Rich countries’ share of the COP30 adaptation pledge could be worth as little as $45 billion a year against the $305 billion developing countries need, UN report finds ahead of COP31, as a deal with no baseline year or dollar figure meets shrinking aid budgets.

The pledge to triple climate adaptation funding hammered out in the closing hours of last year’s UN climate summit in Brazil would still leave developing countries with less than a third of the money they need to protect people from deadly heat, rising seas, failing harvests and other mounting threats from the climate crisis.

The UN Environment Programme’s (UNEP) annual Adaptation Gap Report, released on Wednesday ahead of next week’s COP31 climate talks in Antalya, Türkiye, estimates developing countries will need around $305 billion a year by 2035 to adapt, or $420 billion once inflation is counted.

Rich countries provided $28.2–31.7 billion in public funding for that work in 2024, roughly a tenth of what is needed.

“For every dollar developing countries need to adapt, they receive just 10 cents,” UN Secretary-General António Guterres said. “We know who is most at risk. We know what works. What is missing is the money and the political will.”

“The choice is simple,” the UN chief added. “Invest in adaptation today, or pay for catastrophe tomorrow.”

UNEP said last month that the chance of holding warming to 1.5°C, the Paris Agreement’s stricter limit, without overshooting it “has been lost”, with current policies pointing toward 2.8°C.

Even if emissions nearly halve by 2035, temperatures would peak at around 1.7–1.8°C by mid-century before falling back to 1.5°C by 2100. The adaptation report warns that climate risks will keep rising through any overshoot, and some of the harm done during that time may be irreversible.

“The world is not ready to adapt to current climatic conditions, never mind what overshoot of 1.5°C will bring,” said Inger Andersen, UNEP’s executive director. “Nations must focus on intensifying efforts to achieve the COP30 [pledge] of tripling adaptation finance by 2035, while understanding that they will need to go even higher to save lives, avoid losses and damages and protect economies.”

A pledge ‘not as ambitious as it seems’

An early draft of the COP30 agreement carried a demand from the least developed countries (LDCs), a UN-designated group of the lowest-income nations, to triple adaptation funding to at least $120 billion a year by 2030, in grants rather than loans.

The final deal pushed the deadline to 2035, dropped the requirement for grants so that loans developing countries must repay can count, and never said which baseline year funding should be tripled from, how much money that adds up to or how much of it must come from rich countries’ public budgets.

Depending on the starting point, the pledge could mean anything from about $85 billion a year by 2035, if rich countries triple what they actually provided in 2024, to $120 billion if they triple the roughly $40 billion they promised for 2025 at the Glasgow climate summit in 2021, the report found, leaving developing countries with only 20 or 29% of what they need either way.

Analysts said at the time that the wording had been left vague on purpose. And unlike the Glasgow promise, the report’s authors note, the Belém deal “does not include a baseline”, and its interpretation “should be advanced in the negotiations”.

The deal also ignores inflation and only “calls for efforts” to triple, wording the report says is much weaker than past UN climate finance goals such as the 2009 “promise” of $100 billion a year.

The pledge is also tied to the broader $300 billion-a-year climate finance goal agreed at the COP29 summit in Baku in 2024, so money from developing countries and private investors counts towards it too.

Developing countries’ contributions rose from $3.8 billion in 2019 to $9.6 billion in 2024, roughly a quarter of all international adaptation funding, none of which counted towards the Glasgow promise.

Developing countries’ growing contributions, said Henry Neufeldt, the report’s chief scientific editor, “will contribute to the NCQG goal of reaching $300 billion in climate finance, and we know from last year’s report that, of course, is not enough.”

“It’s not very clear, and I think one of the messages from the report is that the negotiations should look very closely at this relationship between developing countries’ and developed countries’ contributions and responsibilities,” Neufeldt said.

Once inflation and developing countries’ money are stripped out, rich countries could end up providing as little as $45 billion a year by 2035 in today’s money, the report found, only about 60% more than the roughly $28 billion they give now and nowhere near a tripling.

“The money is there, but the political will to provide it isn’t,” said Pooja Dave, adaptation lead at Climate Action Network International. “Adaptation is not charity. It is a legal and moral obligation.”

Flows stall as aid shrinks

Adjusted for inflation, rich countries’ adaptation funding has fallen every year since peaking at $31.5 billion in 2022, even though unadjusted figures from the Organisation for Economic Co-operation and Development (OECD) show it edging up by $1 billion in 2024, UNEP found.

“The pace of growth is slowing when it should be accelerating,” Andersen told reporters, “and this growth is below the pace required to double flows to approximately 40 billion by 2025, which is what we agreed back in Glasgow.”

The Glasgow goal could still be met, the report says, as development banks report a joint $10.3 billion increase in adaptation finance for 2025, but that hinges on rich countries’ foreign aid budgets, which supply much of their adaptation funding and are estimated to have shrunk 23% that year.

“Promises are very important because that means we can hold people to account,” Andersen said when asked whether climate finance pledges were worth anything if they went unfulfilled. “What we often see is, however, that it’s difficult for the collective promise to be fulfilled.”

Private money drawn in by public funding doubled to $3 billion between 2019 and 2024, but UNEP found that only 15 of the 111 such investments it reviewed were clearly aimed at climate risks, and that private finance could cover just 15–20% of the gap for the public projects countries have prioritised, such as flood defences.

“You cannot protect a harvest with a pledge,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. “Protecting a company’s assets is different from protecting a community that cannot afford to pay.”

Losses and damage

In a first attempt to tally “loss and damage”, the UN term for climate harm that adaptation fails to prevent or cannot prevent, the report found that low- and middle-income countries accounted for 99% of the 765 million people affected by floods and landslides between 2020 and 2025.

The Fund for responding to Loss and Damage, agreed at the COP27 climate summit in Sharm el-Sheikh, Egypt, in 2022 to help vulnerable countries recover from such harm, received requests worth $2.8 billion from 119 developing countries in its first funding round.

Governments have pledged $822 million to the fund in total, only $631 million of which has been formally committed, and it has yet to approve money for a single project, with the first approvals not due until December, according to the report.

“The first funding round of the fund for responding to loss and damage generated requests outstripping the initial funding envelope by a factor of eight,” Neufeldt said. “This demonstrates a large unmet demand, but we do not yet know the global loss and damage finance gap.”

The fund’s first real test came in August, when a glacier collapse high in the Himalayas sent a flood tearing through five districts of Nepal, killing more than 1,300 people and leaving over 5,000 missing, according to the report.

Last month the fund provisionally set aside $21.6 million for Nepal, its first allocation to any country, but that is less than 0.5% of the $4.7 billion Nepal says it needs to recover, and none of it has yet been paid out.

“Shortfalls in adaptation finance are a death sentence,” said Jess Beagley, policy lead at the Global Climate and Health Alliance. “Without adaptation finance, governments of the most vulnerable countries cannot guarantee nutrition, safe water, or resilient health systems for their populations.”

Image Credits: CC.

Meg Doherty, Director, Science for Health, announces the WHO recommendation to advance two Bundibugyo Ebolavirus vaccine candidates to Phase2/3 clinical trials.

WHO has greenlighted Phase 2/3 trials for two brand new vaccine candidates that specifically target the Ebola Bundibugyo virus species ravaging the Democratic Republic of Congo. Actual trials could forseeably commence  “within three to four weeks” – as soon as  DRC regulators issue their own approval,  said WHO’s Science Director Meg Doherty, at a Wednesday press briefing.   

The candidates include the ChAdOx1 BDBV, developed by the University of Oxford and the Serum Institute of India, and Moderna’s mRNA-1469. 

Doherty said that the preliminary data from animal and Phase human 1 safety trials of the two vaccine candidates had yielded “very positive results” leading to high hopes that the vaccines could indeed protect humans from the Bundibugyo ebolavirus species – for which there is currently no vaccine or treatment. 

The recommendation was made by the World Health Organization’s Technical Advisory Group on Candidate Vaccines Prioritization (WHO TAG-CVP), and follows their review of the preclinical and Phase 1 clinical data. 

Initial results expected in early 2027

Ebola Bundibugyo vaccine candidate, ChAdOx1 BDBV, developed by the University of Oxford and the Serum Institute of India, and greenlighted by WHO for Phase 2/3 clinical trials along with Moderna’s mRNA-1469.

If all goes well, initial results could then be expected in early 2027. And WHO is meanwhile discussing post-trial access to the vaccine with manufacturers, Doherty said. 

The two new vaccine candidates will be added to the already ongoing Tumaini Trial, Swahili for ‘hope’, launched on 23 October in Bunia. 

The same “ring vaccine” trial protocol, which offers immunization to contacts of people who became ill or died from Ebola, will be used for the new candidates, Doherty added. 

Four vaccination rings are already in place, with several more being prepared. 

So far, that trial has been testing if the Ervebo vaccine might also offer cross protection against Bundibugyo.  Ervebo, developed by MSD, first won European Medicines Agency regulatory approval in 2019 to protect people from the Zaire ebolavirus species, which  ravished West Africa in the 2014-2016 Ebola outbreak and then hit again in DRC and other parts of central Africa in 2018-2020. 

Two vaccine candidate specifically designed to target Bundibugyo

DRC Minister of Health Dr Roger Kamba (centre),receives the first consignment of the Ervebo vaccine at N’djili International Airport in Kinshasa on 21 August.

The two new vaccine candidates specifically target the Bundibugyo species that’s caused the most recent health emergency, killing over 5,300 people, mostly in DRC, with more than 10,500 cases confirmed.  

“Do these vaccines show any immunogenicity in animals and non-human primates? And what we are seeing is ‘yes very much so’,” Doherty said. “They’re seeing very positive-looking results that these will be effective in developing immune response.” 

In terms of human trials, the ChAdOx1 BDBV, a viral vector vaccine. entered its first  Phase 1 trial in the United Kingdom on July 24, evaluating safety and immune response in 50 healthy volunteers. In early October, the trial was expanded to Uganda.  On 4 August, the mRNA-1469 (Moderna) vaccine candidate commenced a Phase 1 rial in Canada across three sites with roughly 80 volunteers.

Research into treatments also advancing 

Ebola treatment centre in the DRC, epicenter of the outbreak in which more than 10,500 people have been confirmed ill and more than 5,300 have died.

The DRC’s Institut National de Recherche Biomédicale, the national public health and biomedical research institute is leading the vaccines trial, with support from the University of Antwerp, Belgium, WHO, Epicentre, Médecins Sans Frontières, the Institute of Tropical Medicine of Antwerp, and the Africa Centres for Disease Control and Prevention. 

The Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), has been supporting R&D for the two vaccine candidates as well as preliminary research on two additional vaccine candidates under development by the global non-profit biotech research organization, IAVI, in collaboration with Hilleman Laboratories and the UK-based biotech company, Public Health Vaccines .

Research into potential treatments is also moving ahead, WHO said in a statement accompanying the TAG recommendations. 

The WHO-sponsored PARTNERS trial, launched in July, is evaluating whether the monoclonal antibody MBP134, the antiviral remdesivir, or a combination of both can improve survival among patients with confirmed Bundibugyo virus disease. In addition, maftivimab will soon be added to the trial to assess its use as a potential treatment. A complementary post-exposure prophylaxis study with obeldevisir is underway.

Said Dr Tedros Adhanom Ghebreyesus, “Vaccines alone will not end this outbreak, but they could become a powerful new tool for bringing it under control.” 

Image Credits: University of Oxford , DRC Health Ministry, WHO Africa.

A new WHO report says six climate-health measures could save 1.6 million lives a year, but most of those lives depend on higher fossil fuel taxes.

Scaling up six climate and health measures worldwide could prevent 1.6 million deaths a year and generate $3.9 trillion in economic benefits annually, the World Health Organization (WHO) said on Wednesday, days before the COP31 climate talks open in Antalya, Türkiye.

Five of the six measures, from improved heat-health warning systems to cleaner household fuels, would save about 360,000 lives a year. They would cost roughly $35 billion a year and return $24 for every dollar spent, according to the new WHO report.

But 1.2 million of the 1.6 million lives saved, and all $5.4 trillion a year in extra government revenue the report projects, would need to come from phasing out fossil fuel subsidies as well as taxing coal, oil and gas at higher rates, to reflect their pollution and climate damage.

And no cost is attached to the fossil fuel pricing reform recommended. The policies would also have to be adopted in all 168 countries the report covers to reach their targets.

“The climate crisis is a health crisis, but much of the harm it causes can be prevented with tools we already have,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “This report shows that scaling up proven, affordable actions could save millions of lives, with the greatest gains in the countries that need them most.”


Fossil fuel subsidies are going up

WHO says the solutions are “available today, ready for global scale-up.” Yet it puts no figure on what the fuel reform would cost, including shielding households, transport operators and all other fossil fuel-dependent industries across the global economy from higher costs.

Meanwhile, governments are heading the other way. With the Strait of Hormuz still closed, the UN Development Programme said last month that fossil fuel subsidies could top $1 trillion this year.

“If countries are able to make the transition to cleaner energy sources, for example by phasing out subsidies on fossil fuels and putting efficient pricing on fossil fuels, that brings a very wide range of benefits,” said Dr Diarmid Campbell-Lendrum, who heads WHO’s climate change, air quality, energy and health unit, at a press briefing on Tuesday. “Most immediately in reducing air pollution, which takes almost 7 million lives every year around the world.”

Familiar figures, new price tags

Comparison of the 2024 WHO analysis issued for COP 29 and the 2026 analysis prepared for COP31.

The estimates of how many lives each measure would save are based on previously published data from WHO’s 2025–2028 investment case, according to the report. These cover deaths averted from extreme heat, unsafe water and sanitation, and polluting cooking fuels, and through removing fossil fuel subsidies.

But the methods, analysis and results are also different from findings issued just before the 2024 COP29 UN Climate Conference in Baku, Azerbaijan.

At that time, WHO issued a report stating that five key interventions, including equipping energy-strapped health facilities with renewables, such as solar power, would save “almost 2 million lives a year” and return $4 per dollar invested. In contrast, the new report estimates only 1.6 million lives saved, but a return of $24 on each dollar invested in the measures.


The new report also drops solar power for health facilities, and splits water, sanitation and handwashing, previously one package, into three separate measures, so the two sets of interventions are not directly comparable.

Dr Frank Pega, the report’s lead author, said in a written response to Health Policy Watch that internal WHO guidelines for health economic analyses have been standardized so that health sector interventions can no longer be assessed with a benefit-cost analysis alone. That made solar power for health facilities ineligible for the 2026 report, he said.

The estimates of lives saved by each measure did not change between the two reports, Pega said. But the three water, sanitation and hygiene measures are now modelled together, which removes overlap in their health effects and lowers their combined total. Dropping solar, which WHO said in 2024 would save about 290,000 lives a year, accounts for most of the gap.

Assumes full fuel price reform in 168 countries

Dr Diarmid Campbell-Lendrum.

The new scenario also assumes a full fossil fuel price reform in 168 countries starting in 2024, a year that has already passed. This would include a removal of all existing fossil fuel subsidies plus new taxes to cover the indirect costs of fossil fuel use, such as air pollution, and the same VAT as other goods.

The estimates also assume universal access to safe drinking water, sanitation and clean cooking fuels by 2030.

In 2024, 2.1 billion people still lacked safely managed drinking water and 3.4 billion lacked safely managed sanitation, according to WHO and UNICEF data. Around 2 billion relied on polluting fuels to cook, a separate energy progress report co-authored by WHO found.

In a separate commentary, published in The Lancet, the authors admit these targets are “aspirational rather than realistic.”

Moving the needle?

The six climate and health measures considered by WHO include: universal access to clean water, sanitation, and hygiene, clean household fuels, and in vulnerable countries, heat-health systems. But the biggest benefits would be from higher prices on fossil fuels.

“Constrained governments really need clear evidence, economic evidence, health evidence, on which investments deliver the greatest benefits,” said Pega. “Governments need to know not only what works, but what offers the greatest value for money.”

Campbell-Lendrum said 30 climate summits had produced too little progress.

“We sometimes hear that this is because there is too much uncertainty around the impacts, or that the actions that we need to take will cost too much,” he said.

“Well, today WHO is launching a report which demonstrates that that is not the case.”

But as WHO attempts to get eyes on the health argument to act against climate change in the run-up to COP31, whether or not this new report, running to more than 550 pages and 22 annexes, can move the needle remains an open question.

The health measures

Heat-health warning systems, which issue alerts when temperatures reach dangerous levels, could save about 100,000 lives a year if built in the 57 countries WHO identified as lacking one. At about $230 million a year, they offer the report’s highest return, $835 per dollar.

“Once they’re implemented,” said Pega, who put the time needed to build them at about five years, “they return huge benefits within a short time.”

Climate-resilient water, sanitation and handwashing services – built to keep working through floods, storms and droughts – together would save about 170,000 lives a year from diarrhoea and pneumonia, at a combined cost of about $30 billion. Returns range from $6 per dollar for drinking water to $32 for handwashing, the report said.

Those three figures are deliberately partial. WHO assumes a tenth of the benefits and costs of giving everyone these services comes from making them climate-proof, and counts only that tenth.

“These services are shown to provide an enormous return on investment,” Pega said of handwashing facilities. “So it’s clear that they’re a no-brainer intervention.”

Switching households from wood, charcoal and kerosene to gas, electric or improved stoves would save about 90,000 lives a year at a cost of about $5.2 billion, a return of $51 per dollar.

Fossil fuel reforms drive the climate and health gains

The opportunity to limit warming to 1.5ºC with no or limited overshoot “has been lost”, UNEP warns for the first time, urging action to “minimise overshoot and return to 1.5ºC” by the end of the century, UNEP said in October.

The fossil fuel reforms would also account for 98% of the climate benefits linked to the six WHO-recommended policies. That is about 16.4 billion of the 16.7 billion tonnes of greenhouse gas emissions, measured in CO2 equivalent, that the six would cut each year, according to International Monetary Fund (IMF) models.

But that would also mean changing how almost every government prices energy. By WHO’s count, 168 countries fall short of the standard, and the scenario modelled has all of them ending subsidies to fossil fuel producers and consumers, beginning in 2024.

Countries would also have to tax coal, oil and gas until prices cover both the cost of supplying them and the damage they cause, and charge fuel the same VAT as other goods. The IMF, whose figures WHO uses, counts two kinds of subsidies for fossil fuels.

Explicit subsidies are the money governments spend keeping fuel cheap, $725 billion in 2024, according to its latest data. Implicit subsidies are the IMF’s estimate of the damage fossil fuels cause that nobody pays for, mostly air pollution and climate change, which it put at $6.7 trillion that same year.

Removing explicit subsidies alone would avert about 70,000 air pollution-related deaths a year, the IMF estimates. Removing both would avert 1.1 million deaths annually, but the implicit subsidies can only be removed through new taxes that would push fuel prices even higher worldwide.

WHO’s own figure of 1.2 million lives saved comes from an older IMF analysis, based on 2019 data on fossil fuel use and subsidies. WHO moved the start date to 2024 without updating the IMF’s inputs, such as how much fuel countries burn and how large their subsidies are.

Those inputs have swung sharply since. The IMF put explicit subsidies at about $1.3 trillion in 2022, during the energy price spike, before they fell to $725 billion in 2024. Assuming nothing changed between 2019 and 2024, the report concedes, “is known to be false.”

In the same Lancet comment, Pega and his co-authors acknowledge that the fuel pricing estimates, which carry most of the report’s headline lives and dollars, “warrant further examination.”

Lives valued in dollars



WHO’s estimate of $3.9 trillion a year in economic benefits from all six measures is also a gross figure. It counts the value of the benefits without subtracting what the measures would cost, and the cost of the fuel price reforms is not estimated at all.

“These are not net benefits,” Pega said, “these are total benefits.”

For the five measures WHO costed, net benefits come to about $844 billion a year, less than a quarter of that total. Even so, savings on outright health-care costs, the part a budget-strapped health ministry would actually see, come to only about 0.5% of the five costed measures’ benefits – $4.75 billion a year worldwide.

Roughly nine-tenths of the five costed measures’ benefits come from the monetary value WHO assigns to the 360,000 lives they would save, according to Health Policy Watch calculations drawn from the report’s tables.

WHO puts a monetary value on each death averted using a “value per statistical life” (VSL), a method widely used to monetize human health gains – but also widely contested. The value is scaled to each country’s average income, so a death averted in a wealthier country counts for far more in WHO’s totals.

On WHO’s formula and the latest World Bank income data, a death averted is valued at about $195,000 in Burundi, $2.4 million in South Africa, $10.2 million in France and $13.4 million in the United States, according to Health Policy Watch calculations.

“Unlike productivity gains, tax revenues or GDP increases,” WHO notes in a Q&A published with the report, “VSL-based monetary estimates are not real economic flows.”

Taken together, low-income countries would account for about a fifth of the lives saved by the five costed measures but only about 6% of their projected economic benefits, according to Health Policy Watch estimates drawn from the report’s income-group tables.

High-income countries account for 4% of all deaths averted but nearly 30% of the $3.9 trillion in projected economic benefits, largely because each death averted in wealthy nations is valued so much higher.

Health still outside the negotiating room and text

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

Türkiye, which holds the COP31 presidency, has made resilient health systems one of ten themes in its action agenda and will open the summit next week with a Health Day. None of that is part of the formal negotiations.

“Everything that I’ve described up until now is sort of adjacent to the negotiations,” Campbell-Lendrum said. “Health should be in the negotiations.”

A WHO review of national climate plans published last month found that 91% of 140 parties mention health, but only 23% estimate what health-related climate action would cost.

WHO’s own COP31 briefing notes that, unlike many of the presidency’s other themes, health “carries no numerical target for 2035.” It also asks parties “to consider the inclusion of health in the UNFCCC process.”

Several civil society groups working on health in the climate talks oppose a stand-alone item. WHO, they say, has never spelled out what such an item would actually negotiate. A separate health track, they argue, could make it easier for countries to push health out of the rooms where fossil fuels and finance are decided, creating the kind of silo the health community has spent years arguing against.

Small delegations from vulnerable countries, already stretched across parallel negotiations, would also struggle to staff yet another negotiating track, civil society groups say, leaving negotiations on a health item to be shaped by larger, wealthier delegations, including fossil fuel producers.

“We are asking the countries there to negotiate as if people’s lives depend on it,” said Campbell-Lendrum of COP31, “because they do.”

Image Credits: CC, Health Policy Watch/WHO , WHO, 2026 , Marcin Jozwiak.

One in four adolescents worldwide get less than an hour of physical activity a week.

One in every four of all adolescents worldwide are getting less than an hour of moderate to vigorous physical activity a week, according to a new World Health Organization (WHO) study.

This translates to around 240 million young people between the ages of 11-17 who are not getting the critical exercise needed to develop into healthy adults, warned the report, released simultaneously today by WHO and in The Lancet Global Health.

The study, ‘A generation missing out’, is based on 389 population-based surveys of some 3.2 million adolescents across 140 countries and territories. The adolescents were asked what physical activities they had engaged in during the previous week, and for how long.  Only 14% of those responding reported being physically active for at least one hour on all seven days of the week, as per WHO recommendations.

On average, adolescents reported being physically active for at least one hour a day on only 2.7 days a week. Girls were less active than boys across all WHO regions, pointing to a major gender gap in the amount of physical activity adolescents experience.

On average, most adolescents were active for three or fewer days in a week.

The data and trends,  covering some 60% of adolescents globally, have remained approximately stayed the same since 2010, when adolescent physical activity was first measured, and then again in 2016, said WHO experts at an embargoed press briefing last week.

“For 15 years, the world has made almost no progress in getting young people moving, and girls are being left furthest behind,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The answer is not to tell adolescents to try harder. It is to build schools, streets and communities where moving, playing and being active is safe, easy and normal.”

Lack of physical activity a risk factor for illnesses

Physical activity is important for mental health and allows adolescents to make social connections.

Physical inactivity is a major risk factor for heart disease, type-2 diabetes, and some cancers.

“Physical activity is one of the most effective ways of preventing stroke, cardiovascular disease, or other NCDs [non-communicable diseases], but it also contributes to better mental health and well-being, supports healthy growth and development, and helps young people to learn, connect, and thrive,” said Dr Etienne Krug, Director at WHO’s Department of Health Determinants, Promotion and Prevention.

When adolescents are not physically active, they also miss out on crucial mental health benefits as well as the social benefits that come with sports.

Adolescence is a particularly crucial period as it also sets up the habits that could last a lifetime.

Stark gender gap

On average, adolescent girls get less physical activity every week than boys across all regions of the world.

Girls were found to be less physically active than boys in almost every country and every WHO region – reflecting a stark gender gap.

Worldwide, nearly 28% of girls reported no active days, compared with 22% of boys.

And only 11% of girls reported being active every day, compared with 17% of boys. WHO recommends at least 60 minutes of physical activity every day, which can be anything that increases the heart rate and breathing, like a brisk walk or cycling.

Adolescents are getting very little physical activity on a regular basis, according to the latest World Health Organization (WHO) estimates.

There’s a basket of reasons why there is a gender gap, said Dr Fiona Bull, WHO’s head of Physical Activity Promotion, at the press briefing.

“Some of the reasons are the lack of visibility of role models, the lack of female coaches when we’re talking about more formal sports. But actually, at the community level, it can get down to simply it being not expected, even culturally inappropriate,” she said.

Girls did appear to prefer dance more, and experts said offering more access to options like dance is an opportunity for policymakers.

“Religious and cultural norms, family dynamics, or preferences may determine whether girls are introduced to activities or supported to sustain them through the adolescent period. Safety is another concern,” Bull added.

Stark regional differences 

In Middle East, South Asian and Sub-Saharan African countries, upwards of 40% of adolescents reported few or no active days in their week, while less than 10% of adolescents in most of Europe, western Asia and parts of the Americas reported no active days.

In most of Europe, Asia and parts of the Americas, 90% or more of adolescents reported an hour of physical activity every day. In others, mainly Africa, the Middle East and parts of South Asia, more than 40% of respondents reported no active days.

“Our data has revealed that there are two quite distinct patterns of active days that are broadly aligned with regions. We see that in many of the low-and middle-income country settings, the pattern is characterized by high prevalence of zero active days,” said Dr Leanne Riley, unit head of surveillance, monitoring and reporting at WHO’s NCD division.

“Whereas in contrast, in the high-income countries and high-income Western nations, in particular, Central and Eastern Europe, Central Asia, East Asia, and the Pacific, they show a more favourable pattern,” she added.

There is no single explanation for the lack of global progress. Physical activity is shaped by where adolescents live, learn, travel and spend their free time. Transport patterns, access to safe public spaces, opportunities for safe walking and cycling, school environments, affordability, social norms and increasingly screen-based lifestyles can all influence adolescents’ opportunities to be active.

Active transport environments need to be part of the solution

Streets in many cities are not safe for walking and cycling to school so improving transport and urban planning is critical to enable adolescents to move more.

The WHO report also calls for more action across education, transport, and urban planning to make environments more conducive for routine physical activity.

The challenge is not simply to persuade adolescents to move more. It is to create environments that make being active a normal and easy part of growing up, WHO’s Riley also said at the press briefing.

“It will look like more communities with safe walking and cycling networks, connected networks, taking us to the places we go to daily, from home to school to community to friends to shops,” she said.

“It will require the public transport systems to enable more walking and cycling,” she added.

That includes investments in safe walking and cycling routes to school, as well as parks and recreational facilities in communities as well as in schools that give young people more opportunities to move, play and be active in their everyday lives.

Sports brands also call to support movement 

Sports companies have pledged to help improve activity among adolescents.

Sports brands also have stepped up to the bat, saying they can play a major role in promoting more healthy physical activity. In response to the WHO report, around 83 sporting goods companies and federations signed an open letter coordinated by the World Federation of the Sporting Goods Industry (WFSGI), pledging to strengthen efforts to help more young people move.

Major brands like Adidas, ASICS, Bauer, Decathlon, New Balance and Nike were among those that signed onto the call to increase movement among adolescents.

“The response will be different for every company. It may mean making products more accessible, investing in participation programmes, supporting schools and communities, rethinking how we engage with young people, or using innovation to remove barriers to activity,” the companies said in the joint letter.

Image Credits: Unsplash/Mi Pham, ‘A generation missing out’ report/WHO, Unsplash/Vitaly Gariev, Unsplash/Vince Fleming, Unsplash/Tahamie Farooqui, Unsplash/Jannes Glas.

Pledging “A WHO the world can count on,” Dr Hanan Balkhy bases her platform on scientific independence, rapid emergency response, and fiscal accountability.
Pledging “A WHO the world can count on,” Dr Hanan Balkhy bases her platform on scientific independence, rapid emergency response, and fiscal accountability.

Hanan Balkhy, Saudi Arabia’s candidate for WHO Director General, is especially concerned about antibiotic resistance, the effects of climate change on health, and healthcare in conflict zones. She also warns about a “normalisation” of attacks on hospitals and healthcare workers in conflict regions.

As a longtime WHO insider, she is also well aware that the WHO needs to reform and do more with less money.

“The bottom line is that the funding is slimmer.” says Balkhy, currently regional director of WHO’s Eastern Mediterranean Regional Office, in an interview with Inside Geneva‘s Imogen Foulkes around her candidacy. A citizen of Saudi Arabia, Balkhy also trained as a medical doctor in the United States, where she also dual citizenship.

Doing the WHO’s top job, she says, is an extension of her lifelong ambition to work in the medical field and “serve the broader humanity.”

Listen to the full podcast:

The interview series with WHO DG candidates is being co-produced by the SwissInfo media platform with the Geneva Graduate Institute’s Global Health Centre, as part of a media collaboration on the upcoming WHO election  also supported by Health Policy Watch.

See more about the candidates on Health Policy Watch’s special WHO election website.

WHO DG Elections 2027

Preventative treatments for schistosomiasis and soil-transmitted helminths, two major NTDs, are distributed to children in Tanzania.

While substantial progress has been made in driving down the global burden of neglected tropical diseases (NTDs), trends are  “uneven and fragile”, and several diseases are off course to meet 2030 targets.

This is according to the World Health Organization (WHO)’s Global Report on Neglected Tropical Diseases 2026, a mid-term evaluation of the 2021-2030 road map published today.

NTDs predominantly affect those living in poverty or remote or fragile settings, and are often referred to as diseases of poverty. WHO refers to some 21 NTDs.  These range from mosquito-borne parasitic diseases such as dengue and chikungunya, whose transmission has soared due to urbananisation and climate change, as well as onchocerciasis (river blindness),  leprosy and trypanosomiasis (sleeping sickness), where big inroads towards elimination have been made. Schistosomiasis, transmitted by water borne-parasite, as well as soil-transmitted helminths also impose a heavy burden of illness and disability. Snakebite evenoming and rabies are also considered NTDs, with extremely high mortality rates. 

In 2024, NTDs affected around 1.41 billion people – a 19% reduction since 2020. By June 2026, 63 countries had eliminated at least one NTD, and Togo became the first country to eliminate four diseases.

Cases of sleeping sickness have dropped by 98% since 1999, while Guinea worm disease fell to a record low of just 10 human cases in 2025.

2025 milestones achieved for three diseases – but lack of finance impedes progress on others

Three disease-specific indicators achieved their 2025 milestones: chikungunya vaccine development, reduced dengue case fatality rates and the availability of WHO-recommended polyspecific antivenoms for snakebites.

However, the pace of progress is “insufficient to achieve most 2030 targets, particularly in relation to financing, mainstreaming into health systems, surveillance and extending interventions to populations in fragile and hard-to-reach settings”, according to the report.

Lack of finance is the biggest barrier to progress. Conflict and displacement are also significant constraints. Meanwhile, climate change is expanding the geographical spread of vector-borne diseases, while extreme weather events can disrupt service delivery. 

Other barriers include that many NTD interventions are not part of national health systems or included in universal health coverage packages in most endemic countries.

Weak surveillance, persistent supply chain constraints and the loss of specialist expertise also weaken the response. 

“Sustainability has emerged as the defining constraint of our time, one that could delay the achievement of the 2030 targets,” said Dr Daniel Ngamije Madandi, WHO director of Malaria and NTDs.

“New barriers demand innovative solutions, yet I am confident that  the momentum generated by the road map endorsed  by the World Health Assembly in 2020, together with 

its inherent flexibility, is strong enough to continue  guiding the global response to the public health  challenges posed by this diverse group of diseases and  conditions throughout the remainder of the decade.”

Image Credits: RTI Fights NTDs.

At the World Health Summit in Berlin, the non-profits behind dozens of medicines for malaria, tuberculosis and neglected tropical diseases were warned that funding for their work is no longer guaranteed as donors cut back their investments in global health.

In the late 1990s, doctors treating sleeping sickness, a parasitic disease spread by tsetse flies that is almost always fatal without treatment, still relied on melarsoprol, an arsenic-based drug that killed roughly one patient in 20.

One patient given melarsoprol in 2003 later recalled the injection “felt like fire” being injected into his veins, turning them black. A safer drug existed, but its manufacturer had stopped making it in 1995 because it turned no profit.

Today a single dose of tablets cures the disease. Acoziborole, registered in the Democratic Republic of the Congo in June, was developed by Sanofi and the Drugs for Neglected Diseases initiative (DNDi), one of around a dozen product development partnerships (PDPs) set up around the turn of the century to make medicines that drugmakers had no commercial reason to invest in bringing to market.

At the World Health Summit in Berlin last month, a senior German research ministry official called the partnerships “an amazingly good deal” – then warned them that funders could no longer guarantee their survival.

“There’s an underlying promise … that I don’t think we can keep,” said Veronika von Messling, director-general for health and life sciences at Germany’s Federal Ministry of Research, Technology and Space (BMFTR), at a session on the future of the partnerships’ model.

“That promise would be that as long as you are a good PDP and stay in this box, somehow financing will be ensured.”

‘Natural selection’

Veronika von Messling, director-general for health and life sciences at Germany’s Federal Ministry of Research, Technology and Space (BMFTR), speaks at the World Health Summit in Berlin.

Global health funding as a whole fell 12% in 2025 to its lowest level since 2012, according to preliminary estimates from the Institute for Health Metrics and Evaluation (IHME), as donor governments moved money toward defence amid rising global tensions and prepare perhaps, as the Financial Times warned last week, for the untimely arrival of World War III.

And even before that crisis, funding received by PDPs for developing drugs critical to fighting NTDs fell for five straight years to a record low in 2023, according to Impact Global Health’s G-FINDER survey.

The Gates Foundation, by far the largest backer, cut its PDP grants by nearly a quarter in 2024, and DNDi cut its research spending by 23% in 2025, its audited accounts show.

The UK, the partnerships’ largest government funder, is cutting aid to 0.3% of gross national income by 2027, and Germany is planning further cuts to global health in its 2027 budget.

The UK gave PDPs $40 million for neglected-disease research in 2023, more than any other government, and raised that by 55% in 2024, G-FINDER data show. Germany’s research ministry gave $4 million and is now splitting €50 million among five PDPs over six years. The Netherlands, Australia, Switzerland, Japan and the European Union also contribute.

As global health investment shrinks across the developed world, von Messling suggested funders could let the partnerships compete for what money remains.

"Just to be provocative here, there is maybe some charm in actually tolerating the tension that comes from a natural selection process or natural evolution," she said. "Some PDPs might actually succeed and others might be less successful."

Dirk Mueller, senior health adviser at the UK's Foreign, Commonwealth and Development Office (FCDO), agreed, saying:  ""If there is no more funding, then there will be more natural selection."

Threats to the pipeline

MMV CEO Martin Fitchet speaks at the World Health Summit in Berlin.

The cuts arrive as the partnerships' costliest work lies ahead, with a coalition of 12 leading PDPs reporting nearly 300 products in development in 2023, more than 100 of them in Phase 2 trials or later.

"There are a lot more needs and a lot more products in the pipeline, and market failures have not yet gone away," said Mueller, who chairs the PDP Funders Group, an informal network of the partnerships' donors.

Of the 1,393 new medicines marketed between 1975 and 1999, just 16 were for tropical diseases and tuberculosis, researchers working with Médecins Sans Frontières (MSF) found in 2002.


Despite the arrival of PDPs at the turn of the last century, the attention paid to neglected tropical diseases – which left 1.6 billion people in need of treatment or prevention in 2022, according to WHO – by the wider pharmaceutical industry remains minimal. They receive 0.2% of private-sector health R&D spending, according to figures cited in a joint paper by four PDPs published for the Berlin summit, while malaria, tuberculosis, HIV and diarrhoeal diseases together receive just under 2%.

"Of 763 medicines approved between 2005 and 2024, only 15 were for neglected diseases," said Martin Fitchet, chief executive of the Medicines for Malaria Venture (MMV), referring to US Food and Drug Administration approvals tallied in a 2025 analysis. "That is the gap PDPs were created to address."

Malaria R&D pipeline at critical crossroads

The event organised by MMV, DNDi and partners titled "Shaping the global health architecture and ending diseases of poverty: the product development partnerships model", underway in Berlin.

Drugmakers finance research against the sales a product is expected to bring in, and for many neglected diseases there is little profit to justify the investment.

“It’s very, very hard to borrow off the future commercial potential for a disease where you are paying no more than 50 to 70 cents for a treatment course,” Fitchet said. “R&D is expensive: $150 to $200 million in direct costs for an anti-infective like malaria, perhaps more. I’m not counting in the failures there.”

The malaria research pipeline is at a critical crossroads, and sustaining investment may determine the future of millions of patients. Malaria parasites are fast developing partial resistance to artemisinin, the backbone of current treatment, pitting the 282 million people who caught malaria in 2024, by WHO’s estimate, against the parasite in a medical arms race. Even with new medicines and the first malaria vaccines reaching African children, cases have risen 23% since 2015 and deaths 6%, WHO estimates show.

Parasite resistance doesn't pay heed to funding declines

The last time the parasite outran a frontline drug, chloroquine in the 1990s, malaria deaths more than doubled to over a million a year before a new class of medicines arrived - artemisinin combination therapies (ACTs). Now, in Rwanda, 40 to 50% of parasites already carry the artemisinin resistance mutation. Should resistance further overcome ACTs and other drugs in use across the continent, which carries 94% of the global malaria mortality burden, the consequences “could be catastrophic,” scientists at the Wellcome Sanger Institute warned.

The most advanced replacement is GanLum, a Novartis drug developed with MMV, which cured 97.4% of patients in a Phase 3 trial across 12 African countries and is awaiting approval. It would be the first malaria treatment in more than 25 years not built on artemisinin, and the drugs that follow it will need money that is now harder to find.

Coartem® Baby, developed by Novartis with MMV, became the first malaria treatment for newborns and young infants when Swiss regulators approved it in July 2025, and WHO prequalified it in April.

“We bring together the best of industry, science and the public sector to develop and deliver medicines that are designed for the people who need them,” Fitchet said in written answers to Health Policy Watch.

Mosquitoes are also resisting the insecticides used on bednets to prevent bites. Insecticide-treated nets accounted for 68% of the 663 million malaria cases averted in Africa between 2000 and 2015, more than any other intervention, a recent study in Nature found.

“The change in the global health architecture might be one thing,” said Justin McBeath, chief executive of the Innovative Vector Control Consortium (IVCC), a PDP that develops insecticides. “But that doesn’t change anything in terms of the evolution of resistance in mosquitoes.”

If not the PDPs, then what?

Mueller also said no one had offered an alternative to the partnerships' model. "I haven't actually heard who will do product discovery and development if not the PDPs," he said.

The last generation of partnership drugs shows what a stalled pipeline would cost. MMV-backed antimalarials averted an estimated 1.6 million deaths between 2000 and 2023, returning about $13 in health benefits for every dollar invested, a study in The Lancet Global Health found in February.

MMV received $2.3 billion over that period, roughly $1,450 for each death averted, by Health Policy Watch's calculation.

"We've been around for 27 years, and we've done absolutely nothing on our own," Fitchet said. "We've been involved in the approval of 19 medicines, and we're 100 people.

"I did not want to give the impression that everything we do is great and the funding should be coming, because we know it's not going to happen," Fitchet added.

But in further written remarks to Health Policy Watch, he urged funders not to abandon the model: "PDPs already compete for funding and rightly must continually show their impact, efficiency and value. Rather than framing the issue as 'natural selection', it is important to consider the broader public health imperative."

"Let's get hung up on the job that needs to be done. Build on and improve the model we have now, not dismantle it and throw it away and try something else, because this works."

A handful of meaningful funders

Unlike the Global Fund or Gavi, the partnerships have no pledging conferences to refill their accounts. Their money comes through competitive grants from governments and philanthropies, which means PDPs "must continually demonstrate value and impact," DNDi, MMV, the TB Alliance and Medicines Development for Global Health wrote in their joint paper.

The Gates Foundation has supplied close to half of all PDP funding for neglected diseases for most of the past two decades; G-FINDER describes its recent cuts as part of a long-term move away from the partnerships.

Gates provided almost 60% of MMV's funding as of 2021, according to a Swiss government case study, and committed a further $180 million over five years in late 2024.

"Realistically, there are just a handful of meaningful funders," said Melvin Spigelman, president and CEO of the TB Alliance. "That's crazy."

DNDi's 2025 financial report lists donor exit first among its risks, warning that donors are shifting toward health security, technology and scalability "with reduced emphasis on PDP models and neglected diseases."

"The runway is very short these days," said Bríd Devlin, executive director of the Population Council's Center for Biomedical Research, adding that grants now average two to three years, which makes it hard to commit to clinical trials.

Spigelman said the first answer to the funding squeeze is to "dramatically expand the base of the funding community," bringing in middle-income countries such as Indonesia and the BRICS members.

Fitchet, however, told Health Policy Watch that diversification "should not simply mean transferring responsibility for financing global health R&D to countries already facing significant health and fiscal pressures."

'Some sort of magic number'

Dr Melvin Spigelman, President and CEO of the Global Alliance for TB Drug Development, speaks in Berlin.

At face value, the idea that PDP mergers could save money - particularly in terms of administration costs - is an attractive prospect.

"That's 18 CEOs, 18 CFOs," one audience member said of the number of PDPs cited in the session. "How do we defend 18 PDPs in the current global architecture environment?"

But PDP leaders like Spigelman are pushing back.

"I would really object to saying, 'Oh, there's some sort of magic number that's too many,' " Spigelman said. "That, to me, makes absolutely no sense given the magnitude of the problems and number of diseases."

In 2022, with the future of its vaginal ring for HIV prevention in doubt, the International Partnership for Microbicides (IPM) sold its products and pipeline to the Population Council, a New York-based non-profit research organisation, and then IPM closed its own doors "In our case, the consolidation of PDPs worked out," said Devlin, who spent more than a decade with the organization.

But Devlin also advised caution: "I'm not sure that this would work for all PDPs to consolidate, given the differences in their diagnostics, services, products."

"Funding is going down, but does that mean that we need to consolidate the PDPs?" Mueller asked. "I'm not so sure about that, because one mega PDP could actually be more costly."

"Whether it is merging or prioritisation," said Elizabeth Juma, who leads WHO Africa's Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), "let's not forget the diseases for which there will never be any economic value."

France’s Global Health Ambassador, Anne Claire Amprou.

France’s Ambassador for Global Health, Dr Anne-Claire Amprou, is joining the leadership of the World Health Organization (WHO) body negotiating the missing piece of the Pandemic Agreement at a crucial moment.

Amprou co-chaired the last stage of Pandemic Agreement talks, which eventually found consensus. However, consensus has eluded WHO member states on the pathogen access and benefit-sharing (PABS) annex, which prevents the agreement’s implementation.

Since July 2025, IGWG members have been unable to agree on how to share information on dangerous pathogens, and any medical products developed from that knowledge.

Brazil’s Ambassador Tovar Da Silva Nunes, co-chair of the Intergovernmental Working Group (IGWG) negotiating PABS, told the opening of its ninth formal meeting on Monday that Amprou would be formally presented for consideration as his co-chair on Tuesday.

Amprou represents France at the Pandemic Fund and Global Fund, and chairs the Unitaid board. She coordinated the French response to COVID-19 in 2021 and is a former French Deputy Director General for Health.

Welcoming Amprou to IGWG, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the IGWG opening that there is “strong political support” for the annex to be completed

Dr Tedros addresses the opening of IGWG 9.

“Just a few weeks ago, the United Nations General Assembly adopted its Political Declaration on pandemic prevention, preparedness and response. Heads of state and government welcomed the Pandemic Agreement and called for the PABS negotiations to be concluded,” said Tedros.

“But ultimately, the reason for finishing this work is not legal or procedural. It is about protecting people. Because a pathogen threat anywhere can become a threat everywhere – to the people of every country.

He added: “You do not need to design a perfect system for all time. You need to agree on a system that works, that delivers equity, and that can be strengthened as we learn from experience,” said Tedros.

He also urged negotiators to negotiate “with the intention and expectation of concluding”, distinguish between “what is essential and what is desirable”, and “keep public health as your North Star”.

“The test of this Annex is whether it will help the world respond faster and more equitably when the next pandemic threat emerges,” said Tedros.

Algeria, representing the Africa Group, at IGWG 9

Algeria, representing the Africa Group, and Egypt, Somalia and Sudan – part of the East Mediterranean Group – reasserted its core position: “Access and benefit sharing are two inseparable pillars on an equal footing. Neither can be implemented at the expense of the other.”

Algeria also called for the Africa Group’s “federated model”, proposed two IGWG sessions ago, to be discussed at this session. 

According to this model, pathogen materials and data always stay in the hands of countries or regions, and manufacturers have to accept a data access agreement (DAA) with the country or regional node and sign a benefit-sharing contract with the WHO to gain access to this information.

“We firmly believe that a system of access by design and benefit by convenience will not earn the trust of those who provide the materials,” Algeria concluded.

Pakistan, for EMRO, and India, for Southeast Asia, also asserted that access and benefit sharing need to be on an equal footing.

“We understand that there is a viewpoint that manufacturers may, in any event, obtain pathogens as sequence information. Our region sees this differently,” said Pakistan.

“Availability somewhere is not the same as timely, lawful, transparent, and traceable access under an agreed international framework. And confidence in the system depends on that traceability. Countries will share rapidly and confidently when they can see what comes back.”

‘No charity’

Indonesia, speaking for the cross-regional Group for Equity, said that “no country wants its response to the next pandemics to depend on charity”. “Multilateralism earns its keep when its outcome changes things substantially, and ensures that no one is left behind. That is the standard by which the PAPS annex will be judged,” said Indonesia. 

“There is no perfect model, but we are not waiting for one. There are choices on the table that clearly bring us closer to equity, greater self-reliance, and health systems that can better withstand future pandemics.”

Noting that “a number of issues still require significant further discussions”, the European Union proposed a variety of formats: formal discussions, informal discussions led by co-facilitators, and “opportunities for delegations to meet in smaller groups and for different groups of delegations to meet bilaterally”. 

Several non-state actors also addressed the meeting, including the International Federat Pharmaceutical Manufacturers & Associations (IFPMA), which urged member states to “enable companies to access the pathogen materials and information needed to begin R&D quickly, with clear, workable, and predictable conditions for participation”.

“As discussions advance across these interconnected elements, we encourage member states to assess them against a simple test: will these arrangements encourage the broad participation needed for PABS to work effectively and rapidly when the next pandemic threat emerges?”

The new generic version of lenacapavir is expected to cost $40 for the two annual injections.a

The US Food and Drug Administration (FDA) has approved the first generic version of lenacapavir, the highly effective twice-yearly injection to prevent HIV, developed by Dr Reddy’s Laboratories based in India.

Dr Reddy’s was one of six pharmaceutical manufacturers that was granted a non-exclusive, royalty-free voluntary licensing agreement from Gilead, which developed lenacapavir.

The agreement, signed in October 2024, limits the sale of the generics to 120 high-incidence, resource-limited countries.

The generics – projected to cost $40 a year for the two injections – are expected to reach countries by the end of this year. Zambia is likely to be one of the first to get supplies. 

Dr Reddy’s Deepak Sapra described the approval as “a moment of immense pride” for the company.

“Developing and manufacturing a complex long-acting injectable like lenacapavir at an affordable price required strong scientific capabilities, manufacturing expertise and the ability to produce at scale,” added Sapra. 

Dr Reddy received “financial, technical, and regulatory support” from Unitaid, Wits RHI, and the Clinton Health Access Initiative (CHAI) to accelerate the development of the generic. The FDA approval comes only 16 months after Gilead’s product was approved. 

“Unitaid’s early risk-taking is helping shorten the time between a scientific breakthrough and real access in countries,” said Dr. Philippe Duneton, Unitaid executive director. 

“Getting a generic approved just 16 months after the originator approval for prevention, rather than a decade later, shows what’s possible when we prioritize access from the start. This should be the new standard for global health,” said CHAI CEO Dr Neil Buddy Shah.

“For someone at risk of HIV, taking a pill every day to prevent a disease they don’t have is a hard thing to ask. Two injections a year, of a product that is almost 100% effective at preventing HIV, changes that entirely,” added Shah. 

“More than 125,000 people in Africa have already started on lenacapavir, and today’s approval brings us closer to making it available to millions more for just $40 a year.”

However, Wits RHI’s Professor Saiqa Mullick warned that an affordable generic is not enough: “Countries need health systems that are ready to deliver new prevention options, providers who are confident in offering them, and communities that are engaged as partners in their introduction and scale-up. Bringing these elements together will be critical to ensuring equitable access and impact.”

“Unitaid, Wits RHI, and CHAI are working with governments, communities, the Global Fund, the US Bureau of Global Health Security and Diplomacy (GHSD), the Gates Foundation, and other partners to turn approval into access on the ground, from supporting country introduction and community engagement to generating real-world evidence to inform how lenacapavir can best reach diverse and underserved populations,” the three groups noted in a media release on Monday.

Image Credits: @Unitaid.

‘MAHA Mom’ Jayme Franklin (left) witnesses US President Donald Trump change childhood vaccines via an executive order in August, with the enthusiastic backing of US Health Secretary Robert F Kennedy Jr (right).

Cuts to Medicaid, the health services for low-income Americans, and fewer childhood immunisations – alongside persistent insinuations that vaccines are unsafe – are the most significant health policy changes made by the Trump administration since January 2025.

They have been accompanied by reduced food support for low-income families, purges of scientists, and slashed research budgets. 

The cumulative impact of these policies will take decades to measure, but the early damage can already be measured in rising infectious diseases and worsening maternal health.

The Trump administration projects it will spend $900 billion less on Medicaid between 2025 and 2034 – largely by making it harder for people to qualify. By its own accounting, 10.5 million people will lose or face reduced health benefits, largely to offset Trump tax cuts that benefit wealthier Americans most. 

Maternal care, rural health care and healthcare for Black and Hispanic communities are expected to be worst affected.

The Health and Human Services (HHS) budget has been cut by 12.5% this financial year (which started on 1 October), with more cuts for research grants and health services expected.

Undermining vaccines

HHS Secretary Robert F Kennedy Jr has been laser-focused on reshaping federal vaccine policy since assuming office in late February 2025. The nation’s most senior health official has led a decades-long crusade against vaccinations – the single health intervention that has saved by far the most lives in the history of humankind.

Twenty-six years ago, the United States had eliminated measles. Today, it faces its biggest outbreak in decades, with over 4,800 cases this year alone. Whooping cough cases have also surged in the past two years. 

Vaccines exist for both, and experts say waning levels of immunisation have driven the outbreaks – with 96% of measles cases in those who are unvaccinated.

Instead of urging immunisation in the face of rising vaccine-preventable diseases, Kennedy has doubled down on his anti-vaccine stance. 

His most recent move was to open a new vaccine injury research center at the US National Institutes of Health (NIH) despite the country already having a sophisticated vaccine surveillance system. HHS also plans to provide financial incentives to doctors for reporting vaccine injuries.

In a September address to Children’s Health Defense (CHD), the anti-vaccine non-profit he founded, Kennedy focused on the harms of vaccines and repeated the disproven theory that they are linked to autism.

COVID-19 vaccines were Kennedy’s priority upon assuming office. Opposition to these vaccines was what cemented a bond between the Kennedy anti-vaxxers, who believed mRNA vaccines were harmful, and the Trump libertarians who did not want to be forced to be vaccinated or masked during the pandemic.

By May 2025, the Food and Drug Administration (FDA) had limited COVID-19 vaccine recommendations to people over 65 and those aged 12 and over with underlying conditions. 

Firing vaccine experts

The following month, Kennedy axed all the country’s vaccine advisers, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). 

After stacking ACIP with vaccine-sceptics, he let them lose on the childhood vaccination schedule. They declared vaccines for hepatitis A, hepatitis B, meningitis, rotavirus, influenza, and COVID-19 are no longer “routine”. Patients and their doctors should have “shared clinical decision-making” about whether to have them.

Professional health groups and 14 states have challenged both the dismissal of ACIP and the changes to the childhood immunisation schedule in separate court challenges. 

After a judge ruled HHS overreach on the ACIP firings (the state is appealing), Kennedy enlisted Trump’s help. 

In August this year, the US president issued an executive order on vaccines that reduced childhood vaccines from 18 to 11, and divided the three-in-one measles, mumps, rubella (MMR) vaccine into separate shots. It is extraordinary for a US president to issue a decree on immunisation outside of a pandemic.

Kennedy also cancelled $500 million in research funding into mRNA vaccines by the US Biomedical Advanced Research and Development Authority (BARDA) – claiming “mRNA technology poses more risks than benefits for these respiratory viruses”.

“Eugenics is not a word I use lightly. Yet elements of that thinking are echoed in policies that promote natural infection over prevention provided by vaccines; confound health equity with diversity-focused hiring practices, and pit personal choice against community,” wrote Dr Demetre Daskalakis, former director of the US CDC’s National Center for Immunizations and Respiratory Diseases.

Purging scientists

Dr Susan Monarez, former CDC director

Daskalakis is one of at least 25 senior health leaders who have been fired, resigned or reassigned across the country’s health and scientific bodies under this Trump administration. Around 10,000 HHS staff have also lost their jobs in “cost-cutting”.

The CDC, charged with preventing and controlling disease, injury, and disability, has been worst affected. The Senate-confirmed CDC director, Dr Susan Monarez,, was fired in August 2025 for refusing to rubber-stamp decisions taken by Kennedy’s political appointees.

After being fired, Monarez told the Senate that Kennedy had directed her to “commit in advance to approving every ACIP recommendation regardless of the scientific evidence” and to “dismiss career officials responsible for vaccine policy, without cause”.

Daskalakis and three other top CDC officials resigned in protest after Monarez was fired. Five other CDC directors were reassigned last year, and earlier this year, the CDC’s acting director and deputy director left the agency.

Nine top NIH officials have also been forced out, including the directors of five NIH institutes.

In May, FDA Commissioner Marty Makary was fired, and Tracy Beth Høeg, who took over as acting head, was removed within weeks.

In April, the White House also fired all 24 members of the National Science Board (NSB), the group that advises the National Science Foundation (NSF), without explanation.

“This is the latest stupid move made by a president who continues to harm science and American innovation,” said Representative Zoe Lofgren, the Democratic ranking member of the House Science, Space, and Technology committee. “Will the president fill the NSB with MAGA loyalists who won’t stand up to him as he hands over our leadership in science to our adversaries?”

Worsening maternal health 

The drop in OB-GYNs in Idaho (JAMA).

The US has the highest maternal mortality rate among high-income countries. Since the federal law allowing access to abortion, Roe v Wade, was overturned, Trump loyalists have tightened abortion access in several states to such an extent that it is hard for doctors to intervene when women are miscarrying.

This has had a chilling effect on maternal health. While 12 of the most restrictive states have seen a small drop in their  number of obstetrician-gynaecologists, some state effects have been severe.

In Idaho, for example, 35% of ob-gyns have left or stopped practising since that state banned abortion. Half of Idaho’s counties no longer have an obstetrician, and in the southeastern corner of the state, there is one obstetrician for 120,000 people, according to a New York Times report.

Infant mortality is generally higher in states with restrictive access to abortion, with Alabama and Mississippi recording the highest deaths and California the lowest, according to a study published in JAMA. 

The 2025 report of March of Dimes, a US non-profit advocating for mothers and newborns, describes the country’s maternal and infant health system as “dangerously stalled”.

The report notes an increase in preterm births among Black mothers and a decline in pregnant women seeking care in their first trimester.

Measles rise as vaccinations fall

A doctor examines a child with measles

There have been 43 new measles outbreaks in 2026, with 4,852 recorded cases by 30 October, according to the US CDC. This is more than double the 2025 caseload.

This is “by far the highest total in 35 years”, according to the Center for Infectious Disease Research and Policy (CIDRAP) based at the University of Minnesota.

“The new data mark the 12th straight week of triple-digit increases nationwide,” CIDRAP noted. “The United States will very likely lose its measles elimination status – which it gained in 2000 – in the coming months.”

The outbreaks are being driven by a drop in vaccinations to below the 95% needed to maintain community immunity.

Johns Hopkins reports declining vaccination rates in kindergarten children. During the 2024-25 school year, coverage for measles, mumps, and rubella (MMR) was just 92.5%.

The diphtheria, tetanus, and pertussis (DTaP) vaccination rate also decreased from 92.3% in 2023-24 to 92.1% in 2024-25. Even polio vaccination coverage dropped from 92.7% to 92.5%

Declining rates of DTaP and MMR vaccination rates in kindergarten children (Johns Hopkins).

Worsening health in the US

Life expectancy in the US is already considerably lower than in most high-income countries, and its “avoidable deaths” are increasing, according to a 2025 report in The Lancet.

Reduced access to Medicaid and the elimination of certain childhood vaccinations, along with vaccine misinformation, are slow-burn activities likely to worsen the health of US citizens. 

Their full impact will only become evident years down the line, as well as the axing of thousands of health professionals and the elevation of political appointees over career scientists.

The US is an outlier in the developed world as it does not offer universal health coverage. Over two-thirds of US citizens rely on private health insurance and around 10% have no health coverage. 

The popularity of Kennedy’s “Make America Healthy Again” movement indicates that millions of Americans are concerned about worsening health. 

But Kennedy’s approach so far has undermined public health measures rather than living up to his campaign promise to address the drivers of poor health, particularly the junk food industry that is a major cause of obesity and cardiovascular disease.

Image Credits: JAMA, Johns Hopkins.