European Parliament Deadlock On Higher Tobacco and Nicotine Taxes Leaves Decision to Divided European Council 19/06/2026 Felix Sassmannshausen EU lawmakers failed to agree on tobacco tax regulations in Strasbourg this week. The European Parliament on Wednesday defeated a proposal to freeze cigarette excise taxes at a 60% rate of retail value – throwing a final decision on tobacco and nicotine policies into the court of the European Council of Ministers. But the politically-divided EU Council is unlikely to raises taxes anywhere near the bar set by the WHO’s latest recommendations for taxes on cigarettes as well as novel nicotine and tobacco products that are surging in popularity. A European Commission initiative, now set to go before the Council this summer, would raise cigarette excise taxes to 63% – still short of the WHO’s 70% benchmark. Meanwhile excise taxes for e-cigarettes at low nicotine concentrations would be set at only 20%; at 40% for products with higher nicotine concentrations, and at 50% for nicotine pouches, according to the EC proposal. That’s in contrast to a WHO recommendation that excise taxes for all novel products be aligned with traditional cigarettes. The requirement for unanimous European Council agreement on a tax package creates a major political hurdle for any initiative to raise cigarette to taxes and taxes on novel products further – in alignment with WHO guidance. This, as the European Union records one of the world’s slowest declines in tobacco use. The EU Commission initiative would also establish a stricter minimum tax floor of €215 per 1,000 cigarettes. The now-rejected European Parliament position had attempted to lower this floor to €200 per 1,000 cigarettes, while setting the proposed minimum excise tax on nicotine pouches to just 28% of the average retail selling price, a full 22% lower than the Commission’s original proposal. EU tobacco tax misses WHO benchmark WHO recommends that excise taxes – that is taxes specific to products like tobacco and alcohol – account for at least 70% of a product’s retail price. Total taxes, including VAT and customs duties, should account for at least 75% of the retail price, according to the WHO recommendations. Furthermore, the WHO has warned against differentiated taxation for novel products. Global health officials warn against creating such regulatory carve-outs, arguing that they sustain lifelong nicotine dependence. Health advocates have meanwhile warned against revised tobacco taxes that make novel products highly affordable and easily accessible for young demographic groups. Surging new products target youth A recent WHO report highlights that retail sales of nicotine pouches surged past 23 billion units globally in 2024. Within the European Union, this market expansion is heavily driven by high consumption in Sweden, where novel pouches have become increasingly popular among young people. WHO officials warn that these aggressively marketed products threaten to create an imminent youth addiction epidemic across the bloc if left unchecked. “The use of nicotine pouches is spreading rapidly, while regulation struggles to keep pace,” said Dr Vinayak Prasad, Unit Head of the Tobacco Free Initiative at the WHO, upon the release of the WHO global report. Health advocates warn that transnational tobacco companies are actively using Sweden’s experience to pressure other EU nations into adopting equally lenient regulatory and tax frameworks. To attract adolescent consumers, manufacturers deploy digital influencer campaigns and candy-inspired flavours. Medical experts caution that some European brands feature extreme concentrations reaching up to 150 milligrams of nicotine per gram, significantly increasing cardiovascular risks and impairing adolescent brain development. Divided Council to decide later this year With the EU parliament failing to find a negotiating position, the burden now falls entirely on the EU’s Council of Ministers, including ministers from all 27 EU member states, to close the tax loopholes. The EU Council must now reach a consensus before adopting the final directive. The likelihood is that a tax increase of some kind will be approved, but it will be unlikely to even meet the level of the EU Commission’s proposal. The Swedish government, in particular, has been lobbying to keep tax levels low on alternative tobacco products due to its large pouch market. Earlier this month, Sweden reportedly blocked an broad EU initiative that would have established a higher tax floor on novel products, sources told Health Policy Watch. Nicotine Pouches: WHO Demands Strict Regulation to Prevent Looming Youth Epidemic Image Credits: Felix Sassmannshausen/HPW. Where You’re Born Still Decides Whether You Can Access Surgical Care 19/06/2026 Faustin Ntirenganya Dr Faustin Ntirenganya (left) and surgeon trainee Dr Victoire Mukamitari. Where a person is born should not determine whether they survive, whether they live with dignity, or whether they are forced to endure years of preventable suffering while waiting for surgical care that may never come. Yet, across large parts of Africa, this remains the reality. At this year’s 79th World Health Assembly (WHA79) in Geneva, world leaders gathered to discuss the future of global health, healthcare equity and international responsibility. Despite the scale of these conversations, one essential component of healthcare continues to receive far too little global attention: access to safe surgery in general, and plastic and reconstructive surgical care in particular. For millions of patients, plastic and reconstructive surgery is not cosmetic. It is not optional. It is essential healthcare that restores function, mobility, independence and dignity. It allows burn survivors to use their hands again. It enables children born with craniofacial malformations to attend school without stigma. It gives patients living with traumatic injuries, cancers or congenital defects the possibility of participating fully in life once more. These surgeries are lifesaving. However, in many regions, access to plastic and reconstructive surgery is effectively denied. Non-existent access to surgeons For more than a decade, I was one of only two plastic and reconstructive surgeons serving Rwanda’s 14 million people. In some parts of the world, highly specialized surgeons are everywhere. In others, they are almost non-existent. When there is less than one trained surgeon for hundreds of thousands – or even millions – of people, the consequences are devastating. In Rwanda, I regularly travel to hospitals where hundreds of patients arrive seeking care in a single day. Many have already waited years for surgery. Some live with severe burns that have left their limbs contracted and immobile. Others endure untreated injuries or tumors that continue to shape every aspect of their life. Some patients travel extraordinary distances only for us to tell them they must continue waiting because the system is already stretched beyond its limits. What is most painful is knowing that many of these patients continue suffering or their conditions worsen to the point of becoming untreatable while waiting for care – not because treatment does not exist, but because access to trained specialists remains critically limited, there is too little infrastructure and too few resources available to meet the overwhelming demand. Dr Faustin examines a 19-month-old child in rural Rwanda with a congenital tumour that will need a 10-12-hour operation to remove. Sustained investment Behind every surgical waiting list, there is a human life suspended in uncertainty. This is not merely a surgical issue; it is a global health issue. Healthcare systems cannot adequately respond to trauma, burns, maternal health complications, cancer reconstruction or congenital conditions without sustained investment in surgical capacity. And still, surgery continues to be treated in many international conversations as secondary rather than foundational to healthcare equity. A documentary has been made about my team, which follows us as we work in remote hospitals in Rwanda and confront the daily realities of providing care within a system under immense strain. Our local work includes efforts to train the next generation of African surgeons, fighting to increase regional access to surgical care for the future. Dr Victoire Mukamitari is a young surgical trainee navigating the immense pressures of training within a male-dominated field while carrying the hopes of becoming part of a new generation of plastic and reconstructive surgeons. Dr Victoire Mukamitari is a young surgical trainee in Rwanda. Unbearable pressure There are days when the pressure feels unbearable. Days when electricity becomes unreliable in the operating room. Days when resources force impossible decisions. Days when a surgeon carries the knowledge that help arrived too late. There is exhaustion, responsibility, grief and the emotional burden of carrying more patients than one healthcare system was ever designed to support. But there is also extraordinary hope and immense pride to serve and contribute to something bigger than us. Several years ago, I realized that no individual surgeon – no matter how committed – could ever meet this level of need alone. My response was to help build a training program capable of preparing the next generation of plastic and reconstructive surgeons across the region. My goal is to help train 30 new surgeons by 2030 so that no surgeon in Rwanda or neighboring regions will ever again have to carry this burden alone. This mission is not about one doctor, one hospital or one documentary. It is about building sustainable healthcare systems capable of serving future generations with dignity and consistency, creating a multiplier effect. And this work cannot happen through temporary interventions alone. It requires a holistic approach with long-term investment in surgical education, healthcare infrastructure, equipment, researchpartnerships and healthcare systems designed not only to respond to crisis, but to endure. Most importantly, it requires the international community to finally recognize that access to surgical care is not optional within global health. It is essential, a fundamental human right. The patients waiting for care deserve healthcare systems capable of treating them safely, compassionately and without years of preventable suffering. The next generation of surgeons is ready to lead if the world is willing to invest in them. This should be a collective responsibility. Dr Faustin Ntirenganya is a consultant, General and Onco-Plastic and Breast surgeon, at University Teaching Hospital of Kigali and Head of Department of Surgery at the School of Medicine and Pharmacy. The documentary, Making of a Surgeon: Fighting Africa’s Hidden Crisis, explores these realities and the growing effort to expand plastic and reconstructive surgical care across Africa. Clean Electricity, Waste and Construction Set to Top COP31 Agenda 18/06/2026 Stefan Anderson COP31 co-Presidents Türkiye and Australia used the Bonn climate talks to launch three flagship goals for November’s summit in Antalya. The targets chart a path to cut emissions from energy, buildings and waste, but steer clear of the fossil fuels and the finance fights that sank the last two COPs. The stepping-stone meetings on the road to COP31 in Antalya unfolding in Bonn this week brought the first real clarity on what the incoming presidency wants the next UN climate summit to deliver on: electrification, reducing waste, and the energy efficiency of buildings and construction. The three headline targets call for electricity to meet 35% of final energy demand by 2035, up from just over 20% today, a goal the presidency calls “35 by 35”. The second would halve the growth in global waste by the same date, and the third would cut the energy intensity of buildings by at least a quarter. Together, they chart a course around sectors that are among the largest sources of global greenhouse gas emissions; the buildings sector alone accounts for around 37% of the global total. But the agenda is deliberately fossil-fuel free, built to dodge the political torpedoes that sank the last two COPs, in Brazil and Azerbaijan. The presidency has cast the package as the practical core of an “implementation COP”, echoing Brazil’s framing of COP30 a year ago. “We need this COP to be a COP of implementation and acceleration,” said Chris Bowen, Australia’s climate minister and COP31’s president of negotiations, calling the agenda “an impressive blueprint to help us do that.” Yet money — the other perennial battleground of recent UN climate summits, and the thing that makes any implementation possible — is also absent from the core agenda. Beyond the three headline goals, the presidency’s ten-theme Action Agenda spans food security, oceans, green industrialisation, youth and education, and, of note for the health community, a pillar on resilient health systems. The core targets, like the rest of the Action Agenda, are set by the presidency and are political objectives, not guaranteed outcomes. Countries must choose to take them up on their own in Antalya during formal negotiations to make the targets a reality. And the political momentum pushed by a presidency is not always enough to get a deal over the line. Hosting last year’s summit in the heart of the Amazon, a setting meant to put the critical role of rainforests in balancing the global climate at the centre of the talks, Brazil threw its weight behind a roadmap to halt and reverse deforestation, backed by more than 90 countries. It never made the final text, with over 100 nations declining to support the roadmaps Brazil’s presidency championed. “What the world needs today is not another round of promises,” COP31 President-Designate Murat Kurum told delegates in Bonn. “It needs to see existing commitments delivered.” 1.5°C’s life or death moment Planet on Course to Permanently Breach 1.5°C Limit by 2030 The new targets for Antalya land as the planet closes in on the 1.5°C limit UN climate negotiations are intended to defend. While the presidency lists protecting that threshold in its official targets, the latest science shows the planet is on course to breach it permanently around 2030. The electrification target is explicitly designed to hold the world on a 1.5°C path, based on International Renewable Energy Agency (IRENA) modelling. But with the fossil fuels behind roughly 70% of global emissions absent from the agenda, the presidency’s strategy looks more like pragmatic damage control than a course correction. Human-caused warming reached 1.37°C last year, and global emissions hit a record 56.8 billion tonnes of CO2-equivalent in 2024, according to the annual Indicators of Global Climate Change report, published last week. A separate analysis released in Bonn on Tuesday by Climate Analytics found that fossil fuel use must halve by 2035 to keep 1.5°C within reach. The growth in CO2 emissions has begun to slow, but emissions are still climbing, not falling. “Fossil fuels are still pouring oil on the climate fire,” said Neil Grant, a senior mitigation expert at Climate Analytics. “We need to cut fossil fuel use sharply this decade, halve it by 2035, and drive it down to real zero by 2070.” “The safer route is a rapid, planned phase-out of fossil fuels, powered by clean electrification,” said Bill Hare, the group’s chief executive. The other key battleground of every COP since Paris – money – is not addressed in the presidency agenda either. A concept note circulated in Bonn unveiled a “Global Implementation Accelerator” and a “Climate Implementation Bridge” to speed climate solutions to the ground. Both are coordination structures. Neither is a fund, and the presidency specifies that no new money is attached. A target for an electric age UN climate meetings underway in Bonn, Germany. The electrification goal draws on analysis from IRENA, whose latest roadmap finds electricity must rise from around 23% of final energy use today to 35% by 2035, and above 50% by 2050, to stay on a 1.5°C-compatible path. The co-presidents frame the pitch as a move towards energy security as much as climate action. The protection renewables can offer from fossil fuel price shocks is drawing fresh attention as the war in the Middle East drives up oil and gas prices, forcing low- and middle-income countries to dig into their treasuries to afford the basic functions of government. Electrification can be a hedge: cheaper, home-grown power that shields households, central banks and economies from volatile global markets and the geopolitical shocks that move them. “The good news is that the answer to improved energy reliability and energy sovereignty is also the answer for emissions reduction – that is more electrification, more renewable energy, sovereign and reliable forms of energy, which is also cheap and is also the best for the climate,” Bowen said. “Accelerating the energy transition will ease shocks to our energy systems, better protect our economies and households from high costs, and help keep bending the curve of emissions downwards,” he added, describing electrification as “the key to transitioning away from fossil fuels.” But more electricity only cuts emissions if the power behind it is clean. While broadly welcoming the strategy, environmental groups warned it must be matched with investment in expanding renewables. “More electricity alone is not the answer if it is still powered by coal, oil and gas,” said Fernanda de Carvalho, global climate and policy head at WWF. “Developing countries will also need finance and technology support to make this transition fair and effective.” The targets released in Bonn do not specify how the extra electricity should be produced. “Electrification can only deliver meaningful climate benefits if the power comes from renewables, not fossil fuels,” said Duygu Kutluay, a campaigner at Beyond Fossil Fuels. Simon Stiell, the UN climate chief, who has thrown his weight behind the electrification push, urged delegates not to backslide. “We don’t have time to re-open past debates or renegotiate commitments already made,” Stiell told the Bonn summit. “Tackling the global climate crisis is the hardest, but most important, thing humanity has ever tried to do together. It is worth doing, because we have no choice.” What kind of waste? The second target takes aim at the climate impact of the world’s waste. The presidency wants to halve the growth in global waste by 2035, notably, not halve waste generation itself. The world already generates around 2.1 billion tonnes of solid waste a year, a figure the UN Environment Programme (UNEP) projects will climb to 3.8 billion tonnes by 2050 in a business-as-usual scenario. Mounting piles of trash and landfills are also a growing climate problem, with organic waste rotting in dumps one of the largest human sources of methane, a major accelerator of global warming. Methane is responsible for nearly 30% of the rise in global temperatures since the Industrial Revolution. Food waste alone accounts for around 10% of global emissions, much of it as methane, a gas roughly 80 times more potent than carbon dioxide over the short term. Yet because methane breaks down in the atmosphere within about 12 years, against centuries for carbon dioxide, cutting it is prized in climate diplomacy as a vital “emergency brake” on near-term warming. What the presidency’s target actually means is hard to say, as little about it has been defined. The announcement set no baseline year and did not specify what kinds of waste it covers. That ambiguity matters, as some waste streams, plastics above all, are politically explosive enough to derail a negotiation. The missing piece: plastics UN Plastics Treaty Talks Fail Again After Overnight Deadlock While the target’s climate aspirations are positive, sidestepping plastics production could prove a gift to petrostates in the long run. A downstream focus on managing and recycling waste, rather than capping production, is exactly what petrostates fought to protect when global plastics treaty talks collapsed in Geneva last year. A bloc led by Saudi Arabia, Russia and Iran, with the United States aligned, blocked any binding limit on production. More than 100 countries, unwilling to leave the upstream untouched, ultimately walked rather than accept a weak deal. With less than a tenth of the world’s plastic recycled and production on track to triple by 2060, the same production-versus-waste-management fight could resurface at COP31. The cause is also a signature of Türkiye’s first lady, Emine Erdoğan, who chairs the UN High-Level Advisory Board on Zero Waste, established by Secretary-General António Guterres in 2023 after a Türkiye-led resolution declared 30 March the International Day of Zero Waste. A Zero Waste forum in Istanbul this month, organised by the foundation she heads, drew Guterres, UNEP chief Inger Andersen and Stiell, but produced no new commitments, even as it set up zero waste to be a central feature of the Antalya agenda. The building target that quietly shrank The third goal aims to reduce the energy intensity of the buildings sector by at least 25% by 2035. Buildings and construction are heavyweight emitters, responsible for around 37% of global emissions and nearly half of all raw material extraction, from the sand, gravel and cement that go into concrete to the steel that frames it. Roughly half the buildings that will stand in 2050 have yet to be built, most of them in fast-growing economies in Asia and Africa, according to UNEP. How those millions of structures are built will lock in emissions for decades. A wave of poorly insulated, fossil-powered construction would commit the world to rising energy demand for the lifespan of every structure. Despite the sector’s importance, the target was watered down hours after it landed, Climate Home News reported, another sign the presidency’s politically careful agenda may face serious headwinds once negotiations begin. An initial presidency statement set a goal of a 25% increase in energy efficiency. A “small update” issued a day later swapped it for a 25% cut in energy consumption intensity. No reason was given. The two metrics are not the same. Energy intensity measures the energy used per square metre, and can be brought down through superficial steps such as dimming lights or adjusting how a building is run, leaving structures untouched. An efficiency target would force the costly structural work that delivers lasting cuts: insulation, heat pumps and retrofitted building envelopes. Recast as an intensity goal, the target can be met by operational tinkering while the deep renovations the sector needs are put off. The fight the agenda leaves out The shape of the COP31 agenda emerges as a pragmatic political choice to build the summit around problems less divisive than the fossil fuel and finance fights that tanked the last two COPs. At COP30 in Belém last November, a bloc of petrostates led by Saudi Arabia drew more than half the nations present to its side and stripped every reference to fossil fuels from the final text, killing a phase-out roadmap that some 80 countries had backed. Under the UN’s consensus rules, a single nation can veto language, even against majority support. With Saudi Arabia, Russia and the United States flanked by other major petrostates set to be in the room, any text dealing with fossil fuel phase-out will be dead on arrival. The concession is a pragmatic but significant moment in the world’s fight against the climate crisis: the fossil fuels driving it are no longer seen as worth fighting over, a reality the joint presidency is conceding before talks begin. That deadlock has forced the fossil fuel question to splinter off into a diplomatic track of its own. Frustrated by the inability of the core UN climate talks to move forward, 57 governments convened in Santa Marta, Colombia, in April for the first summit dedicated to phasing out oil, gas and coal, declaring the transition “past its point of no return.” While the coalition’s power is limited, its creation signals a new shift in the phase-out fight. The Santa Marta countries account for about a fifth of global fossil fuel production, and include sizeable producers such as Norway, Canada, Australia, the United Kingdom, Brazil, Nigeria and host Colombia. The world’s five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – stayed away from the talks. For now, the higher-ambition camp is left to build toward a phase-out on its own, while the UN process moves on around it. The coalition will meet again in 2027 on the Pacific island of Tuvalu, co-hosted by Ireland. The money that isn’t there Achieving the presidency’s three targets, despite their limitations, would be a major achievement in the fight against the climate crisis. But the question of who will pay to make them real, and how much – the defining fight of every COP in recent years as the world shifts from diplomatic documents to delivery – stands to derail the agenda altogether. As of today, the world is paying a tiny fraction of the true costs of the three agenda items alone. Meeting the electrification pathway requires global grid investment to roughly double, to about $1.2 trillion a year, IRENA estimates. Investment in building energy efficiency must more than double to $5.9 trillion by 2030, according to UNEP’s Global Status Report for Buildings and Construction. The direct cost of managing the world’s waste, around $252 billion in 2020, is set to nearly double by mid-century, according to UNEP’s Global Waste Management Outlook. The headline goal agreed at COP29 in Baku commits developed countries to mobilise “at least” $300 billion a year for the developing world by 2035, a figure the Global South denounced as a “betrayal”, alongside an aspirational, all-sources target of $1.3 trillion. On the current trajectory, analysts estimate the flows covered by that goal will reach barely $427 billion a year by 2035, less than a third of the target. Developing economies received around $196 billion in climate finance in 2023, with more than half of it arriving as loans rather than grants, deepening the debt of countries already crumbling under foreign repayment loads. Even the institutions meant to deliver the “billions to trillions” now say it isn’t possible. World Bank President Ajay Banga has called the formula unrealistic, and the bank’s chief economist, Indermit Gill, has branded it a “fantasy.” “Climate finance commitments to small island developing states are facing systemic collapse,” Anne Rasmussen, lead negotiator for the Alliance of Small Island States, told a Bonn press conference on Tuesday. “Developed partners are defaulting on their legal obligations under the Paris Agreement, and key financial mechanisms are being crippled. SIDS are effectively being blocked from implementing vital climate priorities. It leads us to question whether the implementation of the NCQG is dead on arrival, unless these breaches of legal duty are immediately reversed.” The presidency’s new instruments take no steps to close that gap. Kurum has described the Climate Implementation Bridge as a way to turn national climate plans into “investable project portfolios” and help finance reach the ground faster, not as a new source of cash. A wider finance crisis Global Health Leaders Urge Fewer Agencies Amid Funding Crisis The shortfall is part of a wider crisis across the development aid world. Developing countries need an estimated $4.3 trillion a year to meet the Sustainable Development Goals, including $1.8 trillion for climate, according to UN Trade and Development. The OECD warns the overall financing gap, having grown 60% to $4 trillion, could reach $6.4 trillion by 2030 without reform. This year’s Financing for Sustainable Development Report concluded the shortfall “risks reversing decades of progress.” Climate is competing for that money with everything else falling short. Humanitarian appeals drew their lowest funding in a decade in 2025, while food programmes, global health budgets and the finances of the UN itself buckle under simultaneous cuts, led by the United States’ retreat from much of the aid system. As at every COP before it, the fate of Antalya is likely to rest less on the ambition of its targets than on whether anyone agrees to pay for them. “Public finance is not a preference for us, it is an oxygen for us,” said Isatu Kamara, climate finance coordinator for the Least Developed Countries group. Image Credits: UNFCCC. Ebola Outbreak is Three Times Bigger Than Previous Outbreaks at Four Weeks 18/06/2026 Kerry Cullinan Africa CDC epidemiologist Dr Wessam Mankoula The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday. This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing. The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain. Ebola outbreak size at four weeks Where’s the money? Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said. On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda. The meeting mobilised $910 million in pledges, including $80 million from African member states. However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added. The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination. “The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC. Case fatality, contact tracing The six key obstacles hampering the response. Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected. The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks. “Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula. Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient. Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked. However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak. Midwives: The High Return Investment That’s Not Being Made 18/06/2026 Anna af Ugglas, Lwazi Manzi, Chikusela Sikazwe & Rajat Khosla Governments need to prioritise funding and support for midwifery to save the lives of women and babies A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move? When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic. Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most. This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking. Preventable deaths Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost. The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year. These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations. Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1. There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce. For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond. A midwife examines a pregnant woman in a rural community clinic in Guatemala. For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap. With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment. Yet despite all this hard evidence, investment is not being made at the scale required. Midwives’ demands This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence. Their demands are clear and achievable: Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment. Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system. Commit to ICM Global Standards on education, pay, regulation, and leadership. Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away. Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time. That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it. Investing in midwives is an investment in the future of every country that makes it. Anna af Ugglas is chief executive of the International Confederation of Midwives. Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives. Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Where You’re Born Still Decides Whether You Can Access Surgical Care 19/06/2026 Faustin Ntirenganya Dr Faustin Ntirenganya (left) and surgeon trainee Dr Victoire Mukamitari. Where a person is born should not determine whether they survive, whether they live with dignity, or whether they are forced to endure years of preventable suffering while waiting for surgical care that may never come. Yet, across large parts of Africa, this remains the reality. At this year’s 79th World Health Assembly (WHA79) in Geneva, world leaders gathered to discuss the future of global health, healthcare equity and international responsibility. Despite the scale of these conversations, one essential component of healthcare continues to receive far too little global attention: access to safe surgery in general, and plastic and reconstructive surgical care in particular. For millions of patients, plastic and reconstructive surgery is not cosmetic. It is not optional. It is essential healthcare that restores function, mobility, independence and dignity. It allows burn survivors to use their hands again. It enables children born with craniofacial malformations to attend school without stigma. It gives patients living with traumatic injuries, cancers or congenital defects the possibility of participating fully in life once more. These surgeries are lifesaving. However, in many regions, access to plastic and reconstructive surgery is effectively denied. Non-existent access to surgeons For more than a decade, I was one of only two plastic and reconstructive surgeons serving Rwanda’s 14 million people. In some parts of the world, highly specialized surgeons are everywhere. In others, they are almost non-existent. When there is less than one trained surgeon for hundreds of thousands – or even millions – of people, the consequences are devastating. In Rwanda, I regularly travel to hospitals where hundreds of patients arrive seeking care in a single day. Many have already waited years for surgery. Some live with severe burns that have left their limbs contracted and immobile. Others endure untreated injuries or tumors that continue to shape every aspect of their life. Some patients travel extraordinary distances only for us to tell them they must continue waiting because the system is already stretched beyond its limits. What is most painful is knowing that many of these patients continue suffering or their conditions worsen to the point of becoming untreatable while waiting for care – not because treatment does not exist, but because access to trained specialists remains critically limited, there is too little infrastructure and too few resources available to meet the overwhelming demand. Dr Faustin examines a 19-month-old child in rural Rwanda with a congenital tumour that will need a 10-12-hour operation to remove. Sustained investment Behind every surgical waiting list, there is a human life suspended in uncertainty. This is not merely a surgical issue; it is a global health issue. Healthcare systems cannot adequately respond to trauma, burns, maternal health complications, cancer reconstruction or congenital conditions without sustained investment in surgical capacity. And still, surgery continues to be treated in many international conversations as secondary rather than foundational to healthcare equity. A documentary has been made about my team, which follows us as we work in remote hospitals in Rwanda and confront the daily realities of providing care within a system under immense strain. Our local work includes efforts to train the next generation of African surgeons, fighting to increase regional access to surgical care for the future. Dr Victoire Mukamitari is a young surgical trainee navigating the immense pressures of training within a male-dominated field while carrying the hopes of becoming part of a new generation of plastic and reconstructive surgeons. Dr Victoire Mukamitari is a young surgical trainee in Rwanda. Unbearable pressure There are days when the pressure feels unbearable. Days when electricity becomes unreliable in the operating room. Days when resources force impossible decisions. Days when a surgeon carries the knowledge that help arrived too late. There is exhaustion, responsibility, grief and the emotional burden of carrying more patients than one healthcare system was ever designed to support. But there is also extraordinary hope and immense pride to serve and contribute to something bigger than us. Several years ago, I realized that no individual surgeon – no matter how committed – could ever meet this level of need alone. My response was to help build a training program capable of preparing the next generation of plastic and reconstructive surgeons across the region. My goal is to help train 30 new surgeons by 2030 so that no surgeon in Rwanda or neighboring regions will ever again have to carry this burden alone. This mission is not about one doctor, one hospital or one documentary. It is about building sustainable healthcare systems capable of serving future generations with dignity and consistency, creating a multiplier effect. And this work cannot happen through temporary interventions alone. It requires a holistic approach with long-term investment in surgical education, healthcare infrastructure, equipment, researchpartnerships and healthcare systems designed not only to respond to crisis, but to endure. Most importantly, it requires the international community to finally recognize that access to surgical care is not optional within global health. It is essential, a fundamental human right. The patients waiting for care deserve healthcare systems capable of treating them safely, compassionately and without years of preventable suffering. The next generation of surgeons is ready to lead if the world is willing to invest in them. This should be a collective responsibility. Dr Faustin Ntirenganya is a consultant, General and Onco-Plastic and Breast surgeon, at University Teaching Hospital of Kigali and Head of Department of Surgery at the School of Medicine and Pharmacy. The documentary, Making of a Surgeon: Fighting Africa’s Hidden Crisis, explores these realities and the growing effort to expand plastic and reconstructive surgical care across Africa. Clean Electricity, Waste and Construction Set to Top COP31 Agenda 18/06/2026 Stefan Anderson COP31 co-Presidents Türkiye and Australia used the Bonn climate talks to launch three flagship goals for November’s summit in Antalya. The targets chart a path to cut emissions from energy, buildings and waste, but steer clear of the fossil fuels and the finance fights that sank the last two COPs. The stepping-stone meetings on the road to COP31 in Antalya unfolding in Bonn this week brought the first real clarity on what the incoming presidency wants the next UN climate summit to deliver on: electrification, reducing waste, and the energy efficiency of buildings and construction. The three headline targets call for electricity to meet 35% of final energy demand by 2035, up from just over 20% today, a goal the presidency calls “35 by 35”. The second would halve the growth in global waste by the same date, and the third would cut the energy intensity of buildings by at least a quarter. Together, they chart a course around sectors that are among the largest sources of global greenhouse gas emissions; the buildings sector alone accounts for around 37% of the global total. But the agenda is deliberately fossil-fuel free, built to dodge the political torpedoes that sank the last two COPs, in Brazil and Azerbaijan. The presidency has cast the package as the practical core of an “implementation COP”, echoing Brazil’s framing of COP30 a year ago. “We need this COP to be a COP of implementation and acceleration,” said Chris Bowen, Australia’s climate minister and COP31’s president of negotiations, calling the agenda “an impressive blueprint to help us do that.” Yet money — the other perennial battleground of recent UN climate summits, and the thing that makes any implementation possible — is also absent from the core agenda. Beyond the three headline goals, the presidency’s ten-theme Action Agenda spans food security, oceans, green industrialisation, youth and education, and, of note for the health community, a pillar on resilient health systems. The core targets, like the rest of the Action Agenda, are set by the presidency and are political objectives, not guaranteed outcomes. Countries must choose to take them up on their own in Antalya during formal negotiations to make the targets a reality. And the political momentum pushed by a presidency is not always enough to get a deal over the line. Hosting last year’s summit in the heart of the Amazon, a setting meant to put the critical role of rainforests in balancing the global climate at the centre of the talks, Brazil threw its weight behind a roadmap to halt and reverse deforestation, backed by more than 90 countries. It never made the final text, with over 100 nations declining to support the roadmaps Brazil’s presidency championed. “What the world needs today is not another round of promises,” COP31 President-Designate Murat Kurum told delegates in Bonn. “It needs to see existing commitments delivered.” 1.5°C’s life or death moment Planet on Course to Permanently Breach 1.5°C Limit by 2030 The new targets for Antalya land as the planet closes in on the 1.5°C limit UN climate negotiations are intended to defend. While the presidency lists protecting that threshold in its official targets, the latest science shows the planet is on course to breach it permanently around 2030. The electrification target is explicitly designed to hold the world on a 1.5°C path, based on International Renewable Energy Agency (IRENA) modelling. But with the fossil fuels behind roughly 70% of global emissions absent from the agenda, the presidency’s strategy looks more like pragmatic damage control than a course correction. Human-caused warming reached 1.37°C last year, and global emissions hit a record 56.8 billion tonnes of CO2-equivalent in 2024, according to the annual Indicators of Global Climate Change report, published last week. A separate analysis released in Bonn on Tuesday by Climate Analytics found that fossil fuel use must halve by 2035 to keep 1.5°C within reach. The growth in CO2 emissions has begun to slow, but emissions are still climbing, not falling. “Fossil fuels are still pouring oil on the climate fire,” said Neil Grant, a senior mitigation expert at Climate Analytics. “We need to cut fossil fuel use sharply this decade, halve it by 2035, and drive it down to real zero by 2070.” “The safer route is a rapid, planned phase-out of fossil fuels, powered by clean electrification,” said Bill Hare, the group’s chief executive. The other key battleground of every COP since Paris – money – is not addressed in the presidency agenda either. A concept note circulated in Bonn unveiled a “Global Implementation Accelerator” and a “Climate Implementation Bridge” to speed climate solutions to the ground. Both are coordination structures. Neither is a fund, and the presidency specifies that no new money is attached. A target for an electric age UN climate meetings underway in Bonn, Germany. The electrification goal draws on analysis from IRENA, whose latest roadmap finds electricity must rise from around 23% of final energy use today to 35% by 2035, and above 50% by 2050, to stay on a 1.5°C-compatible path. The co-presidents frame the pitch as a move towards energy security as much as climate action. The protection renewables can offer from fossil fuel price shocks is drawing fresh attention as the war in the Middle East drives up oil and gas prices, forcing low- and middle-income countries to dig into their treasuries to afford the basic functions of government. Electrification can be a hedge: cheaper, home-grown power that shields households, central banks and economies from volatile global markets and the geopolitical shocks that move them. “The good news is that the answer to improved energy reliability and energy sovereignty is also the answer for emissions reduction – that is more electrification, more renewable energy, sovereign and reliable forms of energy, which is also cheap and is also the best for the climate,” Bowen said. “Accelerating the energy transition will ease shocks to our energy systems, better protect our economies and households from high costs, and help keep bending the curve of emissions downwards,” he added, describing electrification as “the key to transitioning away from fossil fuels.” But more electricity only cuts emissions if the power behind it is clean. While broadly welcoming the strategy, environmental groups warned it must be matched with investment in expanding renewables. “More electricity alone is not the answer if it is still powered by coal, oil and gas,” said Fernanda de Carvalho, global climate and policy head at WWF. “Developing countries will also need finance and technology support to make this transition fair and effective.” The targets released in Bonn do not specify how the extra electricity should be produced. “Electrification can only deliver meaningful climate benefits if the power comes from renewables, not fossil fuels,” said Duygu Kutluay, a campaigner at Beyond Fossil Fuels. Simon Stiell, the UN climate chief, who has thrown his weight behind the electrification push, urged delegates not to backslide. “We don’t have time to re-open past debates or renegotiate commitments already made,” Stiell told the Bonn summit. “Tackling the global climate crisis is the hardest, but most important, thing humanity has ever tried to do together. It is worth doing, because we have no choice.” What kind of waste? The second target takes aim at the climate impact of the world’s waste. The presidency wants to halve the growth in global waste by 2035, notably, not halve waste generation itself. The world already generates around 2.1 billion tonnes of solid waste a year, a figure the UN Environment Programme (UNEP) projects will climb to 3.8 billion tonnes by 2050 in a business-as-usual scenario. Mounting piles of trash and landfills are also a growing climate problem, with organic waste rotting in dumps one of the largest human sources of methane, a major accelerator of global warming. Methane is responsible for nearly 30% of the rise in global temperatures since the Industrial Revolution. Food waste alone accounts for around 10% of global emissions, much of it as methane, a gas roughly 80 times more potent than carbon dioxide over the short term. Yet because methane breaks down in the atmosphere within about 12 years, against centuries for carbon dioxide, cutting it is prized in climate diplomacy as a vital “emergency brake” on near-term warming. What the presidency’s target actually means is hard to say, as little about it has been defined. The announcement set no baseline year and did not specify what kinds of waste it covers. That ambiguity matters, as some waste streams, plastics above all, are politically explosive enough to derail a negotiation. The missing piece: plastics UN Plastics Treaty Talks Fail Again After Overnight Deadlock While the target’s climate aspirations are positive, sidestepping plastics production could prove a gift to petrostates in the long run. A downstream focus on managing and recycling waste, rather than capping production, is exactly what petrostates fought to protect when global plastics treaty talks collapsed in Geneva last year. A bloc led by Saudi Arabia, Russia and Iran, with the United States aligned, blocked any binding limit on production. More than 100 countries, unwilling to leave the upstream untouched, ultimately walked rather than accept a weak deal. With less than a tenth of the world’s plastic recycled and production on track to triple by 2060, the same production-versus-waste-management fight could resurface at COP31. The cause is also a signature of Türkiye’s first lady, Emine Erdoğan, who chairs the UN High-Level Advisory Board on Zero Waste, established by Secretary-General António Guterres in 2023 after a Türkiye-led resolution declared 30 March the International Day of Zero Waste. A Zero Waste forum in Istanbul this month, organised by the foundation she heads, drew Guterres, UNEP chief Inger Andersen and Stiell, but produced no new commitments, even as it set up zero waste to be a central feature of the Antalya agenda. The building target that quietly shrank The third goal aims to reduce the energy intensity of the buildings sector by at least 25% by 2035. Buildings and construction are heavyweight emitters, responsible for around 37% of global emissions and nearly half of all raw material extraction, from the sand, gravel and cement that go into concrete to the steel that frames it. Roughly half the buildings that will stand in 2050 have yet to be built, most of them in fast-growing economies in Asia and Africa, according to UNEP. How those millions of structures are built will lock in emissions for decades. A wave of poorly insulated, fossil-powered construction would commit the world to rising energy demand for the lifespan of every structure. Despite the sector’s importance, the target was watered down hours after it landed, Climate Home News reported, another sign the presidency’s politically careful agenda may face serious headwinds once negotiations begin. An initial presidency statement set a goal of a 25% increase in energy efficiency. A “small update” issued a day later swapped it for a 25% cut in energy consumption intensity. No reason was given. The two metrics are not the same. Energy intensity measures the energy used per square metre, and can be brought down through superficial steps such as dimming lights or adjusting how a building is run, leaving structures untouched. An efficiency target would force the costly structural work that delivers lasting cuts: insulation, heat pumps and retrofitted building envelopes. Recast as an intensity goal, the target can be met by operational tinkering while the deep renovations the sector needs are put off. The fight the agenda leaves out The shape of the COP31 agenda emerges as a pragmatic political choice to build the summit around problems less divisive than the fossil fuel and finance fights that tanked the last two COPs. At COP30 in Belém last November, a bloc of petrostates led by Saudi Arabia drew more than half the nations present to its side and stripped every reference to fossil fuels from the final text, killing a phase-out roadmap that some 80 countries had backed. Under the UN’s consensus rules, a single nation can veto language, even against majority support. With Saudi Arabia, Russia and the United States flanked by other major petrostates set to be in the room, any text dealing with fossil fuel phase-out will be dead on arrival. The concession is a pragmatic but significant moment in the world’s fight against the climate crisis: the fossil fuels driving it are no longer seen as worth fighting over, a reality the joint presidency is conceding before talks begin. That deadlock has forced the fossil fuel question to splinter off into a diplomatic track of its own. Frustrated by the inability of the core UN climate talks to move forward, 57 governments convened in Santa Marta, Colombia, in April for the first summit dedicated to phasing out oil, gas and coal, declaring the transition “past its point of no return.” While the coalition’s power is limited, its creation signals a new shift in the phase-out fight. The Santa Marta countries account for about a fifth of global fossil fuel production, and include sizeable producers such as Norway, Canada, Australia, the United Kingdom, Brazil, Nigeria and host Colombia. The world’s five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – stayed away from the talks. For now, the higher-ambition camp is left to build toward a phase-out on its own, while the UN process moves on around it. The coalition will meet again in 2027 on the Pacific island of Tuvalu, co-hosted by Ireland. The money that isn’t there Achieving the presidency’s three targets, despite their limitations, would be a major achievement in the fight against the climate crisis. But the question of who will pay to make them real, and how much – the defining fight of every COP in recent years as the world shifts from diplomatic documents to delivery – stands to derail the agenda altogether. As of today, the world is paying a tiny fraction of the true costs of the three agenda items alone. Meeting the electrification pathway requires global grid investment to roughly double, to about $1.2 trillion a year, IRENA estimates. Investment in building energy efficiency must more than double to $5.9 trillion by 2030, according to UNEP’s Global Status Report for Buildings and Construction. The direct cost of managing the world’s waste, around $252 billion in 2020, is set to nearly double by mid-century, according to UNEP’s Global Waste Management Outlook. The headline goal agreed at COP29 in Baku commits developed countries to mobilise “at least” $300 billion a year for the developing world by 2035, a figure the Global South denounced as a “betrayal”, alongside an aspirational, all-sources target of $1.3 trillion. On the current trajectory, analysts estimate the flows covered by that goal will reach barely $427 billion a year by 2035, less than a third of the target. Developing economies received around $196 billion in climate finance in 2023, with more than half of it arriving as loans rather than grants, deepening the debt of countries already crumbling under foreign repayment loads. Even the institutions meant to deliver the “billions to trillions” now say it isn’t possible. World Bank President Ajay Banga has called the formula unrealistic, and the bank’s chief economist, Indermit Gill, has branded it a “fantasy.” “Climate finance commitments to small island developing states are facing systemic collapse,” Anne Rasmussen, lead negotiator for the Alliance of Small Island States, told a Bonn press conference on Tuesday. “Developed partners are defaulting on their legal obligations under the Paris Agreement, and key financial mechanisms are being crippled. SIDS are effectively being blocked from implementing vital climate priorities. It leads us to question whether the implementation of the NCQG is dead on arrival, unless these breaches of legal duty are immediately reversed.” The presidency’s new instruments take no steps to close that gap. Kurum has described the Climate Implementation Bridge as a way to turn national climate plans into “investable project portfolios” and help finance reach the ground faster, not as a new source of cash. A wider finance crisis Global Health Leaders Urge Fewer Agencies Amid Funding Crisis The shortfall is part of a wider crisis across the development aid world. Developing countries need an estimated $4.3 trillion a year to meet the Sustainable Development Goals, including $1.8 trillion for climate, according to UN Trade and Development. The OECD warns the overall financing gap, having grown 60% to $4 trillion, could reach $6.4 trillion by 2030 without reform. This year’s Financing for Sustainable Development Report concluded the shortfall “risks reversing decades of progress.” Climate is competing for that money with everything else falling short. Humanitarian appeals drew their lowest funding in a decade in 2025, while food programmes, global health budgets and the finances of the UN itself buckle under simultaneous cuts, led by the United States’ retreat from much of the aid system. As at every COP before it, the fate of Antalya is likely to rest less on the ambition of its targets than on whether anyone agrees to pay for them. “Public finance is not a preference for us, it is an oxygen for us,” said Isatu Kamara, climate finance coordinator for the Least Developed Countries group. Image Credits: UNFCCC. Ebola Outbreak is Three Times Bigger Than Previous Outbreaks at Four Weeks 18/06/2026 Kerry Cullinan Africa CDC epidemiologist Dr Wessam Mankoula The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday. This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing. The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain. Ebola outbreak size at four weeks Where’s the money? Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said. On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda. The meeting mobilised $910 million in pledges, including $80 million from African member states. However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added. The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination. “The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC. Case fatality, contact tracing The six key obstacles hampering the response. Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected. The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks. “Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula. Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient. Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked. However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak. Midwives: The High Return Investment That’s Not Being Made 18/06/2026 Anna af Ugglas, Lwazi Manzi, Chikusela Sikazwe & Rajat Khosla Governments need to prioritise funding and support for midwifery to save the lives of women and babies A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move? When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic. Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most. This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking. Preventable deaths Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost. The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year. These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations. Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1. There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce. For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond. A midwife examines a pregnant woman in a rural community clinic in Guatemala. For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap. With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment. Yet despite all this hard evidence, investment is not being made at the scale required. Midwives’ demands This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence. Their demands are clear and achievable: Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment. Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system. Commit to ICM Global Standards on education, pay, regulation, and leadership. Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away. Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time. That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it. Investing in midwives is an investment in the future of every country that makes it. Anna af Ugglas is chief executive of the International Confederation of Midwives. Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives. Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Clean Electricity, Waste and Construction Set to Top COP31 Agenda 18/06/2026 Stefan Anderson COP31 co-Presidents Türkiye and Australia used the Bonn climate talks to launch three flagship goals for November’s summit in Antalya. The targets chart a path to cut emissions from energy, buildings and waste, but steer clear of the fossil fuels and the finance fights that sank the last two COPs. The stepping-stone meetings on the road to COP31 in Antalya unfolding in Bonn this week brought the first real clarity on what the incoming presidency wants the next UN climate summit to deliver on: electrification, reducing waste, and the energy efficiency of buildings and construction. The three headline targets call for electricity to meet 35% of final energy demand by 2035, up from just over 20% today, a goal the presidency calls “35 by 35”. The second would halve the growth in global waste by the same date, and the third would cut the energy intensity of buildings by at least a quarter. Together, they chart a course around sectors that are among the largest sources of global greenhouse gas emissions; the buildings sector alone accounts for around 37% of the global total. But the agenda is deliberately fossil-fuel free, built to dodge the political torpedoes that sank the last two COPs, in Brazil and Azerbaijan. The presidency has cast the package as the practical core of an “implementation COP”, echoing Brazil’s framing of COP30 a year ago. “We need this COP to be a COP of implementation and acceleration,” said Chris Bowen, Australia’s climate minister and COP31’s president of negotiations, calling the agenda “an impressive blueprint to help us do that.” Yet money — the other perennial battleground of recent UN climate summits, and the thing that makes any implementation possible — is also absent from the core agenda. Beyond the three headline goals, the presidency’s ten-theme Action Agenda spans food security, oceans, green industrialisation, youth and education, and, of note for the health community, a pillar on resilient health systems. The core targets, like the rest of the Action Agenda, are set by the presidency and are political objectives, not guaranteed outcomes. Countries must choose to take them up on their own in Antalya during formal negotiations to make the targets a reality. And the political momentum pushed by a presidency is not always enough to get a deal over the line. Hosting last year’s summit in the heart of the Amazon, a setting meant to put the critical role of rainforests in balancing the global climate at the centre of the talks, Brazil threw its weight behind a roadmap to halt and reverse deforestation, backed by more than 90 countries. It never made the final text, with over 100 nations declining to support the roadmaps Brazil’s presidency championed. “What the world needs today is not another round of promises,” COP31 President-Designate Murat Kurum told delegates in Bonn. “It needs to see existing commitments delivered.” 1.5°C’s life or death moment Planet on Course to Permanently Breach 1.5°C Limit by 2030 The new targets for Antalya land as the planet closes in on the 1.5°C limit UN climate negotiations are intended to defend. While the presidency lists protecting that threshold in its official targets, the latest science shows the planet is on course to breach it permanently around 2030. The electrification target is explicitly designed to hold the world on a 1.5°C path, based on International Renewable Energy Agency (IRENA) modelling. But with the fossil fuels behind roughly 70% of global emissions absent from the agenda, the presidency’s strategy looks more like pragmatic damage control than a course correction. Human-caused warming reached 1.37°C last year, and global emissions hit a record 56.8 billion tonnes of CO2-equivalent in 2024, according to the annual Indicators of Global Climate Change report, published last week. A separate analysis released in Bonn on Tuesday by Climate Analytics found that fossil fuel use must halve by 2035 to keep 1.5°C within reach. The growth in CO2 emissions has begun to slow, but emissions are still climbing, not falling. “Fossil fuels are still pouring oil on the climate fire,” said Neil Grant, a senior mitigation expert at Climate Analytics. “We need to cut fossil fuel use sharply this decade, halve it by 2035, and drive it down to real zero by 2070.” “The safer route is a rapid, planned phase-out of fossil fuels, powered by clean electrification,” said Bill Hare, the group’s chief executive. The other key battleground of every COP since Paris – money – is not addressed in the presidency agenda either. A concept note circulated in Bonn unveiled a “Global Implementation Accelerator” and a “Climate Implementation Bridge” to speed climate solutions to the ground. Both are coordination structures. Neither is a fund, and the presidency specifies that no new money is attached. A target for an electric age UN climate meetings underway in Bonn, Germany. The electrification goal draws on analysis from IRENA, whose latest roadmap finds electricity must rise from around 23% of final energy use today to 35% by 2035, and above 50% by 2050, to stay on a 1.5°C-compatible path. The co-presidents frame the pitch as a move towards energy security as much as climate action. The protection renewables can offer from fossil fuel price shocks is drawing fresh attention as the war in the Middle East drives up oil and gas prices, forcing low- and middle-income countries to dig into their treasuries to afford the basic functions of government. Electrification can be a hedge: cheaper, home-grown power that shields households, central banks and economies from volatile global markets and the geopolitical shocks that move them. “The good news is that the answer to improved energy reliability and energy sovereignty is also the answer for emissions reduction – that is more electrification, more renewable energy, sovereign and reliable forms of energy, which is also cheap and is also the best for the climate,” Bowen said. “Accelerating the energy transition will ease shocks to our energy systems, better protect our economies and households from high costs, and help keep bending the curve of emissions downwards,” he added, describing electrification as “the key to transitioning away from fossil fuels.” But more electricity only cuts emissions if the power behind it is clean. While broadly welcoming the strategy, environmental groups warned it must be matched with investment in expanding renewables. “More electricity alone is not the answer if it is still powered by coal, oil and gas,” said Fernanda de Carvalho, global climate and policy head at WWF. “Developing countries will also need finance and technology support to make this transition fair and effective.” The targets released in Bonn do not specify how the extra electricity should be produced. “Electrification can only deliver meaningful climate benefits if the power comes from renewables, not fossil fuels,” said Duygu Kutluay, a campaigner at Beyond Fossil Fuels. Simon Stiell, the UN climate chief, who has thrown his weight behind the electrification push, urged delegates not to backslide. “We don’t have time to re-open past debates or renegotiate commitments already made,” Stiell told the Bonn summit. “Tackling the global climate crisis is the hardest, but most important, thing humanity has ever tried to do together. It is worth doing, because we have no choice.” What kind of waste? The second target takes aim at the climate impact of the world’s waste. The presidency wants to halve the growth in global waste by 2035, notably, not halve waste generation itself. The world already generates around 2.1 billion tonnes of solid waste a year, a figure the UN Environment Programme (UNEP) projects will climb to 3.8 billion tonnes by 2050 in a business-as-usual scenario. Mounting piles of trash and landfills are also a growing climate problem, with organic waste rotting in dumps one of the largest human sources of methane, a major accelerator of global warming. Methane is responsible for nearly 30% of the rise in global temperatures since the Industrial Revolution. Food waste alone accounts for around 10% of global emissions, much of it as methane, a gas roughly 80 times more potent than carbon dioxide over the short term. Yet because methane breaks down in the atmosphere within about 12 years, against centuries for carbon dioxide, cutting it is prized in climate diplomacy as a vital “emergency brake” on near-term warming. What the presidency’s target actually means is hard to say, as little about it has been defined. The announcement set no baseline year and did not specify what kinds of waste it covers. That ambiguity matters, as some waste streams, plastics above all, are politically explosive enough to derail a negotiation. The missing piece: plastics UN Plastics Treaty Talks Fail Again After Overnight Deadlock While the target’s climate aspirations are positive, sidestepping plastics production could prove a gift to petrostates in the long run. A downstream focus on managing and recycling waste, rather than capping production, is exactly what petrostates fought to protect when global plastics treaty talks collapsed in Geneva last year. A bloc led by Saudi Arabia, Russia and Iran, with the United States aligned, blocked any binding limit on production. More than 100 countries, unwilling to leave the upstream untouched, ultimately walked rather than accept a weak deal. With less than a tenth of the world’s plastic recycled and production on track to triple by 2060, the same production-versus-waste-management fight could resurface at COP31. The cause is also a signature of Türkiye’s first lady, Emine Erdoğan, who chairs the UN High-Level Advisory Board on Zero Waste, established by Secretary-General António Guterres in 2023 after a Türkiye-led resolution declared 30 March the International Day of Zero Waste. A Zero Waste forum in Istanbul this month, organised by the foundation she heads, drew Guterres, UNEP chief Inger Andersen and Stiell, but produced no new commitments, even as it set up zero waste to be a central feature of the Antalya agenda. The building target that quietly shrank The third goal aims to reduce the energy intensity of the buildings sector by at least 25% by 2035. Buildings and construction are heavyweight emitters, responsible for around 37% of global emissions and nearly half of all raw material extraction, from the sand, gravel and cement that go into concrete to the steel that frames it. Roughly half the buildings that will stand in 2050 have yet to be built, most of them in fast-growing economies in Asia and Africa, according to UNEP. How those millions of structures are built will lock in emissions for decades. A wave of poorly insulated, fossil-powered construction would commit the world to rising energy demand for the lifespan of every structure. Despite the sector’s importance, the target was watered down hours after it landed, Climate Home News reported, another sign the presidency’s politically careful agenda may face serious headwinds once negotiations begin. An initial presidency statement set a goal of a 25% increase in energy efficiency. A “small update” issued a day later swapped it for a 25% cut in energy consumption intensity. No reason was given. The two metrics are not the same. Energy intensity measures the energy used per square metre, and can be brought down through superficial steps such as dimming lights or adjusting how a building is run, leaving structures untouched. An efficiency target would force the costly structural work that delivers lasting cuts: insulation, heat pumps and retrofitted building envelopes. Recast as an intensity goal, the target can be met by operational tinkering while the deep renovations the sector needs are put off. The fight the agenda leaves out The shape of the COP31 agenda emerges as a pragmatic political choice to build the summit around problems less divisive than the fossil fuel and finance fights that tanked the last two COPs. At COP30 in Belém last November, a bloc of petrostates led by Saudi Arabia drew more than half the nations present to its side and stripped every reference to fossil fuels from the final text, killing a phase-out roadmap that some 80 countries had backed. Under the UN’s consensus rules, a single nation can veto language, even against majority support. With Saudi Arabia, Russia and the United States flanked by other major petrostates set to be in the room, any text dealing with fossil fuel phase-out will be dead on arrival. The concession is a pragmatic but significant moment in the world’s fight against the climate crisis: the fossil fuels driving it are no longer seen as worth fighting over, a reality the joint presidency is conceding before talks begin. That deadlock has forced the fossil fuel question to splinter off into a diplomatic track of its own. Frustrated by the inability of the core UN climate talks to move forward, 57 governments convened in Santa Marta, Colombia, in April for the first summit dedicated to phasing out oil, gas and coal, declaring the transition “past its point of no return.” While the coalition’s power is limited, its creation signals a new shift in the phase-out fight. The Santa Marta countries account for about a fifth of global fossil fuel production, and include sizeable producers such as Norway, Canada, Australia, the United Kingdom, Brazil, Nigeria and host Colombia. The world’s five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – stayed away from the talks. For now, the higher-ambition camp is left to build toward a phase-out on its own, while the UN process moves on around it. The coalition will meet again in 2027 on the Pacific island of Tuvalu, co-hosted by Ireland. The money that isn’t there Achieving the presidency’s three targets, despite their limitations, would be a major achievement in the fight against the climate crisis. But the question of who will pay to make them real, and how much – the defining fight of every COP in recent years as the world shifts from diplomatic documents to delivery – stands to derail the agenda altogether. As of today, the world is paying a tiny fraction of the true costs of the three agenda items alone. Meeting the electrification pathway requires global grid investment to roughly double, to about $1.2 trillion a year, IRENA estimates. Investment in building energy efficiency must more than double to $5.9 trillion by 2030, according to UNEP’s Global Status Report for Buildings and Construction. The direct cost of managing the world’s waste, around $252 billion in 2020, is set to nearly double by mid-century, according to UNEP’s Global Waste Management Outlook. The headline goal agreed at COP29 in Baku commits developed countries to mobilise “at least” $300 billion a year for the developing world by 2035, a figure the Global South denounced as a “betrayal”, alongside an aspirational, all-sources target of $1.3 trillion. On the current trajectory, analysts estimate the flows covered by that goal will reach barely $427 billion a year by 2035, less than a third of the target. Developing economies received around $196 billion in climate finance in 2023, with more than half of it arriving as loans rather than grants, deepening the debt of countries already crumbling under foreign repayment loads. Even the institutions meant to deliver the “billions to trillions” now say it isn’t possible. World Bank President Ajay Banga has called the formula unrealistic, and the bank’s chief economist, Indermit Gill, has branded it a “fantasy.” “Climate finance commitments to small island developing states are facing systemic collapse,” Anne Rasmussen, lead negotiator for the Alliance of Small Island States, told a Bonn press conference on Tuesday. “Developed partners are defaulting on their legal obligations under the Paris Agreement, and key financial mechanisms are being crippled. SIDS are effectively being blocked from implementing vital climate priorities. It leads us to question whether the implementation of the NCQG is dead on arrival, unless these breaches of legal duty are immediately reversed.” The presidency’s new instruments take no steps to close that gap. Kurum has described the Climate Implementation Bridge as a way to turn national climate plans into “investable project portfolios” and help finance reach the ground faster, not as a new source of cash. A wider finance crisis Global Health Leaders Urge Fewer Agencies Amid Funding Crisis The shortfall is part of a wider crisis across the development aid world. Developing countries need an estimated $4.3 trillion a year to meet the Sustainable Development Goals, including $1.8 trillion for climate, according to UN Trade and Development. The OECD warns the overall financing gap, having grown 60% to $4 trillion, could reach $6.4 trillion by 2030 without reform. This year’s Financing for Sustainable Development Report concluded the shortfall “risks reversing decades of progress.” Climate is competing for that money with everything else falling short. Humanitarian appeals drew their lowest funding in a decade in 2025, while food programmes, global health budgets and the finances of the UN itself buckle under simultaneous cuts, led by the United States’ retreat from much of the aid system. As at every COP before it, the fate of Antalya is likely to rest less on the ambition of its targets than on whether anyone agrees to pay for them. “Public finance is not a preference for us, it is an oxygen for us,” said Isatu Kamara, climate finance coordinator for the Least Developed Countries group. Image Credits: UNFCCC. Ebola Outbreak is Three Times Bigger Than Previous Outbreaks at Four Weeks 18/06/2026 Kerry Cullinan Africa CDC epidemiologist Dr Wessam Mankoula The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday. This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing. The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain. Ebola outbreak size at four weeks Where’s the money? Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said. On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda. The meeting mobilised $910 million in pledges, including $80 million from African member states. However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added. The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination. “The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC. Case fatality, contact tracing The six key obstacles hampering the response. Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected. The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks. “Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula. Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient. Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked. However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak. Midwives: The High Return Investment That’s Not Being Made 18/06/2026 Anna af Ugglas, Lwazi Manzi, Chikusela Sikazwe & Rajat Khosla Governments need to prioritise funding and support for midwifery to save the lives of women and babies A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move? When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic. Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most. This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking. Preventable deaths Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost. The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year. These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations. Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1. There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce. For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond. A midwife examines a pregnant woman in a rural community clinic in Guatemala. For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap. With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment. Yet despite all this hard evidence, investment is not being made at the scale required. Midwives’ demands This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence. Their demands are clear and achievable: Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment. Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system. Commit to ICM Global Standards on education, pay, regulation, and leadership. Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away. Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time. That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it. Investing in midwives is an investment in the future of every country that makes it. Anna af Ugglas is chief executive of the International Confederation of Midwives. Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives. Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Ebola Outbreak is Three Times Bigger Than Previous Outbreaks at Four Weeks 18/06/2026 Kerry Cullinan Africa CDC epidemiologist Dr Wessam Mankoula The current Ebola Bundibugyo outbreak is three times larger than any other Ebola outbreak was four weeks after being declared a public health emergency, Africa CDC revealed at a media briefing on Thursday. This Ebola outbreak was declared a public health emergency on 17 May, and there are currently 875 cases and 202 deaths, Africa CDC epidemiologist Dr Wessam Mankoula told the briefing. The biggest Ebola outbreak in history, which affected West Africa and infected an estimated 28,600 people, had only registered 242 cases in four weeks – but that outbreak took almost three years to contain. Ebola outbreak size at four weeks Where’s the money? Meanwhile, less than 10% of the money pledged to address the outbreak has been released to responders, Mankoula said. On Tuesday, Burundi’s President Évariste Ndayishimiye, Chairperson of the African Union (AU), convened an emergency high-level meeting of African leaders, Africa CDC, the World Health Organization (WHO), Regional Economic Communities, partners and donors to accelerate the Ebola response in the Democratic Republic of the Congo (DRC) and Uganda. The meeting mobilised $910 million in pledges, including $80 million from African member states. However, only around $90 million of this has reached countries, which is hampering the response, Mankoula added. The high-level meeting resolved to ensure that the full $518 million required for the joint continental preparedness and response plan is mobilised and disbursed within the next four weeks. The plan covers immediate response needs in affected areas and preparedness in at-risk countries, including surveillance, contact tracing, laboratory capacity, case management, infection prevention and control, risk communication, community engagement, logistics, medical countermeasures and cross-border coordination. “The priority now is speed. Every pledge must translate into financing, supplies, people and support reaching the communities and responders on the ground,” said Dr Jean Kaseya, Director-General of Africa CDC. Case fatality, contact tracing The six key obstacles hampering the response. Over the past week, there has been a 38% increase in cases in the DRC, with Ituri province still the heart of the outbreak, while North Kivu and South Kivu are also affected. The case fatality rate (CFR) in the DRC is 23%, and nine treatment centres in the DRC’s Ituri province are over 90% full. There have been 67 recoveries in the DRC, while there have been seven recoveries in Uganda – which has only reported 19 cases and two deaths (a CFR of 10%), a figure that has remained stable for the past few weeks. “Unfortunately, North Kivu, because of insecurity situation, is not accessible for most of the responders, and we are seeing a high case fatality rate coming from North Kivu, and also this is the lowest among the three provinces when we speak about the rate of the contact tracing,” said Mankoula. Contact tracing is still lagging in the DRC, with around 6,000 listed contacts – whereas there should be 17,000 to 35,000 based on an estimated 20-40 contacts per patient. Of the 6,000 contacts, around 4,000 have been traced – meaning that only around 15% of expected contacts have been identified and checked. However, “testing capacity improved significantly”, said Mankoula, with almost no backlog in comparison to the five- to eight-day wait at the start of the outbreak. Midwives: The High Return Investment That’s Not Being Made 18/06/2026 Anna af Ugglas, Lwazi Manzi, Chikusela Sikazwe & Rajat Khosla Governments need to prioritise funding and support for midwifery to save the lives of women and babies A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move? When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic. Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most. This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking. Preventable deaths Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost. The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year. These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations. Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1. There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce. For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond. A midwife examines a pregnant woman in a rural community clinic in Guatemala. For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap. With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment. Yet despite all this hard evidence, investment is not being made at the scale required. Midwives’ demands This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence. Their demands are clear and achievable: Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment. Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system. Commit to ICM Global Standards on education, pay, regulation, and leadership. Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away. Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time. That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it. Investing in midwives is an investment in the future of every country that makes it. Anna af Ugglas is chief executive of the International Confederation of Midwives. Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives. Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Midwives: The High Return Investment That’s Not Being Made 18/06/2026 Anna af Ugglas, Lwazi Manzi, Chikusela Sikazwe & Rajat Khosla Governments need to prioritise funding and support for midwifery to save the lives of women and babies A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move? When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic. Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most. This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking. Preventable deaths Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost. The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year. These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations. Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1. There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce. For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond. A midwife examines a pregnant woman in a rural community clinic in Guatemala. For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap. With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment. Yet despite all this hard evidence, investment is not being made at the scale required. Midwives’ demands This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence. Their demands are clear and achievable: Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment. Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system. Commit to ICM Global Standards on education, pay, regulation, and leadership. Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away. Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time. That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it. Investing in midwives is an investment in the future of every country that makes it. Anna af Ugglas is chief executive of the International Confederation of Midwives. Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives. Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Nearly Every Child on Earth Now Faces a Climate Hazard 17/06/2026 Stefan Anderson Students swim across the Kemp Welch River after school in Launakalana in Papua New Guinea’s Rigo District, who risk the crossing after floods destroyed the community’s only footbridge 14 years ago, leaving the river as their only route to and from school. A landmark UNICEF report that maps children’s exposure to overlapping climate hazards finds that almost half the world’s children – 1.1 billion kids – now contend with at least three threats at once. To reach school each morning, 15-year-old Lorna first has to swim across the Kemp Welch River, known to locals for its strong currents and crocodile-infested waters. The footbridge that once linked her village in Papua New Guinea’s Central Province to its only primary school and health post was washed away by extreme flooding in 2012. More than a decade later, it has not been rebuilt. “Most of the time we swim across the river. We put our school bag and uniforms inside a dish and swim across,” Lorna told the UN children’s agency (UNICEF). “We swim across to the school side and hide in nearby bushes or behind vehicles to change. After changing, we hide our wet clothes in the bush, then we walk to school.” During menstruation, she said, village elders forbid the girls from crossing at all, fearing the blood will draw crocodiles. “In monsoon season, heavy currents, dead trees and debris block the river, causing injuries and deaths,” Lorna’s school’s principal added. “Children also lose their books, bags and clothes in the river. Many children fall sick from the cold river water.” Lorna, 15, swims across the Kemp Welch River after school in Launakalana, Papua New Guinea. Her daily crossing is one of countless adaptations charted in the Children’s Climate Risk Report 2026, released Tuesday by the UN children’s agency. Almost every one of the 2.3 billion children alive is now exposed to at least one climate hazard, the report finds. They range from floods, droughts and tropical storms to heatwaves, extreme heat, wildfires and sand and dust storms. About 1.1 billion, nearly half the world’s children, face three or more overlapping hazards at once. More than four million are exposed to as many as six. “Imagine having to swim across a fast-moving river, known for its strong currents and crocodiles, just to make it to school,” said Tom Slaymaker, who leads UNICEF’s water, climate and environment data unit. “For these children, the impact of climate change is not an abstract or future concern. It is a reality pushing them to risk their lives to not miss out on school.” Next generation data on climate and children Percentage of children exposed to at least 3 climate hazards, per UNICEF data. For the first time, UNICEF has mapped where and how intensely those hazards converge, drawing on a new Global Child Hazard Database that pinpoints exposure down to a 100-metre grid. The database tracks eight climate hazards: riverine and coastal floods, droughts, tropical storms, heatwaves, extreme heat, fires, and sand and dust storms. It adds two more health crises worsened by a warming planet: malaria and air pollution. “The lives of children continue to be upended by the impact of heatwaves, wildfires, droughts and floods,” said UNICEF Executive Director Catherine Russell. “Half of the world’s children are now living with at least three overlapping climate threats shaping their daily lives.” Successive UNICEF assessments, built on progressively more granular data, show the climate threat to children growing more critical the better it is understood. The agency’s first analysis, the 2021 Children’s Climate Risk Index, found around one billion children at extremely high risk and 820 million exposed to heatwaves. The new figure for heatwave exposure is 1.5 billion. Recorded exposure to air pollution has climbed from one billion to 2.3 billion. “Children are at the forefront of the impact of climate change,” Russell said. “Across the globe, millions of children are now facing multiple climate threats without the necessary services to cope.” “They are experiencing extreme heat that causes heatstroke and dehydration. Their homes and schools are being destroyed by storms and floods. Devastating droughts are limiting their access to food and water. And in many cases, the intensity of these hazards is increasing with each passing year.” When the shocks overlap Overview of the number of children exposed to climate-related hazards. Drought, paired with extreme heat and heatwaves, is the most common climate hazard combination, affecting an estimated 296 million children, UNICEF found, feeding into one another in a loop that drives malnutrition, water scarcity and heat illness. A second cluster, drought with extreme heat and tropical storms, affects a further 115 million children, a convergence that drives food and water scarcity, severs access to health care and schooling, and raises the risk of displacement and disease. Drought, heatwaves and tropical storms rank third, affecting 94 million children, followed by drought, extreme heat and riverine floods at 58 million. “When climate hazards overlap, the impacts compound,” Slaymaker said. “A drought can leave children hungry and malnourished. A flood that follows can contaminate water supplies and spread diseases like cholera. Each shock makes the next one more dangerous.” One of the most worrying findings of the report is that the rate of overlap in climate extremes affecting children is accelerating. Between 2012 and 2021, the number of children exposed to three or more hazards rose 69% over the previous decade. Many more children were uprooted, with climate shocks driving the equivalent of 21,000 child displacements a day between 2016 and 2023. Displacement is a compounding hazard that the index does not count. Children driven from home into camps or informal settlements lose access to health care, clean water and schooling, and face sharply higher risks of disease, family separation and exploitation. “These multiple overlapping shocks are building on top of each other and reshaping children’s lives,” Slaymaker said. “Without urgent, child-focused climate action, the shocks they face today will only intensify.” Global but unequal crisis Seven year old Yar ul Haq walks through floodwaters after extreme rainfall submerged his village in Pakistan. In Africa’s Sahel, more than four million children face the combined threat of heatwaves, extreme heat, and sand and dust storms. Children across Burkina Faso, Chad, Mali, Niger and South Sudan are among the most exposed anywhere, in a belt where wind-blown dust also drives meningitis, a disease the region already carries at the world’s highest rates. All children in the world’s 24 small island developing states, including Haiti, are exposed to tropical storms that can knock out entire health and aid systems overnight. For many of these nations, and their children, the danger is existential, as the same warming that fuels hurricanes lifts sea levels that threaten to submerge countries and coastal communities. In Bangladesh, Myanmar and Pakistan, children are exposed to more hazards, and at greater intensity, than anywhere else on Earth. All three nations pair vast child populations with low-lying, flood-prone geography and intensifying storms and heat, exposing children to a perfect storm of simultaneous threats to their well-being. Zunaira, a young activist from Pakistan, told world leaders at the UN General Assembly last year that the 2022 floods that submerged a third of her country “did not just wash away houses.” “They washed away entire communities. They washed away childhoods,” she said. “Schools collapsed or turned into shelters. Families lost homes, and children lost the spaces where they felt safe. And when the waters receded, what remained was not only destruction, it was trauma.” “Children are living the challenges of climate change right now,” she said. “And the impacts are not just physical – they are emotional, mental and deeply personal. We are not imagining this crisis. We are living it, and it affects us more than adults can imagine.” Even moderate climate hazards can ‘put lives at risk’ On 20 September 2025, Nyawar, 30, sits in a canoe amid flooded fields near Bentiu displacement camp in South Sudan. After losing her home and livestock to floods, she now collects water lilies to feed her children, one of the few food sources still accessible. Yet what turns a hazard into a catastrophe is often the ability of the health and government services meant to absorb and rebuild it. “No country is untouched by climate risks, but imagine a child in conflict-affected places, the Central African Republic, Chad, Haiti, or Sudan,” Slaymaker said. “Because they have much lower access to essential services, such as health care, nutrition, or water and sanitation, even a moderate flood or drought can put their life at risk.” That doesn’t mean wealthy countries are wholly spared. In Italy, more than six million children are exposed to prolonged heatwaves and drought, though UNICEF held the country up as proof that adaptation spending can blunt the danger. Heatwave exposure has seen among the sharpest increases of any hazard the agency tracks. In Europe, which is warming faster than any other continent, extreme heat has killed more than 200,000 people over the past four years, the World Health Organization (WHO) said this month, making it the region’s deadliest climate hazard. Every child breathes air pollution Areas exposed to air pollution around the world. An estimated 2.3 billion children, virtually every child on the planet, breathe air that breaches the WHO guideline for safe air, ranking it as the second-leading risk factor for death among children under five, after malnutrition, according to the report. The latest State of Global Air report, produced by the Health Effects Institute with UNICEF, links air pollution to more than 675,000 deaths in children under five and a combined 61 million healthy years of life lost among them. Like the greater climate crisis, air pollution’s effects are deeply unequal, with around 90% of all air-pollution deaths occurring in low- and middle-income countries. Extreme heat and access to safe drinking water exacerbated by climate change follow closely behind air pollution as leading threats to the health of children around the world. The attributable number of extreme hot days of over 35°C, which are highly likely to have materialised due to human-induced climate change. Today, 634 million children lack safe drinking water, and one billion lack safe sanitation. Those conditions are sharpening amid climate shocks, leading to “one of the biggest killers of children under five” due to the role of clean water and sanitation access in increasing the risk of diarrhoea, Slaymaker said. Another 550 million children were exposed to additional extremely hot days in 2024 that scientists attribute directly to human-caused warming, according to Vrije Universiteit Brussel research published this year, which is mapped out in the report. Other, more overlooked threats compound the toll. Each 1°C rise in extreme heat lifts the odds of stillbirth by 14%, the report notes, while a further one billion children live in areas exposed to malaria, a disease whose range expands as temperatures and rainfall shift. The cost of inaction Parents carry their children as they walk on a flooded street in the Phillipine capital of Manila after the family left their home for safety as Typhoon Carina brought massive flooding in 2024. Beyond the health and mortality impacts, the financial costs levied on children and economies globally are equally staggering. Climate hazards disrupted schooling for at least 242 million students across 85 countries in 2024 alone. Lost learning in low- and middle-income countries could cost today’s students up to $11 trillion in lifetime earnings, the report estimates. Prevention, by contrast, pays. Every $1 invested in adapting essential services for children returns more than $10 in benefits over a decade, the report says, citing the World Resources Institute. But developing countries will need $310 billion to $365 billion a year for adaptation by 2035, the UN Environment Programme estimated in October, against just $26 billion in international public adaptation finance in 2023, a shortfall of 12 to 14 times the required amounts. At COP30 in Belem last year, nations agreed to a target of tripling the adaptation finance commitment made years earlier to $120 billion per year by 2035. That ambitious upping of the ante came before the world could hit its previous $40 billion target set in Glasgow, raising questions about how long it may take for the money to arrive – or whether it will materialise at all. ‘Not a warning of what is to come’ Lorna’s classmates swim across the Kemp Welch River after school in Launakalana, Papua New Guinea. Back in Papua New Guinea, Lorna still holds on to hope for the future. “My dream is to become a teacher or a pilot,” she said. “We just want a new bridge, so that we can go to school safely every day.” “Children have done the least to cause the climate crisis, yet they are paying the highest price,” Slaymaker said. UNICEF urged governments to cut emissions, write children into national adaptation plans and disaster response, and fund fixes already proven to work: solar power to keep schools running through outages, groundwater wells as surface water dries up, and storm shelters built to last. “This analysis can help governments and decision makers plan better and invest more effectively in resilient services,” Russell said. “When we strengthen health and education systems and improve infrastructure with children in mind, we protect them from today’s climate threats and help secure their future.” For children like Lorna, who have already adapted once, the margin is thin, Slaymaker warned. “They adapted to one climate shock by swimming across a river to school. But what happens when the next shock comes, the flood waters rise, the river gets faster, and a dangerous journey becomes deadly?” “This is not a warning of what is to come. It is a recognition of our current reality,” he said. “Climate change is not only changing the planet, but also children.” Image Credits: UNICEF, UNICEF, UNICEF. Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Despite Delays, Negotiations Over Critical PABS Annex to WHO Pandemic Treaty Reveal Signs of Progress; Here’s Why 17/06/2026 Suerie Moon, Adam Strobeyko, Daniela Morich & Gian Luca Burci South Africa, speaking for the Africa Group and Group for Equity at the last round of negotiations on an PABS Annex in May 2026. That failed to yield a final agreement. What’s left to tackle in the PABS talks? As the clock ran out, and then was extended for another year, on negotiations over the Pandemic Agreement’s Annex on Pathogen Access and Benefit-Sharing (PABS), the diplomacy and the nitty-gritty of the issues faced were deeply linked This edition of the Governing Pandemics Snapshot of the Geneva Graduate Institute’s Global Health Centre focuses on both, while noting that negotiators’ increased understanding of the technical issues may help pave the way for resolving key sticking points in future rounds of talks. On the side of the nitty-gritty, a perennial challenge is the sheer complexity, as Suerie Moon, the Global Health Centre’s Co-Director, writes in her opening article of this four-part Snapshot series: “What has been achieved and what’s left to tackle in the PABS talks?” One hopeful point of progress, however, is the emerging, common understanding of how genetic databases and related systems work – as well as how the proposed WHO-coordinated laboratory networks and WHO-recognized sequence databases could play a key role. This has given negotiators a much more solid basis for actually making proposals and finding potential points of compromise. Meanwhile, the recent outbreaks of hantavirus and Ebola Bundibugyo virus (EBV) illustrate a case of how open and more restricted gene databases work, as discussed in a narrative elaborated by Adam Strobeyko: “What Hantavirus and Ebola Outbreaks Teach Us About PABS Database Governance.” In the case of hantavirus, Swiss-based researchers who were among the first to sequence the virus opted for an open, unrestricted sharing. Meanwhile Ugandan and DR Congo researchers who sequenced EBV shared the data openly, but chose a model that imposes restrictions upon its use. Researchers registering the Ebola Bundibugyo virus on Pathoplexus, a leading data base for genetic sequences, chose a restricted use model, while the gene code for the Hantavirus was published as entirely open access on the same platform. The narrative illustrates how scientists with different needs and links with databases make different sharing choices in real time. This happens against the backdrop of an increasing number of national laws addressing sequence data. It thus remains technically and legally impossible to impose a single governance model across all pathogen databases worldwide – a fact of life that any PABS agreement will have to acknowledge. Based on these hard facts, Daniela Morich elaborates on the concrete proposals for benefit sharing models that are emerging from the PABS negotiations, and some initial glimmers of convergence in her article: “Building Common Ground: The Evolution of Benefit-Sharing Discussions in the Pandemic Agreement.” Notably, there has been limited but meaningful acceptance — particularly from the European Union — that some form of structured benefit-sharing vis-à-vis products should apply not only during a Pandemic, but also during more “routine” Public Health Emergencies of International Concern (PHEIC), such as the current Bundibugyo Ebola virus raging in central Africa. While far from fully settled, this shift suggests a potential “landing zone”. The European Union delegate expresses regrets over the failure of the last session of PABS negotiations in May to reach agreement; even so, hopeful signals of flexibility by both developed and developing countries could help break the logjams over the coming year. While the 20% target for the real-time provision of products for pandemic emergencies was enshrined in the 2025 Pandemic Agreement – other types of proposed in-kind and monetary contributions have remained a sticking point in the PABS debate. But here, too, points of convergence may be emerging. In terms of monetary contributions, some countries favour a system in which those contributions (presumably by pharma or other users of the pathogen data) serve exclusively to fund the operation of the PABS System, without requiring additional payments linked to the commercial value of products developed. Others argue that benefit‑sharing should reflect the value added of products developed using PABS materials; they therefore support financial contribution models that tie contributions to commercial returns. In “Governance of the PABS Annex”, the final article in this Snapshot series, Gian Luca Burci, looks ahead to the implementation of the Pandemic Agreement. In particular, he points to the rather laconic references to a system of governance for the Accord, and how those might be interpreted and operationalized going forward. Elaborating further on how governance may really work in practice, is one of the next challenges that countries will face – once the PABS hurdle is really overcome. What has been achieved and what’s left to tackle in the PABS talks? The fourth meeting of the Intergovernmental Working Group (IGWG) negotiating a pathogen access and benefit-sharing in December 2025. After the sixth round in May 2026 failed to yield an agreement, negotiations were extended for another year. By Suerie Moon In the corridors of the 79th World Health Assembly (WHA), the frustration and gloom were palpable. Delegates had missed WHA’s May 2026 deadline to deliver the Pandemic Agreement’s (PA) Annex on Pathogen Access and Benefit-Sharing (PABS) – a necessary precondition for WHO member states to begin ratification of the Pandemic Agreement reached in 2025. The WHA agreed to extend the talks for up to a year – noting that if consensus can be reached earlier a special session of the Assembly would be convened in 2026 – and many countries formally reiterated their commitment to getting it done. While the near total absence of ‘green text’ (indicating consensus) in the latest draft left the impression that little headway has been made, that may be misleading. A look back at countries’ original proposals, and the evolution of negotiations over the past year, shows that progress has been significant, even if deep divisions remain. Coming to terms with complexity Grappling with complexity. Computer visualization of a DNA sequence with different colors for each of four base chemicals (adenine, guanine, cytosine and thymine). Hantavirus and bundibugyo virus, however, are comprised of RNA sequences that use uracil instead of thymine. A perennial challenge with PABS is the sheer technical complexity of the issues. Diplomats must not only master the finer points of how laboratories, databases and product R&D work, but also envision how they could work differently. Over the past year, many delegates built a working familiarity with these topics – a necessary pre-condition to reaching agreement – and some previously-contested technical questions have largely been settled. For example, the idea that an individual genetic sequence can be tagged with a ‘universal persistent identifier’ now seems to be widely-accepted, even if countries disagree on the definition and purpose of such identifiers. Most importantly, after 9 months, a clearer common understanding of how the overall system could work seems to be emerging, with WHO-coordinated laboratory networks and WHO-recognized sequence databases comprising the backbone. Seeking a middle ground with a ‘hybrid’ pathogen data registration system The GSAID database was a dominant platform for sharing SARS-CoV-2 sequences during the pandemic. But it’s restrictive use clauses have come under fire. In addition, after months of establishing and defending their positions, delegates have cautiously started to put on the table proposals that seek to find middle ground. For example, a ‘hybrid’ pathogen data registration system has now been proposed. This would give countries a choice of whether to share their data through open-access or registration-based databases; it aims to broker compromise between delegations wanting one or the other, an issue that my colleague Adam Strobeyko discusses further in the second article of this series. The proposals for benefit-sharing during a Public Health Emergencies of International Concern (PHEIC) – and not only during (far less frequent) Pandemic Emergencies – reflect efforts to infuse more meaning into the overarching commitments of Article 12 of the Pandemic Agreement, as my colleague Daniela Morich addresses in her analysis, the third in this series. Countries do not all agree on the particulars of these and other proposals put forward so far, but they reflect real efforts to find elusive ‘landing zones’ – a shift from the pure tug-of-war dynamics that marked the earlier months of PABS negotiations. Notably, the May 2026 WHA decision extending the PABS talks included in its scope of work a mandate for member states to find agreement “to develop legally binding contracts,” a priority for the Global South, even if the content of those contracts remains a point of debate. Financing PABS A great deal of attention has focused on a few of the most contentious issues over the past year (e.g. databases, which benefits should be shared when), but other critical issues have had little air time. For example, how will the PABS system be financed? This question involves not only flows of monetary benefits, but also where would the additional funds needed to operationalize a system come from, and how would PABS financing fit into the broader Coordinating Financial Mechanism agreed in the PA and International Health Regulations. Technology transfer (including but not limited to licensing of intellectual property) is critical to achieve geographically diversified manufacturing capacity. But so far, countries have only agreed on the ends, not the means to make such transfers happen. Furthermore, key provisions for governance of the overall system remain to be defined. There is broad agreement on the need to create an expert PABS Advisory Group, but disagreement persists on the scope of the Advisory Group’s mandate, and to whom it should report, as my colleague Gian Luca Burci discusses in the final article of this series. US bilateral agreements: ‘termites’ in the wood of PABS architecture? US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Nearly three dozen such deals had been signed as of late April 2026. Finally, a new elephant in the room has emerged since negotiations began: how to design a multilateral system that can function alongside the growing number of US bilateral global health agreements – under which countries would be obliged to share pathogen samples and data with the US government in exchange for health aid. Bilateral agreements can weaken multilateral ones if they create escape routes from multilateral obligations, which is particularly problematic for issues like pandemics where all countries are affected. Bilateral deals can be described as ‘termites’ in the wood of the multilateral PABS house that is still under construction, to borrow a phrase from the trade arena. In brief, negotiators must resolve many issues in the months ahead, but the slow wheels of multilateral negotiations have been grinding forward and are set to continue. It’s also important to remember that while the PABS negotiations proceed, delegates will be contending with at least two other political issues on the global health agenda – the race for WHO’s next Director-General and the global health architecture reform process. Contending with all three at the same time will stretch smaller delegations even more thinly across multiple negotiations. However, these additional bargaining chips could also open new possibilities for striking grand political bargains. Countries have in their hands the ingredients for a PABS deal – the question is whether many cooks can make one stew, what ingredients it will contain, and how palatable it will be. Read the entire issue of this Governing Pandemics Snapshot series here. _____________________ Suerie Moon is the Co-Director of the Global Health Centre of the Geneva Graduate Institute, where she is also a Professor of Practice. Adam Strobeyko is a Legal Advisor and Researcher at the Global Health Centre. Daniela Morich is the Global Health Centre’s Head of Policy Engagement and the Global Health Platform. Gian Luca Burci is a Senior Visiting Professor in International Law at the Geneva Graduate Institute and Academic Advisor at the Global Health Centre. He co-leads the Governing Pandemics Initiative. The authors thank Diana Jalea for her editorial review and Anna Bezruki for her comments on an earlier draft. Image Credits: Pathoplexus.org , Gerald Barber, Virginia Tech (with permission of the National Science Foundation), Gisaid.org. Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
Countries Differ on Discharge Criteria for Andes Hantavirus Patients 16/06/2026 Kerry Cullinan Passengers being evacuated from MV Hondius, the cruise ship affected by a hantavirus outbreak, in Tenerife. Dutch, Spanish and Swiss medical experts applied slightly different criteria for discharging patients infected with Andes hantavirus during the recent outbreak on a cruise ship – but none required a negative blood test, as this could remain positive “for months”. This emerged during a briefing convened by the World Health Organization’s (WHO) Information Network for Epidemics (Epi-WIN) team on Tuesday, with medical experts who had treated patients. The Netherlands had the most relaxed criteria. Two patients sought care in the Netherlands, and both were discharged after two negative saliva tests, said Karin Veldkamp, head of infection control at the University Medical Centre in Leiden, Netherlands. “We decided that if the saliva is negative twice, that we could safely discharge the patients at home, and then we could give them additional [isolation] measures if their urine and blood are positive,” said Veldkamp, adding that advice from medical experts from Argentina and Chile, who dealt with an outbreak in 2019, had helped guide this decision. Spain also treated two confirmed cases and managed 12 asymptomatic contacts. It required patients to have two negative PCR tests from oropharyngeal (throat) swabs and urine samples, said Octavio Garcia, from the high-level isolation unit at the Infectious Diseases Department of Hospital Central de la Defensa in Madrid. Switzerland’s single positive case was a 64-year-old man with other underlying conditions, said Professor Walter Zingg from the University of Zurich’s department of infectious diseases. He was hospitalised on 4 May and discharged on 18 May after his saliva and nasopharyngeal swabs tested negative. The virus was still faintly detectable in his urine and blood. “We decided that if the patient is clinically well, and 14 days from the beginning of the acute phase or 21 days from the beginning of the prodromal phase, we would stop isolation without further restrictions,” said Zingg. “We just saw him last week, and he was still positive in both full blood and urine,” said Zingg, adding that his contacts were required to observe 42 days of self-isolation. Garcia said that the PCR tests of the blood of both Spanish patients “were positive throughout the disease, even after clinical convalescence”. “We know that in different studies, especially from our colleague Dr Marcela Ferres [from the University of Chile], full blood PCR will remain positive for a long period of time, even after more than 23 days from symptoms onset,” said Garcia. As the virus can persist in the blood and semen, the Spanish health authorities also recommended four months of safe sex practices post-discharge. “We recommended a monthly clinical review during the first six months after discharge to detect both clinical and psychological sequelae from these patients. They will also have a monthly blood PCR until we get a negative result,” said Garcia. Early phase is most dangerous All the experts agreed that the early stages of infection were the most risky for transmission. Zingg said that their research indicated that the infectious period is two days before the first symptoms. Colin Brown, the UK’s deputy head of epidemics and emerging infections, said that the UK conducted a big literature review, “looking at particular evidence of transmission dynamics”. “Because we know the Andes hantavirus is detectable before symptom onset or antibody development, and that transmission mostly occurs in the prodromal phase or asymptomatic phase, we assume that there’s a big respiratory transmission component, and that there could be a degree which is asymptomatic or indeed presymptomatic,” said Brown. This respiratory transmission is “probably mostly in the symptomatic infected individuals and during their acute symptomatic episode”, said Brown. However, the UK recommended strict PPE guidance as “there are a lot of limitations in knowledge”. Brown added that the UK took a case-by-case approach to the virus, given the variables displayed by different patients. However, the UK designates the hantavirus as a “high consequence infectious disease”, based on the lack of medical countermeasures and vaccines, and its high case fatality rate. A UK citizen who flew to Johannesburg, South Africa, after leaving the cruise ship in St Helena, was the first person to be diagnosed with the virus, prompting the UK to notify the WHO of the outbreak. US evaluates home situation Katherine Willet, medical director of the US National Quarantine Unit in Nebraska, said her unit is using high-level PPE, “adapting some of our prior models, very similar to our approach with COVID for quarantined individuals”. “Some of the US-exposed citizens are quarantining at home and not in the facility, and the approach that we’re taking there obviously is going to be variable, based on their situation,” said Willet. Evaluating their home circumstances was important, particularly their ability to isolate from other individuals in the household. “The most important thing is going to be making sure that there’s airborne precaution, eye protection, and skin covering for these individuals, especially if they’re going to need to come into close contact,” she added. Meanwhile, Health and Human Services Secretary Robert F Kennedy Jr has refused to allow one of the US citizens at the National Quarantine Unit to sit out her 42-day quarantine at home, according to Inside Medicine. Ten of the 18 US passengers on the cruise ship have been allowed to isolate at home, while seven opted to stay in the unit. But the eighth, Angela Perryman, wanted to isolated at home but her home state of Florida refused to implement the 24-hour surveillance required by health authorities to allow this. Last week, Dr Michael Bell, the US Centers for Disease Control and Prevention (CDC)’s quarantine medical reviewer, concluded that Perryman’s confinement was unnecessary and that home-based monitoring would be enough to protect the public. However, Kennedy overruled this decision without giving reasons. Ironically, Kennedy and acting CDC head Dr Jay Bhattacharya were vocal critics of COVID-19 lockdowns. Image Credits: BBC. US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
US Support for Ebola Response is Unclear Amid Opaque Funds Disbursement and Non-Engagement with WHO 15/06/2026 Kerry Cullinan & Felix Sassmannshausen Workers erect an Ebola isolation tent on the grounds of a hospital in Ituri, DRC. Despite claims by the United States that it has allocated over $270 million to the Ebola Bundibugyo outbreak response, countries and groups dealing with the outbreak are in the dark about where the money is going. Washington’s directive to US health experts not to deal with World Health Organization (WHO) officials is also hampering their involvement in the response, sources told Health Policy Watch. The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response, centred in the Democratic Republic of Congo (DRC), and recently launched a joint continental preparedness and response plan. Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security”, he acknowledged that he was unclear of the extent of the US financial contribution, as well as what funds have been disbursed so far, and to whom. “We know that announcements [about funding] were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office]. Currently, we want to understand how much money from what the US gave to a number of partners can really go to supporting the response,” Kaseya told a media briefing last Thursday in response to a question from Health Policy Watch. This Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, chair of the African Union, said Kaseya. “We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount that they are putting into the response,” he added. The US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola”. Over the past few weeks, Kaseya has criticised countries and donors for failing to turn their Ebola pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million, said Kaseya, although he declined to name the countries. Kaseya also revealed last week that China had committed a mere $2 million to the response, less than half of South Africa’s $5 million pledge. Non-engagement with WHO? WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Yap Boum (right), who are leading the continental response team on Ebola. The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they had been instructed not to engage with the WHO. Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise its withdrawal until the US paid its unpaid membership fees. Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak. “In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu. Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response. ‘Unpredictable and unprofessional’ However, Lawrence Gostin, distinguished professor of global health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”. “Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch. “Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law. “Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic. “CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.” Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies such as UNICEF. “When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded. Image Credits: Joël Lumbala/ WHO. ‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts
‘Finish Pandemic Agreement,’ Tedros and Lula Urge Ahead of G7 15/06/2026 Kerry Cullinan WHO Director-General Dr Tedros Adhanom Ghebreyesus, wearing green to encourage consensus during the last round of PABS talks. World leaders need to finalise the Pandemic Agreement by applying political will at the “highest level”, a spirit of equity and a sense of urgency. This is the call made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus and Brazilian President Luiz Inácio Lula da Silva in an open letter published on Monday ahead of the G7 summit in France. Talks on the outstanding annex to the Pandemic Agreement, on a pathogen access and benefit sharing (PABS) system, have deadlocked, with negotiations due to resume between 6 and 17 July. Reminding leaders that around 20 million people died during the COVID-19 pandemic, the letter notes: “To respond to future pandemics in time, countries must be able to quickly identify pathogens with pandemic potential and share their genetic information and material so scientists can develop tools: the tests, the treatments, the vaccines that decide who lives and who does not. “The system that makes this possible, fairly and on equal footing, is the PABS annex. It is the last piece of the puzzle, not only for the Pandemic Agreement but for everything WHO and member states have built from the hard lessons of COVID-19. Until it is finished, the agreement cannot enter into force. The promise stays unkept.” The deadlock is mainly between developed countries, led by Europe and Japan, and developing countries. “The hardest questions, including how the benefits of shared pathogens are defined and shared, how the system is governed, and how equity is guaranteed on equal footing, are difficult for a reason,” the letter notes. “They are the very questions that went unanswered last time, while people who could have been protected were not. The world is wrestling with them now precisely because they matter so much.” Three steps forward Tedros and Lula da Silva propose three urgent steps forward: First, the clear signal that “only a head of government can give: that finishing this annex is a national priority”. “Second, a spirit of equity. The PABS system rests on a simple, fair bargain: those who share dangerous pathogens quickly must be able to trust that the vaccines and treatments born from that sharing will reach their own people too.” Third, a sense of urgency – particularly as scientists predict a close to one-in-four chance of another pandemic within the coming decade. The letter notes that a PABS system is not “charity”, but will enable pathogens with pandemic potential to be identified and addressed at their source. It will establish a system for countries to speedily identify and share genetic information of these pathogens, and get swift access to tests, treatments and vaccines to address these. “Today, the rules for accessing a pathogen and sharing what flows from it are improvised case by case, often mid-crisis. PABS replaces that with a single framework known in advance, stable rules that let laboratories and partners across the world move at the speed an outbreak demands,” the letter notes. It also reassures leaders that neither the Pandemic Agreement nor the PABS annex will undermine national sovereignty. “Nothing in the Agreement gives WHO any authority to direct or alter a country’s laws or policies, or to require measures such as lockdowns, travel restrictions or vaccination mandates. “Those decisions remain with sovereign states. So we ask you, concretely, to instruct your negotiators to come to the July session ready to conclude, and to give them the flexibility to close the remaining gaps and finalise the annex in this round.” Posts navigation Older posts