In Rapidly Growing Cairo, Safer Streets for Pedestrians Remain Elusive

06/04/2026 Sophia Samantaroy

A busy street in the Almazah neighborhood of Cairo.

CAIRO, Egypt – In the bustling neighbourhood of Heliopolis in Africa’s most populated city, it’s nearly impossible to cross the streets without risking a 40-mile-per-hour collision. A man driving a motorcycle nestles his phone against his ear. A car whizzes by with a child sitting on the lap of the driver. The chaotic scene was the norm in the city I volunteered in for several months in 2025.

Sparse traffic lights, limited seatbelt use, and crosswalks that are not always observed, while a daily reality for the city’s residents, pose significant challenges for pedestrian safety in Cairo. Researchers point to the city’s rapidly-built roads and infrastructure programs, designed to improve traffic congestion, as further limiting pedestrian access.

Over 75,000 traffic-related injuries occurred in the North African country, with more than 5,000 deaths each year, according to the latest statistics from Egypt’s national bureau. Pedestrians accounted for a third of these deaths, and researchers say the figures likely underestimate the true burden.

The greater Cairo region, like the rest of the country, is designed around vehicles. An estimated 97% of streets in Egypt lack traffic lights, and 78% of streets do not have footpaths for pedestrians, according to a 2019 World Bank estimate cited in an American University in Cairo (AUC) analysis.

“Already the [pedestrian] mortality rate has increased in Heliopolis,” said Mennah Fathy, an urban researcher with the Institute for Traffic and Development Policy (ITDP) Cairo office.

Children under 15 years and pedestrians are the most likely to be fatally injured.

Cairo is just one of several African megacities. Nigeria’s Lagos, the Democratic Republic of Congo’s Kinshasa, and Angola’s Luanda are all expected to continue surging in population.

Urban health experts link limited pedestrian infrastructure to higher pollution exposure, reduced physical activity, and traffic congestion. The city also ranks in the top 200 most air polluted cities, according to the recent IQAir report – and the country as a whole is ranked ninth. Yet recent initiatives from the city and from other organizations have both raised awareness – and begun to tackle the dangers of Cairo’s streets.

New throughways and cut trees deter walking

People walking in the streets of Misr Gedida.

In Cairo’s eastern neighborhoods of Misr Gedida, Heliopolis, and Medinat Misr, coffee shops, grocery stores, and markets line the streets. But despite their proximity, pedestrians often struggle to reach them across wide, fast-moving throughways.

Other Cairenes noted that they rarely use the broken and blocked sidewalks.

“If you need to walk, we walk on the streets,” said Fatma Khalid, a cultural guide at a Cairo language school. She joked that locals can “immediately tell” if someone is not from Egypt if they try to walk on the sidewalks.

But broken sidewalks are only part of the problem, said ITDP’s Fathy. Expanded roadways have made walking both riskier and less appealing in Cairo’s heat as tree cover and greenery essential to keeping pedestrians cool make way for asphalt.

“Cairo didn’t used to be this way,” said Shahyra, a 30-year-old real estate consultant, at a Cairo coffee shop. “We used to walk, be outside. Now we sit in the AC and Uber for ten minutes to the grocery store.”

The combined pressures of rapid urban growth, rising temperatures, and worsening air quality have also changed how many residents move around the city. Cairenes who can afford it increasingly opt for shorter car rides instead of walking.

With fewer opportunities to walk, residents lose an important source of daily physical activity which researchers say contributes to rising obesity and type 2 diabetes in Egypt and other LMICs.

Heliopolis’s original urban design, which dates back to the early 20th-century when the Belgian industrialist Edourd Empain commissioned the city, had walking-friendly squares and intentional public transit systems. Now, “that’s been destroyed in favor of highways,” said Fathy.

In the newer developments built on reclaimed desert, like the 6th of October City, the New Administrative Capital, and the 5th Settlement, the entire urban design is car-oriented, according to the ITDP, which has researched and proposed ways to improve active mobility in the new settlements.

In both older and newer areas, “these changes deter walking and active mobility” and threaten road safety, said Fathy.

Traffic-related deaths are not “accidents”

A street sweeper on a bridge crossing the Nile.

Some 30 years ago, Hany Kamel’s training as a pilot was cut short in a car crash on the highway from Alexandria to Cairo. Injuries to his arms and head forced him to leave his specialized training school and recuperate.

He made a career as a professional driver instead, racking up accreditations from driver safety programs.

The scars on his arms are a physical reminder of the cost of unsafe roads. “People here don’t follow many of the rules,” he said of the Cairo drivers swerving in and out of traffic.

“Driving in Egypt is extremely dangerous,” the US State Department warns its citizens in its travel guidance to the country. “Egypt has one of the highest rates of road deaths in the world due to unmarked surfaces, pedestrians and animals crossing streets, and speed bumps along major highways.”

Urban experts don’t place the blame solely on road users, but on the design of highways and roads.

“Safe roads are a right, not a luxury,” Dr Etienne Krug, WHO director of the department of social determinants of health, argued in a recent commentary. “While drivers are bound to make errors, transportation planners work on the basis of reducing risks.”

The approach focuses on improving road design, vehicle safety, speed management, and post-crash care.

Proven measures to keep pedestrians safe include crosswalks, appropriate driving speeds, and improved visibility for pedestrians. The approach, focusing on improved road design, vehicle safety, speed management, and post-crash care, has proven challenging to implement in many countries.

International calls for safer roads

The World Health Organization has called for a decade of raod safety.

More than one pedestrian or cyclist is killed every two minutes on the world’s roads. Nearly 1.2 million people are killed and as many as 50 million are injured each year, making road traffic injuries a leading cause of death and disability worldwide, according to the World Health Organization (WHO).

For young people aged five to 29 years, cars, buses, trucks, and motorcycles are the number one cause of death. Pedestrians and cyclists face particularly high risks in low- and middle-income countries (LMICs).

“The risk is remarkably high in low and middle-income countries, where millions face huge risks each day as they walk to work or school on streets with no sidewalks, and no safe places to cross busy roads. Just a tiny fraction of the world’s roads – far less than 1% – have safe cycle lanes,” said the WHO’s Krug.

The overwhelming majority of traffic fatalities – 92% – occur in LMICs, even though these countries have 60% of the world’s vehicles.

That’s not to say the problem is solely concentrated in lower-and-middle income countries. The pedestrian fatality rate in the US is two to five times higher compared to other developed peer nations. That rate has jumped 80% since 2009, per a 2025 AAA Foundation for Traffic Safety report. Those in urban, lower-income areas are at highest risk. The report underscored that pedestrians in US urban centers are often forced to walk along poorly lit roads without sidewalks to reach the nearest crosswalk.

In light of this, the United Nations announced in May 2025 its 8th annual Global Road Safety week with the goal of spurring local and national action for safer roads.

“These actions will help promote and facilitate a shift to walking and cycling, which are more healthy, green, sustainable and economically advantageous modes of transport,” said the UN in a statement.

The safety awareness week comes as traffic fatalities have grown in the past decade across multiple regions.

Safer streets also mean cleaner air, more active population

A quiet, shaded street in the historic neighborhood of Dokki.

Fathy said city authorities have often overlooked the health and safety benefits of walkable urban design. In discussions with city authorities about active transport, the ITDP found that walkability was not a main priority.

“They don’t always see the health co-benefits,” said Fathy, referring to reductions in air pollution and increases in active mobility. Even when the health benefits are recognized, walking is often not convenient for daily commutes to school, the metro, or work, Fathy added.

The Swiss-based air pollution data organization IQAir’s 2025 most polluted countries in the world. Egypt ranks 9th globally for fine particulate matter pollution.

WHO’s Krug calls safe streets a “treasure trove” of add-on benefits: walking or cycling reduces the risk of chronic diseases, curbs air pollution, reduces traffic congestion, and limits climate pollutants.

Egypt, like many others in the Middle East and North Africa, is facing a growing chronic disease crisis the benefits of safe streets could play a role in alleviating. Two-thirds of the population is either overweight or obese; nearly a quarter of all adults live with diabetes.

New metro, bus systems offers promise of expanded, but patchwork public transportation

Cairo’s new third metro line offers regular, affordable transportation west to east across the city.

Cairo’s traffic intensity has improved dramatically in the past decade as a new metro line and bus rapid transit (BRT) system provide alternatives for its residents.

The new metro line runs east to west through the city and is packed in rush hour, offering air-conditioning and two “ladies only” cars. Similarly, the Western BRT bus corridor is part of Egypt’s vision to improve the public transport sector.

The result, however, has been what some experts describe as a “patchwork” network of improved public transport.

A metro stop in a neighbourhood may not be accessible or have a nearby bus stop. Other Cairenes complain of having to take Ubers just to reach a metro stop.

“I either take an Uber or I walk to the microbus stop and then transfer from the microbus to the autobus line,” said Manal, an HR trainer in Cairo’s Dokki quarter.

Fathy’s commute is also a trek – driving her car to a metro stop and then Ubering to her workplace. “These new settlements, and moving the administrative capital to the eastern side of Cairo, means that people have to commute across Cairo. We don’t have a culture of moving to be close to work.”

Gathering municipal and cultural support

A boy crosses a road behind a municipal bus.

If you asked a school-age child in the 6th October settlement in Cairo to envision roads in their neighbourhoods, they would draw wide, multi-lane highways with no trees.

“The younger generations living in the new cities are increasingly removed from the idea of walking, cycling, or public transport,” said Fathy. “They’re not aware of the advantages.”

These insights emerged from focus groups Fathy and colleagues conducted in three schools in the car-centric peripheries of Cairo. After these workshops, the researchers later proposed safer street designs around school zones to improve air quality and promote walking and cycling.

And in the historic quarter of Heliopolis, initially designed to be transport and walking-friendly, the loss of tree cover and the bisecting throughways present a still larger challenge.

Fathy notes that “transformation” of an area like Heliopolis requires a return to its past culture of walkability and green streets, through initiatives like car-free pedestrian zones.

A throughway at dusk in Cairo.

Even though international groups like ITDP have struggled to gain permission and government cooperation for these initiatives, Fathy hopes that with a return to a walkability mindset, Cairo’s rapid growth can include space for smart, green urban design.

Halfway through this “decade of road safety,” Cairo’s road safety progress mirrors that of other megacities, where population growth has so far outpaced infrastructure and public transport projects.

While the primary aim of these investments has been to reduce traffic time and congestion, these improvements fall in line with the United Nations General Assembly’s 2020 goal of preventing at least 50% of road traffic deaths and injuries by 2030.

“We’ve seen a lot of improvement in the past five-to-ten years,” she said. The expanded metro system, and public bus lines are all “significant improvements,” especially efforts to make public transport safer for women, and reducing the number of private cars on the roads.

But whether Cairo’s future streets resemble the wide highways drawn by schoolchildren — or greener boulevards built for walking and cycling — may depend on how quickly the city reimagines its roads.

Image Credits: S. Samantaroy/HPW, WHO, IQAir, S. Samantaroy.

Brain Matters: Equity in the Age of Cognitive Health

06/04/2026 Elaine Ruth Fletcher

Colorized brain scan. Current techniques probing brain function are costly. But research anchored in the Global South can yield affordable strategies, experts say.

DAVOS – In this snow-covered Alpine town where the world’s rich, powerful and elite met in January for the World Economic Forum, a quiet but consequential shift in thinking about dementia research crystallized – one with the potential to shape political engagements and research investments for the coming decade.

Long treated as a disease primarily studied, diagnosed and managed with treatments developed in wealthy countries, Alzheimer’s and related disorders are now a global equity challenge— one where the best new solutions may, paradoxically, emerge from the low- and middle-income regions also facing the biggest future burden.

The simple but powerful approach is central to a strategy being rolled out by the Davos Alzheimer’s Collaborative in 2026 – which aims to make diversity an underpinning of dementia research.

New initiatives across Africa, India and beyond

Aga Khan University, Kenya – one of a number of DAC collaborations in studies testing and validating simpler tools for Alzheimer’s diagnosis and treatment.

The strategy, articulated at the dome-shaped “Brain House” here in Davos, underpins a series of new DAC initiatives being rolled out in Africa, India and elsewhere in the Global South to test new diagnostics; better harness the potential of AI; and build big data platforms that can link research communities and their findings.

In an interview with Health Policy Watch, Drew Holzapfel, DAC Chief Operating Officer (COO), outlined a strategy for a fundamentally different model of dementia research— rooted in global collaboration. Key elements include:

- Expanding diverse data collection
  “We’re going into Kenya, Chile, Egypt… so that we get some better understanding of the heterogeneity of the disease.”
- Breaking down data silos and building large-scale, harmonized datasets
  “Creating platforms that allow researchers to “share, access and analyze brain health and dementia-related data… in giant data sets… so that you can draw some through lines.
- Developing AI-driven discovery platforms
  Integrating multimodal data to map “causal mechanisms to biomarkers, targets, and personalized prevention.”
- Driving personalized treatments – an Al platform that integrates data from genomics, clinical, prevention and trials – mapping causal mechanisms to biomarkers, targets, and personalized prevention and therapeutic strategies.

Harnessing the power of big data sets

Tedros speaking at the ‘Brain House’, World Economic Forum, 2026

The new DAC collaboration with the Gates-funded Alzheimer’s Disease Data Initiative (ADDI) and the African Population Cohorts Consortium (APCC) is a leading example of how the power of big data can be harnessed.

The initiative aims to create an intraoperative data-sharing platform enabling African researchers to share, access and analyze brain health and dementia-related data.

“Giant integrated data sets ideally are harmonized across different populations, so that you can draw some through lines. The fact that we’ll be getting diverse data means we can better understand the heterogeneity of the disease, Holzapfel said.

The numbers of people whose health and lives are at stake are equally big.

As George Vradenburg, DAC founder and chairman put it: “The Global South will have 80% of cases of dementia in the next 20 years.” That reality is forcing researchers, policymakers and investors to confront a new truth: innovation that ignores the global majority is not just inequitable—it is incomplete.

Neurological conditions of some kind affect more than 40% of the world’s population somehow, causing over 11 million deaths each year – with the largest gaps in care in low and middle income countries, pointed out WHO’s Dr Tedros Adhanom Ghebreyesus, speaking at a Brain House session.

“Demographiic and environmental pressures are intensifying these challenges: ageing populations, hypertension and diabetes, pollution, injuries and climate change are driving a sharp rise.”

The ‘Global Majority’ as an innovation catalyst

But investing in brain health research and development in the Global South is not only about equity – it is about efficiency. As such, it’s a win-win for both rich and poor countries alike.

For decades, biomedical research into dementia has been shaped by data drawn largely from populations of primarily European ancestry. And that lends a very incomplete picture of the disease and related conditions, observed Holzapfel: “90% of the data in GWAS [genome-wide association studies] is built upon European ancestry… but only 10% of the world is of that ancestry.”

Because genetic analysis is focused overwhelmingly on white Europeans, we have an incomplete understanding of the way Alzheimer’s disease impacts diverse populations.

That imbalance is not just a scientific gap—it is a barrier to discovery.

Diverse populations bring diverse genetic profiles, environmental exposures and disease pathways, explained Michael Cook, Chief Science Officer of the UK-based research entity Our Future Health . As he put it, “diversity will help… make sure that we create medications and interventions that fit for all populations.”

Added Vradenburg, the Global South is “a potential area of innovation on how to lower cost and increase the access to the products that we would like to have.”

Lawrence Jones, author of the “Influential Minds” podcast series, reframed the conversation with a simple linguistic shift: “Instead of the Global South, we should be referring to that part of the world now as the Global Majority.”

The biology of diversity

‘Influential Minds’ Author Lawrence Jones with DAC founder George Vradenburg at WEF side event focusing on why diversity is critical to dementia research.

Beyond pure cost-efficiencies, the Global South offers richer understanding of the disease itself.

Dementia is not a single condition. As Sam Barrell, CEO of the UK-based non-profit medical research organization LifeArc, explained: “It’s a bit like saying there’s just one type of cancer.” In reality, it is a constellation of subtypes, each with distinct biological drivers.

Research in diverse populations is essential to untangling that complexity.

Environmental exposures—heat, pollutants, agricultural chemicals—vary dramatically across regions and may shape disease pathways in ways not yet understood, said Vradenburg. Noting that even basic factors like water quality and brain health remain understudied, he pointed to the need for more “exposome research across a wide variety of different exposures.”

There are also gender disparities. “Two thirds more likely to happen in women than men,” Barrell noted, emphasizing how much remains unknown.

Without inclusive data, the patterns remain hidden. With it, entirely new avenues for prevention and treatment may emerge.

Rethinking access: from clinics to communities

A fingerprick test for Alzheimer’s would making diagnosis far more accessible in primary health care centers, including the Global South.

In this new R&D paradigm: health system constraints— including limited infrastructure, fewer specialists, tighter budgets—are not just obstacles. They are catalysts for entirely new models of care.

And while bringing solutions to the proverbial “last mile” is an especially acute challenge in low- and middle-income countries, where specialist care is scarce and even basic electricity infrastructure spotty, the same bottlenecks exist in wealthy nations too.

“Wait times now, over a year in the United States,” Vradenburg said, noting that some patients effectively “time out” before they can access treatment.

At the same time, barriers exist to bringing new and potentially transformational research findings to market.

Vradenburg described the challenge starkly: “you can have the most brilliant new discovery… but if, in fact, it doesn’t get through a regulatory system… a clinical trial system…then it is dead in the water.

“The government can fund research,” he added. “But the investors have to take that research into the marketplace through the translational so-called ‘valley of death’. You have to get that [innovation] picked up and bought by an exit strategy with large pharma, and you have to get that through a regulatory system that is hopefully willing to take a degree of risk.

“So you need innovation, a friendly regulatory system, and then you need somebody to pay for this.”

Global cohorts initiative

DAC’s Global Cohort programme is supporting research projects in 7 countries (orange on the map) involving some 350,000 participants.

Moving beyond Africa, the DAC Global Cohorts initiative aims to reduce research costs and amplify results by linking up like-minded initiatives worldwide in North-South collaboration nodes. The programme involves seven research cohorts extending from Kenya to Malaysia and the Caribbean, supported by funders ranging from DAC to the pharma industry and the National Institutes of Health.

Researchers in the cohorts are testing new diagnostics tools as varied as digital voice imprints and olfactory glands – with the aim of bringing successful models to scale.

“Just think of what Kenya community health workers can do,” Vradenburg said, as a simple measure of feasibility. “They’re not going to take a venous blood drop. They’re not going to do a half-hour long, paper and pencil test.”

Disruptive diagnostics

Sam Barrell, center, CEO of LifeArc.

The race to develop more low-cost diagnostics that can predict the risks of developing dementia years before symptoms occur is one recurring theme that illustrates both the challenge and the potential of more linked-up R&D engagements.

Today’s gold-standard diagnostics—such as PET scans and spinal fluid tests—are costly, invasive and inaccessible to most of the world. “Most people do not have access to that,” noted Barrell, the driving force behind LifeArc.

The UK-based self-funded non-profit, is co-sponsoring a multi-country research project on lower cost alternatives, due to yield results due in 2028. The research is comparing the current “gold standard” diagnostics with finger prick tests for blood-based biomarkers and digital tests for other biomarkers, including cognitive tests delivered via smartphones.

Already, blood-based tests based on venous draws can detect certain pathological changes in the brain associated with Alzheimer’s long before symptoms appear: “potentially up to 15 to 20 years before you actually have clinical signs,” Barrell said.

So if the same proteins can be picked up accurately from a fingerprick test, the shift to earlier detection—could redefine the entire trajectory of the disease.

“Early predictive diagnostic tests… can be transformative, particularly if they are scalable, low- cost alternatives to the expensive scans we’ve got now,” Barrell said, noting that preliminary data from the study appears promising.

“If you can intervene earlier on those lifestyle factors that make you more likely to develop dementia and you could fast-track people into the right trials with the right treatments that would make a big difference in the longer term,” she added, noting that there are pioneering treatments in R&D due to come to market in the near term.

And because these tools are being designed with low-resourced settings in mind, they would ultimately benefit everyone. A finger-prick test that works in rural Africa will also be cheaper in Europe or the United States.

“So in the utopia of the future,” Barrell said, “You and I would get a little card in the post; we would just prick ourselves; and put our blood on it… and then… using a digital app, hopefully get a result of our risk of dementia with a high degree of accuracy.”

AI: promise and pitfalls

AI offers unprecedented reach, but…Susan Arminger, Catalight (center). L-R: Michael Cook, Our Future Health; Peter Lee, Microsoft Research in Davos.

Artificial intelligence is another force reshaping the research landscape—but its role is complex.

On one hand, AI offers unprecedented reach. As Susan Armiger, CEO of Catalight, explained, “AI can offer a ‘direct to consumer approach’… somebody could come to a website… and they would talk about whatever they’re experiencing without having the barrier of a medical professional.”

In contexts where doctors are scarce, that could be cost-efficient as well as revolutionary. “Sometimes we find that they are the barrier to someone getting into a screening or a diagnostic evaluation,” added Arminger, who heads America’s leading network of healthcare providers for autism and developmental disabilities.

But prevailing AI models also reinforce existing inequities.

Or as Peter Lee, President of Microsoft Research warned, “AI model training today is oriented towards the Global North… the lack of cultural alignment… continues to be a problem.” Language, imagery and cultural context all shape how AI systems interpret symptoms—and misalignment can lead to misdiagnosis or exclusion.

He also highlighted a deeper structural challenge faced by rich and poorer health systems alike: “Cognitive health intervention involves a mix of different audiences – professional healthcare deliverers, community workers and informal/ family caregivers. And that mix of different communities and people amplifies the trust issues and creates practical problems …that you need [to overcome] in order to collaborate.”

Innovation ‘in all directions’ can benefit us all

Drew Holzapfel, DAC COO

Along with the new African data initiative, DAC is also establishing an India branch in collaboration with the Indian government.

This will include a workplace-based study on cognitive health in collaboration with the Indian Institute of Technology as well expanded research into new AI-based diagnostics assessing voice imprints and eye movements.

“There’s a belief that you can detect a cognitive impairment through voice, and so we’re trying to validate that in India, which has incredible throughput and volume,” observed Holzapfel. “So we’re set up in a giant office park, and we are taking voice samples at a pace you would never believe.

“If you fast forward, the real opportunity here is to have the ambient voice collection when you’re in the doctor’s office that’s listening and determining if you have cognitive impairment.”

And it is planning for a series of high-level events this year to build political will and commitment – from the United Nations General Assembly in New York to technical meetings in Africa that lay the framework for the Global Mental Health Summit in Rwanda in early 2027.

As Vradenburg put it in a moment of stark clarity: we are investing hundreds of billions in artificial intelligence, while the health of the human brain—“eight pounds powered by less than a light bulb”—remains underfunded.

Politicians need to understand that “only when innovation flows not just from North to South, but in all directions. Only when equity is not an afterthought, but a driver of discovery – then the solutions built for the most constrained settings may ultimately benefit us all.”

Image Credits: Flickr: Florey Institute of Neuroscience & Mental Health, DAC , Martin et al., 2019, Health Policy Watch, Witkoppen Clinic, DAC , Health Policy Watch , Us Against Alzheimer's .

Argentina Has Revoked Key Patentability Guidelines, Threatening Citizens’ Access to Affordable Medicine

02/04/2026 Monica Rull & Rachel Soeiro

Argentina took a step backwards last month when it revoked key guidelines that defined what could – and could not – be patented in its pharmaceutical sector.

For more than a decade, Argentina’s patentability guidelines have helped prevent pharmaceutical monopolies, enabling timely competition to enter the market, lowering prices of medical tools, and improving people’s access to treatment.

These guidelines were fully in line with the World Trade Organization’s (WTO) TRIPS Agreement, which allows countries to define patentability standards as based on public health needs. However, Argentina’s recent shift risks undermining access to medical tools by opening the door to broader, unwarranted monopolies.

For Médecins Sans Frontières (MSF), patent rules are not an abstract, legal matter. They determine who can produce medical tools, under what conditions, and whether people receive treatment in time or are left waiting.

Across our projects, we see the same pattern. When monopolies persist, the supply of medical tools is constrained and costs are high, resulting in delayed or denied treatment.

Generic competition

Alternatively, when competition from other pharmaceutical companies is enabled, access expands. For instance, access to hepatitis C treatment has expanded dramatically in places where affordable generic treatments were introduced. With the entry of generic competition, the price for a 12-week treatment course for two new, oral medicines, sofosbuvir and daclatasvir, dropped from $147,000 to $120 per person.

In global health, access to medical tools is often framed as a question of price. But long before exorbitant prices are set by pharmaceutical corporations, other fundamental factors have already been decided.

These include who is allowed to produce, where production can take place, and where those products can be sold. These factors are shaped by patent rules and, crucially, by how strictly those rules are applied.

Patents are time-limited exclusive rights granted by governments with a duration of 20 years from the filing date and are granted only if certain criteria are met.

Under the WTO TRIPS Agreement, patents are granted for new inventions that involve an inventive step and are capable of industrial application.

But countries retain policy space to determine how these criteria are applied in practice. When patentability standards are applied loosely – for example, granting new patents for minor modifications on the same medicine – monopolies extend beyond what the system is meant to protect.

Competition is delayed, and high prices persist. Minor improvements, such as a reduced pill burden or easier administration, can benefit people, but they do not justify a new 20-year monopoly.

Rigorous standards

Applying patentability standards rigorously – by granting patents only where the criteria are truly met – allows competition to emerge earlier, lowering prices and expanding access.

For years, Argentina offered one of the clearest examples of how rigorously applying patentability standards works in practice.

Its patentability guidelines limited the granting of weak patent claims – for example, patents on new forms, dosages, or uses of existing medical tools – and restricted overly broad claims, such as attempts to cover entire classes of compounds without demonstrating a real technical contribution.

These patentability guidelines created a more disciplined system that enabled timely generic competition. Critically, rather than concentrating supply options in the hands of patent holders or their selected licensees, the guidelines allowed independent producers to enter the market which, in turn, supported the importation and domestic production of generic medical tools.

The guidelines also improved how Argentina’s patent system in the pharmaceutical sector functioned by discouraging the filing of weak claims early on, reducing unnecessary filings, easing the administrative burden, and making full use of the policy space under the WTO TRIPS Agreement to ensure that patent rules served innovation as well as public interest.

The impact was measurable. Only about 18% of follow-on pharmaceutical patent applications identified globally were filed in Argentina, while many other countries continued examining large volumes of weak claims.

Under Argentina’s guidelines, patent grant rates dropped from around 9% to below 1%, and the overall likelihood of a patent being granted fell from roughly 70% to about 16% overall. That meant fewer unwarranted monopolies, more room for generic producers to enter the market, and less litigation risk, with disputes arising in less than 1% of cases, according to research.

In other words, the system rewarded genuinely new inventions in a way that was not anti-innovation. It was, instead, a way of applying the rules that aligned patent protection with its intended purpose while also preserving space for competition and access and, ultimately, prioritising public health needs.

Experiences from other countries show how different approaches to the application of patent rules can lead to very different outcomes.

Access at risk

In India, strict patentability standards have supported a strong generic industry that supplies medical tools globally. For example, India rejected a follow-on patent on the cancer drug, imatinib mesylate, making it clear that minor modifications do not justify new monopolies and preserving space for generic production.

In contrast, similar follow-on patents on this drug were granted in South Africa, extending patent exclusivity by 10 years beyond the original patent term and, as a result, delaying competition and keeping the prices of this important drug high.

When monopolies persist and the prices of medical tools are kept high, public health systems may have to ration care; families often face unaffordable treatment costs; and countries’ dependence on a single supplier risks shortages or complete stockouts of medical tools, all of which can delay treatment scale-up.

Argentina’s decision to roll back its guidelines risks moving in this direction, where people’s access to affordable healthcare may be delayed or denied.

At a time when there is a growing global concern over the need to strengthen production capacity and make health supply systems more resilient after the COVID-19 pandemic, Argentina’s patentability guidelines are a rare and functioning example of how to use an existing legal space to balance innovation, access, public health, and development.

That example is at risk.

Argentina’s policymakers now have an urgent responsibility: to restore and safeguard the country’s patentability standards before the damages become entrenched, and access to medical tools is pushed further out of reach.

In the end, access is not only about the invention of medical tools. It is also – and ultimately – about who gets treated and who is left waiting.

Dr Monica Rull is the interim executive director of Médecins Sans Frontières Access.

Dr Rachel Soeiro is head of the Americas Hub of Médecins Sans Frontières Access.

Image Credits: AMR Industry Alliance, Flickr/Takacsi75.

Vaping Likely to Cause Lung and Oral Cancer

01/04/2026 Kerry Cullinan

A new review links vaping to oral and lung cancer.

Vaping is likely to cause oral and lung cancer, according to a comprehensive review of over 100 studies of the effects of nicotine-based e-cigarettes, published this week in the journal, Carcinogenesis.

Carcinogenicity was evident in human studies that monitored biomarkers of harm, including DNA damage, oxidative stress, and “epigenetic change and inflammation in oral and respiratory tissue”, according to the researchers, who hail from a range of Australian universities.

Meanwhile, studies on mice showed that they developed lung tumours after exposure to vape aerosols.

The researchers focused on studies from 2017 of people who only used nicotine-based e-cigarettes or on studies that compared smokers and vapers, and excluded studies that involved people who used both tobacco and e-cigarettes.

“Though direct epidemiological evidence of cancer causation takes time to accumulate, carcinogenicity of e-cigarettes is evident from different types of investigation,” the study concluded.

“To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” according to co-author Bernard Stewart from the University of New South Wales.

In a commentary published alongside the research, Stewart and co-author Freddy Sitas note that it took a long time before the harms of smoking were recognised. The first study to report a link between smoking and tuberculosis was published in 1886, yet smoking was only definitively linked to lung cancer in 1964.

“Though smoking was once given the benefit of doubt, the same should not now be accorded to vaping given the strength of relevant carcinogenicity data,” they write.

The tobacco industry has promoted vaping as a tool to help smokers to quit, while promoting e-cigarettes to young people who have never smoked.

Image Credits: pixabay.

Eliminating Cervical Cancer is a Global Health Equity Challenge

01/04/2026 Caroline Bwanali-Mussa, Haileyesus Getahun, Antje Leendertse & Leslie Ramsammy

A school girl in Dwazark Community, Freetown, Sierra Leone, receives the HPV vaccine to protect against cervical cancer.

Cervical cancer should no longer be killing women. It is one of the few cancers that we already know how to prevent, detect early, and treat effectively.

Yet it remains the fourth most common cancer among women worldwide, causing around 600,000 new cases and 340,000 deaths each year.

The tragedy is not just the scale of the disease—it is the inequality behind it. Women in lower-income countries are three times more likely to develop cervical cancer and six times more likely to die from it than those in wealthy countries.

In other words, cervical cancer is not just a medical problem. It is a stark symbol of global health inequity.

But there is also good news. Unlike most cancers, cervical cancer can be eliminated. The tools already exist: HPV vaccines and screening tests, and effective treatment.

The World Health Organization (WHO) has given us a roadmap with clear goals. What we lack is not science or plans, but global resolve.

History shows what is possible when the world acts together. For centuries, smallpox killed hundreds of millions of people.

In 1958, the World Health Assembly called for its eradication. Countries collaborated—even at the height of the Cold War—sharing vaccines and resources. Two decades later, in 1980, smallpox became the first disease ever eradicated by humanity.

That moment should inspire us today. If the world can eliminate one of the deadliest infectious diseases in history, we can surely eliminate a cancer that we already know how to prevent. The encouraging progress made towards eliminating other diseases – such as polio and HIV transmission from mothers to their children – also provides hope and lessons for cervical cancer.

The path is clear

In 2020, WHO member states adopted a global strategy to eliminate cervical cancer, setting clear milestones known as the 90-70-90 targets for 2030:

90% of girls vaccinated against HPV by age 15
70% of women screened by age 35 and again by 45
90% of women with cervical disease treated.

These targets are ambitious, but achieving them is a key step on the path to elimination, which is defined as an incidence threshold of less than four cases per 100,000 women per year.

Some wealthy countries are well advanced: Sweden aims to eliminate cervical cancer by 2030. Australia may do so by 2035. Canada and several European countries hope to achieve elimination by 2040.

Lower-income countries should also be ambitious, and many could realistically eliminate cervical cancer by 2050 with the right tools and support. Rwanda, for example, has already achieved vaccination coverage close to 98%, while a recent campaign in Malawi targeting schoolgirls and adolescents extended vaccine coverage above 90%, proving that elimination is not a dream—it is a clear policy choice.

Two Rwandan girls sit together after receiving their HPV vaccinations at their primary school in Masaka. Rwanda has achieved 98% vaccination for HPV.

Four actions that can save millions of lives

Countries do not need complex new technologies to make significant progress. The basic strategy is straightforward, using proven approaches that:

Educate and mobilize the public: Awareness about HPV, vaccination, and screening remains uneven. Communities must understand that cervical cancer is preventable.
Expand innovative screening: HPV tests—including molecular assays on self-collected vaginal or urine samples—can detect high-risk HPV early, well before cancer develops.
Vaccinate girls—and boys too: HPV vaccination is one of the most powerful cancer-prevention tools ever developed, offering protection not just against cervical cancer, but anal, penile and throat cancers, as well.
Ensure treatment is available: Women who develop cervical disease must have access to surgery, medicines, and radiotherapy. Pre-cancerous lesions detected early can often be treated through simple procedures in primary care settings.

The equity gap

The greatest obstacle is not knowledge – it is inequality. More than 90% of cervical cancer deaths occur in low- and middle-income countries. Many governments cannot fully afford large-scale vaccination programs or nationwide screening. This is why cervical cancer elimination must become a financing priority.

When the world confronted HIV in the early 2000s, international partnerships, donor funds, and global activism transformed the response. Today, millions of people are living longer because of that mobilization.

Cervical cancer deserves the same sense of urgency and commitment, recognizing that the current global context demands a different approach—one that builds on country leadership and existing services to reach people where they are, in their own communities.

Addressing the equity gap also means that we must continue to fight for the rights of women and girls to education, autonomy and freedom from poverty – conditions that often determine whether health care is within reach. And it means ensuring that vaccines are developed to address the HPV35 genotype that is increasingly contributing to the burden of cervical cancer in Africa and among women with HIV.

Building a global movement

Momentum is growing. In November 2025, the world marked the first World Cervical Cancer Elimination Day, and several countries now hold awareness campaigns throughout January.

In Geneva, we are working to mobilize the diplomatic community and governments on this issue as part of the broader right to health. These initiatives must grow into a true global movement – one that engages communities, strengthens political will, and holds governments accountable for progress. Another lesson from HIV/AIDS is clear: when societies mobilize, transformation follows.

Historic opportunity

If humanity eliminates cervical cancer, it will mark the first time we have ended a cancer as a public health threat. The implications would be profound, giving hope that other cancers can also be prevented or eliminated through advances in science, North-South and South-South cooperation, community empowerment, and political commitment.

The window for action is open, and the tools are at hand. Further delay will cost millions of lives. We cannot allow current pressure on health and development budgets to prevent us from doing what is right – ending cervical cancer as a disease of inequality and neglect. Instead, let’s commit the resources, mobilize the partnerships, and finish the work.

See related story

Caroline Bwanali-Mussa is the Permanent Representative of Malawi to the United Nations in Geneva and Ambassador of Malawi to Switzerland.

Dr Haileyesus Getahun is Chief Executive Officer of the Global Centre for Health Diplomacy and Inclusion, based in Geneva.

Antje Leendertse is the Permanent Representative of the Federal Republic of Germany to the United Nations in Geneva.

Dr Leslie Ramsammy is the Permanent Representative of Guyana to the United Nations in Geneva.

Image Credits: Gavi, Gavi, UNICEF, CeHDI.

Two-Speed Multilateralism: Breaking the Deadlock on Climate and Health

31/03/2026 Felix Sassmannshausen

Panellists Diarmid Campbell-Lendrum (WHO, stage centre), Miguel Ruiz Botero (Colombian UN Mission, stage right), Margarita Gutierrez (IISD, screen left), Ömer Öztürk (Türkiye Min. of Environment, screen right), and Gül Mersinlioğlu Serin (Türkiye Minister of Health, screen centre) discussing two-speed multilateralism in Geneva.

From stalled Pathogen Access and Benefit Sharing (PABS) negotiations to failing consensus in global climate policies, United Nations structures face a profound crisis. Diplomats are currently being forced to explore alternative governance models to bridge the disconnect between sluggish, power-driven diplomacy and the rapid, equitable action required in health and climate crises.

This institutional rupture and the resulting emergence of two-speed multilateralism took centre stage during a critical panel hosted by the Global Health Centre in Geneva on 30 March.

Professor Suerie Moon delivers opening remarks at the event.

“The world order and the postwar institutions that were created to address global problems are at a unique moment of rupture, possibly collapse or transformation, depending on where we go from here,” said Professor Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute, during her opening remarks of the expert panel discussion.

The event was co-hosted by the Centre’s International Geneva Global Health Platform, alongside the World Health Organization (WHO), the International Institute for Sustainable Development (IISD) and the Geneva Environment Network.

There was clear unity among the expert panellists – ranging from global health researchers and climate adaptation advisors to international diplomats – that when traditional, consensus-based multilateralism stagnates, the international community must pragmatically turn to alternative, faster diplomatic channels.

Two-speed multilateralism: agile coalitions accelerate implementation, while universal consensus provides global legal legitimacy.

This “two-speed multilateralism” combines the universal legitimacy of consensus-based UN negotiations with the rapid implementation capabilities of smaller, highly ambitious “coalitions of the willing”, aiming at preventing single nations from vetoing desperately needed progress on environmental and public health protections.

Miguel Ruiz Botero argues for the need of two-speed multilateralism because some nations weaponize consensus to obstruct global progress.

“Consensus has been, in essence, weaponised by a few countries to obstruct progress,” said Miguel Ruiz Botero, second secretary at the Permanent Mission of Colombia to the UN in Geneva, during the panel discussion.

For example, as global temperatures reach record levels, experts argue that traditional structures are simply not mobilising political action fast enough to protect vulnerable populations affected by climate change.

To bypass this gridlock, Colombia is hosting the Santa Marta Conference on 28-29 April, which will serve as a prime example of this accelerated diplomatic speed.

Co-hosted by the Netherlands, the summit aims to establish a clear pathway for transitioning away from fossil fuels outside the traditional UN architecture.

This parallel track aims to establish a strict division of diplomatic labour, as COP30 President André Aranha Corrêa do Lago recently outlined.

While the “first tier” ensures universal legitimacy and sets the collective legal direction, the “second tier,” or fast track tier, focusses exclusively on rapid implementation by mobilising finance and deploying solutions at scale without reopening debates already settled by consensus.

WHO support for two-speed approach

Diarmid Campbell-Lendrum (WHO) argues that health-based fossil fuel transitions offer immense, self-financing benefits.

Notably, the WHO voiced clear support for this parallel approach. “If a certain subset of parties or countries can take a part of the agenda that moves things in a positive way, then you know that has to be supported,” said Dr Diarmid Campbell-Lendrum, WHO head of the climate change, energy and air quality unit.

He noted that the health gains from reducing air pollution would effectively cover the costs of transitioning away from fossil fuels, making a compelling, evidence-based case for this accelerated track.

Key Moments for Climate and Health Diplomacy in 2026

This decisive backing for initiatives outside the formal UN architecture is unusual for an agency traditionally restrained by universal consensus.

However, in private discussions following the event, experts observed that the WHO is navigating new political dynamics. Following the US exit, the institution may be experiencing reduced diplomatic pressure, inadvertently allowing it to embrace more pragmatic, parallel agreements without its usual hesitation.

This momentum will continue at the upcoming 79th World Health Assembly in May. While the WHO will not formally report on its “Global Action Plan on Climate Change and Health” during the main agenda, Türkiye and Brazil are set to co-host a high-level side event to fill the gap and strengthen the integration of the health and climate dossiers ahead of the COP31 summit in November 2026.

Bypassing slow paced consensus is not new

The panellists discussed that while two-speed multilateralism is an old tool, the 2026 rupture makes it a necessity.

The strategy of utilizing alternative diplomatic pathways to bypass institutional gridlock is not a novel invention.

“Two-speed multilateralism is certainly not a new phenomenon,” said Moon. “Ever since the UN was founded 80 years ago, there have been parallel bilateral and minilateral processes that work alongside global multilateral processes.”

In recent decades, parallel negotiations and smaller alliances have historically operated alongside universal frameworks to influence broader international arenas. When traditional consensus rules made a UN-based landmine convention impossible in the late 1990s, Canada and a group of progressive nations moved negotiations outside the formal architecture to create the Ottawa Process.

This historical success, alongside the eventual adoption of the Arms Trade Treaty by the UN General Assembly, demonstrates how coalitions of the willing can effectively force meaningful international agreements when broad consensus fails, explained Colombia’s representative Botero.

The upcoming Santa Marta conference will act as the first major testing ground for establishing this diplomatic strategy in climate policies. Unlike exclusive diplomatic clubs where powerful nations make decisions behind closed doors, this approach remains open to states ready to act.

Integrating health into climate action

Ultimately, these efforts aim to create a push-pull dynamic that elevates the baseline ambition of the entire international community.

Gül Mersinlioğlu Serin from the Ministry of Health, Türkiye highlights the synergy between UN legitimacy and voluntary coalitions.

“We see value in both tracks, the inclusiveness and legitimacy of the UN system alongside the dynamism of the coalition of voluntary initiatives that can accelerate progress,” said Dr Gül Mersinlioğlu Serin, a health expert at the Turkish Ministry of Health.

However, securing these baseline commitments – and breaking down two decades of silos between climate and health negotiations – remains challenging.

Despite these hurdles, the recent COP30 summit in Belém, Brazil, delivered clear progress by finalising the Baku Adaptation Roadmap and establishing 59 voluntary indicators for the Global Goal on Adaptation.

This allows the international community to measure climate impacts through human health metrics, such as heat-related mortality and local health system resilience, explained Ömer Öztürk, head of adaptation to climate change and local policies at the Turkish Ministry of Environment, Urbanization and Climate Change.

Expanding action through local health

WHO Director-General Dr Tedros Adhanom Ghebreyesus speaking at COP30 in Belém, which launched he Belém Health Action Plan.

The Belém Health Action Plan established a critical framework for building low-carbon, climate-resilient health systems, effectively translating slow-moving global agreements into on-the-ground implementation. By targeting surveillance, capacity-building, and digital innovation, the plan ensures adaptation measures actively address severe health inequities.

To successfully execute these measures at an accelerated pace, experts argue that broad climate goals must be communicated in terms that specific sectoral ministries understand.

Margarita Gutierrez (IISD) emphasizes the need to translate climate goals into health-specific language.

“This is a translation, this is different language and this happens with all the sectors,” said Margarita Gutierrez, policy advisor for Friends of Climate and Health at the International Institute for Sustainable Development, emphasising that mainstreaming climate considerations into everyday sectoral policies provides a crucial opportunity to coordinate joint actions.

However, Gutierrez warned that unless countries actively integrate these health metrics into their formal UN commitments – such as Nationally Determined Contributions (NDCs) – securing health’s relevance and funding on future global agendas will remain incredibly difficult.

But as amending these universal UN agreements is a years-long bureaucratic process, experts argue that fast-track, parallel coalitions are urgently needed to bypass the gridlock and deploy health solutions immediately.

Rebuilding trust through equitable cooperation

Small developing island states are highly vulnerable to the effects of climate change and rely on universal diplomatic processes to ensure they hold equal weight to major global powers.

However, building on two-speed multilateralism and operating outside universal frameworks carries significant risks, prompting debates about fragmentation and the potential exclusion of smaller developing nations.

“Considering, for example, that small island developing states are some of the most vulnerable to climate change, it’s really important that they have the equal weight to be able to stop the process,” said WHO’s Campbell-Lendrum, arguing that universal forums allow vulnerable nations to demand the same attention as major powers.

Margot Morris highlights Australia’s commitment to supporting climate-health cooperation with Pacific island nations.

To ensure these frontline voices are not lost, diplomats are actively elevating regional priorities.

Highlighting this effort, Australia, presiding over the negotiations at the COP31 summit, announced that it is cooperating with Pacific islands to support a pre-COP31 gathering.

“We are working hand in hand with Pacific Island Forum members and regional organisations to shine a global spotlight on our region,” said Margot Morris, counsellor at the Permanent Mission of Australia to the UN.

As the Geneva event concluded with characteristic sober pragmatism, the underlying message was clear: by ensuring rapid progress does not come at the expense of equity, two-speed multilateralism could help counter the climate crisis and stabilise the deeply fractured international order.

Image Credits: Felix Sassmannshausen/HPW, WHO/PAHO/Karina Zambrana , Unsplash/Ernests Vaga.

New Open Source AI Platform Aims to Accelerate Malaria Drug Discovery

31/03/2026 Kerry Cullinan

A health worker examines a child with suspected malaria.

Scientists working on new malaria drugs now have access to an open-access artificial intelligence (AI)-powered platform aimed at accelerating drug discovery, thanks to a partnership between Medicines for Malaria Venture (MMV) and deepmirror.

Drug Design for Global Health (dd4gh) uses “both predictive and generative AI to give researchers, especially those in the most resource-limited settings, access to cutting-edge technology that would otherwise be out of reach”, according to a media release from MMV.

The dd4gh platform was developed using input gathered during co‑creation workshops in Ghana and Switzerland with global drug discovery researchers.

Its AI models are trained on data sets from a wide range of studies conducted by global health researchers, enabling scientists to benefit from insights generated across multiple research efforts.

“At a time when the global health sector is facing significant constraints, dd4gh demonstrates the power of partnership,” said MMV CEO Dr Martin Fitchet. “By giving scientists in low and middle-income countries (LMICs) free access to advanced AI tools, we can accelerate the discovery of lifesaving medicines led by the people closest to the diseases we are trying to defeat.”

The platform implements active learning, a technique that allows AI and machine learning (ML) to continuously improve its predictions by learning from new data. It analyses large data sets and proposes the most promising compounds to explore in the lab.

Shorter timelines, reduced costs

These technologies have the potential to dramatically shorten timelines and reduce costs for drug discovery, allowing scientists to focus their time and resources on what is more likely to work, enabling faster discovery of treatments for diseases that pose significant global health challenges.

“Africa is disproportionately affected by many infectious and non-infectious diseases, yet African-led solutions are limited. Tools like dd4gh can have a transformative impact on the continent’s capacity for drug discovery research,” said Prof Richard Amewu, lead of the drug innovation group at the University of Ghana, which tested the platform.

Dr Godwin Dziwornu, senior investigator in medicinal chemistry at the University of Cape Town’s (UCT) H3D, said that the platform is “easy to access and user-friendly”.

Dziwornu added: “I’ve found it very useful in two main areas: generating new compound designs and the models available to assess compound properties and predict their drug likeness to solve a particular liability, for example, absorption, distribution, metabolism and excretion. This helps me guide my decisions to synthesise high-quality compounds, saving me precious time and resources.”

Caroline Maina, a UCT PhD candidate and participant in a co-creation workshop, said there are other AI tools that can help with drug discovery “but being in a resource-limited setting makes purchasing a license prohibitive”.

“Making dd4gh open access for researchers in global health means more of us can explore new ideas and apply AI to finding treatments for diseases that are part of our everyday realities,” said Maina.

Dr Max Jakobs, co-founder and CEO of deepmirror, said the free platform aims to strengthen “a more inclusive global scientific ecosystem” as “access to advanced AI should not depend on where a scientist works or their laboratory’s resources”.

deepmirror builds chemistry-based foundation models for biopharma and research organisations to support active drug discovery programmes. It integrates predictive and generative AI directly into research workflows, combining “proprietary data with models trained on larger, curated datasets, which are continuously updated and strengthened over time”.

MMV is a not-for-profit product development partnership working to discover, develop and deliver medicines to treat, prevent and eliminate malaria. Since 1999, its co-developed medicines have helped 1.3 billion people.

Image Credits: Tommy Trenchard/ Global Fund, Damien Schumann / MMV.

More Countries Refer to Refugees in Health Policies, but Access and Data Gaps Persist

30/03/2026 Stefan Anderson

First global survey of 93 nations shows two-thirds include these populations in health plans, but none provide equal access to undocumented migrants.

More than 60 countries now include refugees and migrants in their national health policies, according to a new World Health Organization (WHO) report tracking progress on commitments first set out by the World Health Assembly in 2019.

The finding, drawn from a survey of 93 member states, is the first systematic count of how countries are implementing a resolution that called on governments to ensure refugees and migrants have access to health services, are included in national health planning, and are counted in health data systems.

“Many countries have begun integrating refugee and migrant health into national strategies,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Yet gaps remain, particularly in collecting and using migration-related health data, ensuring participation of refugees and migrants in decision-making, and guaranteeing access to care for all, regardless of legal status.”

“Like anyone else, refugees and migrants need uninterrupted, affordable and equitable access to health services wherever they are,” Tedros said.

While WHO called the findings “encouraging,” the picture the report paints is difficult to read clearly. What “inclusion in a national health policy” actually means for care access for migrants and refugees varies widely – and the report does not name which countries fall where.

Two-thirds of the 93 surveyed countries said they include refugees and migrants in their health policies. When asked what level of access different groups receive, 16 countries said refugees can access services on a par with the host population, 14 extended that standard to documented migrant workers, and 11 to asylum seekers.

No country surveyed reported providing equal access to migrants in irregular situations – those living without legal status or formal documentation. The positive examples the report does name – from Belgium to Chile – are presented as case studies.

Only 37% of countries routinely collect and disseminate migration-related health data. Fewer than 40% train health workers in culturally responsive care. Just 30% have run campaigns to counter misinformation or discrimination, the report found. The report is the first systematic quantification of these indicators, further blurring the picture of progress, as there is no baseline to compare against.

The data is also entirely drawn from a voluntary survey completed by member states with no independent verification, meaning the results are unvetted self-assessments.

The report explicitly does not rank countries on the success, impact or implementation of their policies, and “did not assess the level of implementation or impact of any given initiative,” meaning real-world outcomes “cannot be evaluated,” it said.

The survey also contains no questions about financing, meaning a country can report including refugees in its national health policy while allocating no dedicated budget to deliver on it.

“Rather than ranking countries on their progress,” the report notes, it seeks to identify how key gaps can be addressed going forward.

The report comes as conflict, climate change and economic insecurity displace more people than ever before.

More than one billion people live as refugees or migrants worldwide, though over 800 million remain within their own borders. There are 405 million international migrants, 36.8 million refugees, 8.4 million asylum seekers and 83.4 million internally displaced people.

Dr Santino Severoni, head of WHO’s Special Initiative on Health and Migration and lead author of the report, said it was intended as a roadmap for coordinated action across governments, UN agencies, civil society, academia and migrant communities themselves.

“The health of refugees and migrants is not a marginal concern: it is a defining issue of our time,” Severoni said. “By acting now, countries can ensure that refugees and migrants are not left behind, and that health systems are stronger, fairer and more prepared for the future.”

Data ’emergency’, exclusion from emergency plans

Progress roadmap for the World Health Assembly Resolution on migrant and refugee health.

The new report follows a first edition published in 2022, which was a literature review of around 82,000 documents that established the scale of health disparities facing refugees and migrants worldwide. Two further progress checks are planned for 2027 and 2029, ahead of the 2030 deadline set by WHA member states for full implementation.

The 2022 report identified fragmented data collection as the central structural obstacle to effective policy. That remains unresolved. Severoni described the situation as “almost an emergency.”

“It’s not because data is not collected, but because they are collected in a very fragmented way, which makes it very, very difficult for us to have a full picture,” he said.

Just 42% of countries include refugees and migrants in emergency preparedness or disaster risk reduction plans. Irregular migrants – those without legal residency status – are entirely absent from those frameworks, even as the crises that drive displacement, from war to climate-related disasters, intensify.

“We cannot talk about refugee and migrant health without also addressing emergencies,” said Dr Chikwe Ihekweazu, WHO’s executive director for health emergencies. “Whether it’s a conflict, a climate-related crisis or an epidemic that forces movement, these crises expose the fragility of health systems and magnify the vulnerabilities of all those already at risk.”

Population groups among refugees and migrants included in national health policies,
legislation, strategies or plans.

“This is not only an equity issue — it is a global health security risk,” he added. Excluding displaced populations from health systems, he said, weakens the collective capacity to detect and respond to outbreaks and crises. “Health does not begin and end at borders.”

WHO is calling on governments to strengthen disaggregated health data collection, tailor policies to specific migrant groups including those in irregular situations, involve refugees and migrants in health governance, train health workers in culturally responsive care, and protect and expand financing.

“The phenomena of displacement is unfortunately happening more frequently in countries with fragile systems, fragile economies and limited domestic resources,” Severoni said.

“There is almost no mention of irregular migrants in those emergency plans and response or in disease risk reductions, there is no systematic approach in assessing the system to see how their system is really functioning, how efficient and effective it is.”

“This is really a call for action to keep the promise of sharing a bit of responsibility in managing those emergencies,” he added.

Political wave washes away progress

Political sentiment in many wealthy nations has turned against expanding access for migrants, refugees and asylees.

The report highlights progress in some countries. Chile has embedded migrant community representatives in municipal health councils, with direct input into maternal and mental health priorities.

Belgium has run a national intercultural mediation programme since 1999; as of late 2024, 113 trained mediators were working across 76 hospitals and community health centres.

Yet the report’s release comes as several wealthy nations move to restrict refugee and migrant healthcare, driven by economic pressures and political campaigns questioning whether asylum seekers and refugees should be entitled to publicly funded care.

In the United States, legislation passed in 2025 changed the definition of “eligible alien” for Medicaid eligibility, cutting coverage for many lawfully present immigrants, asylees, refugees, and trafficking and domestic violence survivors.

On 1 May, its northern neighbour Canada will start requiring refugees and asylum seekers to pay out of pocket for essential health services previously covered under its Interim Federal Health Program.

The programme “has provided basic health coverage to people fleeing war, genocide, torture, and persecution since 1957,” according to the Migrant Rights Network. Services affected include medications, dental care, mental health, vision and physiotherapy.

Across the Atlantic, Germany extended to 36 months the period in which asylum seekers are restricted to emergency-only care, doubling the previous threshold of 18 months.

In France, a similar fight is playing out over the future of its Aide Médicale de l’État programme, which provides medical care to undocumented migrants. Critics say the programme encourages migration and is an undue cost to taxpayers, though it accounts for just 0.5% of national public health spending.

International funding for refugee health has also fallen sharply. UNHCR’s 2025 budget stands at $10.6 billion, of which only 23% had been secured at mid-year. The agency has warned that up to 12.8 million displaced people could be left without life-saving health interventions this year.

“Around the world, more than one billion people are on the move, seeking safety, opportunity and dignity,” Tedros said. “Investing in refugee and migrant health is both ethically essential and strategically beneficial. Supporting their health and inclusion strengthens health systems and benefits everyone.”

Image Credits: Wikipedia Commons.

Pandemic Agreement Talks Get Five More Negotiating Days

30/03/2026 Kerry Cullinan

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing IGWG6 on Saturday evening.

With no agreement in sight, World Health Organization (WHO) member states curtailed talks on the Pandemic Agreement annex five hours earlier than scheduled on Saturday night, resolving to meet again within a month for a further five days of negotiations.

Member states will reconvene between 27 April and 1 May to negotiate further on the Pathogen Access and Benefit Sharing (PABS) annex, with the hope of tabling the annex at the World Health Assembly (WHA) in May.

The PABS annex is intended to ensure, on equal footing, the rapid sharing of pathogens with pandemic potential and the fair and equitable sharing of benefits arising from their use, including vaccines, diagnostics and therapeutics.

Addressing the tired delegates of the Intergovernmental Working Group (IGWG) after six days of intense talks, WHO Director General Dr Tedros Adhanom Ghebreyesus said that their efforts had not been wasted.

“At the same time, we must be candid,” said Tedros. “Despite best efforts, differences remain on key issues. These are not trivial matters. They go to the heart of equity, access, sovereignty and global solidarity. It’s therefore understandable that more time is needed to bridge these gaps in a meaningful and durable way.”

Tedros expressed support for IGWG’s decision to resume negotiations in about four weeks.

“This pause is not a setback. It’s an opportunity. It allows us to reflect, to consult further with our capitals, and to return with renewed clarity and flexibility, not to keep negotiating indefinitely, but to continue and to close the deal.”

However, tension was palpable at the start of the sixth – and supposedly final – round of talks last Monday when the African region rejected the Bureau’s draft of the PABS Annex.

Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February.

African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported.

After some tension during the closed session, member states accepted this position.

The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain key issues. These include that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty”, including contracts for commercial users of pathogen information.

Burkina Faso, speaking for the WHO Africa and Egypt, Sudan, Libya and Somalia, noted that registration should be mandatory for all users of the PABS system, benefit-sharing obligations should be clearer, and there should be more capcity-building –including technology transfer – for developing countries.

New Funding Models Needed as Global Health Faces Growing Financial Strain

28/03/2026 Health Policy Watch

Christoph Benn (left) and Patrick Silborn

Global health is facing a funding crisis. Aid is shrinking, debt is rising, and the needs are only increasing. According to Christoph Benn of the Joep Lange Institute and Patrik Silborn of UNICEF Afghanistan, health systems will need to fundamentally rethink how they finance and sustain care.

On a recent episode of the Global Health Matters podcast, host Gary Aslanyan was joined by these two experts, who said “innovative finance” has become central to discussions on sustaining health systems.

Benn said that while the term is widely used, few agree on what it actually means. He described it as a “spectrum” of approaches, ranging from philanthropic grants and conditional funding to private-sector investment models that expect financial returns.

“It has frustrated us deeply that so many people are talking about innovative finance, but very few actually know what they’re talking about,” Benn said.

Silborn emphasised that these mechanisms should not be treated as one-size-fits-all solutions. Instead, financing models must be designed around specific problems whether that means raising new funds, improving efficiency, or linking payments to measurable outcomes.

Drawing on his experience in Rwanda, Silborn described how a results-based funding model tied disbursements directly to performance, helping the country to maintain progress against major diseases despite reduced funding.

Both experts stressed that private-sector engagement requires a clear understanding of incentives.

“Private corporations are not charities,” Benn said. They can, however, contribute through marketing partnerships, technical expertise, or investment models that align financial returns with social outcomes.
Looking ahead, Benn pointed to targeted taxes and debt swaps as among the most scalable tools. Still, both warned that innovative finance is not a substitute for public responsibility.

“It only works when it is designed to solve real problems in specific contexts,” Benn said, underscoring that strong systems and governance remain essential to any lasting solution.

Listen to the full episode >>

Image Credits: Global Health Matters podcast.