounding harms. Nearly 40% of the children tested were stunted, over a third underweight, and 55.7% were anaemic. These figures rise to 63–66% in Karachi and Lahore.

Children with detectable blood-lead levels had significantly higher rates of stunting, being underweight, and anaemia than those without. Behaviourally, 74% of exposed children showed hyperactivity, 71% frequent mood swings, and 68% regular tantrums. These patterns are consistent with the neurodevelopmental damage lead is known to cause.

But blood-lead testing itself remains a bottleneck. 

“Most primary, secondary and even tertiary care public-sector hospitals don’t have the facility for lead testing in their laboratory,” Dr Ammara Naeem said, warning that real surveillance would require major investment in lab equipment, trained phlebotomists and electronic reporting – infrastructure Pakistan largely lacks outside a single accredited national facility.

A plan, if it is enforced

Pakistan’s first Multi-Sectoral National Action Plan on Childhood Lead Poisoning has been developed as a result of the study. It is endorsed by federal and provincial stakeholders and built around a national steering committee, harmonised standards for paint, food and cosmetics, formal oversight of informal battery recycling, and integration of lead screening into routine child-health programmes.

“Lead poisoning is one of the most preventable threats to child health and development,” said Abdullah Fadil, director of the Partnership for a Lead-Free Future, whose mission to Pakistan coincided with the study’s launch, with a stated goal of eliminating childhood lead poisoning by 2040.

Whether that target is credible will depend on the same institutional weaknesses that have long stalled clean-air enforcement in Pakistan — chronic under-resourcing, poor federal-provincial coordination, and industries able to absorb fines more easily than they can afford filtration.

For now, in Hattar, Tariq Mehmood says villagers are still filing complaints with the  Environmental Protection Agency office that rarely seals a factory, breathing air that a UN agency has linked directly to the lead now circulating in their children’s blood.

Image Credits: Luis Arias/ Unsplash, WHO, IQ Air.

A baby in Niger shortly after being vaccinated.

In the face of dwindling health budgets, the World Health Organization’s (WHO) expert committee on immunisation has made several suggestions to enable countries to optimise existing vaccine supplies.

Countries can continue giving a single dose of the human papillomavirus (HPV) vaccine to girls aged 9-14 years to prevent cervical cancer – instead of two doses, the Strategic Advisory Group of Experts on Immunization (SAGE) advised.

This could enable resource-constrained countries to extend the vaccine to women aged up to 30 who have missed out, and routine vaccination to boys aged 9-14.

SAGE also recommends that countries can consider routine vaccination of girls aged 4-8 years with a single dose of HPV vaccine “if this is likely to result in increased vaccination uptake and coverage”.

“The global HPV vaccine coverage, at 33%, is far short of the global target we’re looking for, which is 90%,” SAGE chairperson Professor Anthony Scott told a media briefing on Tuesday.

“So, based on a review of updated evidence, SAGE decided the single dose schedule for girls aged 9 to 14 is now the most efficient approach to achieve this global target.”

SAGE chairperson Professor Anthony Scott

Diphtheria booster during outbreaks

Countries may also consider a single diphtheria vaccination during an outbreak, although SAGE cautions that this must be followed by routine immunisation. Children under a year usually get three doses of a diphtheria-tetanus-pertussis (DTP3) vaccine.

“[Diphtheria] outbreaks have been increasing globally, particularly in West Africa, South[ern] Africa, and the Eastern Mediterranean region. The outbreaks clearly reflect gaps in immunity caused by low vaccine coverage,” Scott explained.

SAGE also confirmed that a one-fifth fractional dose of yellow fever vaccine can be used in outbreaks for people aged two and older “when vaccine demand exceeds supply”.  

The same fractional dose can be used for preventive vaccination campaigns for people aged 2-59  “when vaccine supply, financial or other programme constraints would otherwise limit the timely implementation, scale or coverage of vaccination”, said Scott.

There should be no skimping on the polio vaccine, however. Countries giving fewer than three polio doses “should transition without delay to a three-dose infant schedule administered at 6, 10 and 14 weeks of age” and ensure 90% coverage.

However, fractional or full additional doses can supplement the three doses during outbreaks.

Gavi funding shortfall

SAGE executive secretary Professor Annelies Wilder-Smith

SAGE executive secretary Professor Annelies Wilder-Smith said that all SAGE’s policy decisions are “focused on optimising the use of existing vaccines to achieve the greatest possible public health impact amid growing financial constraints”.

“Immunisation programmes now more than ever must maximise the impact of available vaccines, while safeguarding equity and still protecting the most vulnerable,” she stressed.

The key driver of SAGE’s new recommendations is the funds shortfall facing Gavi, the global vaccine platform. Gavi supports immunisation in the world’s poorest countries with a gross national income per capita of $2,300 or less – and 56 countries qualify this year.

However, Gavi has only secured $9.3 billion of its recalibrated $10.2 billion strategic budget.

SAGE noted that currently available Gavi funding is “insufficient to maintain use of vaccines currently included in national immunisation programmes, which jeopardises country gains achieved to date and may undermine trust in vaccine programmes”.

Dr Kate O’Brien, WHO’s director of Immunisation, Vaccines and Biologicals, acknowledged that domestic and Gavi funding shortfalls will require countries to make “difficult prioritisation decisions”.

“Countries must be “supported to make evidence-informed decisions” through strong national immunisation technical advisory groups (NITAGs), to ensure that existing immunisation gains are protected, said O’Brien. 

“Against the funding constraints, SAGE has emphasised that maintaining vaccines already included in national programmes in GAVI eligible countries should be a top priority.”

Ebola and mpox

Dr Kate O’Brien, WHO’s director of Immunisation, Vaccines and Biologicals

SAGE welcomed the accelerated development of vaccines that target Ebola Bundibugyo Virus Disease (BVD), and the establishment of the “single protocol, adaptive platform design of the TUMAINI randomised controlled trial (RCT)”.

This platform will enable the efficient evaluation of two BVD-specific vaccine candidates (Oxford University’s ChAdOx1 BDBV and Moderna’s mRNA-1469), and Ervebo, a vaccine already licensed for Ebola Zaire.  

O’Brien said that the phase 1 trial for ChAdOx1 has been completed and a WHO technical advisory committee would be reviewing its data “in a short number of days or weeks”, and reviewing Moderna’s vaccine’s progress.

If the safety data is “sufficiently positive”, she expects the vaccines to move rapidly into phase 2 and phase 3 trials – possibly as early as the end of this month.

SAGE also recommended targeted mpox vaccination of people at risk of infection in communities affected by the virus, including children, people exposed through sexual networks, contacts of people with mpox and health workers with repeated exposure. 

“Preventive mpox vaccination may be considered in those at high risk of infection or severe disease, while preventive vaccination for children in endemic areas may only be considered within a research setting,” SAGE noted.

Image Credits: Gavi.

Pandemic risk is climbing to new highs as post-COVID reform momentum stalls, outpaced by accelerating climate pressures, declining health aid, and eroding public trust.
Pandemic risk is climbing to new highs as post-COVID reform momentum stalls, outpaced by accelerating climate pressures, declining health aid, and eroding public trust.

Escalating pandemic risks are outpacing international readiness as the Global Preparedness Monitoring Board (GPMB) completes its eight-year mandate. The board demands an urgent shift from technical fixes to sustained political commitment and independent oversight, laying out a five-pillar blueprint to translate technical evidence into intergovernmental action. 

BERLIN – A comprehensive review of global health reforms by the Global Preparedness Monitoring Board (GPMB) presented at the World Health Summit on Monday (12 October) reveals that nearly 70% of recommendations designed to safeguard the world have stalled or progressed too slowly.

The capstone report “Getting ahead of pandemic risk,” finds that out of 32 core recommendations issued by the independent panel since 2018, governments and international institutions have fully achieved only two. While 59 percent of technical implementation measures remain on track, 87% of political commitment initiatives have stalled – with pandemic risks increasing.

“The GPMB’s monitoring shows that the interconnected drivers of pandemic risk are actually intensifying,” warned Ibrahim Abubakar, professor of infectious disease epidemiology at University College London (UCL) and GPMB board member.

Co-convened by the World Health Organisation (WHO) and the World Bank Group, the independent board is co-chaired by Joy Phumaphi, former Minister of Health of Botswana, and Kolinda Grabar-Kitarović, former President of Croatia.

Key drivers accelerating global vulnerability include climate change, environmental degradation, and growing social mistrust, according to the report. To guide future global surveillance, the board outlined five foundational insights, emphasising political pathways, multisectoral One Health integration, continuous tracking across the risk continuum, artificial intelligence, and independent oversight.

Transitioning oversight to Health Assembly

From left to right: Gabriel Leung (moderator), Joy Phumaphi, Ibrahim Abubakar, Victor J. Dzau, and Ilona Kickbusch discuss the GPMB’s findings at the World Health Summit in Berlin.
From left to right: Gabriel Leung (moderator), Joy Phumaphi, Ibrahim Abubakar, Victor Dzau, and Ilona Kickbusch discuss the GPMB’s findings at the World Health Summit in Berlin.

Crucially, the report demands clear, reliable pathways into political leadership structures to ensure technical evidence translates directly into sustained accountability and decision-making moving forward. Key to this is the proposed global pandemic risk monitoring mechanism that is designed to be formally mandated and established by member states through the World Health Assembly (WHA), securing a direct reporting line to the UN General Assembly (UNGA).

Professor Joy Phumaphi, co-chair of the GPMB.
Professor Joy Phumaphi, co-chair of the GPMB.

To convert technical evidence into concrete political accountability, its assessments will feed directly into key intergovernmental governance structures, including the States Parties Committee for the Implementation of the International Health Regulations (IHR) and the future Conference of the Parties (COP) under the WHO Pandemic Agreement, the report’s authors note.

The framework will rank the overall severity of pandemic risks, establishing clear triggers where elevated risk levels mandate immediate political review, resource mobilisation, and collective international action. Beyond health governance, the mechanism will align its reporting cycles with broader political and economic bodies – such as the G20, BRICS+, African Union, ASEAN, the World Bank, and the IMF.

“Evidence alone is not enough,” said Phumaphi at the WHS event. “It must be anchored in the political processes that can generate action.”

Connecting political action to One Health

With over 70% of emerging infectious diseases originating in animals, ape sampling reflects the urgent need to intercept zoonotic spillovers before pandemics erupt.
With most emerging infectious diseases originating in wildlife, early animal sampling is vital to intercepting zoonotic spillovers before pandemics erupt.

Translating political commitment into effective prevention requires confronting where pandemic threats actually originate – at the interface of human, animal, and environmental systems. Yet, while over 70% of emerging infectious diseases originate in animals, the GPMB’s maturity audit reveals that 75% of its One Health recommendations and 90% of multisectoral engagement initiatives have stalled or progressed too slowly.

To close these governance gaps, the board calls for formally integrating non-health agencies – such as the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the UN Environment Programme (UNEP) – into global monitoring structures alongside WHO.

However, global institutional reforms must align with frontline realities. For example, studies in Central Africa show top-down environmental restrictions fail because 78% of local forest communities rely directly on surrounding ecosystems for food and livelihoods.

“Mistrust has repeatedly emerged as a source of vulnerability affecting how people interpret information, how institutions work together, and how effectively societies respond during health emergencies,” said Phumaphi.

Public health leaders emphasise that establishing mutual trust between institutions and local communities is essential for long-term stewardship and sustainable spillover prevention. Future One Health monitoring must therefore maintain an independent analytical layer and total transparency to guarantee equitable access to data, tools, and medical countermeasures.

Integrating fragmented data across the risk continuum

Professor Ilona Kickbusch, GPMB board member.
Professor Ilona Kickbusch, GPMB board member.

To synthesise vast amounts of fragmented global data into actionable intelligence, the report calls for harnessing artificial intelligence and digital technology through a federated model.

Crucially, this digital network must track the complete pathway of risk – from upstream drivers and emerging threats through to political commitments, resources, implementation, and real-world impacts.

Tracking the full spectrum provides decision-makers with a dynamic picture of trajectory rather than static snapshots, revealing precisely where the chain from early warning to political action breaks down.

“This is not about building yet another parallel system in an already fragmented global health architecture,” underscored Professor Ilona Kickbusch, founder of the Geneva Global Health Centre and GPMB board member. “We want a connected system that connects what already exists.”

Overcoming the pandemic financing disconnect

Frontline Ebola responders in the DRC. The ongoing crisis underscores the urgent imperative to close the gap between global donor pledges and resources reaching the ground.
Frontline Ebola responders in the DRC. The ongoing crisis underscores the urgent imperative to close the gap between global donor pledges and resources reaching the ground.

Financing reforms remain among the most severely bottlenecked areas of global preparedness, with the GPMB report revealing that nearly three-quarters of its financial recommendations have stalled or progressed too slowly. The board identifies unpredictable political commitment as the primary barrier preventing high-level pledges from translating into sustained funding architecture.

This funding disconnect creates severe operational impairments on the ground during active crises, such as the Ebola outbreak in the Democratic Republic of Congo (DRC). Highlighting this gap during a WHS panel session on pandemic preparedness financing, Africa CDC Director-General Dr Jean Kaseya noted that while international donors reported disbursing $700 million, local authorities in the DRC were aware of only $160 million reaching the front lines.

To eliminate these blind spots, the GPMB stresses that future monitoring must track financing across the entire risk continuum – following funds from initial donor commitments down to actual resource allocation and frontline impact.

To bridge these gaps and break the historical “cycle of panic and neglect,” multilateral platforms like the World Bank-hosted Pandemic Fund, a core structural reform championed by the GPMB, use grant aid to leverage broader co-financing. Operating across 128 low- and middle-income countries, the fund yields a 1-to-7 catalytic effect, where every $1 in grant aid unlocks $4 from development banks and $3 in domestic co-financing.

While catalytic grants aim to maximise international aid, African nations are increasingly asserting financial ownership, with 28 countries recently mobilising over $130 million in domestic funds for continental outbreak responses.

Global health leaders have echoed the GPMB’s call to treat pandemic preparedness as an essential global public good, pointing to African-led frameworks like the Accra Reset and the Lusaka Agenda as the path to genuine health sovereignty and country-led coordination.

A sense of déjà vu

Professor Hajime Inoue cautions that today's pandemic warnings echo past unheeded lessons.
Professor Hajime Inoue cautions that today’s pandemic warnings echo past unheeded lessons.

Despite advancements, experts voiced mixed feelings regarding the panel’s recommendations, warning against repeating familiar cycles of complacency.

Pointing to earlier monitoring efforts, Hajime Inoue, professor at the International University of Health and Welfare in Japan, cautioned that nearly identical warnings followed the H5N1 avian influenza outbreak two decades ago and the West African Ebola crisis 10 years ago.

“Life is 5% planning and 95% implementation,” he said. “We are hearing this recommendation again because we failed to implement the recommendations that we heard before.”

Major political hurdles remain

Beyond implementation fatigue, political hurdles remain in intergovernmental negotiations, where member states must conclude the Pathogen Access and Benefit-Sharing (PABS) system before ratifying the broader WHO Pandemic Agreement, with the UN Political Declaration on Pandemic Prevention, Preparedness and Response providing crucial momentum to this process.

Taking the stage, WHO Director-General Dr Tedros Adhanom Ghebreyesus urged member states to convert high-level political momentum into legally binding commitments by swiftly concluding the pathogen access and benefit-sharing (PABS) annex.

Dr Tedros Adhanom Ghebreyesus thanks the board members for their work.
Dr Tedros Adhanom Ghebreyesus thanks the board members for their work.

“The world can only be better prepared when we implement all the initiatives,” said Tedros, thanking the board. “It should be everybody’s business to conclude this agreement, so the world is better prepared before the next pandemic.”

Establishing reliable pathways into political decision-making remains the critical test to ensure future warnings trigger immediate global action. As the GPMB’s original mandate concludes in December 2026, Tedros asked board members to extend their service voluntarily to guarantee a smooth transition while member states translate the panel’s blueprint into a permanent oversight structure.

See related story:

With Only Three ‘No’ Votes, UN Adopts Political Declaration on Pandemic Preparedness

Image Credits: Felix Sassmannshausen/WHS, GPMB Report, Felix Sassmannshausen, Wildlife Conservation Society Congo, X/Tedros Adhanom Ghebreyesus.

Katrín Jakobsdóttir, former Prime Minister of Iceland, moderates a session on One Health and pandemic prevention at the World Health Summit, Berlin, 12 October 2026.

Six years after COVID-19, with Ebola Bundibugyo virus still raging in eastern Congo and the pandemic treaty stalled, a packed World Health Summit workshop asked why the world keeps paying for fire engines instead of fire prevention.

BERLIN – By the time Katrín Jakobsdóttir opened the session, people were standing two deep along the back wall. The former Icelandic Prime Minister, now chair of the Pan-European Commission on Climate and Health, joked that the panel would have to keep to time or the room would run out of oxygen. Then she named the problem that has dogged pandemic prevention for decades: its success “is measured by the crisis that never happened”. Nobody gets much credit for an outbreak that never occurs, so budgets for averting crises remain equally slim.

That paradox ran through Monday’s workshop at the World Health Summit, Preventing the Next Pandemic, co-hosted by Germany’s Federal Ministry of Health and the animal welfare organisation FOUR PAWS.

Kenya
Pathogen risks prevented by good management get little attention.  Here a community health volunteer visits a Kenyan farmer to support anthrax vaccination.

A threat that is accelerating

The science on where pandemics come from is no longer in dispute. About 60% of known human infectious diseases, and 75% of emerging ones, pass to us from animals, according to UNEP. The UN biodiversity panel IPBES estimates that some 1.7 million undiscovered viruses circulate in mammals and birds, and up to 850,000 of them could infect people. A 2021 study in PNAS put the yearly chance of a COVID-scale pandemic at about 2%, which works out to a 38% chance of living through one. The authors warned that the risk could double in coming decades as land clearance and climate change push people and wildlife closer together.

This year has tested that warning. The Bundibugyo Ebola outbreak in eastern DRC, caused by a strain with no licensed vaccine or treatment, had reached 8,116 confirmed cases and 3,924 deaths by late September, making it the second-largest Ebola epidemic on record. An Andes hantavirus cluster killed passengers on a cruise from Ushuaia. New World screwworm, eradicated from Mexico in the 1990s, has been back since November 2024.

“Since the COVID-19 emergency period, the world has been responding to a health emergency around 70% of the time,” said Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response. “Is this sustainable, economically, politically, morally?” On Bundibugyo, responders had no community-level test and no dedicated vaccine or antiviral. But her harder question went further back: “Could it have been prevented altogether? What would it have taken to stop it?“

Gambian pouched rat – rodents are a common animal reservoir for monkeypox

The opportunity reflected in the numbers

The economics point firmly towards prevention. A 2022 analysis in Science Advances put the cost of primary prevention, including less deforestation, tighter regulation of the wildlife trade and surveillance at spillover hotspots, at about $20 billion a year. That is less than 5% of the value of lives lost to emerging zoonoses, at least $350 billion annually, and under 10% of the direct economic losses of $212 billion. IPBES, the Intergovernmental Platform on Biodiversity and Ecosystem Services, estimates that prevention costs about 100 times less than response. COVID-19 alone cost an estimated $8 to 16 trillion.

Some money is starting to flow. In February, the World Bank-hosted Pandemic Fund awarded US$499.6 million to 20 projects, half of them with “One Health” in their titles, and its first three rounds now reach 128 countries. Clark said that virtually every application to the fund now carries a One Health dimension. The WHO Pandemic Agreement, adopted in May 2025, is the first international health treaty to write One Health into its text.

But the treaty is stuck. It cannot open for signature until governments settle its annex on pathogen access and benefit sharing (PABS). “There are ways through this,” Clark said, but it will take “some political will and some heavy lifting. In the end, no one gets everything they want from a negotiation.”

For the host government, Parliamentary State Secretary Georg Kippels said a PABS deal would come only if every party was willing to compromise. “Prevention is the most straightforward solution we have…It protects people before anyone falls ill, and it costs far less than responding once an outbreak has been detected or even spread.”

What works on the ground

(L-R) Mahbubur Rahman of One Health Bangladesh, Thainá Landim de Barros of FOUR PAWS and Frédéric Singa of WWF Central African Republic.

Bangladesh offers a working model. Mahbubur Rahman, an epidemiologist at the Institute of Epidemiology, Disease Control and Research, described how One Health Bangladesh began in 2008 as a civil society response to avian influenza. It produced a national strategic framework in 2012, and by 2016, its activities were integrated with those of government, including an inter-ministerial steering committee, a technical advisory committee and a secretariat. 

A new 2025–2030 framework extends the approach below the national level and adds environment and ecosystem health. Money is still the weak link, because no mechanism lets one ministry fund another. Yet joint working paid off: after two rejections, the country’s One Health surveillance and early-warning project won US$25 million from the Pandemic Fund on the third attempt.

Asked whether governments actually listen to scientists, Maxine Whittaker of the One Health High-Level Expert Panel answered: “Yes, maybe, no.” Scientists are one voice among party positions, public opinion and the hourly news cycle, she said, and evidence lands only when it is framed with its economic and social costs. On data she was blunter: when governments pay to collect data and then do not share it, “it’s actually unethical. If we’ve invested government money, donor money, and don’t actually get them to work together. We’re actually doing more harm than good.”

Restricting human access to wildlife products is not a solution

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

In the Central African Republic, WWF veterinarian Frédéric Singa found that 78% of forest-edge residents routinely go into the forest to capture wildlife or collect wildlife products and 96% eat what they capture or gather.

 “Restricting the access is not a solution,” he said. His team instead watches for unusual wildlife deaths and tests samples in a German-funded field laboratory. That picks up pathogens like anthrax in animal carcasses, as well as Mpox in people, before they can spread. 

And the key drivers of the leap of wildlife pathogens into human communities are often modern practices, such as the deforestation of land cleared for pasture and feed stocks; the trade and transport of animals; and crowded intensive farm production where close quarters foster pathogen transmission and stress weakens immunity, said Thainá Landim de Barros, a veterinarian for the international wildlife protection group FOUR PAWS.

 “We cannot start acting when the problem reaches us,” she added. “That’s too late.”

Intensive livestock production creates a hothouse for pathogen transmission among animals and to humans.

Trust is the missing infrastructure

NCDC anthropologist Obinna Jude Eze, known in his Lassa fever field community as “the doctor of rats”.

The most memorable contribution came from the floor. Obinna Jude Eze is an anthropologist with the Nigeria Centre for Disease Control and Prevention. Eze spent nine months living in a community with high Lassa Fever transmission under the auspices of the research initiative COPE, of the German-based Robert Koch Institute. Because his questions always came back to rodents, villagers called him “the doctor of rats”. 

But the cumulative sense of familiarity and trust that he managed to build helped identify community champions and local facilitators for a community-based Lassa Fever project. “If we want communities to trust One Health,” Eze said, “we also need to show that One Health trusts communities.”

What has to change

Helen Clark (centre) and Germany’s Parliamentary State Secretary for Health Georg Kippels (second from left) in the front row before the opening remarks.

One Health has the arguments and its importance is increasingly being recognized. It is written into a treaty and into most Pandemic Fund proposals. What One Health has not yet won is a budget line. Three shifts would change that, workshp participants agreed.

Finish the Pandemic Agreement. Member state ratification of the WHO Pandemic Agreement cannot begin until negotiations over the Annex for Pathogen Access and Benefit Sharing is completed. So the agreement remains a promise without force, and every month of delay is a month in which the next pathogen spillover event from wildlife into human communities could go unchecked.

Measure what matters. The Sustainable Development Goals carry no true One Health indicator, and finance ministries do not fund what they cannot measure. The post-2030 framework is the chance to fix that.

Treat prevention as an investment, not a cost. Investments of about $20 billion a year against more than $500 billion in annual economic losses to health, trade and food systems is a return that any finance ministry would accept in any other sector.

But on the accounting score, Jakobsdóttir said, a change of mindset is the hardest part. Until governments find a way to value the outbreak that never happened, they will keep paying many times over for the ones that do.

Image Credits: Sebastien Assoignons/ Wildlife Conservation Society, Hossain/HPW, International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society, Laëtitia Dudous, Hossain/Health Policy Watch .

Anita Zaidi, president of the gender equality division, pledges $100 million to halve global stillbirth rates in the next decade.
Gates’ Anita Zaidi, (far right) announces the new $100 million initiative with Wellcome Leap and Uzima Foundation to halve global stillbirth rates.

BERLIN – A new $100 million initiative to halve stillbirth rates across select countries over the next decade launched at the World Health Summit on Monday (12 October). Backed equally by the Gates Foundation and Wellcome Leap, a spin-off of the UK-based Wellcome Trust, the effort will test and deploy a package of diagnostic technologies to address a global crisis of nearly 2 million stillbirths each year, almost half of which occur in sub-Saharan Africa.

Each organization is contributing $50 million during an initial three-year validation phase to deploy the point-of-care technologies in high-burden settings. Named after the Swahili word for life and well-being, the Uzima initiative will develop a scalable blueprint to cut stillbirth rates by 50% across participating nations, with its first official country partner set to be announced in the coming months.

The initiative will assemble an initial package of diagnostic and monitoring tools by early 2027 to help health workers detect pregnancy complications earlier. The suite includes artificial intelligence-enabled ultrasound, labour monitoring sensors, biomarker diagnostics, and automated clinical decision-support systems. Over 40% of stillbirths occur during labour and could be prevented with timely emergency obstetric care and routine fetal monitoring.

“In most parts of the world, pregnancy care remains in the dark ages, and AI will be transformative not to make clinical decisions, but to help health workers instantly spot who is most at risk,” said Anita Zaidi, president of the gender equality division at the Gates Foundation, speaking at the World Health Summit Signature Event on Monday. “The $100 million is not going to be enough to scale, and we will need many other partners joining us to make this a reality.”

Mobilising political leadership for stillbirth prevention

Despite the staggering human toll, stillbirth prevention remains severely underfunded and overlooked within broader maternal and newborn health agendas. Program leaders are inviting health ministers across Africa to shape implementation frameworks that fit directly within their domestic health systems.

“When external resources decline, our responsibility as government to our people should not also decline,” said Kwabena Mintah Akandoh, minister of health of Ghana. “It is our opportunity to step up.”

Organisers emphasised that durable health resilience requires dismantling structural inequalities rather than merely managing emergency responses.

Meeting 2030 WHO targets

Nurses Fatmata Bamorie Turay ( left) and Elizabeth Tumoe look after newborns at the Princess Christian Maternity Hospital in Freetown, Sierra Leone.

Without more urgent interventions, there will be a cumulative toll of 15.9 million stillbirths between 2020 and 2030, with nearly half concentrated in sub-Saharan Africa, and 56 countries will miss the WHO Every Newborn Action Plan (ENAP) target of 12 or fewer third-trimester stillbirths per 1000 births by the end of the decade.

Highlighting stark global disparities, Nigeria’s stillbirth rate remains seven times higher than Germany’s rate of 4.3 per 1000 births and 14 times higher than Japan’s, the panellists pointed out.

“I am tired of talking about the data, and it is time we expose the human experience behind these statistics,” said Professor Jacqueline Dunkley-Bent, chief midwife of the International Confederation of Midwives at the Berlin launch event. “A grieving woman in Nigeria or Germany asks the exact same question: Why did my baby die? Yet, because of where she lives, the health system’s answer will be drastically different.”

Added Wellcome Leap’s Veronica Adamson: “What matters at the end of the day is not how many devices we develop, but how many babies actually go home healthy in the arms of their families.” The Wellcome spinoff, founded in 2020, aims to support “bold, unconventional programs,” that can make a transformational difference to global health and fund them at scale.

See related story:

From Waiting Room to Labour: How Task-Shifting in Nigeria is Saving Lives

Note: The piece has been updated to reflect that the aim is to halve stillbirth rates in select countries.

Image Credits: World Bank/Flickr, World Health Summit.


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Children playing on swings at a playground. Playground equipment is often painted with lead paint. Deteriorating lead paint is a source of exposure to lead.

Over 800 million children have unsafe lead levels in their blood, according to the latest estimates of the World Health Organization (WHO).

A toxic metal found in the Earth’s crust, humans are increasingly exposed to lead contained in a range of everyday products, including paint, cookware, cosmetics and spices. Informal recycling and contaminated environments can also contain lead.

Lead exposure affects multiple organs – brain, liver, kidney and bones – and often accumulates in teeth and bones.

“This is a health threat that is largely invisible. A child can be exposed without showing any obvious symptoms. The damage to their developing brain and nervous system may be already taking place,” said Bruce Gordon, WHO director a.i., Department of Environment, Climate Change, One Health and Migration.

WHO has launched a week-long campaign starting 18 October to raise awareness among public health professionals, governments and industry.

“We’re calling on governments to strengthen regulations and enforcement, remove lead hazards from products and environments, invest in surveillance and safer industrial practices, and prioritize the protection of children and other vulnerable populations,” said Gordon.

This year’s theme is “From Detection to Prevention” to emphasize that exposure can come from multiple and often invisible sources like food and water.

The damage lead can cause

Children going home after school in Irisan Elementary School.

No level of exposure to lead is considered safe by the WHO. In 2023, an estimated 3.5 million deaths were attributed to lead poisoning by the US-based Institute for Health Metrics and Evaluation (IHME). It also estimated that lead exposure accounted for more than 71.5 million years lost to disability (disability-adjusted life years, or DALYs) worldwide in 2023.

Another study done in 2022, and led by researchers at China’s Southeast University, estimated that the largest number of deaths from lead poisoning were concentrated in three countries: China, India, and Bangladesh.

Young children and women of childbearing age are particularly vulnerable to the harmful effects of lead poisoning, as lead can affect the development of the central nervous system.

Exposure during pregnancy can cause reduced fetal growth and preterm birth. In adults, lead poisoning can cause long-term effects like increased risk of high blood pressure, cardiovascular problems, and kidney damage.

“Lead does not belong in the body. It disrupts, it gets incorporated, and it really interferes with brain development,” explained Gordon.

Much of the damage caused by lead is largely preventable.

Phasing out lead in cosmetics: A case study from Nigeria

There is no known safe level of lead exposure.

Nigeria is raising awareness about the use of toxic chemicals like lead and mercury in cosmetics with the assistance of global non-profit Resolve to Save Lives.

“That was a policy win that gave the government sort of the strength and the mandate to work on leaded cosmetics without having to go through a very long policy process,” said David Berendes, Resolve senior technical advisor on lead poisoning prevention.

Resolve is also supporting greater dialogue between the government and industry bodies to find solutions to phase out lead at source. They are also building capacity by training enforcement environment officials to test products to check for the presence of lead and seize them.

Also read: Phasing Out Mercury in Cosmetics Requires ‘Detoxifying’ Perceptions of Beauty

Why lead poisoning remains undetected

A man melts lead metallic waste used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast.

A key reason why lead poisoning continues is that most countries currently do not have the required testing capacity, national regulations, and surveillance in place to respond appropriately.

WHO is hoping to fill this gap soon. In the coming year, the world health body is set to release a Global Action Plan on Lead Mitigation. The aim is to help countries prevent, detect, and manage lead exposure and poisoning better.

“This builds on a successful history of WHO technical packages in a number of areas like tobacco control, cardiovascular disease, reducing salt in food, etc. And they aim to be a package of effective, evidence-based measures, actions that governments can take to move from identifying the problem to actually taking action to address,” said Richard Brown, Technical Officer in the Chemicals, Radiation and Health Unit, WHO.

Image Credits: WHO/Yoshi Shimizu, WHO, EPA/L. Koula.

Ukraine war
A patient with COVID-19 in intensive care in Chernivtsi in southwestern Ukraine. The declaration guides countries to better respond to pandemics.

The United Nations General Assembly adopted the Political Declaration on Pandemic Prevention, Preparedness, and Response (PPPR) by a substantial majority at a plenary meeting in New York on Monday, with 153 countries voting in favor and only three against.

The declaration went to a vote after the UN High-Level Meeting on 25 September could not adopt it by consensus – but only the US, Israel, and Argentina voted against it, while New Zealand and Paraguay abstained.

Although European Union (EU) member states voted for the declaration, several distanced themselves from its references to technology transfers and flexibilities when applying World Trade Organisation intellectual property rights agreements during health crises. 

Recognizing that the world is not prepared for the next pandemic, the declaration affirms that pandemic readiness rests on resilient health services anchored in “universal health coverage and a primary healthcare approach that ensures access to essential health services”.

It also recognizes that it is “critical” to strengthen local, national and regional capacity to develop and produce vaccines, therapeutics and diagnostics. This will “advance equitable, timely and affordable access to prevent and respond to pandemic emergencies and other health emergencies”.

The 64-clause declaration also calls for more coordinated financing, highlighting an estimated $15 billion annual gap in pandemic preparedness financing, warning that existing funding arrangements remain fragmented, underfunded and overly reliant on development financing. 

A civil society alliance, Friends of the High-Level Meeting on PPPR, described the adoption as an “important marker of multilateral commitment to make the world safer from pandemic threats”. 

However, it “contains few concrete, measurable or time-bound commitments,” according to the alliance, urging leaders to “turn words and commitments into action.” 

“Pandemic risks are not waiting,” it noted. “A rapidly growing Ebola outbreak, two mpox emergencies since 2022 and an Andes hantavirus outbreak have all required multinational responses.

“H5N1 is still infecting farm animals and wildlife, and climate change and biodiversity loss are driving new threats. Which political leaders will now step forward to turn that urgency into policy change and investment in countries and regions?”

US and Iran find common cause

During Monday’s debate, the US objected to the declaration’s use of “sexual and reproductive health (SRH) language” – ironically, finding common cause with Iran on this.

“While we support strengthening health systems and protecting women’s health, we do not support references to sexual and reproductive health and reproductive rights, and ‘sexual and reproductive health care service’s without caveats and qualification,” the US delegate said.

 “The United States strongly opposes the inclusion of harmful gender ideology, including comprehensive sexuality education, as it is detrimental to the well-being and development of children and undermines parental authority.”

Echoing the US’s opposition to this language, Iran said SRH references “do not enjoy universal agreement and cannot be construed as creating an international obligation or commitment.”

The declaration commits member states to “mainstream gender equality” and ensure “universal access to sexual and reproductive health care services, including for family planning,” by 2030. It does not refer to “reproductive rights”, gender ideology, or comprehensive sexuality education.

Canada and Australia argued that the document’s language “weakened commitments” to gender equality and sexual and reproductive health and rights.

International Health Regulations

The US also expressed  “strong concerns” about the declaration’s references to the International Health Regulations (IHR), the Pandemic Agreement, and “the excessive and repetitive use of ‘equity’ and its variance”.

This language “seeks to commit member states to international agreements to which they are not party, or endorse processes that remain incomplete,” the US stated, adding that it could not “support a text that overlooks national policy boundaries.” 

The IHR are the only binding legal requirements for countries during a public health emergency of international concern (PHEIC).

New Zealand objected to reference to the IHR, reminding the assembly that it had rejected the regulations as it is “very important” that the country’s “sovereign decision-making on health is protected.” 

Pathogen access and benefit-sharing 

Member states are negotiating a pathogen access and benefit-sharing (PABS) system in Geneva.

Several other nations referred to the unfinished Pathogen Access and Benefit-Sharing (PABS) system, an annex to the Pandemic Agreement currently being negotiated at the WHO. 

WHO member states are wrestling with whether countries that share pathogens and genetic sequence data will be guaranteed a fair share of the vaccines, treatments and diagnostics developed from them – and how enforceable those guarantees should be. 

Namibia, which spoke on behalf of the African group, expressed its support for rapid and timely sharing of materials and sequenced data alongside their “fair and equitable sharing in benefits arising from their use.”

“While progress has been made, significant gaps persist in the global health architecture, as shown by mpox, Andes hantavirus, and the current Ebola Bundibugyo emergency,” said Namibia’s delegate.

“The high-level meeting reaffirmed the fundamental lesson: no country can address pandemics alone,” he said.

However, the US – which is no longer part of the WHO – stated that linking the sharing of benefits to pathogen access could impede the cooperation necessary in an active outbreak. 

Several other nations and blocs, including the EU, France, New Zealand, and Italy, registered their concerns with the declaration’s pathogen information sharing language, citing intellectual property rights and even sovereignty issues.

EU bloc in favor – with key caveats

While the EU praised the declaration’s overarching objective, it distanced the bloc’s nations from what it termed “uncaveated references to technology transfers.” 

Speaking for the EU, Ireland said that these transfers can only be undertaken on “a voluntary basis and on mutually agreed terms”, and stressed the need to respect intellectual property rules, citing the World Trade Organization’s Doha Declaration. 

These concerns mirror much of the past five years’ debate over the PABS annex: whether countries should rely on voluntary arrangements, or establish stronger, binding commitments to share the benefits of scientific research and manufacturing.

“Action requires consensus and respect of international rules. The text before us offers salient elements to advance PPPR,” Ireland’s representative said to the assembly. “It also contains setbacks towards our crucial shared goal: a safer, healthier world for all.”

The EU also questioned the continued use of the widely cited $15 billion funding gap in pandemic preparedness, arguing that the declaration’s estimate is “no longer current.” However, it did not provide a revised figure, instead calling for better financial tracking and more efficient use of existing funding mechanisms through a global financial tracker.

Civil society organisations held a protest outside the European Parliament in Brussels earlier this year, urging the EU to support a fair and equitable PABS Annex.

Report back by 2028

“WHO welcomes this strong commitment by UN member states to continue working together on pandemic prevention, preparedness and response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“The world has come a long way since COVID-19. We urge countries to now fulfil the commitments they have made – especially to finalize negotiations on the [PABS] annex, so the WHO Pandemic Agreement can be opened for signature, begin the process of ratification and enter into force as international law.”

The declaration commits countries to report on their progress made in implementing the declaration at the 2028 UN General Assembly.

“Countries can and must do better, and work together with the urgency pandemic threats demand. This means finding a way through the impasse to agree to the PABS annex by May,” urged Helen Clark, co-chair of The Independent Panel for Pandemic Preparedness and Response.

“In the meantime, it is vital to implement provisions of the Pandemic Agreement. Delays will only increase our collective risks.”   

David Reddy, Director-General of the  International Federation of Pharmaceutical Manufacturers and Associations (IFMPA) urged governments to seize the opportunity that the declaration provides and “accelerate practical commitments that strengthen preparedness for future health crises”.

“Medicines and vaccines will remain a cornerstone of pandemic prevention, preparedness, and response. As governments put the Political Declaration into practice, they should ensure intellectual property frameworks that enable the development of life-saving products and foster voluntary partnerships remain stable, predictable and robust,” said Reddy.

“We also call on governments to adopt policies that strengthen the systems needed to deliver medicines and vaccines rapidly. Preparedness does not begin when a crisis hits. It is built through the choices countries make every day to value innovation and invest in resilient health systems.”

The article was updated to include the IFPMA’s comment.

Image Credits: Mstyslav Chernov/ Wikimedia Commons.

A Lancet Commission puts the odds of humanity’s extinction this century at “non-zero” as the threats of nuclear war and weaponised artificial intelligence loom.

BERLIN – As candidates to become WHO director-general squabbled in the halls of the InterContinental, a three-year effort by the Lancet on future health threats delivered a sombre if uncertain warning: There is a chance, however small, that humanity will not survive this century – and we may all die.

Two of the extinction threats it identifies – nuclear war leading to global famine, and the malicious use of artificial intelligence, including to build biological weapons – carry a “non-zero risk of human extinction during this very century,” said Natalia Kanem, a former head of the UN Population Fund who co-chairs the Lancet Commission on 21st Century Global Threats to Health, launching its report at the World Health Summit on Sunday.

“The devastation that could result from nuclear war cannot be overstated,” the report says, noting 22 nuclear weapon accidents and 21 close calls between 1948 and 2010. AI’s potential to improve health is enormous, it adds, but “the risk of catastrophic harm is equally profound.”

With no historical record to model projections for artificial intelligence, the commission leaned on expert opinion and on “superforecasters,” people judged by the Commission to “consistently make unusually accurate predictions about future events.” The report does not name them.

The superforecasters put the odds of AI-driven human extinction by 2100 at 0.4%, while AI specialists put them at 3%, according to the report. AI companies themselves acknowledge this risk, too. Anthropic chief executive Dario Amodei said last year there was a 25% chance that things go “really, really badly” with AI. Elon Musk has put the odds of “annihilation” at 20%.

Asteroid strikes and supervolcanoes – which the report deemed “can, in theory, cause human extinction” – were left off the list altogether, judged too unlikely to matter before 2100. So that’s good news.

The other 15 threats

The report highlights a total of 17 threats to human health, each forecast to cost at least one billion disability-adjusted life years (DALYs) between now and 2100. DALYs represent years of healthy life lost to illness, disability and early death.

Most of the other 15, such as obesity, mental health, lack of access to education, climate change, pandemics and antimicrobial resistance (AMR), are well known. Panellists at the launch described them as “among the less dramatic major catastrophes.”

“The other 15 are major catastrophic threats, each forecast to receive 1 billion cumulative DALYs, disability-adjusted life years, by the year 2100 in the reference scenario,” Kanem said. “For scale, COVID-19 caused roughly 500 million full healthy life years lost. Every one of the 17 threats we identified is measured in billions of DALYs.”

The commission’s definition of a threat was “deliberately inclusive,” she said, covering the largest causes of future health loss that policy can still change. “That’s why obesity and low educational attainment sit squarely and surprisingly on the same list as nuclear war.”

Obesity alone accounts for an estimated 23 billion “amenable” DALYs – the health loss the commission judges policy could still prevent, measured as the gap between the best and worst plausible futures it modelled. “Yesterday was certainly a milestone day for obesity,” Johanna Ralston, CEO of the World Obesity Federation, said of the Lancet commission’s findings. “It is that bad. But also, guess what? There’s a lot we can do.”

Low educational attainment accounts for 16 billion and income inequality for nearly 14 billion. AMR, a growing threat that remains under-addressed in the global health and national governance spheres, accounts for another 3.44 billion.

“Let’s admit there is a big, uncomfortable elephant in this room,” Kanem said. “These are threats that, frankly, we’ve known about for decades. Yet they’ve been systematically underprioritised.”

Obesity outweighs the apocalypse?

Threat pyramid presented by the Lancet Commission on future global health threats.

After obesity, low education and income inequality, the next-largest burdens belong to the two extinction threats: malicious AI, at 10.4 billion amenable DALYs, and nuclear conflict, at 9.35 billion. Both rest on expert judgment rather than data, and the commission’s uncertainty ranges for each run from zero, meaning no harm at all, up to 15.6 billion and 24.5 billion, respectively.

The commission scores each threat by multiplying the healthy life it would destroy by the odds of it happening. In the report’s own example, a 1% chance of losing 10 billion healthy years counts the same as a 10% chance of losing one billion.

Extinction would erase every remaining healthy year of everyone alive, but the forecasters put its odds at a fraction of a per cent. Obesity is already here and almost certain to grow; while it rarely kills outright, it shortens lives through diabetes, heart and kidney disease and cancer, and adds years lived in poor health along the way. DALYs count both, across billions of people.

The count also stops in 2100. And because DALYs only measure healthy years lost by people who are alive, the future generations who would never be born after an extinction do not register at all in the Commission’s calculations. The report itself warns the comparison “should not be read as placing these threats low among priorities.”

Poor mental health, unhealthy ageing, conventional conflict and smoking each top 7 billion, while childhood malnutrition sits at the bottom with 1.02 billion. The commission insists the figures are not a ranking of priorities. Still, obesity comes out as the leading threat in 154 of the 204 countries and territories analysed, and low educational attainment leads in sub-Saharan Africa.

“These 17 threats to future health are greater in scope, they’re greater in magnitude, they’re greater in complexity than previously understood,” Kanem said of the findings. “Each has the potential to place unsustainable pressure on societies and economies, and the harms fall unequally.”

Growing population and poverty in sub-Saharan Africa

Historic and forecasted trends in extreme poverty by GBD super-region, 1980–2100.

The other big subsection of the report’s threat indicators is the effect of income inequality and growing extreme poverty on the potential to live healthy lives.

“What came out of the data was that there are some profound headwinds for us in the next 25 to 50 years or more. The first is what’s happening to poverty,” Murray told the launch.

After “an extraordinary period of reduction in extreme poverty,” progress has flatlined since around 2015, he said, and “the number in extreme poverty in sub-Saharan Africa will actually go up.”

In the commission’s reference scenario, which projects what happens if current trends hold, the global number of people living on less than $3 a day stays flat for decades. In sub-Saharan Africa, slow economic growth and a fast-growing population push it up until late in the century.

The trajectory of global health is “profoundly affected by what happens to economic growth in sub-Saharan Africa, particularly in the Sahel,” the report says.

The sub-Saharan African region’s share of the world’s population is projected to rise from 15.3% today to 36.7% by 2100, as global population peaks at about 9.5 billion in 2064 and then declines, the report projects.

The commission’s growth forecasts for the region are also much lower than those used in climate modelling. Some Intergovernmental Panel on Climate Change scenarios have income per person there growing twelvefold by 2100, after minimal growth over the past 75 years. On the commission’s numbers, the gap between rich and poor countries widens.

Even nuclear war would hit sub-Saharan Africa hardest, accounting for 2.97 billion of its 9.35 billion amenable DALYs, even if no bombs fell on the region. Nuclear famine “would affect all regions of the world, including those far from the conflict itself,” the report says, and the region bears the heaviest burden “despite having no nuclear weapons, owing to nuclear extinction probability and its young age structure.”

‘Lives were lost’ in collapse of development assistance

Income inequality, which the commission measured through median household consumption rather than average income, accounts for 13.8 billion amenable DALYs, the equivalent of more than 25 COVID-19 pandemics. More than half of that, 7.31 billion, is in sub-Saharan Africa.

Low educational attainment, at 16.1 billion, is the largest threat in sub-Saharan Africa, which holds more than two-thirds of its amenable burden. Most of that burden falls on children and adolescents, the Commission said.

“Low education attainment is a chronic and many times a silent threat,” said Juan Pablo Uribe, the World Bank’s director for Mexico, Central America and the Dominican Republic. “In a way, we live with it.”

The collapse of development assistance for health counts as a threat of its own, worth 1.5 billion amenable DALYs, 70% of them – again – in sub-Saharan Africa. IHME estimates health aid fell 9.7% between 2024 and 2025, with official development assistance sliding to 0.26% of donors’ gross national income in 2025, from 0.33% a year earlier.

The report finds little evidence that finance ministries in poorer countries fill such gaps, with debt payments squeezing their budgets.

“The cuts had a direct impact almost overnight. Lives were lost. Individuals died,” Izukanji Sikazwe, head of HIV at the Global Fund, said at the launch. Recipient countries should spend more, she said, “but domestic financing is not going to bump up overnight.”

Is climate an existential threat?

Lancet editor-in-chief Dr Richard Horton speaks at the report launch.

The Commission’s decision to focus headlines on the world-ending potential of AI and nuclear war did not come without controversy.

Sources close to the Lancet Countdown on Health and Climate Change – the annual report published by the journal quantifying the health threats posed by the climate crisis, which will come out this month – told Health Policy Watch the categorisation of obesity, alcohol use, and smoking on the same scale as catastrophic climate impacts was, at best, unhelpful.

“It is a bit misleading, I would say,” said Melissa Jiménez Gómez Tagle, a planetary health scientist and UNFCCC advocate for climate and health who has collaborated with the Countdown. “I’m not saying that it is reporting the wrong thing, but maybe it is the way they are phrasing it that is confusing for people who are not knowledgeable of the whole report.”

The report stresses that its figures are not a ranking, she said, “but then do not number it.” When she raised the point with one of the authors, she was told the list did not imply an order of importance. “I told them, okay, you’re telling me this as a scientist, but for the people who are not in touch with scientific publications, the first thing they will say is this is in order,” she said.

On the commission’s own yardstick, climate change accounts for 1.89 billion amenable DALYs over the century. That is less than high alcohol use, at 2.35 billion, and roughly a twelfth of obesity’s burden. Only air pollution, which kills nearly 8 million people a year, the collapse of health aid – which separate Lancet projections estimate could cause 14 million additional deaths by 2030 for US aid cuts alone – and childhood malnutrition, which affects at least 150.2 million children under five around the world, come in lower.

“I do not deny that these are public health problems, for example obesity, or also smoking, alcohol,” Jiménez Gómez Tagle said. “But I do believe that these numbers are skewed.”

“The report identifies a relatively smaller quantified burden for climate change, but climate is not necessarily a smaller systemic threat,” Vanessa Kerry, CEO of Seed Global Health and the WHO director-general’s special envoy for health resilience, wrote on LinkedIn. “It makes other threats worse, from disease outbreaks to food shortages, while driving up demand for care and damaging the clinics and health workers that provide it.”

What the climate estimate leaves out

Launch panel underway at the World Health Summit in Berlin.

The report’s climate estimate leaves out migration, biodiversity loss, drought and sea-level rise. It also excludes some of the tipping points climate scientists fear most, including a full collapse of the Atlantic Meridional Overturning Circulation (AMOC), the system of ocean currents that carries heat north to Europe, abrupt shifts in Arctic and Antarctic sea ice, and the melting of the Greenland ice sheet, which it judges extremely unlikely this century.

“The doctors of the planet are saying that the planet, which is the patient, is sick,” Jiménez Gómez Tagle said. Seven of the nine “planetary boundaries” that scientists say keep Earth’s systems stable have already been breached, according to the Potsdam Institute for Climate Impact Research’s 2025 Planetary Health Check.

“They are putting the [tipping points] aside,” she added of the report’s methodology. “It’s like, oh yes, it is happening, but it’s not important. If we do not look at them as objectively and urgently as it’s needed, then what are scientists for?”

Last year’s Lancet Countdown report put heat-related deaths at an average of 546,000 a year, up 23% since the 1990s. It linked droughts and heatwaves to an extra 124 million people facing moderate or severe food insecurity in 2023.

The commission treats a collapse in global food production as the route by which nuclear war could end humanity. Yet it leaves drought-driven famine out of its climate estimate, arguing that famine “is a sociopolitical phenomenon” that depends more on governance than on weather.

Climate Change Is Here, And It’s Killing Millions

Its uncertainty range for climate, 1.32 billion to 2.48 billion DALYs, covers only the pathways it modelled. The authors concede that the uncertainty “runs in both directions,” and that the climate figure “could reasonably increase in future evaluations.”

The same parts of sub-Saharan Africa where extreme poverty is set to rise also face the most damaging increases in temperature, the report notes. “Rising extreme poverty in a world with declining [development assistance for health] will create populations that might be under severe duress,” it warns.

Beyond 2100, the report concedes, climate change “could escalate into an extinction threat in subsequent centuries if emissions are not curtailed.”

“This is not an attack against them,” Jiménez Gómez Tagle said. “It’s just a request for clarification.” An open discussion between the authors and other scientists would help, she said, “so then we avoid, as they say, fatalism among people.”

The criticism crystallised the unconventional scope of the report, venturing far outside the prestigious medical journal’s specialist remit. Asked about the reasoning behind the report, Julio Frenk, chancellor of UCLA and a former Mexican health minister, recalled the commission’s first meeting, in Berlin at the World Health Summit in 2023.

“We all felt that we were in one of those periods in history where you sense that an era is coming to an end,” he said. He pointed to the end of the pandemic, when billions of people in the Global South were “wanting and needing and being willing to pay for vaccines that were being hoarded by rich countries, many of whose citizens were refusing to take the vaccines.”

“Today, among all the forms of erosion of trust,” Frenk said, “the most serious one is the erosion of trust in the future.”

Visitors register at the World Health Summit in Berlin under the banner “From Crisis to Resilience,” with over 4,000 visitors expected in person.
Visitors register at the World Health Summit in Berlin under the banner “From Crisis to Resilience,” with over 4,000 visitors expected in person.

BERLIN – The WHO Director-General election process ignited its first public candidate conversation on Sunday (11 October) at the 2026 World Health Summit in Berlin, as four of the race’s seven declared contenders tackled the thorny question of how to make global health institutions more responsive and fit for purpose.

The opening day’s flagship event on ‘global health architecture reform’ packed the auditorium to capacity – in a session widely perceived as the most significant of this year’s conference events.  But even if the candidates were prepared with ready prescriptions of ‘what’ reforms are needed – the ‘how’ to implement proved to be much more elusive, critics observed.

“The election of the next Director-General will take place at a pivotal moment for the World Health Organization and for global health more broadly,” declared World Health Summit President Dr Axel Pries at an opening press briefing Sunday, just ahead of the event.

“We are meeting at a moment when health around the world is under pressure from several directions – conflict and geopolitical tensions, economic strains, climate crisis, and increasing inequities,” Pries said at the opening of this year’s summit Sunday, just ahead of the panel event.

Held from 11-13 October this year under the theme “From Crisis to Resilience: Innovating for Health,” the summit has drawn over 4,000 in-person delegates to Germany’s capital as well as tens of thousands of online participants. Representing two-thirds of the world’s nations across more than 75 thematic sessions, delegates gather to debate pressing global health challenges and, crucially, the upcoming WHO Director-General election.

High stakes WHO Director-General election contest and empty chairs

WHO Director-General candidate panel (left to right): María Neira, Gevorg Tamamyan, Hanan Al-Kuwari, and Budi Gunadi Sadikin address the World Health Summit in Berlin.
WHO Director-General candidate panel (left to right): María Neira, Gevorg Tamamyan, Hanan Al-Kuwari, and Budi Gunadi Sadikin take questions from German diplomat and moderator Björn Kümmel at the World Health Summit in Berlin.

Responding to questions assigned by randomised lot by Björn Kümmel, a senior German Health Ministry advisor on global health and co-chair of the WHO-hosted task force on global health architecture reform, four prospective contestants took the stage to confront pressure to overhaul the world’s premier health agency: former Qatari Health Minister Dr Hanan Al-Kuwari, Indonesian Health Minister Budi Gunadi Sadikin, Spanish public health veteran Dr María Neira, and Armenian paediatric oncologist Dr Gevorg Tamamyan (nominated by Botswana).

Notably, three candidates were absent, including Saudi Arabia’s Dr Hanan Balkhy, stranded in Panama after an earthquake grounded her flight. Also missing – with no clear explanation as to why – was Belgium’s Dr Hans Kluge, and China’s Dr Song Li, whose nomination was only publicly confirmed last week.

The contestants directly addressed the high-stakes elephant in the room: an agency reeling from severe budget cuts and a 25 per cent workforce reduction following the withdrawal of the United States and member states’ demands for a restructured global health architecture that elevates country sovereignty and eliminates institutional overlap.

While senior observers pointed out that the exchange lacked deep specifics – cautioning that only four of the seven candidates were present to face scrutiny – the session nonetheless produced sharp contrasts. The contenders put forward distinct positions outlining how they intend to steer the organisation during their first 100 days in office.

Al Kuwari pledges executive review and functional reform

Dr Hanan Al Kuwari
Dr Hanan Al Kuwari

Former Qatari Health Minister Al-Kuwari offered a structured executive management approach to the WHO Director-General post, promising to eliminate administrative duplication across headquarters, regional offices, and country missions.

“Within my first 100 days, I will commission an independent functional review of the three levels of the organization and publish the findings,” she said.

She advocated for raising mandatory assessed contributions to 50 per cent of the base budget, securing flexible funding through the WHO Foundation, and establishing independent oversight over WHO’s scientific advice.

Neira focusses on primary prevention and environmental threats

Dr María Neira
Dr María Neira

Former Director of WHO’s Department of Environment, Climate Change and Health Dr María Neira advocated for a strategic pivot toward primary prevention, calling on governments to direct sovereign capital into clean water, air pollution abatement, and climate resilience to prevent illness before patients require hospitalization.

“We need a massive shift towards primary prevention -acting on the causes of disease before people become patients,” said Neira.

During her first 100 days in office, she pledged to motivate WHO staff and establish an early-warning “antenna” to detect emerging environmental and health risks, including microplastics, endocrine-disrupting chemicals, and declining global fertility rates. Underscoring that WHO’s authority rests on evidence rather than budget size, she maintained that the agency must serve as a scientifically fearless voice capable of influencing upstream investments across agriculture, energy, and urban planning – as well as better preparing health systems to address unavoidable disease burden.

Sadikin opts for unlocking financing for member state plans

Budi Gunadi Sadikin
Minister Budi Gunadi Sadikin

Former commercial banker and Indonesian health minister Sadikin argued that WHO must shed some of its broader operational functions to refocus strictly on its two constitutional mandates: scientific norm-setting and its unearmarked convening authority.

“When I talked to almost 100 health ministers across the world, the main message they gave me is to bring WHO back to its core mandate of setting norms and guidelines based on science,” he said.

Drawing on his experience co-chairing the Accra Reset High-Level Panel, he urged WHO to assist health ministries in converting national health plans into costed compacts that unlock development bank capital, while consolidating overlapping functions across global health initiatives. He emphasised that restoring internal credibility is an essential task for the next WHO Director-General to earn back flexible donor trust, maintaining that global health security ultimately requires keeping diplomatic doors open to all states.

Tamamyan puts patient outcomes over diplomatic protocol

Dr Gevorg Tamamyan
Dr Gevorg Tamamyan

Paediatric oncologist Tamamyan brought a clinician’s perspective to the stage, challenging conventional diplomatic protocol and demanding that WHO measure performance by patient health outcomes rather than process documents. He argued that WHO must never allow bureaucratic boundaries to obscure its ultimate moral purpose.

“We should be the place where anyone can call, can say, ‘Okay, I have this problem,’ even if it is not within our mandate, but we are able to help. We should not hesitate to take the call, to call someone we know and help,” he said.

Addressing the elephant in the room

Pledging to bring the United States and Argentina, which withdrew from the WHO in 2025, back into the fold of the UN specialized agency – Tamanyan said he would travel personally to Washington and Buenos Aires within his first 100 days to ask both member states to return. He insisted that WHO must do whatever it takes to protect health, even if it means stepping beyond formal constitutional boundaries to engage disaffected capitals.

Al-Kuwari, asked by Kümmel about how to maintain WHO’s credibility as a universal norm-setting body when major member states have retreated, took a more measured stance, saying: “WHO is richer with everybody being in the organisation and everyone having an equal voice.”

She argued that departed capitals “have more to gain than to lose by staying in the organisation,” noting that the structural changes they demand – such as eliminating duplication, increasing transparency, and enforcing accountability – are identical to the reforms requested by remaining member states. Instead of offering any particular set of concessions.

Analysts have cautioned that bold personal diplomacy alone cannot resolve deep geopolitical divides. “Bringing back departed Member States requires building an environment for genuine dialogue rather than making unilateral promises,” pointed out Michel Kazatchkine, former Global Fund Executive Director and senior fellow at the Geneva Graduate Institute, in an interview with Health Policy Watch.

Rebooting WHO after cutbacks

Asked how the candidate would remotivate WHO staff internally following a devastating year of cutbacks, Neira called for a fosteríng “a more creative internal environment” as well as ensuring that staff recruitment was “high quality” and independent.

Tamamyan said he’d focus on bringing more young professionals into the organization – the same group that bore the brunt of the recent, deep cuts in WHO staff over the past year.

Measuring success

Asked to summarize in just a sentence what success would look like by the end of the DG’s five-year term in 2032, Sadikin also referred to the US and Argentinian withdrawal saying, “what I envisioned is that all 194 countries will be back, and they will happily pay the assessment fee, and then they will proudly say that ‘Hey, WHO, you make our people live long and healthy.’”

For Al-Kuwari a successful team would mean that: “the world is healthier, it’s better prepared for emergencies, and it’s a fairer one.”

And for Neira, it would be “global health at the centre of government policy”  while Tamanyan said “for me the best achievement would again be about people” – adding that he wanted to also see a 90% satisfaction rating amongst the staff of WHO itself – as a reflection of success.

Candidate conversation was ‘high-level warm-up’

Michel Kazatchkine
Michel Kazatchkine

While praising the unscripted, randomised format, Kazatchkine stressed that candidates avoided debating the hard institutional trade-offs facing the agency, leaving the conversation high-level and mostly non-contentious.

“Everyone agrees that WHO should be normative. That means it should put science at the heart of everything it does, undisputable, unchallengeable science. Yet, they did not speak about science,” said Kazatchkine.

He pointed out that contenders sidestepped critical structural issues, including who should appoint Regional Directors, how regional offices interact with headquarters, and how WHO coordinates with regional bodies. He noted that while Regional Directors sit closer to Member States, the candidates offered no clarity on resolving structural friction across these tiers.

Many details of WHO’s own institutional reform will depend on how Assistant Directors-General are chosen.

“There was maybe a little too much pressure on the Director-General rather than on the team surrounding him,” said Kazatchkine.

However, framing the Berlin WHO Director-General election panel as a good warm-up, he emphasised that observers must remain cautious in drawing conclusions at this stage.

Following the first stop in Berlin, the candidate field turns to the official WHO Candidates’ Forum in Geneva this November. The 34-member Executive Board will subsequently shortlist and nominate three finalists during its session in January 2027, ahead of the decisive World Health Assembly vote in May.

As WHO Nominations For Next Director-General Close, Six Contenders Emerge – But More May Remain Under Seal

Image Credits: Felix Sassmannshausen/HPW, Elaine Ruth Fletcher/HPW, Graduate Institute.