One in four adolescents worldwide get less than an hour of physical activity a week.

One in every four of all adolescents worldwide are getting less than an hour of moderate to vigorous physical activity a week, according to a new World Health Organization (WHO) study.

This translates to around 240 million young people between the ages of 11-17 who are not getting the critical exercise needed to develop into healthy adults, warned the report, released simultaneously today by WHO and in The Lancet Global Health.

The study, ‘A generation missing out’, is based on 389 population-based surveys of some 3.2 million adolescents across 140 countries and territories. The adolescents were asked what physical activities they had engaged in during the previous week, and for how long.  Only 14% of those responding reported being physically active for at least one hour on all seven days of the week, as per WHO recommendations.

On average, adolescents reported being physically active for at least one hour a day on only 2.7 days a week. Girls were less active than boys across all WHO regions, pointing to a major gender gap in the amount of physical activity adolescents experience.

On average, most adolescents were active for three or fewer days in a week.

The data and trends,  covering some 60% of adolescents globally, have remained approximately stayed the same since 2010, when adolescent physical activity was first measured, and then again in 2016, said WHO experts at an embargoed press briefing last week.

“For 15 years, the world has made almost no progress in getting young people moving, and girls are being left furthest behind,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The answer is not to tell adolescents to try harder. It is to build schools, streets and communities where moving, playing and being active is safe, easy and normal.”

Lack of physical activity a risk factor for illnesses

Physical activity is important for mental health and allows adolescents to make social connections.

Physical inactivity is a major risk factor for heart disease, type-2 diabetes, and some cancers.

“Physical activity is one of the most effective ways of preventing stroke, cardiovascular disease, or other NCDs [non-communicable diseases], but it also contributes to better mental health and well-being, supports healthy growth and development, and helps young people to learn, connect, and thrive,” said Dr Etienne Krug, Director at WHO’s Department of Health Determinants, Promotion and Prevention.

When adolescents are not physically active, they also miss out on crucial mental health benefits as well as the social benefits that come with sports.

Adolescence is a particularly crucial period as it also sets up the habits that could last a lifetime.

Stark gender gap

On average, adolescent girls get less physical activity every week than boys across all regions of the world.

Girls were found to be less physically active than boys in almost every country and every WHO region – reflecting a stark gender gap.

Worldwide, nearly 28% of girls reported no active days, compared with 22% of boys.

And only 11% of girls reported being active every day, compared with 17% of boys. WHO recommends at least 60 minutes of physical activity every day, which can be anything that increases the heart rate and breathing, like a brisk walk or cycling.

Adolescents are getting very little physical activity on a regular basis, according to the latest World Health Organization (WHO) estimates.

There’s a basket of reasons why there is a gender gap, said Dr Fiona Bull, WHO’s head of Physical Activity Promotion, at the press briefing.

“Some of the reasons are the lack of visibility of role models, the lack of female coaches when we’re talking about more formal sports. But actually, at the community level, it can get down to simply it being not expected, even culturally inappropriate,” she said.

Girls did appear to prefer dance more, and experts said offering more access to options like dance is an opportunity for policymakers.

“Religious and cultural norms, family dynamics, or preferences may determine whether girls are introduced to activities or supported to sustain them through the adolescent period. Safety is another concern,” Bull added.

Stark regional differences 

In Middle East, South Asian and Sub-Saharan African countries, upwards of 40% of adolescents reported few or no active days in their week, while less than 10% of adolescents in most of Europe, western Asia and parts of the Americas reported no active days.

In most of Europe, Asia and parts of the Americas, 90% or more of adolescents reported an hour of physical activity every day. In others, mainly Africa, the Middle East and parts of South Asia, more than 40% of respondents reported no active days.

“Our data has revealed that there are two quite distinct patterns of active days that are broadly aligned with regions. We see that in many of the low-and middle-income country settings, the pattern is characterized by high prevalence of zero active days,” said Dr Leanne Riley, unit head of surveillance, monitoring and reporting at WHO’s NCD division.

“Whereas in contrast, in the high-income countries and high-income Western nations, in particular, Central and Eastern Europe, Central Asia, East Asia, and the Pacific, they show a more favourable pattern,” she added.

There is no single explanation for the lack of global progress. Physical activity is shaped by where adolescents live, learn, travel and spend their free time. Transport patterns, access to safe public spaces, opportunities for safe walking and cycling, school environments, affordability, social norms and increasingly screen-based lifestyles can all influence adolescents’ opportunities to be active.

Active transport environments need to be part of the solution

Streets in many cities are not safe for walking and cycling to school so improving transport and urban planning is critical to enable adolescents to move more.

The WHO report also calls for more action across education, transport, and urban planning to make environments more conducive for routine physical activity.

The challenge is not simply to persuade adolescents to move more. It is to create environments that make being active a normal and easy part of growing up, WHO’s Riley also said at the press briefing.

“It will look like more communities with safe walking and cycling networks, connected networks, taking us to the places we go to daily, from home to school to community to friends to shops,” she said.

“It will require the public transport systems to enable more walking and cycling,” she added.

That includes investments in safe walking and cycling routes to school, as well as parks and recreational facilities in communities as well as in schools that give young people more opportunities to move, play and be active in their everyday lives.

Sports brands also call to support movement 

Sports companies have pledged to help improve activity among adolescents.

Sports brands also have stepped up to the bat, saying they can play a major role in promoting more healthy physical activity. In response to the WHO report, around 83 sporting goods companies and federations signed an open letter coordinated by the World Federation of the Sporting Goods Industry (WFSGI), pledging to strengthen efforts to help more young people move.

Major brands like Adidas, ASICS, Bauer, Decathlon, New Balance and Nike were among those that signed onto the call to increase movement among adolescents.

“The response will be different for every company. It may mean making products more accessible, investing in participation programmes, supporting schools and communities, rethinking how we engage with young people, or using innovation to remove barriers to activity,” the companies said in the joint letter.

Image Credits: Unsplash/Mi Pham, ‘A generation missing out’ report/WHO, Unsplash/Vitaly Gariev, Unsplash/Vince Fleming, Unsplash/Tahamie Farooqui, Unsplash/Jannes Glas.

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

Hanan Balkhy, Saudi Arabia’s candidate for WHO Director General, is especially concerned about antibiotic resistance, the effects of climate change on health, and healthcare in conflict zones. She also warns about a “normalisation” of attacks on hospitals and healthcare workers in conflict regions.

As a longtime WHO insider, she is also well aware that the WHO needs to reform and do more with less money.

“The bottom line is that the funding is slimmer.” says Balkhy, currently regional director of WHO’s Eastern Mediterranean Regional Office, in an interview with Inside Geneva‘s Imogen Foulkes around her candidacy. A citizen of Saudi Arabia, Balkhy also trained as a medical doctor in the United States, where she also dual citizenship.

Doing the WHO’s top job, she says, is an extension of her lifelong ambition to work in the medical field and “serve the broader humanity.”

Listen to the full podcast:

The interview series with WHO DG candidates is being co-produced by the SwissInfo media platform with the Geneva Graduate Institute’s Global Health Centre, as part of a media collaboration on the upcoming WHO election  also supported by Health Policy Watch.

See more about the candidates on Health Policy Watch’s special WHO election website.

WHO DG Elections 2027

Preventative treatments for schistosomiasis and soil-transmitted helminths, two major NTDs, are distributed to children in Tanzania.

While substantial progress has been made in driving down the global burden of neglected tropical diseases (NTDs), trends are  “uneven and fragile”, and several diseases are off course to meet 2030 targets.

This is according to the World Health Organization (WHO)’s Global Report on Neglected Tropical Diseases 2026, a mid-term evaluation of the 2021-2030 road map published today.

NTDs predominantly affect those living in poverty or remote or fragile settings, and are often referred to as diseases of poverty. WHO refers to some 21 NTDs.  These range from mosquito-borne parasitic diseases such as dengue and chikungunya, whose transmission has soared due to urbananisation and climate change, as well as onchocerciasis (river blindness),  leprosy and trypanosomiasis (sleeping sickness), where big inroads towards elimination have been made. Schistosomiasis, transmitted by water borne-parasite, as well as soil-transmitted helminths also impose a heavy burden of illness and disability. Snakebite evenoming and rabies are also considered NTDs, with extremely high mortality rates. 

In 2024, NTDs affected around 1.41 billion people – a 19% reduction since 2020. By June 2026, 63 countries had eliminated at least one NTD, and Togo became the first country to eliminate four diseases.

Cases of sleeping sickness have dropped by 98% since 1999, while Guinea worm disease fell to a record low of just 10 human cases in 2025.

2025 milestones achieved for three diseases – but lack of finance impedes progress on others

Three disease-specific indicators achieved their 2025 milestones: chikungunya vaccine development, reduced dengue case fatality rates and the availability of WHO-recommended polyspecific antivenoms for snakebites.

However, the pace of progress is “insufficient to achieve most 2030 targets, particularly in relation to financing, mainstreaming into health systems, surveillance and extending interventions to populations in fragile and hard-to-reach settings”, according to the report.

Lack of finance is the biggest barrier to progress. Conflict and displacement are also significant constraints. Meanwhile, climate change is expanding the geographical spread of vector-borne diseases, while extreme weather events can disrupt service delivery. 

Other barriers include that many NTD interventions are not part of national health systems or included in universal health coverage packages in most endemic countries.

Weak surveillance, persistent supply chain constraints and the loss of specialist expertise also weaken the response. 

“Sustainability has emerged as the defining constraint of our time, one that could delay the achievement of the 2030 targets,” said Dr Daniel Ngamije Madandi, WHO director of Malaria and NTDs.

“New barriers demand innovative solutions, yet I am confident that  the momentum generated by the road map endorsed  by the World Health Assembly in 2020, together with 

its inherent flexibility, is strong enough to continue  guiding the global response to the public health  challenges posed by this diverse group of diseases and  conditions throughout the remainder of the decade.”

Image Credits: RTI Fights NTDs.

At the World Health Summit in Berlin, the non-profits behind dozens of medicines for malaria, tuberculosis and neglected tropical diseases were warned that funding for their work is no longer guaranteed as donors cut back their investments in global health.

In the late 1990s, doctors treating sleeping sickness, a parasitic disease spread by tsetse flies that is almost always fatal without treatment, still relied on melarsoprol, an arsenic-based drug that killed roughly one patient in 20.

One patient given melarsoprol in 2003 later recalled the injection “felt like fire” being injected into his veins, turning them black. A safer drug existed, but its manufacturer had stopped making it in 1995 because it turned no profit.

Today a single dose of tablets cures the disease. Acoziborole, registered in the Democratic Republic of the Congo in June, was developed by Sanofi and the Drugs for Neglected Diseases initiative (DNDi), one of around a dozen product development partnerships (PDPs) set up around the turn of the century to make medicines that drugmakers had no commercial reason to invest in bringing to market.

At the World Health Summit in Berlin last month, a senior German research ministry official called the partnerships “an amazingly good deal” – then warned them that funders could no longer guarantee their survival.

“There’s an underlying promise … that I don’t think we can keep,” said Veronika von Messling, director-general for health and life sciences at Germany’s Federal Ministry of Research, Technology and Space (BMFTR), at a session on the future of the partnerships’ model.

“That promise would be that as long as you are a good PDP and stay in this box, somehow financing will be ensured.”

‘Natural selection’

Veronika von Messling, director-general for health and life sciences at Germany’s Federal Ministry of Research, Technology and Space (BMFTR), speaks at the World Health Summit in Berlin.

Global health funding as a whole fell 12% in 2025 to its lowest level since 2012, according to preliminary estimates from the Institute for Health Metrics and Evaluation (IHME), as donor governments moved money toward defence amid rising global tensions and prepare perhaps, as the Financial Times warned last week, for the untimely arrival of World War III.

And even before that crisis, funding received by PDPs for developing drugs critical to fighting NTDs fell for five straight years to a record low in 2023, according to Impact Global Health’s G-FINDER survey.

The Gates Foundation, by far the largest backer, cut its PDP grants by nearly a quarter in 2024, and DNDi cut its research spending by 23% in 2025, its audited accounts show.

The UK, the partnerships’ largest government funder, is cutting aid to 0.3% of gross national income by 2027, and Germany is planning further cuts to global health in its 2027 budget.

The UK gave PDPs $40 million for neglected-disease research in 2023, more than any other government, and raised that by 55% in 2024, G-FINDER data show. Germany’s research ministry gave $4 million and is now splitting €50 million among five PDPs over six years. The Netherlands, Australia, Switzerland, Japan and the European Union also contribute.

As global health investment shrinks across the developed world, von Messling suggested funders could let the partnerships compete for what money remains.

"Just to be provocative here, there is maybe some charm in actually tolerating the tension that comes from a natural selection process or natural evolution," she said. "Some PDPs might actually succeed and others might be less successful."

Dirk Mueller, senior health adviser at the UK's Foreign, Commonwealth and Development Office (FCDO), agreed, saying:  ""If there is no more funding, then there will be more natural selection."

Threats to the pipeline

MMV CEO Martin Fitchet speaks at the World Health Summit in Berlin.

The cuts arrive as the partnerships' costliest work lies ahead, with a coalition of 12 leading PDPs reporting nearly 300 products in development in 2023, more than 100 of them in Phase 2 trials or later.

"There are a lot more needs and a lot more products in the pipeline, and market failures have not yet gone away," said Mueller, who chairs the PDP Funders Group, an informal network of the partnerships' donors.

Of the 1,393 new medicines marketed between 1975 and 1999, just 16 were for tropical diseases and tuberculosis, researchers working with Médecins Sans Frontières (MSF) found in 2002.


Despite the arrival of PDPs at the turn of the last century, the attention paid to neglected tropical diseases – which left 1.6 billion people in need of treatment or prevention in 2022, according to WHO – by the wider pharmaceutical industry remains minimal. They receive 0.2% of private-sector health R&D spending, according to figures cited in a joint paper by four PDPs published for the Berlin summit, while malaria, tuberculosis, HIV and diarrhoeal diseases together receive just under 2%.

"Of 763 medicines approved between 2005 and 2024, only 15 were for neglected diseases," said Martin Fitchet, chief executive of the Medicines for Malaria Venture (MMV), referring to US Food and Drug Administration approvals tallied in a 2025 analysis. "That is the gap PDPs were created to address."

Malaria R&D pipeline at critical crossroads

The event organised by MMV, DNDi and partners titled "Shaping the global health architecture and ending diseases of poverty: the product development partnerships model", underway in Berlin.

Drugmakers finance research against the sales a product is expected to bring in, and for many neglected diseases there is little profit to justify the investment.

“It’s very, very hard to borrow off the future commercial potential for a disease where you are paying no more than 50 to 70 cents for a treatment course,” Fitchet said. “R&D is expensive: $150 to $200 million in direct costs for an anti-infective like malaria, perhaps more. I’m not counting in the failures there.”

The malaria research pipeline is at a critical crossroads, and sustaining investment may determine the future of millions of patients. Malaria parasites are fast developing partial resistance to artemisinin, the backbone of current treatment, pitting the 282 million people who caught malaria in 2024, by WHO’s estimate, against the parasite in a medical arms race. Even with new medicines and the first malaria vaccines reaching African children, cases have risen 23% since 2015 and deaths 6%, WHO estimates show.

Parasite resistance doesn't pay heed to funding declines

The last time the parasite outran a frontline drug, chloroquine in the 1990s, malaria deaths more than doubled to over a million a year before a new class of medicines arrived - artemisinin combination therapies (ACTs). Now, in Rwanda, 40 to 50% of parasites already carry the artemisinin resistance mutation. Should resistance further overcome ACTs and other drugs in use across the continent, which carries 94% of the global malaria mortality burden, the consequences “could be catastrophic,” scientists at the Wellcome Sanger Institute warned.

The most advanced replacement is GanLum, a Novartis drug developed with MMV, which cured 97.4% of patients in a Phase 3 trial across 12 African countries and is awaiting approval. It would be the first malaria treatment in more than 25 years not built on artemisinin, and the drugs that follow it will need money that is now harder to find.

Coartem® Baby, developed by Novartis with MMV, became the first malaria treatment for newborns and young infants when Swiss regulators approved it in July 2025, and WHO prequalified it in April.

“We bring together the best of industry, science and the public sector to develop and deliver medicines that are designed for the people who need them,” Fitchet said in written answers to Health Policy Watch.

Mosquitoes are also resisting the insecticides used on bednets to prevent bites. Insecticide-treated nets accounted for 68% of the 663 million malaria cases averted in Africa between 2000 and 2015, more than any other intervention, a recent study in Nature found.

“The change in the global health architecture might be one thing,” said Justin McBeath, chief executive of the Innovative Vector Control Consortium (IVCC), a PDP that develops insecticides. “But that doesn’t change anything in terms of the evolution of resistance in mosquitoes.”

If not the PDPs, then what?

Mueller also said no one had offered an alternative to the partnerships' model. "I haven't actually heard who will do product discovery and development if not the PDPs," he said.

The last generation of partnership drugs shows what a stalled pipeline would cost. MMV-backed antimalarials averted an estimated 1.6 million deaths between 2000 and 2023, returning about $13 in health benefits for every dollar invested, a study in The Lancet Global Health found in February.

MMV received $2.3 billion over that period, roughly $1,450 for each death averted, by Health Policy Watch's calculation.

"We've been around for 27 years, and we've done absolutely nothing on our own," Fitchet said. "We've been involved in the approval of 19 medicines, and we're 100 people.

"I did not want to give the impression that everything we do is great and the funding should be coming, because we know it's not going to happen," Fitchet added.

But in further written remarks to Health Policy Watch, he urged funders not to abandon the model: "PDPs already compete for funding and rightly must continually show their impact, efficiency and value. Rather than framing the issue as 'natural selection', it is important to consider the broader public health imperative."

"Let's get hung up on the job that needs to be done. Build on and improve the model we have now, not dismantle it and throw it away and try something else, because this works."

A handful of meaningful funders

Unlike the Global Fund or Gavi, the partnerships have no pledging conferences to refill their accounts. Their money comes through competitive grants from governments and philanthropies, which means PDPs "must continually demonstrate value and impact," DNDi, MMV, the TB Alliance and Medicines Development for Global Health wrote in their joint paper.

The Gates Foundation has supplied close to half of all PDP funding for neglected diseases for most of the past two decades; G-FINDER describes its recent cuts as part of a long-term move away from the partnerships.

Gates provided almost 60% of MMV's funding as of 2021, according to a Swiss government case study, and committed a further $180 million over five years in late 2024.

"Realistically, there are just a handful of meaningful funders," said Melvin Spigelman, president and CEO of the TB Alliance. "That's crazy."

DNDi's 2025 financial report lists donor exit first among its risks, warning that donors are shifting toward health security, technology and scalability "with reduced emphasis on PDP models and neglected diseases."

"The runway is very short these days," said Bríd Devlin, executive director of the Population Council's Center for Biomedical Research, adding that grants now average two to three years, which makes it hard to commit to clinical trials.

Spigelman said the first answer to the funding squeeze is to "dramatically expand the base of the funding community," bringing in middle-income countries such as Indonesia and the BRICS members.

Fitchet, however, told Health Policy Watch that diversification "should not simply mean transferring responsibility for financing global health R&D to countries already facing significant health and fiscal pressures."

'Some sort of magic number'

Dr Melvin Spigelman, President and CEO of the Global Alliance for TB Drug Development, speaks in Berlin.

At face value, the idea that PDP mergers could save money - particularly in terms of administration costs - is an attractive prospect.

"That's 18 CEOs, 18 CFOs," one audience member said of the number of PDPs cited in the session. "How do we defend 18 PDPs in the current global architecture environment?"

But PDP leaders like Spigelman are pushing back.

"I would really object to saying, 'Oh, there's some sort of magic number that's too many,' " Spigelman said. "That, to me, makes absolutely no sense given the magnitude of the problems and number of diseases."

In 2022, with the future of its vaginal ring for HIV prevention in doubt, the International Partnership for Microbicides (IPM) sold its products and pipeline to the Population Council, a New York-based non-profit research organisation, and then IPM closed its own doors "In our case, the consolidation of PDPs worked out," said Devlin, who spent more than a decade with the organization.

But Devlin also advised caution: "I'm not sure that this would work for all PDPs to consolidate, given the differences in their diagnostics, services, products."

"Funding is going down, but does that mean that we need to consolidate the PDPs?" Mueller asked. "I'm not so sure about that, because one mega PDP could actually be more costly."

"Whether it is merging or prioritisation," said Elizabeth Juma, who leads WHO Africa's Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), "let's not forget the diseases for which there will never be any economic value."

France’s Global Health Ambassador, Anne Claire Amprou.

France’s Ambassador for Global Health, Dr Anne-Claire Amprou, is joining the leadership of the World Health Organization (WHO) body negotiating the missing piece of the Pandemic Agreement at a crucial moment.

Amprou co-chaired the last stage of Pandemic Agreement talks, which eventually found consensus. However, consensus has eluded WHO member states on the pathogen access and benefit-sharing (PABS) annex, which prevents the agreement’s implementation.

Since July 2025, IGWG members have been unable to agree on how to share information on dangerous pathogens, and any medical products developed from that knowledge.

Brazil’s Ambassador Tovar Da Silva Nunes, co-chair of the Intergovernmental Working Group (IGWG) negotiating PABS, told the opening of its ninth formal meeting on Monday that Amprou would be formally presented for consideration as his co-chair on Tuesday.

Amprou represents France at the Pandemic Fund and Global Fund, and chairs the Unitaid board. She coordinated the French response to COVID-19 in 2021 and is a former French Deputy Director General for Health.

Welcoming Amprou to IGWG, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the IGWG opening that there is “strong political support” for the annex to be completed

Dr Tedros addresses the opening of IGWG 9.

“Just a few weeks ago, the United Nations General Assembly adopted its Political Declaration on pandemic prevention, preparedness and response. Heads of state and government welcomed the Pandemic Agreement and called for the PABS negotiations to be concluded,” said Tedros.

“But ultimately, the reason for finishing this work is not legal or procedural. It is about protecting people. Because a pathogen threat anywhere can become a threat everywhere – to the people of every country.

He added: “You do not need to design a perfect system for all time. You need to agree on a system that works, that delivers equity, and that can be strengthened as we learn from experience,” said Tedros.

He also urged negotiators to negotiate “with the intention and expectation of concluding”, distinguish between “what is essential and what is desirable”, and “keep public health as your North Star”.

“The test of this Annex is whether it will help the world respond faster and more equitably when the next pandemic threat emerges,” said Tedros.

Algeria, representing the Africa Group, at IGWG 9

Algeria, representing the Africa Group, and Egypt, Somalia and Sudan – part of the East Mediterranean Group – reasserted its core position: “Access and benefit sharing are two inseparable pillars on an equal footing. Neither can be implemented at the expense of the other.”

Algeria also called for the Africa Group’s “federated model”, proposed two IGWG sessions ago, to be discussed at this session. 

According to this model, pathogen materials and data always stay in the hands of countries or regions, and manufacturers have to accept a data access agreement (DAA) with the country or regional node and sign a benefit-sharing contract with the WHO to gain access to this information.

“We firmly believe that a system of access by design and benefit by convenience will not earn the trust of those who provide the materials,” Algeria concluded.

Pakistan, for EMRO, and India, for Southeast Asia, also asserted that access and benefit sharing need to be on an equal footing.

“We understand that there is a viewpoint that manufacturers may, in any event, obtain pathogens as sequence information. Our region sees this differently,” said Pakistan.

“Availability somewhere is not the same as timely, lawful, transparent, and traceable access under an agreed international framework. And confidence in the system depends on that traceability. Countries will share rapidly and confidently when they can see what comes back.”

‘No charity’

Indonesia, speaking for the cross-regional Group for Equity, said that “no country wants its response to the next pandemics to depend on charity”. “Multilateralism earns its keep when its outcome changes things substantially, and ensures that no one is left behind. That is the standard by which the PAPS annex will be judged,” said Indonesia. 

“There is no perfect model, but we are not waiting for one. There are choices on the table that clearly bring us closer to equity, greater self-reliance, and health systems that can better withstand future pandemics.”

Noting that “a number of issues still require significant further discussions”, the European Union proposed a variety of formats: formal discussions, informal discussions led by co-facilitators, and “opportunities for delegations to meet in smaller groups and for different groups of delegations to meet bilaterally”. 

Several non-state actors also addressed the meeting, including the International Federat Pharmaceutical Manufacturers & Associations (IFPMA), which urged member states to “enable companies to access the pathogen materials and information needed to begin R&D quickly, with clear, workable, and predictable conditions for participation”.

“As discussions advance across these interconnected elements, we encourage member states to assess them against a simple test: will these arrangements encourage the broad participation needed for PABS to work effectively and rapidly when the next pandemic threat emerges?”

The new generic version of lenacapavir is expected to cost $40 for the two annual injections.a

The US Food and Drug Administration (FDA) has approved the first generic version of lenacapavir, the highly effective twice-yearly injection to prevent HIV, developed by Dr Reddy’s Laboratories based in India.

Dr Reddy’s was one of six pharmaceutical manufacturers that was granted a non-exclusive, royalty-free voluntary licensing agreement from Gilead, which developed lenacapavir.

The agreement, signed in October 2024, limits the sale of the generics to 120 high-incidence, resource-limited countries.

The generics – projected to cost $40 a year for the two injections – are expected to reach countries by the end of this year. Zambia is likely to be one of the first to get supplies. 

Dr Reddy’s Deepak Sapra described the approval as “a moment of immense pride” for the company.

“Developing and manufacturing a complex long-acting injectable like lenacapavir at an affordable price required strong scientific capabilities, manufacturing expertise and the ability to produce at scale,” added Sapra. 

Dr Reddy received “financial, technical, and regulatory support” from Unitaid, Wits RHI, and the Clinton Health Access Initiative (CHAI) to accelerate the development of the generic. The FDA approval comes only 16 months after Gilead’s product was approved. 

“Unitaid’s early risk-taking is helping shorten the time between a scientific breakthrough and real access in countries,” said Dr. Philippe Duneton, Unitaid executive director. 

“Getting a generic approved just 16 months after the originator approval for prevention, rather than a decade later, shows what’s possible when we prioritize access from the start. This should be the new standard for global health,” said CHAI CEO Dr Neil Buddy Shah.

“For someone at risk of HIV, taking a pill every day to prevent a disease they don’t have is a hard thing to ask. Two injections a year, of a product that is almost 100% effective at preventing HIV, changes that entirely,” added Shah. 

“More than 125,000 people in Africa have already started on lenacapavir, and today’s approval brings us closer to making it available to millions more for just $40 a year.”

However, Wits RHI’s Professor Saiqa Mullick warned that an affordable generic is not enough: “Countries need health systems that are ready to deliver new prevention options, providers who are confident in offering them, and communities that are engaged as partners in their introduction and scale-up. Bringing these elements together will be critical to ensuring equitable access and impact.”

“Unitaid, Wits RHI, and CHAI are working with governments, communities, the Global Fund, the US Bureau of Global Health Security and Diplomacy (GHSD), the Gates Foundation, and other partners to turn approval into access on the ground, from supporting country introduction and community engagement to generating real-world evidence to inform how lenacapavir can best reach diverse and underserved populations,” the three groups noted in a media release on Monday.

Image Credits: @Unitaid.

‘MAHA Mom’ Jayme Franklin (left) witnesses US President Donald Trump change childhood vaccines via an executive order in August, with the enthusiastic backing of US Health Secretary Robert F Kennedy Jr (right).

Cuts to Medicaid, the health services for low-income Americans, and fewer childhood immunisations – alongside persistent insinuations that vaccines are unsafe – are the most significant health policy changes made by the Trump administration since January 2025.

They have been accompanied by reduced food support for low-income families, purges of scientists, and slashed research budgets. 

The cumulative impact of these policies will take decades to measure, but the early damage can already be measured in rising infectious diseases and worsening maternal health.

The Trump administration projects it will spend $900 billion less on Medicaid between 2025 and 2034 – largely by making it harder for people to qualify. By its own accounting, 10.5 million people will lose or face reduced health benefits, largely to offset Trump tax cuts that benefit wealthier Americans most. 

Maternal care, rural health care and healthcare for Black and Hispanic communities are expected to be worst affected.

The Health and Human Services (HHS) budget has been cut by 12.5% this financial year (which started on 1 October), with more cuts for research grants and health services expected.

Undermining vaccines

HHS Secretary Robert F Kennedy Jr has been laser-focused on reshaping federal vaccine policy since assuming office in late February 2025. The nation’s most senior health official has led a decades-long crusade against vaccinations – the single health intervention that has saved by far the most lives in the history of humankind.

Twenty-six years ago, the United States had eliminated measles. Today, it faces its biggest outbreak in decades, with over 4,800 cases this year alone. Whooping cough cases have also surged in the past two years. 

Vaccines exist for both, and experts say waning levels of immunisation have driven the outbreaks – with 96% of measles cases in those who are unvaccinated.

Instead of urging immunisation in the face of rising vaccine-preventable diseases, Kennedy has doubled down on his anti-vaccine stance. 

His most recent move was to open a new vaccine injury research center at the US National Institutes of Health (NIH) despite the country already having a sophisticated vaccine surveillance system. HHS also plans to provide financial incentives to doctors for reporting vaccine injuries.

In a September address to Children’s Health Defense (CHD), the anti-vaccine non-profit he founded, Kennedy focused on the harms of vaccines and repeated the disproven theory that they are linked to autism.

COVID-19 vaccines were Kennedy’s priority upon assuming office. Opposition to these vaccines was what cemented a bond between the Kennedy anti-vaxxers, who believed mRNA vaccines were harmful, and the Trump libertarians who did not want to be forced to be vaccinated or masked during the pandemic.

By May 2025, the Food and Drug Administration (FDA) had limited COVID-19 vaccine recommendations to people over 65 and those aged 12 and over with underlying conditions. 

Firing vaccine experts

The following month, Kennedy axed all the country’s vaccine advisers, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). 

After stacking ACIP with vaccine-sceptics, he let them lose on the childhood vaccination schedule. They declared vaccines for hepatitis A, hepatitis B, meningitis, rotavirus, influenza, and COVID-19 are no longer “routine”. Patients and their doctors should have “shared clinical decision-making” about whether to have them.

Professional health groups and 14 states have challenged both the dismissal of ACIP and the changes to the childhood immunisation schedule in separate court challenges. 

After a judge ruled HHS overreach on the ACIP firings (the state is appealing), Kennedy enlisted Trump’s help. 

In August this year, the US president issued an executive order on vaccines that reduced childhood vaccines from 18 to 11, and divided the three-in-one measles, mumps, rubella (MMR) vaccine into separate shots. It is extraordinary for a US president to issue a decree on immunisation outside of a pandemic.

Kennedy also cancelled $500 million in research funding into mRNA vaccines by the US Biomedical Advanced Research and Development Authority (BARDA) – claiming “mRNA technology poses more risks than benefits for these respiratory viruses”.

“Eugenics is not a word I use lightly. Yet elements of that thinking are echoed in policies that promote natural infection over prevention provided by vaccines; confound health equity with diversity-focused hiring practices, and pit personal choice against community,” wrote Dr Demetre Daskalakis, former director of the US CDC’s National Center for Immunizations and Respiratory Diseases.

Purging scientists

Dr Susan Monarez, former CDC director

Daskalakis is one of at least 25 senior health leaders who have been fired, resigned or reassigned across the country’s health and scientific bodies under this Trump administration. Around 10,000 HHS staff have also lost their jobs in “cost-cutting”.

The CDC, charged with preventing and controlling disease, injury, and disability, has been worst affected. The Senate-confirmed CDC director, Dr Susan Monarez,, was fired in August 2025 for refusing to rubber-stamp decisions taken by Kennedy’s political appointees.

After being fired, Monarez told the Senate that Kennedy had directed her to “commit in advance to approving every ACIP recommendation regardless of the scientific evidence” and to “dismiss career officials responsible for vaccine policy, without cause”.

Daskalakis and three other top CDC officials resigned in protest after Monarez was fired. Five other CDC directors were reassigned last year, and earlier this year, the CDC’s acting director and deputy director left the agency.

Nine top NIH officials have also been forced out, including the directors of five NIH institutes.

In May, FDA Commissioner Marty Makary was fired, and Tracy Beth Høeg, who took over as acting head, was removed within weeks.

In April, the White House also fired all 24 members of the National Science Board (NSB), the group that advises the National Science Foundation (NSF), without explanation.

“This is the latest stupid move made by a president who continues to harm science and American innovation,” said Representative Zoe Lofgren, the Democratic ranking member of the House Science, Space, and Technology committee. “Will the president fill the NSB with MAGA loyalists who won’t stand up to him as he hands over our leadership in science to our adversaries?”

Worsening maternal health 

The drop in OB-GYNs in Idaho (JAMA).

The US has the highest maternal mortality rate among high-income countries. Since the federal law allowing access to abortion, Roe v Wade, was overturned, Trump loyalists have tightened abortion access in several states to such an extent that it is hard for doctors to intervene when women are miscarrying.

This has had a chilling effect on maternal health. While 12 of the most restrictive states have seen a small drop in their  number of obstetrician-gynaecologists, some state effects have been severe.

In Idaho, for example, 35% of ob-gyns have left or stopped practising since that state banned abortion. Half of Idaho’s counties no longer have an obstetrician, and in the southeastern corner of the state, there is one obstetrician for 120,000 people, according to a New York Times report.

Infant mortality is generally higher in states with restrictive access to abortion, with Alabama and Mississippi recording the highest deaths and California the lowest, according to a study published in JAMA. 

The 2025 report of March of Dimes, a US non-profit advocating for mothers and newborns, describes the country’s maternal and infant health system as “dangerously stalled”.

The report notes an increase in preterm births among Black mothers and a decline in pregnant women seeking care in their first trimester.

Measles rise as vaccinations fall

A doctor examines a child with measles

There have been 43 new measles outbreaks in 2026, with 4,852 recorded cases by 30 October, according to the US CDC. This is more than double the 2025 caseload.

This is “by far the highest total in 35 years”, according to the Center for Infectious Disease Research and Policy (CIDRAP) based at the University of Minnesota.

“The new data mark the 12th straight week of triple-digit increases nationwide,” CIDRAP noted. “The United States will very likely lose its measles elimination status – which it gained in 2000 – in the coming months.”

The outbreaks are being driven by a drop in vaccinations to below the 95% needed to maintain community immunity.

Johns Hopkins reports declining vaccination rates in kindergarten children. During the 2024-25 school year, coverage for measles, mumps, and rubella (MMR) was just 92.5%.

The diphtheria, tetanus, and pertussis (DTaP) vaccination rate also decreased from 92.3% in 2023-24 to 92.1% in 2024-25. Even polio vaccination coverage dropped from 92.7% to 92.5%

Declining rates of DTaP and MMR vaccination rates in kindergarten children (Johns Hopkins).

Worsening health in the US

Life expectancy in the US is already considerably lower than in most high-income countries, and its “avoidable deaths” are increasing, according to a 2025 report in The Lancet.

Reduced access to Medicaid and the elimination of certain childhood vaccinations, along with vaccine misinformation, are slow-burn activities likely to worsen the health of US citizens. 

Their full impact will only become evident years down the line, as well as the axing of thousands of health professionals and the elevation of political appointees over career scientists.

The US is an outlier in the developed world as it does not offer universal health coverage. Over two-thirds of US citizens rely on private health insurance and around 10% have no health coverage. 

The popularity of Kennedy’s “Make America Healthy Again” movement indicates that millions of Americans are concerned about worsening health. 

But Kennedy’s approach so far has undermined public health measures rather than living up to his campaign promise to address the drivers of poor health, particularly the junk food industry that is a major cause of obesity and cardiovascular disease.

Image Credits: JAMA, Johns Hopkins.

The Global Health Campus in Geneva, HQ of the Global Fund, where Dybul must navigate funding shortfalls and structural reform.
The Global Health Campus in Geneva, shared by Gavi and the Global Fund. Incoming Executive Director Mark Dybul argues the real priority is country-level alignment, not consolidation.

Returning to lead the Global Fund, Mark Dybul argues that the future of global health lies with domestic health systems, not agency mergers in Geneva. Evoking the founding ambition of the early 2000s, the incoming executive director explains how the Accra Reset and US bilateral aid can align under unified national plans – and how his active ties to Washington can help navigate political fragmentation.

Health Policy Watch: You’re stepping back into the Global Fund at a critical moment for multilateral health. What’s different about this term compared to your first stint starting in 2013?

Mark Dybul: The Fund is in a remarkably strong position – I would say the strongest position it’s ever been in. Peter [Sands] deserves a lot of praise and credit for leading the Fund over the last nine years with the full partnership of the board and the secretariat, built on the depth and breadth of cross-sector partnership that is central to the next phase of global health.

Mark Dybul speaking during the interview.
Mark Dybul speaking during the interview.

What’s really different is the landscape. It has changed radically from the last time I was executive director. I’ve been part of that shifting landscape for the last nine years from my position at Georgetown [University], working closely with countries and communities as they’ve already begun to prepare for transitions. This is not new; it’s happening in an accelerated way, but it’s been moving.

It reminds me a little bit of 2000, but in a totally different way. In 2000, there was enormous energy, excitement, lots of new resources, lots of new institutions.

Today is more about asking: “Where are we, and where are countries today?” This is something I don’t think gets enough emphasis: countries are in a completely different position than they were 25 years ago. Their technical capacity, their desire for ownership and sovereignty within a supportive international system of solidarity, and their financial capacity, have been transformed. GDPs in countries have grown from single-digit billions to triple-digit billions, some growing to trillions. While external financing is also facing a very different climate, that shift reflects the progress countries have made.

HPW: You’ve argued that global health aid must end dependencies and shift toward national sovereignty – a core pillar of the Accra Reset, which calls for a five- to 10-year wind-down of duplicative functions. What does that transition look like for the Global Fund under your leadership?

Dybul: That will ultimately be determined by the board within the international architecture, but people are jumping straight to that one piece of the Accra Reset. The other components are actually pivotal to making that happen. Those other pieces are supporting countries for successful transitions – not just from external financing, but to a new approach that some countries are in a position to adopt.

That includes a reduction in external financing, which they want, but it’s going to take time; it has to be careful, and it has to be flexible and responsive because countries will go in different directions. There are some countries that will take much longer, some that are in a crisis state, and some that could enter a crisis state, so there’s no one pathway here.

I think the most critical parts are successful, well-planned, and executed transitions where possible, which frees up capital for countries that will take longer. 60% to 80% of current bilateral and multilateral budgets go to countries that are in a very strong position to be able to transition over time, which is something they very much want to do.

On the architecture piece: I used to spend a lot more time on this. Right now, to me, the focus – and again, this is what the Accra Reset says – is on the countries and the communities to best support them to achieve better health outcomes over the coming years, while they decrease external financing requirements because of their capacity to increase domestic financing.

If we take that perspective, then what countries want and need from the international system will begin to emerge. That’s why in the Accra Reset it says five to 10 years, because we don’t know yet what that looks like, and it will evolve – and I won’t be executive director when that happens.

Country impact over Geneva-centered consolidation

As debates continue over consolidating global health agencies in Geneva, incoming leadership argues that the real test is operational - managing the convergence of vaccines and treatments while balancing Asian procurement scale with calls for regional manufacturing.
As debates continue over consolidating global health agencies in Geneva, incoming leadership argues that the real test is operational – managing the convergence of vaccines and treatments while balancing Asian procurement scale with calls for regional manufacturing.

HPW: On that outcome perspective – in malaria, TB, and looking ahead to the HIV pipeline – there is an increasing convergence of vaccine and therapeutic options. Should Gavi and the Global Fund work closer together or even merge?

Dybul: I’ve always believed that Gavi and the Global Fund should work more closely together. When I was executive director the last time, we did joint trips together, we worked on plans together. It’s been very exciting to see Peter’s leadership with Sania [Nishtar] putting together a task force where they actually work closely together, especially on malaria right now because we have a malaria vaccine and malaria treatment. From what I’ve seen from the outside, there’s been tremendous partnership. All of us coming together to support countries and communities is the path to that transition, and it will lead to a natural architecture change.

I don’t spend a lot of time thinking about mergers and acquisitions, because then the focus is in Geneva, New York, or Copenhagen. The focus needs to be in the country and how we all work together to support them. Again, the Board sets the direction and the vision, and we execute. But there’s tremendous opportunity to work together to support countries in a stronger way.

HPW: The Global Fund leverages massive scale for rock-bottom prices, predominantly from Asia. With Africa CDC pushing for regional manufacturing sovereignty, is the Fund prepared to pay a price premium for African-made diagnostics and therapeutics?

Dybul: That will require extensive board discussions, but price supplements are only one approach. This is something that we started when I was there, and Peter and the secretariat have really built on: how you actually score things in procurement.

For example, initially when I came in, it was only on cost of goods, and not on shipping costs or on-time and full delivery. Once you start building those in, you can actually start tilting towards more regional and local production because those costs were invisible before in costing decisions. In fact, there was a significant shift towards local manufacture of bed nets and things that could be done locally.

At the same time, we have to recall that two of the best antiretroviral producers in the world were in Africa, and both failed because they didn’t have access to markets. These are longer-term conversations that the Board has to lead, but technology and pooled mechanisms give us opportunities that could be a win-win for everyone, especially by improving demand forecasting.

Managing the risks of new tech philanthropy

Two female health extension workers in white lab coats and headwraps administer a finger-prick blood test to an elderly man seated across a table during an outdoor community health clinic in Nigeria.
Amid an influx of AI philanthropy, the Global Fund’s incoming leadership insists tech investments must align with sovereign health plans and empower community-led healthcare delivery.

HPW: Global health is seeing an influx of AI philanthropy, raising alarms over data extraction and private-sector priorities. How will the Global Fund channel this tech wave without compromising national data sovereignty?

Mark Dybul is an experienced Global health expert (2016).
Mark Dybul is appointed Executive Director of the Global Fund.

Dybul: Sovereignty is not just financing; it’s also data sovereignty, and planning and execution sovereignty. I’ve had the privilege of working with some of these tech groups in my life and have grants from some of them, so I know them and know how they function.

They are deeply committed, very well-intentioned people, and it’ll be a process of working together. Their goal is to get the greatest impact, and that is going to require deep engagement of countries and communities.

By working together and understanding the complexities country by country – because one size does not fit all – I think this can be a tremendous opportunity for the future, especially as public financing is likely to continue to decrease over time.

As you point out, there are risks, and the risks have to be managed. It comes back to something unique about the Global Fund: the strength of the partnership, the fact that foundations and private sector actors are at the table with a voting seat on the Board. I want to emphasise that: the money is not coming directly from the tech companies; they don’t own the data that they put money in for. I worry less about data sovereignty because these are not the tech companies coming in; these are tech companies giving funds through other mechanisms. But there are issues about planning, execution, and flexibility that need to be worked out.

And I really want to keep emphasising: when I say countries, it’s communities too. Governments are hugely important, but so are communities and non-governmental organisations; they deliver enormous amounts of healthcare – in some countries, 40% of healthcare delivery is outside the public sector.

HPW: Speaking of communities – in many transitioning countries, domestic governments are openly hostile to funding harm reduction or LGBTQ+ programmes. If co-financing takes over and drops key populations, will the Global Fund continue directly financing civil society outside government channels?

Dybul: These are board decisions, not secretariat decisions. Having said that, this is not the first time we’ve faced this. When I was executive director before, we worked with UNAIDS in Latin America to help governments understand that non-governmental entities and communities are integral to their health systems.

We ran numbers showing finance ministries that an uncontrolled epidemic among key populations would destroy their national budgets and fiscal sovereignty. In response, several countries actually changed laws so governments could legally transfer state funding to civil society groups delivering these frontline services. It is a risk, and we have to pay very careful attention to it.

There are other potential funding sources – philanthropies that are now focusing on this. I’ve spent a fair amount of time over the last five years working with philanthropies to understand this risk, and that these populations have to be involved and protected, or you will not control your epidemics, which is the core goal of the Global Fund. It’s a complex dynamic, but it’s something that’s very front and centre in my mind, and I know it’s front and centre in the board’s mind and across delegations.

Aligning US bilateralism with country sovereignty

The United States Capitol Building in Washington, DC, with a clear blue sky.
Pointing to his active, bipartisan engagement with Congress and the administration, Dybul argues that strong US bilateral assistance and Global Fund financing can align – provided all partners subordinate their funding to sovereign, country-led health plans.

HPW: Despite your strong bipartisan ties in Washington, the current political climate favours bilateral deals over multilateral pooling. How do you satisfy Washington’s demands without alienating the rest of the Board?

Dybul: It comes back to working collaboratively, humbly, and everyone aligning under national plans. That’s actually what the current people in the [US] State Department are calling for: that we all align under national plans, and that’s what the countries want.

All working together, as long as everyone’s aligned with that national plan, with that national budget, with the reporting requirements – it can be bilateral, it can be multilateral, it can be whatever which way you want. There might be disagreements, but you’ll have to work that out in the country, with the country, which will be radically different from place to place.

I’m very optimistic. I have spent a lot of time in a bipartisan way working with multiple administrations and multiple Congresses, and I’m very active with Congress and the administration right now.

2000 gave this great opportunity because of huge amounts of money; reductions in resources can lead to innovation and a whole new way of doing things, including a new way to involve communities and non-governmental organisations. Think of all the things people said were impossible in 2000, and nearly all of them have been achieved!

As we’re looking forward, rather than saying, “This is going to be so difficult, it’s going to be impossible,” why don’t we start looking as we did then: “Well yeah, true, but what are the opportunities? How do we make it work? And how do we solve problems?” If everyone comes together with a solution-minded approach, these are very solvable problems.

Image Credits: Global Fund/Vincent Becker, HPW/Felix Sassmannshausen, Elements Interactive via Pexels, mk_photoz via Pexels, Georgetown University, Ramaz Bluashvili via Pexels.

Speakers at the launch of the Independent Panel’s report on mpox, “Hiding in Plain Sight”.

The World Health Organization (WHO) declared mpox a public health emergency of international concern (PHEIC), its highest alarm level, twice within two years, in 2022 and 2024.

But “preventable health emergencies are a sign of failure”, said Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response. “They happen when community health care is neglected, signals are missed, and pathogens are allowed to spread beyond their original habitats.

The mpox virus had been circulating for over 50 years, causing sporadic outbreaks in poor West African communities – but neglect enabled it to evolve into a global public health risk affecting 82 countries, according to a new report by the Independent Panel published on Friday.

“Mpox was not new at all. It was actually known for decades, yet had received little attention because it was affecting neglected communities in faraway regions in Central and West Africa,” report author Dr Els Torreele told a media briefing on Friday.

“Decades of neglect allowed the virus to mutate into more easily transmissible variants, in particular, transmissible among humans through sexual contact, and spread outside of the original habitat, leading to this first [WHO] public health emergency declaration.”

Yet even after the 2022 PHEI declaration, neglect continued in places where it was first endemic. Vaccines were rolled out in wealthier affected countries, yet they were not available in the Democratic Republic of Congo (DRC), the epicentre.

An adult infected with mpox in DRC.

By 2023, “there were signals that the numbers of cases were increasing, that the patterns of transmission were changing, that actually a new variant had arisen that also was transmittable through sexual contacts,” Torreele said. “A lot of alarm bells were ringing, but nobody was really listening until August 2024.”

That was when the WHO and Africa CDC declared mpox a public health emergency for the second time, mobilising resources to address it.

The recent media hype about one potential case of plague in Russia ignored the fact that the plague virus “is circulating in animal reservoirs in many different countries with sporadic spillovers and infection of humans, including in countries of known fragility”, said Torreele.

“We need to shift from repeatedly responding to crises to sustained investment in preparedness before they occur,” Clark told the briefing.

“Instead of scrambling to respond, how could we stop outbreaks where and when they occur? How could we prevent them?” she asked. “Once a public health emergency is declared, it means we’re already acting too late for so many people.”

Community readiness

A health worker takes a sample from a person suspected of having mpox. There are still no rapid diagnostic tests for mpox.

Clark and Torreele argue that investment in communities and primary healthcare are the best ways to prevent outbreaks from becoming public health emergencies.

“One answer is to stop treating communities as beneficiaries in a crisis, and instead invest in them as ongoing partners who can help detect and report risks to their communities,” urged Clark.

“It’s often said that outbreaks begin and end in communities, yet so rarely have we invested as though we believe that, and we must ask: What other diseases are we neglecting in plain sight?”

Torreele called for immediate investment in country-led research into neglected diseases, “looking at the pathogens that cause them, and their habitats, and design context-relevant control measures, including those that can really be adopted at community level, that actually can help us avoid further outbreaks becoming epidemics”.

She described the declaration of a health emergency as “a failure” to stop an outbreak when and where it occurs. 

“Of course, it remains important to call out when an outbreak is out of control. But it is wasteful and expensive to do it so late.”

“We have to learn the lesson that we should not treat communities as just consumers of outcomes of our health interventions, but people who can really help us produce better outcomes and support health intelligence that can help us manage these disease outbreaks,” said Aggrey Aluso, executive director of Resilience Action Network Africa (RANA).

Ebola Bundibugyo outbreak

Aluso said that, like mpox, detection of the Ebola Bundibugyo outbreak in the DRC had taken too long, and “we are paying the price for that”.

Dr Marie Roseline Belizaire, WHO Africa regional director of emergency preparedness and response, outlined some of the hurdles hampering the Bundibugyo response, including diagnostic delays as samples had to be transported to labs hundreds of kilometres, gaps in staff training, fuel shortages, the lack of isolation facilities and local funding.

Referring to “invisible transmission”, Belizaire said cases needed to be detected earlier, and patients needed to be treated earlier.

“That means we need to strengthen surveillance and contact tracing.”

Independent Panel member Dr Joanne Liu noted that the cost of effective annual pandemic preparedness and response is $15 billion, but only about $2 billion had been raised annually. 

She also called for fund recipients to have stronger accountability: ‘We need to up our game on this accountability. It’s not enough to have a tracking tool. We need to have real accountability processes and mechanisms, and then we need to make sure that it gets dispersed to the frontline health workers.”

What is success?

“True mpox readiness in areas of fragility would require significantly cheaper and registered vaccines available in regional or national stockpiles, hand in hand with easy-to-use diagnostics that can differentiate it from chickenpox and measles,” said Torreele.

“Emergency response success should not just be measured by a decrease in the numbers of cases and countries affected, but the number of medical countermeasures rolled out,” she added.

“[We] should also measure success by the capacity to leave behind communities and health systems, especially in fragile areas, that are more able, more resilient, more able to monitor and respond to future outbreaks, including by having the needed diagnostic capacity and potential regional stockpiles of countermeasures close to where outbreaks might occur.”

Image Credits: WHO, Katson Maliro/ WHO.

This story was originally published by The New Humanitarian.