Panellists (left to right): Akila Kosaraju, Chikwe Ihekweazu, Jane Halton, Paul Friedrichs, David Reddy, and moderator Shiulie Ghosh speaking during a World Health Summit panel on global health security and biodefence.
Panellists (left to right): Akila Kosaraju, Chikwe Ihekweazu, Jane Halton, Paul Friedrichs, David Reddy, and moderator Shiulie Ghosh.

Speaking at a flagship World Health Summit panel global health officials and pharmaceutical executives urged governments to reframe pandemic preparedness as ‘biodefence’ – a core national security asset and not a discretionary health expenditure.

BERLIN – That strategic pivot is becoming urgent as both global health and aid budgets shrink and multilateral diplomacy on pandemic prevention, preparedness and response stalls.

The Pandemic Agreement is in a gridlock with member states still at odds over the details of a  Pathogen Access and Benefit-Sharing (PABS) system – the contentious annex governing the sharing of biological samples and sequence data that must be concluded before the broader WHO Pandemic Agreement can be ratified by member states and come into force.

Chikwe Ihekweazu urges agreement on WHO PABS.
Chikwe Ihekweazu urges agreement on WHO PABS.

“By May 2027, we need countries to come together and agree the PABS to the pandemic agreement,” urged Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme during the panel discussion, co-hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA),  “Otherwise, our generation will live in regret.”

His warning comes amid accelerating health security risks – ranging from the active Ebola epidemic in the Democratic Republic of the Congo and a recent hantavirus outbreak aboard a vessel carrying crew members from 23 nations off Cape Verde to ‘dual use’ threats from military research or use of artificial intelligence by hostile actors to generate dangerous new pathogens.

Compounding threats drive health security risks

Members of the West Virginia National Guard’s Task Force Chemical, Biological, Radiological and Nuclear (CBRN) Response Enterprise assist medical responders to COVID-19 patients of a West Virginia nursing home in Apri, 2020.

Currently, however, the spillover of zoonotic diseases into human populations remains the primary catalyst for disease outbreaks, as environmental damage, climate pressures, and habitat destruction accelerate pathogen transmission between animals and humans. Resurgences in active conflict zones, such as in eastern DRC, demonstrate how transmission of such pathogens can quickly overwhelm fragile health infrastructure.

Reinforcing the urgency for better health security measures, David Reddy, director general of IFPMA, cautioned governments against ignoring long-term biological risks while focusing on immediate geopolitical crises.

“The next pandemic may not be the closest snake, but it might be the biggest, meanest snake we’ve ever seen, and it is worth considering where that might be hiding and doing something about it,” Reddy said.

Simultaneously, antimicrobial resistance (AMR) poses a silent, increasing threat that risks eclipsing the mortality of acute pandemic outbreaks.

“It’s estimated that the number of deaths between 2025 and 2050, if we aren’t able to address antimicrobial resistance, could be in the order of 39 million people, which is just extraordinary and outstrips pandemics,” Reddy added.

AI’s double-edged sword

Akila Kosaraju highlights AI-driven novel antibiotic discovery.
Akila Kosaraju, CEO of Phare Bio, highlights AI-driven novel antibiotic discovery.

Technological innovation is helping to overcome traditional market failures in antibiotics manufacturing. With generative models screening chemical space 10,000 times faster than traditional laboratories, artificial intelligence is transforming R&D for novel antibiotic compounds to counter AMR.

“Within three days, AI was able to come up with a solution that our medicinal chemists were equal parts amazed and troubled by,” said Akila Kosaraju, CEO and co-founder of Phare Bio, at the panel, sparking laughter and surprise among the audience.

At the same time, experts warned that AI models lower technical barriers by substituting for decades of tacit laboratory experience. Open-source genome models enable non-expert actors to computationally design novel viral sequences and optimize pathogens for higher transmissibility, lethality, or immune evasion.

These technological threats compound the potential risks of pathogen escape from the growing number of high-containment Biosafety Level 4 (BSL-4) laboratories, three-quarters of which are located in densely populated urban centres, according to analyses by the RAND Corporation, a global health security think tank.

Economic case for proactive ‘biodefence’

David Reddy warns against ignoring long-term risks.
David Reddy warns against ignoring long-term risks.

Despite technological advances, security against expanding biosecurity risks remains imperative and requires framing as a strategic investment rather than a discretionary expense. Industry leaders contrasted the $31 billion annual price tag of global preparedness with the catastrophic multi-trillion-dollar cost of inaction.

“Preparedness does not begin when a crisis hits,” said Reddy, citing industry calculations estimating that the overall economic cost of COVID-19 amounts to $13.8 trillion globally.

“It is built through the choices countries make every day to value innovation and invest in resilient health systems.”

Soaring defence budgets and plunging health aid

This warning comes as funding is being rebalanced towards national defence spending, while global development assistance is contracting sharply. Net official development assistance (ODA) is projected to drop 6.9% in 2026 following a record 23.3% collapse in 2025, according to OECD data. Sectoral health aid faces the deepest cuts of all, projected to fall between 29% and 46% from 2024 levels, pulling global health funding well below pre-pandemic baselines.

In contrast, global military expenditure reached an all-time high of $2.89 trillion in 2025 after eleven consecutive years of growth, according to Stockholm International Peace Research Institute data.

Paul Friedrichs, Rand Corporation

Noting that meeting annual global health security needs ($31 billion) represents just 1% of world military spending, Paul Friedrichs, senior biopreparedness fellow at the RAND Corporation and former White House pandemic advisor, urged governments to view biodefence as a strategic national security investment rather than a discretionary health expenditure.

Eliminating friction for 100-day response

As biological threats compound, Coalition for Epidemic Preparedness Innovations (CEPI) chair Jane Halton warned that global health security faces “genuine gaps in governance and oversight” alongside critical delays in outbreak response.

To operationalize the G7- and G20-backed 100-Day Mission, CEPI advocates eliminating administrative “white space” by pre-positioning clinical trial networks and establishing “R&D safe harbours” that grant scientists immediate pathogen data access on day zero.

Jane Halton, CEPI chair.

Under CEPI’s proposed framework, developers would defer full PABS benefit-sharing obligations until reaching defined downstream commercialization thresholds, preventing upfront contractual negotiations from stalling early R&D.

“When it comes to these risks, you need three words: Speed, speed, speed,” emphasised Halton during the panel debate.

Debate over speed and industry red lines

Sustaining high-risk pharmaceutical R&D and overcoming antibiotic development hurdles requires viewing health security as a strategic national investment.
Sustaining high-risk pharmaceutical R&D and overcoming antibiotic development hurdles requires viewing health security as a strategic national investment.

Differing slightly from CEPI’s downstream trigger proposal, Reddy reiterated the pharmaceutical industry’s central red line in pandemic negotiations: unhindered, day-zero access to pathogen genetic data without transactional preconditions or upfront compliance hurdles.

While supporting multilateral approaches to pandemic preparedness and health security, IFPMA maintains that contractual preconditions risk creating fatal research delays, arguing that actual emergency bottlenecks stem from regulation, financing, and supply logistics rather than data access.

Citing IFPMA data, Reddy emphasised that predictable intellectual property frameworks are essential to sustain high-risk private R&D, noting a 91% clinical failure rate for new drug candidates. Addressing the unique market dynamics of novel antibiotics, Kosaraju added that companies face up to 33 years to recover development investments.

To preserve research speed, industry advocates for a non-exclusive system that leverages existing open databases and WHO-coordinated laboratory networks, allowing manufacturers to enter voluntary partnerships and licensing agreements on mutually agreed terms rather than facing upfront contractual roadblocks.

The battle over binding PABS terms

Delegates debate the WHO Pandemic Agreement’s PABS System, balancing immediate pathogen data access for research against binding equity commitments for developing nations.

Negotiators from the Africa Group and the Group of Equity have consistently countered that voluntary mechanisms failed during COVID-19.

The WHO Pandemic Agreement, approved by member states in 2025, commits countries to providing 20% of needed medicines and vaccines to WHO for equitable distribution – 10% as donations and 10% at affordable prices, when the next such global threat emerges.

However, the precise mechanisms of how that will work were supposed to be defined by the PABS Annex. And over a year into negotiations, developing and high-income nations remain at odds as to exactly how to achieve those targets.

Developing nations continue to push for a legally binding PABS mechanism with mandatory technology transfers and binding requirements on manufacturers for allocations of their production – in exchange for access to pathogens sequences and data.

Many developed countries, meanwhile, have said that any constraints on the immediate sharing of pathogen data could hinder development of critical countermeasures – a position industry supports in principle.

Asserting health sovereignty in the Global South

Raji Tajudeen underscores African regional self-reliance.
Raji Tajudeen underscores African regional self-reliance.

Highlighting the lessons of recent health crises, Raji Tajudeen, head of public health institutes at Africa CDC, underscored that African states are asserting health sovereignty to build regional self-reliance. The Africa CDC is operationalising the African Medicines Agency and coordinating pooled regional procurement, supported by 28 African nations that recently mobilised over $130 million in domestic funds for the continental Ebola outbreak response.

These regional initiatives align with broader reform frameworks such as the Accra Reset and the Lusaka Agenda, which advocate treating health security as an essential global public good requiring country-led coordination. Yet, as collapsing development aid, proliferating biosecurity risks, and commercial impasses converge, global monitoring reveals that implementation continues to lag dangerously far behind political rhetoric.

“Infectious diseases cannot be dealt with one country at a time,” concluded Ihekweazu. “Sovereignty is not opposed to universality.”

See related story:

With Only Three ‘No’ Votes, UN Adopts Political Declaration on Pandemic Preparedness

Image Credits: U.S. Army National Guard/Edwin L. Wriston, Felix Sassmannshausen/HPW, WHS/HPW, European Union, WHO / Mark Nieuwenhof.

A child is marked by a healthcare official after receiving the polio vaccination.

A polio-free Africa is within reach, but only if we make it a priority. Ending the disease will not only protect our children, but it will also strengthen our health systems and safeguard us against future threats. The Ebola outbreak in Central Africa, with several cases of polio lurking in the shadows, remains an instructive lesson to keep in mind for World Polio Day, October 24, and after.

The urgent Ebola outbreak in Central Africa may be demanding attention, but polio, a disease without a cure, is a threat that has yet to completely disappear. Just this month, the poliovirus has been detected in six African countries this month, including DR Congo and Nigeria, and, earlier this year, in Australia, the United Kingdom, Malawi, Zambia, and South Africa.

Polio is caused by a virus that can invade the nervous system and cause paralysis in a matter of days, but fortunately there is an effective vaccine that drives our efforts to stop the spread of this disease. In particular, the detection and response at the start of the year in Blantyre, Malawi, reflected everything we strive to do on the ground. The poliovirus was detected from an environmental sample collected from the city’s sewage system. The government response, a political priority, centered on an intensive four-day immunization campaign that reached 1.3 million children and transmission was eventually averted.

The polio paradox

Polio
Polio cases are falling, but there remains persistent wild poliovirus transmission in Afghanistan and Pakistan, as well as vaccine-derived outbreaks elsewhere, while funding gaps impede global eradication goals.

Today, the “wild” version of the polio virus remains endemic in only two countries, Afghanistan and Pakistan. However, an outbreak of wild poliovirus in East Africa in 2022 linked to the importation of wild poliovirus from Pakistan, and triggering a massive multi-country immunization campaign, shows how easily progress can be threatened when gaps in vaccination coverage persist.

Most vaccine-derived infections that we see emerging today also come from virus strains that result from less than optimal immunization coverage. Efforts to vaccinate communities are often disrupted by conflict, natural disasters, cross-border migration, poor access to health services, and vaccine hesitancy. The consequences of these will lead to persistent transmission coupled with the emergence of new virus strains.

Thus, we live with a paradox: The oral polio vaccine that has been our most powerful tool in driving poliovirus to the brink of eradication globally can also circulate, mutate and regain virulence in areas with inadequate vaccination coverage. This paradox doesn’t diminish the value of oral polio vaccination, rather it underscores the urgency of achieving and sustaining high coverage. It also highlights the importance of innovation, such as the introduction in 2021 of the novel polio vaccine (nOPV2), designed to be more stable and reduce the risk of reversion to virulence.

In the 1950s, the poliovirus killed or paralyzed half a million people around the world every year. In 2024, between the “wild” strains and “vaccine-derived” strains derived from suboptimal immunizations, more than 500 polio infections were confirmed around the world.

Outsized progress despite diminished resources

At the mouth of Lokaro Bay, a place in the Taolagnaro district of the Anosy region of Madagascar. On May 13, 2024, the official launch of the Anosy region’s polio vaccination campaign took place. At just 19 years old, Laha Elersene Razafimahavory is a champion of childhood immunization.

In late 2024 and early 2025, we faced a steep reduction in global health and foreign aid from a number of donor countries. The impact of these cuts can be seen clearly in many health outreach programs.

However, by this point in 2025, countries had worked together to vaccinate nearly 200 million under-five children across sub-Saharan Africa. In the Democratic Republic of Congo, type 1 cases fell from 149 in 2022 to just one case in 2025.

In the first half of 2026, we have noted significant and continued progress towards the eradication of poliomyelitis in our Region. Polio detections are down 33% since 2024, but rising detections of polio types 1 and 3 remain a concern. Moreover, outbreaks in Burundi, Ghana, Guinea-Bissau, Republic of Congo, and Uganda were successfully closed.

In the Horn of Africa, persistent outbreaks are driven by low immunity, population displacement, and limited access to health services. But between February and April 2025, a massive, coordinated campaign reached over 18 million children across Djibouti, Ethiopia, Kenya, and Somalia, demonstrating the power of regional solidarity. In May of this year, Ethiopia reached an additional 1 million children in border areas and refugee camps.

Overall, 168 million children in sub-Saharan Africa received at least one dose of the polio vaccine between January and September 2026, with vaccination campaigns conducted in 22 countries. This includes cross-border immunization campaigns in March that vaccinated 10 million children in Angola, the Democratic Republic of Congo and Namibia after laboratory testing confirmed more than three dozen polio cases were genetically linked.

A four-point strategy to continue momentum

Health surveillance assistants prepare the oral polio vaccine before heading out on foot to vaccinate children under the age of 10.

Our efforts to end polio are under pressure, though, without secure global funding. Many countries are working to maintain sensitive surveillance, resilient laboratories, and rapid response systems. Securing long-term funding to fill key gaps and keep the polio programme running, even after eradication, remains one of four strategic imperatives.

Making the most of polio investments remains a priority. As the Democratic Republic of the Congo continues to respond to the latest Ebola outbreak, the infrastructure, expertise and community networks built through decades of polio eradication efforts provide a foundation for surveillance and emergency coordination, reinforcing national response efforts in a highly complex operational environment.

At the same time, the outbreak highlights the broader value of polio investments. Amid ongoing global funding constraints, sustaining these capacities is essential not only to achieve a polio-free world, but also to strengthen health security and protect communities from current and future public health threats.

Polio vaccination campaign in Malawi 2022

We also need to work better across borders. We will improve coordination among countries with migratory populations, such as the Lake Chad Basin region, by coordinating vaccination campaigns, sharing data, and reaching children on the move or in hard-to-reach areas.

And lastly, improving testing and tracking is critical. We must invest in stronger labs and faster virus detection across the region. Better sample transport and more local testing will help us act quickly when outbreaks happen.

A polio-free Africa is within reach, but only if we make it a priority and remain steadfast in these last miles. Ending the disease will not only protect our children, but it will also strengthen our health systems and safeguard us against future threats. This is something we need to remember in particular this week, as we observe World Polio Day on 24 October – with several cases of polio lurking in the shadows of the Ebola epidemic in Central Africa.

As a cardiologist who has spent many a day listening to hearts, I’ve learned one vital truth—prevention is everything. With strong leadership, community support, and strengthened partnerships, we can protect our children and show Africa’s strength in global health.

Dr Mohamed Janabi is the WHO Regional Director for Africa.

Image Credits: UN Photo/JC McIlwaine, WHO Africa, WHO.

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 María Neira. Access all candidate profiles on our dedicated election site.

Championing primary prevention: Dr María Neira’s platform calls for using WHO’s normative authority to direct global capital toward environmental drivers before populations become patients.
Championing primary prevention: Neira’s platform calls for using WHO’s normative authority to direct global capital toward environmental drivers before populations become patients.

The nomination of Dr María Neira by Spain introduces a distinct leadership paradigm to the WHO Director-General race. As former director of WHO’s Department of Environment, Climate Change and Health (2005-2025) and a former Spanish vice minister of health, she enters the election as an internationally recognised authority on primary prevention and planetary health. Backed by a broad coalition of civil society groups and scientific networks, Neira has formally launched her official manifesto, “Global Health Vision,” alongside her presentations at the World Health Summit in Berlin and responses to Health Policy Watch.

Anchored by her central proposition that “health should be the compass for a changing world,” her platform asserts that WHO must move beyond reactive emergency response to drive primary prevention and strengthen country-level capacity to act. Positioning environmental health as the frontline of disease control, Neira frames climate resilience, clean water, and primary prevention not merely as environmental policies, but as WHO’s most essential bulwark against cascading global health emergencies and increased pandemic threats.

However, her central challenge will be convincing sceptical and disengaged member states that a candidate propelled by civil society can govern as a pragmatic realist, capable of steering an agency confronting severe budget contraction, geopolitical pushback against climate policies, and structural overextension.

Blueprint for primary prevention and planetary health

From frontline waterborne disease response to Geneva executive leadership, Neira’s career bridges field environmental health with top-tier global policy.
From frontline waterborne disease response to Geneva executive leadership, Neira’s career bridges field environmental health with top-tier global policy.

Neira’s official manifesto sets out five commitments to guide the WHO towards a more focused and accountable future:

  1. Primary prevention as a fiscal strategy: Her platform elevates clean air, heat protection, universal safe drinking water, and sanitation as non-negotiable health baselines, while addressing NCD risk factors (tobacco, alcohol, unhealthy diets, physical inactivity). She advocates using WHO’s normative authority to evaluate the health impact of investments in non-health sectors – such as energy, agriculture, transport, and urban planning – reframing prevention not as a financial burden, but as a foundation for prosperous, resilient economies.
  2. Data integration and AI governance: The manifesto calls for deploying artificial intelligence and advanced analytics to consolidate WHO’s dispersed technical guidance and databases, making actionable evidence directly accessible to country ministries. It also advocates for WHO to lead in setting global governance standards for AI in healthcare while safeguarding independent scientific advice from political or financial interference.
  3. Country-level delivery over headquarters directives: Shifting evaluation toward measurable national outcomes, Neira’s platform focuses on building sustainable local capabilities – including public health institutions, surveillance networks, regulatory bodies, and supply chains. It explicitly emphasises investment in the full multidisciplinary health workforce, from clinical specialists to community health workers, as essential to national health security.
  4. Institutional focus and predictable financing: Addressing WHO’s structural and financial constraints, the platform proposes concentrating resources on core areas of unique organisational value while consolidating or sunsetting redundant activities. On financing, Neira supports the agreed target of funding 50% of WHO’s base budget through assessed contributions, alongside flexible voluntary funding and regular Executive Board performance reviews.
  5. Workplace integrity and technical impartiality: Regarding internal administration, the manifesto outlines zero-tolerance policies for harassment, bullying, and discrimination, backed by independent reporting and anti-retaliation mechanisms. Neira stresses that WHO must maintain technical impartiality across all member states and conflict zones, keeping assessments independent of political considerations.

To translate these principles into immediate momentum, Neira pledged in Berlin that within her first 100 days she will establish a specialised internal “antenna” to detect non-traditional health risks – specifically targeting declining global fertility rates, endocrine-disrupting chemicals, microplastics, and artificial intelligence (AI).

By placing normative leverage and primary prevention at the heart of her programme, Neira offers a blueprint designed to maximise WHO’s global reach even within the sharp realities of multilateral austerity.

From conflict zones to two decades at WHO’s Geneva core

From Médecins Sans Frontières conflict zones to WHO executive leadership, Neira leverages deep institutional knowledge to guide policy.
From conflict zones to WHO executive leadership, Neira leverages deep institutional knowledge to guide policy.

Her campaign focus is grounded in a career that bridges frontline medical crises and top-tier global health diplomacy. Born in 1962 in Asturias, Spain, Neira completed her medical degree at the University of Oviedo before specialising in endocrinology in Paris.

She forged her early professional commitment in active conflict zones, serving as medical coordinator for Médecins Sans Frontières (MSF) in refugee camps across El Salvador and Honduras. Subsequently, Neira spent five years as a public health adviser to the Ministry of Health in Mozambique, followed by service as a UN public health adviser for UNDP in Rwanda.

Her multilateral career began in 1993 when she joined WHO in Geneva as coordinator of the Global Task Force on Cholera Control, later directing the Department of Control, Prevention and Eradication. In 2002, she returned to Spain to serve as vice minister for health and consumer affairs and founding president of the Spanish Food Safety Agency (AESA, now the Food Safety and Nutrition Agency AESAN). Here, she managed national health protection and nutrition policy grounded in the universal, publicly funded principles of Spain’s national health system.

Recruited back to Geneva in 2005 as director of WHO’s Department of Environment, Climate Change and Health, Neira spent two decades leading global initiatives on climate change, air pollution, sanitation, and occupational safety. During this tenure, she played a central role in embedding public health commitments within the Paris Climate Agreement, establishing the Alliance for Transformative Action on Climate and Health, and spearheading the global One Health framework.

Domestic campaign challenges

Domestic political deliberations in Madrid delayed Neira’s nomination as Spain simultaneously backed high-profile candidates for leadership posts across other UN agencies.
Domestic political deliberations in Madrid delayed Neira’s nomination as Spain simultaneously backed high-profile candidates for leadership posts across other UN agencies.

Notwithstanding her technical credentials, Neira’s candidacy faces distinct political and strategic hurdles as the election campaign unfolds.

Spain presents a mixed financial backdrop: Madrid’s overall recorded WHO budget envelope contracted from $42.81 million (2024-2025) to $37.57 million (2026-2027) due to shrinking voluntary contributions. Aligning with Neira’s emphasis on sustainable core financing, the Spanish government has simultaneously demonstrated firm statutory commitment by steadily raising its mandated assessed contributions from $20.54 million to $26.11 million over the same period.

Despite this financial track record, domestic political dynamics in Madrid reportedly created ministerial delays regarding her nomination. The Spanish government had simultaneously mounted high-profile campaigns for other UN agency leadership posts – nominating labour minister Yolanda Díaz to lead the International Labour Organization (ILO) and agriculture minister Luis Planas to head the Food and Agriculture Organization (FAO). Running multiple parallel UN campaigns risks diluting Spain’s political leverage across voting caucuses, a challenge further complicated by domestic political headwinds facing the Spanish government.

Multilateral hurdles and the civil society counterweight

Multilateral headwinds: While European vote-splitting and diplomatic friction challenge Neira’s candidacy, civil society endorsement provides a key counterweight.
Multilateral headwinds: While European vote-splitting and diplomatic friction challenge Neira’s candidacy, civil society endorsement provides a key counterweight.

Institutionally, Neira faces scrutiny over her background as a two-decade Geneva insider (2005-2025). Despite her standing as a planetary health authority, health’s share of multilateral climate finance stagnated during her tenure, while her WHO department underwent administrative downsizing and structural merger.

Politically, European member states do not vote as a unified bloc, and with two nominees from the region – Neira and Belgium’s Hans Kluge – the European vote is fragmented. Beyond regional vote-splitting, Neira must navigate re-engagement with key powers – including the United States following its withdrawal and shifting domestic stance on international climate policy and multilateral funding – as well as scepticism from Global South and industrializing nations concerned that an aggressive environmental health agenda could constrain economic development.

Addressing these concerns in a response to Health Policy Watch, Neira frames planetary health as a pragmatic, economic agenda. Pointing out that “health is increasingly engineered outside the health sector,” she advocates using WHO’s normative authority to demonstrate the direct financial dividends of primary prevention before populations require clinical care. Investments in clean air, extreme heat protection, universal safe water, and climate-resilient health systems represent “no-regrets investments” that protect fiscal budgets and national productivity, regardless of a government’s stance in international climate negotiations.

Balancing these hurdles are distinct coalition strengths. Strong backing from civil society organisations and environmental health networks provides grassroots momentum, though it risks alienating more conservative Member States. Simultaneously, women’s advocacy networks and gender equity groups are mobilizing around her bid to lead an organisation where only two women – Gro Harlem Brundtland and Margaret Chan – have ever served as Director-General in its nearly eight-decade history.

A ‘compass for a changing world’?

By formally registering Neira’s nomination, Madrid provided the official statutory vehicle for a campaign underpinned by a broad global coalition of scientific societies, indigenous advocates, elders’ rights coalitions, and environmental health networks across the Global North and Global South.

Yet her status as a two-decade Geneva headquarters veteran remains a significant point of friction. To member states demanding operational decentralisation, fiscal austerity, and an end to top-down directives, an executive rooted in Geneva’s normative corridors and propelled by activist networks risks being perceived as detached from frontline, country-level realities.

Her viability hinges on convincing sceptical capitals that a headquarters insider can step outside the Geneva bubble to govern with clear-eyed pragmatism – proving that primary prevention and planetary health are hard-nosed fiscal buffers against disease. Ultimately, her candidacy offers member states a distinct strategic choice: electing a physician-environmentalist who asserts that “health should be the compass for a changing world” to reposition primary prevention and planetary health as central drivers of global health policy.

Note: This article incorporates research findings and comparative evaluations from Rifat Hossain. Profiles will be updated as the campaign progresses, stay tuned on the microsite.

Image Credits: WHO, Pixelshot via Canva, Yeray Díaz Zbida, WHO/Antoine Tardy .

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 United Arab Emirates’ 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 United Arab 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 with the disease as the firefighter dealing with 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 policy 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 like 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 October 3rd, started showing symptoms on October 7th 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 a diplomat’s wife. 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 .