Thousands of Zimbabweans passing through the Musina repatriation centre are desperate to find safety after fleeing anti-migrant unrest in South Africa.

HARARE, Zimbabwe – For the past two decades, 49-year-old Renious Gumbi from Mberengwa in Zimbabwe lived in South Africa, where he worked as a bricklayer.

Gumbi, who was living with HIV, received free antiretroviral (ARV) treatment from his local clinic in South Africa as, according to that country’s Constitution, “everyone has the right to have access to healthcare services”.

But worsening economic conditions and growing unemployment in South Africa have led to the formation of anti-immigrant groups such as Operation Dubula and March and March, which have blamed non-citizens for service delivery problems – although these have been caused largely by systemic corruption.

Over several months, anti-immigrant groups have blockaded many clinics and hospitals, refusing to allow non-citizens to enter.

As a result, Gumbi was unable to get ARVs since June and became seriously ill. In desperation, his wife, Senzeni, arranged for him to return to Zimbabwe using cross-border transporters known as malayitshas.

Gumbi was at last given ARVs at the Zimbabwean border with South Africa, but it was too late. He died soon after returning to the country of his birth.

“It was cruel for South African leaders to leave anti-migrant activists blocking my husband from getting his ARV treatment drugs,” Senzeni told Health Policy Watch.

“It is also heartless for the Zimbabwean government not to have a plan for its people living with HIV in South Africa when the same regime benefits from the money many Zimbabweans based in South Africa formally send to help their loved ones back home.”

Harder to get ARVs 

Access to ARV  treatment in Zimbabwe has grown more difficult since talks between the United States and Zimbabwe on future US aid for HIV and other health services broke down in February, jeopardising the HIV treatment of some 1.2 million people reliant on US aid.

A recent study also projects that approximately 75,000 Zimbabweans will contract HIV within a year if there is a complete withdrawal of the US President’s Emergency Plan for AIDS Relief (PEPFAR).

While South Africa has also been badly affected by the US decision to phase out all HIV and other health support, it was not reliant on the US to pay for antiretroviral treatment.

It is hard to estimate how many Zimbabweans are in South Africa as thousands have entered the country illegally through poorly policed borders. However, between two and three million Zimbabweans are estimated to be living in the country following the near-collapse of the Zimbabwean economy from the early 2000s. 

This has contributed to strain on the country’s health services, already damaged by systemic government corruption.

Despite the guarantees in South Africa’s Constitution, Dr Sibongiseni Dhlomo, chairperson of the country’s Parliamentary Health Portfolio Committee, told Parliament last year that non-South Africans should only be entitled to emergency health services, not comprehensive healthcare, as the country does not have “unlimited resources”. 

However, this would require changes to various laws and the Constitution. Meanwhile, in 2025 the South African High Court ruled that Operation Dudula could not bar people without South African identity documents from health facilities.

But March and March gave undocumented migrants until 30 June to leave South Africa, and have resorted to threats, violence and ongoing blockages of health facilities.

On 30 June, thousands of people were forced to leave their homes amid anti-migrant protests and violence in South Africa, seeking refuge in parks, churches, and consulates.

Amidst the chaos, many Zimbabweans fleeing from the flaring xenophobic tensions in South Africa have heart-rending stories.

Gilbert Muzokomba, aged 58, has lived in South Africa since 1999, and was also prevented from accessing his ARVs from a clinic in Gauteng province’s East Rand.

Five years into this 27-year-stay in South Africa, Muzokomba married a South African. In 2009, he and his wife tested positive for HIV and started ARV medication.

However, his wife died in 2020, and recently Muzokomba found himself under pressure to leave South Africa from his neighbours.

After defaulting on treatment for a very long time, he decided to head back to Zimbabwe in the hope of quickly resuming ARVs. But there was no guidance for new arrivals about how and where to get ARVs, he said.

“I left South Africa voluntarily after seeing that I might end up dying without access to my HIV treatment drugs, having been repeatedly barred from accessing the treatment by anti-immigrant groups. I had already defaulted, and my health is deteriorating fast,” Muzokomba told Health Policy Watch.

He was placed on a waiting list for a register for local HIV patients accessing free ARVs, but the process has taken longer than expected, costing him his health.

Delayed treatment

Meanwhile, 23-year-old Nelisiwe Mugodhi was born with HIV in South Africa, but also fled from xenophobic violence several days after she also defaulted on her treatment after being barred from a clinic in Khayelitsha, a large slum settlement in Cape Town.

Mugodhi claimed that her parents succumbed to AIDS a few years ago and, as their only child, she was able to soldier on thanks to Good Samaritans in South Africa.

But when xenophobia tensions broke out this year, Mugodhi fled to a place she barely knew.

Mugodhi said she was eventually placed on ARV treatment back home, but it took a long time and her condition had deteriorated for days, rendering her sick from bouts of diarrhoea, headaches, swollen feet and incessant coughing.

“To be honest, I don’t know if I will ever recover. I was healthy and have never fallen sick when I had access to treatment while in South Africa before the latest xenophobic tensions,” Mugodhi told HPW.

Zimbabwe’s brave face

People fleeing South Africa were relieved to get the ARV triple therapy, Reydin, from Médecins Sans Frontières (MSF) at the Zimbabwean border.

It remains to be seen how the Zimbabwean government is going to cope with the influx of HIV positive migrants from South Africa.

For now, officials have put on a brave face. During a recent appearance in Parliament, Health Minister Douglas Mombeshora said health workers had been deployed at the country’s borders to screen returnees and identify those living with chronic conditions like HIV, diabetes and hypertension.

“We have put in place our health workers at the ports of entry to make sure that every returnee is being screened, from adults to children. So far, we have screened over 99,000 Zimbabweans,” Mombeshora said.

But the Minister also said: “We are not able to institute long-term treatment on their arrival because we need to first take baseline tests, like viral load and things like that, which cannot be done at the port of entry at the moment.” 

In late July, Médecins Sans Frontières (MSF) reported that it was running a clinic alongside the South African government’s repatriation centre in Musina, a town bordering Zimbabwe and South Africa.

MSF reported assisting people who have defaulted on ARVs and chronic medication, particularly to treat high blood pressure.

Media reports indicate that 34,000 people have returned to Malawi and 100,000 to Zimbabwe, illustrating the regional scale of displacement, according to MSF.

“More than 100,000 people fleeing or being displaced are the kind of numbers MSF see in hot conflict areas, not relatively stable democracies like South Africa,” says MSF’s Caroline Masunda. “With so many displaced people, we call on governments in the region to step up collaborative efforts to ensure continuity of care for patients”.

The temporary repatriation camp at Musina, the South African town on the border with Zimbabwe.

 Official figures show that by early July 2026, 21,000 Zimbabweans had been repatriated with government assistance, while a further 57,000 returned at their own expense.

Kensington Marufu, an HIV/AIDS activist and lawyer aged 36 who was born with HIV, says that the return of migrants from South Africa will worsen the country’s HIV crisis.

“Most of these returnees are definitely secretive about their health status, especially HIV,  which will cause problems here. They don’t know where to get help with their condition after being away from home for many years. I think these returning migrants will have a problem with adherence to treatment, which will negatively impact on their health,” Marufu told Health Policy Watch.

Marufu, who tested positive for HIV at the age of 10, is a renowned lawyer. His parents and only brother succumbed to AIDS some years ago.

Zimbabwean Pastor Reki Jimu, who has lived with HIV for decades and spearheads the fight against HIV in Zimbabwe, says he has the names of many Zimbabwean migrants now back in the country who have defaulted on treatment and are now faced with life-threatening complications.

“I know several returnees from South Africa who have defaulted on ARV treatment after getting disturbed by xenophobic tensions there. Many of these people are now hospitalised here because of missing out on opportunities to acquire their medication here,” Jimu told Health Policy Watch.

An estimated 1.3 million people are living with HIV in Zimbabwe, according to UNAIDS. But the return of the country’s migrants will swell this number and strain the country’s health system.

“I don’t know if I will survive here in Zimbabwe,” said Mugodhi.

Image Credits: Kate Stegeman/ MSF, Taduw Andre/ MSF, MSF.

The Cairo EMRO headquarters, maintaining regional operations as Director Hanan Balkhy takes leave to campaign in the Director-General election race.
The Cairo EMRO headquarters, maintaining regional operations as Director Hanan Balkhy takes leave to campaign in the Director-General election race.
Dr. Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean (EMRO).
Balkhy, WHO Regional Director for the Eastern Mediterranean (EMRO).

Eastern Mediterranean Regional Director Dr Hanan Balkhy will take immediate leave effective Tuesday to formally launch her campaign in the WHO Director-General Election, according to an internal notice from DG Dr Tedros Adhanom Ghebreyesus seen by Health Policy Watch.

Balkhy becomes the first serving regional director required to take leave after Tedros issued newly tightened election guidelines in July to resolve campaign finance and ethical concerns.

Under the new directive, all internal candidates must exhaust their accrued annual leave before transitioning to special leave on half-pay, effectively levelling the playing field.

Previously, regional directors enjoyed a distinct structural advantage over other internal candidates such as Assistant Directors-General by retaining their full salaries, travel budgets, and administrative machinery while actively campaigning.

To comply with the newly enforced guidelines, internal candidates must ensure a complete separation between official WHO functions and campaign activities.

“The election of the Director-General must be conducted in a manner that safeguards the independence, impartiality and integrity of the organization,” Tedros stated in the internal notice.

Ensuring regional continuity

Dr Ismail was appointed officer-in-charge of EMRO.
Ismail was appointed officer-in-charge of EMRO.

To maintain regional operations during the leave period, Tedros has designated Dr Adham Ismail Abdel-Moneim as Officer-in-Charge of the Eastern Mediterranean Regional Office (EMRO).

Before assuming his current role as director of programme management in 2024, Abdel-Moneim served as the WHO Representative to Saudi Arabia, Yemen, and Iraq. Before these field assignments, he spent 13 years with the regional medicines team in Cairo.

In the circular note, Tedros expressed his gratitude to Ismail for assuming these responsibilities, stating he is confident that “WHO’s vital work will continue without interruption” and that the new officer-in-charge “will ensure continuity in the leadership and management of the Region”.

For Balkhy, her new status has significant consequences, as she must now withdraw from speaking in her official capacity at global forums such as the upcoming World Health Summit in Berlin in October.

The WHO code of conduct dictates that internal candidates must “clearly separate their WHO functions from their candidacy and avoid any overlap, or perception of overlap, between campaign activities and their work for WHO.”

Balkhy is, however, permitted to attend the Berlin summit as a private candidate on campaign leave. However, the code actively encourages candidates to utilise major international conferences to hold bilateral meetings and campaign activities strictly on the margins of the event.

Another procedural grey area persists regarding when a candidate is officially recognised. For instance, a nominating country can delay its formal request to allow their candidate to continue high-profile diplomatic travel.

Without strict enforcement during the pre-nomination phase, candidates may still utilise official platforms to build international support. This gap highlights the limits of voluntary ethical commitments before formal nominations are announced.

Narrowing field of prospective contenders

As the September deadline for official applications draws closer, the field is slowly taking shape, with the first candidates officially entering the Director-General election race.

However, several high-profile global health leaders have recently removed themselves from the succession race. The Pan American Health Organization’s regional director, Dr Jarbas Barbosa, ruled out a bid to focus on leading his region. WHO Chief Scientist Jeremy Farrar also told Politico he has “no intention” to run.

Want to Become the Next WHO Director-General? Get in Line 

Image Credits: WHO/EMRO, Hannan Balkhy, WHO.

HIV activists disrupt US AIDS Coordinator Jeff Graham at a US pre-conference session. Quantifying the effect of the Trump cuts is difficult
.

VITAL SIGNS COLUMN: Eighteen months into the dismantling of the global AIDS response, how many have died? The honest answer is that nobody knows. Rio’s numbers are inferences, its assumptions and projections disputable. But 30 years and tens of billions of dollars into the HIV/AIDS pandemic, we should not still be guessing.

The week’s Vital Signs came from Rio de Janeiro, where the 26th International AIDS Conference convened last week under the banner “Rethink. Rebuild. Rise.” A stirring slogan that would surely awaken even the dead? Therein lies the question: 18 months after Washington started dismantling the architecture of the global HIV response, how many people are dying as a result?

Nobody knows, because no one has counted the dead. Every figure in circulation is a projection against a hypothetical world without aid cuts. Mourning the unknown dead dampened the vibrant Rio buzz that I have so enjoyed in the past.

A third kind of half-truth

The assassination of evidence by advocacy should worry a global health enterprise proud of its underlying scientific base. That base is now under assault from multiple directions, with “mal-information” – distinct from misinformation or disinformation – being the latest threat.

Mal-information concerns data analysis that could be taken out of context and manipulated to make misleading connections, which damage or advance particular causes. Nowadays, that is facilitated by generally reduced population numeracy, which undermines trust in public policy and institutions and fuels weird theories and conspiracies.

Coming to HIV/AIDS, the message from Rio is that foreign aid cuts cost lives. The arithmetic of this is somewhat awkward. Policymakers scanning the headlines of well-presented UNAIDS updates may not understand, or overlook, that these are centred on epidemiological modelling. And so we rely on estimations. 

However, as we learnt from disputed mortality projections when COVID-19 was advancing relentlessly, it is the assumptions underlying mathematical models that have a huge bearing on the numbers churned out. These, in turn, take on a life of their own to support or refute whatever case protagonists want to push.

Meanwhile, it is doubtful whether the Rio delegates had time to study the UNAIDS modelling methodology note, whose entrails require forensic drilling with advanced statistical tools.

This is what is revealed. As UNAIDS does not count AIDS deaths, it estimates them in worst-affected countries via a model fed by prevalence tests at antenatal clinics, household surveys and clinic treatment registers. The model already contains assumptions about how many people die when treatment is interrupted, and so it cannot independently prove that the aid cuts killed anyone.

Worse, when clinics stop reporting – for example, if funding and staffing shrink – the model reads the silence as falling treatment and over-estimates deaths. Or, when registers go stale, it under-estimates them. 

Furthermore, the published margin of error covers only the model’s own arithmetic, not mistakes in the country data collection process. The historical series must also be revised annually, shifting past figures and making trend comparisons unstable. 

Where countries do not produce data, UNAIDS makes estimates that reviewers cannot inspect. The share filled in by such statistical guesswork is rising, as surveillance and reporting systems fray under resource constraints.

While UNAIDS documents these challenges honestly, the obvious question is whether future global HIV policy can be formulated on this basis. Even stock market indices are easier to understand.

Reduced confidence

IAS President Beatriz Grinsztejn,  UNAIDS executive director Winnie Byanyima, Erika Castellanos of the Global Action for Trans Equality, Aouth Africa’s Deputy Health Minister Dr Joe Phaahla, PAHO regional director Jarbas Barbosa and Brazilian Secretary of Health Dr Mariângela Simao launching the UNAIDS report.

With this caveat, the UNAIDS special report for Rio models AIDS-related deaths at 570,000 in 2025 with a range (430,000 to 780,000) so wide as to greatly reduce confidence in the central estimate. The spread is wider still around the number of people living with HIV, put at 41 million within bounds of 35.3 and 47.5 million.

The same modelling offers a mirror image. If the United Nations HIV/AIDS Political Declaration’s targets were met in full, it says, 3.2 million infections and 1.3 million deaths would be averted by 2030. That projects what success would buy, not what failure will cost –  an important distinction lost at the conference.

Confusion comes from other projections that disagree, partly because they model different worlds. One gives 74,000 excess deaths across seven African countries by 2030, assuming a 90-day funding freeze followed by near-total collapse. Another gives 770,000 to 2.9 million across all low- and middle-income countries.

Thirteen months ago, UNAIDS itself feared four million deaths by 2029, on the assumption that American-supported services collapsed entirely. The spread reflects assumptions, not data.

No dose-response curve for aid

The principal villain portrayed as responsible for future projected deaths is the aid cuts. How justified is that?

Donor government funding for HIV/AIDS dropped 25% in a year – from $8.3 billion in 2024 to $6.2 billion in 2025, the lowest level since 2007.  

It was entirely American: US disbursements fell $2.09 billion against a global fall of $2.08 billion. Other donors had already cut earlier, and now their combined total held level.

That could potentially translate into raised AIDS mortality, but by how much is uncertain. There is no “dose-response curve” for foreign aid akin to that for a drug, or even for a public health intervention like clean air.

Meanwhile, the overall financing picture is complex. Foreign aid cuts for HIV have been partially offset by a 4% increase in domestic funding in 2025, with more than 55 countries now committing to raise their own contributions. Domestic resources, public and private, carry 59% of total HIV financing in low- and middle-income countries. Total resources therefore fell by only 6%, to $17.6 billion.

The models don’t tell us how many lives are thereby saved.

What was measured, not modelled?

Meanwhile, and remembering the pathology of HIV progression, it is not the magnitude of aid cuts that matters but where they fall. What we do know, because it has been measured rather than estimated, comes from the US programme’s own returns. 

Between 2024 and 2025, prevention spending fell 51%, testing by 17% and pre-exposure prophylaxis (PrEP) initiations by a third.

Direct service staff fell by 62,541, a quarter of that cadre. Some 77,000 fewer children received treatment through those programmes. Facilities that had treated ALMOST 442,000 people simply stopped reporting, their status now unknown.

That last figure is the modelling problem made flesh. Silence from a clinic is read by the model as treatment failing and converted into deaths – whether or not anybody died. How that is folded into a mortality calculation is not clear.

Meanwhile, the foreign aid picture is not static. Could US money be spluttering back? The US Congress appropriated $4.633 billion for bilateral HIV assistance this fiscal year, against the administration’s request of $2.9 billion. But the administration is delaying disbursements as far as possible.

The evidence sits in the gap between the two verbs. US HIV appropriations were flat across 2023, 2024 and 2025, yet disbursements fell 31% last year. Our AIDS mortality modelling is too simple to accommodate such shenanigans by factoring in actual aid flows.

A further twist is the America First Global Health Strategy, issued by the State Department last September, in which the US is seeking bilateral agreements with countries.

Ageing multilateralists like me should, in principle, be dismayed by such blatant subjugation of the collective global good to any country’s national interest.

But before automatically condemning the new US approach, is it not worth keeping an open mind on whether this is good or bad for long-term HIV control?

Time will tell. The 34 bilateral compacts signed since December 2025 commit some $24 billion to 2030, of which around $14 billion is from the US and close to $10 billion is required from recipients. 

Sovereignty-sensitive people will not like aid conditionalities. But this is not new, even in multilateral approaches where the World Bank is the master. And if this incentivises stronger national ownership and sustainability, it is a useful counter to the dependency that traditional aid has created.

Conditionality concerns

Guinea and the US sign a minerals MOU shortly before an MOU on health aid.

There are also concerns about sharing data and biomaterials, or about leveraging health assistance in business bargaining.  

A Kenyan court suspended implementation days after the country’s leadership signed an MOU with the US. Zambia and Zimbabwe backed away, the former having found its health agreement entangled with American access to copper and cobalt.

More serious for public health, the agreement texts examined so far are largely silent on “key populations”. These are people most at risk of HIV, including men who have sex with men, sex workers, transgender people, and people who inject drugs. 

Where preventive medication (PrEP) appears at all, it is as a commodity line item, with no commitment to reach the people most exposed.

Key populations are essential because this is where HIV/AIDS is increasingly concentrated, as we embark on the remaining journey toward an “AIDS-free world”. 

The critical question is whether the US will allow counterpart recipient funds to target key groups as part of jointly funded national programmes, even if American funding may not be used for them for ideological reasons.

Such twists and turns are difficult to include in current modelling, which does not reveal the weightings given to multiple factors at play. But new AI capabilities make that possible, whenever there is a resurgence of evidential rigour over convenient advocacy.

The harms donors are not causing

A protest against Uganda’s attempts to pass a ‘kill the gays’ law in 2012. In 2023, Uganda’s parliament tightened its anti-homosexuality laws, and this trend has been followed by several other African countries.

The consequences of donor leverage are one thing, but domestic policies have their own impacts. In 2026, 168 countries criminalised sex work, 152 the possession of small amounts of drugs, and 66 same-sex relations. 

For the first time since UNAIDS began tracking these trends, criminalisation of marginalised populations increased.

The Sahel led the way. Burkina Faso and Niger newly criminalised same-sex activity, and Senegal raised its penalties this year. Visits to Senegal’s treatment centres then fell by a quarter between January and February, as patients stayed away for fear of arrest.

This drives the condition underground. It would show up as falling rates in the data inputs of conventional models, which would then underestimate mortality. Meanwhile, no country can end AIDS while criminalising the people most at risk of it.

Aid cuts did not write those laws. That raises the question of whether foreign aid should be used to compensate for irresponsible domestic policies.

Nor did aid cuts set the price of the drug that could end HIV transmission. This was a lively topic in Rio. Two injections a year of Lenacapavir prevented every infection among women in its South African and Ugandan trial and cut infections by 96 % in a second trial. With 22 % of people living with HIV still not on treatment, this is game-changing.

But it carries a United States list price of $28,218 a year as a patented product, while analysts estimate it could be made generically for $25 to $40.

Pending generic availability, the manufacturer has offered no-profit supply through the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund across the 120 countries of its voluntary licence. This is enough for up to two million people over three years. 

Compared to the past, this is a lightning-speed transition from costly patented to more affordable generic medicines.

However, 17 middle-income countries, including Brazil, sit outside that licence and account for 19% of new HIV cases. This exposes an uncomfortable truth: solidarity in global health does not come free. Even among developing countries, the richer ones need to carry a bigger financial burden for the sake of the really poor.  Will they?

How this prevention breakthrough is integrated into mortality modelling is unclear and depends on the currently unknown rate of scale-up.

One detail is informative of the state of the world. Americans will benefit enormously and should thank South Africans for the trials that proved the drug. Yet Washington began a phased drawdown of its HIV programme in South Africa in June, citing the country’s failure to meet its policy demands.

A legacy worth leaving

Tracking HIV/AIDS through mathematical modelling using outdated assumptions is increasingly questionable. Especially in an era of rapid policy and pharmaceutical innovations, tightening resources, and geopolitical and social shifts that are not always benign. 

This is not a sound basis for the smart national and global strategies necessary to achieve the AIDS-free shared goal.

There is something indictable here. Thirty years into the pandemic, we still base many of our actions on inferences, deductions and sometimes, frankly, guesswork. Despite expending tens of billions of dollars, including creating two dedicated international bodies – UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria – and an extensive ecosystem of national bodies and numerous NGOs.

UNAIDS is meanwhile contemplating its own end. The UN80 review proposed closing it by the end of this year. UNAIDS has countered with a phased plan, and its board expects recommendations in October. 

Whatever is decided, it should consider its legacy. That legacy cannot be advocacy or therapeutic advances, because those are mostly the push of courageous people who have themselves endured HIV and those who work directly with them. 

As a Joint Programme of the biggest and most influential United Nations agencies, UNAIDS should leave behind something more systematic and tangible. How about a robust global system for measuring – not estimating – actual AIDS-related mortality?

 

Mukesh Kapila is professor emeritus of global health and humanitarian affairs at the University of Manchester, and a board member of Health Policy Watch. Vital Signs in Global Health is a regular column, and the opinions expressed are solely those of the author.  

Image Credits: Felipe Varanda/ IAS, Peter Tatchwell Foundation.

Scientists at Tanzania’s Ifakara Health Institute analyse malaria parasite samples to track genetic mutations associated with drug resistance, helping detect emerging threats before current treatments begin to fail.

KARAGWE, Tanzania – Maria Mwijage had barely reached the footpath home from the village well when mosquitoes began circling her legs. Overnight rain had filled roadside puddles and cattle hoof prints with stagnant water, turning them into breeding grounds.

She brushed the insects away, balanced the yellow jerry can on her head and continued towards her home in Nyachika village, in Tanzania’s northwestern Karagwe District.

For families here, the rains bring more than greener fields. They also mark the return of malaria.

“I usually know when it’s malaria before we even get to the hospital,” says Mwijage, 33, who has endured repeated bouts of the disease over the years.

She still remembers the night her 12-year-old son developed a high fever and began shivering uncontrollably.

“He was so weak. He kept crying through the night. None of us could sleep,” she recalls.

The following morning, she wrapped him in a blanket and hired a motorcycle taxi for the hour-long ride to Kayanga District Hospital. A rapid diagnostic test confirmed malaria, and health workers prescribed an artemisinin-based combination therapy (ACT), the treatment recommended across most of Africa.

Within days, he had recovered. For now, that remains the experience of most malaria patients across Tanzania. ACTs continue to cure uncomplicated malaria and health authorities are not recommending any changes to treatment. But scientists monitoring the malaria parasite say the organism itself is beginning to change.

A study published in Frontiers in Genetics has detected genetic mutations associated with partial resistance to artemisinin in northwestern Tanzania, raising concerns that the parasite could gradually become less responsive to one of the world’s most effective malaria medicines if its evolution is not closely monitored.

Mystery mutation

Researchers analysed 2,866 Plasmodium falciparum samples collected between 2021 and 2023 in seven districts of Kagera Region. Although the mutation remains uncommon, its wider distribution has caught scientists’ attention.

They found the K13 R561H mutation, recognised by the World Health Organization (WHO) as a marker of partial artemisinin resistance, remains concentrated in Karagwe and neighbouring Kyerwa District but has also appeared in Muleba and Bukoba Rural, suggesting it is spreading beyond its original hotspot.

“The medicines we use today are still effective,” says Dr Deus Ishengoma, a molecular biologist at the Ifakara Health Institute and one of the study’s authors.

“What this study shows is that the parasite is changing. We are seeing resistance-associated mutations in areas where they were previously uncommon, and that’s an early warning that we need to take seriously.”

Unlike routine malaria surveillance, which records infections and treatment outcomes, genomic surveillance looks inside the parasite’s DNA, allowing scientists to detect mutations years before patients begin failing treatment. That early warning can give countries time to strengthen surveillance while existing medicines are still working. Researchers point to Southeast Asia as a reminder of why that matters.

Felista Tarimo, a researcher at Tanzania’s Ifakara Health Institute, demonstrates mosquito collection as part of malaria surveillance activities. Photo by Ifakara Health Institute.

Crucial cooperation

More than a decade ago, scientists in western Cambodia detected similar mutations that initially caused parasites to clear more slowly after treatment. Patients still recovered, but resistance eventually spread to the partner medicines used alongside artemisinin, forcing several countries in the Greater Mekong Subregion to replace their first-line malaria treatments.

Africa is not facing that situation. ACTs continue to perform well across the continent, and the Tanzanian study found no evidence that patients are failing treatment. Instead, researchers see the findings as a signal to watch the parasite more closely.

Karagwe’s location adds to the concern. The district borders Rwanda and Uganda, where thousands of people cross every day to trade, visit relatives, farm and seek healthcare. Malaria parasites travel with infected people and mosquitoes, making drug resistance difficult to contain within national borders.

“Cross-border cooperation is essential because malaria does not stop at immigration checkpoints,” says regional malaria expert Zul Premji. “If one country detects resistance-associated mutations but neighbouring countries are not looking for the same markers, resistant parasites can spread unnoticed. Sharing surveillance data gives countries the best chance of detecting changes early and protecting the medicines we still have.”

Scientists say neighbouring countries around the Lake Victoria basin should not only exchange malaria case data but also compare genetic information and coordinate therapeutic efficacy studies so changes in parasite populations can be tracked consistently across the region.

Over the past two decades, governments and donors have invested heavily in mosquito nets, indoor spraying, rapid diagnostic tests and ACTs, helping reduce malaria deaths across much of sub-Saharan Africa.

Can We Win the Malaria Arms Race?

Far less money has gone into genomic surveillance—the specialised laboratories, sequencing technology and trained personnel needed to detect resistance before medicines begin to fail.

“Changing first-line malaria treatment is a major undertaking,” says Syabo Mwaisengela, a health economics and policy expert at Mzumbe University. “It means revising national treatment guidelines, retraining health workers, procuring new medicines and reorganising supply chains. Those changes are expensive. Detecting resistance early allows countries to respond before treatment failure becomes widespread.”

The researchers stress that Tanzania’s current malaria treatment policy remains appropriate. ACTs continue to cure uncomplicated malaria, and the study found no evidence that the medicines are losing their effectiveness.

Beyond the K13 mutation, scientists also detected genetic markers linked to resistance against older antimalarial drugs, including sulfadoxine-pyrimethamine, offering a broader picture of how Plasmodium falciparum is evolving across northwestern Tanzania.

For Mwijage, those scientific findings feel distant from everyday life. When her son became ill, she was not thinking about parasite genetics or molecular surveillance. She wanted the nearest hospital to have medicine that would make him well. It did. Scientists hope it stays that way.

They say identifying resistance-associated mutations while they remain uncommon gives Tanzania and its neighbours a chance to strengthen surveillance, expand laboratory capacity and coordinate monitoring across borders before one of Africa’s most effective malaria treatments comes under threat.

The inaccurate map of Africa shown during the US government information session.

RIO DE JANEIRO – The United States’ rapid dismantling of its HIV funding since January 2025 has caused the worst financial crisis for the sector in decades – but the US government’s willingness to host an information session on its new America First Global Health Strategy on the eve of the International AIDS Conference earned it some goodwill from delegates.

However, that goodwill rapidly evaporated when the US government displayed a wildly inaccurate map of Africa during a briefing by Jeff Graham, the acting US global AIDS co-ordinator. 

The US map locates Mozambique in the Horn of Africa, almost diametrically opposite to its actual position on the west coast of southern Africa. Nigeria appears in Niger, while West Africa’s Côte d’Ivoire was located in East Africa.

However, Graham did not notice the mistakes when he displayed the map during a session attended by Health Policy Watch.

The International AIDS Society (IAS) president-elect, Professor Kenneth Ngure of Jomo Kenyatta University in Kenya, responded, saying: “It is disheartening that a map mislabelling African countries was displayed. African countries must be taken seriously. The African continent continues to bear the greatest burden of the HIV pandemic, and our focus must now return to advancing the HIV response.”

Earlier, the US State Department told Reuters that it takes “full responsibility for ​the confusion and misrepresentation it ​caused for attendees, including ⁠our African partners”, claiming that a staff member had made last-minute changes to the presentation.

However, it did not offer any apology for not being able to locate the African countries with which it has signed Memorandums of Understanding (MOU), which outline the transition from US-supported to domestically financed HIV programmes.

 

Hygienists at the Rwampara Ebola Treatment Center (CTE) put on their personal protective equipment (PPE) in the isolation area before entering the centre, May 29, 2026.

BUNIA, Democratic Republic of Congo – Victorine Ngwobu Kasemi is the director of nursing at the Evangelical Medical Centre in Bunia, the epicentre of the Democratic Republic of Congo’s record-breaking Ebola epidemic. In recent weeks she’s had to watch colleagues succumb to the virus, and her children isolate themselves from her to keep safe.

“I’m afraid that at any moment I could die or infect my children, because this is a disease we can’t control, and no one knows where or when I might get contaminated,” said Kasemi.

Like hundreds of nurses working on the frontline, Kasemi faces the challenge of providing life-saving supportive care to patients without being infected. The most painful experience, she said, is watching helplessly as her colleagues succumb to the virus.

“There was a woman who came in with a miscarriage, and she had Ebola; two doctors and several nurses who treated this patient were infected,” she said. “One doctor, unfortunately, died from the toll it took. When a nurse was declared positive, she couldn’t bear it and fell into a depression until we lost her. We were unable to save her.”

These cascading infections illustrate a well-documented mode of transmission: Ebola, a severe viral hemorrhagic fever, spreads through direct contact with the blood, vomit, or other bodily fluids of an infected person, or via contaminated equipment – that puts healthcare workers at high risk. The average fatality rate is about 50%.

At home, medical staff have to carry the added burden of protecting their families.

“When I come home, my children ask me to stay on the balcony. They prepare my shower, I leave the balcony to go shower, and my clothes are immediately soaked in water,” Kasemi said. “That’s the life I’ve lived up until now.”

Unpaid wages, anger and infection risks 

At the Ebola Treatment Centre (CTE) in Ituri province, eastern DRC, Ebola response workers protest against delayed payment, July 13, 2026.

In mid-July, the severely underfunded frontline response was thrown deeper into chaos. Dozens of medical workers at Rwampara General Hospital in Ituri, a northeastern province on the border with Uganda where the first case was detected, on strike to protest unpaid wages.

Health workers from epidemiologists to health investigators and gravediggers leading the strike said they had not received pay since the epidemic began. The strike included everyone from epidemiologists and health investigators to gravediggers.

It has been a stop-cycle of strikes since protests began. Health staff walk out, receive new promises of payment, return to work, then resume strikes when the promised money doesn’t materialise.

Visits from top country officials have done little to quell the frustration. Prime Minister Judith Suminwa visited Ituri on July 24 to reassure health staff – they were back on strike within a day, still owed months of pay.

In a separate visit to Ituri, Health Minister Roger Kamba said that the government was in the process of verifying a list of people working on the epidemic response in order to sort out payments. He said the delay was due to unrelated names being added to it.

“We must make sure these payments reach the right people,” said Kamba. “We have the means to resolve this issue.”

Uncontained spread

Hygienists at the Rwampara Ebola Treatment Center (CTE) put on their personal protective equipment (PPE) in the isolation area before entering the center, May 29, 2026.

The DRC’s current outbreak – its 17th Ebola epidemic since 1976 – is spreading faster than any on record globally. It is already the third-largest ever in the DRC – and is on pace to become the largest in the history of the continent.

Africa Centre for Disease Control (Africa CDC) director Dr Jean Kaseya said at a press briefing on Thursday that the current outbreak has recorded seven times more cases than at the same stage of the 2014-2016 West Africa Ebola outbreak,

The critical threshold of 1,000 cases, which signals that an epidemic is spiralling out of control, was crossed in just 40 days, a pace the Africa CDC described as the “fastest-growing” epidemic ever recorded.  The 2,000-day threshold was crossed in only 20 days.

it took 235 days to reach 1000 cases during the 2018 North Kivu epidemic, which until recently, was at the time was the DRC’s worst outbreak on record.

The country has recorded 3,442 confirmed cases and 1,521 deaths – a case fatality rate of 44% – as of July 28, according to the DRC Ministry of Communications and Media. Nearly 800 patients remain in isolation or hospitals.

The toll includes 112 infected health workers – 35 of whom have died – across five provinces in eastern DRC: Haut-Uele, Ituri, North Kivu, South Kivu, and Tshopo.

Contact list far behind the curve

Test positity remains over 40%, indicating ongoing intense community transmission and gaps in active case search in the community, Africa CDC said Thursday.

As the response crumbles and contact tracers struggle to track the spread, the epidemic continues to break containment efforts, outpacing the response at every turn.

Over 80% of new cases in Ituri, the epicentre of the outbreak, are not linked to known cases, according to Africa CDC. Over 60% of deaths are linked to communities instead of treatment centres, showing authorities still have major ground to cover to catch up with the speed of the outbreak.

Struggles in contact tracing are compounded by the lack of medical countermeasures. Unlike previous epidemics in the DRC, caused by the Zaire strain for which vaccines exist, this one is caused by the Bundibugyo strain, which remains without a vaccine or approved treatment — making tracing one of the only tools responders have to get ahead of the virus.

The disease often begins abruptly with fever, extreme fatigue, muscle pain, headaches, and sore throat, before progressing to vomiting, diarrhoea, skin rash, and, in the most severe cases, internal and external bleeding, according to the World Health Organization (WHO).

The incubation period lasts 2 to 21 days, and an infected person becomes contagious only after symptoms appear. Close contact with a sick person, particularly during care or funeral rites, is the main route of transmission.

‘Heroes’ on the frontline

Medical staff prepare to enter the Centre Médical Évangélique to treat Ebola patients.

Dr Mubarack Kano, Medical Director of the Ituri Neuropsychopathology Centre in Bunia, said those risking it all to contain the virus are “heroes.”

Kano, who leads Ebola investigation in Bunia’s CNK Sayo health area, said this is especially true as they face backlash from community members who want to maintain traditional funeral customs like washing, dressing, and even kissing deceased victims that are still carrying massive viral loads.

“The workers responsible for breaking the chain of transmission by organising safe and dignified burials are the most exposed people, in a community that struggles to accept giving up customary funeral rites,” said Kano.

As medical workers and authorities refuse to hand over highly contagious bodies, it is only sowing deeper mistrust among some community members, who see it as part of a cover-up and even doubt the virus’s existence and see it as part of a resource grab.

Bahati Jhon, a father of eight, is a member of a safe and dignified burial (SDB) team in Rwampara.

“Since May 15, we’ve been doing this work. We face all kinds of risks. We’re sometimes physically attacked, threatened with death, chased,” Bahati Jhon, a father of eight and member of a safe and dignified burial (SDB) team in Rwampara, explained.

“During a burial the other day, someone in the community threw a stone at me, which unfortunately damaged one of my teeth, which I ultimately lost,” Jhon said.

It was not a one-off incident. In Rwampara, a centre was burned down on 21 May after authorities refused to return a body to its family. Elsewhere, burial teams were forced to abandon a coffin under pressure from angry residents.

Workers like Jhon keep taking on these risks, even as they go unpaid. “Since the epidemic began, we haven’t received a single franc. We don’t know what to do, as we can no longer provide for our families’ basic needs,” he said.

‘No one is coming to our aid’

Medical staff put on their personal protective equipment (PPE) before entering the Ebola Treatment Center (CTE) to care for patients at the Centre Médical Évangélique, July 9, 2026.

Despite efforts by relief teams to build trust and awareness, healthcare workers remain frequent targets of disinformation. In some cases, they’re being blamed for having invented the disease to enrich themselves.

“We are not here for the money. We face a critical situation,” Dr Kamara, a Rwampara health zone doctor, said. “There is a disease that is very real, and the goal of every healthcare worker is to treat, to save lives, and to limit the spread of the disease.”

An important part of the local response now centres on building local capacity to fight disinformation. The National Institute of Public Health is training local journalists, and MONUSCO has trained community leaders in Mambasa. DRC Authorities are also calling on community radio stations to step up awareness efforts.

The response is also being hamstrung by ongoing war. The armed conflicts in eastern DRC between Congolese forces and the Rwanda-backed AFC/M23 rebellion in North Kivu, South Kivu, and Ituri have displaced over a million people and blocked health workers’ access to affected areas, putting strain on an already fragile health system and exposing frontline workers to even more insecurity.

A patient inside one of the ETCs in Ituri, who declined to give his name, described the situation as becoming dire.

“We are shocked to see the absence of caregivers. What’s even more serious is that there are patients who arrived yesterday, and others even today, in critical condition. These patients are calling for help,” he said. “But no one is coming to our aid. We are here with no medication, no nurses.”

He said patients have had no food since last Monday morning.

Beyond the treatment centres, the war is fuelling another dark crisis for eastern DRC’s civilians. Panzi Hospital in South Kivu reported an 85% increase in newly registered survivors of sexual violence in the first half of 2026 compared to the previous year.

Sexual Violence Surges in Eastern DRC as Conflict and Ebola Overwhelm Health System

Who’s stepping up?

Continental overview of planned and disbursed funding for the Ebola outbreak and response shared by Africa CDC on Thursday.

The early weeks of the Ebola response were difficult and unbalanced, delaying the construction of Ebola treatment centres and proper patient care. Since then, funding has poured in, though not always fast enough to keep pace with the outbreak.

In June, Africa CDC and the WHO launched a joint response plan costing $518 million for the period June-November 2026.

Since then, the DRC government has already injected more than $50 million into the response. Paid in two instalments ($20 million then $30 million) by the public treasury, the funding pales in comparison to the overall national response plan budgeted at $319 million, and the continental Africa CDC/WHO plan of $518 million for June-November 2026.

In total, nations and international organisations have pledged around $1 billion to the response. Some 472$ million of that total has been distributed so far, according to Africa CDC. The agency estimates $1.4 billion will be required to fully quell the outbreak.

Among the main donors: the United States ($270 million), the United Kingdom (£20 million), the EU (€15 million), and the World Bank ($243 million). The WHO Foundation is running a campaign to raise $115 million, but so far has received less than half of that amount.

While international mobilisation remains visible, execution on the ground has struggled. Among the main donors: the United States ($270 million), the United Kingdom (£20 million), the EU (€15 million), and the World Bank ($243 million).

Questions and hope

US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO

Some donor countries are channelling funds directly through NGOs, which are involved in awareness campaigns and the construction of treatment centres. But in some cases, including funds allocated by the United States, questions have also arisen around the opacity of fund recipients and how they have been used.

Criticisms have also arisen that the WHO-Africa CDC coordination effort may have diffused, rather than sharpened accountability over the management of the crisis.

John Katabuka, a doctor at the ETC of La Grâce General Referral Hospital in Bunia and deputy coordinator of the Bunia health zone, is looking at the future with caution, but not without hope.

“We need to monitor entry and exit points and rely on community-based surveillance to track every alert – contacts, suspected cases, and contacts of contacts,” he said, adding that disinformation and community resistance early in the epidemic caused delays in care and a cascading rise in deaths.

“We are not pessimistic. We believe treatment centres and their equipment can be brought up to standard, so that even expatriates who fall ill can trust the local ETC rather than being evacuated abroad.”

 This article is published in collaboration with Egab.

Image Credits: Anicet Kimonyo.

United Nations (UN) Secretary-General António Guterres warned countries that the temperature extremes will continue unless fossil fuel usage is halted.

As wildfires rage across continents, heatwaves claim thousands of lives and ocean temperatures shatter records, UN Secretary-General António Guterres warned on Friday that the climate crisis has entered “overdrive.”

“This is only a warm-up act,” he said. “El Niño is strengthening, adding fuel to a planet already on fire with scorching heat domes, apocalyptic wildfires and record hot seas.”

New forecasts from the World Meteorological Organization (WMO) show El Niño, the naturally occurring climate pattern that amplifies global temperatures and disrupts rainfall, is developing into a strong event at unprecedented speed.

The Niño 3.4 index, a key measure of Pacific warming, surged from 0.5°C in April to 1.6°C in June. Sea-surface temperatures in key monitoring regions are forecast to average nearly 3°C above normal between August and October.

The WMO projects the event will continue intensifying into November, meaning the extremes already battering communities worldwide are likely a prelude rather than a peak. Through October, nearly every land area on Earth is expected to be hotter than normal.

“Fossil fuels are fanning the flames of this crisis. Expansion must stop,” Guterres said. “More coal, oil and gas will lead to a more combustible future.”

“Unless we act, to protect people and tackle the root cause of the crisis, the dangers will become deadlier still,” he warned. “The warm-up act is over. We cannot afford to wait for the main event.”

Guterres called extreme heat “the silent killer,” warning that even that description may understate the crisis. Heat deaths are vastly undercounted worldwide, he said, with many fatalities never recorded as heat-related even when heat plays a decisive role.

“Behind all of the numbers are people,” he said. “Families trapped in unsafe homes. Workers forced to choose between their health and their income. Children unable to learn.”

El Niño continues to intensify

El Niño causes wetter than normal temperatures in some parts of the world and drier than normal in others.

El Niño and La Niña are naturally occurring phases that are characterised by above-average sea-surface temperatures in the central and eastern equatorial Pacific Ocean, and affect weather patterns globally.

The WMO had warned of a strong El Niño following a hot summer that left thousands dead in Europe alone, and now is hoping to give countries a heads-up to prepare.

“This El Niño, developing against the backdrop of unprecedented ocean heat and rising temperatures, provides governments and communities with a window of opportunity to anticipate risks and act before impacts unfold. The decisions we make today will shape the impacts we experience tomorrow,” said WMO Secretary-General Celeste Saulo.

Currently, though, countries continue to invest in fossil fuels, and pension funds also invest in such projects instead of clean technology. “The hope is that the public, who are being impacted by these extreme climate-related events, that the public will demand urgent and ambitious climate action, and action not only to protect them, but also action to address the root cause,” said a UN official as part of background comments made to the media.

Also read: As El Niño Intensifies – WMO Warns Policymakers to Brace for Escalating Impacts on Health Worldwide

Extreme heat and rainfall – a deadly combination

WMO forecasts above-average temperatures across most land areas globally. Africa, southern Europe, the Arabian Peninsula, the Indian subcontinent, eastern Asia, Central America, the Caribbean, Southern Africa, much of South America and New Zealand are expected to be worst-hit by extreme heat.

“Every city and country should have heat-health action plans, early warning systems and public health measures that reach every community in time,” Guterres said.

Wetter-than-normal conditions are expected across the Greater Horn of Africa, parts of Central Asia, Southern Europe, Western North America and Southeastern South America.

In contrast, drier-than-normal conditions are more likely over the Indian subcontinent; Southern and eastern Australia; Southern Central America and parts of the Caribbean; Northwestern South America; and Northern Europe.

“The impacts are accelerating, as we’re seeing in real time. Solutions are available, as we’ve seen over the course of the last two years since the Secretary General’s call to action was launched, but what is really missing is the political will to act at the speed and scale this moment demands,” the UN official speaking on background said.

Pointing to the recent geo-political tensions between the US and Iran, UN officials are also highlighted how clean energy can help countries be sovereign. Clean energy, supported especially by China, has helped Cuba and Pakistan rapidly deploy solar energy to tide against their serious energy crunch. This shift highlights how market forces and people’s needs can shape climate action even if political will lags.

Image Credits: UN Photo, WMO, WMO.

Dr Jason Mitchell, who heads FIJI’s HIV task team, and Mark Shaheel Lal, founder of Living Positive Fiji.

RIO DE JANEIRO – A graph showing the progression of HIV infections in Fiji resembles a cobra poised to strike. For years, the 330+ islands that make up Fiji had almost zero HIV cases, but the country’s 14-fold increase in infections over the past five years is represented by a near-vertical line rearing up over the country.

Around 12,000 people are believed to have HIV in a country of less than a million people spread over 100 or so habitable islands.

“What is driving this epidemic now is risky injecting drug use of people who currently inject methamphetamines,” said Dr Jason Mitchell, chair of Fiji’s National HIV Outbreak Cluster Response Task Force.

People share needles to inject the crystal meth, another exploding epidemic, and sometimes also deliberately share their blood after taking the drug to make it go further.

The Pacific islands – positioned between East Asia, the Americas, Australia and New Zealand – have long been a gateway for drug traffickers. But during COVID-19, the drugs were unable to move, and a domestic market for crystal meth was cultivated.

Map of Fiji

“In January 2025, we declared a national HIV outbreak, which was initially confined to the population of people who inject drugs. The epidemic is now spilling over into every other population group in the country,” Mitchell told a media briefing at the International AIDS Conference (AIDS 2026).

“UNAIDS estimates that we currently have 1.2% prevalence in people between the ages of 15 to 49, and that of course continues to increase. That’s roughly one in every 60 adults,” said Mitchell.

‘The prevalence in our antenatal population now exceeds 2% and, in 2025, one child was born with HIV every week, and we lost one child to HIV-related matters every month,” Mitchell added. 

“In a country of less than a million people, this is very significant, and perhaps for me it is the greatest crime and shame of all because this is all preventable.”

Last year, around 18% of mothers with HIV passed the virus on to their babies – the highest vertical transmission rate in the world.

Two in three of last year’s people diagnosed with HIV were aged between 20 and 34, and  94% are from the indigenous iTaukei population. Men initially outnumbered women by over 2:1, but the rates in women are increasing.

There has been a 45% increase in children aged 10 to 19 becoming infected with HIV, said Mitchell.

Communal culture drives HIV spread

Mitchell attributes the rapid spread among people who inject drugs to two things: the culture of communality in indigenous Fijians and a shortage of clean needles and syringes.

“We typically share everything,” explained Mitchell, giving the example of kava, a root used in traditional ceremonies that has an antidepressant effect. 

“The practice of consuming kava is you have one mixing bowl and one receptacle or glass that we all share. The practice of kava has spilt over into our consumption of alcohol. Anyone who has grown up in Fiji will have been introduced to this practice of one glass and one [bottle of] alcohol. You would never have your own glass.”

Similarly, with crystal meth, people pool resources to buy the drug, which they then share along with the needles and blood.

But Mark Shaheel Lal, founder of Living Positive Fiji and one of the few people to come out publicly with his HIV status, says that “a needle and syringe programme is something that really needs to be implemented, and it is not”. 

“We constantly run out of [antiretroviral] medication, which has just been introduced, and no one really knows about antiretrovirals themselves.”

Huge obstacles

An HIV awareness march in Fiji.

Mitchell concedes that Fiji is struggling: “Our 90-90-90 [global HIV] targets are 40-22-3.2,” he says. This means that, instead of 90% of people knowing their HIV status, only 40% do. Instead of 90% of those living with HIV being on treatment, only 22% are in  Fiji. Of those that are, only 3.2% have undetectable viral loads, instead of the 90% target.

Many HIV cases are being diagnosed through routine HIV testing when people donate blood.

The government has introduced pre-exposure prophylaxis (PrEP) and “we’re trying to strengthen our condom programming in a region that does not use condoms”, said Mitchell. 

However, he agrees with Lal that “what is missing from this response is the availability of a needle and syringe programme”.

“That is a central part of a harm reduction programme,” said Mitchell. “There’s a lot of will, especially from our politicians and government, but we need to introduce the systems first.”

However, Mitchell concedes that police crackdowns on pharmacies selling needles and syringes have exacerbated the situation. He also recognises that it will be hard to convince people that “the practices they have adopted from consuming kava and alcohol should not be used in the situation where you’re injecting drugs”. 

The country is also struggling with resources. Australia and New Zealand are assisting Fiji, both with resources and technical support, and India has made a significant donation of ARVs, but Mitchell says the islands need more.

Despite getting a small grant from the Global Fund, Fiji is heavily dependent on this – although it is due to transition off Global Fund money within three years.

“We need a full upscaled response,” said Mitchell, warning that the epidemic also poses a threat to other Pacific islands.

Image Credits: World Health Organization, Kerry Cullinan, Fiji Ministry of Health, Wikipedia.

Restored frozen Gavi funding secures global childhood vaccination while Gavi faces intense political pressure over preservatives.
Restored frozen Gavi funding secures global childhood vaccination, while Gavi faces intense political pressure over preservatives.

The United States has unlocked frozen Gavi funding, resolving a bitter political impasse in Washington while doubling down against the WHO. But can the alliance eliminate thimerosal, a mercury-containing preservative, from its stockpiles without leaving millions of vulnerable children unprotected?

The United States will immediately release $600 million for fiscal years 2025–2026 in frozen Gavi funding, ending a tense congressional stand-off that threatened global immunisation plans, the US announced in a joint media note by the State Department and Department of Health and Human Services (HHS). The decision follows a bipartisan campaign led by Senate Appropriations Committee Chair Susan Collins and Vice Chair Patty Murray, who urged Secretary of State Marco Rubio to restore the funds.

However, the US money comes with a strict caveat, demanding Gavi work towards transitioning away from vaccines that use thimerosal as a preservative. “The Administration believes reducing reliance on mercury-containing vaccines, where suitable alternatives are available, is a pro-vaccine, pro-innovation policy,” the statement declared. Secretary of Health and Human Services Robert F Kennedy Jr reportedly associates the preservative with autism, a claim that international scientific bodies and paediatricians have repeatedly rejected.

In a press release on Thursday, Gavi welcomed the US decision. “This investment will help us to strengthen global defences against outbreaks and pandemics and protect more children from preventable diseases,” Gavi Chief Executive Officer Sania Nishtar said.

The breakthrough strengthens Gavi’s recalibrated $10.2 billion strategic budget, keeping the alliance on track to meet its 2026–2030 mobilisation goals. According to recent Gavi board projections, the partnership has already secured $9.3 billion in qualifying resources, including $2.7 billion formally signed in donor agreements.

Gavi insists science guides portfolio decisions

The State Department said Gavi committed to work towards transitioning away from using thimerosal as a vaccine preservative to unlock the funding.

Responding to a query by Health Policy Watch, Gavi noted that transitions were already underway but had previously stalled due to financial constraints. The alliance “began supporting adoption of the hexavalent and multivalent meningococcal conjugate vaccines (MMCV) in 2023,” highlighting these newer vaccine options. However, Gavi explained that “progress has been held back due to funding challenges”.

The alliance also insisted that its medical portfolio remains anchored strictly in global science. “Gavi always has and always will be guided by the global scientific consensus,” the alliance stated. It added that any portfolio changes remain “subject to Gavi Board approval and dependent on factors including country demand, programmatic context, global manufacturing capacity and affordability”.

No scientific evidence for autism claims

The American Academy of Pediatrics (AAP) and the European Medicines Agency (EMA) have repeatedly reviewed clinical safety evidence, confirming that the preservative is safe. Expert fact-checks of the scientific evidence reiterate that “extensive research proves that thimerosal is a safe ingredient in vaccines, and it does not cause neurological problems or autism”.

While the US and Europe transitioned to single-dose, mercury-free vaccines 25 years ago, developing countries still rely on cheaper multi-dose vials, where thimerosal is used to destroy any bacteria and fungi that may enter a vial each time a new dose is drawn.

Around 14% of Gavi vaccines contain thimerosal, including the five-in-one pentavalent vaccine (Diphtheria, Pertussis, Tetanus, Hepatitis B and Haemophilus influenzae type b), the Diphtheria, Pertussis and Tetanus (DPT) vaccine, Tetanus-Reduced Diphtheria (Td), Hepatitis B, Meningococcal A Conjugate (MenA) and Pneumococcal Conjugate Vaccine (PCV).

Gavi funding fire-walled from WHO

The geopolitical fracture between Washington and the WHO leaves multilateral health partnerships in financial limbo.
The geopolitical fracture between Washington and the WHO leaves multilateral health partnerships in financial limbo.

In addition, the US placed another strict financial firewall on its restored $600 million contribution, explicitly demanding that no American taxpayer funds reach the World Health Organization (WHO) through Gavi – even though the two global health bodies collaborate closely.

“The United States also reaffirms that it will not provide US Government funding to the World Health Organization through Gavi,” said the joint State Department and HHS media note.

While Gavi accepted the funding, legally binding the alliance to the US donor restrictions, it bypassed the political blockade with a simple accounting adjustment. Gavi explained that since the WHO is a core partner, its funding “is already accounted for through existing funding” from other international donors.

“As a result, US funding will be focused on vaccine procurement, which is consistent with past practices,” Gavi confirmed.

The US boycott of WHO reflects the deep and continuing diplomatic fracture with President Donald Trump, ever since he signed an executive order to exit the global health agency in January 2025, plunging the WHO into a severe financial crisis. Although Washington declared its withdrawal complete in early 2026, the WHO refuses to recognise the departure because the US has failed to pay outstanding dues.

A query to the WHO asking for comment on the funding firewall remained unanswered.

Despite a lack of scientific evidence supporting the US administration’s safety claims, Gavi will have to navigate these political demands while striving to reach its vaccination goals so as not to leave vulnerable children behind.

See related story:

US Freezes All Funds to Gavi Over Vaccine Preservative Thimerosal

Image Credits: Nana Kofi Acquah, Felix Sassmannshausen/HPW.

Three decades of conflict have made eastern DRC the worst-affected region in the world for wartime sexual violence. New reports show the current war is no exception. / Photo: Child shelters in an unfinished structure in a displacement camp in Ituri province.

Panzi Hospital, a facility in South Kivu province in eastern Democratic Republic of the Congo (DRC), a region overrun by a civil war that has displaced millions, recorded an 85% increase in newly reported survivors of sexual violence in the first six months of 2026 compared with the same period last year, according to a report released Wednesday.

The hospital admitted 646 newly reported survivors between January and June, among them “119 women and girls who became pregnant as a result of rape, including 84 girls under the age of 18,” the report said.

South Kivu province recorded 91 suicides in the first five months of 2026, already three-quarters of the full-year total for 2025, according to Panzi’s psychiatric team.

Located in the South Kivu capital Bukavu, Panzi hospital was founded by gynaecologist Denis Mukwege, who was awarded the 2018 Nobel Peace Prize for his treatment of survivors of conflict-related sexual violence in eastern DRC. Since its founding in 1999, it has served as a last resort for survivors in a region where rape has been systematically used as a weapon of war across three decades of near-continuous conflict.

Supplies arrive at Panzi Hospital in the South Kivu capital of Bukavu.

The United Nations Children’s agency (UNICEF) estimates a child is raped there every 30 minutes, accounting for up to 45% of sexual violence victims. Thousands of children were raped in the first two months of the civil war alone, a pattern UNICEF describes as the worst outbreak of such atrocities against children in decades.

UNFPA recorded 81,388 rape cases in eastern DRC between January and September 2025, a 32% increase on the same period in 2024. An estimated 250,000 to one million women have been raped in the country’s conflicts since the 1990s, according to the Global Survivors Fund. No country has recorded more conflict-related sexual violence in the period.

The surge is unfolding in the same provinces where DRC is battling the fastest-spreading and deadliest Ebola outbreak on record, stretching a health system that armed groups and funding cuts have devastated over the past 18 months.

The country has recorded 3,360 confirmed Ebola cases and 1,487 deaths in 10 weeks since the outbreak was declared on 15 May, nearing the case total of the 2018-2020 outbreak, which lasted roughly two years.

M23’s ‘reign of terror’

WFP vehicle passing through the town of Bule in Ituri province, which has been abandoned due to the conflict.

In a separate statement last week, UN experts called for an end to what they described as a “reign of terror” by the Rwanda-backed M23 armed group, citing a growing volume of testimony from civilian victims.

“Rapes, gang rapes, violent assaults and killings of civilians are a common feature of M23’s modus operandi,” the experts said. “While these crimes are not exclusive to M23, the number of individuals affected is staggering and must end.”

M23 has established a de facto system of authority in the territory it controls, using arbitrary detention, torture including sexual torture, forced labour and forced recruitment against the civilian population, the UN experts said.

Detainees are held in unofficial sites in overcrowded and unsanitary conditions with little or no medical access. Several deaths in custody have been recorded, and release has in many cases depended on payments demanded from relatives.

“The violence is unacceptable. It must end immediately and be thoroughly investigated so that those responsible are held accountable,” they said, calling on states and the UN to help revive the ceasefire signed between the Congolese government and M23 in December 2025.

“All parties to the conflict must comply with international human rights and humanitarian law and take all means necessary to protect civilians from harm.”

Care for sexual violence ‘almost non-existent’

People shelter from the rain at a displacement camp in Ituri, July 2026.

The Panzi figures are the latest in a series of major documentation of escalating sexual violence in eastern DRC this year.

In January, Human Rights Watch and the Congolese women’s rights organisation SOFEPADI documented sexual violence by at least five non-state armed groups and by the Congolese army across Ituri, North Kivu and South Kivu – the three provinces at the epicentre of the Ebola outbreak.

Survivor support collapsed at the same moment demand rose, the report found. The United States had been the primary donor of post-exposure prophylaxis kits, which must be administered within 72 hours to prevent HIV transmission and pregnancy. After US funding was withdrawn, clinics across the three provinces faced a near-total absence of PEP kits for months, leaving survivors without access to emergency care.

In April, Médecins Sans Frontières (MSF) warned that care for survivors of sexual violence in Ituri was “almost non-existent” as fighting between the Convention for the Popular Revolution and the DRC armed forces displaced tens of thousands. Seven of 14 health centres in the Fataki health zone shut down and relocated to displacement camps.

Nearly one million people are displaced across Ituri, according to OCHA, a figure that has continued to rise amid ongoing violence and the Ebola outbreak. The broader conflict across eastern DRC has displaced over 5.35 million people, UN Human Rights Office data shows.

“Many patients no longer dare to travel to seek care,” said Sylvain Groulx, MSF head of programmes in Ituri. MSF provided more than 10,000 consultations in Fataki after deploying in February and treated roughly 30 survivors of sexual violence, a fraction of the caseload it says exists.

DRC – sadly – isn’t alone. The UN Secretary General reported that more than 90,000 cases of conflict-related sexual violence were recorded globally in 2025.

The UN verified 9,788 of them across 21 situations of concern, more than double the 2024 figure, with the highest numbers in the Central African Republic, DRC, Haiti, Somalia and South Sudan. Sexual violence has also been extensively documented in Sudan, where mass rape has accompanied the Rapid Support Forces’ campaign in Darfur.

Food delivery suffers under Ebola restrictions

Man carries supplies back to his camp in Ituri, July 2026.

The same conflict driving sexual violence is now compounding the fastest-spreading Ebola outbreak in DRC’s history. The country has recorded 3,360 confirmed cases and 1,487 deaths as of 29 July, according to its health ministry, nearing the 3,400 cases of the 2018-2020 outbreak in roughly 10 weeks rather than two years.

The outbreak, caused by the rare Bundibugyo strain, was declared on 15 May. There is no approved vaccine or treatment for it. Ituri accounts for around 90% of confirmed cases. The outbreak’s index case has not been identified, and roughly 80% of new infections are emerging from unknown chains of transmission, hampering contact tracing.

More than 100 health workers have been infected. Staff at the Elikya Ebola Treatment Centre in Bunia walked out over unpaid wages on 25 July, the second such strike at the epicentre in as many weeks, in a response already hampered by attacks on treatment centres and ongoing conflict.

The outbreak has reached five provinces, with more than 2.7 million people in those zones facing acute food insecurity, including 628,000 in emergency conditions. Measures to contain the spread, including border closures and movement restrictions, have disrupted supply routes, driving up food and fuel prices amid the shortage, the World Food Programme said Wednesday.

The agency needs $101 million for the Ebola response over the next six months.

“Ebola feeds on delay, fear and hunger,” said Carl Skau, WFP’s acting executive director. “Food assistance is frontline Ebola containment. It helps families stay home, supports safe isolation, builds trust with communities and keeps health teams moving.”

“We know what works. What we need now is the speed and resources to scale it before this outbreak outruns the response.”