As Deadline Nears, Civil Society Urges Spain to Nominate María Neira in WHO DG Election 21/09/2026 Felix Sassmannshausen Civil society leaders urge Spain to back Dr María Neira’s last-minute WHO Director-General nomination. With Thursday’s 24 September deadline looming, international scientific societies and civil society leaders are pushing Spain to sponsor a last-minute nomination of Dr María Neira as candidate in the World Health Organization (WHO) Director-General election. Neira is WHO’s former Director for Environment, Climate Change and Health, and her nomination has been endorsed by Nobel Peace Prize Laureate Adolfo Pérez Esquivel and Dr Carlos Ferreyra of Climate, Life and Health International. They have joined other civil society groups to petition Spanish ministers to register her candidacy before entries close. “Dr Neira does not merely represent a highly competent nominee for Spain, but a truly decisive planetary asset,” said the Argentine-based Citizens’ Roundtable and Planetary Civil Society in a press release on Monday. Despite earlier indications that Spanish authorities would pass on the current election cycle, Health Policy Watch understands that Madrid is deliberating the nomination. At present, there are four official nominees: Belgium’s Hans Kluge, Saudi Arabia’s Hanan Balkhy, Qatar’s Hanan Al-Kuwari, and Indonesia’s Budi Gunadi Sadikin. Neira declined to comment when reached by Health Policy Watch, while the Spanish government has not responded to official queries. Campaign organisers said they received positive informal signals from Spanish officials. Nonetheless, Madrid faces internal diplomatic friction after launching competing international bids for the UN Food and Agriculture Organization (FAO) and the International Labour Organization (ILO). Climate experience drives potential nomination Mounting climate and environmental health challenges underscore civil society calls for Spain to nominate Neira for WHO Director-General. Neira recently joined the Clean Air Fund as an inaugural Senior Fellow advising on atmospheric pollution, after leading WHO’s Department of Environment, Climate Change and Health from 2005 to 2025. During her two decades in Geneva, she spearheaded the global “One Health” approach connecting human, animal, and environmental health, while leading global cholera control initiatives. She previously served as Spanish Vice Minister of Health and President of the Food Safety Agency, following earlier WHO work coordinating global cholera control. An epidemiologist and physician, Neira began her career managing Médecins Sans Frontières emergency operations in Central American conflict zones. Advocates argue her nomination would expand the candidate field by introducing a recognized climate expert to address the defining health challenges of coming decades, exacerbated by extreme heatwaves and environmental crises. Backed by an international coalition anchored in Latin America and spanning the Global South, indigenous groups, and Small Island Developing States, supporters contend her entry translates Spain’s 1986 universal health system legacy to the multilateral stage. Neira calls for ‘scientifically fearless’ WHO Maria Neira posted her WHO leadership vision on LinkedIn. Outlining her leadership vision on LinkedIn earlier this month, Neira argued that WHO requires a “scientifically fearless” strategist rather than a mere administrator. “The world does not need a personality to manage WHO. It needs a leader who can unleash its collective intelligence and lead global health,” she wrote, fuelling speculation about a potential bid. She advocates for primary prevention, treating global health as a positive dividend of development across energy, technology, and urban planning. With the nomination window closing on Thursday, a Spanish submission would ensure a dedicated climate advocate enters the final election contest. Whether Madrid registers her candidacy before the deadline will determine if environmental health takes centre stage in shaping global health governance. See related story: The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General Image Credits: Alexandre P. Junior via Pexels, Felix Sassmannshausen/HPW. As Global Pandemic Approach Flounders, Experts Offer Blueprint to Protect All Citizens 21/09/2026 Kerry Cullinan Health workers visit a Burmese migrant worker and her child in her dormitory in Thailand to discuss how to stay safe from COVID-19. It’s been barely three years since the COVID-19 pandemic ended, yet many world leaders appear to have little appetite for pandemic-proofing. Ahead of the UN High-Level Meeting on Pandemics, a major 20-country research project offers a blueprint for the future that could save millions more lives. The United Nations hosts a High-Level Meeting on Pandemics on Friday, but the political declaration draft, currently thin on practical implementation plans, may be rendered even skinnier as the United States is almost certain to throw its spanner in the multilateral wheel. At the end of the eighth round of talks to negotiate the last outstanding piece of the World Health Organization’s (WHO) Pandemic Agreement last Friday, WHO Director-General Dr Tedros Adhanom Ghebreyesus, its most ardent cheerleader, admitted that progress is “slow”. Barely three years ago, in May 2023, the global trauma of the COVID-19 pandemic was declared to be at an end – after seven million official deaths, 28 million “excess deaths” and at least 70 million more people being thrust into poverty. Yet other global crises appear to have blunted world leaders’ appetite to pandemic-proof their countries. However, a global team of experts, coordinated by the National University of Singapore (NUS) and The Lancet, has been hard at work since September 2023, working out what went wrong during COVID-19, and offering a blueprint to enable the world to perform better next time. The overarching conclusion of the PRIME Commission report is that many countries failed to protect those who needed it most, relying on technical plans that left millions exposed to infection. “Protection failed in contexts where housing was overcrowded, work was insecure, administrative systems excluded people, distrust disrupted communication, or health and social systems shifted risk onto households and communities,” the commission notes. Twenty-country case studies A nurse takes temperature of child suspected of COVID in a public health centre The research rests on 20 country case studies, ranging from the United States, the worst affected developed country, to low-income countries such as Mozambique. “What the PRIME Commission found is that people themselves aren’t ‘vulnerable’, but rather that systems create vulnerability,” said Professor Helena Legido-Quigley, co-chair of PRIME Commission. “A person living in a crowded apartment cannot socially isolate, a person with no identity papers cannot access a government payment, and a person who doesn’t speak the dominant language cannot understand health advice.” In Ethiopia, Indonesia, Mozambique, Tanzania, and Lebanon, lockdown regulations that restricted movement meant that the subsistence income of millions collapsed, with households “falling into hunger within days”. “We would survive the night after eating a piece of bread in the morning,” an internally displaced person in Ethiopia told researchers. In Indonesia, people without a national ID number could not get vaccines. In Peru, domestic workers were not covered by emergency cash transfers. Older Japanese residents did not know how to use digital information systems. “USA represents the deepest form of systemic exclusion, where immigration status, historical labour exclusions, and powerful industry lobbies combine to block access to services. Fear generated by federal immigration policy prevented workers from seeking basic care,” the report notes. In contrast, countries with universal health coverage, social protection, and there was trust in institutions, fared better – such as New Zealand, South Korea, Finland, and Bhutan. Groups commonly overlooked by national systems included older people, migrant workers, people with disabilities, indigenous peoples, informal workers, and people living in remote and underserved communities. “Across the 20 countries, common patterns emerged. People could be put at greater risk because they could not afford to stop working, did not have housing that allowed them to isolate, could not access government support, did not trust the information they received, or depended on health and other essential services that struggled under pressure,” the research found. Social distancing circles in a park in San Francisco, aimed at controlling COVID-19. More equity, more lives saved The Commission modelled future pandemic scenarios, comparing a response driven by power and national interest with a response favouring international cooperation and public health. In a hypothetical future influenza A pandemic, if vaccines were developed rapidly, this could reduce deaths by 59% (from 58.5 million to 23.9 million), even when vaccines were distributed first to countries with the greatest ability to pay. But if vaccine allocation was based on population size rather than purchasing power, global mortality would be reduced by 64%, to 21·2 million deaths. Measures to improve vaccine confidence would reduce deaths by another 1.9 million lives. “The influenza pandemic modelling findings unequivocally show that while the status quo will protect many lives, a more equitable approach to vaccine distribution will save millions more,” said Legido-Quigley. “There is every moral justification to create a system where vaccines reach those who need them in order to live, and not only those who can afford them.” COVID-19 vaccines finally arrived in Rwanda in March 2021. Modelling shows that millions more lives can be saved if vaccines are allocated according to population size rather than purchasing power. What must change? The Commission has developed a blueprint for the future based on six blocks, starting with protecting people and communities. It argues that the missing element in pandemic readiness is a “practical and profound whole-of-society approach that connects communities, health systems, social protection, finance, law, education, labour, food systems, environmental governance, and regional and global cooperation”. Pandemic “readiness” must be geared to ensuring that people and systems can withstand a pandemic, it argues, offering a practical test for any plan. To be effective, any measure needs to reduce avoidable harm, strengthen the capabilities and wellbeing of people and communities, reach those most underserved and remove structural barriers to protection and care. Communities should be involved in the design of the intervention, which must also be able to respond to misinformation. “Governments have heard for years that they should take a ‘whole-of-society’ approach to pandemic planning,” said Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response. “It is a government’s responsibility to protect all of their citizens and residents. We know that a new pandemic threat could arise at any time. The NUS-Lancet PRIME Commission offers a blueprint that must not be ignored.” Image Credits: Photo by Joshua Fernandez on Unsplash, WHO / Ploy Phutpheng, UNICEF , Luisvilla, WHO. DRC’s Ebola Outbreak: The Vast Mobilisation That Doesn’t Measure Itself (Part II) 21/09/2026 Mukesh Kapila A person with suspected Ebola arrives at a treatment centre in DRC. The world has ridden fast to rescue DRC from Ebola. But four months on, nobody can say for sure how many agencies are responding, how many people they employ, how much money has arrived, or what it bought. There are, however, coordinators galore. But the virus is still outwitting them. Time and again, we learn that how a crisis is defined is how it evolves and resolves. So what is DRC’s 17th Ebola outbreak: a health crisis, humanitarian tragedy, or development failure? This matters because health labelling implies a technocratic approach to squash an un-eradicable virus until it re-emerges, while a humanitarian framing dooms the afflicted to dependency, and development tagging signifies solutions kicked into the long term. These are, of course, generalisations. But the reality is that multiple dimensions are always present in complex socio-politico-economic-security contexts like in DRC. These defy simple prescriptions and, often, all we can do is to muddle through uncertainty and confusion. How well we are muddling through is the focus of the second part of my analysis of the Ebola response in DRC. The first part considered how slow recognition of the outbreak’s start allowed the virus to outpace control. A major national and international mobilisation has followed. What difference is that making? An arguable response DRC Minister of Health Dr Roger Kamba (centre),receives the first consignment of the Ervebo vaccine at N’djili International Airport in Kinshasa on 21 August. As I write, the response is arguing within itself. Over the space of a few days, the DRC’s health minister announced encouraging signs since cases peaked in the week of 3-9 August, the UN coordinator warned that the peak call was premature, Africa CDC scientists said that the situation is heterogeneous with peaks and declines in different zones, and the WHO chief landed in between with cautious optimism while noting that the outbreak continues to grow. All are reading the same daily situation reports, and all are right within their own remits. A government must show its strategy is working, a coordinator must keep agencies galvanised, a regional agency must be sensitive to constituency concerns, and a global agency must cheer-lead the world. But when the drivers cannot agree on the speed and direction of their train, there is a problem beyond epidemiology. And that befuddles the public at a time when careful information is as lifesaving now as a potential vaccine may be in the future. However, do not be too hard. With dynamic virus spread, data interpretation debates are expected before a professional consensus emerges. However, the time and patience that takes are always short during emergencies. Meanwhile, if it is challenging to get four lead agencies – DRC government, UN, WHO, Africa CDC – to cohere, consider the truth-determining complexity around scores of partners with fingers in the response pie. Each has constituencies to keep on side, not least for funding. Hence, the determination of whether the outbreak is waxing or waning is not simply about examining numbers. It can be an existential issue for some aid-fuelled agencies. For them, a longer crisis is better for balance sheets. Besides, how is the end of the 17th Ebola outbreak to be defined? WHO has the easy job of declaring it over when no new cases have been detected for 42 days (twice the maximum incubation period). But that is not the end of the crisis for those mourning their losses while trying to recover fractured lives and livelihoods. Even without aspiring to “build back better” through improved healthcare and surveillance for the next outbreak. These are some reasons why this columnist has long argued for independent mechanisms for evaluating the progression and outcomes of humanitarian and health crises. This is of utmost importance to reverse the loss of trust in aid systems. Painful root canal data extraction In that spirit, how do we assess Ebola response in DRC? It starts with verifying scale-up claims. Why is it so difficult to get a clear answer on who is doing what and where? The WHO-led health cluster in DRC has 119 partners: 45 international NGOs, 60 national NGOs, 5 UN agencies, 5 national authorities, 2 donors and 2 observers. But this was in June. Besides, it covered the country and is not specific to Ebola. Meanwhile, also in June, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) listed 218 operational actors in six eastern DRC provinces, but an up-to-date breakdown is difficult. Many agencies discharge crucial tasks such as building and operating treatment centres (WHO, Médecins Sans Frontières, International Medical Corps, Congolese-led ALIMA), safe and dignified burials (DRC Red Cross with the International Federation of Red Cross and Red Crescent Societies), family care, child protection, water and sanitation (UNICEF), food and logistics including the UN Humanitarian Service (World Food Programme), screening along travel routes and border crossings (International Organisation for Migration). Several are also engaged in risk communications and community engagement, and not to be overlooked are Congolese institutions – the health ministry and its technical bodies and provincial divisions – as well as many local civil society organisations. If a comprehensive census of agencies is elusive, counting the numbers of people engaged in Ebola work – a proxy for response effort – is even more so. Some numbers can be gleaned from agency publicity. Thus, WHO has 300 experts deployed in September, Africa CDC had 84 in June, while MSF, the largest non-state agency has 1400 staff, presumably mostly nationals. Pull out your own calculator WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Dr Yap Boum on the ground in Ituri in the DRC to address Ebola. Putting together patchy data, I estimate that 10,000 to 15,000 people are working on Ebola, ranging from epidemiologists to doctors, nurses to laboratory technicians, and pilots to grave diggers. Not forgetting administrators, accountants, logisticians, and security personnel. But how many are needed to cover all essential action fronts across a vast Ebola-affected zone approaching the size of France and Greece combined? There is no consolidated target, even as advocates plead for more resources. And while there is some modelling of outbreak size, there is no translation into the response scale-up required to achieve control. Although we have public health criteria and indicators for determining when we get there. Concerned outsiders must mine data from selective agency reports, publicity releases, and media interviews, and do their own calculations. We learn from WHO that 1,600 more treatment beds are needed, which, at three carers each, require 4,800 more skilled workers. Africa CDC says that it needs 450 more field staff. Meanwhile, 25 more decentralised testing facilities with trained staff are needed, doubling the current endowment. Half the affected zones still don’t have safe burial teams. Increasing coverage with eight volunteers per Red Cross team equates to needing 1,000 more volunteers. Achieving the target of 20 contacts traced and followed up daily for 21 days requires at least 3,000 more tracers. With screening at 153 points only partly staffed, and using staffing ratios from previous outbreaks, IOM could benefit from 800 more screeners. In addition to direct clinical responses, community risk must be tackled across the 14 million frontline population. UNICEF estimates there are three million vulnerable children and adolescents, while WFP says that 2.65 million face food insecurity. My projections suggest an additional need for some 10,000 responders of different types i.e. a doubling of current capacity. Practically, this must be overwhelmingly sourced from among the Congolese – suitably trained and financed. We live in a world of dashboards. Would it not be helpful if some authority maintained one to show these numbers and how they tick upwards? Multiple plans, appeals, and a missing ledger That brings us to financial confusion. A joint WHO – Africa CDC continental plan asks for $518 million for June to November. This covers 11 countries, not just DRC. On 4 September, the DRC government launched a revised six-month plan costing $1.3 billion. On the humanitarian side, OCHA’s revised plan for DRC calls for $2.1 billion, of which some $300 million is Ebola-related. The Red Cross Red Crescent appeals independently, and IFRC increased its ask to CHF 65 million in August. The largest independent responder – MSF – has a private funding approach. It requires forensic accounting skills to disentangle these plans to verify gaps and overlaps. How do these resourcing envelopes map to priority activities under, to quote Dr Tedros, “one plan, one budget, one team”? Africa CDC and WHO are seeking to unify financial tracking. But will that include the humanitarian track under OCHA? That such a system does not exist several months into a serious emergency does little for urgent resource mobilisation from sceptical donors who are obliged to make their own funding decisions that may not coincide with priorities. Meanwhile, how much funding has come in? Nobody provides an accurate tally. My own rough calculation suggests that about $1.5 billion out of the ask of $3 billion has been secured. Terms such as “mobilised, secured, committed, allocated, pledged and disbursed” are being used interchangeably while they mean different things. That means we don’t really know what cash has actually been turned into practical goods and services delivered at the frontlines. Traditionally, budget execution rates tend to be low. Therefore, the current Ebola financing system is worse than broken. It has gone backwards from the previous DRC outbreak by becoming less transparent even as appeal sizes have grown. Donor aid cuts cannot be blamed for this. This is a mess that some call a lucrative Ebola business, with the host country’s health minister reduced to asking in public where the money is and what is being done with it. Meanwhile, on the ground, problems are being caused by agencies paying different remuneration rates, while health workers have been striking because of not being paid fairly in a timely manner. Conversely, fraud and scams with fictitious payrolls are requiring the belated introduction of biometric registration, distracting effort from the primary response. Two systems, two constitutions Africa CDC staff on the ground in the DRC to assist with the Ebola outbreak (May 2026). The financing muddle is reflective of a structural problem. Eastern DRC is served by two international machines with separate legal foundations that pull in opposite directions. Global health co-operation rests on respecting national sovereignty under the International Health Regulations (IHR). States report outbreaks, and responses are state-led. That is why Dr Tedros says WHO works under the government’s leadership, and why Africa CDC frames its role as African solutions for African problems. The global humanitarian system rests on UN General Assembly resolution 46/182 of 1991 – a political settlement based on four principles, one of which is independence. Thus, humanitarians have the dispensation to negotiate with whoever controls the ground, including armed groups the state is fighting. Eastern DRC is a patchwork of territories controlled by different groups and varying virus epidemiologies. It is difficult to honour differing international health and humanitarian approaches within the same broad space. The tension is reflected in top-level pronouncements. In briefing member states, the UN Emergency Relief Coordinator committed to a combined response led by the UN Humanitarian Coordinator. In the same session, the WHO Director-General said they were working under the government’s leadership. Each is correct within their own constitutions. But the two statements are not fully compatible despite affable expressions of partnership. This is not legalistic nitpicking but has life-and-death implications. For example, safe and dignified burials are an infection control act, which is why the DRC health minister complained that some partners (humanitarian system) undertaking burials were not funding (health system) the gravediggers or providing body bags. Feeding isolating households is WFP’s humanitarian mandate, yet you cannot quarantine (health mandate) a breadwinner without it. Access negotiation with armed groups is an ICRC and OCHA competence. Essential services – measles, malaria, maternal care – fall between both systems, and neither appeal owns them. It is possible that when final audits are done, as many or more people may have died from non-Ebola causes as from Ebola itself. An epidemic of coordinators Meanwhile, as the Bundibugyo ebolavirus doubled every two to three weeks, so did the coordinators. In May there was a DRC health minister and a national institute. By June, there was an Emergency Operations Centre in Kinshasa, and seven provincial health teams with their coordinators. In June, the UN Resident and Humanitarian Coordinator, WHO Representative and an incident manager were activated, as well as WHO’s regional directorate in Brazzaville, and of course, the WHO Emergencies Team in Geneva and the Pandemic Hub in Berlin. By July, a UN/WHO Senior Ebola Coordinator had been installed at Bunia and a WHO/Africa CDC Continental Incident Management Support Team in Kampala. Also, the Geneva-based UN Inter-Agency Standing Committee was activated with a system-wide scale-up, which is a mechanism for coordinating the coordination. August was less frantic on the coordination front, as it is the traditional northern hemisphere holiday season. The virus, of course, took no vacation. By September, the Africa CDC Emergency Consultative Group was reviewing the work of others, and the African Union Summit convened in Bujumbura. In approximate summation, we have around 16 strategic coordination initiatives, each with their own coordinators. Plus coordinators of eight operational clusters and some 11 pillars. The plethora could not avoid being highly productive, with at least three plans and five appeals that now require further coordination to deconflict, update, and track. Amazingly, there remains scope for yet more coordinators. With insufficient burial teams, perhaps we need a Chief Burials Coordinator, and to accelerate contact tracing, a Chief Contact Tracing Coordinator. Looking ahead, we will need a Chief Vaccination Coordinator when the scramble starts to access a successful but inevitably scarce vaccine. To be fair, all the coordination functions have followed recommendations made after past Ebola and other emergency crises. But the virus attends no coordination meetings. Muddling through So, back to my original question. What is DRC’s 17th Ebola outbreak? On four months of evidence, it is all things. The virus is being confronted by a health system that treats it technically, a humanitarian system that treats it as a caseload, and a development discourse that promises to address underlying causes once both go home. Each answers honestly within its own frame. But none of them own the space between the frames, and that is where the virus proliferates. Meanwhile, muddling through this crisis is not a disgrace. But there is a difference between muddling honestly and unaccountably. Honest muddling publishes its numbers, admits what it does not know or can’t do, and submits to outside scrutiny. What we have instead is a response that cannot say how many agencies are working, how many people they employ, how many more they need, and what it has received or spent. This is not a problem of field workers labouring under risky circumstances with several losing their lives. It is the responsibility of chiefs, communicators, and coordinators in Geneva, Addis, and Kinshasa to sort out. Mukesh Kapila is professor emeritus of global health and humanitarian affairs at the University of Manchester, and a board member of Health Policy Watch. Vital Signs in Global Health is a regular column, and the opinions expressed are solely those of the author. Image Credits: DRC Health Ministry, DRC Health Ministry, Africa CDC. Pandemic Agreement Negotiator Warns Against Losing Momentum 21/09/2026 Health Policy Watch As countries continue negotiating the unfinished WHO Pandemic Agreement, one of the original accord’s architects warns that delays could put the process itself at risk. “I think it’s quite risky to have a too-long negotiation because that means that we will lose diplomats and public health experts who were involved at the very beginning,” said Anne-Claire Amprou, French Ambassador for Global Health and former co-chair of the intergovernmental negotiations that delivered the agreement. Speaking on a recent episode of Global Health Matters, Amprou joined Lia Tadesse Gebremedhin, former Ethiopian Minister of Health, to take listeners behind the scenes of the three-year negotiations that culminated in the agreement’s adoption in May 2025. Their conversation comes as countries are still trying to complete the Pathogen Access and Benefit Sharing (PABS) annex, intended to establish a system for sharing pathogens with pandemic potential while ensuring equitable access to resulting vaccines, therapeutics and diagnostics. See related article: Developing Countries Unite Over Need for Binding Contracts with Pharma at Pandemic Talks Amprou said the original negotiations repeatedly collided with geopolitical tensions, including wars and the US withdrawal from WHO, making it essential to bring countries back to their shared public health objective. “Just to remember why we were in the room together, even at 4 a.m., 5 a.m., that was key in the determination to finalise the negotiation and to go beyond geopolitical tensions and political divergences,” she said. For Tadesse, the negotiations also demonstrated how smaller countries could build influence despite arriving with far fewer negotiators. While some countries had delegations of 20 to 25 experts, she said African countries might have only one or two, forcing them to combine expertise and coordinate their positions. “The approach was really to work as a group. So the Africa group really worked well together,” Tadesse said. That cooperation ultimately helped 47 countries build a common voice, while Amprou said compromise was unavoidable if the agreement was going to survive. “It’s not perfect, but it’s better to have something which is maybe less ambitious than the initial wish than nothing,” she said. “Because after that, we can build on that.” Listen to other Global Health Matters podcasts on Health Policy Watch. Image Credits: Global Health Matters Podcast. When Ebola strikes, HIV care cannot stop 20/09/2026 Jean Kaseya, Winnie Byanyima & Samuel Roger Kamba The Ebola outbreak has frightened patients away from clinics in Ituri in the DRC, threatening the lives of people living with HIV and other conditions. As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow. This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care. Falling clinic attendance For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases. That is why the current Ebola outbreak demands a broader response than Ebola control alone. The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most. This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death. The good news is that solutions already exist. Community-led organizations Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities, a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies. In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing. These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response. People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain. Yet these networks remain underfunded, only reaching only a fraction of those who need them. The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work. A patient cured of Ebola virus disease gets certificates from a health worker at the Ebola Treatment Center at Bunia General Reference Hospital. The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm. Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care. Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions. The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing. Maintaining essential health services The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately. This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission. If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities. The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind. When Ebola strikes, HIV care cannot stop. Lives depend on it. Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention. Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS). Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo. Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS. The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
As Global Pandemic Approach Flounders, Experts Offer Blueprint to Protect All Citizens 21/09/2026 Kerry Cullinan Health workers visit a Burmese migrant worker and her child in her dormitory in Thailand to discuss how to stay safe from COVID-19. It’s been barely three years since the COVID-19 pandemic ended, yet many world leaders appear to have little appetite for pandemic-proofing. Ahead of the UN High-Level Meeting on Pandemics, a major 20-country research project offers a blueprint for the future that could save millions more lives. The United Nations hosts a High-Level Meeting on Pandemics on Friday, but the political declaration draft, currently thin on practical implementation plans, may be rendered even skinnier as the United States is almost certain to throw its spanner in the multilateral wheel. At the end of the eighth round of talks to negotiate the last outstanding piece of the World Health Organization’s (WHO) Pandemic Agreement last Friday, WHO Director-General Dr Tedros Adhanom Ghebreyesus, its most ardent cheerleader, admitted that progress is “slow”. Barely three years ago, in May 2023, the global trauma of the COVID-19 pandemic was declared to be at an end – after seven million official deaths, 28 million “excess deaths” and at least 70 million more people being thrust into poverty. Yet other global crises appear to have blunted world leaders’ appetite to pandemic-proof their countries. However, a global team of experts, coordinated by the National University of Singapore (NUS) and The Lancet, has been hard at work since September 2023, working out what went wrong during COVID-19, and offering a blueprint to enable the world to perform better next time. The overarching conclusion of the PRIME Commission report is that many countries failed to protect those who needed it most, relying on technical plans that left millions exposed to infection. “Protection failed in contexts where housing was overcrowded, work was insecure, administrative systems excluded people, distrust disrupted communication, or health and social systems shifted risk onto households and communities,” the commission notes. Twenty-country case studies A nurse takes temperature of child suspected of COVID in a public health centre The research rests on 20 country case studies, ranging from the United States, the worst affected developed country, to low-income countries such as Mozambique. “What the PRIME Commission found is that people themselves aren’t ‘vulnerable’, but rather that systems create vulnerability,” said Professor Helena Legido-Quigley, co-chair of PRIME Commission. “A person living in a crowded apartment cannot socially isolate, a person with no identity papers cannot access a government payment, and a person who doesn’t speak the dominant language cannot understand health advice.” In Ethiopia, Indonesia, Mozambique, Tanzania, and Lebanon, lockdown regulations that restricted movement meant that the subsistence income of millions collapsed, with households “falling into hunger within days”. “We would survive the night after eating a piece of bread in the morning,” an internally displaced person in Ethiopia told researchers. In Indonesia, people without a national ID number could not get vaccines. In Peru, domestic workers were not covered by emergency cash transfers. Older Japanese residents did not know how to use digital information systems. “USA represents the deepest form of systemic exclusion, where immigration status, historical labour exclusions, and powerful industry lobbies combine to block access to services. Fear generated by federal immigration policy prevented workers from seeking basic care,” the report notes. In contrast, countries with universal health coverage, social protection, and there was trust in institutions, fared better – such as New Zealand, South Korea, Finland, and Bhutan. Groups commonly overlooked by national systems included older people, migrant workers, people with disabilities, indigenous peoples, informal workers, and people living in remote and underserved communities. “Across the 20 countries, common patterns emerged. People could be put at greater risk because they could not afford to stop working, did not have housing that allowed them to isolate, could not access government support, did not trust the information they received, or depended on health and other essential services that struggled under pressure,” the research found. Social distancing circles in a park in San Francisco, aimed at controlling COVID-19. More equity, more lives saved The Commission modelled future pandemic scenarios, comparing a response driven by power and national interest with a response favouring international cooperation and public health. In a hypothetical future influenza A pandemic, if vaccines were developed rapidly, this could reduce deaths by 59% (from 58.5 million to 23.9 million), even when vaccines were distributed first to countries with the greatest ability to pay. But if vaccine allocation was based on population size rather than purchasing power, global mortality would be reduced by 64%, to 21·2 million deaths. Measures to improve vaccine confidence would reduce deaths by another 1.9 million lives. “The influenza pandemic modelling findings unequivocally show that while the status quo will protect many lives, a more equitable approach to vaccine distribution will save millions more,” said Legido-Quigley. “There is every moral justification to create a system where vaccines reach those who need them in order to live, and not only those who can afford them.” COVID-19 vaccines finally arrived in Rwanda in March 2021. Modelling shows that millions more lives can be saved if vaccines are allocated according to population size rather than purchasing power. What must change? The Commission has developed a blueprint for the future based on six blocks, starting with protecting people and communities. It argues that the missing element in pandemic readiness is a “practical and profound whole-of-society approach that connects communities, health systems, social protection, finance, law, education, labour, food systems, environmental governance, and regional and global cooperation”. Pandemic “readiness” must be geared to ensuring that people and systems can withstand a pandemic, it argues, offering a practical test for any plan. To be effective, any measure needs to reduce avoidable harm, strengthen the capabilities and wellbeing of people and communities, reach those most underserved and remove structural barriers to protection and care. Communities should be involved in the design of the intervention, which must also be able to respond to misinformation. “Governments have heard for years that they should take a ‘whole-of-society’ approach to pandemic planning,” said Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response. “It is a government’s responsibility to protect all of their citizens and residents. We know that a new pandemic threat could arise at any time. The NUS-Lancet PRIME Commission offers a blueprint that must not be ignored.” Image Credits: Photo by Joshua Fernandez on Unsplash, WHO / Ploy Phutpheng, UNICEF , Luisvilla, WHO. DRC’s Ebola Outbreak: The Vast Mobilisation That Doesn’t Measure Itself (Part II) 21/09/2026 Mukesh Kapila A person with suspected Ebola arrives at a treatment centre in DRC. The world has ridden fast to rescue DRC from Ebola. But four months on, nobody can say for sure how many agencies are responding, how many people they employ, how much money has arrived, or what it bought. There are, however, coordinators galore. But the virus is still outwitting them. Time and again, we learn that how a crisis is defined is how it evolves and resolves. So what is DRC’s 17th Ebola outbreak: a health crisis, humanitarian tragedy, or development failure? This matters because health labelling implies a technocratic approach to squash an un-eradicable virus until it re-emerges, while a humanitarian framing dooms the afflicted to dependency, and development tagging signifies solutions kicked into the long term. These are, of course, generalisations. But the reality is that multiple dimensions are always present in complex socio-politico-economic-security contexts like in DRC. These defy simple prescriptions and, often, all we can do is to muddle through uncertainty and confusion. How well we are muddling through is the focus of the second part of my analysis of the Ebola response in DRC. The first part considered how slow recognition of the outbreak’s start allowed the virus to outpace control. A major national and international mobilisation has followed. What difference is that making? An arguable response DRC Minister of Health Dr Roger Kamba (centre),receives the first consignment of the Ervebo vaccine at N’djili International Airport in Kinshasa on 21 August. As I write, the response is arguing within itself. Over the space of a few days, the DRC’s health minister announced encouraging signs since cases peaked in the week of 3-9 August, the UN coordinator warned that the peak call was premature, Africa CDC scientists said that the situation is heterogeneous with peaks and declines in different zones, and the WHO chief landed in between with cautious optimism while noting that the outbreak continues to grow. All are reading the same daily situation reports, and all are right within their own remits. A government must show its strategy is working, a coordinator must keep agencies galvanised, a regional agency must be sensitive to constituency concerns, and a global agency must cheer-lead the world. But when the drivers cannot agree on the speed and direction of their train, there is a problem beyond epidemiology. And that befuddles the public at a time when careful information is as lifesaving now as a potential vaccine may be in the future. However, do not be too hard. With dynamic virus spread, data interpretation debates are expected before a professional consensus emerges. However, the time and patience that takes are always short during emergencies. Meanwhile, if it is challenging to get four lead agencies – DRC government, UN, WHO, Africa CDC – to cohere, consider the truth-determining complexity around scores of partners with fingers in the response pie. Each has constituencies to keep on side, not least for funding. Hence, the determination of whether the outbreak is waxing or waning is not simply about examining numbers. It can be an existential issue for some aid-fuelled agencies. For them, a longer crisis is better for balance sheets. Besides, how is the end of the 17th Ebola outbreak to be defined? WHO has the easy job of declaring it over when no new cases have been detected for 42 days (twice the maximum incubation period). But that is not the end of the crisis for those mourning their losses while trying to recover fractured lives and livelihoods. Even without aspiring to “build back better” through improved healthcare and surveillance for the next outbreak. These are some reasons why this columnist has long argued for independent mechanisms for evaluating the progression and outcomes of humanitarian and health crises. This is of utmost importance to reverse the loss of trust in aid systems. Painful root canal data extraction In that spirit, how do we assess Ebola response in DRC? It starts with verifying scale-up claims. Why is it so difficult to get a clear answer on who is doing what and where? The WHO-led health cluster in DRC has 119 partners: 45 international NGOs, 60 national NGOs, 5 UN agencies, 5 national authorities, 2 donors and 2 observers. But this was in June. Besides, it covered the country and is not specific to Ebola. Meanwhile, also in June, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) listed 218 operational actors in six eastern DRC provinces, but an up-to-date breakdown is difficult. Many agencies discharge crucial tasks such as building and operating treatment centres (WHO, Médecins Sans Frontières, International Medical Corps, Congolese-led ALIMA), safe and dignified burials (DRC Red Cross with the International Federation of Red Cross and Red Crescent Societies), family care, child protection, water and sanitation (UNICEF), food and logistics including the UN Humanitarian Service (World Food Programme), screening along travel routes and border crossings (International Organisation for Migration). Several are also engaged in risk communications and community engagement, and not to be overlooked are Congolese institutions – the health ministry and its technical bodies and provincial divisions – as well as many local civil society organisations. If a comprehensive census of agencies is elusive, counting the numbers of people engaged in Ebola work – a proxy for response effort – is even more so. Some numbers can be gleaned from agency publicity. Thus, WHO has 300 experts deployed in September, Africa CDC had 84 in June, while MSF, the largest non-state agency has 1400 staff, presumably mostly nationals. Pull out your own calculator WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Dr Yap Boum on the ground in Ituri in the DRC to address Ebola. Putting together patchy data, I estimate that 10,000 to 15,000 people are working on Ebola, ranging from epidemiologists to doctors, nurses to laboratory technicians, and pilots to grave diggers. Not forgetting administrators, accountants, logisticians, and security personnel. But how many are needed to cover all essential action fronts across a vast Ebola-affected zone approaching the size of France and Greece combined? There is no consolidated target, even as advocates plead for more resources. And while there is some modelling of outbreak size, there is no translation into the response scale-up required to achieve control. Although we have public health criteria and indicators for determining when we get there. Concerned outsiders must mine data from selective agency reports, publicity releases, and media interviews, and do their own calculations. We learn from WHO that 1,600 more treatment beds are needed, which, at three carers each, require 4,800 more skilled workers. Africa CDC says that it needs 450 more field staff. Meanwhile, 25 more decentralised testing facilities with trained staff are needed, doubling the current endowment. Half the affected zones still don’t have safe burial teams. Increasing coverage with eight volunteers per Red Cross team equates to needing 1,000 more volunteers. Achieving the target of 20 contacts traced and followed up daily for 21 days requires at least 3,000 more tracers. With screening at 153 points only partly staffed, and using staffing ratios from previous outbreaks, IOM could benefit from 800 more screeners. In addition to direct clinical responses, community risk must be tackled across the 14 million frontline population. UNICEF estimates there are three million vulnerable children and adolescents, while WFP says that 2.65 million face food insecurity. My projections suggest an additional need for some 10,000 responders of different types i.e. a doubling of current capacity. Practically, this must be overwhelmingly sourced from among the Congolese – suitably trained and financed. We live in a world of dashboards. Would it not be helpful if some authority maintained one to show these numbers and how they tick upwards? Multiple plans, appeals, and a missing ledger That brings us to financial confusion. A joint WHO – Africa CDC continental plan asks for $518 million for June to November. This covers 11 countries, not just DRC. On 4 September, the DRC government launched a revised six-month plan costing $1.3 billion. On the humanitarian side, OCHA’s revised plan for DRC calls for $2.1 billion, of which some $300 million is Ebola-related. The Red Cross Red Crescent appeals independently, and IFRC increased its ask to CHF 65 million in August. The largest independent responder – MSF – has a private funding approach. It requires forensic accounting skills to disentangle these plans to verify gaps and overlaps. How do these resourcing envelopes map to priority activities under, to quote Dr Tedros, “one plan, one budget, one team”? Africa CDC and WHO are seeking to unify financial tracking. But will that include the humanitarian track under OCHA? That such a system does not exist several months into a serious emergency does little for urgent resource mobilisation from sceptical donors who are obliged to make their own funding decisions that may not coincide with priorities. Meanwhile, how much funding has come in? Nobody provides an accurate tally. My own rough calculation suggests that about $1.5 billion out of the ask of $3 billion has been secured. Terms such as “mobilised, secured, committed, allocated, pledged and disbursed” are being used interchangeably while they mean different things. That means we don’t really know what cash has actually been turned into practical goods and services delivered at the frontlines. Traditionally, budget execution rates tend to be low. Therefore, the current Ebola financing system is worse than broken. It has gone backwards from the previous DRC outbreak by becoming less transparent even as appeal sizes have grown. Donor aid cuts cannot be blamed for this. This is a mess that some call a lucrative Ebola business, with the host country’s health minister reduced to asking in public where the money is and what is being done with it. Meanwhile, on the ground, problems are being caused by agencies paying different remuneration rates, while health workers have been striking because of not being paid fairly in a timely manner. Conversely, fraud and scams with fictitious payrolls are requiring the belated introduction of biometric registration, distracting effort from the primary response. Two systems, two constitutions Africa CDC staff on the ground in the DRC to assist with the Ebola outbreak (May 2026). The financing muddle is reflective of a structural problem. Eastern DRC is served by two international machines with separate legal foundations that pull in opposite directions. Global health co-operation rests on respecting national sovereignty under the International Health Regulations (IHR). States report outbreaks, and responses are state-led. That is why Dr Tedros says WHO works under the government’s leadership, and why Africa CDC frames its role as African solutions for African problems. The global humanitarian system rests on UN General Assembly resolution 46/182 of 1991 – a political settlement based on four principles, one of which is independence. Thus, humanitarians have the dispensation to negotiate with whoever controls the ground, including armed groups the state is fighting. Eastern DRC is a patchwork of territories controlled by different groups and varying virus epidemiologies. It is difficult to honour differing international health and humanitarian approaches within the same broad space. The tension is reflected in top-level pronouncements. In briefing member states, the UN Emergency Relief Coordinator committed to a combined response led by the UN Humanitarian Coordinator. In the same session, the WHO Director-General said they were working under the government’s leadership. Each is correct within their own constitutions. But the two statements are not fully compatible despite affable expressions of partnership. This is not legalistic nitpicking but has life-and-death implications. For example, safe and dignified burials are an infection control act, which is why the DRC health minister complained that some partners (humanitarian system) undertaking burials were not funding (health system) the gravediggers or providing body bags. Feeding isolating households is WFP’s humanitarian mandate, yet you cannot quarantine (health mandate) a breadwinner without it. Access negotiation with armed groups is an ICRC and OCHA competence. Essential services – measles, malaria, maternal care – fall between both systems, and neither appeal owns them. It is possible that when final audits are done, as many or more people may have died from non-Ebola causes as from Ebola itself. An epidemic of coordinators Meanwhile, as the Bundibugyo ebolavirus doubled every two to three weeks, so did the coordinators. In May there was a DRC health minister and a national institute. By June, there was an Emergency Operations Centre in Kinshasa, and seven provincial health teams with their coordinators. In June, the UN Resident and Humanitarian Coordinator, WHO Representative and an incident manager were activated, as well as WHO’s regional directorate in Brazzaville, and of course, the WHO Emergencies Team in Geneva and the Pandemic Hub in Berlin. By July, a UN/WHO Senior Ebola Coordinator had been installed at Bunia and a WHO/Africa CDC Continental Incident Management Support Team in Kampala. Also, the Geneva-based UN Inter-Agency Standing Committee was activated with a system-wide scale-up, which is a mechanism for coordinating the coordination. August was less frantic on the coordination front, as it is the traditional northern hemisphere holiday season. The virus, of course, took no vacation. By September, the Africa CDC Emergency Consultative Group was reviewing the work of others, and the African Union Summit convened in Bujumbura. In approximate summation, we have around 16 strategic coordination initiatives, each with their own coordinators. Plus coordinators of eight operational clusters and some 11 pillars. The plethora could not avoid being highly productive, with at least three plans and five appeals that now require further coordination to deconflict, update, and track. Amazingly, there remains scope for yet more coordinators. With insufficient burial teams, perhaps we need a Chief Burials Coordinator, and to accelerate contact tracing, a Chief Contact Tracing Coordinator. Looking ahead, we will need a Chief Vaccination Coordinator when the scramble starts to access a successful but inevitably scarce vaccine. To be fair, all the coordination functions have followed recommendations made after past Ebola and other emergency crises. But the virus attends no coordination meetings. Muddling through So, back to my original question. What is DRC’s 17th Ebola outbreak? On four months of evidence, it is all things. The virus is being confronted by a health system that treats it technically, a humanitarian system that treats it as a caseload, and a development discourse that promises to address underlying causes once both go home. Each answers honestly within its own frame. But none of them own the space between the frames, and that is where the virus proliferates. Meanwhile, muddling through this crisis is not a disgrace. But there is a difference between muddling honestly and unaccountably. Honest muddling publishes its numbers, admits what it does not know or can’t do, and submits to outside scrutiny. What we have instead is a response that cannot say how many agencies are working, how many people they employ, how many more they need, and what it has received or spent. This is not a problem of field workers labouring under risky circumstances with several losing their lives. It is the responsibility of chiefs, communicators, and coordinators in Geneva, Addis, and Kinshasa to sort out. Mukesh Kapila is professor emeritus of global health and humanitarian affairs at the University of Manchester, and a board member of Health Policy Watch. Vital Signs in Global Health is a regular column, and the opinions expressed are solely those of the author. Image Credits: DRC Health Ministry, DRC Health Ministry, Africa CDC. Pandemic Agreement Negotiator Warns Against Losing Momentum 21/09/2026 Health Policy Watch As countries continue negotiating the unfinished WHO Pandemic Agreement, one of the original accord’s architects warns that delays could put the process itself at risk. “I think it’s quite risky to have a too-long negotiation because that means that we will lose diplomats and public health experts who were involved at the very beginning,” said Anne-Claire Amprou, French Ambassador for Global Health and former co-chair of the intergovernmental negotiations that delivered the agreement. Speaking on a recent episode of Global Health Matters, Amprou joined Lia Tadesse Gebremedhin, former Ethiopian Minister of Health, to take listeners behind the scenes of the three-year negotiations that culminated in the agreement’s adoption in May 2025. Their conversation comes as countries are still trying to complete the Pathogen Access and Benefit Sharing (PABS) annex, intended to establish a system for sharing pathogens with pandemic potential while ensuring equitable access to resulting vaccines, therapeutics and diagnostics. See related article: Developing Countries Unite Over Need for Binding Contracts with Pharma at Pandemic Talks Amprou said the original negotiations repeatedly collided with geopolitical tensions, including wars and the US withdrawal from WHO, making it essential to bring countries back to their shared public health objective. “Just to remember why we were in the room together, even at 4 a.m., 5 a.m., that was key in the determination to finalise the negotiation and to go beyond geopolitical tensions and political divergences,” she said. For Tadesse, the negotiations also demonstrated how smaller countries could build influence despite arriving with far fewer negotiators. While some countries had delegations of 20 to 25 experts, she said African countries might have only one or two, forcing them to combine expertise and coordinate their positions. “The approach was really to work as a group. So the Africa group really worked well together,” Tadesse said. That cooperation ultimately helped 47 countries build a common voice, while Amprou said compromise was unavoidable if the agreement was going to survive. “It’s not perfect, but it’s better to have something which is maybe less ambitious than the initial wish than nothing,” she said. “Because after that, we can build on that.” Listen to other Global Health Matters podcasts on Health Policy Watch. Image Credits: Global Health Matters Podcast. When Ebola strikes, HIV care cannot stop 20/09/2026 Jean Kaseya, Winnie Byanyima & Samuel Roger Kamba The Ebola outbreak has frightened patients away from clinics in Ituri in the DRC, threatening the lives of people living with HIV and other conditions. As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow. This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care. Falling clinic attendance For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases. That is why the current Ebola outbreak demands a broader response than Ebola control alone. The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most. This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death. The good news is that solutions already exist. Community-led organizations Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities, a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies. In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing. These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response. People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain. Yet these networks remain underfunded, only reaching only a fraction of those who need them. The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work. A patient cured of Ebola virus disease gets certificates from a health worker at the Ebola Treatment Center at Bunia General Reference Hospital. The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm. Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care. Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions. The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing. Maintaining essential health services The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately. This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission. If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities. The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind. When Ebola strikes, HIV care cannot stop. Lives depend on it. Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention. Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS). Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo. Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS. The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
DRC’s Ebola Outbreak: The Vast Mobilisation That Doesn’t Measure Itself (Part II) 21/09/2026 Mukesh Kapila A person with suspected Ebola arrives at a treatment centre in DRC. The world has ridden fast to rescue DRC from Ebola. But four months on, nobody can say for sure how many agencies are responding, how many people they employ, how much money has arrived, or what it bought. There are, however, coordinators galore. But the virus is still outwitting them. Time and again, we learn that how a crisis is defined is how it evolves and resolves. So what is DRC’s 17th Ebola outbreak: a health crisis, humanitarian tragedy, or development failure? This matters because health labelling implies a technocratic approach to squash an un-eradicable virus until it re-emerges, while a humanitarian framing dooms the afflicted to dependency, and development tagging signifies solutions kicked into the long term. These are, of course, generalisations. But the reality is that multiple dimensions are always present in complex socio-politico-economic-security contexts like in DRC. These defy simple prescriptions and, often, all we can do is to muddle through uncertainty and confusion. How well we are muddling through is the focus of the second part of my analysis of the Ebola response in DRC. The first part considered how slow recognition of the outbreak’s start allowed the virus to outpace control. A major national and international mobilisation has followed. What difference is that making? An arguable response DRC Minister of Health Dr Roger Kamba (centre),receives the first consignment of the Ervebo vaccine at N’djili International Airport in Kinshasa on 21 August. As I write, the response is arguing within itself. Over the space of a few days, the DRC’s health minister announced encouraging signs since cases peaked in the week of 3-9 August, the UN coordinator warned that the peak call was premature, Africa CDC scientists said that the situation is heterogeneous with peaks and declines in different zones, and the WHO chief landed in between with cautious optimism while noting that the outbreak continues to grow. All are reading the same daily situation reports, and all are right within their own remits. A government must show its strategy is working, a coordinator must keep agencies galvanised, a regional agency must be sensitive to constituency concerns, and a global agency must cheer-lead the world. But when the drivers cannot agree on the speed and direction of their train, there is a problem beyond epidemiology. And that befuddles the public at a time when careful information is as lifesaving now as a potential vaccine may be in the future. However, do not be too hard. With dynamic virus spread, data interpretation debates are expected before a professional consensus emerges. However, the time and patience that takes are always short during emergencies. Meanwhile, if it is challenging to get four lead agencies – DRC government, UN, WHO, Africa CDC – to cohere, consider the truth-determining complexity around scores of partners with fingers in the response pie. Each has constituencies to keep on side, not least for funding. Hence, the determination of whether the outbreak is waxing or waning is not simply about examining numbers. It can be an existential issue for some aid-fuelled agencies. For them, a longer crisis is better for balance sheets. Besides, how is the end of the 17th Ebola outbreak to be defined? WHO has the easy job of declaring it over when no new cases have been detected for 42 days (twice the maximum incubation period). But that is not the end of the crisis for those mourning their losses while trying to recover fractured lives and livelihoods. Even without aspiring to “build back better” through improved healthcare and surveillance for the next outbreak. These are some reasons why this columnist has long argued for independent mechanisms for evaluating the progression and outcomes of humanitarian and health crises. This is of utmost importance to reverse the loss of trust in aid systems. Painful root canal data extraction In that spirit, how do we assess Ebola response in DRC? It starts with verifying scale-up claims. Why is it so difficult to get a clear answer on who is doing what and where? The WHO-led health cluster in DRC has 119 partners: 45 international NGOs, 60 national NGOs, 5 UN agencies, 5 national authorities, 2 donors and 2 observers. But this was in June. Besides, it covered the country and is not specific to Ebola. Meanwhile, also in June, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) listed 218 operational actors in six eastern DRC provinces, but an up-to-date breakdown is difficult. Many agencies discharge crucial tasks such as building and operating treatment centres (WHO, Médecins Sans Frontières, International Medical Corps, Congolese-led ALIMA), safe and dignified burials (DRC Red Cross with the International Federation of Red Cross and Red Crescent Societies), family care, child protection, water and sanitation (UNICEF), food and logistics including the UN Humanitarian Service (World Food Programme), screening along travel routes and border crossings (International Organisation for Migration). Several are also engaged in risk communications and community engagement, and not to be overlooked are Congolese institutions – the health ministry and its technical bodies and provincial divisions – as well as many local civil society organisations. If a comprehensive census of agencies is elusive, counting the numbers of people engaged in Ebola work – a proxy for response effort – is even more so. Some numbers can be gleaned from agency publicity. Thus, WHO has 300 experts deployed in September, Africa CDC had 84 in June, while MSF, the largest non-state agency has 1400 staff, presumably mostly nationals. Pull out your own calculator WHO’s Dr Roseline Belzaire (centre) and Africa CDC’s Dr Yap Boum on the ground in Ituri in the DRC to address Ebola. Putting together patchy data, I estimate that 10,000 to 15,000 people are working on Ebola, ranging from epidemiologists to doctors, nurses to laboratory technicians, and pilots to grave diggers. Not forgetting administrators, accountants, logisticians, and security personnel. But how many are needed to cover all essential action fronts across a vast Ebola-affected zone approaching the size of France and Greece combined? There is no consolidated target, even as advocates plead for more resources. And while there is some modelling of outbreak size, there is no translation into the response scale-up required to achieve control. Although we have public health criteria and indicators for determining when we get there. Concerned outsiders must mine data from selective agency reports, publicity releases, and media interviews, and do their own calculations. We learn from WHO that 1,600 more treatment beds are needed, which, at three carers each, require 4,800 more skilled workers. Africa CDC says that it needs 450 more field staff. Meanwhile, 25 more decentralised testing facilities with trained staff are needed, doubling the current endowment. Half the affected zones still don’t have safe burial teams. Increasing coverage with eight volunteers per Red Cross team equates to needing 1,000 more volunteers. Achieving the target of 20 contacts traced and followed up daily for 21 days requires at least 3,000 more tracers. With screening at 153 points only partly staffed, and using staffing ratios from previous outbreaks, IOM could benefit from 800 more screeners. In addition to direct clinical responses, community risk must be tackled across the 14 million frontline population. UNICEF estimates there are three million vulnerable children and adolescents, while WFP says that 2.65 million face food insecurity. My projections suggest an additional need for some 10,000 responders of different types i.e. a doubling of current capacity. Practically, this must be overwhelmingly sourced from among the Congolese – suitably trained and financed. We live in a world of dashboards. Would it not be helpful if some authority maintained one to show these numbers and how they tick upwards? Multiple plans, appeals, and a missing ledger That brings us to financial confusion. A joint WHO – Africa CDC continental plan asks for $518 million for June to November. This covers 11 countries, not just DRC. On 4 September, the DRC government launched a revised six-month plan costing $1.3 billion. On the humanitarian side, OCHA’s revised plan for DRC calls for $2.1 billion, of which some $300 million is Ebola-related. The Red Cross Red Crescent appeals independently, and IFRC increased its ask to CHF 65 million in August. The largest independent responder – MSF – has a private funding approach. It requires forensic accounting skills to disentangle these plans to verify gaps and overlaps. How do these resourcing envelopes map to priority activities under, to quote Dr Tedros, “one plan, one budget, one team”? Africa CDC and WHO are seeking to unify financial tracking. But will that include the humanitarian track under OCHA? That such a system does not exist several months into a serious emergency does little for urgent resource mobilisation from sceptical donors who are obliged to make their own funding decisions that may not coincide with priorities. Meanwhile, how much funding has come in? Nobody provides an accurate tally. My own rough calculation suggests that about $1.5 billion out of the ask of $3 billion has been secured. Terms such as “mobilised, secured, committed, allocated, pledged and disbursed” are being used interchangeably while they mean different things. That means we don’t really know what cash has actually been turned into practical goods and services delivered at the frontlines. Traditionally, budget execution rates tend to be low. Therefore, the current Ebola financing system is worse than broken. It has gone backwards from the previous DRC outbreak by becoming less transparent even as appeal sizes have grown. Donor aid cuts cannot be blamed for this. This is a mess that some call a lucrative Ebola business, with the host country’s health minister reduced to asking in public where the money is and what is being done with it. Meanwhile, on the ground, problems are being caused by agencies paying different remuneration rates, while health workers have been striking because of not being paid fairly in a timely manner. Conversely, fraud and scams with fictitious payrolls are requiring the belated introduction of biometric registration, distracting effort from the primary response. Two systems, two constitutions Africa CDC staff on the ground in the DRC to assist with the Ebola outbreak (May 2026). The financing muddle is reflective of a structural problem. Eastern DRC is served by two international machines with separate legal foundations that pull in opposite directions. Global health co-operation rests on respecting national sovereignty under the International Health Regulations (IHR). States report outbreaks, and responses are state-led. That is why Dr Tedros says WHO works under the government’s leadership, and why Africa CDC frames its role as African solutions for African problems. The global humanitarian system rests on UN General Assembly resolution 46/182 of 1991 – a political settlement based on four principles, one of which is independence. Thus, humanitarians have the dispensation to negotiate with whoever controls the ground, including armed groups the state is fighting. Eastern DRC is a patchwork of territories controlled by different groups and varying virus epidemiologies. It is difficult to honour differing international health and humanitarian approaches within the same broad space. The tension is reflected in top-level pronouncements. In briefing member states, the UN Emergency Relief Coordinator committed to a combined response led by the UN Humanitarian Coordinator. In the same session, the WHO Director-General said they were working under the government’s leadership. Each is correct within their own constitutions. But the two statements are not fully compatible despite affable expressions of partnership. This is not legalistic nitpicking but has life-and-death implications. For example, safe and dignified burials are an infection control act, which is why the DRC health minister complained that some partners (humanitarian system) undertaking burials were not funding (health system) the gravediggers or providing body bags. Feeding isolating households is WFP’s humanitarian mandate, yet you cannot quarantine (health mandate) a breadwinner without it. Access negotiation with armed groups is an ICRC and OCHA competence. Essential services – measles, malaria, maternal care – fall between both systems, and neither appeal owns them. It is possible that when final audits are done, as many or more people may have died from non-Ebola causes as from Ebola itself. An epidemic of coordinators Meanwhile, as the Bundibugyo ebolavirus doubled every two to three weeks, so did the coordinators. In May there was a DRC health minister and a national institute. By June, there was an Emergency Operations Centre in Kinshasa, and seven provincial health teams with their coordinators. In June, the UN Resident and Humanitarian Coordinator, WHO Representative and an incident manager were activated, as well as WHO’s regional directorate in Brazzaville, and of course, the WHO Emergencies Team in Geneva and the Pandemic Hub in Berlin. By July, a UN/WHO Senior Ebola Coordinator had been installed at Bunia and a WHO/Africa CDC Continental Incident Management Support Team in Kampala. Also, the Geneva-based UN Inter-Agency Standing Committee was activated with a system-wide scale-up, which is a mechanism for coordinating the coordination. August was less frantic on the coordination front, as it is the traditional northern hemisphere holiday season. The virus, of course, took no vacation. By September, the Africa CDC Emergency Consultative Group was reviewing the work of others, and the African Union Summit convened in Bujumbura. In approximate summation, we have around 16 strategic coordination initiatives, each with their own coordinators. Plus coordinators of eight operational clusters and some 11 pillars. The plethora could not avoid being highly productive, with at least three plans and five appeals that now require further coordination to deconflict, update, and track. Amazingly, there remains scope for yet more coordinators. With insufficient burial teams, perhaps we need a Chief Burials Coordinator, and to accelerate contact tracing, a Chief Contact Tracing Coordinator. Looking ahead, we will need a Chief Vaccination Coordinator when the scramble starts to access a successful but inevitably scarce vaccine. To be fair, all the coordination functions have followed recommendations made after past Ebola and other emergency crises. But the virus attends no coordination meetings. Muddling through So, back to my original question. What is DRC’s 17th Ebola outbreak? On four months of evidence, it is all things. The virus is being confronted by a health system that treats it technically, a humanitarian system that treats it as a caseload, and a development discourse that promises to address underlying causes once both go home. Each answers honestly within its own frame. But none of them own the space between the frames, and that is where the virus proliferates. Meanwhile, muddling through this crisis is not a disgrace. But there is a difference between muddling honestly and unaccountably. Honest muddling publishes its numbers, admits what it does not know or can’t do, and submits to outside scrutiny. What we have instead is a response that cannot say how many agencies are working, how many people they employ, how many more they need, and what it has received or spent. This is not a problem of field workers labouring under risky circumstances with several losing their lives. It is the responsibility of chiefs, communicators, and coordinators in Geneva, Addis, and Kinshasa to sort out. Mukesh Kapila is professor emeritus of global health and humanitarian affairs at the University of Manchester, and a board member of Health Policy Watch. Vital Signs in Global Health is a regular column, and the opinions expressed are solely those of the author. Image Credits: DRC Health Ministry, DRC Health Ministry, Africa CDC. Pandemic Agreement Negotiator Warns Against Losing Momentum 21/09/2026 Health Policy Watch As countries continue negotiating the unfinished WHO Pandemic Agreement, one of the original accord’s architects warns that delays could put the process itself at risk. “I think it’s quite risky to have a too-long negotiation because that means that we will lose diplomats and public health experts who were involved at the very beginning,” said Anne-Claire Amprou, French Ambassador for Global Health and former co-chair of the intergovernmental negotiations that delivered the agreement. Speaking on a recent episode of Global Health Matters, Amprou joined Lia Tadesse Gebremedhin, former Ethiopian Minister of Health, to take listeners behind the scenes of the three-year negotiations that culminated in the agreement’s adoption in May 2025. Their conversation comes as countries are still trying to complete the Pathogen Access and Benefit Sharing (PABS) annex, intended to establish a system for sharing pathogens with pandemic potential while ensuring equitable access to resulting vaccines, therapeutics and diagnostics. See related article: Developing Countries Unite Over Need for Binding Contracts with Pharma at Pandemic Talks Amprou said the original negotiations repeatedly collided with geopolitical tensions, including wars and the US withdrawal from WHO, making it essential to bring countries back to their shared public health objective. “Just to remember why we were in the room together, even at 4 a.m., 5 a.m., that was key in the determination to finalise the negotiation and to go beyond geopolitical tensions and political divergences,” she said. For Tadesse, the negotiations also demonstrated how smaller countries could build influence despite arriving with far fewer negotiators. While some countries had delegations of 20 to 25 experts, she said African countries might have only one or two, forcing them to combine expertise and coordinate their positions. “The approach was really to work as a group. So the Africa group really worked well together,” Tadesse said. That cooperation ultimately helped 47 countries build a common voice, while Amprou said compromise was unavoidable if the agreement was going to survive. “It’s not perfect, but it’s better to have something which is maybe less ambitious than the initial wish than nothing,” she said. “Because after that, we can build on that.” Listen to other Global Health Matters podcasts on Health Policy Watch. Image Credits: Global Health Matters Podcast. When Ebola strikes, HIV care cannot stop 20/09/2026 Jean Kaseya, Winnie Byanyima & Samuel Roger Kamba The Ebola outbreak has frightened patients away from clinics in Ituri in the DRC, threatening the lives of people living with HIV and other conditions. As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow. This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care. Falling clinic attendance For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases. That is why the current Ebola outbreak demands a broader response than Ebola control alone. The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most. This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death. The good news is that solutions already exist. Community-led organizations Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities, a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies. In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing. These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response. People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain. Yet these networks remain underfunded, only reaching only a fraction of those who need them. The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work. A patient cured of Ebola virus disease gets certificates from a health worker at the Ebola Treatment Center at Bunia General Reference Hospital. The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm. Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care. Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions. The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing. Maintaining essential health services The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately. This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission. If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities. The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind. When Ebola strikes, HIV care cannot stop. Lives depend on it. Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention. Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS). Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo. Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS. The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
Pandemic Agreement Negotiator Warns Against Losing Momentum 21/09/2026 Health Policy Watch As countries continue negotiating the unfinished WHO Pandemic Agreement, one of the original accord’s architects warns that delays could put the process itself at risk. “I think it’s quite risky to have a too-long negotiation because that means that we will lose diplomats and public health experts who were involved at the very beginning,” said Anne-Claire Amprou, French Ambassador for Global Health and former co-chair of the intergovernmental negotiations that delivered the agreement. Speaking on a recent episode of Global Health Matters, Amprou joined Lia Tadesse Gebremedhin, former Ethiopian Minister of Health, to take listeners behind the scenes of the three-year negotiations that culminated in the agreement’s adoption in May 2025. Their conversation comes as countries are still trying to complete the Pathogen Access and Benefit Sharing (PABS) annex, intended to establish a system for sharing pathogens with pandemic potential while ensuring equitable access to resulting vaccines, therapeutics and diagnostics. See related article: Developing Countries Unite Over Need for Binding Contracts with Pharma at Pandemic Talks Amprou said the original negotiations repeatedly collided with geopolitical tensions, including wars and the US withdrawal from WHO, making it essential to bring countries back to their shared public health objective. “Just to remember why we were in the room together, even at 4 a.m., 5 a.m., that was key in the determination to finalise the negotiation and to go beyond geopolitical tensions and political divergences,” she said. For Tadesse, the negotiations also demonstrated how smaller countries could build influence despite arriving with far fewer negotiators. While some countries had delegations of 20 to 25 experts, she said African countries might have only one or two, forcing them to combine expertise and coordinate their positions. “The approach was really to work as a group. So the Africa group really worked well together,” Tadesse said. That cooperation ultimately helped 47 countries build a common voice, while Amprou said compromise was unavoidable if the agreement was going to survive. “It’s not perfect, but it’s better to have something which is maybe less ambitious than the initial wish than nothing,” she said. “Because after that, we can build on that.” Listen to other Global Health Matters podcasts on Health Policy Watch. Image Credits: Global Health Matters Podcast. When Ebola strikes, HIV care cannot stop 20/09/2026 Jean Kaseya, Winnie Byanyima & Samuel Roger Kamba The Ebola outbreak has frightened patients away from clinics in Ituri in the DRC, threatening the lives of people living with HIV and other conditions. As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow. This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care. Falling clinic attendance For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases. That is why the current Ebola outbreak demands a broader response than Ebola control alone. The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most. This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death. The good news is that solutions already exist. Community-led organizations Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities, a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies. In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing. These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response. People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain. Yet these networks remain underfunded, only reaching only a fraction of those who need them. The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work. A patient cured of Ebola virus disease gets certificates from a health worker at the Ebola Treatment Center at Bunia General Reference Hospital. The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm. Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care. Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions. The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing. Maintaining essential health services The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately. This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission. If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities. The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind. When Ebola strikes, HIV care cannot stop. Lives depend on it. Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention. Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS). Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo. Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS. The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
When Ebola strikes, HIV care cannot stop 20/09/2026 Jean Kaseya, Winnie Byanyima & Samuel Roger Kamba The Ebola outbreak has frightened patients away from clinics in Ituri in the DRC, threatening the lives of people living with HIV and other conditions. As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow. This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care. Falling clinic attendance For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases. That is why the current Ebola outbreak demands a broader response than Ebola control alone. The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most. This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death. The good news is that solutions already exist. Community-led organizations Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities, a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies. In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing. These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response. People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain. Yet these networks remain underfunded, only reaching only a fraction of those who need them. The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work. A patient cured of Ebola virus disease gets certificates from a health worker at the Ebola Treatment Center at Bunia General Reference Hospital. The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm. Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care. Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions. The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing. Maintaining essential health services The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately. This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission. If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities. The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind. When Ebola strikes, HIV care cannot stop. Lives depend on it. Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention. Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS). Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo. Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS. The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General 18/09/2026 Felix Sassmannshausen An analysis of early digital campaigns in the race for the next WHO Director-General reveals a sharp contrast between consolidated sovereign-technical networks and broad policy forums. The race to lead the World Health Organization (WHO) is intensifying. Early digital campaign data reveals an active contest to capture the pivotal African vote and outreach to established United States, European Union and corporate networks. While the full field of contenders is still taking shape ahead of the formal nomination deadline, digital engagement metrics already highlight clear geographical and institutional dividing lines across the prospective candidates. Ahead of the 24 September deadline for candidates to enter the race for WHO Director-General, early digital campaign footprints offer initial insights into the contenders’ strategic priorities, reach, and professional networks. While online interactions – such as ‘likes’ or comments – do not constitute formal endorsements, analysing them provides a crucial window into early campaign dynamics. Mapped systematically, this data consisting of nearly 7,500 direct interactions reveals the distinct geopolitical and institutional networks each candidate taps into. Currently, this dynamic is most visible in the digital campaigns of Dr Hans Henri Kluge (Regional Director for Europe) and Dr Hanan H. Balkhy (Regional Director for the Eastern Mediterranean). Their head-to-head duel is flanked by the candidacy of Indonesian Health Minister Budi Gunadi Sadikin and former Qatari Public Health Minister Hanan Mohammed Al-Kuwari. While Al-Kuwari currently lacks an active social media presence, Sadikin commands a massive domestic reach of approximately 280,000 followers on Instagram. Although he has yet to launch a dedicated personal campaign account on professional networks, his candidacy is already generating significant discussion and commentary among global policy analysts, health executives, and financial strategists. Our analysis examines the contrasting leadership models and campaign themes established in the candidates’ initial announcements and maps their core networks across state and diplomatic accounts. It tracks their competing bids for the pivotal African regional vote, evaluates their strategic reach into US and European policy circles, and unpacks the distinct corporate, academic, and civil society networks reacting to their campaigns. Here is what the data reveals. Technical stewardship versus deliberative diplomacy Screenshots from Dr Balkhy’s and Dr Kluge’s early digital campaigns. Postings and interactions highlight contrasting leadership styles and distinct global influence networks. Balkhy’s campaign strategy is built on a narrative centred on clinical frontline credibility, state-sovereign legitimacy, and scientific stewardship. Her tone in her post announcing her nomination is authoritative and defined by respect and gratitude towards Saudi Arabia’s leadership, notably King Salman and Crown Prince Mohammed bin Salman. She systematically links her personal career as a paediatrician and infectious diseases specialist directly to the establishment of Saudi Arabia’s national infection control authorities and her hands-on management of the MERS-CoV crisis. This narrative of clinical stewardship is celebrated by regional colleagues and commentators as a historic moment for women to lead global health, mirroring wider praise across her network that frames her candidacy as an inspiration for women and girls in the Arab world. Through her subsequent campaign updates across the African continent and South-East Asia, Balkhy has expanded this clinical core into a broader platform of international health diplomacy. During her engagements at the African Regional Committee in Addis Ababa and the South-East Asia Regional Committee in Timor-Leste, she framed her vision around mutual capacity building, ‘One Health’ collaboration, and strengthening local manufacturing and regulatory infrastructure. Kluge leverages multilateral forums like the South-East Asia Regional Committee to project a platform of participative dialogue and institutional consensus building. Kluge’s campaign framing, on the other hand, relies on bottom-up messaging centred on administrative transparency and participative dialogue. His tone is inclusive, marked by active listening and explicit deference towards member states – a strategy designed to allay concerns surrounding a European candidacy. He links his career as a field-tested public health physician directly to decades of operational crisis management in conflict zones, spanning Somalia, Liberia, Siberia, Myanmar, and the Central African Republic. He pairs this background with his strategic stewardship of the WHO European region. In his recent campaign updates and official manifesto, “Rebuilding WHO Together”, Kluge has further formalised this platform around structural institutional reform, sustainable financing, and a networked “One WHO”. His campaign tour across Africa, framed as a personal “homecoming”, and his participation in the Dili Declaration on health workforce equity reinforce his emphasis on placing local health workers and primary health care at the heart of universal health coverage. Sovereign bases: securing the home turf Geographic data highlights regional networks while capturing competing candidate efforts to build diplomatic traction across Africa and US policy circles. Translating these narratives into future campaign momentum relies heavily on state-level alignment. A granular analysis of candidate interaction reveals how each nominee’s sovereign network mirrors the distinct administrative and political architecture of their nominating regions. State-level interactions with Kluge’s posts are anchored by continuous, repeat reactions from key European officials, led by the Belgian diplomatic corps. This digital base is highlighted by Ambassador of Belgium to Finland Karel Tousseyn, who repeatedly reacts across several campaign posts, alongside active engagement from Belgian Ambassador to India Didier Vanderhasselt. Beyond his nominating state, a wider European footprint is consistently visible across his campaign updates. The most frequent cabinet-level engager on Kluge’s platform is Latvian Health Minister Hosam Abu Meri, who continuously responds to major announcements. Reactions also came from Monegasque Minister for Social Affairs and Health Christophe Robino, Irish Minister of State for Mental Health Mary Butler, and Swedish Global Health Ambassador Karin Tegmark Wisell. Notably, programmatic updates also drew direct engagement from the official WHO Bangladesh country office page. While Sovereign & Ministries leads both campaigns, Balkhy anchors a sovereign-multilateral core versus Kluge’s broad European policy, civil society, and corporate network. Mirroring this network, online interactions with Balkhy’s campaign updates reveal a highly consolidated, sovereign-technical base dominated by Saudi government and regulatory authorities who demonstrate sustained, repeat engagement across multiple posts. This platform footprint is anchored by senior Ministry of Health leadership, including Chief of Staff Fahad Alkhowaiter, Assistant Deputy Minister Abdulaziz Alrabiah, and Risk Management Director Najla Almutairi. Continuous interactions also came from Saudi Food and Drug Authority (SFDA) leads Adel A. Alharf and Khaloud Alzahrani. This sovereign core is reinforced across the Eastern Mediterranean by regional public health leads and ministerial figures who maintain steady engagement across her international tour updates. Continuous digital interaction is driven by Egyptian Ministry of Health and Population Associate Minister for International Relations Hatem Amer, Omani Ministry of Health Head of AMR Abdullah Alqayoudhi, and former Sudanese Health Minister Akram Ali Eltom. Together, they reflect strong regional networks across the region, complemented by interactions from the official WHO Lebanon country office page. Competing for the pivotal African regional vote Balkhy leverages key regional events in Addis Ababa to pivot her sovereign base toward building strategic, continent-wide health security partnerships across Africa. With their respective home bases digitally engaged, both candidates turned their focus outward to contest one of the election’s most critical voting blocks representing 47 sovereign member states. Both regional directors targeted the WHO’s African region (AFRO) around its regional committee meeting at the end of August, seeking traction across a bloc that frequently votes in unison and that is an indispensable force in the Director-General election. Surrounding his campaign travels across the African continent, Kluge’s collaborative, bottom-up model was reflected in his online engagement. Digital momentum for his campaign was driven by regional representatives, technical experts, and advocates across AFRO who demonstrated sustained engagement. This footprint was anchored by repeated interactions with Africa CDC Senior Country Representative for Ethiopia and Mauritius Aniekeme Uwah, WHO Regional Office for Africa Programme Support Specialist Pascal Mulindwa, West African Health Organization (WAHO) Healthcare Services Director Virgil Lokossou, Africa CDC Youth Division Program Coordinator Simon Ernest, and acting Africa CDC Deputy Director General Tajudeen Raji. In a parallel strategic move, Balkhy’s major campaign update marked a pivot toward the African continent. This triggered immediate digital momentum among operational, technical, and institutional figures on the ground. Repeat interactions were led by Institut Pasteur de Dakar CEO and former WHO Assistant Director-General Ibrahima Socé Fall, UNICEF Human Resources Manager Stanley Kilel, International Planned Parenthood Federation (IPPF) Regional Director for Africa Claudia Shilumani, and Africa CDC One Health-AMR Technical Officer Fowzia Mohamed, alongside former Africa CDC Acting Director Ahmed Ogwell Ouma. This platform footprint was further reinforced by continental leadership, including Ethiopian Public Health Institute (EPHI) Deputy Director General Getachew Tollera, African Union Interafrican Bureau for Animal Resources (AU-IBAR) Director Huyam Salih, and Sudanese International Health Director General at the Federal Ministry of Health Alaa Altayeb Mudathir. This indicates that Balkhy generated substantial momentum among key institutional and technical accounts in the African region. Geopolitical ties: US health security and the EU executive machinery Candidate networks highlight strategic geopolitical reach, connecting Balkhy to Washington biosecurity circles and Kluge to EU executive bodies. Notably, Balkhy also maintains digital links to US security and public health institutions, marked by sustained reactions from key figures across her campaign updates. High-ranking US government advisers and biosecurity experts – including former presidential adviser Larry Kerr and former US Ambassador Jimmy Kolker – sustained regular engagement across her platform. Online reactions to her campaign posts extend across core US health security bodies. Key accounts interacting with her updates include former CDC leader Scott McNabb, CDC Senior Global Health Adviser Lynn Filpi, Health and Human Services Senior Global Health Officer Angela Monahan, and former US global health security executive Summer Galloway. This network hints at her potential to serve as a diplomatic bridge for the United States following Washington’s withdrawal from the WHO. Kluge, meanwhile, maintains deep administrative ties to the heart of the European Union, reflected in ongoing engagement across the EU’s health executive machinery. Senior officials from the European Commission Directorate-General for Health and Food Safety (DG SANTE), including Head of Unit Florina Telea, Team Leader Ines Elise Prainsack-Ward, and Policy Officer Irini Kessissoglou. European Health Emergency Preparedness and Response Authority (DG HERA) leads Giorgos Rossides and Margarida Alho, also feature as interaction partners across his updates. This footprint is further reinforced by European Health and Digital Executive Agency (HaDEA) Deputy Head of Unit Nadia Elhaggagi and Team Leader Debora Fumagalli. This indicates that Kluge’s platform actively connects with the day-to-day regulatory and health security machinery of the EU – despite the Commission declining to endorse Kluge so far. Corporate connects: big pharma versus biotech R&D Kluge’s corporate network centres on European pharma C-suites and trade federations, while Balkhy draws from regional market access, biotech R&D, and AMR leads. Beyond geography, clear economic and academic dividing lines draw a sharp boundary between the two campaign ecosystems. In times of increased public-private partnerships to leverage the funding gap in global health, these networks might prove to be highly effective. Kluge’s platform maintains high visibility within the established European industrial healthcare sector. His digital interactions feature top-level corporate figures, anchored by engagements with Bayer AG Board Member Stefan Oelrich, European Federation of Pharmaceutical Industries and Associations (EFPIA) Director General Nathalie Moll, and Vaccines Europe Executive Director Sibilia Quilici. This commercial reach extends across multinational pharma through engagement from Astellas Pharma Vice President Matt Slabbert, Johnson & Johnson EMEA Government Affairs Lead Anouk De Vroey, and MSD Italia Managing Director Nicoletta Luppi. Together, these connections reflect an extensive European industrial footprint. By contrast, Balkhy’s economic connections are concentrated in specialised research and development networks and clinical transformation leads. Alongside Saudi healthcare executives – such as King Abdullah Bin Abdulaziz University Hospital CEO Nesreen Alwallan – her platform engages clinical and scientific pioneers in antimicrobial resistance (AMR) and biosecurity. Repeat interactions come from Swiss biotech firm BioVersys AG Chief Executive Marc Gitzinger, alongside engagements from Roche Pharma Global Head of Infectious Diseases Michael Lobritz, Roche Diagnostics Policy Director Jilian Sacks, Sanofi Head of Vaccines Tine Rikke Jorgensen, AstraZeneca Saudi Arabia Country President Hatem Werdany, and Eli Lilly Government Affairs Lead Fahad Alsafri Alharbi. Academic pedigree and civil society anchors The candidates’ digital campaign footprints reveal a distinct strategic split: Kluge draws heavily from health policy, economics, and civil society architects, whereas Balkhy mobilises a coalition of clinical researchers, epidemiologists, and AMR patient advocates. Kluge’s continuous digital interaction is driven by London School of Economics Professor of Health Policy Elias Mossialos and Associate Professor Rocco Friebel, alongside Bocconi University Health Economics Professor Aleksandra Torbica. His platform also draws engagement from former Médecins Sans Frontières International President Joanne Liu, alongside civil society representatives including European Public Health Alliance (EPHA) Director General Milka Sokolović, Movendi International President Kristina Sperkova, former EURORDIS-Rare Diseases Europe CEO Yann Le Cam, and US Sepsis Alliance Chief Medical Officer Cindy Hou. Closely mirroring her clinical background in epidemiology and infectious diseases, Balkhy draws continuous engagement from leading researchers, including Institut Pasteur de Dakar CEO Ibrahima Socé Fall, Boston University Center on Emerging Infectious Diseases Founding Director Nahid Bhadelia, and Mohammed Bin Rashid University Professor Abiola Senok. This footprint is further reinforced by patient advocacy leaders, such as WHO Taskforce of AMR Survivors Chair Vanessa Carter, International Centre for Antimicrobial Resistance Solutions (ICARS) Head of Human Health Danilo Lo-Fo-Wong, and Harvard Medical School Director Emeritus John G. Meara. Inspirational advocates and policy lightning rods WHO headquarters in Geneva. Kluge’s open-door campaign has drawn critical feedback on past reorganizations. Not only engagement and interactions point to the rift between the candidates’ networks. Public commentary under their official nomination posts reveals that they operate in entirely different narrative landscapes. The community response to Balkhy’s announcement is remarkably cohesive, combining themes of scientific authority, regional progress, and the historic symbolic impact of female Arab leadership. Her clinical and strategic credentials are heavily emphasised; for instance, former Afghan Health Minister and WHO Executive Board Member Wahid Majrooh praises her “courage and humble leadership” during complex regional geopolitical crises. Her role as a pioneer is widely celebrated: WHO policy adviser Alissar Rady declared that it is “time for women to lead health,” while patient advocate Vanessa Carter described Balkhy as an exceptional role model for women in global health. Additionally, commentators link her candidacy directly to Saudi Arabia’s expanding contributions to the WHO. Meanwhile, Kluge’s platform serves as a highly active forum for both institutional celebration and systemic critique. On one hand, supporters praise his communicative warmth and crisis-tested, human-centric diplomacy. Some commentators commend his leadership during humanitarian emergencies in Myanmar, while others express gratitude for his supportive role in establishing Kazakhstan’s primary healthcare demonstration platform. On the other hand, his open-door approach acts as a lightning rod for internal structural grievances. The most sensitive critiques come from within the WHO’s own technical ranks; WHO international classification committees expert Patricia Welch Saleeby delivers a blunt indictment of past reorganisations, warning against the use of external management consulting firms. Notably, WHO Health Emergencies Response Officer Banza Freddy Mutoka flags the diplomatic hurdles Kluge will face in convincing Eastern Mediterranean (EMRO) and African (AFRO) member states to align behind his European-backed reform vision. Doctors, Diplomats, and Disruptors The prospective candidates for WHO Director-General (left to right): Dr Hanan Balkhy (WHO EMRO Director), Dr Hans Kluge (WHO EURO Director), Budi Gunadi Sadikin (Minister of Health, Indonesia), and Dr Hanan Al-Kuwari (former Minister of Public Health, Qatar). With only days remaining before the official nomination window closes, early digital campaigns show that the next Director-General must navigate a highly visible web of online influence, public policy critique, and multi-regional networks. Ultimately, the divergence between the active platforms of Balkhy and Kluge highlights a critical strategic contrast in how the prospective candidates envision leading the WHO through its next era: Balkhy’s campaign relies on a foundation of clinical authority and biosecurity expertise, targeting scientific excellence and frontline epidemic containment. Backed by a highly disciplined GCC sovereign core and key ties within Washington’s health security circles, her model offers the organization institutional stability and sovereign financial backing. Kluge’s campaign, positioned at the intersection of European public administration, multinational industrial partners, and progressive civil society, relies on diplomatic agility and open-door dialogue. Yet, because his platform functions as a public policy forum, his candidacy is directly bound to the friction of systemic WHO reform, internal staff grievances, and post-colonial African demands for structural financial autonomy. Meanwhile, Qatari candidate Hanan Mohamed Al-Kuwari has remained largely absent from social media channels, whereas Indonesian Health Minister Budi Gunadi Sadikin has featured prominently in high-level policy commentary. Digital engagement surrounding the announcement of his candidacy on Health Policy Watch was notably robust, drawing significant analysis from global health executives, financial strategists, and policy experts intrigued by his non-traditional, finance-driven background. As the candidates prepare for the next leg of the campaign, the geographical focus shifts toward remaining regional forums. What is already clear, however, is that the winner of this election will inherit a highly fragmented agency operating under unprecedented fiscal and institutional strain – and their capacity to convert early digital engagement into real-world sovereign trust will determine their success in shaping the future of global health. Editorial note: how we analysed the data To analyse the dynamics of the early digital campaigns, Health Policy Watch conducted a comprehensive social media listening study of the candidates’ digital footprints on LinkedIn. The analysis mapped the campaigns of Kluge, Balkhy, and the broader candidate field by extracting interactions across official campaign updates, nomination announcements, and policy manifestos collected through 16 September. In total, we evaluated nearly 7,500 direct interactions (reactions, likes, and comments) – representing a network of more than 5,200 unique professional accounts. Dual engagements – where individual accounts interacted with campaign posts across multiple competing candidates – were systematically excluded to isolate primary candidate-specific networks (leaving 5,098 primary accounts). The evaluation relies strictly on publicly accessible engagement from accounts disclosing self-reported affiliations, excluding private communications and non-public diplomatic negotiations. While social media listening offers a unique lens into the professional ecosystems surrounding the Director-General election, several analytical boundaries apply. The dataset relies on LinkedIn as the primary professional platform for global health governance. Consequently, it captures digitally active, English-speaking policy elites, but may under-represent contacts whose main reach relies on domestic consumer networks or traditional, non-digital diplomatic channels. See related story: Want to Become the Next WHO Director-General? Get in Line Image Credits: Felix Sassmannshausen/HPW, Felix Sassmannshausen, Hans Kluge via LinkedIn, Hanan Balkhy via LinkedIn, Wikipedia . US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
US Medicare Pricing Policies Could Drive Global Costs and Hinder Access Worldwide 18/09/2026 Sophia Samantaroy A new modelling study suggests that US Medicare “Most-Favored-Nation” policies on drug prices would cut Medicare spending on brand-name drugs, but potentially incentivize companies to increase prices or delay new drug launches elsewhere. Efforts to control the cost of government spending on drugs culminated in a Most-Favored-Nation (MFN) policy, a Trump administration initiative which ties what Medicare pays for medicines to prices charged in other high-income countries. But a new analysis from researchers at Harvard University, the London School of Economics, and the University of Zurich outlined how, while the policy would decrease costs in the US, prices could soar elsewhere. For about 75% of the medicines analyzed, the resulting Medicare savings would be worth almost four times the annual profits from the medicine’s sales in the country used to benchmark the price. “To avoid losing that much revenue, manufacturers would have a strong incentive to raise prices outside the US or delay launches”, the Lancet wrote in a statement. Already, the policies have helped a pharmaceutical company secure higher drug prices in Japan in March 2026. Astellas Pharma, a Tokyo-based drug company, argued that domestic drug costs could influence US pricing under the MFN policy, leading Japanese officials to award the drugmaker a higher price than typical. The study authors also pointed to market withdrawals of a cholesterol drug in Denmark, and US-UK pharmaceutical trade agreements and disruptions to access and pricing as a result of the Trump administration’s threat of tariffs on companies outside the US. “Referenced countries, from Germany to Japan to Australia, are facing substantial pressure from the US administration and industry to raise prices and spending on medicines,” said Dr Thomas Hwang, the lead study author and professor at Brigham and Women’s Hospital and Harvard Medical School. “But this is colliding with the reality that other countries have limited budget room to give.” Attempts to cut Medicare drug spending President Trump with members of his cabinet at a press conference announcing new Medicare drug pricing policies. “People living in the United States have long paid more for medicines than virtually anywhere else in the world,” said study author Dr Aaron Kesselheim, also a researcher at Harvard’s Brigham and Women’s Hospital. To understand how these policies would impact pricing in the US and elsewhere, the researchers analysed 195 patented medicines that together account for $87.9 billion of Medicare’s annual spending through its two programs: GLOBE, which covers medicines given in hospitals and clinics, and GUARD, which covers those in pharmacies. Both are MFN pricing models under the Trump Administration’s executive order to combat Medicare drug pricing. The researchers estimated savings by comparing how much Medicare is currently spending to prices in 19 countries referenced in the MFN executive order. They then modelled two scenarios: expanding MFN to include all Medicare beneficiaries instead of the current 25%, and excluding manufacturers with confidential deals. A graphic from KFF.org showing how the national share of Medicare’s spending on drugs has increased dramatically in the past decade, outpacing any peer nation. Without any exemptions, the researchers estimate Medicare could save $5.2 billion (16%) under GLOBE and $6.4 billion (18%) under GUARD during its initial phase. Expanding the rules to cover all Medicare beneficiaries could raise these savings to $21 billion and $25.5 billion. Under these payment models, the lowest price used as an international benchmark was found to be 71% lower than what Medicare pays, with South Korea, Norway, and Australia as the most common countries referenced by Medicare to set pricing. “The Most-Favoured-Nation pricing models were meant to address this gap,” said Kesselheim in reference to how much more the US pays for drugs. “[B]ut their scope is limited by various exemptions and will likely face legal challenges,” said Kesselheim. These exemptions- where companies strike side deals with Medicare, are likely to undercut government savings from MFN. The study estimates that reported confidential deals between manufacturers and the Trump administration could cut the policy’s overall Medicare savings: for the initial group of 17 manufacturers with announced agreements, the study’s projected savings would be cut by 71%. “The Trump administration’s Most-Favoured-Nation pricing models have the potential to deliver real savings to the US federal government and taxpayers. But if manufacturers can evade participation in these models by striking side deals, most of those savings might not be realised,” said Hwang. Concerns for global pharmaceutical market The MFN policy ties what Medicare pays to prices charged in other high income countries, leading the researchers to argue that the policy could unintentionally drive prices up outside of the US. That’s because for the 138 medicines analyzed in the study, the estimated Medicare savings are nearly four times larger than that medicine’s total annual sales in the country used as the price benchmark. “For most of these medicines, keeping prices low in other countries would cost manufacturers more in lost Medicare revenue than they earn from selling there, creating a strong incentive to raise prices or block them from being visible to Medicare for referencing,” the Lancet said in a press statement. “Manufacturers could try to do that by developing different formulations, converting existing discounts into confidential rebates, or delaying launches.” Dr Kerstin Vokinger of ETH and the University of Zurich noted that “policies in the US may impact access to medicines globally. Policymakers should ensure that availability of important medicines is not delayed as a result,” the study author said. Confidential deals may wipe out Medicare savings Medicare covers around 68 million older and disabled Americans- and the program was historically barred from negotiating medicine prices directly with manufacturers until the Biden-era 2022 Inflation Reduction Act authorised it to negotiate prices for a small number of costly medicines. The Trump administration’s MFN policy goes further, aligning what Medicare pays for brand-name medicines with prices in comparable high-income countries, after adjusting for purchasing power. Under the GLOBE and GUARD pricing models, a randomly selected 25% of Medicare beneficiaries would be covered over a five-year period. Yet even with the 16-18% savings reduction through MFN, the cost gap in what the US pays versus other countries persists, the authors write. Confidential deals between manufacturers and Medicare also jeopardize savings, they write. These deals are excluded from MFN rules, meaning actual savings are likely lower–roughly 4-6% instead. The authors did acknowledge study limitations, including reliance on public databases, which may not reflect other countries’ confidential discounts. They also relied on historical data, which may not capture newly approved medicines–and could not predict how manufacturers or insurers will ultimately respond to the MFN rules. Image Credits: Unsplash, WHO, PBS News, KFF . Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
Controversy, Secrecy and Suffering after Year One of the America First Global Health Strategy 18/09/2026 Kerry Cullinan Kenya’s President William Ruto (left) applauds Kenyan Cabinet Secretary Musalia Mudavadi and US Secretary of State Marco Rubio after they signed the first MOU in terms of the American First Global Health Strategy. Country controversies, secret terms, opaque procurement, and massive unspent Congressional funds have characterised the first year of the America First Global Health Strategy.. “Services are weaker than they were a year ago, HIV testing is down, treatment of children living with HIV is down, and community-based prevention is gutted,” said Emily Bass, expert consultant for Physicians for Human Rights (PHR), about the change in US policy. Introducing the new strategy a year ago (18 September 2025), United States Secretary of State Marco Rubio pitched it as an antidote to “inefficient and wasteful” past global health programmes. Since then, 35 countries have signed bilateral memorandums of understanding (MOUs) with the US in terms of this strategy. Two of these, Kenya and the Democratic Republic of Congo (DRC), face legal challenges from civil society groups over the terms. Three – Ghana, Zimbabwe and Namibia – have refused the terms offered by the US, the main sticking point being US demands for sensitive health data. Zambia is struggling to find a way to secure US aid without having to sell the family silver. Several others, notably the DRC and Guinea, have signed agreements offering the US favourable terms to access their minerals, alongside the health agreements. The Trump administration has refused any further aid to South Africa, the country with the largest HIV population in the world, primarily over its measures to address apartheid-era racial injustice and its case against Israel at the International Court of Justice. ‘Safer, stronger, more prosperous’? Guinea signed a minerals MOU with the US before signing a deal to secure health aid. The stated aim of the MOUs, which replace US Agency for International Development (USAID) and President’s Emergency Plan for AIDS Relief (PEPFAR) grants, is to “make America safer, stronger, and more prosperous”. The five-year MOUs also aim to rapidly transfer responsibility for key health services to countries themselves, with domestic “co-financing” commitments progressively increasing every year. The MOUs also demand that countries invest heavily in disease surveillance networks in order to supply the US with pathogen information within a week of any outbreak. The aim is not only to “keep America safe” but to give US firms exclusive access to pathogen information to enable them to make vaccines, medicines and diagnostics to combat these. This is a direct challenge to the pathogen access and benefit-sharing (PABS) system currently being negotiated at the World Health Organization (WHO), of which the US is no longer a member. Onerous co-financing and sanctions Now that the MOUs are signed, countries are engaged in working out implementation but the process appears onerous and is running behind schedule, as documented by Bass in several Substack posts. In the meantime, essential programmes are unfunded, A recent analysis of 18 MOUs by Public Citizen and Partners In Health found US funding would be cut to the countries by over $2 billion by 2030, a 59% reduction in comparison to 2024 funding. The organisations had to resort to Freedom of Information Act (FOIA) requests and lawsuits against the Trump administration to extract some of the secretive MOUs. Countries facing the steepest cuts are Rwanda (97% reduction), Liberia (84%), Burundi (78%), Madagascar (77%), and Sierra Leone (71%). Five years will be insufficient for 11 of the 18 countries to raise domestic funds to cover the gap left by the cuts, yet the US forbids countries from including “funding from other donors or multilateral organisations” to bolster their commitments, according to the analysis. “Malawi would have to mobilise new funding equal to 56% of the country’s total health expenditure to meet its annualised co-financing commitment,” the analysis notes. By 2030, seven of the poorest African countries will have fewer health workers, thanks to reduced US and partner government investment. These are Burundi, Cameroon, Eswatini, Kenya, Lesotho, Madagascar and Malawi. Some of the 18 MOUs also stipulate financial punishment if countries fail to meet their co-financing commitments. Uganda and Côte d’Ivoire face a $2 reduction in US aid for every $1 they fail to pay. Ethiopia, Kenya, Mozambique, Cameroon, and Malawi will lose $1 for every $1 domestic shortfall. Money in the House DRC Health Minister Dr Roger Kamba, US Chargé d’Affaires Ian McCary, DRC Prime Minister Judith Tuluka Suminwa at the signing of the health MOU. The DRC also opened its minerals to the US before the health deal was struck. Perversely, as the Trump administration slashes health aid packages for some of the world’s poorest countries, over $3.6 billion in funds allocated for this very purpose by the US Congress have not been disbursed. “September 30 marks the expiration of $1.35 billion of appropriated funding for TB, malaria, HIV and maternal and child health. While this money has already been approved by Congress, it will not reach the patients it was meant for unless the State Department releases it in the next 12 days,” Sheila Davis, CEO of Partners in Health (PIH), told reporters on Thursday. Her colleague, Dr Vincent Lin, described the date, the end of the US fiscal year, as a ”funding cliff”, noting that over 100 PEPFAR programmes under the Centers for Disease Control and Prevention (CDC) covering the HIV treatment of eight million people are also set to expire. Meanwhile, PEPFAR is $2.3 billion underspent this year due to the US State Department delaying payments, jeopardising the HIV treatment of 20 million people. “The executive branch agencies, especially the Office of Management and Budget (OMB), USAID’s Legacy Unit, and the State Department, have been withholding and underspending global health funds at an unprecedented level,” said Lin. “If that money is continuously withheld, that would cause tens of thousands of preventable deaths from infectious diseases, including TB, malaria, and HIV, and among moms and babies from illness in childbirth and delivery, furthering this backsliding that we’ve already seen over the last two years,” he added. In late August, 170 Members of Congress wrote to Rubio and OMB head Russell Vought demanding that they release the over $3 billion in “unobligated” global health funding, warning that their refusal to spend the funds as directed by Congress “defy the law and threaten lives”. Vought has previously told US Congress that he intends to keep millions of previously appropriated funds to wind down USAID. Opaque procurement A year ago, Rubio described US foreign assistance programs as “deeply broken”, claiming that 60% of US health funding was “spent on technical assistance, program management, and other forms of overhead”. The Center for Global Development disputes this in a review of PEPFAR’s 2024 spending, finding that 63% of funds “directly enables lifesaving treatment programs”. And what the US State Department characterised as “low-priority site-level technical assistance” – only 18% of funding – covered “essential elements” including data tracking treatment adherence, health worker training, and community outreach. Meanwhile, procurement for the new MOUs is characterised by little transparency or official guidelines. PIH monitoring of how the 35 MOUs are being implemented has uncovered “potentially $3- $5 billion” going out to implementers this month by “sole source or non-competitive mechanisms”, said Lin. “We’re also tracing a new Innovation Fund for US companies that’s set to dole out $800 million this year to handpicked entities without a competitive process, and the [State Department’s] Annual Program Statement, a semi-competitive mechanism that will push out several billion dollars in funding without clear guidelines or alignment to federal procurement law,” he added. An extract from the US State Department’s Annual Progam Statement. “It is shocking, to say the least, that federal procurement is not being utilised for huge volumes of US dollars,” Lin noted. “We’ve heard through the grapevine a handful of junior staff are reviewing hundreds of submissions.” Awards via the Innovation Fund include $150 million to US company Zipline, and undisclosed amounts to Gilead for HIV drug lenacapavir and SC Johnson for a mosquito repellent. Congress has indicated that the Innovation Fund is set to scale up to $800 million at least “which is a huge portion of overall global health spending, but there’s minimal information at all about what’s happening”, said Lin. Silver lining? Twenty-five years ago, African leaders agreed to commit at least 15% of their domestic budgets to health – but only four of the continent’s 55 nations have come close. It is gratifying to imagine dictators like Paul Biya, the draconian 94-year-old president of Cameroon who has ruled his country for 44 years, being forced to divert some of the money he spends on frequent Swiss shopping trips to his citizens’ health. Under Cameroon’s MOU with the US, the Biya government has committed to increasing its health spending by $450 million over five years to unlock $400 million in US aid. Shortly after signing the MOU, Cameroon proposed a health budget of over $684 million for 2026, an increase of around 30% on the previous year. But by July, it had only released 19% of its immunisation budget. MP Essomba Bengono told local media outlet SBBC that about 430,000 Cameroonian children had not received their vaccines because the country has been unable to meet its financial commitments. The danger with the new bilaterals is that rulers like Biya may make promises to the US, then shift money around to meet these terms with scant regard for their countries’ health priorities. Even leaders with their citizens’ interests at heart may have to slant their budgets to suit US needs before their own. For example, meeting the US demand for pathogen information requires an army of data capturers that will likely shift money away from healthworker posts. Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 clients is in jeopardy. Before Trump, PEPFAR grants were allocated via country operational plans developed by governments in partnership with civil society organisations. Even in countries where civil society organisations have little room, such as Uganda and Burundi, governments were forced to include them. The current MOUs are purely government-to-government with no provision for civil society, and community-based services are all but abolished. This means that community health workers and peer educators, those who know best how to reach poor and at-risk populations, are no longer budgeted for. It also almost certainly means service delivery will be weaker – particularly for “key populations” most at risk of HIV, such as sex workers and men who have sex with men. Of course, the Trump aid shock provided the impetus for the “Accra Reset”, aimed at fostering African sovereignty and resilience. Achieving this is a long way off, but starting this journey is long overdue. Finally, as the Ebola outbreak has shown, bilateral agreements are no match for outbreaks, epidemics and pandemics. Imagine trying to coordinate 35+ disparate agreements in the face of a fast-spreading pathogen. Image Credits: UNAIDS. Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
Ebola Outbreak Shows Signs of Containment in Northeastern DRC – Still Expanding Elsewhere 16/09/2026 Elaine Ruth Fletcher While transmission eases in the original Ituri province hotspot, Ebola Bundibugyo virus continues to spread in many parts of the Democratic Republic of Congo. The Ebola Bundibugyo virus outbreak is showing early signs of containment in the Ituri province in the northeastern part of the Democratic Republic of Congo (DRC), where it first surfaced in April. But in North Kivu province, to the south, cases are still rising fast, with weekly cases nearly doubling over the past two weeks, from about 100 to 200. Elsewhere, there are mixed signals, which make it difficult to define a single trend, said WHO Director-General Dr Tedros Adhanom Ghebreyesus and other senior WHO staff at a Geneva press conference on Wednesday. To date, more than 7,200 cases have been reported, and over 3,500 deaths across seven DRC provinces. “Although there are signs of reduced transmission in Ituri … in the past week alone, around 300 new cases and 160 deaths were reported, accounting for nearly half the national total,” Tedros said. WHO declared the outbreak a Public Health Emergency of International Concern in May. With regard to trends elsewhere, “the area is so vast that it’s hard to speak of a single epidemic,” Tedros noted, referring to DRC’s span, a country the size of western Europe. “It’s many outbreaks in many places. We must get the response right in every one of them. “There are major cities such as Kisangani, home to 1.5 million people, and remote villages,” he continued. “There are conflict-affected areas, mining zones, and sparsely populated lands near the border with South Sudan in a region of very high population mobility. “In many areas, roads are barely passable and reaching people by small aircraft is often hard. And while most Congolese people support the response, a small minority have attacked aid workers and health facilities.” Urges approval of UN draft declaration on pandemics WHO Director General Dr Tedros Adhanom Ghebreyesus Tedros urged WHO and UN member states to approve a draft resolution on Pandemic Prevention, Preparedness and Response, due to be considered at a High-Level Meeting of the UN General Assembly on 25 September, saying that the declaration could help move the world from the kind of ‘ad hoc’ actions that have been a feature of the Ebola response to more coherent measures. “The world remains insufficiently prepared,” the WHO head declared. “In the draft declaration, countries are committing to expand research and geographically diversified production, so vaccines, diagnostics, and treatments can be available, affordable, and accessible within the first 100 days of a pandemic threat. “The draft declaration also calls for a one-health approach, inclusive community engagement, action against misinformation, stronger implementation of the [WHO] International Health Regulations,” Tedros added, referring to the rules that require countries to inform WHO promptly about any outbreak posing an epidemic risk, and coordinate its response.” And it calls for timely completion of the Pathogen Access and Benefit-sharing (PABS) annex to the WHO pandemic agreement, “which member states are negotiating here in Geneva as we speak,” he said. “It’s essential that countries finalize negotiations so the Pandemic Agreement can begin the ratification process and enter into force.” See related story here: ‘Critical’ to Complete Pandemic Agreement by UN Meeting in 2026 Humanitarian crisis shadows outbreak challenges Kigonzi camp for internally displaced persons in Bunia, DRC on 2 June, one of the original virus hotspots. The deep humanitarian crisis facing DRC continues to confound response to the Ebola outbreak in multiple dimensions, the WHO officials underlined. The crisis is the result of years of fighting between the powerful, Rwanda-backed M-23 militia and government forces, leading to mass displacement and loss of livelihoods. The conflict’s resurgence in late 2024 and January 2025 made things even worse. The M-23 forces took over large chunks of eastern Congo, including the regional capital of Goma, forcing a new wave of displacement from homes and farms. “Nearly a million people in Ituri alone are living in refugee camps, and then, together with that, there is hunger,” Tedros said. Amidst the rise in hunger and threats of insurgent forces, people are less likely to turn to health clinics, leading to more maternal and newborn deaths, as well as illness and death from other treatable conditions, like HIV, the WHO DG pointed out. The conflict has also led to simmering resentment in DRC, which has seen a massive response to the Ebola outbreak, while deeper, underlying problems are left to fester. Against that landscape, local communities have sometimes resented the visibly massive deployment of health workers, seeing it as a reflection of cynical self-interest by Western donors fearful of the virus’s international spread, rather than an effort to save local lives. Those attitudes are changing in light of the deadly toll the virus has taken, but ever so slowly. Tedros observed: “Ebola is seen as a more serious, but lesser evil still” in comparison to issues like the loss of livelihoods.” Humanitarian groups have asked donors for some $1.1 billion to address the deeper roots of the DRC’s crisis, noted Chikwe Ihekweazu, Executive Director of WHO Health Emergencies Programme. That is along with a request for some $1.3 billion from donors for the Ebola response. Ihekweazu declined to say how much of those funds had actually been raised. Vaccine and therapeutic trials DRC Minister of Health Dr Samuel-Roger Kamba, launches a vaccination campaign against Ebola virus disease in Kisangani, Tshopo Province. Along with improved case reporting and contact tracing, at least in Ituri province, the past several weeks has seen the initial rollout of the ERVEBO Ebola vaccine among health workers. The vaccine, approved for the Zaire Ebola virus strain, is being administered in the context of observational trials to see if it also offers protection against Bundibugyo, for which no vaccine yet exists, said WHO’s Meg Doherty, director of the Department of Science for Health, at the press briefing. “Already, in Kisangani more than 3,000 or so persons have been vaccinated,” Doherty said, adding that soon, Médecins Sans Frontières (MSF) is planning to launch a much larger study, involving some 20,000 frontline health workers. This study “will look at the vaccine’s impact on Bundibugyo disease, morbidity, mortality.” Kisangani is the capital of DRC’s Tshopo province, just to the west of the hotspots in Ituri province. In parallel, a laboratory study of blood samples drawn from people who received the ERVEBO vaccine should also get underway in the coming two or three weeks, she said, led by the University of Antwerp and the DRC’s Institut National de Recherche Biomédicale (INRB). The study will attempt to determine if the antibodies generated against the Zaire Ebola strain can also provide cross-protection against the Bundibugyo virus strain. “Then, after that, we will be bringing in sequentially other vaccines that are specific for Bundibugyo and those are the ChAdOx1 and the Moderna vaccines that you’ve heard much about,” Doherty said. The ChAdOx1 vaccine candidate is being developed by the Oxford Vaccine Group in partnership with the Serum Institute of India, and is in Phase 1 trials. It utilises the same adenovirus platform that underpinned the Oxford/AstraZeneca COVID-19 vaccine, adapted to target a Bundibugyo virus protein. Moderna’s mRNA-1469 vaccine candidate uses mRNA technology deployed in the COVID pandemic to teach host cells to identify and target a Bundibugyo surface glycoprotein. Phase 1 trials of that vaccine were initiated in August in Canada, supported by funding from the Coalition for Epidemic Preparedness Innovations (CEPI). In terms of deployment of the vaccine candidates in DRC field trials, Doherty did not provide a timeline. Image Credits: X/Tedros Adhanom Ghebreyesus, X/@DrTedros, DRC Health Ministry. EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts
EU Proposes ‘Kids Act’ Banning Social Media Under 13 Over Mental Health Risks 16/09/2026 Felix Sassmannshausen The proposed EU Kids Act aims to shield youth from algorithmic mental health risks by banning under-13 social media access. Social media will be banned for children under 13 across the European Union according to the newly proposed “EU Kids Act”, announced by European Commission President Ursula von der Leyen today (16 September) in Brussels. The sweeping digital health initiative mandates strict parental oversight for young teenagers aged 13 to under 15 across all 27 member states. “It is not about our minors accessing social media. It is about when and how we allow social media to access minors,” said von der Leyen during her State of the Union address in the European Parliament. A leaked Commission draft of the “EU Kids Act”, published online by the media group Euractiv, highlights how the proposed legislation would target escalating youth mental health crises linked to addictive platform architecture and excessive daily screen time. Recent Eurobarometer data indicates that European teenagers currently average 4.5 hours online on school days, triggering urgent public health concerns regarding sleep disruption, anxiety, and exposure to harmful algorithmic content. If successful, the initiative would set a precedent as the first binding supranational agreement establishing unified digital health and age-restriction standards for minors. Key measures in the EU Kids Act Ursula von der Leyen announces the “EU Kids Act”. The draft EU strategy specifically targets “Social Media+” platforms, video-sharing services, and conversational artificial intelligence companions that pose psychological risks to developing brains. Under the proposed framework, adolescents aged 13 to under 15 may only access guardian-supervised “mini-accounts” restricted to an explicit one-hour daily screen-time cap, default private settings, and limited contact lists. Platform operators will be legally required to enforce safety-by-design standards by default including: eliminating infinite scrolling, push-notification triggers, and engagement-driven reward loops that exploit adolescent dopamine systems. The legislation also requires technology companies to scientifically demonstrate that their services are safe before deploying them to young users. The European Commission proposal builds directly on recommendations from an EU expert panel, which urged Brussels to establish an EU-wide minimum digital age and shift the burden of proof onto technology companies. The proposal comes after a major legal setback in France, where the Constitutional Council struck down a national social media ban for under-15s over constitutional rights concerns. It also follows a historic multi-billion dollar settlement in the United States between Meta and state attorneys general over claims that its platform features deliberately harm minors, and lead to their addiction. Privacy safeguards and legal compromises To address privacy concerns, the draft requires platforms to use an open-source EU age verification tool built on zero-knowledge cryptographic proofs, allowing users to verify their age threshold without disclosing their identity or exact birthdate. However, legal experts like Christiane Wendehorst from the University of Vienna warn that critical circumvention loopholes remain, as teenagers could easily bypass one-off checks by registering under the credentials of older siblings or friends. While the EU Special Panel recommended a single access restriction below age 13 alongside more evolving autonomous use for older adolescents, the leaked Commission draft adopts a significantly stricter approach that extends mandatory parental oversight up to age 15. By opting for supervised “mini-accounts” rather than an outright ban, Brussels seeks to avoid the legal flaws of France’s national law, which was struck down for disproportionately restricting minors’ freedom of expression. Furthermore, the Commission draft formalises the EU expert panel’s recommendation to shift the burden of proof regarding compliance onto platform operators, via administrative mechanisms. Platforms classified as “Very Large Online Platforms” under EU law must submit plans for public authority approval 30 days before rolling out any new service or feature, funded by an EU-wide supervisory fee on the operators. Next steps in European lawmaking The European Parliament and the Council of the EU act as co-legislators, negotiating the EU Kids Act’s final binding rules. By pairing strict age-gated access with systemic design overhauls, European regulators also intend to set a standard for a binding international framework for child online health and safety, harmonizing rules across a now fragmented EU landscape. “Europe has the power to act; it is we who decide our rules, not Big Tech,” said EU Commission President von der Leyen. While the European Commission will formally table its proposal on Thursday, the ultimate fate of the “EU Kids Act” rests with the European Parliament and the EU Council, where parliamentarians and government ministers will have to negotiate over the final, binding rules. Within this legislative process, member states exercise decisive power through the Council, where qualified majority approval is required before any text can become binding law. See related story: Warning labels, Time restrictions? Experts Mull How to Curb Social Media Harms Image Credits: Ron Lach via Pexels, EU/HPW. Posts navigation Older posts