Call for US Congressional Oversight on Bilateral Health Agreements

15/04/2026 Kerry Cullinan

Mark Lagon of the Friends of the Global Fight against AIDS, TB and Malaria,

The US Congress needs to exercise oversight over the bilateral global health agreements that the United States has reached with 30 low- and middle-income countries, relative to the 2025 congressional budget, as they represent a decrease of around a third in allocated spending.

Mark Lagon of the Friends of the Global Fight against AIDS, TB and Malaria, told this to a meeting on financing health equity and security, organised by the AIDS Healthcare Foundation in Washington DC on Tuesday.

“In many countries, the US will no longer be doing core global health work on maternal and child health, family planning, and non-communicable diseases. They’re barely in the MOUs negotiated with African and other countries,” Lagon warned at the meeting held on the outskirts of the World Bank’s spring meeting.

US funding for bilateral malaria and TB programmes has stopped, while funding for “social interventions and education are falling away in favour of commodities and services,” Lagon added.

“Those countries that don’t have MOUs, or even have been bold in refusing them, face disasters – South Africa, Tanzania, Zimbabwe and Zambia. Finally, those countries that have agreed to the MOUs have co-financing targets that may not be feasible,” he said.

Not just the US….

Lagon also said that, while there had been global focus on the US cuts to Official Development Assistance (ODA), several other advanced industrial countries had made similar cuts.

“If you look at Global Fund’s Replenishment last November, the Trump administration pledged $4.6 billion, but Germany and Japan cut their contributions by 50%, and a co-host of the replenishment, the UK, with the Prime Minister announcing it without embarrassment, had a 30% cut.”

Sven Clement, chair of the Board of the Parliamentary Network on the World Bank and IMF.

Sven Clement, chair of the Board of the Parliamentary Network on the World Bank and IMF, said that the United Nations had reported two weeks ago that only four countries are on track to spend 0.7% of their Gross National Income (GNI) on ODA spending in their budgets.

The UN General Assembly had accepted this 0,7% target back in 1970. However, Li Junhua, UN Under-Secretary-General for Economic and Social Affairs, reported recently that 25 countries had decreased their ODA last year, leading to a 23% drop in ODA from 2024 to 2025 – the largest annual contraction on record.

“Only four countries met the 0.7% target – Denmark, Luxembourg, Norway, and Sweden,” said Li. “Based on preliminary data, ODA is expected to further decline by another 5.8% in 2026. Developing countries, especially the poorest, face mounting debt, with debt service burdens hitting 20-year highs.”

Highest debt repayments in two decades

Debt payments are at their highest level in two decades, according to the UN, particularly affecting investments in health, education and climate resilience.

AHF’s Kemi Gbadamosi told the meeting that over 3.3 billion people live in countries that “spend more on servicing debt than on education and health combined”.

While interest rates on debt had increased, many countries’ annual spending on health had stagnated at $17 per person – yet a basic health package cost $60, she said.

Rosemary Mburu, executive director of WACI Health

Rosemary Mburu, executive director of WACO Health, told the AHF meeting that, aside from debt, African countries faced “a high rate of access to capital,” – accessing credit at an interest rate of about 10% while wealthier countries accessed the same credit at around 2% of interest rate.

“More than half the world’s population – 4.5 billion – are without access to essential health services,” said Mburu.

Crises exacerbate pandemic risk

Riya Basu, executive director of the Pandemic Fund.

“Scientists predict that there is more than a 50% chance of another COVID-like pandemic hitting us in the next 20 to 25 years,” warned Priya Basu, the Pandemic Fund’s executive director.

“Pandemic risk is exacerbated by climate change, by changing land use patterns, by urbanisation, by changes in biodiversity,” she added.

She urged countries and leaders not to neglect pandemic preparedness in the midst of “multiple crises and multiple challenges”.

“Let’s not fall into a cycle of neglect followed by the panic of COVID-19,” said Basu. “If there’s one lesson that COVID taught us, it’s that the cost of being unprepared.

“The cost of being unprepared is tremendous, in terms of lives lost, trillions of dollars in world GDP lost; hard-won gains in economic development being reversed.

“After COVID, the smart calculus for any finance minister or leader to make is to invest in preparedness.”

Clement said that NATO countries are now on track to spend 5% of GDP on defence, yet “spending for health is something that should fall under resilience spending, the 1.5% that we’re currently looking at NATO”.

“If you don’t have a healthy population, you can’t be resilient against external shocks. So first of all, we don’t necessarily need to reprioritise. We just need to be very intelligent in how we account for different kinds of spending,” he added.

Sudan’s Catastrophic Civil War Enters Fourth Year

15/04/2026 Stefan Anderson

As donors gather in Berlin, tens of millions in Sudan face famine, genocide and displacement.

The world’s darkest ongoing war – defined by sexual violence, extermination, famine and genocide – enters its fourth year today. With no end in sight, tens of millions of Sudanese people are facing a historic humanitarian crisis of “industrial proportions,” according to the United Nations (UN).

Seven years after a new generation overthrew a three-decade dictator, two of his top lieutenants entrusted with shepherding the nation to democracy have become the commanders of its destruction. Sudan is torn in half, facing de facto partition in a land once hopeful of a democratic future.

“For three years, we have warned that Sudan was on the brink of catastrophe, and those warnings have gone unanswered,” said Richard Data, the International Rescue Committee’s Sudan director. “This is not just a conflict, it is a collapse of an entire country and a crisis that is rapidly engulfing the region.”

The civil war in Africa’s third-largest country has made Sudan a twin record holder: the world’s largest displacement crisis, and the worst humanitarian emergency on earth. Fourteen million people, a quarter of the population, have been forced to flee for their lives, including 4.3 million refugees who now find themselves in neighbouring nations unequipped to support them.

Sudanese refugees receive critical medical care at an MSF-run health centre in the Adré refugee camp, Chad (2024).

Thirty million of Sudan’s 50 million people required humanitarian aid last year. That number is expected to grow to 33.7 million in 2026, the World Food Programme (WFP) projects, as aid dwindles and the globe forgets about its most brutal conflict amid international focus on the Middle East War.

At least tens of thousands, with some estimates reaching 150,000 people, are dead as a result of the violence. In El Fasher, the capital of Darfur, 6,000 killings by the Rapid Support Forces (RSF) have been confirmed by the UN Human Rights Office. The actual toll is “undoubtedly significantly higher,” the agency said, noting reports of mass graves and blood-soaked streets visible from space via satellite imagery.

The RSF’s systematic violence against the non-Arab population of Darfur has led UN experts to quantify their actions as holding the “hallmarks of genocide.” Their detention facilities – “slaughterhouses.” Their violence – “amounting to the crime against humanity of extermination.”

“During the siege of El Fasher and surrounding areas, [the RSF] committed myriad crimes against humanity, including murder, torture, enslavement, rape, sexual slavery, sexual violence, forced displacement and persecution on ethnic, gender and political grounds,” the Independent UN Fact Finding Mission in Sudan found.

The incalculable violence, atrocities, and the depth of the humanitarian crisis facing Sudan’s population continue to accelerate.

“Three years of war have already cost Sudan immeasurably,” said Amande Bazerolle, Sudan lead for Médecins Sans Frontières (MSF). “Allowing this trajectory to continue risks condemning an entire generation.”

Iran war butterfly effect endangers millions

The war in Iran has paralysed the delivery of WHO supplies from Dubai’s international humanitarian hub, the world’s largest.

As the world looks away from Sudan, the German government is holding an emergency meeting on the anniversary of the war in an attempt to marshal desperately needed funding.

Neither warring party was invited to the meeting in Berlin, which aims to raise $1 billion in aid for Sudan out of a total of $3 billion in costs set out in the 2026 crisis plan developed by international humanitarian organisations.

That number is down from $4.2 billion in the 2025 plan. Not due to falling needs, but falling ambition in acquiring aid from donor nations, particularly the US.

Sudan aid summits in the previous two years, held in Paris and London, fell well short of their targets. Current funding is around 16% of the needed levels, according to the UN Development Programme. The 2025 plan received around $1 billion in aid, just under a quarter of its goal.

The war in the Middle East also poses a critical threat to Sudan’s agricultural system at a time of mass famine. Sudan is by far the most dependent nation globally on fertiliser passing through the Strait of Hormuz, accounting for 54% of its imports, UN Trade and Development (UNCTAD) figures show.

In addition, fuel prices – critical to its agriculture system heavily dependent on oil-powered irrigation from the Nile River – are up 24% since the war began, leaving millions struggling to afford basic necessities and threatening crops needed for food and livelihoods. Nearly 70% of Sudanese households relied on farming and agriculture for their income before the civil war.

As the war in Iran batters Sudan’s people, aid and agriculture, it is simultaneously contextualising the scale and achievability of its financial needs. The $3.2 billion funding gap in the Sudan humanitarian plan for 2025 – designed to keep 21 million people alive for an entire year – would be covered by three days of US military operations in the current war.

The Iran War Cost Tracker, based on Pentagon briefings and official estimates, places the running cost of the US war at around $52 billion – enough to cover 15 years of fully funded humanitarian response in Sudan.

Health supplies stranded, health system collapsed

An MSF nurse attends to a patient amid the violence in North Darfur, April 2025. / MSF

The war in Iran is also holding up lifesaving medical and humanitarian supplies as Sudan’s medical system collapses.

Save the Children reported that medical shipments for at least 400,000 people in Sudan are currently stranded in Dubai due to the closure of the Strait of Hormuz. The lost antibiotics, antimalarials, deworming treatments, pain and fever medicines, vitamins and pediatric drugs put more than 90 primary health care facilities across the country “at risk of running out of essential medicines,” the agency said.

The World Health Organization (WHO) also suspended operations from its global emergency logistics hub in Dubai due to the war, leaving Sudan without critical cholera supplies, among other medicines.

Sudan’s health system, staff and facilities are equally under constant attack.

In 2025, Sudan accounted for 82% of all global deaths from attacks on healthcare, according to WHO figures. Over 2,000 people were killed in the 213 confirmed attacks across the country since the civil war began. Both warring parties have attacked health facilities in the last two weeks, killing 80 people, including 15 children.

Humanitarian supllies arriving in Sudan are faced with further challenges in the delivery stage. Vast swathes of the country remain inaccessible to international relief groups.

“Hospitals have been looted, bombed, and occupied,” MSF said. “Medical staff have been threatened, detained, or forced to flee. Ambulances are blocked from reaching the wounded.”

“Funding cuts are making an already dire situation even worse, with people once again paying the price: they are dying from preventable causes because Sudanese authorities and the world are failing to come to their aid.”

Over 80% of hospitals and primary health facilities in conflict areas are closed. Across the country, 37% of health facilities are “non-functional,” according to WHO. Twenty million people require health assistance as outbreaks of malaria, dengue, measles, polio, hepatitis E, meningitis, and diphtheria continue to spread, the UN health agency estimates.

“The health system has been crippled, leaving millions without essential care,” said Dr Tedros Adhanom Ghebreyesus, WHO’s director general. “Doctors and health workers can save lives, but they must have safe places to work and the medicines and supplies they need. Ultimately, the best medicine is peace.”

‘People are eating things that are not food’

Famine in Sudan has been declared in two states, with 20 more facing severe threats.

Famine has already gripped several provinces, including El-Fasher and Kadugli, the world authority on food security, the Integrated Food Security Phase Classification (IPC) system, declared in November.

The IPC identified further famine risk in more than 20 localities across North Darfur and South Kordofan, the current epicentres of the ongoing fighting. Beyond the famine zones, a total of 45% of the population experienced acute food insecurity in September last year.

The international response plan assessing the humanitarian needs in Sudan reported that over half – 61.7% – of people are now acutely food insecure. Millions of families have access to one or fewer meals a day, with many turning to boiling leaves or eating animal feed to survive.

Amid the crisis, WFP food assistance fell 14% since the start of the year due to a lack of financing.

“People are eating things that are not food anymore. That is how bad it is,” one community leader in South Kordofan told Action Against Hunger (AAH). “We no longer ask what we will eat. We ask who will eat,” Ikhlas, a resident in North Darfur, added.

Transporting food to Sudan’s besieged regions requires drivers to risk their life to deliver lifesaving nutrition, Action Against Hunger’s report found.

Moving food has also become a life-threatening exercise. Armed soldiers exact bribes on major road routes, frequently attacking and killing those attempting to bring food into the most besieged areas.

“Every road has checkpoints. At each one, they take money or food,” one trader in North Darfur told AAH. “By the time you arrive, nothing is left.”

The independent UN Fact-Finding Mission in Sudan found that both sides have used starvation as a weapon of war.

“The extent of hunger and displacement we see in Sudan today is unprecedented and never witnessed before,” the mission said. “Both the SAF and the RSF are using food as a weapon and starving civilians.”

“The RSF and its allies used starvation as a method of warfare and deprived civilians of objects indispensable to their survival, including food, medicine and relief supplies which may amount to the crime against humanity of extermination,” the UN mission added.

Sexual violence is defining warfare

The vast majority of confirmed sexual assault cases are committed by military men. The total count so far is considered a vast undercount by experts due to broken reporting systems.

Sexual violence, mass rape, gang rape, forced marriage, and sexual slavery are inseparable from the war. Thousands of cases, primarily committed by RSF fighters in Darfur, have been documented since the war began.

The youngest case documented by UNICEF occurred against a girl who was just one year old.

“They took us to an open area. The first man raped me twice, the second once, the third four times,” a survivor told MSF. “Apart from the rapes, they beat us with sticks and pointed guns at my head.”

Gender-based violence has further compounded the food crisis for women and girls. The Action Against Hunger report, based on nearly 100 interviews with women in Sudan, found “simply being female has become a key predictor of hunger,” with female-led households three times more likely to experience food insecurity.

Routine activities to reach food – going to the farm, market, or waiting in water or food lines – put women at risk of rape and sexual violence. “These gendered threats are inseparable from the hunger crisis,” the report found. “Food scarcity both heightens exposure to violence and amplifies its consequences.”

“Sexual violence is a defining feature of this conflict – not confined to frontlines, but pervasive across communities,” said Ruth Kauffman, emergency health manager at MSF. “This war is being fought on the backs and bodies of women and girls.”

Disabled people have not been spared in the RSF’s assault. Human Rights Watch has confirmed deliberate targeting of disabled civilians amid the siege of El Fasher, adding to the interminable depths of violence in the world’s darkest war.

“The Rapid Support Forces treated people with disabilities as suspects, burdens, or expendable,” said Emina Ćerimović, associate disability rights director at Human Rights Watch. “We heard how they accused some victims, particularly those missing a limb, of being injured fighters and summarily executed them.”

“Others were beaten, abused, or harassed because of their disability, with fighters mocking them as “insane” or for not being a “complete person,”” Ćerimović added.

Foreign money and arms continue to fuel the war engine

North Darfur capital of El-Fasher from above.

Hopes of ending the violence are stymied by continued foreign military and financial assistance to the warring parties.

The United Arab Emirates, in particular, has been accused of being the primary backer of the genocidal RSF, with little diplomatic consequence on the world stage. Drone attacks critical to RSF advances operate from bases claimed by the UAE as humanitarian posts, which a New York Times investigation found also serve as weapons smuggling hubs.

Turkey, Egypt and Saudi Arabia are the key backers of the Sudanese army. All governments deny accusations of involvement in the war.

“There are many external actors involved in this war,” Luca Renda, the UN Development Programme’s Sudan representative, said at the Berlin aid summit. “And as long as this continues, unfortunately, the chances of peace are very slim.”

No reliable estimates exist for the total value of foreign military assistance flowing to either side. What is known is that the weapons keep arriving — routed through intermediaries, in violation of a UN arms embargo — while the humanitarian funding that could keep Sudan’s people alive does not.

“The UAE, Iran, Turkey, Pakistan and others must stop supplying arms and support immediately,” Mo Ibrahim, Sudanese-British billionaire and founder of the Mo Ibrahim Foundation, wrote in the Financial Times on Tuesday. “All those countries profess love for the Sudanese people. We welcome your affection but not your bullets and drones.”

“You are enabling the bloodshed and famine and causing the displacement of innocent civilians. Instead, you should put pressure on both sides to stop this madness.”

Image Credits: UNICEF, WHO/Nicolò Filippo Rosso, Dubai Humanitarian , MSF, UN Sudan Envoy.

One Million More People to Get HIV ‘Miracle’ Drug Lenacapavir as US, Global Fund Expand Access

14/04/2026 Kerry Cullinan

Eswatini officials, including Prime Minister Russell Dlamini (right) and Minister of Health Mduduzi Matsebula (centre), during the lenacapavir introduction ceremony at Hhukwini Clinic near Mbabane last November.

The United States and the Global Fund will support three million people to get lenacapavir, the twice-a-year HIV injection that is almost 100% successful in preventing transmission of the virus – a million more than their previous commitment.

Jeremy Lewin, US Under Secretary of State for Foreign Assistance, Humanitarian Affairs and Religious Freedom at the State Department, made this announcement at an event in Washington DC on Tuesday.

In 2024, the US and the Global Fund announced that they would distribute up to two million doses of lenacapvir to HIV high-burden countries over the next three years.

But the two groups are “upping our financial commitment” to reach three million people, Lewin told an event convened by the Center for Strategic and International Studies (CSIS) on the sidelines of the World Bank spring meeting.

Global Fund executive director Peter Sands added that “the experience we’ve got so far suggests that, if we really want to make the most of this, we have to go bigger and we have to go faster”.

Meanwhile, Lewin said that the US would “be willing to fund additional doses as we get that manufacturing capacity ramped up,” adding that “we’d like to see countries fund doses.”

He praised Gilead Sciences, the US company that developed lenacapvir, as “an example of American excellence in biomedical innovation”.

Jeremy Lewin, US Under Secretary of State for Foreign Assistance, Humanitarian Affairs and Religious Freedom at the State Department

Nine countries get deliveries

Since last November, some 135,000 doses of lenacapavir have been delivered to nine African countries: Eswatini, Kenya, Lesotho, Mozambique, Nigeria, South Africa, Uganda, Zambia and Zimbabwe.

Last November, Eswatini became the first country to get the medicine, only five months after the US Food and Drug Administration (FDA) had approved lenacapavir for pre-exposure prophylaxis (PrEP).

Twelve additional countries – Benin, Botswana, Dominican Republic, Fiji, Georgia, Haiti, Honduras, Indonesia, Morocco, Papua New Guinea, Rwanda and Thailand – will also receive the medicine soon, according to a Global Fund statement on Tuesday.

“We’ve taken a deliberate decision to focus on the places where it can have the most impact,” said Sands, adding that the aim is to reach 24 countries by the end of 2027

Countries also needed to have programmes to test people for HIV, enrol HIV negative people for lenacapavir and ensure that they will return after six months for their second injection, and put those who test HIV positive on treatment, Sands added.

He hopes that the promise of lenacapavir will provide an incentive for people to test for HIV, which would also enable health systems to reach the estimated nine million people with HIV not on treatment.

Fast-tracking generics

Gilead CEO Daniel O’Day.

Gilead CEO Daniel O’Day told the meeting that, within two weeks of getting the clinical trial results for lenacapavir, his company had “signed voluntary licences with six generic manufacturers, royalty-free with no obligation to us” and completed all the technology transfer in two weeks.

“We have 1.3 million new cases of HIV every year, the vast majority in sub-Saharan Africa, and 41 million people are living with HIV,” said O’Day. “We have to bend the arc of those 1.3 million [new cases] to get to a stage where this disease is now under control.”

The first generics are due to become available from mid-2027. The Global Fund, Gilead and the US have been working to “reduce the risk” for generic manufacturers by “making sure [they] already have a market as they roll their product out the door,” said O’Day.

Last week, the Global Fund launched a global call for Expressions of Interest (EOI) from manufacturers to submit their generic products for review by its Expert Review Panel to “accelerate the availability of quality-assured generic products and expand global supply capacity over the coming months”.

O’Day added that it had taken Gilead 17 years to develop lenacapavir: “My scientists call this a unicorn of a molecule. The fact that you could get a molecule that is nearly 100% effective at preventing HIV, given every six months, is quite extraordinary.”

Delivery via US bilateral agreements?

US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya.

Lewin said that the bilateral Memorandums of Understanding (MOU) the US had signed with various countries enabled the US to work directly with health ministries in those countries to prepare for lenacapavir.

However, Sands said that getting lenacapavir to those most at risk of HIV involved both community organisations and governments: “We are very much engaged with community-led organisations, and this is an important part of how we maximise the impact of lenacapavir.

“We have to follow the epidemiology. We have to ensure that the communities most at risk get access to the most powerful tools. Some governments are quite good at that. Some governments are less good at that, and where they’re less good at that, the answer is to work through community-based organisations.”

The HIV sector has identified “key populations” where the virus is flourishing – including sex workers, men who have sex with men, people who inject drugs and adolescent women – as groups that need particular attention to end HIV.

However, the Trump administration has stopped funding most of these groups and is focusing narrowly on pregnant women and children in its HIV response. Trump wants to end mother-to-child transmission of HIV by the end of his second term in office, according to Lewin.

A Global Fund statement released on Tuesday names “priority populations” for lenacapavir as “including pregnant and breastfeeding women, adolescent girls and young women, and people accessing PrEP for the first time.”

However, at a briefing last September Lewin said that there is “no formal restriction” on who the recipient countries choose to give the medicine to, although the “strong recommendation” of the US is to focus on eliminating mother-child HIV transmission.

“We’re working with the countries to meet their needs in their high-risk populations. And the Global Fund, of course, is targeting their doses in their own manner as well,” Lewin told the briefing.

Key African countries excluded from MOUs

The US has signed 30 bilateral MOUs so far and, while it might sign a further 10 or so, 85% of the budget has already been allocated, said Lewin.

“I think the $21 billion in co-investment commitments from the countries is the largest mobilisation of African domestic resources for health ever,” he added.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) focused on 20 high-burden countries, and Lewin said that the US had signed MOUs with all of these, bar “one or two exceptions, that have unique circumstances.”

However, the US has not offered a bilateral agreement with South Africa, the country with the biggest HIV positive population in the world, as the two countries have several political disagreements.

Despite this, a statement from the US Embassy in South Africa described the arrival of lenacapavir last week as exemplifying “commercial diplomacy between the United States and South Africa.”

Historic moment for HIV prevention! 🎉

South Africa receives first Lenacapavir shipment through @GlobalFund & @GileadSciences collaboration. The U.S. is proud to support this life-saving innovation. 🇺🇸🇿🇦 https://t.co/g8axF0whV2 #EndHIV #GlobalHealth pic.twitter.com/lqxMyjLabw

— US Embassy SA (@USEmbassySA) April 10, 2026

The Global Fund is providing South Africa with the medicine, but the US can take some credit as it is the fund’s largest donor, pledging $4.6 billion to the Fund for its next budget cycle.

Zambia has been unable to secure an agreement as there has reportedly been a dispute over US access to its resources. Tanzania also hasn’t reached an agreement, while Zimbabwe rejected the terms the US proposed.

Massive potential to end HIV

Peter Sands

Sands said that the rollout of lenacapavir is “one of the most exciting things I’ve ever been involved with.”

“What’s really exciting is when you meet frontline health workers, and they are buzzing, and saying: ‘When did you say we’re getting it? How quickly?’.”

He described meeting mentors of mothers-to-be in Kabira, a large informal settlement in Nairobi in Kenya, who told him that lenacapavir would be a game-changer.

The mentor mothers encourage pregnant women to test for HIV and, while the programme has not had a baby born with HIV in four years, “they have nothing to offer the mothers who test negative to protect them from HIV”.

Many women are not in a position to control what happens to them sexually, he added, but the six-monthly injection is a discreet intervention that can protect them from infection.

Protecting an adolescent woman from HIV also means saving 50 to 60 years of antiretroviral treatment and supporting services, said Sands.

“The sheer economics of preventing infection are enormously compelling,” added Sands, who was a commercial banker.

Implementing MOUs

Meanwhile, Lewin said that by the end of the US fiscal year on 30 September, the US wants implementation agreements with all countries with bilateral compacts.

By then, these countries “will all be onboarded onto new mechanisms that align with the commitments and focus on the America First Global Health Strategy,” said Lewin.

“We’re trying to prioritise the work right now and get the plans right. It’s a lot of work to work with these countries on these plans, and it’s hard to do in the public eye. You’ve got to do that with a level of trust in the governments.”

Lewin added that US President Donald Trump’s proposed 2027 budget aims to dispense with disease-specific funding to enable more flexibility.

“In some places, we have more HIV money than we know what to do with, and we’d like to use it on global health security or on malaria,” said Lewin.

“Giving more flexibility to policymakers to make those decisions doesn’t mean that we’re eliminating HIV funding or seeking to do that. It means that we want more flexibility, something we’re working with Congress on,” he said, adding that the new MOUs “include all the disease areas in the same agreement.”

Image Credits: Karin Hatzold /PSI..

WHO Director General in Germany for Series of High Level Meetings – What’s At Stake?

14/04/2026 Elaine Ruth Fletcher & Editorial team

WHO Director General Dr Tedros Adhanom Ghebreyesus meets with members of the German Bundestag in a series of high-level meetings this week in Berlin.

As WHO Director General Dr Tedros Adhanom Ghebreyesus visits Germany, a high stakes week for Germany’s future role in the World Health Organization agency may be unfolding in Berlin.

On Monday, Tedros began a two-day high-level visit to Germany at the invitation of the World Health Summit where he has served as a patron.

The visit also reportedly includes meetings requested by Tedros with Minister of Foreign Affairs Johann Wadephul, Minister of Health Nina Warken, and Berlin Mayor Kai Wegner as well as members of Germany’s Bundestag, or Parliament. Germany’s Chancellor Friedrich Merz, meanwhile, declined a request from the Director-General to convene a meeting, Health Policy Watch learned.

The question is this: what exactly is Tedros doing in Berlin, and why is he prioritizing bilaterals with German ministers a month before the World Health Assembly?

According to a WHO spokesperson, the answer is simple: he is in Berlin “at the invitation” of the World Health Summit.

“On Monday, 13 April, he attended the WHS-organized high-level dinner, ‘From Crisis to Resilience: Innovating for Health,’ which focused on the future of international organizations and the role of Germany and Europe in a changing global order.

In addition, “the Director General is meeting with key German stakeholders, including the Federal Minister of Health and the Mayor of Berlin, to reaffirm Germany`s role as a strategic partner and champion of multilateral global health.

“The visit aims to strengthen cooperation on pandemic preparedness, global health reform and sustainable financing, while highlighting the WHO Hub in Berlin as a global asset made possible through Germany`s support,” the WHO spokesperson added.

However, diplomatic sources told Health Policy Watch that the meetings have less to do with the World Health Summit and more to do with the pending loss of German voluntary donations to WHO – as well as Germany’s positioning in the upcoming race for WHO Director General.

German cuts to WHO funding

WHO’s Pandemic and Epidemic Intelligence team meeting with WHO’s DG Dr Tedros Monday in Berlin.

Following the US withdrawal from the WHO, Germany has emerged as the Organization’s largest member state donor. But it is reportedly cutting back its voluntary contributions in both 2026 and 2027 and it is unclear whether it will come through with all of the $262.2 million in funding pledged at the World Health Summit in October 2024 for the years 2025-2028.

Since that 2024 pledge, only about $84 million has so far been committed by the Health Ministry in the 2026 German national budget approved by the Bundestag. The remaining $180 million pledged remains in question.

Germany’s plans to halve its annual funding for the Berlin-based WHO Hub for Pandemic and Epidemic Intelligence from €30 million to €15 million, were reported by Health Policy Watch in January.

Meanwhile, despite dramatic budget cuts and layoffs of at least 25% of the workforce over the past 16 months, WHO still faces an estimated $640 million budget gap for the current 2026-2027 biennium, according to a Director General’s report at the February 2026 Executive Board meeting.

WHO disclosed plans for a 25% staff cut in November 2025 with professional staff at low and mid-level hit hardest. But a budget gap of $640 million remains.

Will Germany put forward a candidate for DG ?

Another likely issue in bilateral discussions is the election campaign for the next WHO Director General. That is expected to kick off formally later this month or in early May when Tedros issues a call to WHO member states to nominate candidates.

Former German Health Minister Karl Lauterbach.

Two influential German health policy actors have been eyeing the race, as reported in February by Health Policy Watch and German media outlets. Those include former German Health Minister Karl Lauterbach and Paul Zubeil, deputy director general of European and International Health Politics in the German Ministry.

Both bring distinct strengths along with potential trade-offs. While Lauterbach is widely known, his prominent role in the COVID-19 response made him a more polarizing figure domestically, which could affect how he is received on the global stage.

Paul Zubeil, German Ministry of Health, at the World Health Summit in Berlin in 2025.

Zubeil, who currently oversees all funding to WHO and UNAIDS on behalf of the German Federal Ministry of Health, is highly regarded in expert circles for his decades of experience in fragile and complex settings and his deep understanding of global health systems. The key question is whether he has the political backing to mobilize a German nomination.

Deferring or not?

Within German political circles, there is a debate underway, however, about how the country should position itself in the DG race.

“German opinion on whether there should be a candidate [for WHO DG] is highly disputed inside and outside of ministries. German foreign policy might just have other problems right now than running a [WHO] campaign,” said one expert on the European arena.

And recently, German Chancellor Merz’s fractious coalition of conservatives and the centre-left, has been further strained by the geopolitical challenges of the war in Iran and the consequent sharp hike in fuel prices.

In what are likely to be Tedros’ final strategic engagements with Germany before the race begins, he is understood to be encouraging his counterparts in Berlin not to enter the contest and instead back allied candidates, according to WHO sources. Tedros’ own personal preferences in the race, while the subject of informal speculation, have yet to emerge.

For Berlin, the implications of deferring any nomination of a German candidate is politically significant. Germany, despite being a major multilateral donor, does not have anyone serving in the top posts of the UN system. Its one remaining shot to secure a major global leadership role over the next five years is the WHO Director-General race, so it is not surprising that Germany had been considering nominating a candidate.

But not putting forward a candidate may be the least favorable option of all, others argue.

“To defer to the current WHO DG’s preference rather than put forward its own candidate would not just be a missed opportunity. It would raise serious questions about judgment and independence at a moment when leadership in global health is under intense scrutiny,” said one German diplomatic source.

Germany in WHO’s Executive Board calculus

WHO European Region Executive Board representation – the allocation of three-year terms is by three country groupings.

While Berlin debates its position in the DG race, its near-term role in the Executive Board, WHO’s governing body, is also unclear. In late January or early February 2027, the EB will screen and select three candidates among the slate of DG nominees to be voted on by member states at the May 2027 World Health Assembly.

That gives the 34-member WHO governing body with immense power to sway the final outcome of the race.

Currently, Germany does not have a seat on the Board so its say on the final three candidate slate will be shaped by broader European Union currents and Policies.

It will have a chance to return to the EB at the May 2027 WHA, as member states elect a new DG.

At that time, four European member states will rotate out of the eight EB seats allocated to European Region members.

But the complex subregional grouping system that the European Region uses to select EB representatives will continue to represent a critical constraint for the success of a German EB candidate. That’s because Germany is a member of the European region’s Group A countries, where only one seat is available.

It will be competing with Iceland and Luxembourg, which both expressed interest in the seat at an informal Regional consultation in late 2025, according to documents from the meeting seen by Health Policy Watch.

France’s EB position is more secure

The 158th WHO Executive Board meeting on 8 February, the final day of its last session.

That means three countries would likely be competing directly for a single position, with two guaranteed to be eliminated.

Former Health Minister and WHO Academy Executive Director Agnès Buzyn – potential French nominee?

At the same time, France, which is also eyeing at least three nominees for the DG race – including Agnès Buzyn, Anne-Claire Amprou and Marisol Touraine – sits within the Region’s Group B where two Executive Board seats are available. As a Permanent Member of the United Nations Security Council, France benefits from extra privileges rotating into one of the available positions more frequently than other member states.

This means France will almost definitely secure a Board seat in 2027, even if its DG candidate is unsuccessful, while Germany does not have the same privilege.

Meanwhile, Group C, which includes the Russian Federation, Israel, and Turkey – as well as Balkan and Central Asian member states – will have one vacant seat in 2027 with Romania and Moldova already expressing interest.

So, whether by design or by drift, Germany risks being edged out of both the WHO Executive Board and the broader WHO leadership conversation, critics say.

Largest OECD donor with the lowest UN boardroom profile

This comes at a time when Germany has also become the largest provider of official development assistance (ODA) for the first time, with total aid reaching $29.1 billion, according to the 2025 Organisation for Economic Co-operation and Development report released last week.

Despite that historic financial weight, Germany has not managed to parry funding into multilateral power.

Until 2025, Germany held one senior role through Achim Steiner, who served as Administrator of the United Nations Development Programme until his term concluded. However, he remained a relatively low-profile figure across the system, with limited recognition beyond core development circles.

Berlin’s subsequent attempt to secure the top role at the UN High Commissioner for Refugees fell short, with its candidate Niels Annen, a former parliamentary State Secretary at the Federal Ministry of Economic Cooperation and Development, losing out to Barham Salih, the former President of Iraq.

Even with the cutbacks in support to WHO, Germany is likely to continue ranking as one of the largest member state donors to the global health agency for the foreseeable future

But here, too, critics argue that financial power as a donor to the UN system shouldn’t come with such explicit strings attached. “What’s the message? I pay and you vote for me or…? Sounds like the USA!” one observer told Health Policy Watch.

Decisive moment in Berlin vis a vis Washington DC?

Financial considerations aside, relations between Germany and Washington are at one of their lowest points in decades, with US President Donald Trump repeatedly attacking his European allies over defense, trade, and alignment with US priorities.

At the same time, Merz has warned of a deep rift between Europe and the US, while still insisting that transatlantic cooperation must be preserved.

That is exactly where the WHO race becomes more than a health decision. It becomes a diplomatic lever.

At a time when Washington is increasingly transactional and relationship-driven, Berlin putting forward a credible nominee could signal alignment, rather than distance, some sources who spoke with Health Policy Watch, asserted.

Said one, “It could demonstrate that Germany is willing to lead where it matters, to reset the course of WHO and do so in a way that keeps the US anchored in global institutions rather than drifting further away.”

–Felix Sassmannshausen also contributed reporting to this story.

Image Credits: X/DrTedros, X/Dr Tedros, WHO , Steffen Prößdorf, Health Policy Watch , Amélie Tsaag Valren.

Delhi Has a New Plan to Fight Its Toxic Air, But Will it Deliver?

13/04/2026 Chetan Bhattacharji

Delhi air pollution during peak pollution days in mid-November.

Delhi’s new action plan 2026 promises to double the bus fleet, deploy more smog guns, and impose pollution-linked curbs on fuel sales. But experts warn of missing enforcement muscle and dodging hard decisions.

DELHI – The world’s most polluted capital has a new air quality action plan, but the Delhi state government is yet to release the details – more than a week after the Chief Minister Rekha Gupta announced it.

A press release with sketchy details on the Air Pollution Mitigation Action Plan 2026 has been welcomed by experts and civil society, but cautiously; a follow-up draft electric vehicle (EV) policy has more details on how to phase out certain categories of fossil-fueled vehicles over the next two to three years to improve air quality.

How effective are smog guns?

However, the government plans to double down on questionable measures such as anti-smog guns and water sprinklers on a “large scale”. According to an Indian Institute of Technology (IIT) Delhi finding, spraying water had a very small impact on the small particulate matter in the air, PM2.5, and this was limited to an area up to 200 metres from the machine.

Last year, the government released the Air Pollution Mitigation Plan 2025. Some of the policy proposals are the same, such as a curb on entry of old goods vehicles, the deadline for which has been postponed by a year. But the scale of other promises, such as a lot more buses and EV chargers, has grown significantly.

Delhi Chief Minister Rekha Gupta announced the Air Pollution Mitigation Action Plan 2026 on 3 April. It follows the Air Pollution Mitigation Plan 2025.

Scepticism is understandable given that Delhi’s average PM2.5 pollution has hovered around 100 micrograms for the last seven years. Earlier this year, the government announced a target of a 15% reduction in the annual average PM2.5 level for 2026. The new plan doesn’t mention this, but the list of promises is long and ambitious.

Details of Delhi’s Air Pollution Mitigation Action Plan

Vehicular and transport curbs

Curbs on fuel sale: ‘No PUC, No Fuel’ – vehicles without a pollution-under-control (PUC) certificate will not be sold fuel at pumps. Cameras will use digital tracking to identify them.
Curbs on old goods vehicles: Starting 1 November 2026, only the most recent emission standard BS-VI (Bharat Stage), CNG (compressed natural gas), or electric goods vehicles will be allowed into Delhi. Last year’s plan had promised the same thing by 1 November, 2025.
Doubling the bus fleet: A target fleet of 13,760 buses by 2028-29, more than double the current 6,100, with a heavy focus on electric models. Last year’s plan promised 5,004 electric buses.
Adding more than three times the current number of EV charging points: 32,000 charging points over the next four years, almost triple the current 8,800, and a new EV Policy 2026 targeting commercial fleets. Last year’s plan promised 18,000 EV chargers.

Traffic and dust management

Eliminating 62 traffic congestion Hotspots: Using an “Intelligent Traffic Management System”.
Anti-smog guns for roads and large buildings: Large-scale deployment of mechanical sweepers and water spray systems to control dust.
Paving & greening: 3,500 km of roads and the planting of 7 million trees and shrubs in a year. Incidentally, just weeks earlier, the chief minister had announced plans to recarpet 750 km of roads as a step to improve the air quality.

Waste and construction monitoring

Removing Delhi’s garbage mountains: South Delhi’s Okhla site by July 2026, North Delhi’s Bhalswa by December 2026, and East Delhi’s Ghazipur by December 2027. Past deadlines to rid the national capital of these towering landfills were missed. Seven months ago, the deadline set by Gupta for all three was December this year.
AI Oversight: Rollout of portal for real-time, geo-tagged monitoring of construction sites to prevent dust leakages.
Biomass ban: Complete ban on biomass burning with penalties for violators and the distribution of electric heaters as alternatives.

“Clean air is not a luxury, it is a fundamental right, and we are committed to delivering it,” said Gupta at the launch, promising strict timelines, accountability, “new” solutions and engagement with the public and technical experts.

Delhi’s air is dependent on the seasons. This view, after rain, shows its potential for clean air.

However, experts and environmentalists point out measures in this list which need to change or are missing. The aim is to reduce pollution by reducing the sources of pollution.

‘Pollution-under-control’ system needs to change

Delhi’s traffic contributes to some 18% to 24% or air pollution, depending on the season. There are almost 8.8 million vehicles on the road, up 7.9% from the previous year. Over two-thirds are two-wheelers, while an estimated 1.2 million vehicles visit daily from neighbouring cities.

Vehicles also account for 60% of nitrogen oxide (NOx) emissions in Delhi and neighbouring region, which can have devastating health effects, including higher risk of asthmatic attacks, coughing, wheezing, chronic lung disease, heart disease, strokes and lung cancer among others. NOx also contributes to the creation of other pollutants like ozone and fine particulate matter PM2.5, equally damaging to human health.

Fossil fuel vehicles in Delhi without a valid pollution-under-control certificate will be barred from buying fuel, according to a proposed action plan by the government.

Caption: Fossil fuel vehicles in Delhi without a valid pollution-under-control certificate will be barred from buying fuel, according to a proposed action plan by the government. Source: CMO Delhi’s account on Instagram.

But the PUC certificate, which the government has vowed to police, doesn’t measure NOx or PM2.5, which is a critical gap according to Amit Bhatt, managing director for India at the International Council for Clean Transportation (ICCT), a research organisation.

“The key limitation of the existing PUC system is that it is a stationary test and does not capture emissions under real-world driving conditions.

However, the actual impact on human health occurs when vehicles are operating on the road. Therefore, it is important to reimagine vehicular emission testing to better reflect real-world conditions and align with public health priorities,” Bhatt told Health Policy Watch.

Bhavreen Kandhari, a prominent environmentalist, warns of another danger of continuing with the old PUC regime.

“Continued reliance on the PUC system, widely considered outdated/corrupt without scaling robust real-time emission monitoring, weakens enforcement,” says the founder of Warrior Moms, an air quality activist group.

New EV plan announced

However, the Delhi government has announced details for a new, draft EV policy, vehicles contributing up to almost a quarter of the megacity’s pollution and identified as the fastest growing pollution source.

It promises a rapid push for EVs in all categories by providing incentives from subsidies for new EVs to incentives for scrapping fossil-fuel vehicles.

Proposed subsidies range from a few hundred dollars for two-wheelers up to about $2,500 for cars, and about $1,000 for trucks in the first year of the policy.

These incentives will be phased in, ending by 2030. Private EV four-wheelers don’t get any subsidies but are exempt from road tax and registration fees for vehicles costing up to about $32,000.

The policy also provides a roadmap for phasing out fossil-fueled vehicles in certain categories. Petrol and diesel vehicles will no longer be added to delivery and ride aggregator fleets in Delhi from this year, while only electric auto-rickshaws will be registered from next year, and only electric two-wheelers will be registered in Delhi from 1 April, 2028.

“The proposed Delhi EV Draft Policy 2026 is a significant step towards establishing a clean, accessible and sustainable transport system in the capital,” Chief Minister Gupta says.

Break-up of Delhi’s vehicular pollution

The draft provides no data on how much each category contributes to the 24% of vehicular pollution in Delhi. However, Health Policy Watch has learnt that a recent, yet-to-be-published study estimates that a quarter of vehicular pollution is from two-wheelers, which number over five million in Delhi.

The share of three-wheelers for goods is even more than this. Trucks of various sizes are estimated to contribute about a fifth of the pollution, while the share from private cars is under 10%.

Notably, buses, which are either CNG-fueled or electric, contribute the least, which is why the government’s move to more than double the fleet holds promise.

Are ‘smog guns’ effective?

A visible part of Delhi’s pollution control measures has been smog guns, atop trucks and buildings. These are essentially water-mist cannons and sprinklers. The new action plan persists with them to control dust and vehicular pollution.

But a recent study by the Council on Energy, Environment and Water pointed out that putting these on top of large buildings would cover less that 0.5% of Delhi’s area, or about 3-7 square km. This assessment was based on last year’s Air Pollution Mitigation Plan. The new criteria details are yet to be released.

The truck-borne versions cover more distance as they drive along the main roads, spraying water, but their effectiveness in reducing pollution is equally questionable.

A study by the Indian Institute of Technology (IIT) Delhi found that while smog guns reduce average PM2.5 greatly immediately after sprinkling, the benefit reduces sharply over the next 2-3 hours, and the overall effect after 24 hours was 8%. The range of efficacy is limited to just about 100 to 200 metres on either side of the machine, the research found.

A smog gun on a Delhi road. An IIT-Delhi study has questioned the effectiveness in reducing air pollution.

Measures like smog towers, cloud seeding and even smog towers have been called cosmetic changes and red herrings. While pollution control agencies have ditched smog towers, the Gupta government is planning to continue with cloud seeding trials this year again – despite last year’s fiasco and criticism – although the action plan doesn’t mention it.

Action plan silent on firecrackers

But while there are gaps, several commentators have welcomed the new plan.

It offers “real hope”, says Jyoti Pande Lavakare, a clean air advocate and author of the memoir, “Breathing Here is Injurious to Your Health”.

But the critical missing piece, she says, is the Delhi government’s silence on banning firecrackers. “Without a complete ban, at least from October to March, Delhi’s winter pollution peaks are unlikely to see a significant fall,” she wrote in an opinion piece.

That, however, is not likely, as the Rekha Gupta government had gone to court to lift the ban and got it overturned.

Kandhari calls for deeper reforms. Regional sources, including industrial pollution in NCR (national capital region) and non-compliant thermal power plants within a 300 km radius, remain insufficiently addressed, she points out.

Governance challenges, staff shortages, weak enforcement capacity and fragmented institutions compromise implementation.

“Overall, the plan prioritises visible, technocratic solutions while neglecting deeper structural and institutional reforms needed for sustained air quality improvement,” says Kandhari.

Old plan, but stiffer targets

HPW reached out to pollution-control officials for comment but had not received this at time of publication.

Meanwhile, the government has promised a hard line backed by budgetary allocation and measurable outcomes.

During the peak pollution season, October to January, when PM2.5 levels can be 30-40 times above the WHO’s safe guidelines, the government may consider staggered office timings, work-from-home directives and additional restrictions on polluting vehicles for immediate relief, which is the same as previous years.

It all boils down to implementation. If the chief minister drives her new action and holds officials accountable for reducing pollution, old wine in a new bottle may still work.

Image Credits: Chetan Bhattacharji, CMO Delhi, CMO Delhi.

Digital Tools Can Transform Maternal and Child Health – But Access Barriers Need to be Addressed

13/04/2026 Louise Kpoto & Rajat Khosla

Several digital tools are available to help African women during pregnancy – but millions of women, particularly in rural areas, don’t have access to the internet while data costs too much for poor families.

Each year, hundreds of thousands of women die from complications related to pregnancy and childbirth that are well understood and largely preventable.

Most of these deaths occur in low and middle-income countries, with sub-Saharan Africa carrying the greatest burden. At the same time, millions of families continue to face financial barriers to essential health services, with out-of-pocket costs still accounting for a significant share of health spending.

These outcomes are not inevitable. They reflect choices about how health systems are prioritised, financed, and delivered.

As governments gather this week for the 59th Session of the Commission on Population and Development, there is an opportunity to refocus attention on what will determine progress in the years ahead.

This year’s emphasis on technology is both timely and necessary, but it must be anchored in a broader commitment to equity, financing, and access to quality care, particularly for women, children, and adolescents.

Digital tools to enable informed decisions

Sexual and reproductive health and rights are central to this agenda. Yet access to these services remains uneven, and in many contexts increasingly contested. Today, more than 200 million women globally still lack access to modern contraception.

Ensuring that women and adolescents can make informed decisions about their health is not only a matter of rights. It is fundamental to public health and long-term development outcomes.

Technology and scientific research offer practical pathways to address some of these gaps. Across the Global Leaders Network for Women’s, Children’s and Adolescents’ Health countries, digital tools are already improving access to information, strengthening referral systems, and supporting frontline health workers.

In Kenya, a toll-free digital hotline provides around-the-clock guidance on contraception, sexual violence, and mental health to young women in marginalised communities, reaching tens of thousands of callers annually who would otherwise have had nowhere to turn.

In Tanzania, a mobile application co-designed with community health workers and beneficiaries is improving continuity of care for maternal, child, and adolescent health by connecting facilities, community workers, and local drug dispensing outlets through a shared digital referral system.

New mothers in Khayelitsha in South Africa get guidance from the Mom Connect app. But only women with a mobile phone and data can benefit from this digital tool.

In South Africa, the MomConnect platform has helped register pregnant women attending antenatal clinics in the public health system, delivering targeted health information throughout pregnancy and early infancy directly to women’s mobile phones, including in rural communities where in-person support is harder to access consistently.

Across Ethiopia and Malawi, governments are investing in integrated health information systems that give decision-makers a clearer picture of where services are reaching people and where they are not.

And in Liberia, a WhatsApp-based mobile referral system, MORES, linking rural health facilities to district hospitals has shown to improve the transfer of obstetric emergencies and cut the time to emergency caesarean section significantly.

Barriers to digital health

But the promise of digital innovation will only be realised if we address the scale of the barriers that remain.

As of 2024, internet penetration in Africa reached 40%, yet more than 900 million people on the continent remain offline, and in rural areas, the internet penetration stands at just 28%.

The average cost of 1GB of data on the continent consumes nearly 6% of monthly income, more than three times the level the United Nations considers affordable.

Women, older adults, and people in conflict-affected settings face the steepest exclusion, and research consistently shows that digital health innovations tend to reach more affluent, urban populations first, deepening the very inequalities they are designed to address.

Demographic change makes this work more urgent, not less. Across much of Africa, Asia, and the Global South, populations are young and growing. This can be a source of economic dynamism and social innovation, but only if the right investments are made.

A young population without access to quality education, health services, and economic opportunity is not a dividend. It is a pressure point.

The question before us is not whether population growth presents challenges. It is whether we will make the investments that convert demographic potential into genuine human progress.

Domestic investment in health

The path forward requires prioritisation of domestic investment in health, including reproductive, maternal, newborn, child, and adolescent health. Financing decisions must be aligned with population needs and supported by stronger coordination across sectors, including health, finance, and planning.

At the same time, international partners have a role to play in supporting country-led strategies and ensuring that resources are predictable and aligned.

Technology and research should support these efforts, not operate in isolation from them. Expanding access to digital infrastructure, reducing the cost of connectivity, and investing in local research capacity will be essential to ensure that innovation contributes to equitable outcomes.

The cost of inaction is not borne by those who choose it. It is borne by the woman who cannot reach a health facility in time, by the adolescent girl who has no one to turn to, by the newborn who does not survive the first day of life. For their sake, and for the kind of world we want to build, we cannot afford to step back from this agenda.

Dr Louise Kpoto is the Minister of Health of Liberia

Rajat Khosla is executive director of the Partnership for Maternal, Newborn & Child Health (PMNCH).

Image Credits: Unicef.

Europe Has the Tools to Stop Paediatric RSV. Why Are So Few Countries Using Them?

13/04/2026 Andrew Ullmann & Michael Moore

Unimmunised infants are at a high risk of respiratory infections such as RSV and pneumococcal disease.

Andrew Ullmann and Michael Moore

For six decades, respiratory syncytial virus (RSV) in infants was a public health problem without a solution.

According to the European Centre for Disease Prevention and Control (ECDC), an estimated 250,000 children under five are hospitalised each year across Europe due to RSV infection, overwhelming paediatric wards each winter, and leaving families with lasting emotional and financial scars – yet clinicians have almost nothing to offer beyond supportive care.

That era is over. Since 2022, the European Union (EU) has authorised safe and effective RSV prevention tools: long-acting monoclonal antibodies for infants and maternal vaccines for pregnant women.

The European Centre for Disease Prevention and Control (ECDC) now reports that 23 EU/EEA countries recommend RSV immunisation. The science is settled. The tools are available. The tragedy now is no longer a lack of medicine; it is a lack of political will for timely access.

Troubling divide

The first few seasons of implementation have revealed a troubling divide. Some countries moved decisively and are seeing dramatic results. Others remain held back by structural barriers, political inertia, and fragmented delivery systems.

Between us, we have spent decades on both sides of this equation — one of us (Ullmann) spent eight years in the German Bundestag while holding a chair in infectious diseases; the other (Moore) served as an Independent politician for over a decade and served as Health Minister in the Australian Capital Territory.

We have made the case for public health interventions and had to decide whether to fund them. That dual perspective compels us to say plainly: the remaining barriers to RSV prevention in Europe are not scientific. They are political, structural, and communicative – and every one of them is solvable.

From left to right: Ben Deighton, Monbi Stefanova Chakma, and Dr Michael Moore at the “Communicating the Science of RSV Prevention More Effectively to Policymakers” workshop on the sidelines of the ReSViNET Conference

Europe’s first real-world seasons: a scorecard

The data from the 2023/24 and 2024/25 RSV seasons tell a clear story.

Spain set the benchmark. The region of Galicia was among the first in Europe to roll out a monoclonal antibody, achieving over 90% uptake and an 82% reduction in infant RSV hospitalisations.

The multi-country REACH study, presented at ESPID in 2025, confirmed a 69% reduction in infant RSV hospitalisations across Spain in 2024/25 compared with the pre-immunisation season of 2022/23. Crucially, once Galicia moved, other Spanish regions followed – no health authority wanted to be the one that failed to protect its children.

Italy demonstrated that rapid scale-up is achievable. A central recommendation provided political cover for regional health authorities, and the approach of starting with infants born during the RSV season before expanding to universal coverage proved effective. Lombardy’s 2024/25 campaign showed marked reductions in both emergency department visits and hospitalisations. Some Italian regions achieved coverage rates above 85%.

Germany’s first season under the STIKO recommendation was promising but incomplete. Coverage reached 54% for pre-season infants — a notable achievement for a newly introduced programme — and RSV incidence in children under one year dropped by more than half.

At the University Hospital of Würzburg, postnatal coverage reached 68%. One finding should focus minds: every severe RSV case requiring paediatric intensive care during that season occurred in unimmunised infants. Yet, a parental acceptance study at German university hospitals found that while only 14% of parents actively declined, nearly a third remained undecided. This is not an opposition problem. It is an information gap — and therefore fixable.

UK’s cautionary tale

The United Kingdom chose a different path, opting for maternal vaccination as its primary strategy. The REACH study measured a 26.7% reduction in infant RSV hospitalisations compared to Spain’s 69% with monoclonal antibodies.

Maternal vaccine uptake reached 53% overall, with some disparities: coverage among Black British-Caribbean women was as low as 28%, compared to 61% among White British women.

This is not a failure of the vaccine itself, which has demonstrated efficacy in clinical trials. It is a cautionary lesson in what happens when a single-modality strategy is deployed due to a possible lack of awareness and without adequate attention to delivery infrastructure and equity.

Participants at the workshop: “Communicating the Science of RSV Prevention More Effectively to Policymakers” on the sidelines of the ReSViNET Conference in Rome.

The barriers that data alone won’t fix

In our work with RSV advocates and public health professionals across multiple countries, we hear the same obstacles described again and again – and very few of them are about the evidence.

The first and perhaps most consequential barrier is framing. RSV is still widely perceived as a paediatric problem rather than a population-level public health issue. This distinction matters more than it might seem because it determines which budget line pays for prevention, which ministry owns the policy, and how much political capital a government is willing to spend.

When RSV is reframed as a workforce issue – parents unable to work, productivity losses, the strain on family wellbeing – and as a health system capacity issue – emergency departments overwhelmed, elective procedures delayed – the political calculus changes entirely.

The second barrier is infrastructural. Consider the Netherlands, where a high proportion of births occur at home. Midwives are typically the first point of contact in healthcare, but they are not authorised to administer monoclonal antibodies.

By the time a newborn reaches a health centre, days or even weeks may have passed – a critical window during which infants are most vulnerable to severe RSV infection.

Similar delivery pathway gaps exist across Europe, wherever immunisation programmes assume hospital-based birth as the default. One size does not fit all.

Third, terminology itself creates confusion. The distinction between vaccines and monoclonal antibodies is meaningful to clinicians but baffling to parents and policymakers alike.

In a post-COVID environment where vaccine hesitancy remains elevated, this confusion is not neutral – it generates unnecessary resistance. Countries that adopted the simple framing of “RSV prevention” rather than expecting the public to navigate technical distinctions achieved markedly higher uptake.

Finally, and this is something we can speak to from direct experience, policymakers respond to different incentives than clinicians.

A health minister facing competing demands from cancer services, cardiovascular disease, mental health, and social care will not be moved by cost-effectiveness ratios alone.

They need to understand cost savings – hospital beds freed up this winter, emergency departments decongested this season, and parents returning to work this month.

The distinction is not academic. One of us (Ullmann) observed it repeatedly in the Bundestag. Many policymakers are not really interested in a cost-effective solution. They want to know what can save money quickly. And the public health officials who write guidelines and allocate regional budgets are equally important — and far too often overlooked in advocacy strategies.

From left to right: Dr Andrew Ullmann, Roberto Adriani, and Prof Federico Martinón-Torres at the “Communicating the Science of RSV Prevention More Effectively to Policymakers” workshop on the sidelines of the ReSViNET Conference.

What the successful countries did right

The lessons from Spain and Italy are transferable, and they go well beyond the clinical evidence.

Both countries benefited from national-level recommendations that gave political cover to regional health authorities. In Spain, once Galicia published its results — crucially, not just in Spanish but also in English-language journals — other regions came under immediate pressure to follow suit. Publication strategy became an advocacy strategy.

RSV prevention through monoclonal antibodies has an unusual advantage: the impact is visible within a single season. Unlike some immunisation programmes, where benefits accumulate over years, the before-and-after effect of RSV immunisation is evident across the entire health system. Doctors, hospital managers, and nursing staff all notice when paediatric wards are less full during winter. This immediacy is a powerful tool for sustaining political commitment.

Coalition-building proved essential. Success came about when paediatricians, academic researchers, patient groups, and the media worked in concert. In Spain, sustained media coverage of RSV outbreaks created public demand that reinforced the clinical evidence. Advocates did not simply publish papers and hope for the best; they built and maintained relationships with journalists and editors over time.

And a practical insight that should not be underestimated: delivering monoclonal antibodies in the birth centre, as part of routine newborn care, removes friction. It eliminates the need to recall families, avoids missed appointments, and carries inherent credibility. When something is administered as standard care in the first days of life, parental trust follows naturally.

What Europe must do now

As we approach the 2026/27 RSV season, we see five priorities.

First, every EU/EEA country should have a funded RSV infant immunisation programme in place, either through the public health authority or through the mandatory health insurance, as applicable.

Twenty-three countries now recommend immunisation, but not all have backed that recommendation with funding.

Second, messaging must be unified and simple. “RSV prevention” should be the standard term and should be easy to implement in the health care system. Health literacy is a system responsibility, not a burden to place on parents navigating a newborn’s first weeks.

Third, delivery pathways must be designed on a country-by-country basis. Countries with high rates of home birth, decentralised health systems, or fragmented primary care need tailored strategies, not imported models.

Fourth, we must invest in advocacy infrastructure. Clinicians and public health professionals need structured support in communicating with policymakers and the media. The ability to translate science into politically compelling arguments is a skill – and one that can and should be taught. Science alone has never been sufficient to drive implementation. It takes people who can carry that science into the rooms where decisions are made, and these are parents and physicians.

Fifth, countries must commit to rapid, transparent publication of their outcomes. Spain’s early results created a demonstration effect that accelerated adoption across Europe. Every country implementing RSV prevention owes it to the continent – and to the families it serves – to publish what it finds, quickly and in English, so that the evidence base continues to grow.

The season ahead

The science has delivered. The tools are here. What is needed now is the political courage to ensure funding for these programmes, the structural imagination to deliver them across the diverse healthcare settings across Europe, and the communication skills to sustain public and political support that makes implementation possible.

Every RSV season without comprehensive prevention is a season of preventable hospitalisations, preventable family suffering, and preventable strain on health systems that are already under immense pressure. We have waited sixty years for these tools. We should not waste another winter.

Dr Andrew Ullmann is a former member of the German Bundestag (2017–2025) and professor of infectious diseases at the University Hospital of Würzburg in Germany.

Dr Michael Moore AM is chair of the World Federation of Public Health Associations’ (WFPHA) International Taskforce on Immunisation, Minister for Health in the government of the Australian Capital Territory (1998–2001), and former president, of the WFPHA (2016–2018) in Australia.

Image Credits: Alamy.

Pandemics Are Not Just Biological Crises

12/04/2026 Health Policy Watch

People typically think of pandemics in terms of their biological consequences, but science journalist Laura Spinney argues that their impact is shaped just as much by human behaviour and language.

On a recent episode of “Dialogues,” part of the Global Health Matters podcast series, Spinney joined host Garry Aslanyan to discuss the lessons of the 1918 influenza pandemic. Spinney is the author of Pale Rider: The Spanish Flu of 1918 and How it Changed the World.

She argues that despite its global ramifications, the so-called “Spanish flu” remains largely absent from collective memory. Its impact extended far beyond Europe and North America, with countries like India suffering some of the worst losses, and it influenced the course of major wars, independence movements, and even the arts.

“The 1918 pandemic accelerated the pace of change in the first half of the 20th century and helped shape our modern world,” Spinney said.

Central to this understanding is the role of language. The way a pandemic is named shapes how it is perceived, and the term “Spanish flu” is, in hindsight, a misnomer that obscures its global nature.

Naming informs how people assign blame, assess risk, and respond to a crisis. Early in the HIV epidemic, for instance, labelling the disease as “gay-related” distorted public understanding and fueled stigma.

As Spinney explains “When there is an outbreak of [infectious] disease somewhere, it has to be named quite quickly because you can’t respond to it if you can’t talk about it.”

At the same time, she suggests global health must move toward a more inclusive linguistic approach. While English dominates international discourse, relying on a single language poses significant risks in managing health crises in a multilingual world.

Listen to the full episode >>

Image Credits: Global Health Matters Podcast.

Trump’s 2027 Budget Deepens Cuts to Global and Domestic Health

10/04/2026 Kerry Cullinan

The proposed elimination of “disease-specific account” is likely to mean the end of the US President’s Emergency Plan for AIDS Relife (PEPFAR).

US President Donald Trump wants to eliminate $4.3 billion from the US government’s global health budget, including all funding for the Pan-American Health Organization (PAHO), the World Health Organization’s (WHO) regional organisation for the Americas.

His proposed budget for 2027, which needs to be approved by the US Congress, includes a 42% increase – some $445 billion – for defence, including “$1.1 trillion in base discretionary budget authority” for the Department of War.

In contrast to the lavish military budget, deep cuts are proposed to domestic health programmes, with an overall 12,5% reduction in the Department of Health and Human Services (HHS) budget.

Domestic cuts include $923 million less for HIV/AIDS, $561 million less for maternal and child health, a $576 million cut to mental health (including suicide prevention, substance use prevention and treatment) and a $872 million cut to health workforce programs.

The Centers for Disease Control and Prevention (CDC) is allocated $663.8 million, the same amount as previously and the budget claims that CDC “will play a key role in implementing an America First approach to global health to replace the functions of the World Health Organization.”

Driving these cuts is Russell Vought, head of the White House Office of Management and Budget. Vought, former vice-president of the right-wing think tank Heritage Foundation, co-authored Project 2025, the conservative blueprint for governance being followed by the Trump administration.

No money for ‘corrupt’ PAHO

When Trump announced that the US would leave the WHO on his first day in office in January 2025, he made no mention of PAHO, and US officials have continued to interact with the other 34 member states in the regional body.

However, the US has not paid its membership fees (called assessed contributions) to PAHO since 2024, and owes the body over $134 million.

In his latest budget ask, Trump describes the WHO and PAHO as “corrupt organizations [that] have shown no independence from inappropriate political influences, such as when the WHO aided in the COVID-19 coverup.”

In February, PAHO projected a 19% reduction in its 2026/27 budget, and is cutting 17% of staff. Its 2024/24 budget was $820 million, which means a $155 million cut. Measles and dengue are surging in the region, while health services in the Caribbean have been badly affected by extreme weather events.

WHO staff in the Americas region (PAHO) researching mosquitos to better understand the distribution of disease-carrying species.

No more disease-specific aid

In a death knell for the US President’s Emergency Plan for AIDS Relief (PEPFAR), the proposed budget for the US State Department will “eliminate disease-specific accounts”.

The reason given is that this will “provide the Department crucial agility to address the actual needs of each recipient country—across HIV/AIDS and other infectious diseases such as malaria, tuberculosis, and polio—to strengthen global health security and protect Americans from disease.

PEPFAR, started by Republican President George W Bush, is the US government’s most successful aid programme, credited with saving 25 million lives and preventing millions of new HIV infections.

However, the Trump budget claims 60% of its funds were “wasted”. It also makes the misleading claim that “PEPFAR funded health workers who performed over 21 abortions in Mozambique”.

The US has not allowed its foreign aid to be used to fund or lobby for abortions since it enacted the Helms Amendment in 1974.

Four Mozambican nurses, whose salaries were partly covered by PEPFAR, did not know that they could not provide abortions (which are legal in Mozambique) if they received PEPFAR funding, as previously reported by Health Policy Watch.

PEPFAR’s own compliance mechanisms identified the violation, and it took “immediate corrective action with the partner”, including ensuring that Mozambique repaid PEPFAR for the nurses’ salaries, the plan said in a statement.

Anti-contraception bias

There is no funding ask for contraception or reproductive health. The budget also contains several disparaging references to contraception, something that Project 2025 also takes issue with, preferring “natural contraception”.

The proposed budget disparages PEPFAR for “promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana.”

“The Budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance.” according to proposal.

“The United States should not pay for the world’s birth control and therapy.”

New ‘America First Global Health Strategy’ bilaterals

DRC Health Minister Dr Roger Kamba, US Charge D’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the bilateral health MOU

Included in the State Department Budget is $5.1 billion to “execute” its America First Global Health Strategy (AFGHS), the bilateral Memorandums of Understanding (MOUs) with individual countries.

“The President’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” according to the budget.

By 10 April, the State Department had signed 30 bilateral global health agreements. The latest is with the Philippines, signed on 9 April (no details available, including the amount involved).

It follows an MOU with Cambodia, the first in Asia, signed on 6 April. The US will provide $30.8 million over five years for infectious disease prevention and response capabilities, including “accurately identify pathogens of epidemic and pandemic potential before they spread internationally” and “a robust network of laboratories” aimed at eliminating malaria in Cambodia.

A day before this, a bilateral was signed with Tajikistan, the first in the South and Central Asia region, involving $38 million in US aid over the next five years to “support Tajikistan’s efforts to combat HIV/AIDS and tuberculosis, while bolstering disease surveillance and outbreak response.”

Way forward

The US Congress still needs to approve the budget and may well authorise more money, particularly for domestic health.

In February, Congress approved a $50 billion Foreign Affairs Bill, including $9.4 billion for global health for the fiscal year 2026, almost three times larger than Trump’s request for $3.8 billion.

White House budget head Vought will testify before the House budget committee on Trump’s request next Wednesday.

Image Credits: Gage Skidmore, International AIDS Society, PAHO/WHO.

Record ODA Cuts: Top Donors Slash Aid as Global Health Risks Grow

10/04/2026 Felix Sassmannshausen

Five major economic powers – led by the US – drove nearly 96% of 2025’s global aid funding reduction.

Historic declines in Official Development Assistance (ODA) have set international aid back a decade, prompting civil society warnings that the ODA cuts will further devastate funding for global health, education and social protection.

The Organisation for Economic Co-operation and Development (OECD) released preliminary data showing total global aid fell by 23.1% in real terms during 2025, marking the most severe single-year contraction ever recorded.

“It’s deeply concerning to see this huge drop in ODA in 2025, due to dramatic cuts among the very top donors,” Carsten Staur, chair of the OECD Development Assistance Committee (DAC), said in a press statement.

While a few countries exceed the United Nations target of allocating 0.7% of their gross national income to foreign aid, the world’s major economic powers have abruptly withdrawn their support. This collective retreat was highly concentrated, with five top nations driving 95.7% of the total global reduction.

German Development Minister Reem Alabali Radovan.

The United States alone accounted for three-quarters of the overall drop after slashing its budget by nearly 57%. Germany, France, the United Kingdom and Japan all reported significant decreases alongside the US, marking the first time these top providers simultaneously shrank their budgets.

This collective retreat resulted in Germany becoming the single largest global provider for the very first time, despite reducing its own overall aid by over 17%.

“Despite painful cuts, we stand by our international responsibility,” Reem Alabali Radovan, Germany’s development minister, said. “This is existential for millions of people in light of extreme global challenges, crises and wars.”

Core development and humanitarian aid slashed

Drastic ODA cuts threaten the basic survival and essential infrastructure of the world’s most vulnerable.

Beneath the headline figures, the OECD data highlights severe structural shifts that are draining funds from vulnerable countries precisely when their economic burdens are mounting.

“Fiscal pressures on developing countries are growing, and the ongoing conflict in the Middle East represents a significant risk for global growth and food security,” OECD Secretary-General Mathias Cormann said during the data launch.

According to the OECD data, vital humanitarian aid plunged by almost 36%, accelerating the reversal of a five-year growth trend, while bilateral assistance to sub-Saharan Africa fell by 26.3%. Core development programming also suffered its largest historical contraction, dropping by over 26%.

Multilateral contributions similarly faced severe constraints, declining by 12.7% overall across the international landscape. Core funding to the United Nations (UN) system experienced a 27% decline, marking the largest annual drop on record for the global body.

Global health advocates warn these broader funding contractions arrive just as major initiatives, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, face critical cuts.

Geostrategic and economic pivot reshapes aid

EU humanitarian supplies face uncertainty as European institutions pivot funding toward regional security and domestic interests.

The recent ODA cuts expose a stark geostrategic pivot, as major donors increasingly prioritise immediate regional security and domestic economic interests over broad human development. Beyond the massive volume drops from individual nations, European Union (EU) institutions accelerated this downward trajectory by reducing their overall assistance by 13.8%.

Adding to the shifting landscape, bilateral funding to Ukraine fell by 38.2%, yet when including EU institutional funds, total assistance to the nation still exceeded the combined aid given to all Least Developed Countries.

Civil society organisations warn that these institutional funding choices will inflict direct damage on fragile communities and dilute the core purpose of international cooperation.

“Though framed as part of the ‘paradigm shift’, EU Institutions and EU Member States have already been cutting grants to those who need them the most,” Mafalda Infante from Plataforma Portuguesa das ONGD said in a joint press release by Concord, a European confederation of development NGOs.

Critics argue this controversial policy shift toward mutual interests heavily disadvantages vulnerable states by increasingly designing cooperation to benefit European companies.

“In order to support the reduction of poverty and inequalities the EU should dedicate more ODA to sectors like health, education and social protection, but today’s figures show another path being taken,” the NGOs stated.

Projections remain grim

OECD projections indicate a continued decline in global aid through 2026, extending a historic downward trend.

Despite the gloomy overarching narrative, several nations have demonstrated a steadfast commitment to sustaining international development. Eight member countries actually increased their assistance in 2025, resisting the broader fiscal pressures that drove the global reductions.

Notably, Denmark, Luxembourg, Norway and Sweden continued to exceed the UN target of allocating 0.7% of their gross national income to foreign aid. Additionally, 12 non-DAC countries increased their collective development finance by 4.5% to reach $13.3 billion.

However, these non-DAC providers shifted their direct funding from multilateral contributions to country-to-country assistance. Nations like Qatar and the United Arab Emirates drove this growth, with the UAE specifically directing its bilateral funds to immediate regional development and humanitarian crises in the West Bank and Gaza Strip.

Looking ahead, the OECD projects an additional 5.8% decline in global aid for 2026, raising alarms over the international community’s ability to respond to future shocks.

“I can only plead that DAC donors reverse this negative trend and start again to increase their ODA,” DAC Chair Staur said.

Drastic UK Aid Cuts Hit Fragile African Health Systems

Image Credits: ‪Salah Darwish via Unsplash, Felix Sassmannshausen/HPW, Bundesregierung/Steffen Kugler, European Union, OECD.