An educational banner about Ebola in the DRC.

Nigeria’s first Ebola Bundibugyo patient may have crossed paths with Kenya’s recently deceased index patient at Uganda’s Entebbe Airport on 3 October, according to Dr Wessam Mankoula, head of health emergencies at Africa Centre for Disease Control and Prevention (CDC).

Mankoula told a media briefing on Thursday that this was one of the possibilities being considered by health experts who are trying to unravel how the woman in Nigeria became infected.

The Nigerian patient, identified by Mankoula as the Ugandan-born wife of a Swiss diplomat in Nigeria, flew from Uganda to Abuja while the Kenyan man flew to Nairobi’s Jomo Kenyatta International Airport.

“Has there been any touch or contact between the two cases at the airport at the same time?” This is one of the theories that is currently under investigation,” said Mankoula.

“There are a lot of possibilities. A lot of effort is going into the investigation to verify the source of the infection. So let’s avoid anticipating the investigation and try to reach a conclusion at this stage.”

Dr Wessam Mankoula, head of health emergencies at Africa Centre for Disease Control and Prevention (CDC).

Kenyans in quarantine

The Kenyan was picked up at the airport by a family member who drove him directly to Nairobi Hospital, where he died of Ebola two days’ later. Eight of his contacts, four health workers and four relatives, have since been infected with Ebola.

Mankoula said all eight patients had been in quarantine and that Kenya had traced all his known contacts. The man had spent several weeks in the Democratic Republic of Congo (DRC), which is currently experiencing the world’s fastest-growing Ebola outbreak ever recorded.

Some 118 of the man’s 135 contacts are in quarantine.

Mystery infection

But the Nigerian patient’s infection is a mystery. She visited Uganda for two weeks from mid-September, but Uganda has been declared Ebola-free since August after it contained an outbreak caused by a case imported from the DRC.

She started feeling sick on 7 October, was admitted to a health facility on 11 October, and her initial diagnosis was malaria, said Mankoula.

On 19 October, in light of her symptoms, the health facility suspected Ebola, and she was tested that day. The test confirmed Ebola, and after a follow-up test was conducted the following day, the outbreak was announced.

Forty-four of her “high risk” contacts are in quarantine in a designated facility.

Illegal crossings

Mankoula told the briefing that the land border between the DRC and Uganda was only open to trucks carrying goods and for humanitarian reasons.

“However, we’re still reporting some illegal crossings between DRC and Uganda, and one of those examples is related to this case in Kenya. He crossed the border from DRC to Uganda, and this was an illegal crossing,” said Mankoula.

He urged countries neighbouring the DRC, particularly in the north where the outbreak is centred, to ensure screening at points of entry and strong surveillance systems to detect cases that may have been asymptomatic during travel.

South Sudan, Central African Republic, Burundi and Rwanda are most at risk.

The latest figures from the DRC (20 October) showed 9,704 confirmed cases and 4,687 deaths. Ituri and North Kivu provinces still account for 94% of cases. 

Although reported cases had declined slightly since epidemiological week 37, Wessam cautioned that reporting lags, community resistance, security and operational challenges made it too early to call this a sustained decrease. 

More than 80% of cases are still coming from outside contact lists, and over half of deaths were occurring in communities.

The United Nations headquarters in New York has become a key site of anti-gender contestation.

Political opposition to sexual and reproductive health services and LGBT rights is becoming well organised – and researchers argue that its targets are central to an autocratic reorganising of society, not simply ‘culture war’ casualties. 

It has become customary for conservative member states to object to even cursory references to sexual and reproductive health (SRH), gender and sexual identity in United Nations (UN)  documents – the latest example being the United States and Iran’s complaints about phrases in the UN pandemic declaration.

But these once knee-jerk objections have coalesced in a well-organised global campaign to curtail abortion and the rights of lesbian, gay, bisexual and transgender (LGBT) people.

The US has succeeded in recruiting 47 countries to join its anti-abortion campaign, the Geneva Consensus Declaration (GCD), which was launched by the first Trump administration in late 2020. 

Trump 2.0 reassumed leadership of the GCD in August, driven by Bethany Kozma, the US Health and Human Services director of global affairs and former Trump 1.0 official Valerie Huber.

Kozma is known for far-right views, including that climate change is being used as “population control”. Huber established the Institute for Women’s Health to keep the GCD alive after Trump’s electoral defeat a few weeks after the GCD was launched, and has devoted herself to wooing First Ladies in conservative African countries.

Meanwhile, several countries have tightened anti-LGBT legislation, and last month a meeting of conservative diplomats and organisations on the sidelines of the UN General Assembly agreed to establish a “core group”, or informal caucus of UN member states to “counterbalance the influence of the UN LGBTI Core Group”.

Thousands of Hungarians protesting against anti-LGBTQ laws in Budapest during Viktor Orban’s rule in 2021.

Autocratic project, not ‘culture war’

For Central European University’s Professor Andrea Krizsan, excluding and “subordinating” women, girls and LGBT people isn’t simply a “culture war issue” – but a “fundamental part of the autocratic project”, in which the political community is reordered to create “hierarchies of citizenship”.

In 2024, autocracies surpassed democracies for the first time in 20 years, with 72% of the global population living under autocratic rule and only 12% living in liberal democracies, according to the V-Dem Institute, based at the University of Gothenburg in Germany.

Krizsan, a Hungarian academic with first-hand experience of such political reorganisation under former Hungarian Prime Minister Viktor Orban, spoke at a recent conference at Stellenbosch University in South Africa.

She identified three key tactics used to drive political reorganisation, starting with democratic manipulation. The anti-rights actors co-opt the language and institutions of democracy to establish a “hierarchy of rights” that undermines human rights and equality.

“They talk about rights of majorities, the rights of parents, the rights of the nation, rights of the foetus. They prioritise freedom of expression, academic and religious freedom over equality and human dignity,” Krizsan told the conference, “Resisting anti-gender ideology and feminist backlash”.

The second tactic involves “knowledge control”, which involves suppressing human rights initiatives, including eliminating university gender studies departments, curriculum changes, institutional restructuring, setting up new think tanks and data manipulation.

The third and final tactic is coercion, covering everything from violence to “ideological and legal harassment, criminalisation, impunity and state tolerance of attacks against activists, politicians, academics and civil society”, Krizsan explained.

‘Pure torture’ in Ghana

Ghana’s parliament passes the anti-LGBTIQ Bill

Several African countries have resorted to coercion against LGBT people. In late May, Ghana’s Parliament passed a harsh anti-LGBT law, the Human Sexual Rights and Family Values Bill, which outlaws LGBT identity as well as sexual activity.

The Bill “is a signal that queer identity is a public problem that institutions must handle”, said Solomon Atsuvia, a University of Pretoria doctoral student.

While conducting fieldwork in Ghana last year, Atsuvia uncovered instances where people suspected of being gay were assaulted, forced to fast for 21 days, isolated at their family home and made to pray on their knees for weeks on end.

One example involved Kwame (not his real name), a 28-year-old man from Accra, who told Atsuvia that his family took him to a prayer camp. 

“For three nights, he was tied to a tree so, in his words, they could ‘burn the gay spirit out of him’. He was hungry, humiliated, and terrified. What they call deliverance was actually pure torture,” Atsuvia told the conference.

Ghana is championing the reorganisation of the global health architecture through the Accra Reset, which rests on the idea of African sovereignty over its health services and products.

However, the notion is also being used to evade internationally established human rights.

“In Ghana, LGBTQ+ rights are called a Western agenda. Churches are political players. The family is the basic unit of society, not the individual, and sovereignty is used against international scrutiny [of human rights violations],” said Atsuvia.

Asserting ‘sovereignty’ to protect FGM 

African countries where female genital mutilation is practised.

Ghana is not the only country to assert national sovereignty to sidestep international human rights agreements.

Sierra Leone is using “sovereignty” to avoid outlawing female genital mutilation (FGM) despite international and regional norms and rulings declaring it to be torture and a human rights violation, according to Matilda Lasseko-Phooko from the Centre for Human Rights at the University of Pretoria.

Sierra Leone First Lady Fatima Maada Bio has refused to condemn FGM, and the practice is supported by a phalanx of national religious and cultural organisations, including the secretive Bondo and Poro societies that hold sway in the country’s politics.

In July 2025, the Economic Community of West African States (ECOWAS) Court of Justice found Sierra Leone’s government in violation of its fundamental duty to protect women and girls for failing to outlaw FGM. 

The court declared the government in breach of the African Charter on Human and Peoples’ Rights, the Maputo Protocol and the International Covenant on Civil and Political Rights and ordered it to take legislative and other appropriate measures to prohibit and prevent FGM.

But it is precisely these regional and international laws and conventions that conservative countries are trying to usurp using “sovereignty” as their defence.

“Sierra Leone has ratified relevant treaties without reservations but maintains that consenting adults may choose FGM. This position was reiterated during its 2026 Universal Periodic Review engagement,” said Lasseko-Phooko.

‘Against African culture’

US conservative Christian group Family Watch International meets with Uganda’s First Lady Janet Museveni and other government officials in April 2023 to encourage passage of a new anti-homosexuality law.

For Kenyan human rights lawyer Tabitha Saoyo, the anti-rights campaign in Africa was initially driven by Western religious groups as a colonial project to convert Africans, using religious schools and universities to cement their values.  However, it is now being driven by Western-educated Africans who aim to change Africa’s laws and policies by describing several rights as “against African culture”.

“Many of today’s anti-gender actors in Africa started with the conditioning that happened at the [Catholic] Strathmore schools [in Kenya] and similar schools across Africa,” Saoyo told the Stellenbosch conference.

The influential US and European anti-rights groups that used to initiate anti-rights action on the continent now act as “advisors” to their African proteges. Some have established offices on the continent, including alongside the African Union (AU) in Addis Ababa, Ethiopia (Family Watch International) and the African Court of Justice in Arusha, Tanzania (Ordo Iuris).

They have assisted in drafting the African Charter on Family, Sovereignty and Values, a conservative challenge to the Maputo Protocol, which commits countries to eliminating “all forms of discrimination against women”, including FGM and child marriage, and allowing abortion “in cases of sexual assault, rape, incest”, and when the pregnancy “endangers the mental and physical health of the mother or the foetus”.

Conservative MPs across the continent want to put their charter to the AU for adoption as early as next year.

Conservatives want a “shift from rights-based governance to values-based regulation, where sovereignty, family, culture and religion are used to weaken substantive rights protections”, explained Sibongile Ndashe, executive director of the Institute for Strategic Litigation in Africa (ISLA).

Several African countries, including Senegal, Burkina Faso, Uganda, and Ghana, have also introduced anti-LGBT laws as distractions as they face elections or economic challenges. 

Sovereignty and the Geneva Consensus Declaration

Pablo Quirno, Argentina’s Minister of Foreign Affairs, International Trade and Worship and US official Bethany Kozma, at Argentina’s signing of the Geneva Consensus Declaration.

Asserting national sovereignty is also one of the pillars of the Geneva Consensus Declaration, which asserts that there is “no international right to abortion”.

While no international treaty explicitly establishes the right to abortion, the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which came into force in 1981, sets out the right to reproductive choice and access to “family planning” services.

The World Health Organization (WHO) has also established that removing restrictions on abortion results in the reduction of maternal mortality.

The GCD’s 47 signatories include several authoritarian regimes with repressive policies towards women, girls and LGBT people.

Several GCD signatories allow, or turn a blind eye to, FGM, including the Gambia, Sudan, Djibouti and Egypt. At least 14 allow child brides, including Bahrain, Burkina Faso, Haiti, Iraq, Niger, Pakistan, Qatar, Russia, Senegal and parts of the United States.

Meanwhile, a group of NGOs calling itself the Global Coalition for Women’s Health, the Protection of Life, and the Family was launched on the sidelines of UNGA to support the Geneva Consensus Declaration and promote its aims across the UN.

The coalition is convened by four US conservative groups that have actively promoted anti-abortion, anti-LGBT measures globally: the Center for Family and Human Rights, Family Watch International, the Institute for Women’s Health, and the Heritage Foundation.

What is next?

Earlier this month, 52 nations supported a French statement to the UN Human Rights Council (UNHRC) declaring that “the criminalization of consensual same-sex conduct is incompatible with the fundamental principles of international human rights law.”

However, UNGA recently elected a new 15-member UNHRC, including five countries that criminalise LGBT activity – Burundi, Ghana, Kuwait, Nigeria and Zambia.

Melanie Nathan, executive director of the African Human Rights Coalition, said it is “unconscionable that governments criminalising LGBTI people are entrusted with protecting human rights worldwide. A seat on this Council should demand accountability, not provide a cloak of legitimacy.”

Ipas, a global SRHR organisation, has documented the growing trend of UN member states “advancing anti-gender goals in the UN’s unexpected spaces”, noting that the number of UN member states attacking gender in these has grown to 15 times what it was in 2019.

It urges governments to train diplomats on gender equality and human rights, and how to respond to anti-gender tactics. It also advises feminist advocates to build broad partnerships with other social justice and human rights movements, and support government delegations to counter

Image Credits: Wikimedia Commons, Lydia Gall/ Human Rights Watch, FGM/C Research Initiative, US HHS.

As climate change accelerates, millions of pregnant women and newborns face growing health risks from extreme heat. UN climate chief Simon Stiell warned at the pre-COP ministerial meeting in Fiji this month that pregnancy and birth are now “a new fault line in the global climate crisis.”

Countries should watch for spikes in preterm births, stillbirths and child deaths during heatwaves, four UN agencies said on Wednesday, launching what they called the first global set of indicators to help governments track the health toll of extreme heat on mothers and newborns.

The 19 indicators from the World Health Organization (WHO), the World Meteorological Organization (WMO), UNICEF and the UN Population Fund (UNFPA) range from preterm births and clinic visits to air temperature readings and whether health ministries include mothers and children on their climate task forces.

Matched with weather data, routine hospital and clinic records can help health officials prepare for patient surges, sharpen warnings to pregnant women and pinpoint the communities most at risk, the agencies said. Over time, they should also reveal how heat harms mothers and babies as heatwaves grow longer, more frequent and more severe.

“Heat is already affecting our most vulnerable populations, including pregnant women, newborns and children,” said Dr Pascale Allotey, director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing. “But what health systems do not count, they cannot respond to.”

“By tracking outcomes such as preterm birth, child deaths and illnesses, and health-facility visits alongside heat exposure, countries can identify potential impacts and take action to protect women and children,” Allotey added.

An estimated 1.5 billion children are exposed to heatwaves that are becoming more frequent, longer or more severe, according to the agencies. Babies under one experienced 389% more heatwave days per person in 2024 than the 1986–2005 average, according to the Lancet Countdown.

Heatwaves raise the odds of preterm birth by 26%, a 2024 meta-analysis of 198 studies across 66 countries found. Complications of preterm birth are the leading cause of death in children under five, according to WHO.

“Many countries lack practical guidance on which health indicators to track, how to interpret trends alongside heat exposure data, and how to integrate these considerations into routine monitoring systems,” senior officials from WHO, WMO, UNICEF and UNFPA wrote in a joint foreword to the report.

The indicators are not meant to prove cause and effect, but offer “a practical starting point for identifying trends, signalling potential impacts, and informing action,” the officials said.

“What remains constant, however, is the need to ensure that women, newborns and children are visible in climate and health monitoring efforts and that their needs are reflected in policies and programmes,” they wrote.

Mothers and newborns missing from heat plans

The new indicators land the same week UNEP confirmed the world is on track for 2.8C of warming this century. That level of warming would push about 2 billion people – and the mothers and newborns among them – into regions with average annual temperatures of 29C or higher.

Research on extreme heat’s effects on pregnancy and newborn health has expanded quickly in recent years, yet monitoring has lagged because of uncertainty over which outcomes heat affects most, the agencies’ joint report says.

A 2025 WHO-commissioned review of 83 heat-health action plans from 24 countries found only 52% named pregnant women as an at-risk group, while 39% named newborns and 14% postpartum or breastfeeding women. None comprehensively addressed the risks to mothers and children during extreme heat, and monitoring mechanisms were inadequate to assess heat’s impact on them. 

The review also found no plans from low-income countries, where a woman faces a 1 in 66 lifetime risk of dying from a maternal cause, compared with 1 in 7,933 in high-income countries, according to WHO data.

Only 3% of studies on heat and pregnancy come from low-income countries, compared with 63% from high-income countries and temperate climates, according to the International Confederation of Midwives (ICM), which took part in talks that shaped the indicators.

ICM also cites a WHO survey of member states that found 80% of countries mention heat in their national health adaptation plans, but only 30% include concrete actions and just 2% explicitly mention actions for mothers, newborns and children.

“As our world continues to heat up, it creates new risks for health, and older people, pregnant women, newborns and children are among those least able to escape them,” said Bruce Gordon, acting director of WHO’s Department of Environment, Climate Change, One Health and Migration. “Our health systems need the data to recognise this reality and take action.”

What countries are asked to track

Preterm births and outpatient visits form the core of routine monitoring. Both are read against air temperature, the baseline heat measure recommended for every country. Measures that also factor in humidity, such as the heat index and wet-bulb globe temperature, are optional.

Countries are also urged to watch for hypertension in pregnancy, late stillbirths, low birthweight and under-five deaths in facilities, and to break down deaths and emergency visits during heat events by age and sex, while tracking school attendance can show how heat disrupts children’s lives, the agencies said.

Six more indicators in the report test whether governments are following through with policy and monitoring. They include whether vulnerability assessments treat women and children as distinct at-risk groups and what share of local health authorities receive heat early warnings.

WHO also urged all countries to develop heat-health action plans that meet the needs of pregnant women, newborns and children, strengthen early warning systems and trigger timely action when heat risks emerge.

“Measurement drives action,” the officials wrote in their foreword. “By strengthening our ability to monitor the impacts of heat on maternal, newborn and child health, we can better protect those at greatest risk.”

Image Credits: Wellcome Trust.

The ministerial panel at Abu Dhabi’s ‘Advancing the Future of Health’ conference, with Greek Health Minister Adonis Georgiadis, UAE Minister of Health and Prevention Ahmed bin Ali Al Sayegh and Jordan’s Minister of Digital Economy and Entrepreneurship Sami Smeirat.

At the Abu Dhabi Future Health Summit, ministers and officials from Greece to Jordan lined up to learn from the emirate’s bet on genomes, wearables and artificial intelligence. Away from the main stage, the clinicians and engineers building these systems were more candid about consent, price and proof.

ABU DHABI – Greece’s health minister did not hide his envy. “I always say UAE lives in the 22nd century. We still are in the 21st,” Adonis Georgiadis told the opening session of the Abu Dhabi Future Health Summit on Tuesday (20 October). 

On genomics, he was blunter still: “We’re practically zero, to be honest.”

Georgiadis had come, he said, to learn how the Emirates plans to use the genome to know “far faster what is going to happen”. He was not the only visitor shopping for a model. The three-day summit, convened by Abu Dhabi’s Department of Health (DoH) under the theme “To Sense is to Predict”, drew participants from about 100 countries, with health ministers from Armenia, Egypt, Montenegro, Kosovo and Colombia expected to attend.

Health systems everywhere wait for people to fall ill and then try to fix them. Abu Dhabi wants to use genomes, connected health records, wearables and AI to spot risk years earlier and act before disease takes hold. 

“The next chapter of health will be defined by our ability to act earlier,” DoH Undersecretary Dr Noura Al Ghaithi said ahead of the summit.

For readers in Lilongwe, Dhaka or La Paz, the more useful questions are about what sits underneath that promise. Who owns the data that makes prediction possible? Who pays for it? Does it reach the foreign residents who make up nearly nine in ten of the UAE’s population? And what, if anything, can a ministry with a fraction of Abu Dhabi’s budget take home?

Greece’s Health Minister Adonis Georgiadis.

‘More years in good health’

UAE Minister of Health and Prevention Ahmed bin Ali Al Sayegh set out the national version of the plan: “In simple words, the future really means more years in good health,” he told the opening panel.

His country is building what he called “an approach we call Healthy UAE”, rooted in a national public health and wellbeing strategy that would reach “beyond healthcare”. 

“This is the first time we really look at public health and well-being across the UAE,” he said, describing it as a response to a presidential call to link all of the country’s medical systems. 

The minister also gave a new figure for the Emirati Genome Programme, which he said “has covered almost 920,000 people”. Reports are now being prepared for those who agreed to receive their results. 

“Those at risk will receive a personalized action plan, which they can visit their primary family doctor to go through further testing and arrive at a preventative action plan for their disease,” Al Sayegh said.

“It’s heading towards a personalized approach to each one of us. And that’s something that’s doable today if we have the data and if we have the resources.”

Georgiadis, who described medicine since Hippocrates as “dealing the disease as the firefighter dealing the fire”, was frank about the money. 

“The resources you have as ministers of health are never enough,” he said. “To find a way to use our resources in a more efficient way is the only way out.”

Greece has moved fast on the digital basics. Georgiadis told the conference that 11 million Greeks now carry their medical records on the MyHealth app and that the national screening drive had examined 6.8 million people. 

UAE Minister of Health and Prevention Ahmed bin Ali Al Sayegh

Changing tyres at full speed

Jordan offered the clearest example of what the Abu Dhabi model looks like when it travels. Jordan’s Minister of Digital Economy and Entrepreneurship, Sami Smeirat. described the work as “basically like changing your tyres while racing your race car. That is how difficult it is.”

“Medicine is governed by protocols, procedures that have matured over years and years and hundreds of years,” said Smeirat. “And coming to them and trying to do changes overnight is not an easy task.”

Jordan’s Digital Health Centre in Salt, funded by the Abu Dhabi Fund for Development and built with M42’s Abu Dhabi Health Data Services and G42’s Presight, now links dialysis and intensive care units in 12 public hospitals and radiology in 19. 

By July, it had monitored more than 55,000 dialysis sessions and issued more than 45,000 radiology reports, according to Jordan’s Royal Hashemite Court.

On stage, Smeirat said mortality in the remote ICU had dropped from 14% to around 2–3%, a figure Health Policy Watch could not find in published sources. “This is sensing at its best,” the official said. “When you provide remote sensing, then you drop mortality.”

Jordan’s Minister of Digital Economy and Entrepreneurship, Sami Smeirat.

Who owns a million genomes?

Data is the fuel for all of this, and Abu Dhabi has a great deal of it. Its health information exchange, Malaffi, held 3.5 billion clinical records and 12.7 million patient profiles by August 2025. 

A Future Health white paper with EY, released on the eve of the summit, says more than 900,000 genomes had been sequenced by June and that about 660,000 participants’ data sit inside a government-run Trusted Research Environment, where companies and researchers can analyse the data without taking it away.

The rules are tight on paper. Under the DoH policy for that environment, raw genome files are never released and the encryption keys “must be under the exclusive control of DoH”. 

UAE federal law bars health data from being stored or transferred outside the country unless the health authorities allow it. On the question of who owns it, DoH’s 2022 draft policy on genomics is unambiguous: “Data ownership belongs to the UAE government.”

However, Dr Angela George, clinical director of genomics at London’s Royal Marsden, which is helping Dubai Health to develop the Hamdan Bin Rashid Cancer Hospital, said that patients should own their data.

“And I think there is a responsibility to use this information appropriately,” George told Health Policy Watch. 

Asked about middle-income countries that lack the capacity to regulate private and AI companies moving into health, she did not single out any country, but her worry was plain. 

“There has to be some eye to the regulatory oversight, because that’s also how you protect people,” George said. “This should not be something where people are harvesting other people’s genetic data to make money, and I worry about some of what is going on in some other countries. … So I think we have to be really careful about how this is used.” Large population programmes, she added, could have “enormous power” if used appropriately.

Populations missing from the data

George also made the case for why population genome programmes in under-studied regions matter well beyond them. Genomic science has been built overwhelmingly on people of European descent. As of mid-2021, 86.3% of participants in genome-wide association studies were of European ancestry, according to a roadmap published in Nature Medicine. 

Arabs, about 5% of the world’s population, account for roughly one in 600 participants in genome-wide studies of common disease.

“It is really important that we actually map the genomes from these other countries as well, because there are differences in diseases, there are differences in how things like cancer behave,” George said. “It is really clear to me as a clinician that my patients from different ethnic backgrounds will develop slightly different side effects … for different drugs.”

Her own work suggests the gap is not only about money. She directed the Royal Marsden’s Mainstreaming Cancer Genetics programme, which moved BRCA testing for women with ovarian cancer out of specialist genetics clinics and into routine cancer care, cutting waiting times for results from 12–15 weeks to about four. 

The approach was then tested in Malaysia, a country with very few genetic counsellors. “So actually we know that it does [work], because we ran the same program in Malaysia,” she said. The MaGiC study, of 790 women at 23 sites, found that 80% took up testing when oncologists offered it, against 79% when genetics specialists did.

Price is the other barrier. George said a large DNA panel on a tumour costs “a few hundred pounds” at NHS-approved prices in her lab, and a liquid biopsy closer to £1,500. 

Tests from some commercial companies, she said, “can cost upwards of £3,500, £5,000. So I think there is a bit of a wild west sometimes.” Depending on the market, “there aren’t necessarily controls on price”.

‘Pura already knows everything about you’

PureHealth’s Pura health app enables citizens opt in to share their medical records. They can also contact health professionals.

The same questions follow data into consumer apps. At the PureHealth stand, the state-linked group that owns the SEHA hospital network, a senior AI engineer for its health app, Pura, explained its selling point. “The main differentiator here is that Pura already knows everything about you,” the engineer told Health Policy Watch.

Users who sign in with the national digital identity, UAE Pass, and consent to share their records get “hyper-personalized suggestions” drawn from their hospital files, the engineer said. 

Visitors without UAE Pass can answer onboarding questions and upload their own blood tests instead. 

The app offers meal plans, exercise plans and answers to health questions, but “strictly within the boundaries of not diagnosing something or not recommending you medication to take”. 

Asked how many patient records sit behind those suggestions, the engineer said that was a technical question, adding: “We have a lot of data with us, since we are integrated with all these hospitals, which we use to train our AI.”

Pura’s App Store listing advertises an AI health assistant and “smart insights” drawn from wearables and SEHA medical records. Health Policy Watch could not find a published document setting out whether, and under what consent, patients’ hospital records are used to train the company’s AI models.

Deals, drugs and a shifting map of research money

The summit was also a marketplace. On 21 October, DoH signed an agreement with Isomorphic Labs, the AI drug discovery company that grew out of Google DeepMind, to work inside Abu Dhabi’s secure research environment; a 24-month heart and metabolic health study with the wearables firm WHOOP; and an agreement with Cleveland Clinic Abu Dhabi and AstraZeneca to explore the feasibility of up to 30 clinical trials by 2030, worth an estimated AED 180 million (US$50 million). 

Mubadala Bio and Eli Lilly announced they would localise packaging and logistics for Lilly’s GLP-1 medicines in the emirate.

Sanofi signed a memorandum with DoH in June to explore a Vaccine Innovation Centre in Abu Dhabi covering AI-enabled vaccine design, mRNA research and clinical manufacturing. 

It follows a 2025 agreement, signed by Baptiste de Clarens, Sanofi’s vaccines head for the Greater Gulf, that, in his words, “allows us to examine how Sanofi’s experience in vaccine development could complement Abu Dhabi’s growing R&D ecosystem”. Both texts still speak of exploring; no budget, site or timeline has been published.

The talks come as traditional funders pull back. In August 2025, the US Department of Health and Human Services cancelled or scaled back 22 mRNA vaccine projects worth nearly US$500 million, and Washington said it would withhold its US$1.58 billion pledge to Gavi. 

Stanford’s Prof Jeffrey Glenn, whose ViRx@Stanford programme is building antivirals for the next pandemic on the premise that “even the fastest vaccine takes one year to deploy”, was among the summit’s speakers. 

In the TOGETHER trial, a single dose of interferon lambda, a drug that grew out of his lab’s work, cut hospitalisations and long emergency visits among Covid-19 patients by about half.

Can prediction reach the poor?

For lower-income countries, the risk is that prediction becomes another layer of care that only the rich can use. 

Dr Jayasree Iyer, chief executive of the Access to Medicine Foundation, came to the summit with two decades of data on how far medicines actually travel. 

In the foundation’s last published Index, only 43% of clinical trials by the largest drug companies took place in the 113 low- and middle-income countries it covers, which are home to nearly 80% of the world’s people. 

Its March AMR Benchmark found that in 17 sub-Saharan African countries, none of the companies assessed had registered a child-friendly version of any of their antimicrobials. “We can tilt the battle against superbugs in humanity’s favour,” Iyer said then.

Some of the most convincing prediction tools on show were also the cheapest. VectorCam, built at Johns Hopkins and taken to scale by Vector Control Innovations, turns a basic smartphone into a mosquito identifier for village health workers in Uganda, where malaria surveillance has long depended on a handful of entomologists. 

“Every district just has one entomologist,” Prof Peter Waiswa of Makerere University said when the scale-up was announced. “The app does it in 20 seconds using computer vision.” 

The tool is now being rolled out in 14 districts under Uganda’s malaria programme, just as US funding cuts have ended 80% of USAID awards with malaria activities.

ThinkMD, which won the $200,000 first prize in Future Health’s global innovation challenge earlier this year, gives offline clinical decision support to more than 9,000 frontline workers in 885 facilities. 

BlueDot’s Dr Kamran Khan, whose system flagged a cluster of unusual pneumonia cases in Wuhan on 31 December 2019, has long argued that early warning is about speed. “What I learned during SARS is, let’s not get caught flat-footed; let’s anticipate rather than react,” he said in 2020.

The test ahead

A small, wealthy state is trying to rebuild a health system around early warning when the traditional donors of global health are cutting back. If it works, its tools, data rules and failures will shape what other countries copy. 

If its benefits stay with a small group of citizens and paying clients, it will become another example of the global health divide it says it wants to close.

Three things will show which way it goes: who controls the genomes, whether patients see what their data earns, and whether the next generation of tools is built for a nurse in Uganda as well as a clinic on Saadiyat Island.

Georgiadis, for one, has set himself a deadline. “And after three years, I’ll be here again to see what we’ve really done with you, with your cooperation,” he told his hosts

Image Credits: Abu Dhabi Ministry of Healthh, Abu Dhabi Ministry of Health.

Who will steer the World Health Organization through its next chapter? Explore Health Policy Watch’s daily series examining the platforms, records, and institutional hurdles facing each contender for WHO Director-General, continuing today with Dr Hans Kluge. Access all candidate profiles on our dedicated election site.

Kluge assesses emergency operations at Mechnikov Hospital in Dnipro in 2022.
Kluge (right) has extensive experience in crisis management in conflict zones. Here, he is assessing emergency operations at Mechnikov Hospital in Dnipro (Ukraine) during Russia’s ongoing invasion in 2022.

Nominated by Belgium, Dr Hans H. Kluge enters the contest for WHO Director-General after a career spanning frontline missions to leading WHO’s 53-nation European region through COVID-19 and the war in Ukraine. Re-elected as regional director in 2024, the Belgian physician brings a quarter-century of WHO insider experience to an election defined by severe financial contraction and geopolitical strain.

Rather than adopting the bureaucratic caution typical of senior WHO leadership, Kluge grounds his campaign in a direct critique of the agency he serves. In his election manifesto, “Rebuilding the World Health Organization Together”, he positions himself as WHO’s “biggest advocate, yet also its most candid critic.”

However, his central challenge will be proving that a 25-year institutional insider can convincingly dismantle WHO’s bureaucratic inertia, while reassuring Global South member states that a European candidate can deliver genuine decentralisation and equity.

Four reform pillars and a primary care signature initiative

Kluge’s platform champions regional biomanufacturing and voluntary technology transfers to bridge North–South divides in pathogen benefit-sharing negotiations.
Kluge’s platform champions regional biomanufacturing and voluntary technology transfers to bridge North-South divides.

Kluge’s campaign platform centres on the argument that WHO must undergo structural reform to preserve its technical authority and political neutrality in an increasingly multipolar world. Bluntly characterising the organisation as “overstretched, under-focused, overly bureaucratic, with rising inefficiencies, fragmented financing and complex governance,” Kluge was the first of the now seven candidates to present an ambitious platform for structural renewal.

To move beyond what he terms “yesterday’s model,” his campaign articulates four foundational pillars of institutional restructuring – modern governance, sustainable financing, a networked “One WHO”, and workforce modernisation – designed to support four substantive global health priorities.

His core operational commitments focus on:

  1. Devolving Geneva’s power: Kluge promises to shift operational weight and financial resources away from Geneva towards country offices and regional structures. A compact headquarters will focus strictly on core normative functions and global standards. To reduce administrative overhead, he advocates leveraging national public health institutes and WHO Collaborating Centres, while deepening ties between regional directors and WHO representatives to create interregional networks linking nations facing shared challenges.
  2. Overhauling the funding model: To address chronic underfunding and donor earmarking, Kluge commits to securing the agreed baseline of 50% assessed contributions while expanding flexible, multi-year voluntary funding aligned with member state priorities.
  3. Modernising governance: Kluge pledges a review of the governing body working methods within his first months in office to streamline decision-making. Explicitly referencing Global South reform frameworks like the Accra Reset, he aligns his platform with core calls for health sovereignty, domestic resource mobilisation, and expanded regional manufacturing and pooled procurement capacity. To ensure smaller and vulnerable nations are not sidelined, he advocates for affordable technology tailored to low-resource settings, proposes appointing a WHO special envoy for Small Island Developing States (SIDS), and seeks to scale up regional support mechanisms.
  4. Workforce and organisational modernisation: Updating WHO’s human resources framework, Kluge commits to enforcing zero tolerance for harassment, improving geographic representation, and upskilling staff in artificial intelligence and emotional intelligence. Crucially, his updated platform emphasises that retaining healthcare workers requires professional development, improved working conditions, and family support, rather than relying solely on pay adjustments.

These structural pillars support four substantive health priorities: strengthening health security, tackling the triple health agenda (maternal/child health, infectious diseases, and NCDs), framing disease prevention as a core economic policy, and advancing universal health coverage (UHC). To turn prevention into economic strategy, Kluge calls for lifting the current 2-3% budget allocation for primary prevention into broader fiscal planning, explicitly integrating youth mental health and social media impacts, while establishing national workforce investment compacts with the International Labour Organization (ILO) and the Organisation for Economic Co-operation and Development (OECD).

Uniting these priorities, primary health care (PHC) serves as his signature initiative heading into the 50th anniversary of Alma-Ata in 2028, backed by a unified PHC data dashboard and responsible frontline medical AI. Finally, his health security agenda introduces three concrete protection mechanisms for health workers in conflict zones: a head-of-state coalition, an independent WHO rapporteur, and a “Park of Remembrance” at Geneva headquarters.

Seventeen years at WHO European region, shaped by crisis response

WHO’s European office in Copenhagen: Kluge’s executive track record rests on his Copenhagen tenure.
WHO’s European office in Copenhagen: Kluge’s executive track record rests on his Copenhagen tenure.

This focus on the security of healthcare personnel in conflict zones is forged by Kluge’s own formative experiences on the humanitarian front lines.

Born in Belgium in 1968 into a family of medical professionals, Kluge qualified in medicine, surgery, and obstetrics at the Catholic University of Leuven in 1994 before specialising in tropical medicine at the Institute of Tropical Medicine in Antwerp. Following a brief period as a general practitioner in Belgium, he joined Médecins Sans Frontières (MSF), coordinating frontline emergency health interventions during civil conflicts in Liberia and Somalia.

He subsequently moved to the post-Soviet region to direct tuberculosis control programmes across Siberian prisons, joining WHO in 1999 at its Moscow office as head of the TB and TB-HIV Project. Serving in Myanmar from 2004 to 2009, he co-created the $100 million Three Diseases Fund to preserve HIV, TB, and malaria care following the Global Fund’s withdrawal, safely bypassing state payment barriers to initiate the country’s first multidrug-resistant TB treatment programme.

In 2009, Kluge transferred to the WHO Regional Office for Europe in Copenhagen, and was appointed as director of health systems and public health in 2010. In this role, he worked directly with Greece to preserve primary healthcare services during the European debt crisis and coordinated implementation of the 2018 Astana Declaration on Primary Health Care.

Leveraging a multilingual diplomatic profile – he is fluent in English, French, German, Russian, and Dutch – Kluge was appointed regional director for Europe in 2019 and unanimously re-elected for a second term in 2024. Under his leadership, Kluge guided 53 Member States through the COVID-19 pandemic, mpox outbreaks, and the health crisis arising from the war in Ukraine, while establishing the Pan-European Commission on Climate and Health to build community resilience against extreme weather.

Uphill battle for a European candidacy

While Kluge’s track record in Copenhagen speaks to his standing as a capable regional executive, his candidacy sits at the intersection of European financial support and shifting multilateral dynamics.

Following the withdrawal of the United States, European member states collectively represent WHO’s most vital public funding base. Belgium itself has demonstrated financial stability: while its overall recorded envelope contracted slightly from $28.15 million (2024-2025) to $25.32 million (2026-2027) due to lower earmarked voluntary contributions, Brussels actively increased its compulsory assessed dues from $9.51 million to $10.65 million and maintained steady, flexible Core Voluntary funding ($9.41 million, up from $9.30 million).

However, translating this donor stability into votes at the World Health Assembly and across the Global South in particular remains Kluge’s central campaign challenge, as competing candidates from the Eastern Mediterranean, South-East Asia, African and Western Pacific regions push for leadership.

This is further complicated by Belgium’s prominent footprint in United Nations executive leadership – highlighted by former Prime Minister Alexander De Croo assuming leadership of UNDP in December 2025 – and compounded by diplomatic reservations toward Europe amidst broader North-South equity divides over technology access and historic Western dominance of multilateral governance.

Struggle for credible reform from the inside

Dr Hans Kluge's bid for WHO Director-General tests whether a veteran insider can convincingly deliver institutional reform.
Kluge’s bid for WHO director-general tests whether a veteran insider can convincingly deliver institutional reform.

Crucially, Kluge must overcome fundamental questions regarding his status as an established institutional insider. Having served as WHO regional director for Europe under Dr Tedros Adhanom Ghebreyesus since 2020, he has participated directly in shaping the administrative and leadership structures he now pledges to overhaul.

Notably, the controversy surrounding the withdrawal of WHO Europe’s report on Italy’s early COVID-19 response raised lasting questions regarding how his leadership would insulate public health data and technical evaluations from political and administrative leverage.

Navigating such political friction is already central to his executive record. His diplomatic engagements with senior Russian officials following the 2022 invasion of Ukraine triggered sharp backlash among Ukrainian officials as well as Baltic and Nordic delegations, who argued that the high-level contact crossed red lines of political legitimisation. However, senior European officials, speaking to Health Policy Watch on condition of anonymity, defended the outreach as pragmatic diplomacy essential for maintaining vital technical health channels and humanitarian dialogue.

Beyond these broader political hurdles, Kluge faces scrutiny regarding the concrete operational realism of his reform roadmap. Like other candidates, he must prove that shifting financial and operational weight to country offices can work despite heavily earmarked voluntary funding, while demonstrating how new mechanisms – such as appointing an independent WHO rapporteur to monitor facility attacks – can avoid introducing further political friction into WHO’s technical mandate.

Global outreach to assemble a cross-regional coalition

Kluge attends the WHO Regional Committee for the Eastern Mediterranean, engaging regional health leaders as part of his global campaign tour.
Kluge (fourth from left) attends the WHO Regional Committee for the Eastern Mediterranean, engaging regional health leaders as part of his global campaign tour.

Following his transition to formal campaign leave in August, Kluge launched an intensive global campaign tour to assemble a cross-regional coalition beyond his European base. This international itinerary – taking him across East Asia, North America, and the Middle East and Latin America – prevented his in-person attendance at the World Health Summit candidate exchange in Berlin.

Rather than conducting routine courtesy calls, he engaged in direct caucusing across key geopolitical caucuses: signalling efforts to re-engage the United States through meetings in Washington with National Institutes of Health Director Dr Jayanta Bhattacharya on lives-saved metrics and AI governance; presenting his manifesto to 15 Eastern Mediterranean Member States in Cairo on country-first delivery in fragile settings; endorsing the Accra Reset and voluntary mRNA technology transfer in Beijing and Haikou with Chinese health leadership; and reviewing frontline crisis response with Central American delegates in Panama.

Ultimately, pitching himself as “WHO’s biggest advocate, yet also its most candid critic”, Kluge presents member states with a central question: whether a veteran insider can deliver genuine structural reform from within, or whether his background represents institutional continuity at a time of severe financial and governance challenges.

Note: Health Policy Watch reached out to Kluge and his campaign for comments but had not received a response by the time of publication. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, WHO/Adam Mørk, Hans Kluge/LinkedIn.

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.

The window to hold global warming below 1.5ºC has closed, and greenhouse gas emissions must nearly halve within a decade to keep the chance of limiting peak warming to 1.8C in reach, the UN Environment Programme (UNEP) declared on Wednesday.

In its annual Emissions Gap Report, which tracks the gap between where countries’ pledges put global emissions and the levels needed to stay below certain warming thresholds, UNEP for the first time dropped the premise that staying below 1.5ºC of warming was possible if deep and rapid emissions cuts took place.

With fossil fuel emissions and infrastructure both still expanding as the US exits the Paris Agreement, and the 67 new climate pledges submitted over the past year having a “near-zero impact” on expected warming in the face of the nearly 6% annual cuts required, the agency has flipped its framing to attaining the “lowest possible” overshoot.

“The chance of holding global warming to below 1.5ºC with no or limited overshoot is gone,” UNEP chief Inger Andersen said. “We climate procrastinated, and accordingly, we are now saying that this window has closed.” 

“Nations must understand that the point of return begins now. Not later – now,” she added.


The report finds that cuts of 18% by 2030, 45% by 2035, and 69% by 2040 – all from 2025 levels – and the removal of some 320 billion tonnes of CO2 from the atmosphere by 2100 are required to limit peak warming to 1.7-1.8ºC around 2050, before returning to 1.5ºC by the end of the century.

In their current state, fully delivered national climate plans (NDCs) – the emissions targets each country must update every five years – submitted by nations under the Paris Agreement would cut emissions just 5-8% by 2030 and 11-15% by 2035.

Under current policies, warming is tracking towards 2.8ºC, UNEP said. This emissions trajectory leaves the world with a 6% chance to hold warming below 2ºC this century and a one-in-four chance of exceeding 3ºC.

"The world can no longer avoid overshooting the 1.5º limit. And the consequences are already devastating," UN Secretary-General António Guterres said in his final remarks on UNEP's flagship report before his term ends in December. "Deadly floods. Brutal heatwaves. Raging wildfires. Lost lives. Crippled economies.”

"Those least responsible are suffering first and worst," Guterres added. "The emissions gap is now a leadership gap. And the world is running out of time and excuses to close it."

Emissions outlook worsens as US exits Paris

Contributions to the increase in GHG emissions (excluding LULUCF) in 2025 of the six largest emitters, the other G20 members, the rest of the world, and international transport.

Projected warming under the full delivery of NDCs scenario is up 0.2-0.3ºC from last year's report, to 2.6-2.7ºC. The scenario assuming the full delivery of net-zero pledges also increased to 2.1ºC, up from 1.9ºC.

Both rises are driven largely by a wholesale deletion of US commitments to climate action under Trump, who has described climate change as "the greatest con job ever perpetrated on the world". 

The US climate plan and Washington's former net-zero target were both struck from the calculations, accounting for about half of the rise under the NDC scenario, with revised historical emissions data making up the rest.

"We completely scrapped the NDC emissions scenario projections and assumed that the US will follow the current policy projections under the current administration's policies," Takeshi Kuramochi of the University of Tokyo, a lead author of the report, told reporters.

Projections of global warming under the pledge-based scenarios assessed in the report.

The US State Department, noting that its country’s exit from the UN climate convention will take formal effect in February 2027, inserted a disclaimer – as it did last year – that the US "does not support the Emissions Gap Report, does not endorse or agree with its analysis or conclusions, and has not provided comments to this report."

The US also posted the largest emissions increase of any country in 2025, adding 133 million tonnes of CO2 equivalent as electricity demand, driven in part by mass data centre expansion to fuel the AI boom, rose and coal power rebounded, with the Trump administration using emergency orders to delay coal plant closures.

"The climate impacts will not shield anyone," Andersen said when asked for her message to Washington. "We are seeing and will continue to see impacts on every nation on the planet, including the US."

Türkiye, host of next month's COP31 summit in Antalya, recorded the second-largest increase at 24.4 million tonnes, followed by Iran (18.9 million) and Indonesia (17.4 million). China's emissions rose by 17.2 million tonnes. International shipping and aviation together added 44.9 million tonnes, more than any country except the US.

Every five years of delay adds 0.1ºC to peak warming

Overall, global emissions held roughly flat in 2025, as lower wildfire and land-use emissions masked the continued growth in fossil fuel CO2.

"This is similar to the level in 2024, which is a welcome divergence from a growth trend of past decades," said Anne Olhoff, the report's chief scientific editor. "However, it's too soon to conclude anything about plateauing or peaking of global emissions."

While a plateau may appear positive news, UNEP data show it is far from enough. Five years of emissions at current levels adds around 200 billion tonnes of CO2 to the atmosphere, locking in an increase in peak warming of about 0.1ºC.

"Continued insufficient emission reductions over the next decades could make warming of 2ºC inevitable, putting the Paris Agreement at risk of failure," the report warns.

This rate of increase is visible in the literature. When the IPCC last assessed emissions pathways in 2022, assuming deep cuts would begin in 2020, the lowest peak still within reach was about 1.6ºC. Those cuts never came. With action now assumed to start in 2025, the best achievable peak has risen to around 1.7ºC.

"This is a historic failure of political leadership. The science has been clear for decades, but governments have chosen delay over action," said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. "The consequences will be measured in lives lost, not just degrees of warming."

'On track' to weak targets

GHG emissions in 2035 resulting from the full implementation of the new NDCs of G20 members compared with current policies projections, absolute (MtCO2e/yr) and percentage (%) change.

Only six G20 members – China, India, Indonesia, Russia, South Africa and Türkiye – are "on track" to meet their 2030 emissions targets. Together, G20 members account for 76% of global emissions.

That may seem an odd list – because it is. In fact, as nations set their own pledges, in turn reflecting varying ambition to curb emissions, the list of "on track" nations is better read, in several cases, as a list of those with low-ambition targets.

Russia and Türkiye's projected emissions already sit more than 20% below their 2030 emissions targets, providing headroom for major emissions increases from their current baseline without technically breaching their commitments. Both have "historically always set NDC target emission levels that are considerably above the current policy scenario projections," the report notes.

India – the world's third-largest emitter – is also likely to meet its target. This is explained by the unusual formulation of India's NDC, which sets an emissions-intensity target tied to its GDP, meaning an expanding economy also allows for expanding emissions. 

India's pledge allows its emissions to rise about 1.25 billion tonnes between 2030 and 2035, though at 3.1 tonnes per person, its per capita emissions remain under half the world average.

The nine G20 members judged off track include the UK, Japan, Canada, Australia, and South Korea. Mexico – previously on track for its 2030 goals – fell off the list after strengthening its emissions targets.

The European Union, committed to the largest absolute cut of any G20 member between 2030 and 2035, at about 630 million tonnes, may narrowly miss its 2030 goal, according to two of the three studies the report reviewed.

Still building, still burning


Clean energy investment is set to reach $2.2 trillion in 2026, almost double investments in fossil fuels, the report says, citing the International Energy Agency. But as renewables gain an ever-growing foothold on traditional energy markets, governments continue to lock in new fossil fuel infrastructure and keep drilling.

Governments plan to produce 120% more fossil fuels in 2030 than a 1.5C pathway allows, up from 110% two years ago, according to the 2025 Production Gap Report, which measures the gap between governments' planned fossil fuel production and levels consistent with the Paris Agreement's warming limits. Some 96% of upstream oil and gas companies are still developing new reserves, according to campaign group Urgewald.

Fossil fuel subsidies climbed from $660 billion in 2018 to $920 billion in 2024, after hitting a record during the 2021-22 energy crisis, and could rise again as governments shield consumers from the ongoing energy shocks of the US-Israeli war on Iran, the report said.

Counting the unpriced costs of the pollution and climate damage fossil fuels cause, the International Monetary Fund puts implicit subsidies at a further $6.7 trillion in 2024, three-quarters of it from air pollution and climate change.


As governments subsidise oil and gas to stave off inflation, fossil fuel giants are reaping massive windfalls. The five largest Western oil majors earned $48 billion in the second quarter, or $535 million a day, according to Global Witness analysis.

Saudi Aramco reported $104.7 billion in adjusted net income for 2025 and paid out $85.5 billion to shareholders, more than three times the $26 billion in international public finance that reached developing countries for climate adaptation in 2023.

The world's 65 largest banks, meanwhile, continued to provide nearly $1 trillion in fossil fuel financing in 2025.

"It is time for major fossil fuel producers such as the US and Saudi Arabia (which produce 20-25% of fossil fuels globally) to stop playing politics and face the scientific reality," said Bill Hare, chief executive of Climate Analytics. "Right now, they are looking at the fire, denying it exists and pouring more petrol on it."

"Do the governments and fossil fuel producers of the world really want seven metres of sea level rise and the demise of many entire island countries as their legacy?"

Image Credits: Marcin Jozwiak.

A health worker in protective gear responds to Ebola.

Nigeria’s lone Ebola patient was only diagnosed almost two weeks after showing symptoms – and is reported to have travelled to the capital, Abuja, from Uganda.

She entered Nigeria on 3 October, started showing symptoms on 7 October and was admitted to hospital two days later – but was only diagnosed on Tuesday (20 October), according to a statement from the World Health Organization’s (WHO) Africa region.

The patient is said to be the wife of a diplomat. Uganda was declared Ebola-free in August after treating 20 people who had contracted the Bundibugyo virus imported from the Democratic Republic of Congo (DRC)

“Investigations are ongoing to establish the likely source of her infection and reconstruct her full travel and exposure history,” said the WHO, adding that Nigeria’s Health Ministry had identified 44 contacts.

“[These contacts] are being monitored as efforts are intensified to find other people who may have been exposed. Infection prevention and control measures are being ramped up in the private health facility where the patient sought care,” the WHO added.

Kenya’s nine cases were all quarantined contacts of the first case, who died after travelling across the DRC, according to the country’s Health Ministry. Three are health workers, one is a hospital cleaner, and four are relatives of the patient. 

The Kenyan government says it has traced 128 of the 130 identified contacts (98.5%)  of the deceased, and they are all in quarantine.

The case fatality rate in the DRC is over 48%, with most cases in Ituri province. On Sunday, authorities in North Kivu introduced a week-long ban on people travelling from Ituri in a bid to slow transmission.

North Kivu’s authorities have also suspended large sporting activities, concerts, parades and nightclubs. They have limited passenger numbers for vehicles and introduced mandatory vehicle disinfection, hand washing and temperature screening at checkpoints.

In light of the Nigeria case, the WHO Africa region has urged countries to “maintain strong disease surveillance and rapid alert investigation, ensure laboratories can safely test suspected cases, keep rapid response and clinical teams ready for immediate activation, [and] reinforce infection prevention and control in both public and private health facilities.”

African health ministers will meet next week to discuss Ebola as Nigeria reported its first case, Kenya’s outbreak has infected nine people, and the DRC reported 9,455 cases.

The meeting was announced on Wednesday by the Africa Centre for Disease Control and Prevention (CDC), which described Ebola as an “escalating threat to health security across the continent”.

Image Credits: Belen B Massieu/Shutterstock.com, Africa CDC .

Who will steer the World Health Organization through its next chapter? Explore Health Policy Watch’s daily series examining the platforms, records, and institutional hurdles facing each contender for WHO Director-General, continuing today with Dr Hanan H. Balkhy. Access all candidate profiles on our dedicated election site.

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

Saudi Arabia’s nomination of Dr Hanan H. Balkhy, an infectious disease epidemiologist and WHO regional director for the Eastern Mediterranean region, brings a senior regional executive into the candidate pool to succeed Dr Tedros Adhanom Ghebreyesus as Director-General. Drawing on a background combining frontline clinical care, scientific research, and multilateral governance, Balkhy positions her candidacy as a direct response to institutional distrust and member state demands for operational transparency and accountability.

A US-trained paediatrician and infectious disease specialist, she centres her campaign around the core pledge: “A WHO the world can count on.” Balkhy frames her background as a “hybrid” career: combining 20 years of domestic health system leadership in Saudi Arabia – including 15 years serving on WHO external expert committees – with over seven years inside WHO as Assistant Director-General and Regional Director – spanning headquarters in Geneva and regional leadership over the agency’s most complex emergency settings.

As a senior WHO executive, however, her central challenge will be overcoming the perception of being an institutional insider at a moment when many member states are calling for fundamental restructuring. To build a winning coalition, she must convincingly prove that an executive who rose through the agency’s own hierarchy can deliver genuine operational decentralisation and fiscal discipline while remaining a steadfast guardian of WHO’s normative core and independent technical authority.

Balkhy’s three-layered vision for WHO’s future

The Cairo EMRO headquarters, maintaining regional operations as Director Hanan Balkhy begins her campaign leave.
The Cairo EMRO headquarters where Balkhy serves as regional director (currently on campaign leave).

Balkhy structures her election platform around a three-part framework focused on restoring trust through scientific independence, accelerating impact through rapid emergency preparedness, and demonstrating fiscal value through quantifiable results:

  1. Scientific integrity and transparent governance: Balkhy frames institutional credibility as WHO’s foundational requirement, pledging to restore scientific authority, protect technical guidance from political interference, and strengthen internal reporting across all three organisational tiers. As evidence of her commitment to administrative accountability, she points to her operational track record in the Eastern Mediterranean, where she reduced the regional audit backlog by 50%.
  2. Emergency preparedness and regional sovereignty: Focusing on rapid crisis response, she advocates for an integrated One Health framework bridging human, animal, and environmental vectors, while positioning Small Island Developing States (SIDS) as the benchmark for equitable global health security. To build regional health sovereignty, she prioritises binding Pathogen Access and Benefit-Sharing (PABS) equity and promotes collaboration with regional bodies like Africa CDC and the African Medicines Agency to expand local biomanufacturing and regulatory infrastructure.
  3. Frontline delivery and climate resilience: Balkhy links organisational performance directly to quantifiable country-level health gains, establishing primary healthcare (PHC) as the leading operational vehicle for universal health coverage (UHC). Her agenda embeds climate resilience into primary care, prioritises the elimination of wild poliovirus and vaccine-preventable diseases, and advocates for mechanisms to ensure lower-income countries access new health technologies on equitable timelines.

Addressing global health architecture reform, Balkhy’s platform highlights the imperative of rebalancing operational power toward country and regional offices. Pointing to her track record as EMRO Regional Director – where over 70% of regional programme resources were allocated directly to country offices – she pledges to transition WHO from top-down directives toward a consultative, country-led model that moves resources directly to where health care is delivered.

Formative clinical training and two decades of prevention

Massachusetts General Hospital in Boston: Balkhy completed her paediatric residency here before spending two decades directing infection control in Saudi Arabia.
Massachusetts General Hospital in Boston where Balkhy completed her paediatric residency before spending two decades directing infection control in Saudi Arabia.

While born in Saudi Arabia, Balkhy spent her early childhood in the United States until the age of six when her family returned to the Kingdom. She later completed her undergraduate medical degree at King Abdulaziz University in Jeddah in 1991. She returned to the US for postgraduate clinical training, completing a paediatric residency at Massachusetts General Hospital in Boston (1993-1996), followed by a fellowship in paediatric infectious diseases at the Cleveland Clinic Foundation and Rainbow Babies & Children’s Hospital in Cleveland, Ohio (1996-1999).

Upon returning to Saudi Arabia, Balkhy spent two decades developing national infection prevention and research infrastructure. She served 10 years as hospital epidemiologist and 10 years as executive director of infection prevention and control at the Ministry of National Guard. In that capacity, she established and directed the infectious diseases research department at the King Abdullah International Medical Research Centre (KAIMRC) within King Saud bin Abdulaziz University for Health Sciences in Riyadh.

Under her direction, KAIMRC served as a regional reference centre for MERS-CoV, where she led Saudi Arabia’s first Phase I clinical vaccine trial for the virus and established cross-sectoral One Health research linkages. Meanwhile, she directed the Gulf Cooperation Council (GCC) Center for Infection Control and the WHO Collaborating Centre for IPC and Antimicrobial Resistance (AMR).

Executive trajectory in Geneva and regional leadership

Balkhy’s candidacy draws on executive experience in Geneva and regional emergency response across EMRO.
Balkhy’s candidacy draws on executive experience in Geneva and regional emergency response across EMRO.

Building on her national track record, Balkhy transitioned to international governance as WHO’s first Assistant Director-General for Antimicrobial Resistance (AMR) in Geneva (2019–2024). In this role, she steered global policy against drug resistance, launching the Quadripartite collaboration with the FAO, WOAH, and UNEP, raising $20 million for WHO’s AMR division, and establishing the AMR Multi-Partner Trust Fund. During the COVID-19 pandemic, her portfolio expanded as acting ADG for Access to Medicines and Health Products, while co-leading WHO’s role in the ACT-Accelerator Diagnostics Pillar.

Following her Geneva tenure, the WHO Executive Board appointed Balkhy as Regional Director for the Eastern Mediterranean in 2024. In this role – from which she is currently on formal leave to pursue her Director-General campaign – she oversees WHO health operations across 22 Member States and territories, serving a population of 750 million. Under her leadership, the region carried roughly one-third of WHO’s global graded-emergency burden, managing acute crisis responses across Yemen, Gaza, Sudan, and Lebanon, while raising over $1.6 billion in additional programme resources.

Demonstrating operational crisis management, she negotiated directly with senior representatives of the Taliban-led de facto administration in Afghanistan, utilizing community-level engagement in Kandahar to overcome vaccine hesitancy, protect essential health infrastructure, and secure access for polio vaccination teams. In the Occupied Palestinian Territory, following the re-emergence of polio in Gaza after 25 years, she coordinated a cross-agency emergency response and three vaccination cycles that reached more than 600,000 children to contain the outbreak.

“Across these roles, I have remained a physician, a scientist and a public health leader – committed to turning knowledge into action and keeping people at the centre of global health,” she noted in launching her campaign in August.

Expanding Saudi footprint and regional competition

The Riyadh skyline: Saudi Arabia’s expanding financial and diplomatic footprint provides a powerful institutional backdrop for Dr Hanan Balkhy’s candidacy.
The Riyadh skyline: Saudi Arabia’s expanding financial and diplomatic footprint provides a powerful institutional backdrop for Dr Hanan Balkhy’s candidacy.

Besides her clinical credentials and executive experience, Balkhy enters the race anchored by Saudi Arabia’s diplomatic and financial influence. The Kingdom’s total WHO contribution reached $100.12 million for 2024-2025 and stands at $81.72 million for 2026-2027. This places the country in the top 15 overall contributors worldwide (including both sovereign states and philanthropic organisations).

Her campaign could also benefit from a compelling institutional precedent: a Director-General has never been elected from the Eastern Mediterranean region. If member states prioritise geographic equity and regional rotation across WHO’s six regions, her standing as a prominent EMRO candidate and experienced regional executive gives her a distinct strategic advantage. Furthermore, as the first woman ever elected to lead WHO’s Eastern Mediterranean office, Balkhy’s candidacy aligns with global gender equity coalitions likely to push for the election of only the third female Director-General in the organisation’s history.

However, regional support across the Middle East and Islamic caucuses remains fragmented. The entry of Qatar’s former health minister, Dr Hanan Al Kuwari, introduces a direct rival within the Gulf Cooperation Council (GCC). Deep geopolitical fault lines across the region – most notably active hostilities involving Iran and Yemen – alongside the secret-ballot nature of WHO elections, make any unified regional bloc improbable, forcing Balkhy’s campaign to build a cross-regional coalition beyond the Middle East.

Navigating normative and climate challenges

Balkhy engages cross-regional delegations ahead of the election, seeking to become the Eastern Mediterranean’s first WHO director-general.
Balkhy engages cross-regional delegations ahead of the election, seeking to become the Eastern Mediterranean’s first WHO Director-General.

To build broad cross-regional consensus, her campaign emphasises her commitment to global health stewardship. This involves articulating how her drive to direct operational resources closer to country offices reflects administrative subsidiarity while fully reinforcing WHO’s centralised normative and standard-setting authority.

Having been nominated by a conservative member state and given current pressure on sexual and reproductive health and rights (SRHR), Balkhy will also have to convince liberal voting blocs that she will uphold WHO’s universal health mandates and preserve normative civil society partnerships without compromising technical integrity. Recent Executive Board proceedings highlighted these fault lines when delegates from conservative member states raised formal reservations regarding WHO’s official ties with reproductive health NGOs.

Finally, while her platform prioritises strengthening health system capacities to respond to climate-driven emergencies, her nomination by a major oil-exporting country reflects the broader institutional challenge of aligning fossil-fuel reliance with WHO’s normative commitments to climate action, clean air, and primary prevention.

A guardian of WHO’s normative core in an era of fragmentation?

Seeking to become the first WHO Director-General from the Eastern Mediterranean Region, Balkhy faces the challenge of uniting deeply divided member states behind her platform. To build a broad coalition, she launched an early diplomatic tour across the African Region (AFRO), South-East Asia (SEARO), and the Americas (PAHO) – although an earthquake in Panama briefly disrupted her travel, preventing her attendance at the candidate exchange at the World Health Summit in Berlin.

Ultimately, her candidacy represents a test of whether an institutional insider and physician-scientist can deliver structural decentralisation while remaining the steadfast guardian of WHO’s normative core. In an era marked by superpower exits, geopolitical rifts, severe fiscal austerity, and North-South divides, her pitch of “A WHO the world can count on” asks Member States to weigh her promise of operational subsidiarity against the imperative to preserve independent technical authority.

Note: Health Policy Watch reached out to Balkhy for comments, but has not received a response by the time of publication. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, WHO/EMRO, Wikipedia/InvictaHOG, abul lais via Pexels.

Who will steer the World Health Organization through its next chapter? Explore Health Policy Watch’s daily series examining the platforms, records, and institutional hurdles facing each contender for WHO Director-General, starting today with Hanan Al Kuwari. Access all candidate profiles on our dedicated election site.

Serving as IGWG Vice-Chair alongside WHO leadership: Al Kuwari frames mandatory pathogen access and benefit-sharing as the essential equity commitment of pandemic reform.
As IGWG vice-chair, Al Kuwari framed mandatory pathogen access and benefit-sharing as the essential equity commitment of pandemic reform.

The State of Qatar has nominated former minister of public health Dr Hanan Mohamed Al Kuwari for Director-General of the World Health Organization (WHO). Entering a competitive contest alongside six other candidates as the WHO faces financial instability, workforce restructuring, and geopolitical fragmentation, her campaign positions her as a pragmatic, delivery-focused nominee.

During the first public candidate exchange at the World Health Summit in Berlin with four of the seven candidates, Al Kuwari articulated an operational roadmap centred on country-facing impact, emergency preparedness, and institutional reform. Central to her pitch is the assertion that WHO’s ultimate success must be measured in countries rather than in Geneva, arguing that member states are “not choosing an administrator; they are choosing a direction.”

Yet her candidacy raises questions for the member states: can a hospital and ministry executive safeguard WHO’s normative authority and scientific independence, and can middle-power mediation build lasting multilateral consensus amid escalating geopolitical superpower competition and persistent North-South divides?

Turning knowledge into country results: four pillars of change

Dr Hanan Al Kuwari discusses global health reform alongside fellow prospective WHO Director-General candidates at the World Health Summit in Berlin.
Dr Hanan Al Kuwari discusses global health reform alongside fellow prospective WHO Director-General candidates at the World Health Summit in Berlin.

In her election manifesto, “A healthier, fairer, better-prepared world”, Al Kuwari presents a four-pillar roadmap for the future of the WHO.

  1. Rebuilding institutional trust and independent authority: To address institutional distrust, Al Kuwari’s platform proposes strengthening WHO’s technical authority through open communication and objective governance. During the conversation in Berlin, she stated that “trust is built by process” and pledged to extend transparency standards to emergency and interim technical guidance while establishing independent oversight of WHO’s scientific advice with published reports.
  2. Ensuring political independence through stable financing: Confronting WHO’s ongoing fiscal crisis, her platform contends that an agency reliant on a narrow set of donors cannot maintain true political independence. She commits to working with member states to achieve the target of 50% assessed contributions (members’ fees) to the base budget by 2031 at the latest, while expanding flexible funding through the investment round and the WHO Foundation.
  3. Country-level delivery and primary healthcare execution: Emphasising that WHO’s value is ultimately demonstrated in country-level outcomes, her platform positions primary healthcare (PHC) as the core delivery vehicle for universal health coverage (UHC). She prioritises health workforce protection alongside targeted commitments to women’s, children’s, and adolescent health. Her agenda integrates non-communicable disease prevention, mental health, and polio eradication with emergency preparedness – operationalised through the amended International Health Regulations, One Health frameworks, and the WHO Pandemic Agreement.
  4. Preparing for future health threats: To address evolving health determinants, Al Kuwari proposes aligning global health research with equitable access, aiming to ensure lower-income countries receive vaccines, therapeutics, and diagnostics on the same timeline as high-income nations through regional manufacturing and streamlined WHO pre-qualification. Her platform also pledges to translate WHO’s digital health and artificial intelligence guidance into practical operational tools for member states, while framing climate change as a health emergency that requires WHO to supply the scientific evidence for climate negotiations.

To translate these four pillars into early operational reform, Al Kuwari pledged in Berlin to commission an independent functional review across WHO’s three organisational tiers within her first 100 days. Aiming to publish the findings within a year to eliminate bureaucratic overlap, she framed her benchmark for the end of a five-year mandate in 2032 not around Geneva administrative outputs, but around delivering tangible health results where people live.

From hospital management to national crisis response

Medical readiness for FIFA World Cup Qatar 2022: A cornerstone of Al Kuwari’s emergency portfolio and the operational basis for the WHO-Qatar Sport for Health framework.
Medical readiness for FIFA World Cup Qatar 2022: A cornerstone of Al Kuwari’s emergency portfolio and the operational basis for the WHO-Qatar “Sport for Health” framework.

Long before navigating Geneva’s diplomatic corridors, Al Kuwari built her executive credentials across nearly three decades of frontline institutional management and national crisis response in Doha.

Her early career encompassed freelance health reporting for Reuters and professional engagement with WHO, before she entered healthcare management in 1996 at Hamad Medical Corporation’s (HMC) Women’s Hospital. After earning a PhD in healthcare management from Brunel University in the United Kingdom in 2002, she was appointed managing director of HMC in 2007. Over a 17-year tenure, she expanded Qatar’s principal public healthcare provider into an integrated academic health system comprising 17 hospitals and specialised centres employing over 31,000 health workers.

Appointed Minister of Public Health in 2016, Al Kuwari steered Qatar’s health system through dual high-stakes emergencies. She chaired the national COVID-19 committee and directed emergency medical readiness for the FIFA World Cup in 2022. This three-year WHO-FIFA-Qatar “Sport for Health” partnership produced the global blueprint report, Changing the Game, which established international health security standards for mega-sporting events. Following an eight-year ministerial tenure, she was appointed advisor to the prime minister for public health affairs in late 2024.

Under her ministerial leadership, Qatar became the first country in the Eastern Mediterranean Region to achieve WHO “Healthy City” status across all of its municipalities, alongside two “Healthy University” certifications. Grounding her vision in Qatar’s National Health Strategy 2024-2030, she systematically embedded WHO normative standards nationally by establishing WHO Collaborating Centres spanning trauma, tobacco dependence, healthy ageing, zoonotic threats, and infectious disease research.

Global health governance and international leadership

The Assembly Hall at the Palais des Nations in Geneva during the 79th World Health Assembly.
The Assembly Hall at the Palais des Nations in Geneva during the 79th World Health Assembly.

Al Kuwari’s global health governance record spans senior leadership positions across WHO’s highest governing bodies and multilateral treaty negotiations in Geneva. As chair of the WHO Executive Board (2023-2024), she guided the organisation through a critical reform period, finalised the 14th General Programme of Work, and championed procedural changes to ensure greater transparency and accountability in the election of WHO regional directors.

On the treaty front, Al Kuwari served as vice-chair of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement, where she helped broker delicate consensus around the Pathogen Access and Benefit-Sharing (PABS) framework. She previously presided over deliberations during the 2021 special session of the World Health Assembly that initiated the accord, establishing her reputation among Member State delegations as a mediator capable of bridging North-South divides.

She rounded out her institutional footprint by chairing the WHO Eastern Mediterranean Regional Committee (2024-2025), anchoring her experience across the agency’s headquarters and regional tiers. That executive performance has drawn peer recognition beyond Geneva, including election to the US National Academy of Medicine in 2018, the WHO Director-General’s Health Champions Award in 2022, and the Best Minister Award at the 2024 World Governments Summit.

That delivery-oriented philosophy anchors her overarching campaign pitch: “The world already knows how to prevent most of the diseases that still occur,” Al Kuwari noted. “What it needs now is a WHO strong enough to turn that knowledge into results, in every country.”

Gulf competition and regional voting caucuses

Al Kuwari alongside Dr Hanan H. Balkhy: two prominent Gulf candidates whose parallel WHO bids create immediate sub-regional vote-splitting.
Al Kuwari (right) alongside Dr Hanan Balkhy: the two prominent Gulf candidates whose parallel WHO bids create immediate sub-regional vote-splitting.

Beyond individual credentials, Al Kuwari’s candidacy highlights the expanding financial and diplomatic footprint of the Gulf Cooperation Council (GCC) within the multilateral system. Qatar’s contribution to the WHO Programme Budget for the 2024-2025 biennium stands at $10.24 million – a figure modest in absolute terms compared to major sovereign donors like China ($201.82 million), Saudi Arabia ($100.12 million), or Belgium ($28.15 million), but distinguished by its internal structure. Crucially, $6 million of Qatar’s contribution was delivered as fully unearmarked core voluntary funding, providing WHO with flexible capital during an era of severe organisational downsizing and budget deficits.

Converting that financial commitment into an electoral majority, however, requires building broad coalitions far beyond Geneva and the Gulf. To secure WHO’s top post, Al Kuwari has pursued a cross-regional campaign strategy, aligning her platform with Global South priorities during high-level discussions in Addis Ababa with African Union Commission leadership. She followed this with extensive engagements at the Pan American Health Organization’s 63rd Directing Council in Washington, D.C., consulting PAHO Director Dr Jarbas Barbosa and regional health ministers on antimicrobial resistance, digital innovation, and equitable technology access.

Securing cross-regional backing is critical because Middle Eastern delegations rarely vote as a monolithic bloc. The concurrent nominations of Qatar’s Al Kuwari and Saudi Arabia’s Dr Hanan Balkhy further divide regional support, forcing both campaigns to look well beyond the Gulf for winning coalitions.

At the same time, both candidates stand to benefit from major structural tailwinds: a Director-General has never before been elected from the Eastern Mediterranean region. Furthermore, with only two women having served as WHO Director-General in the agency’s history, gender equity advocacy groups and women’s health coalitions will be actively pushing for female executive leadership at the helm of the UN health agency.

Key campaign challenges and diplomatic scrutiny

Al Kuwari receives WHO recognition for leading the FIFA World Cup health partnership, alongside persistent international scrutiny regarding occupational safety and migrant worker health.
Al Kuwari receives WHO recognition for leading the FIFA World Cup health partnership, alongside persistent international scrutiny regarding occupational safety and migrant worker health.

However, to secure broad member state backing, Al Kuwari must navigate significant diplomatic scrutiny across structural, normative, and operational fronts. While her campaign platform advocates for subsidiarity and a 100-day functional review to streamline WHO’s three levels (headquarters, regional, and country offices), traditional donors and observers are closely examining whether such administrative decentralisation – amid the GCC’s expanding footprint in global health – could weaken WHO’s centralised normative authority in Geneva.

Her proposed financing model also intersects with ongoing institutional debates. While her platform proposes expanding flexible funding through the Investment Round and the WHO Foundation, WHO’s external auditors have highlighted governance and disbursement shortfalls regarding the Foundation. Auditors have urged WHO to enforce contractual transfer targets, formalise donor engagement protocols under a Joint Strategic Plan to avoid donor overlap, and conduct regular joint performance assessments. To build donor trust, Al Kuwari will need to show that her financing proposal is accompanied by stronger, more transparent oversight.

On normative policy, while Al Kuwari has established strong credentials as a champion of maternal, newborn, and women’s health, liberal member states draw a sharp distinction between clinical health programmes and rights-based sexual and reproductive health and rights (SRHR). As a candidate nominated by a conservative Gulf state, she will have to prove that WHO’s global technical guidance on rights-based civil society partnerships, safe abortion access, and contraception would remain fully insulated from domestic political pressures.

Finally, her operational record faces questioning at the intersection of climate, worker safety, and human rights. Despite international recognition for leading the FIFA World Cup health security partnership, Qatar’s handling of the tournament raised persistent questions regarding migrant worker health and safety. Human rights organisations pointed to unaddressed gaps in extreme heat enforcement, occupational safety, and transparent mortality reporting among migrant construction workers. Compounded by Qatar’s fossil-fuel reliance and high per-capita emissions, these issues highlight the delicate task of reconciling domestic realities with WHO’s global climate-resilience and universal human rights standards.

A middle-power bridge builder for a fractured WHO?

Reflecting Qatar’s diplomatic posture, Al Kuwari seeks to convert her middle-power mediation skills into lasting institutional trust across a polarised World Health Assembly.
Reflecting Qatar’s diplomatic posture, Al Kuwari seeks to convert her middle-power mediation skills into lasting institutional trust across a polarised World Health Assembly.

As Qatar positions itself at the intersection of Global South advocacy and multilateral governance, Al Kuwari’s platform offers a synthesis: combining pragmatic executive management with non-aligned mediation to deliver a WHO that is “trusted because it is independent, sustainably financed, and valued because it delivers where people live.”

Having established a reputation in Geneva as a pragmatic consensus builder, she offers the operational discipline and non-aligned posture an overextended WHO requires. Yet her candidacy ultimately tests whether middle-power diplomacy can bridge deepening geopolitical fractures without diluting the agency’s technical rigour and independent normative authority.

Note: This article incorporates research findings and comparative evaluations from Rifat Hossain. Health Policy Watch reached out to Al Kuwari for comments but did not receive a response ahead of publication. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, Felix Sassmannshausen/HPW, WHO/Antoine Tardy .

5. Countries and Potential Votes by WHO region
In May 2027, the World Health Assembly will select the next WHO Director General. Here are votes by region; but 20 countries would lose their eligibility to vote unless they paid back dues.

Presented as part of our brand-new series on the Election of the WHO Director General.  See our DG Election website for profiles of all the candidates and latest campaign news. 

What is the WHO Director-General election?

The Director-General is WHO’s chief technical and administrative officer. The WHO Member States will elect the next Director-General at the May 2027 World Health Assembly out of a list of three finalists, including all 194 member states that are up-to-date on dues and thus eligible to vote. Voting is by secret ballot. 

There are currently seven announced candidates, is this the definitive list?  

Nominations of candidates for this election closed on 24 September 2026. Currently there are seven announced candidates – although the full, final list will only be formally announced “on or shortly after 29 October 2026”.  

What happens after 29 October and who decides on the three finalists?

After nominations close, candidates are presented to member states, and there will be an official WHO candidates’ forum on 18 or 19 November, which the public can also access. 

In late January, the 34-member Executive Board will meet (EB160), shortlist five candidates and screen them, likely behind closed doors. The Board will then nominate up to three finalists for the World Health Assembly to consider at its May 2027 session (WHA80). A second candidates forum for the three finalists is then scheduled for March 15. 

Executive Board Countries Selecting DG Finalists
The WHO Executive Board will select three finalists for the May 2027 election of the new WHO Director General in January 2027. Here are the countries voting.

Can all WHA members vote? 

The 79th session of the WHA in Geneva, in May 2027 disqualified 20 member states from voting next year unless they pay back dues.

All 194 WHA member states are eligible to vote, including even the United States and Argentina, which announced their withdrawal from WHO – but were refused by the WHA for various legal reasons. But member states in arrears on their assessed contributions are ineligible to vote. And as of the last World Health Assembly, over a dozen member states, including the United States, were deemed to be ineligible to vote at the next Assembly – unless they had paid dues in arrears by that time.

Nine other developing nations would also have their voting rights suspended at the WHA in  2027, unless they catch up on dues: including: Burundi, Côte d’Ivoire, Djibouti, Equatorial Guinea, Nigeria, Panama, São Tomé and Príncipe, Timor-Leste, and Turkmenistan. And this in addition to another 10 states in arrears already in 2026, including:  Afghanistan, Dominica, Grenada, Myanmar, Saint Lucia, Somalia, South Sudan, Sudan, Venezuela (Bolivarian Republic of) and Yemen. Iran’s voting rights had also been suspended but were reinstated at the last WHA after they paid their dues.

Effectively, that means that out of 194 potentially eligible states, only 174 member states may actually be eligible to vote in the upcoming election – unless they cover outstanding dues in time. 

How long does the Director-General serve?

The Director-General is appointed for a five-year term and may be reappointed only once – meaning a ten-year term is the maximum possible. Following the May WHA vote, the newly elected DG will take office on 16 August 2027.  

How has the DG election process changed since WHO was first constituted in 1948?  

WHO’s ongoing Executive Board session in Geneva in February 2026.

Historically, the Executive Board selected only one finalist out of the candidates’ list, and submit  the name of that candidate to the World Health Assembly for appointment – giving just 34 member states near absolute power over the election. 

However, in 2012, during the second term of then-Director General Margaret Chan, the WHA adopted a resolution that changed the system dramatically giving the WHA the right to vote between three finalists selected by the EB. This was first applied in the 2017 election and still in effect today.  This followed earlier reforms during the 1990s that mandated EB and WHA voting by secret ballot and a maximum of two five year terms for any Director General. 

So 2017 was the first election in which the new system was tested? 

Yes, It was in 2017, when Chan was retiring, that the new system was put to a full-test as a result of pressures from member states for more representation. In January 2017, the EB shortlisted the initial list of 6 candidates to five, conducted interviews with those five, and then  short-listed the slate to three finalists. They included: the late David Nabarro (United Kingdom), Sania Nishtar of Pakistan (currently head of Gavi, The Vaccine Alliance) and Ethiopia’s nominee, Tedros Adhanom Ghebreyesus. Tedros went on to win the election in May and become the first WHO Director from the African region.  

And how will the system work in this election? 

The voting sequence will be much the same as in 2017.  In their January 2027 meeting, the EB will nominate three finalists out of the list of candidates. And then the final decision passes to the full Assembly, voting by secret ballot in May. 

If no candidate gets the support of two-thirds of eligible member states on the first voting round, a complex series of runoffs are held between the two top candidates, with the bar finally lowered to a simple majority for selecting the next director general. 

What further reforms were instituted in the 2017 election that are still in effect today? 

A Code of conduct was established for the election of the Director-General, which sets out agreed standards of conduct for Member States and candidates throughout the election process. A dedicated WHO page and handbook details all policies and relevant WHA and EB decisions.

Forums with Member States, both virtual and in-presence, were instituted by the WHA . This in turn has encouraged further public engagements with the candidates outside WHO, as is notably the case in the Global Health Centre’s Enhancing the WHO Director-General 2027 Election Process initiative, in which Health Policy Watch is a media partner.  

This year, as in 2017, candidates will be competing to secure a substantial majority in the WHA. This has democratized the process but also changed its political nature – making it more public-facing, stimulating more debate, and also giving more weight to the role of regional groupings of states with common interests in a candidate’s election.  See our new DG Election website for profiles of all of the candidates and latest campaign news.

Sources: Adapted from FAQs by Gian Luca Burci, Geneva Health Platform, Graduate Institute DG election site;  WHO — Election of the Director-General; WHO — Frequently asked questions; WHO — Process, as well as Health Policy Watch — WHO nominations close.

Image Credits: WHO/X, WHO/X.