The final passengers were evacuated on Monday from the MV Hondius, the cruise ship affected by a hantavirus outbreak while it crossed the South Atlantic.

The World Health Organization said Friday it is embarking on a plan to coordinate studies in more than 20 countries to “better understand the natural history of the disease” following an outbreak of the Andes strain of the hantavirus linked to the cruise ship MV Hondius. 

While stressing that the risks to the public remain low, officials also warned that more infections could still emerge during a six-week long incubation period.

Speaking at a press briefing, WHO Director-General Tedros Adhanom Ghebreyesus said the agency’s “current priorities are to continue to better understand the epidemiology of the Andes virus, including how this outbreak began and spread,” adding that WHO is “working with more than 20 countries to coordinate studies to better understand the natural history of the disease.”

More needs to be understood about potential human-to-human modes of transmission of this particular species of hantavirus, he and other WHO officials at the briefing acknowledged. While hantavirus is usually transmitted by rodents, the Andes species can be transmitted between people. But key questions remain regarding modes of virus transmission and the length of time that an infected person could remain infectious to others, even after testing negative for the virus. 

So far, the outbreak aboard the ship that emerged as it traveled to Antartica and then across the Atlantic, seems to have been contained, Tedros said, noting that “The response to the Hantavirus outbreak is a recent prime example of what can happen when the world comes together to confront a disease threat.”

Risk to public remains low, says Dr Tedros Adhanom Ghebreyesus at the WHO briefing Friday on hantavirus.

Ten cases to date – but more could emerge during six-week incubation

As of Friday, a total of 10 cases, including three deaths, have been reported to WHO,  including “eight people who were laboratory-confirmed for Ande’s virus infection, and two probable,” the Director Genera reported

The operation to repatriate the ship’s remaining passengers who disembarked Monday at the port of Tenerife, in the Canary Islands, has been completed, with “more than 120 people now being cared for – all in their home countries or quarantined in host countries en route to their final destination.” 

Route of the infected cruise ship Hondius across the Atlantic.

Some 26 crew members and captain are still on board, but “there are no symptomatic persons on board as of today” Tedros observed. The ship is sailing to the Netherlands where the crew is due to disembark on Monday. 

More cases may be still reported in coming days as passengers are quarantined and tested in specialized facilities or at home, Tedros warned, but he added, “This does not mean the outbreak is expanding. It shows that the control measures are working, that laboratory testing is ongoing, and that people are being cared for with support from their governments.”

He and other WHO officials at the briefing stressed that the risk from this outbreak to the global population is low, even as investigations continue into possible human-to-human transmission aboard the vessel as well as prior to its early April departure from the port of Ushuaia, Argentina, on what was supposed to be a routine a sightseeing cruise hopping from Antartic glaciers to a string of tropical islands off the coast of West Africa.

Outbreak likely began with infection before the ship left Argentinian port

Maria Van Kerkhove, Director Epidemic and Pandemic Management

Maria Van Kerkhove, WHO Director for Epidemic and Pandemic Management, said there was “some evidence” of human-to-human transmission in the closed confines of the ship  “particularly between a husband and wife, between the ship’s doctor and a patient.”

She said WHO’s “working hypothesis is that the outbreak began with infection prior to the disembarkment of the ship.”

Van Kerkhove said all passengers and crew were being treated as “high risk” contacts because “we simply don’t have all of the answers yet.” WHO has recommended 42-day quarantines for everyone aboard the ship because “people could be infected and not know it.”

She also confirmed that the third death linked to the outbreak was “an older woman who did die on board on the second of May,” and that testing in the Netherlands later confirmed she was positive for the virus.

Genome sequences of the virus from infected patients have been analyzed in labs in South Africa, Institut Pasteur in Dakar, Senegal and at the Geneva University Hospital, Van Kerkhove said, adding that the United States Centres for Disease Control and Transmission (CDC) has also been involved. None have identified significant mutations in the virus of the sort that occurred in the SARS virus, kicking off the COVID pandemic: 

“I am not a virologist, but what they are telling me is, and what they have said is, that they haven’t identified any changes to suggest a change in the virus to make it more transmissible, more severe, or anything like that,” Van Kerkhove said.

“But what we do hope, actually, is to have more samples coming from rodents, so that we can look at the sequences within the rodents themselves, and do a deeper analysis understanding the circulation of this virus, particularly in South America, disentangle  how circulation happens, and how we can prevent spillover and outbreaks from happening in the future.” 

No WHO hantavirus emergency committee so far

To date, there is no need to convene a WHO emergency committee on the outbreak: Abdirahman Mahamud, Director Health Emergency Response Operations.

Since the outbreak has so far been contained, and no dangerous virus mutation has been identified, WHO has not called for an emergency meeting of hantavirus experts, said Abdirahman Mahamud, Director Health Emergency Response Operations. Convening an emergency committee would be a required step to any WHO declaration of a global public health emergency, 

“We will do regular updates and risk assessments, should something change, should the DG need to trigger the mechanisms that he has to convene an emergency committee,” Van Kerkhove added. 

Even so, two noted global experts, Ellen Johnson Sirleaf and Helen Clark, co-chairs of The Independent Panel for Pandemic Preparedness and Response, which in 2021 evaluated the global response to COVID-19, last week called for review of how the outbreak had been handled in its preliminary stages aboard the ship.

“A review should determine whether a more precautionary approach could have been applied pursuant to the guidelines in the WHO Handbook for Managing Public Health Events on Board Ships,” said the two women in a statement, adding that the hantavirus outbreak has “tested the international system” demonstrating both its strengths and gaps. 

New Ebola virus outbreak in the Democratic Republic of Congo

Separately, Tedros announced a new Ebola outbreak in the northeastern Ituri province of Democratic Republic of the Congo, with 13 confirmed cases so far. It is the country’s 17th recorded Ebola outbreak since 1976.

Tedros said WHO had released $500,000 from WHO contingency fund for emergencies to immediately support the response,” including “risk communication and community engagement, strengthening disease surveillance, active case finding and contact tracing.”

WHO Africa Regional Director Mohamed Yakub Janabi said the outbreak area was “a very densely populated area” with “population movement linked to mining and cross-border trade,” which “naturally increases the transmission rate.”

WHO officials said they were still awaiting confirmation of the Ebola strain but noted that vaccine protocols and emergency response systems were already being prepared.

See related hantavirus coverage here:

https://healthpolicy-watch.news/review-of-global-outbreak-response-as-all-passengers-leave-hantavirus-hit-ship/

Image Credits: Franklin Braeckman/Oceanwide Expeditions , BBC, El Pais/OpenStreetMap.

Despite sharply rising levels of diabetes, access to  diagnosis and basic treatment tools remains sharply limited in developing countries.

On the five-year anniversary of the Global Diabetes Compact, WHO has issued a call to manufacturers to submit requests for “prequalification” of generic versions of the GLP-1 weight-control drug semaglutide and newer, fast-acting insulin analogues. The call is part of a broader initiative to accelerate access to life-saving diagnosis and treatment which remains out of reach for most people living with diabetes in developing countries.  

It was only when Selasi Hormenoo was hospitalized in Accra Ghana’s Regional Hospital in a coma in 2021 that doctors finally diagnosed her Type 1 diabetes – just in time to save her life. 

The university student had been in and out of clinics and smaller hospitals for a variety of infectious diseases as well as chronic conditions. Following a mistaken diagnosis with Type 2 diabetes, she was put on insulin for a while. But when the medication ran out, she didn’t try to get it refilled. No one had even explained to her that diabetes is a lifelong condition. 

Selasi Hormenoo, Ghana diabetes activist.

“The diagnosis, in a way, was a blessing,” says the young woman, now 25 and a peer mentor for others living with the condition.  “I no longer have to be consistently in the hospital for any minor issue. I graduated university in 2024 and I can confidently work and go out into the corporate space.” 

But until last year, when Ghana included soluble human insulin into the National Health Insurance Scheme basket of free medicines, she was spending about $200 a month for insulin drugs appropriate to her type 1 condition. And even now, she can only access newer, rapid-acting insulin analogue products, which she finds more convenient to use, through donations – when they are available. 

Milestone moves to expand access to diabetes treatment   

This week, in milestone moves, WHO published a call to generic manufacturers of both rapid-acting analogue insulin and the now famous GLP-1 weight loss drug, semaglutide, to submit their products for “WHO Prequalification” approval – a global label of quality control. 

WHO “Prequalification” of products by manufacturers aims to help expedite mass procurement of generic versions of the treatments in low- and middle countries, signaling quality assurance of the manufactured product to global and national procurement agencies.    

And those moves aim to help dramatically expand access to improved diabetes treatment across low- and middle-income countries. 

“The burden of diabetes falls disproportionately on people with the least access to diagnosis and treatment. Increasing the number of quality-assured manufacturers can help reduce barriers to access and support more equitable diabetes care globally,” said WHO’s Alarcos Cieza, who heads up the WHO unit on Management of Noncommunicable Diseases (NCDs).  

The moves coincide with the five year anniversary of the Global Diabetes Compact agreed upon by the World Health Assembly in 2021.

The Compact’s targets, subsequently endorsed by WHA in 2022, aim to achieve by 2030 an 80% rate of diabetes diagnosis, glycaemic and blood pressure control – along with 60% use of statins to reduce the risks of cardiovascular disease from high cholesterol.  And 100% of people with type 1 diabetes, the most threatening, should have access to affordable insulin and self-monitoring tools. 

World far from reaching diabetes diagnosis and treatment goals

Adults living with diabetes – most of those lacking access to diagnosis and treatment are in developing countries.

The world remains far from those goals. As of 2024, roughly 43% of adults living with diabetes were undiagnosed with 90% of the undiagnosed living in low and middle income countries. Around 830 million people worldwide are living with diabetes, up from 200 million in 1990. That includes about 589 million adults in 2025, according to the International Diabetes Federation. 

And while diabetes prevalence was once higher in wealthier nations, it is now rising most rapidly in low- and middle-income countries, a 2025 Lancet study found. Obesity, a leading risk factor for diabetes, also is accelerating in developing countries, even while it has plateaued in high-income countries, according to another study published this week in Nature. 

Yet in those same countries, insulin products remain unaffordable if available at all. And the even newer GLP-1s like semaglutide, which helps reduce obesity and other health risks for people living with type 2 diabetes, is even harder to come by in Ghana, notes Hormenoo, who works as a peer mentor with Diabetes Youth Care, a Ghana-based non-profit.

While use  of GLP-1s are not usually recommended for type 1 diabetics – people she knows with type 2 diabetes find the products “extremely inaccessible,” Hormenoo says.

Just one semaglutide pen costs around $500 in Accra, meaning that monthly costs for the weekly injections can amount to $2000 or more. 

“GLP-1s are almost unknown – the knowledge that people do have is more around celebrities using it for weight loss,” she concludes.

Explosion in generic manufacture may lead to chain

But the recent expiration of the core patent for the weight-loss drug Semaglutide in India, China and Brazil in March may signal a big change for Africa as well. Domestically, the patent expiration has already led to expanded generic production in countries that are drug manufacturing as well as export powerhouses.  And therein lies the role of the WHO prequalification of that and other products, to ensure that the products purchased and sold are quality-controlled. 

“WHO Prequalification does not re-evaluate whether semaglutide works or is safe –  that has already been established through clinical trials, subsequent approvals by stringent national regulatory authorities and confirmed by its inclusion on the WHO Essential Medicines List,” said WHO’s Bianca Hemmingsen, technical lead for diabetes.

“What WHO Prequalification assesses is whether a specific [generic] manufacturer can produce semaglutide at the required quality standard. The WHO invitation to manufacturers opens a pathway to apply for prequalification of GLP-1 receptor agonists, specifically semaglutide, for the first time.”

Nature NCD Risk Factor Collaboration (NCD-RisC): Obesity incidence is now growing more rapidly in low- and middle-income countries, while it has plateaued in many higher-income countries, .

Semaglutide was added to the WHO Essential Medicines List in 2025 

The new generation of obesity drugs reached sky-high popularity – and prices. Now, with the opening of generic competition, that is changing.

While the drug first gained fame for its effects on weight loss, semaglutide,  originally developed by Novo Nordisk and marketed under the brand names of Wegovy®, Ozempic® and Rybelsus®, was added to WHO’s essential medicines list last year. That was in recognition of the drug’s beneficial effects on diabetes control. 

The medication, part of a family of new glucagon-like peptide-1 receptor agonists (GLP-1 RA) drugs, mimics the natural incretin hormone GLP-1, lowering blood sugar, slowing stomach emptying to increase satiety, and reducing appetite.  While used first for weight loss and glucose control, the medication also improves cardiovascular health, reduces blood pressure, and is being studied for neuroprotective effects.

“It’s a very welcome step, we believe it will allow more access to more markets than the generic manufacturers had until now, presuming they meet the technical qualifications and standards,” said Dr Nikhil Tandon, professor and head of the Department of Endocrinology and Metabolism at the All India Institute of Medical Sciences in New Delhi, of the WHO moves.  

“Generic manufacture of GLP-1 has already dramatically brought down the price in India,”  by as much as 80%, said Tandon. Indian manufacturers were “ready to launch” generic versions of the drug in late March, the day after the patent expired. 

Nikhil Tandon, All India Institute of Medical Sciences

Now, the WHO prequalification process should provide a gateway for manufacturers to export more easily to other low- and middle-income countries –  where national regulatory processes may be weaker and slower to take up new products.  Recent research has meanwhile projected a worldwide price drop as a result of the shift to generics. 

Although generic sales in developing countries may soon begin to boom, secondary patents for the drugs will continue to protect the brand-name drugs from generic competition in the United States and Europe until around 2031-2032.

WHO process may also expand access to rapid-acting insulin analogues 

Insulin supplementation, traditionally administered through a vial and syringe. The emergence of new rapid-acting products and ready-made pens can make use easier.

While semaglutide may be headline-grabbing, Tandon is also hopeful that the global manufacture of insulin will also increase through the expanded WHO Prequalification insulin track, which now includes rapid-acting analogues in both vial and cartridge forms. 

Just three large pharma firms, Novo Nordisk, Eli Lilly and Sanofi still produce more than 90% of the world’s insulin. 

Smaller manufacturers based in China, India and elsewhere are gradually scaling up activities, particularly in emerging markets, including production of popular “biosimilar” analogues of human insulin products – which have also been off patent for some time. But breaking into new markets remains difficult. 

That makes the WHO prequalification call particularly timely with respect to insulin analogues particularly, as well, observes Tandon, who sits on a WHO Technical Advisory Committee for Insulin products.  

“In India, a drug price control order already makes insulin much cheaper than products sold in many other parts of the world,” he noted.  But in many low-income countries, conventional human insulin remains difficult to access – while analogues can be almost impossible.  

“If the products of manufacturers are based in lower income countries are prequalified by the WHO, this will allow many countries to access insulin at much cheaper rates than those sold by other manufacturers,” Tandon said. “With WHO prequalification, it helps cut through some of the steps of the [country’s] regulatory process.” 

While Tandon still regards human insulin as largely equivalent in terms of clinical benefits for the type 1 diabetes patients who need it the most, newer analogues also offer some “nuanced” benefits in the case of risks of night-time  or severe hypoglycemia, he said.  

Notably, users tend to find them “more convenient” because they can be taken just a few minutes before meals, as compared to human insulin, which requires more advance planning. 

In the updated WHO call, it is these rapid-acting insulin analogues that are a new addition; the rest of the analogues were already listed for WHO prequalification. 

But Tandon is hopeful that this new addition of these very popular, rapid-acting formulations could make a difference, stimulating more manufacturing interest and leveling the playing field “with good and sound technical targets. With the number of players available, I think access to markets will perhaps increase and it will bring prices down.”

Marketing surveys show growth of manufacturing capacity 

Benefits of using insulin pens instead of syringe and vial. But such pens, as well as fast-acting analogue insulin, remains harder to access in LMICS.

Indeed, the number of companies manufacturing both GLP-1 and insulin analogue products seems to be slowly increasing. 

Earllier this year, WHO conducted a marketing survey of manufacturers of semaglutide in collaboration with the University of Geneva. The results were striking.  

Preliminary findings indicate that more than 80 companies are currently marketing or registering the new generic GLP-1 formulations across 11 countries including Argentina, Bangladesh, Brazil, Canada, China, India, Indonesia, Laos, Pakistan, Paraguay, and Russia. The bulk of production, particularly for injectable formulations (such as prefilled pens and syringes) as well as oral forms, is concentrated in India and China.

In February, WHO convened an insulin manufacturers’ dialogue.  Some  28 insulin manufacturers joined the meeting – more than even the WHO team had heard about previously.  

Collaborative Registration Procedure another gateway to increasing access

The WHO Collective Registation Procedure is complementary to the Prequalification process in terms of expanding product access.

As production and export of new diabetes products expands to more low- and middle-income countries national regulatory authorities still face challenges in reviewing and approving the drugs and devices – even if their producers have been approved by the WHO prequalification channel.

“This is due to the often limited capacity to assess complex biological medicines. And there are additional complexities for those delivered in delivery systems like injection pens, which require evaluation of both the product and the device,” Hemmingsen notes. 

So along with the prequalification process, which can single out quality-approved manufacturers, WHO is also encouraging low- and middle-income countries to take advantage of another tool, called the Collaborative Registration Procedure (CRP), which can support more rapid national regulatory evaluation and approval. 

“The goal is to avoid duplication of effort,” stresses Hemmingsen.  “If a product has already been rigorously assessed, countries should not need to start from scratch. This is particularly important for LMICs where regulatory capacity often is limited.  

This process can work through two complementary pathways, she explains: 

  • If the product of a particular manufacturer has been “prequalified” by WHO, countries can reliably use that assessment as the basis for expedited national registration via the CRP. 
  • If a product has been approved by another stringent national regulatory authority – that  recognized as such as a “WHO Listed Authority”, other countries can rely upon that country’s regulatory approval to fast-track their own.   
WHO Prequalification process and the Collaborative Regulatory Procedure are complementary pathways to expedite regulatory approval of new drugs and devices.

Current WHO-listed Authorities that participate in the WHO CRP process include the European Medicines Agency, SwissMedic, the United Kingdom’s MHRA, TGA Australia and, most recently, Health Canada. 

“Both pathways reduce the regulatory burden on under-resourced national authorities and accelerate the journey from manufacturer approval to patient access,” observed Hemningsen. 

Together, the combined processes should help expedite access of quality-controlled products to more markets than generic manufacturers have had until now, leading to eventual price reductions and more access – along the lines of the 2030 goals. 

For Hormenoo, the young woman living with diabetes in Ghana, her diagnosis and regular access to insulin has been nothing short of transformational. From being chronically ill, and in and out of hospitals, she has completed university, national service, and is now hunting for a job.  

“It’s still hellish walking in the sun and I can’t go to the beach at all,” Hormenoo notes, referring to the nerve damage she suffered before she began regular insulin treatment.  “But the diagnosis has really helped with my quality of life – having uninterrupted education and being able to work, has been a major upgrade for me. I can confidentaly go out into the corporate space.”

And as Tandon puts it: “Every single person with type 1 diabetes should have access to insulin and monitoring equipment. It’s critical, because there is no other way of putting it politely, people who have Type 1 diabetes and who don’t have access to insulin will die.”

Image Credits: isensusa/Unsplash, Nature , Chemist4u, WHO, MSF, WHO Special Access Programme, Regulation and Safety Unit.

WHO experts Dr Ranti Fayokun and Dr Vinayak Prasad demand strict global nicotine pouch regulations.
WHO experts Dr Ranti Fayokun and Dr Vinayak Prasad demand strict global nicotine pouch regulations at a press conference.

The World Health Organization (WHO) has called on governments to strictly regulate nicotine pouches to prevent an imminent epidemic among vulnerable adolescents. These highly addictive products threaten to dismantle decades of global progress in tobacco control if left completely unchecked, health officials warn.

Faced with declining cigarette sales, tobacco companies continuously release new product lines, expanding their portfolios to include vaping products, heated tobacco, and nicotine pouches. While the industry promotes these pouches as tools to help adults quit smoking, public health experts argue that companies deliberately target children to draw in young generations.

According to the WHO’s first-ever report on nicotine pouches, published Friday, retail sales volumes skyrocketed past 23 billion units in 2024, reflecting a 50% increase from the previous year. The global market valuation subsequently approached $7 billion by 2025. Sales are largely driven by North American consumption, with a revenue share of almost 80%. Sweden leads the per person use globally.

Aggressive marketing of nicotine pouches

A global regulatory void leaves 160 states without specific frameworks to govern nicotine pouch sales.
A global regulatory void leaves 160 states without specific frameworks to govern nicotine pouch sales.

Only 32 countries and territories, including Canada and Colombia, actively regulate nicotine pouches, while 16 more have banned their sale. Conversely, roughly 160 states currently lack specific regulatory frameworks.

This legislative void enables manufacturers to deploy aggressive marketing tactics with sleek packaging, vast social media influencer campaigns, and candy-inspired flavours without restriction. Digital algorithms promote these deceptive products across platforms heavily frequented by teenagers.

“With nicotine pouches, tobacco companies have added a new item to their menu of addiction,” explained Jorge Alday, director of STOP at Vital Strategies, in a statement to Health Policy Watch, commenting on the report.

‘Harms are well documented’

Varied nicotine concentrations across major tobacco brands highlight the wide range of potency in pouches.
Varied nicotine concentrations across major tobacco brands highlight the wide range of potency in pouches.

Sustained nicotine exposure significantly increases cardiovascular risks by stimulating the sympathetic nervous system, explained Ranti Fayokun, author and coordinator of the WHO report, presenting the report on marketing of nicotine pouches. This chemical reaction releases adrenaline, which subsequently elevates heart rates and constricts blood vessels. Crucially, early nicotine exposure damages adolescent brains that are still actively developing.

While a study of various nicotine pouches found a median content of 9.48 milligrams per pouch, toxicological testing reveals extreme chemical concentrations in certain brands, with some tiers reaching up to 150 milligrams of nicotine. If a young child were to ingest these packages, the acute dose could easily prove lethal.

“The harms of nicotine are very well documented,” underscored Vinayak Prasad, unit head of the WHO’s Tobacco Free Initiative.

WHO urges strict regulation and tax increases

WHO’s recommended regulatory pillars: flavor bans, advertising restrictions, tax increases, and closing legislative loopholes.
WHO’s recommended regulatory pillars: flavour bans, advertising restrictions, tax increases, and closing legislative loopholes.

To mitigate risks and reduce addiction among adolescents, the WHO insists that policymakers establish strict flavour bans that specifically target youth-oriented options, such as bubble gum and alcohol-inspired varieties like Mojito, Cosmo, and Gin & Tonic. Furthermore, comprehensive advertising restrictions must explicitly prohibit the use of social media influencers and sports sponsorships.

The agency also calls for prominent health warnings and plain packaging to counter the sleek, deceptive designs currently dominating the market, and taxation must increase substantially to reduce overall market affordability, the experts demand. To mitigate the risk of severe dependence, regulators must implement strict caps on the maximum allowable nicotine content per pouch.

States with regulations and prohibitions in place should strictly enforce their existing mandates. Legislative loopholes must be closed that allow synthetic nicotine, as manufacturers increasingly use lab-made nicotine and analogues to evade existing laws.

Health officials emphasise that “nicotine is nicotine”, noting that synthetic variants carry the same addictive properties and must be regulated uniformly alongside tobacco-derived products. “These products are engineered for addiction, and there is a strong need to protect our youth from industry manipulation,” underscored Etienne Krug, director of the Department of Health Determinants, Promotion and Prevention at the WHO.

Global Anti-Tobacco Summit Targets Youth Nicotine Addiction ‘Epidemic’ and Environmental Harms

Image Credits: WHO, Felix Sassmannshausen/HPW.

Protests against fossil fuel lobbyists at COP30 in Bélem, Brazil, likening them to having the tobacco industry at a health conference.

Just as health leaders reframed tobacco from a consumer product to a public health threat, they can now help shift the narrative on fossil fuels.

In the coming days, the annual World Health Assembly will convene in Geneva. Following the recent Santa Marta Conference on Transitioning Away from Fossil Fuels, national health ministers and global health leaders have both an opportunity and responsibility to address the root cause of the climate-induced health crisis: fossil fuels.

The Santa Marta conference addressed the need to transition away from fossil fuels, the root cause of climate change. Fifty-seven countries, representing one-third of the global economy, committed to developing roadmaps to end fossil fuel use, marking an important step toward protecting public health and the climate.

Santa Marta demonstrated growing momentum beyond traditional climate negotiations. While the UN climate COP process remains essential, countries increasingly recognize that progress has been too slow given the escalating impacts of climate change and health. The next Santa Marta conference, hosted by Tuvalu and Ireland in 2027, will provide a key opportunity to strengthen international cooperation on phasing out fossil fuels.

Fossil fuel combustion constitutes the biggest public health emergency of our time

Heavy-Duty trucks and buses spew out soot, including climate-changing black carbon and health harmful PM2.5 on a highway.

Climate change is not only an environmental issue; it is a public health emergency. Fossil fuels are not just an energy source; they are harmful to health. Despite this, health was largely overlooked – the final Santa Marta conference text had no mention of health. The health community must raise a clamour to ensure that future climate negotiations take our health into consideration.

Fossil fuels harm human health throughout their lifecycle, from extraction and refining to transport, combustion, and petrochemical production. They pollute air, water, and soil; drive extreme heat and food insecurity; worsen respiratory and cardiovascular diseases; and contribute to millions of premature deaths each year. Frontline communities near extraction sites, refineries, highways, ports, and petrochemical facilities face disproportionate risks of toxic exposure, cancer, displacement, and economic disruption.

The world is already experiencing the consequences of the fossil-fuel-driven climate crisis. Last month, temperatures in parts of South and Southeast Asia reached 45 to 46°C, making outdoor work unsafe and pushing the limits of human survivability. Floods, wildfires, storms, crop failures, and infectious disease outbreaks are increasingly overwhelming health systems worldwide.

Subsidizing the sale of products that harm human health 

Ending fossil fuel subsidies would be one of the most effective global public health interventions ever, also averting 1.2 deaths a year from air pollution.

Yet governments continue to subsidize the very products causing this harm. In 2024 alone, fossil fuels received an estimated US$725 billion in public subsidies, even as air pollution, much of it from fossil fuels, costs the global economy about US$8.1 trillion annually in healthcare expenses, lost productivity, and premature deaths. From a public health perspective, this contradiction is stark: governments are using public funds to subsidize disease, death, climate disruption, and increased pressure on already overburdened health systems.

The true cost of fossil fuels remains obscured because health harms are treated as “externalities.” But asthma, strokes, heat deaths, cancers, pregnancy complications, and polluted drinking water are not externalities; they are direct and devastating impacts. When these costs are fully accounted for, fossil fuels are no longer economically rational. They are a dangerous and outdated relic.

Following the example of Tobacco

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

For decades already, the health community has carried the weight of responding to the symptoms of the climate-induced health crisis while often avoiding its primary cause. This must change.

And yet, the health community has both the moral authority and institutional capacity to speak to the impacts of fossil fuels directly. Just as health leaders reframed tobacco from a consumer product to a public health threat, they can now help shift the narrative on fossil fuels.

There is already a clear precedent: the World Health Organization Framework Convention on Tobacco Control (FCTC), the first global treaty negotiated under WHO leadership. The FCTC recognized that protecting health requires more than treating disease; it requires regulating the industry responsible for the harm. We can apply this same approach to fossil fuels.

Tobacco control showed that effective public health action requires conflict-of-interest protections, restrictions on advertising and sponsorship, public education, fiscal measures, warning labels, litigation support, and international cooperation to reduce demand for harmful products. Fossil fuels require a similarly comprehensive response.

Health ministries and the WHO have a critical role in advancing this agenda.

The 78th session of the World Health Assembly in May 2025 – member states passed a Global Action Plan for climate and health.  Ending fossil fuel subsidies would put teeth into that decision.

The World Health Assembly is the world’s highest decision-making forum on health. Resolutions passed in Geneva shape national health priorities, influence financing, guide public health norms, and determine how governments respond to emerging threats.

WHA can guide the WHO Secretariat in advocating for stronger conflict-of-interest protections to limit the influence of the fossil fuel industry in health policymaking and other multilateral processes. They can document the full lifecycle health harms of fossil fuels, plan protective health measures, promote health impact assessments for fossil fuel projects and infrastructure, and support air pollution standards based on current science. They can also champion subsidy reform as a public health intervention and help redirect public finance toward clean energy, resilient health systems, and social protection.

The health community can also help revoke the social license of the fossil fuel industry by clearly communicating that these products are fundamentally incompatible with health protection. This is especially urgent as fossil fuel companies continue to use disinformation, greenwashing, and political influence to delay action, tactics long recognized by the public health community from efforts against other health-harming industries.

At WHA78 last year, countries made progress through the WHO Global Action Plan on Climate Change and Health and commitments to reduce air pollution deaths. However, these efforts will remain incomplete unless governments address the primary driver of both climate change and air pollution: fossil fuels. WHA member states must recognise that fossil fuels are health-harming products, and their phase-out is a public health imperative.

The science is clear, the health evidence is overwhelming, and solutions exist. The question now is whether the global health community is prepared to address the cause of the crisis, not just its consequences.

On May 19th, the Global Climate and Health Alliance and the Office of the United Nations High Commissioner for Human Rights (OHCHR) will co-host Fossil Fuels, Health, and Human Rights – Centering Health and Human Rights in the Global Transition Away from Fossil Fuels where the issue will be discussed. It would be open to attend in person in Geneva and via Zoom.


Dr Jeni Miller is Executive Director of the Global Climate and Health Alliance, a consortium of more than 250 health professional and health civil society organisations and networks from around the world addressing climate change.

Image Credits: Mike Muzurakis IISD/ENB , UNEP, Galen Crout , Sarah Johnson.

Climate change, rising food insecurity and overwhelmed health systems have created a perfect storm for child undernutrition in parts of sub-Saharan Africa.

Philanthropy can help make every dollar deliver more impact.

I often think about a boy I met in Kajiado County, Kenya. He was the same age as my son, but half his weight. A World Health Organization (WHO) colleague measured the circumference of his arm to confirm what was already painfully clear: he was severely malnourished and needed urgent medical care.

He and his mother had walked to a clinic not far from fields of dead animals, victims of prolonged drought linked to climate change. It was one point in a chain of dominoes – failed rains, lost livestock, rising food insecurity, overwhelmed health systems – that would determine whether this child would have the chance to realize his full potential.

As governments reduce aid budgets and global health institutions confront growing financial pressure, it is imperative that we ground ourselves in how our decisions affect lives such as his.

Imperative to turn resources into sustained impact

The current crisis in global health is often described as a crisis of insufficient funding. That is true. But it is also something deeper: a growing imperative to turn resources into sustained impact more effectively.

In the past twenty-five years, global health financing has driven extraordinary progress against infectious diseases. Investments through organizations such as Gavi and the Global Fund cut child mortality in half and saved nearly 100 million lives. Those investments built systems that benefit everyone, from rapid vaccine development during COVID to catch-up immunization campaigns reaching millions of children.

Testing for hypertension. The burden of non-communicable diseases (NCDs) is growing globally, including in low- and middle-income countries.

Over that same period, the global health landscape has changed. Many countries are transitioning from low- to middle-income status and rightly want greater ownership of their own health priorities and systems. The burden of disease is increasingly shifting toward noncommunicable diseases (NCDs) and mental health conditions, whose prevention and treatment depend on strong regional and national health systems.

Identifying, scaling and sustaining what works

In this new environment, the WHO’s role becomes even more important.

WHO’s greatest value is not that it delivers services directly. Its value lies in helping countries identify, scale, and sustain what works: setting evidence-based norms and guidelines, coordinating surveillance and emergency response, convening governments around shared priorities, and supporting countries to adapt global knowledge into effective national action.

In the last year alone, the WHO helped additional countries eliminate neglected tropical diseases; prequalified the first malaria treatment for newborns and infants; and negotiated concrete global targets to control NCDs and promote mental health. In a more fragmented world, this work underscores why trusted global institutions are becoming more – not less – important.

This is also where philanthropy can play a transformative role. Not because philanthropy can replace governments; it cannot. Public financing will remain the foundation of global health. But philanthropy can help improve how all financing is mobilized and used.

Globally, charitable giving represents an enormous source of social investment – roughly $2 trillion annually. (For perspective, that is roughly 100 times larger than government aid for global health.) Yet only a small fraction supports global health, and an even smaller share strengthens the systems required to deliver health interventions at scale.

Some of the most compelling examples of WHO’s role are not always the most visible

Zambia started to roll out the malaria vaccine in December 2025. This baby is being vaccinated at the Lumezi Urban Clinic.

In my experience, mobilizing philanthropic capital requires clear theories of change, measurable outcomes, accountability for results, and the ability to adapt based on evidence. It requires organizations to explain not only what they will do, but why it matters, how progress will be measured, and how local institutions and communities will ultimately sustain impact.

Those disciplines improve the effectiveness not only of philanthropic dollars, but of all dollars invested in global health.

In its first five years, the WHO Foundation raised $214 million from charitable sources, including support from 84 new donors to the WHO, generating $4.40 in commitments for every dollar invested in fundraising. Our experience reinforces a simple lesson: philanthropy responds not only to need, but to clarity, trusted partnerships, measurable outcomes, and the confidence that institutions can deliver meaningful impact at scale.

Some of the most compelling examples are not the most visible.

WHO-supported measles surveillance networks, spanning hundreds of laboratories across more than 190 nations, help countries detect outbreaks early and sustain routine immunization. WHO’s Basic Emergency Care program has trained frontline health workers in low-resource settings to reduce mortality from trauma, sepsis, and shock. WHO’s work on mental health is helping countries integrate care into primary health systems, expanding access where services have historically been absent altogether.

Philanthropy can help accelerate the impact of global health investments

None of these efforts depend on philanthropy alone. But philanthropy can help accelerate them, strengthen accountability around them, drive new evidence, and demonstrate models that governments and national systems can sustain and scale over time.

The closing Plenary session of the 78th World Health Assembly at the Palais des Nations in Geneva, Switzerland, on 27 May 2025.

As global health leaders gather in Geneva for this year’s World Health Assembly, the conversation cannot simply be about how much money has been lost. It must also be about how effectively we use the money that remains – and how we build institutions capable of turning resources into measurable, equitable, and sustainable impact.

I think again of the boy and his mother in Kajiado County.

They do not care whether help comes from governments or philanthropies. They care whether systems work. Whether medicines and vaccines are available. Whether a health worker shows up before it is too late.

Yes, global health needs more money. But it also needs the discipline, partnerships, and institutions capable of turning resources into lives saved — consistently and at scale. In a period of shrinking aid budgets, that may matter as much as the funding itself.

 

Anil Soni is CEO of the WHO Foundation and a global health leader and innovator with nearly 30 years of experience expanding access to healthcare across the public, private, and nonprofit sectors.

Image Credits: Christine Olson/Flickr, WHO Global Report on Hypertension/Natalie Naccache, Temwanani Mtonga/ Gavi, WHO .

Commissioner for International Partnerships Jozef Síkela (right) announces the EU’s new Global Health Resilience Initiative on Wednesday.
Commissioner for International Partnerships Jozef Síkela (right) announces the EU’s new Global Health Resilience Initiative on Wednesday.

The European Commission announced its long-awaited Global Health Resilience Initiative on Wednesday. While the policy roadmap aims to support partner countries’ transition toward health sovereignty amid historic aid cuts and shifting geopolitical realities, critics are concerned about its heavy reliance on private funding.

As global health gains face a severe threat of reversal from stagnating health system coverage and emerging pathogens, the European Commission’s newly announced strategic guidance seeks to do more than just fill funding gaps. It outlines key priorities and flagship actions designed to fundamentally revamp the multilateral health architecture and support partner countries’ transition toward health sovereignty amid a rapidly changing funding landscape.

The proposed strategy, issued in a formal communication to the EU parliament and the member states, reinforces the pivot away from fragmented development assistance. Instead of relying solely on traditional grants, European policymakers intend to use “de-risking” tools and blended finance – combining public funds with loans and guarantees – to foster investments in national health systems of partner countries.

Jozef Síkela, European Commissioner for International Partnerships
Jozef Síkela, European Commissioner for International Partnerships

“Europe gains from stronger supply chains,” said European Commissioner for International Partnerships Jozef Síkela at a press conference on Wednesday. “Our partners gain from investments in local infrastructure, skills and jobs based on partnership with EU companies.”

Beyond immediate crisis management, the new initiative lays down a strategic, long-term pathway for European funding. It essentially sets the broad strategic strokes that will shape the global health priorities of the European Union’s next long-term Multiannual Financial Framework, which begins in 2028.

Recommitment to a leaner multilateral system

The EU’s strategy reaffirms the bloc's commitment to the WHO as centre of a streamlined multilateral architecture.
The EU’s strategy reaffirms the bloc’s commitment to the WHO as centre of a streamlined multilateral architecture.

Ahead of the upcoming World Health Assembly in Geneva next week, the Global Health Resilience Initiative is a recommitment to the World Health Organization (WHO). However, to overcome the deep fragmentation of the global health landscape caused by competing funds, the Commission is actively advocating for a leaner, more streamlined institutional architecture – which now includes not only WHO, but UNAIDs, UNICEF and other health-related bodies under the UN umbrella.

“We need a more effective and less fragmented global health architecture. There are too many players, too many overlapping mandates,” said EU-Commissioner Síkela.

To better coordinate these efforts, the strategic proposal aims to significantly step up alignment between European member states before major international replenishments and key financing milestones. This approach involves creating a comprehensive map of all European global health investments to actively eliminate redundancies and boost donor synergies.

This unified diplomatic front will be supported by a novel global health and resilience tracker. Developed in collaboration with the World Bank, the Organisation for Economic Co-operation and Development (OECD), and the WHO, this tool will initially focus on pandemic preparedness, prevention, and response by mapping both the domestic spending of partners and the international support they receive.

Over time, this tracking will be progressively expanded to cover broader global health priorities. The tool is explicitly designed to increase the transparency and accountability of global health security financing.

Upgrading detection capabilities and implementing a ‘One Health’ approach

Wastewater monitoring for poliovirus in Malawi showcases the critical role of environmental surveillance.
Wastewater monitoring for poliovirus in Malawi showcases the critical role of environmental surveillance.

To complement these financial tracking and governance reforms, the Global Health Resilience Initiative introduces major infrastructural upgrades aimed at crisis response. The Commission wants to support the establishment of an EU Therapeutics Hub and a parallel EU Diagnostics Hub to ensure the rapid deployment of essential medical countermeasures, with a specific focus on equitable access for vulnerable and minority populations. Further details are yet to be published.

Additionally, the Commission announced that early detection capabilities will receive a boost through investments in international epidemiological surveillance networks, including advanced wastewater and environmental monitoring that detects pathogens well before clinical alarms trigger. By partnering with regional public health institutes, the EU hopes to close the vast data reporting gaps that currently obscure the true scale of mortality worldwide.

By formally embedding the “One Health” principle into the European external agenda and recognising the intrinsic connection between human health, animal health, and resilient natural ecosystems, the strategy shifts focus toward “deep prevention” – the ability to identify and address environmental threats before pathogens cross from animals to humans.

Acknowledging that climate change, biodiversity loss, and environmental degradation drive these dangerous zoonotic spillovers, the bloc announced it would be pushing for stronger environmental safeguards within multilateral treaties. This holistic, root-cause approach also extends to combatting antimicrobial resistance through the prudent use of antimicrobials and new clinical research.

Fostering private investments and EU interests

The initiative’s economic engine balances partner sovereignty with EU competitiveness through controversial blended finance models.
The initiative’s economic engine balances partner sovereignty with EU competitiveness through controversial blended finance models.

Driven by a historic collapse in Official Development Assistance (ODA), European policymakers are moving beyond traditional aid to finance this sweeping agenda of infrastructural upgrades, and environmental and health monitoring.

To bridge the current massive financial shortfall, the Global Health Resilience Initiative leverages the EU’s external action tool, the Global Gateway, to mobilise up to €300 billion in investments. By shifting away from direct grants, the strategy relies on blended finance – using loans and guarantees – to de-risk and incentivise private sector involvement in emerging economies.

According to Commissioner Síkela, this approach has already successfully channelled over €6 billion specifically into health projects by the end of 2025. The flagship initiative on Manufacturing and Access to Vaccines, Medicines and Health Technologies in Africa (MAV+) is part of this and exemplifies the strategy, having directed roughly €2 billion toward building pharmaceutical manufacturing capacities across the African continent, including investments in South Africa and Senegal.

The communication signals the Commission’s intent to formalise this approach within the EU’s executive branch, cementing a policy shift that explicitly aligns international development with European economic security and competitiveness. In practice, this means that while partner countries receive investments to build their resilience, European pharmaceutical and biotech firms are now strategically positioned to access these expanding, rules-based markets as a complementary alternative to relying solely on exports.

“Global health is not immune to the fierce competition, coercive power politics, and information manipulation that influence international relations,” warned Kaja Kallas, High Representative for Foreign Affairs and Security Policy. “While some pull back from multilateral organisations that protect global health, the EU is stepping up with more support.”

Critics concerned about risks of market-based health financing

While the initiative rightly acknowledges the way in which institutional fragmentation can exacerbate, rather than address, global health threats, civil society critics were quick to note that the EU’s new initiative largely ignores the political drivers of health inequality. Critics warn that increasing the role of private corporations in the health systems of low-income countries could also fuel higher health care costs and inequalities – and undermine the goal of  ‘health sovereignty’.

Karolin Seitz, Director of the Global Health and Human Rights Program at Global Policy Forum Europe.
Karolin Seitz, global health financing expert at Global Policy Forum Europe.

“The strong focus on expertise, investments and supply chains points more towards a model in which dependencies are reorganised rather than fundamentally overcome,” explains Karolin Seitz, Program Director of the global health and human rights programme at Global Policy Forum Europe, in a statement to Health Policy Watch. She notes that while promoting “health sovereignty” is commendable, it remains unclear how much real fiscal and political policy space low- and middle-income countries will actually gain.

Seitz cautions that the Commission’s reliance on market-based mechanisms, such as blended finance through the Global Gateway, frequently socialises financial risks while securing guaranteed returns for private investors using public money. Rather than offering innovative solutions, these models can impose significant long-term costs on the public budgets of vulnerable nations, she warns.

Furthermore, the EU’s strategy frames global health primarily as an issue of efficient governance and capital mobilisation, neglecting root causes like debt crises, unequal patent rules, and local tax evasion. Genuine health sovereignty, Seitz argues, requires structural reforms and sufficient public fiscal space – issues the EU’s approach currently leaves largely unaddressed.

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

Image Credits: EU/Bogdan Hoyaux, Felix Sassmannshausen/HPW, WHO , Global Policy Forum Europe..

The World Health Assembly in Geneva. At this year’s 79th session, member states will review a proposed process for reforming the UN global health architecture.

Leaders of the international NGOs, Save the Children, Seed Global Health, AMREF, and LSE Health make five asks to member states attending next week’s 79th World Health Assembly, as they take the first steps to launch a joint UN process for reforming the global health architecture. 

As governments prepare for the 79th World Health Assembly (WHA79), the stakes could not be higher. On the table is a once-in-a-generation opportunity to reform the global health architecture (GHA) – triggered by the unprecedented cuts in foreign aid. But in the rush to redesign institutions and redirect funding flows, we risk losing the principle that should anchor every reform effort: universal health coverage (UHC), or the right of every person, everywhere, to access quality healthcare without financial hardship.

At the 158th WHO Executive Board, Member States requested the WHO to convene a joint process on global health architecture reform. The World Health Assembly remains uniquely positioned to convene Member States, civil society, donors, and multilaterals around a more coherent reform agenda.

The funding crisis is exposing deeper structural failures

The year 2025 saw the largest annual decline in total official development assistance (ODA) on record, with a 23.1% reduction compared to 2024, bringing global aid back to levels seen in 2015, at the outset of the 2030 Sustainable Development Goals (SDGs).

Preliminary data from the Organisation for Economic Co-operation and Development (OECD) indicate that 2025 saw the largest annual decline in total official development assistance (ODA) on record, with a 23.1% reduction compared to 2024, bringing global aid back to levels seen in 2015 at the start of the 2030 Agenda for Sustainable Development.

A further 5.8% decrease is anticipated for 2026. These cuts risk leading to an additional 22.6 million deaths by 2030, including 5.4 million children under the age of five.

This downturn exposes structural weaknesses in systems that have long depended on external financing. For women, children, and adolescents, the health systems consequences are profound and immediate: disrupted maternal and newborn care, collapsing immunization and nutritional programmes, and reduced access to sexual and reproductive health services.

In humanitarian settings, conflict-affected and displaced populations may soon have no safety net at all.

Although it is said that “crises create opportunities,” the funding shock has exposed a long-recognized reality within global health: an architecture dependent on a small group of donors is inherently unstable and unable to deliver UHC.

Preventing future crises will require new foundations: domestic financing models insulated from geopolitical shifts, institutional mandates that endure beyond individual funders, external partners aligning behind national priorities, and a global health architecture in which UHC is structurally embedded rather than dependent on external support. Central to this is a well-trained and adequately financed health workforce, without which neither health systems nor universal health coverage (UHC) can be achieved.

UHC must guide global health reform

Delivering Universal Healthcare requires countries to invest more in primary healthcare.

The 79th World Health Assembly will discuss several major issues separately: UHC (item 12.4) and primary health care (PHC) (item 12.5), implementation of the Pandemic Accord (item 13.3), the strategy on Economics of Health for All (item 15.5), and global health architecture (GHA) reform (item 20.1). While this reflects standard WHA procedures, the risk is that these discussions proceed in parallel rather than as part of a coherent reform agenda.

The appointment of Thailand and Andorra as co-facilitators for negotiations on the 2027 UN High-Level Meeting on UHC is politically significant. The 2027 UHC High Level Meeting (HLM) cannot become a separate process alongside GHA reform discussions. It should serve as one of the accountability mechanisms for reforms currently being debated in Geneva.

Five priorities for WHO Member States at WHA79

A Nepali woman with her child in a sling on her back. Global funding crisis has hit women and children especially hard.

For WHA79 to make a real impact, Member States must ensure their decisions translate into practical improvements for the people most affected by systemic failure. In the lead-up to the 2027 UN High Level Meeting on UHC, we call for five key changes:

  • Anchor GHA reform in UHC and country ownership
    Global health reform must align existing initiatives to avoid fragmentation. The WHO-led GHA reform process can help build that cohesion and should align mandates, structures, and incentives behind country-led priorities. Reform efforts need to address power imbalances, align behind country priorities, support global public goods, and strengthen mutual accountability. Country-led governance must be the foundation of any reformed architecture. To ensure commitments translate into action, Member States should establish clear, time-bound implementation milestones and accountability mechanisms, including civil society and affected communities. The 2027 UHC HLM should explicitly track and build on GHA reform commitments made in Geneva.
  • Invest in PHC and sustainable financing
    Governments should increase domestic public spending on health – including an additional 1% of GDP for primary health care – while strengthening public financial management and institutionalizing health financing coordination through country-led platforms. However, many low-income countries face severe debt distress, limiting their ability to expand fiscal space for health without broader reforms to debt architecture and progressive domestic taxation. Meeting UHC targets will require progressive financial reforms and renewed attention to the Economics of Health for All agenda. Financing must be directed toward essential services, health workers, and financial protection for vulnerable populations.
  • Strengthen the health workforce for UHC
    Health workers underpin resilient health systems, pandemic preparedness, and climate adaptation. Member States should expand fiscal space for the health workforce through sustained domestic financing, while aligning donor investments behind national workforce strategies and employment plans. This includes equitable recruitment, training, fair remuneration, and protection of frontline workers, including community health workers, particularly in underserved settings.  GHA reform and global financing mechanisms must support sustainable, country-led health systems rather than fragmented, short-term parallel programming.
  • Institutionalize social participation and accountability
    Civil society engagement is critical to shaping policies that reflect the needs of affected populations. WHA77’s resolution on social participation should now be operationalized by embedding participation and transparency as core accountability mechanisms. WHO should establish regional and national consultative bodies bringing together Ministries of Health and Finance, donors, civil society, and affected communities to enable continuous dialogue and oversight. This should be supported by transparent reporting of health financing data, building on national health accounts and the Global Health Expenditure Database with open access to disaggregated data.
  • Safeguard UHC in crisis and conflict settings
    GHA reform discussions cannot turn a blind eye to the humanitarian needs caused by conflicts and crises worldwide. Member States should mandate that GHA reform financing instruments – including the Pandemic Fund and IHR/Pandemic Agreement’s Coordinated Financing Mechanism – include ring-fenced allocations for essential health services in crisis-affected settings. In an era of rising polycrisis, protecting and advancing UHC reforms is not just morally necessary, but can also create momentum for health system reform.

WHA79 is a pivotal juncture. It will be remembered either as the moment governments anchored health reforms in equity and the needs of the people they serve, or as another missed opportunity clouded by consensus language and procedural paralysis.

Alhadi Khogali, is Senior Global Health Policy Advisor, Save the Children.

Renee de Jong is Senior Advocacy Advisor, Save the Children.

Marionka Pohl is Senior Director of Policy, Seed Global Health.

Rispah Walumbe is Health of Strategy & Policy, Amref Health Africa.

Arush Lal, is a Visiting Fellow at LSE Health, London School of Economics and Political Science.

Image Credits: WHO, OECD, WHO, Lisa Marie Theck/Unsplash.

Passengers being evacuated from MV Hondius, the ship affected by a hantavirus outbreak, in Tenerife on Monday.

All passengers were evacuated from the cruise ship, Hondius, by Monday night – and a Spaniard taken to a military hospital in Madrid to quarantine has become the 11th person from the ship to test positive for hantavirus.

The evacuation was completed 10 days after the World Health Organization (WHO) was notified about the outbreak – and experts have called for a review of the global response to identify and fix “gaps and vulnerabilities in the system”.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), and Spanish President Pedro Sánchez, described the evacuation as a success and a show of international solidarity.

Hondius captain Jan Dobrogowski, described the past few weeks as “extremely challenging”, as he and 24 crew, accompanied by a doctor and nurse, sailed on to Rotterdam. 

In a social media message on Monday, Dobrogowski thanked all passengers and staff for their “patience, discipline and the kindness they showed to each other” during the outbreak, particularly commending crew members for their “courage and selflessness”.

The Hondius evacuation had not taken place in Cabo Verde as the island lacked the capacity to handle the operation, Tedros clarified at a media briefing on Tuesday.

After docking in Cabo Verde for a couple of days, the ship sailed on to Tenerife in the Canary Islands, which is an autonomous community of Spain.

Under the International Health Regulations (IHR), of which Spain is a party, “countries are required not to allow people to be stranded at sea when they have the capacity to manage the risk safely and responsibly”, said Tedros.

‘Inhumane and unnecessary’

Spanish President Pedro Sánchez addresses the media on the evacuation of passengers from the cruise ship hit by hantavirus.

“There were some people around the world calling for the passengers to be contained on the ship for the full quarantine period. Our view was that would have been inhumane, and unnecessary,” he added.

“We were convinced it was possible to disembark these passengers in a way that was safe for them and the people of Tenerife, and that was respectful of the human rights of the passengers and crew.”

There were almost 150 people from 23 countries on the ship for weeks, “in what must have been a very frightening situation”, said Tedros, adding that “some of the passengers were facing mental breakdown” and “have the right to be treated with dignity and compassion”.

Meanwhile, Sánchez told the media briefing: “This world doesn’t need more selfishness, nor more fear. What it needs is countries that show solidarity and want to move forward.

He also appealed for “international cooperation and organisations like the WHO to be provided with the resources to realise their work”.

More cases possible

Three people travelling on the Hondius have died from hantavirus, the last of whom died on 2 May – the day that the WHO was first notified of the cluster of cases by the UK. South African scientists identified the virus in a British man flown to the country for treatment. 

“At the moment, there is no sign that we are seeing the start of a larger outbreak,” said Tedros. “But of course, the situation could change. And given the long incubation period of the virus, it’s possible we might see more cases in the coming weeks.”

The recommended quarantine period is 42 days, which is how long the virus can take to manifest.

Each country is responsible for monitoring the health of its citizens evacuated from the ship. Some, like Australia, will require them to remain in government quarantine facilities. Others, like the US, have stated that they will allow asymptomatic citizens to isolate at home.

The WHO recommends that they “should be monitored actively at a specified quarantine facility or at home for 42 days from the last exposure, which is the 10 May, which takes us to the 21 June,” said Tedros.

Is the system working?

Ellen Johnson Sirleaf and Helen Clark, co-chairs of The Independent Panel for Pandemic Preparedness and Response, which evaluated the global response to COVID-19, said that the hantavirus outbreak has “tested the international system”, ” demonstrating its strengths and gaps.

The pair, who previously described the WHO response to COVID-19 as “analogue” in a digital age, commended the international response to the hantaviris outbreak from 2 May.

“The identification and communication of the hantavirus results from South Africa to the United Kingdom, its subsequent reporting to the WHO [on 2 May], and from WHO to countries worldwide demonstrated the importance of rapid application of the International Health Regulations,” they said.

However, between the first death on board on 11 April and 2 May, “a series of events resulted in the growth of the hantavirus outbreak”, they noted. 

“There were risks to passengers onboard, to people interacting with them on remote islands, and following the 24 April disembarkation in St Helena, to those who contacted them on land, in the air, and in their next destinations,” said Sirleaf and Clark.

“A review should determine whether a more precautionary approach could have been applied pursuant to the guidelines in the WHO Handbook for Managing Public Health Events on Board Ships. 

In a social media recording of ship’s captain Dobrogowski notifying passengers of the first death, he assures them that it was due to the man’s underlying conditions and posed no risk to other passengers.

“While sadly deaths on ships do occur, as more people embark on adventure travel to remote locations, the need to protect travellers and those in contact with them from potential exposure to pathogens will increase,” they said.

Review of outbreak planning

The co-chairs appealed to governments to “review outbreak and pandemic planning to address vulnerabilities in the system, including in shipping, marine health and death-related protocols, port management, and protection of populations in remote locations”.

They also appealed to leaders to follow “all relevant protocols for contact tracing, infection control, reporting, isolation and supportive care” to break the chain of hantavirus transmission.

Despite negotiating a Pandemic Agreement since the end of the COVID-19 pandemic, WHO member states have been unable to agree on a Pathogen Access and Benefit Sharing (PABS) annex to set out how information about dangerous pathogens should be shared.

A few weeks back, at the conclusion of the last round of PABS negotiations, Tedros called for urgency, “because the next pandemic is a matter of when, not if”.

In September, the United Nations will convene a High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response (PPPR).

Member states need to “ensure that the Political Declaration [adopted by the HLM] includes measurable commitments to close the gaps in PPPR, including in One Health, in financing – including for surge financing, equity, monitoring, and accountability”, said Sirleaf and Clark.

Image Credits: BBC.

Fatmata Bamorie Turay (far left) and Elizabeth Tumoe, registered nurses look after newborns at the Princess Christian Maternity Hospital, in Freetown Sierra Leone

Recently, I met with African nursing leaders who told me stories of nurses in countries such as Ghana and Nigeria earning the equivalent of only a few hundred US dollars a month – sometimes less than $300 – while being offered opportunities abroad with salaries many times higher.

They described a growing crisis, where nurses are now leaving not yearly or monthly, but almost weekly. In some hospitals, managers only discover a nurse has accepted a post overseas when a resignation letter is pushed under the door. One nurse leader told me: “We are training nurses for export.”

 Migration itself is not the problem. Like anyone else, all nurses have the right to migrate and pursue opportunities. But many have been put in an impossible position, where they are also leaving behind families, colleagues and communities they care deeply about.

And the countries they leave behind are losing the experienced nurses they have trained, often with little evidence of any meaningful reinvestment in return.

This story is now being repeated across the world at an alarming scale. This is why, ahead of this month’s World Health Assembly (WHA), the International Council of Nurses (ICN) has written to WHO Member States recommending concrete actions to address the escalating international recruitment that is deepening workforce shortages in lower-income countries and threatening global health system sustainability. 

We are calling for coordinated co-investment by recruiting countries into nurse education, retention, and workforce and leadership development.

But this is not just a story about migration and workforce shortages.

This situation speaks to the profound global failure to understand the true power of nursing and the enormous cost of not investing in it.

No nurses, no care

A registered nurse vaccinates a child for polio in Beirut, Lebanon.

The world faces a global shortage of 11 million health workers. More than half, 5.8 million, are nurses.

That fact alone should be setting off alarm bells everywhere. No nurses means no healthcare. Nurses are the backbone of health systems. But right now, that backbone is showing signs of spinal instability.

We are asking nurses to carry more and more: ageing populations, rising chronic disease, pandemics, conflict, climate-related crises, mental health pressures, and widening inequalities. Yet too often we continue to treat nursing as a cost to be contained instead of one of the smartest investments societies can make.

That is why this year’s International Nurses Day report from ICN, Our Nurses. Our Future. Empowered Nurses Save Lives is so important.

The report moves beyond outdated, one-dimensional images of nursing to show how nurses both save and improve lives at scale. For too long, nursing has too often been portrayed only through the language of compassion and sacrifice. Compassion matters enormously. But nursing is also power: economic power, clinical power, leadership power, workforce power, and social power.

Our report sets out seven key nursing powers that are transforming health systems around the world.

There is the Power of Trust: year after year nurses remain the most trusted profession globally, a foundation that becomes critical during health emergencies, public health crises, and vaccination campaigns.

There is the Power of Practice: advanced nurse practitioners and specialist nurses are delivering high-quality care, reducing waiting times, improving outcomes, and expanding access, particularly in underserved communities.

There is the Power of Numbers: nearly 30 million nurses worldwide represent the single largest health workforce on earth.

Another of the most important powers is what we call the Power of Proximity.

Nurses are where people are. In hospitals, clinics, schools, refugee camps, conflict zones, remote villages, and people’s homes. Nurses are often the first health professional a person sees and the last one they remember. They understand communities because they are part of those communities.

That proximity saves lives.

And when nurses are empowered to work to their full potential, the evidence is overwhelming. Expanding primary healthcare, where nurses are central, could save 60 million lives by 2030. Closing global health workforce gaps could prevent  189 million years of life lost and add US$1.1 trillion to the global economy.

We can’t see these as “soft skills”. These are hard powers delivering hard outcomes.

Investing for impact

This year’s report builds on ICN’s wider work, including our 2024 report, Our Nurses. Our Future. The economic power of care. This has consistently shown that investing in nursing is not a cost to health systems and economies; it is one of the highest-return investments societies can make. Investing in health brings a $2–4 return per $1, while poor health reduces GDP by 15%.

Yet despite all this evidence, many countries continue to underinvest in nursing. Exacerbating inequalities, high-income countries continue to underinvest in educating enough nurses domestically while increasingly relying on international recruitment to fill workforce gaps.

This means many lower-income countries are effectively financing the health systems of wealthier nations through the loss of their trained nurses. Countries already facing severe shortages are losing experienced clinicians, educators, and leaders faster than they can replace them.

At the same time, destination countries are making substantial savings. Training costs are being avoided. Workforce gaps are being filled quickly. Tax revenues are being generated by internationally educated nurses working in destination countries.

But where is the reinvestment?

Recent evidence submitted by ICN to a UK All-Party Parliamentary Group inquiry highlighted the enormous financial benefit that recruiting countries derive from this model. By recruiting abroad, data shows that the UK has saved £14 billion in health workforce training costs. Canada has saved an estimated C$1 billion.

In effect, lower-income countries are subsidising the workforce costs of richer nations. Some high-income countries are effectively outsourcing responsibility for nurse education internationally while failing to adequately reinvest in the systems they depend upon.

That is neither sustainable nor equitable. It risks creating exactly the perceptions many countries are now voicing openly: neo-colonialism, exploitation, and a growing erosion of global solidarity.

 

Nurse Everlyne Esige examines an expectant mother at Vihiga County Referral Hospital in Kisumu, Kenya. 

WHA as a turning point

This is why ICN has urged WHO Member States to use this year’s World Health Assembly as a turning point.

In our letter, we call for practical and collective action to strengthen the WHO Global Code of Practice on the International Recruitment of Health Personnel.

That includes coordinated co-investment by major recruiting countries into nurse education, employment, retention, leadership development, and workforce planning in source countries.

We are proposing practical mechanisms: proportionate reinvestment linked to recruitment, directing a share of education savings and tax revenues into source-country health systems, debt relief linked to workforce investment, and even a global fund to strengthen fragile health workforces.

Imagine the impact if high-income countries pooled resources and coordinated action instead of acting individually and reactively.

The sums involved would not be insignificant. But neither are the savings currently being made.

And the return on investment would be enormous: stronger health systems, greater global health security, reduced inequalities, and a more sustainable global workforce for everyone.

Strengthen support for nursing

At the same time, we are increasingly concerned that the global focus on nursing and the health workforce risks being diluted precisely when it should be intensifying.

Last year, WHO Member States agreed to extend the Strategic Directions for Nursing and Midwifery and to accelerate progress. That word matters: accelerate.

Yet we are still hearing concerns about cuts and reduced capacity at exactly the institutions and programmes designed to support the global health workforce.

We understand the financial pressures that the WHO and many governments face. These are difficult decisions. But support for the very people who deliver healthcare, the foundations upon which health systems are built, must be the very last place to cut.

Because ultimately, this conversation is about far more than staffing numbers.

Nursing is also one of the largest majority-women workforces in the world. Investing in nursing means investing in women, in economic participation, in education, in families, and in reducing inequality.

This International Nurses’ Day, we should celebrate nurses. But celebration alone is not enough.

We must also recognise nurses’ power to change lives, strengthen economies, and transform societies and finally invest in that power for the sake of all our health.

International Council of Nurses CEO Howard Catton

Howard Catton is CEO of the International Council of Nurses.

 

Image Credits: World Bank/Flickr, Flickr – World Bank, International Council for Nurses, Brian Otieno /Global Fund, Studioregard.ch.

The official WHO DG election cycle for 2026–2027 traces the path from the initial call for nominations in April 2026 to the final appointment in May 2027.
The proposed WHO Director-General election cycle for 2026–2027 lays out the path from the initial call for nominations in April 2026 to the final appointment in May 2027.

As the campaign to elect a new World Health Organization Director-General officially opens, a timeline and guidelines for the process have been published by outgoing DG Dr Tedros Adhanom Ghebreyesus for consideration by member states at next week’s World Health Assembly and the upcoming Executive Board. While these aim to promote a transparent and level playing field, structural loopholes remain.

With the call for nominations for the next World Health Organization (WHO) Director-General officially underway, the global health community is bracing for an intense, year-long campaign season. The upcoming 2026/2027 WHO DG election cycle marks a definitive departure from the previous race in 2021, which unfolded amidst the COVID-19 pandemic, featured an incumbent, and relied heavily on remote adaptations.

The current contest expects a full return to “normal” physical in-person campaigning at regional committee sessions. However, a “new normal” is also unfolding under complex conditions, as the WHO grapples with a sharply polarized body of member states and a drastically reduced budget following the United States’ withdrawal last year, forcing it to implement massive, ongoing workforce reductions.

To maintain fairness in this highly pressured, post-pandemic landscape, WHO has published a draft set of guidelines that would help create a firewall between candidates’ campaign activities and official organisation business – rules that will be particularly important for candidates that emerge from within WHO’s ranks.

The Director-General’s recommendations on the election process, to be reviewed by Member States at the upcoming World Health Assembly and Executive Board, aim to reinforce established parameters from the previous election cycle. But enforcement still relies mostly on ‘good faith’ as compared to legally binding measures.

WHO staff members who join the race will have to go on leave – but Regional Directors may be exempt

Current WHO staff members entering the competition face the election’s strictest internal guardrails, according to the newly published guidelines. To prevent conflicts of interest between campaigning and official business, they will be immediately placed on annual leave. Once their annual leave allowance is exhausted, they would be placed on mandatory special leave with half pay leading up to the January 2027 Executive Board nominations. If they survive this initial selection process and make the final shortlist, their full salary would be restored for the remainder of the race.

Yet, past precedent has explicitly exempted WHO Regional Directors from this rule – due to their status as WHO officials elected by member states. This means that potential candidates such as Hanan Balkhy, Regional Director of WHO’s Eastern Mediterranean Region, or Hans Kluge, European Regional Director, could theoretically campaign while remaining in their positions – while other potential candidates such as Assistant Director-General Jeremy Farrar, would have to spend months on leave in order to compete, at a sharp inherent professional and financial disadvantage.

Prospective candidates also must not conduct campaign activities as part of WHO regional committees’ official programmes. Reaffirming the standing rules, candidates will not be given speaking time during official meetings to promote their campaigns, and must instead restrict their promotional events strictly to the margins of these meetings.

The guidelines also set forth a proposed timeline – following the Director-General’s invitation to member states to nominate candidates, which was delivered by letter to Geneva’s UN missions on 24 April. After nominations close on 24 September, contenders would participate in a live candidates’ forum, with a proposed date of November 18. The field would then be narrowed to up to three finalists during the 160th Executive Board session, preliminarily set for 25 January-2 February 2027. After a second interactive forum, tentatively set for 15 March 2027, member states will vote at the May 2027 World Health Assembly, with the winner taking office in August 2027.

A gauntlet of public appearances

Economy Class in an airplane.
Economy-class travel remains the standard for WHO candidates, underscoring the organisation’s push for financial equity.

The framework further aims to create a gauntlet of public scrutiny for the election process. During the first live candidates’ forum, contenders will face structured 60-minute interviews. To ensure the question and answer process is not rigged, member states will drop colour-coded tokens into receptacles, which the Chair of the Executive Board will draw by lot to determine exactly who gets the opportunity to ask the candidates a question.

To curb the potential for opaque backroom deals, the WHO relies on a Code of Conduct to oversee activities on the physical campaign trail. Originally adopted by the World Health Assembly in 2013 and most recently amended in November 2020, this framework was specifically designed to promote an open, fair, equitable, and transparent election process.

Additionally, previous World Health Assembly decisions and WHO Secretariat practices guarantee financial travel support. Specifically, this involves provision of an economy-class airline ticket and a daily per diem for every candidate participating in both of the two live public forums that will be sponsored by WHO, and, upon request, for their interviews at the 160th session of the Executive Board.

This logistical support aims to ensure prospective leaders from lower-income regions receive a genuinely fair opportunity without relying entirely on massive domestic or private funding.

Guardrails built on ‘good faith’ – no binding enforcement

Newly elected WHO Director-General Dr Tedros Adhanom Ghebreyesus receives congratulations from members of the Executive Board after the previous WHO DG election.
Outgoing Director-General Tedros’s 2022 pandemic-era election gives way to a high-stakes, in-person 2026 WHO DG election cycle.

While these guidelines aim to promote a transparent and level playing field, structural loopholes remain. A closer reading of the WHO’s rulebook reveals that the Code of Conduct is not legally binding. The framework openly acknowledges it is merely a “political understanding” that recommends “desirable behaviour”, relying on the good faith of candidates and member states to honour its contents.

This lack of binding enforcement mechanisms leaves critical transparency measures vulnerable. For instance, candidates and member states are instructed to promptly disclose all campaign activities and funding sources to the Secretariat for public posting. But this system relies on self-reporting without independent audits.

Furthermore, while the regulations state that campaign-related travel should be “limited” to prevent financial inequality, and that using official technical meetings as a guise for electoral promotion “should be avoided”, these vague parameters leave vast room for interpretation.

Ultimately, as the mandate of Dr Tedros Adhanom Ghebreyesus approaches its expiration after the end of the upcoming election cycle, the focus will inevitably shift from the rules of the campaign trail to the monumental task awaiting his successor. Whoever emerges victorious from this highly scrutinised election must not only navigate deep geopolitical divides and restore internal trust, but also prepare the global health body for future crises.

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Image Credits: WHO/Christopher Black , Felix Sassmannshausen/HPW, Alexander Schimmeck via unsplash.