·         Read of the week

·         World Malaria Day

·         World Immunization week

·         Run-up to the World Health Assembly

·         WHO DG race

·         Resumed sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement (27 April-1 May)

·         More on PPPR & GHS

·         Regional World Health Summit Nairobi

·         More on Global health reform & reimagining (+ post-2030 brainstorm)

·         More on Global Health Governance & Funding/Financing

·         FfD Forum in New York

·         Impact aid cuts

·         Bilateral health agreements & US Global Health Strategy

·         Trump 2.0

·         UHC & PHC

·         TB Accelerator Forum (& more on TB)

·         More on Health Emergencies

·         Covid

·         NCDs & CDH

·         Human Resources for Health

·         Women Deliver (Melbourne)

·         SRHR

·         Santa Marta conference (Colombia)

·         More on Planetary Health

·         Access to Medicines, Vaccines & other health technologies

·         Conflict/War & Health

·         AI & Health

·         Miscellaneous

Read of the week

Habib Benzian – Bullshit Bingo

Habib Benzian;  

“Not all global health buzzwords are empty – but some were designed to be.” Fabulous post again.

“Not all ambiguous language is empty, and not all buzzwords are bullshit. In health diplomacy, ambiguity can be both, a tool of progress or a shield against it. The difference matters….”

World Malaria Day (25 April)

With a few more news snippets from World Malaria Day, celebrated last Saturday (see also the previous IHP newsletter issue).

WHO prequalifies first-ever malaria treatment for newborns and infants, adds new diagnostic tests

https://www.who.int/news/item/24-04-2026-who-prequalifies-first-ever-malaria-treatment-for-newborns-and-infants-adds-new-diagnostic-tests

“Ahead of World Malaria Day on 25 April, the World Health Organization (WHO) has announced a significant step forward in the fight against malaria with the prequalification of the first treatment developed specifically for newborns and young infants weighing between two and five kilograms… … The newly prequalified treatment, artemether-lumefantrine, is the first antimalarial formulation designed specifically for the youngest malaria patients. Until now, infants with malaria have been treated with formulations intended for older children, which increase the risk of dosing errors, side effects and toxicity. WHO prequalification will enable public sector procurement, contributing to closing a long-standing treatment gap for some 30 million babies born each year in malaria-endemic areas of Africa.”

Nature Africa – Malaria vaccines scale up in Africa amid new threats

https://www.nature.com/articles/d44148-026-00108-w

“As rollout expands to millions of children, emerging resistance is challenging prevention, treatment across the continent.”

HPW – Malaria Funding Crisis and Drug Resistance Compel African Investment

https://healthpolicy-watch.news/malaria-funding-crisis/

“As global health leaders gathered in Geneva on Monday to commemorate this year’s World Malaria Day, an  advocacy forum featuring high-level diplomats addressed the rising threat of antimalarial drug resistance. Celebrations of medical progress and clinical discussions quickly gave way to discussion about a rapidly escalating malaria funding crisis, with more funding cuts are on the horizon.”  “… The high-level event, co-hosted by the RBM Partnership to End Malaria and Medicines for Malaria Venture (MMV), balanced stark clinical realism with a pragmatic call to action….”

“Faced with retreating Western donors and mutating parasites, African diplomats demanded a decisive shift towards health sovereignty, local manufacturing, and integrated regional investments….”

“…In 2024, total malaria funding reached $3.9 billion, a mere 42% of the $9.3 billion required annually to remain on track toward global elimination targets, directly compounding the malaria funding crisis….”

PS: “Charlotte Rasmussen, technical officer at the World Health Organization, took the stage early in the event to confirm that artemisinin partial resistance is steadily spreading across Africa….” 

“… If this genetic resistance is allowed to progress to full treatment failure, experts warn of a catastrophic surge in mortality that would entirely reverse decades of public health progress, potentially leading to more than 50 million treatment failures in the year 2060 alone. Mathematical modelling from Imperial College London suggests that delaying a transition to alternative therapies could rapidly overwhelm fragile medical infrastructure, costing affected nations well over $1 billion  over the next 15 years….”

World Immunization week (24-30 April)

HPW – Making Better Vaccine Choices in a Shifting Global Health Landscape

C Weller  ( Head of Prevention in Wellcome’s Infectious Disease team.) ; https://healthpolicy-watch.news/making-better-vaccine-choices-in-a-shifting-global-health-landscape/

“In an era of big global health budget cuts that often demand tough choices, identifying vaccine needs and priorities at national level is increasingly important. As we observe World Immunization Week, it’s time to recognize the pivotal role that National Immunization Technical Advisory Groups (NITAGs) can play in guiding effective, evidence-based decisions – alongside global guidance from the World Health Organization.”

“… This is why Wellcome is investing in the African-led NITAG Support Hub, or NISH, which helps strengthen NITAGs across Africa. ….”

Run-up to the 79^th World Health Assembly (18-23 May)

Still some weeks, but tension is rising : )

WHO – Some preparatory documents are already online

https://apps.who.int/gb/e/e_wha79.html

With more to come.

·         Including for example:  Collaboration within the United Nations system and with other intergovernmental organizations  eport by the Director-General

G2H2 – Series of policy debates hosted by the Geneva Global Health Hub (G2H2), 4 – 8 May 2026, ahead of WHA79

https://g2h2.org/posts/policy-debates-may-2026/

“Ahead of the 79th session of the WHO Executive Board, this series of G2H2 policy debates offers a platform for civil society to engage with  key questions concerning global health, connecting policy discussions with their implications for health systems, communities, and equity worldwide. Spanning from the assessment of “hot” topics to be addressed at the upcoming WHA, to a detailed analysis of other burning technical or political matters that have been left out, each session will feature selected speakers which will guide us into an enriching discussion….”  

WHO DG race

Devex – Let the race begin  

“The World Health Organization has finally opened nominations for its next director-general, with the call for proposals now circulating among permanent missions in Geneva, Devex has confirmed.
The move follows the election timeline already set out by WHO. According to the document shared with member states and seen by Devex, any country may nominate one or more candidates, but submissions must reach WHO headquarters by 18:00 CEST on Sept. 24 — exactly four months before the executive board convenes in January 2027 to shortlist up to three candidates for the World Health Assembly.  Candidate names will be disclosed after the last WHO regional committee meetings in October….”

“The document also states that the incumbent WHO director-general “intends to place internal candidates on leave to ensure a clear separation between their campaign activities and their WHO functions.””

“While no officials have publicly announced their candidacy, the rumor mill is already spinning. Names being floated include WHO officials such as Dr. Hanan H. Balkhy and Dr. Hans Kluge, as well as Indonesian health minister Budi Gunadi Sadikin. Others have also mentioned former Qatar health minister Hanan Mohamed Al Kuwari, PAHO Director Dr. Jarbas Barbosa da Silva Jr., and Gavi CEO Sania Nishtar….”

HPW – WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun

https://healthpolicy-watch.news/germany-who-dg-elections/

With some info on this Braun, former chief of staff in the government of then Chancellor Angela Merkel.  One of three potential German candidates. (His chance to become the next DG: nil.)

PS: “meanwhile,  the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board.  Holding a PhD in healthcare management and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world. She is personally celebrated for her crisis resilience and for shaping the WHO’s recent global work programme.”

“Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health….”

Resumed sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement (27 April-1 May)

“The resumed session of the sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement  [takes place] in a hybrid format from 27 April to 1 May 2026.  The outcome of the PABS annex negotiations will be submitted to the Seventy-ninth World Health Assembly in May 2026 for its consideration.”

Ending today normally.  

Starting from some pre-analysis end of last week (including on the state of affairs after the ‘informals’), and then coverage/analysis from this week.   

And no, there was no agreement by Friday morning … as one might have expected.

HPW – Developed Countries Propose ‘Hybrid’ Model Ahead of Pandemic Agreement Talks

https://healthpolicy-watch.news/developed-countries-propose-hybrid-model-ahead-of-pandemic-agreement-talks/

With this coverage of a High-level webinar (hosted by the University of Miami’s Public Health Policy Lab) from end of last week, yet another crucial “PABS” week began.   Recommended read.

“Yet another negotiating session on the outstanding annex of the Pandemic Agreement begins at the World Health Organization’s (WHO) headquarters on Monday (27 April) – and developed nations have presented a “hybrid” solution in an attempt to find consensus.  The “hybrid” proposal consists of a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information….”

PS:  “…the PABS system was a contentious issue that evaded negotiators, who packaged it into an annex and kicked it down the road to new negotiations. This enabled the World Health Assembly to adopt the Pandemic Agreement last year, described by some observers as the Pandemic Agreement Lite precisely because it dodged the detail about PABS. Adopting a vague PABS annex and kicking further details down the road again – this time to the COP – might save face for multilateralism. But it simply delays the adoption of the Pandemic Agreement to yet another set of talks, leaving all member states vulnerable to public health emergencies in the meantime.”

·         See also TWN: WHO: EU proposes burdensome “Blended model” –  access to pathogen samples and sequence data without benefit sharing contracts   (by S Shashikant & N Ramakrishnan);

(29 April)  “ Members of the European Union informally circulated a document titled the “Blended model for the sharing of PABS Material and Sequence Information”, the much-discussed hybrid compromise, in the lead-up to the resumed session of the 6th meeting of Intergovernmental Working Group (IGWG6R) negotiating the Pathogen Access and Benefit-Sharing (PABS) Annex to Pandemic Agreement. Disregarding the mandate in Article 12 of the Pandemic Agreement (PA), the document was presented as a landing zone for the EU and Norway (and possibly other developed countries). It proposes a PABS system with two parallel pathways for sharing pathogen materials and sequence information: one subject to contractual obligations including benefit-sharing requirements, and another that permits access without such conditions.”

“During Tuesday’s informal discussions, this “blended” approach came under sustained questioning and criticism from multiple delegations and was reportedly rejected by the Africa Group, according to diplomatic sources. However, the proposal may yet resurface, with or without modifications, during the formal sessions in the week….”

TWN – WHO: PABS negotiation set to resume, consensus elusive during ‘informals’ 

https://www.twn.my/title2/health.info/2026/hi260404.htm

(27 April)   With focus on the ‘informals’ of the past days.  “The stage is set to resume the negotiations on the Pathogen Access and Benefit Sharing (PABS) System with consensus remaining elusive during the informal meetings of WHO Member States co-facilitated by France and South Africa. Informal sessions were organised in a hybrid mode at the WHO Headquarters in Geneva from 21 to 24 April, ahead of the resumed session of the 6th meeting of the Intergovernmental Working Group (IGWG6). “

“Little movement was seen on the contentious issues related to benefit sharing during the initial days of the informal meetings. The meetings were fruitless since developed countries continue to oppose key elements such as standard contracts that would make benefit-sharing obligatory on the recipients of the biological materials of pathogens with pandemic potential and their digital sequence information (PABS materials and sequence information)….”

“The following subjects were dealt with during the informal sessions:  (a)  Benefit sharing during public health emergencies of international concern (PHEIC), (b)  Benefit sharing during non-pandemic, non-emergency situations, (c)   Monetary benefit sharing, (d)  Access to PABS materials, and (e)  Access to PABS sequence information. ….”

“The informal sessions focussed on reaching consensus on the above conceptual issues instead of the draft negotiating text…”

GHF – The PABS Cheat Sheet; Perspectives from Negotiators

https://newsletter.genevahealthfiles.com/the-p/?ref=geneva-health-files-newsletter 

(27 April) Geneva Health Files Monday edition & obligatory reading, as this important PABS week was about to start.

This edition has two parts: Part I: … a cheat sheet on what to expect.  Part II: Perspectives of some negotiators from an event that took place last week (by my colleague Anjan Wilfrid D. Rosario – with some long quotes from the abovementioned webinar organized by the University of Miami)…

TWN –  WHO: Director-General steps up efforts for a compromise on PABS System

https://www.twn.my/title2/health.info/2026/hi260405.htm

With coverage of the opening day (27 April) of this last PABS round.

“The WHO Director-General Dr Tedros Adhanom Ghebreyesus has stepped up his efforts to bring a compromise among Member States to reach consensus on various differing positions on the side-lines of the resumed negotiations on the Pandemic Agreement’s Pathogen Access and Benefit Sharing (PABS) System. … During the opening session of the negotiations the DG called upon countries to find a landing zone. ….”

The article also has some other opening statements of the day.

GHF – Examining The Narrative of Incentivizing Pharma Industry Participation in The WHO Pathogen Access Benefit Sharing System

Geneva Health Files;

“Guest essay from South African scholar Lauren Paremoer, who offers for our readers a critical examination of the narrative on incentivising the pharmaceutical industry for their participation in the WHO Pathogen Access Benefit Sharing System.  She argues why it is important to look more closely at the diverse actors funding research and development, and manufacturing, and how the PABS system can be made applicable to them….”

A few quotes from the essay:

“Throughout the negotiations for the Pandemic Agreement (PA), Global North countries – especially those with big pharmaceutical manufacturing industries – insisted that the Agreement had to be structured in a manner that would incentivize pharma to participate. They have repeatedly echoed this sentiment over the last year in the context of the PABS Annex negotiations. But which “industry” is being spoken about here? And is the fairness and functionality of the PABS Annex completely dependent on them? ….”  “The pharmaceutical manufacturing industry is dominated by a few large corporations and manufacturing sites. These are largely situated in the Global North, with China and India being the major exceptions to this with their capability in generic production.  It is exactly this over-concentration of the pharma supply chain that contributed to vaccine apartheid during the Covid-19 pandemic. …”

“Speaking in January 2021, DG Tedros noted that “hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption” resulted from vaccine nationalism on the part of Global North countries and prioritisation of supply to these markets by pharmaceutical corporations.    This is presumably the “industry” that the Global North is referring to when saying that commercial entities should be incentivised to join the PABS system, otherwise it will fail. The Global North – notably the EU and others  – have so far opposed proposals having the potential to change the status  quo. This includes ear marking of health products to be shared during the early stages of an outbreak and public health emergency of international concern (PHEIC),  user registration when access PABS materials and digital sequencing information, and legally binding contracts at the point of access. According to Global North arguments, incorporating such elements in the PABS framework may effectively cause the industry to boycott PABS…”

PS: this GHF issue also has some statements made at the opening of the resumed session on the PABS negotiations earlier this week in Geneva.

HPW – No Pandemic Agreement Annex by World Health Assembly, Says Civil Society

https://healthpolicy-watch.news/no-pandemic-agreement-annex-by-world-health-assembly-says-civil-society/

“The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May)….”

“Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation.

While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives….”

PS: “Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement.”

TWN –  WHO: Member States propose extending PABS Negotiations beyond WHA79

https://www.twn.my/title2/health.info/2026/hi260408.htm

(30 April)  “Members of the World Health Organization (WHO) proposed extending the timeline for the negotiations on the Pathogens Access and Benefit Sharing (PABS) System, beyond the 79th World Health Assembly (WHA79) scheduled to take place in May.   Member states proposed the extension during the stocktaking session on the third day of the  resumed session of the 6th meeting of the intergovernmental working group (IGWG) negotiating the PABS system, taking place in Geneva at the WHO headquarters from 27 April-1 May.”

“Delegates participating in the closed stocktaking session report that several countries—both developing and developed—expressed concern over the limited progress to date, citing persistent and wide divergences among WHO Member States on key aspects of the PABS system….”

More on PPPR & GHS

Telegraph – Why are we seeing more outbreaks of the deadliest diseases?

https://www.telegraph.co.uk/global-health/science-and-disease/why-are-we-seeing-more-outbreaks-of-the-deadliest-diseases/

“Cases of illnesses like haemorrhagic fever were once sporadic but have been increasing in frequency… “

“Haemorrhagic outbreaks of Ebola and Marburg go back 50 years, but now their frequency is increasing. Data analysed by The Telegraph found that clusters of Ebola and Marburg have increased significantly decade-on-decade since the 1960s.  “

““Outbreaks of diseases like Ebola were once sporadic,” says Laura Appleby, head of epidemiology and preparedness at the Coalition for Epidemic Preparedness Innovations (CEPI).  “However, since 2010, an outbreak of a filovirus, the family to which Ebola, as well as its deadly relatives, Marburg and Sudan, belong, has occurred every year almost exclusively in Africa, and the diseases are extremely lethal. They are “not only occurring more frequently but also becoming more widespread”, she added. “Last year Ethiopia reported its first-ever Marburg outbreak.”…”

The analysis then discusses some of the hypotheses.

Telegraph – World Cup health security hub launched as measles surges

https://www.telegraph.co.uk/global-health/science-and-disease/world-cup-health-security-hub-launched-as-measles-surges/

“A World Cup health security hub to track threats including measles, dengue and Zika virus among football fans is being established by academics for the first time. Millions of fans are expected to travel to and across North America for the tournament, which is being held in 16 cities in Canada, Mexico and the United States in June and July. With 48 teams, it will be the biggest World Cup in history. Yet there are concerns the competition could become a super-spreader event. Mass gatherings from Glastonbury and the Rugby World Cup to the Hajj pilgrimage and mega-church services have all seen outbreaks of diseases, including norovirus, meningitis and Covid-19.”

“Now, global health academics at Georgetown University in Washington DC are setting up a temporary surveillance hub to monitor these risks this summer.  Called the Health Security Operations Centre, the unit will operate from a repurposed microbiology lab. The aim is to track, warn and support health officials if any disease runs the risk of spiralling out of control. It is the first non-government led initiative to monitor and respond to infectious disease outbreaks during a mass event like the World Cup. “

Regional World Health Summit Nairobi (27-29 April)

Lots of important news, including on some meetings that took place on the margins of the regional WHS.

WHS press release – World Health Summit Regional Meeting 2026 Opens in Nairobi with Strong Call for Action on Resilient Health Systems

https://a.storyblok.com/f/305196/x/5976ed681c/whs-press-release-rm-27-april.pdf

(27 April)  With some quotes from the opening session by Kenya’s president Ruto, Axel Pries (WHS), WHO Afro’s boss Janabi, Jean Kaseya and others.

HPW – African Leaders Declare End of Aid Era at Nairobi World Health Summit, But The Data Tell a More Complicated Story

https://healthpolicy-watch.news/african-leaders-declare-end-of-aid-era-at-nairobi-world-health-summit/

Must-read analysis of the regional WHS.               Excerpts:

“African leaders opened the World Health Summit Regional Meeting at the United Nations complex in Nairobi this week with a unified declaration that two decades of dependence on foreign aid for health is over.  The Nairobi meeting, the first co-organised by the World Health Organization (WHO) and the World Health Summit, has positioned itself as the continent’s first high-level response to the collapse of official development assistance (ODA) for health, which fell by an estimated $31.1 billion in 2025, according to the Africa Centres for Disease Control and Prevention (Africa CDC). Over 2,000 delegates from more than 50 countries, including health and finance ministers from 17 nations, are convening in the Kenyan capital to coordinate a united African position ahead of next month’s World Health Assembly in Geneva.”

“… On the sidelines of the summit, Africa CDC launched the African High-Level Ministerial Committee on Global Health Architecture Reform.   The body brings together health and finance ministers from across the continent to coordinate African positions ahead of the World Health Assembly and broader UN reform processes. Convening both portfolios in the same room is a long-standing demand of global health advocates, who have struggled for decades to make the economic case for health investment to treasuries that hold the purse strings….” “The committee, chaired by former Liberian president Ellen Johnson Sirleaf, will produce coordinated African position papers on health architecture reform and a 2026–2030 reform roadmap focused on five axes: governance, financial sovereignty, data sovereignty, local manufacturing, and pandemic preparedness.”

PS: “A Centre for Global Development (CGD) audit of 442 government actions across all 54 African countries found a continental reaction to the historic aid cuts split in radically uneven ways, a story of inequality within Africa as much as between Africa and its donors. The countries that moved fastest are those with the deepest pockets and most diversified economies, including Nigeria, Ghana and Ethiopia. Lower-income, debt-burdened countries, many of which were the largest per-capita recipients of foreign assistance, have largely absorbed the loss in silence…. “Governments with limited fiscal space and weaker administrative capacity have less room to cushion abrupt external shocks,” the analysis found. “What is slightly surprising is that they were not only doing little about the aid cuts, they are also saying little about them.”….”

“A separate CGD study published in February examined the budget statements of 18 sub-Saharan African countries: among the world’s poorest, most heavily aid-dependent and exposed to the cuts. It found that only two, Tanzania and Sierra Leone, proposed new revenue measures to replace lost financing in their 2025 budgets. None reprioritised spending from other sectors to protect health…. “

PS: “Thirty-two African nations now spend more servicing external debt than funding healthcare. The continent paid almost $90 billion in external debt service in 2024 alone, with African governments now spending an average of 17% of state revenue on debt servicing, according to leading estimates………”   “ “The IMF warned last week that more than a third of African countries are at high risk of, or already in, debt distress, with rising interest bills “crowding out essential development spending, healthcare above all.”…”

Journal of Public Health in Africa (Editorial) –  Reshaping global health architecture: African health sovereignty as the foundation of global health equity and security

Jean Kaseya et al ; https://publichealthinafrica.org/index.php/jphia/article/view/1976

This editorial set the scene well for the regional WHS in Nairobi. « …. We propose six interlocking reforms to realign global health architecture with epidemiological reality and African sovereignty …”:  « Equity as a binding operating principle; restructuring financing mechanisms; bringing African institutions in decision-making; reinforcing technology transfer & regional manufacturing; streamlining political leadership; maintaining data equity and digital sovereignty. … “

Africa CDC Launches African High-Level Ministerial Committee to Shape Global Health Architecture Reform

https://africacdc.org/news-item/africa-cdc-launches-african-high-level-ministerial-committee-to-shape-global-health-architecture-reform/

See above. Africa CDC’s press release: “Africa Centres for Disease Control and Prevention (Africa CDC) today launched the African High-Level Ministerial Committee on Global Health Architecture Reform (AHLMC) on the margins of the World Health Summit Regional Meeting 2026 in Nairobi, Kenya.”    “The Committee brings together Ministers of Health and Finance from across the continent to consolidate Africa’s voice, strengthen political coordination, and advance a unified African position on global health governance reform. It is designed to provide stewardship, strategic coherence, and accountability for Africa’s engagement across interconnected reform processes, including the Pandemic Agreement and related annexes, International Health Regulations implementation discussions, UN80-linked reforms, and wider global health financing debates…..”

“… The AHLMC is a central pillar of Africa’s Health Security and Sovereignty agenda and will drive action across five thematic workstreams: leadership reform and governance; financial sovereignty; data sovereignty and digitalisation; product sovereignty and local manufacturing; and pandemic prevention, preparedness, and response. Across these areas, the Committee will help define a consolidated African reform platform, coordinate ministerial engagement, develop guidance on common negotiating positions, and support reforms that strengthen African representation, reduce duplication, align financing, and reinforce continental institutions…..”

“… The Committee’s work will be results-oriented. Expected outputs include a consolidated African Position Paper on global health architecture reform, engagement and negotiation packages for priority global processes, a Reform Roadmap 2026–2030, a Financing Alignment and Mutual Accountability Framework aligned with the “One Plan, One Budget, One Report” approach, and regular progress reports to Africa CDC governance organs and African Union policy organs….”

Africa CDC and Africa Frontline First Strengthen Partnership to Accelerate Community Health Workforce Expansion

https://africacdc.org/news-item/africa-cdc-and-africa-frontline-first-strengthen-partnership-to-accelerate-community-health-workforce-expansion/

“The Africa Centres for Disease Control and Prevention (Africa CDC) and Africa Frontline First (AFF) have strengthened their strategic partnership through the signing of a Memorandum of Understanding (MoU). The agreement will support the deployment of 200,000 Community Health Workers (CHWs) across Africa.  The signing took place on the margins of the World Health Summit Regional Meeting 2026 in Nairobi, marking a significant step forward in advancing Africa’s community health agenda. ….”

“Building on the achievements of the 2023–2025 collaboration, the agreement sets out a joint action plan for 2026–2028. It will combine AFF’s financing and technical expertise with Africa CDC’s convening power and leadership to accelerate the institutionalisation of CHWs within national health systems and support the African Union’s target of deploying 2 million polyvalent CHWs by 2030.”

Devex Check up – with some snippets from Nairobi

Devex

Partly self-inflicted problems?    “The 2026 World Health Summit regional meeting kicked off in Nairobi, Kenya, this week, where African leaders are recognizing that some of the continent’s health development gaps are, at least in part, self-inflicted.

“ Devex contributor David Njagi, who was on the ground, didn’t quite walk in on a full-blown “it’s me, hi, I’m the problem” moment à la Taylor Swift’s “Anti-Hero” — but the sentiment wasn’t far off. He captured Kenyan President William Ruto sharing the gibberish explanations he got after digging into why Kenya is not buying health products from Kenyan companies.  “Many leaders in Africa believe health is somebody else’s responsibility. You are producing a commodity that is being imported globally, and you cannot buy it in Kenya. These are Kenyan companies owned by Kenyans. But when you ask the people at the Ministry of Health, why are we not buying from these people? There is a lot of ‘English’ that has no substance,” he said….”

“The problem extends beyond manufacturing to access to treatment…”

And some more snippets from the WHS in Nairobi:

·         launch of the Continental Immunisation Strategy (CIS).

“The CIS is Africa’s response to closing equity gaps, reaching zero-dose children, and integrating immunisation within resilient primary health care systems.  … With the support of UNICEF, Gavi, the Vaccine Alliance, this Strategy marks a shift toward stronger country ownership, sustainable financing, and long-term health security….”

·         Re the Africa CDC Ministerial Dialogue on Health Financing

Tweet Jean Kaseya:  “Africa carries 22% of the global disease burden, yet accounts for just 1% of global health expenditure. At the same time, external support is shrinking, debt is rising, and climate risks are accelerating. This morning at the World Health Summit Regional Meeting in Nairobi, I convened African Ministers of Health, development partners, and financing experts for the Africa CDC Ministerial Dialogue on Health Financing.”

“The discussion was clear: the tools are within reach. Domestic resources, efficiency gains, debt-for-health swaps, and the African Sovereign Health Fund can help turn commitments into results.”

More on Global Health reform & reimagining (& international development/post-2030 brainstorm)

Partnership for International Politics and Diplomacy for Health-  4^th issue – Insights on global health reform discussions, trends and perspectives: April 2026

https://globalhealthdiplomacy.se/insights-on-global-health-reform-discussions-trends-and-perspectives-april-2026

With a good overview of the past month. Even if it’s only “one take”/perspective too.

“Discussions on global health reform remain highly active and continue to garner high-level political attention. The intent behind reform initiatives is starting to shift from inspiring thinking to seeking action. The Accra Reset and the WHO-hosted process stand out in this regard, both promising to deliver on a much-needed roadmap. Nonetheless, as these two distinct initiatives develop, it is crucial to ensure complementarity. “

“The WHO-hosted process is a time-bound, multilateral effort, aspiring for broad geographical and institutional engagement. Yet it may struggle to achieve this in practice given the asymmetries in Member States’ capacities and interests to engage. By contrast, the Accra Reset reflects a stronger Global South anchoring with Head of State leadership and diverse representation in its high-level panel. Progress updates from the Accra Reset are anticipated during major global governance moments. The upcoming 79th World Health Assembly will be a key chance to assess whether processes intend to converge. “

“The US continues to reaffirm that its interest is not to retreat from global health, but to engage on its own terms. The ‘America First’ approach should not be treated as an unspoken or negligible factor in reform discussions. Its tensions with multilateral cooperation for health have been apparent, not least through the bilateral health compacts. Clarifying and navigating the US’ red lines could help manage the volatility in the current landscape. “

“The international system for health must sustain the gains it has helped to achieve, as well as deliver new health improvements. Reform will be incremental, driven by cumulative decisions taken across institutions and levels, rather than one decisive moment. These efforts must be aligned around a shared direction, shaped by voices across regions. “

Lancet Comment – A WHO worth fighting for: the case for focused, ambitious reform

A Nordström, J Nkengasong, P Piot et al ;  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00805-6/fulltext

Must-read.   « The world needs WHO. This should be an unambiguous and uncontroversial statement. But it is not. There are signals that WHO’s perceived value has eroded, and that its central position in the international system for health is under threat. Some critiques of the organisation have been politically natured, but that should not inhibit debate over legitimate concerns: WHO’s lack of agility, insufficient transparency in key processes and decision making, and the absence of a clear narrative of the indispensable benefit the agency provides to the world.  WHO urgently needs reforms or risks a decline into irrelevance. “

« The calls for reforms are not new. Yet the imperative to act has never been greater and the environment for delivering change rarely more conducive—at a time when the global health ecosystem is shifting. Discussions about reforms of the international system for health and of the multilateral system at large are active, partly due to the political imperative to navigate the sharp decline in official development assistance. The future of WHO must be a central part of the broader reform efforts. This is not a question of technical design, but of political choice—and it is WHO member states that must make that choice. The build-up to the 2026 World Health Assembly in May, 2026, and the forthcoming election of WHO’s next Director-General in May, 2027 are an opportunity to debate the vision for the organisation….. 

“ We propose three key functions and six structural reforms (panel) to guide the path ahead. These reforms need to be sequenced over time, a recognition that change is not immediate, but that the work must start now….”

(small side comment: I don’t recall at least of a few these high-profile global health experts being equally ‘vocal’ on the Gaza genocide – maybe it wasn’t ‘global health’ for them)

Lancet Letter – Decentralisation must be the future of global health

J P Allen & S Asiimwe; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00745-2/fulltext

Nailing it in many ways, this short letter.  Including with respect to the serious concern they flag.

Lancet Letter – The need for a new global health narrative

S L Jensen ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00746-4/fulltext

“Richard Horton calls for a new narrative for global health to replace the narrative from the turn of the century that “rooted in macroeconomics” turned attention to the strategic importance of global health. Horton summarises the older narrative as follows: “extreme poverty is the biggest obstacle to sustainable economic growth; the causes of extreme poverty are a small number of preventable and treatable diseases; by tackling those diseases, poverty can be defeated and economic growth secured”. As the world now faces multiple crises (eg, climate, conflict, and migration) Horton calls for “the story of global health…to be rewritten”….

“Horton misses a vital point. A new narrative emerged over the past 25 years, namely that global health is the international community’s only major success this century—an era defined by forever wars, terrorism, financial crisis, displacement, and climate disasters. This success was driven forward by the responses to HIV/AIDS, tuberculosis, and malaria…”

Jensen concludes: “… Global health is that 21st century success that has wider strategic significance. Without being triumphant, we should insist on the enduring relevance of the 21st century story of global health. A new narrative for global health can rightly start from here.”

G20 & G7 Health & Development partnership -Beyond Aid: Restructuring Global Health for an Uncertain Future

By Emmanuel Lacresse, Global Ambassador and Alan Donnelly, Chairman  https://g20healthpartnership.com/beyond-aid-restructuring-global-health-for-an-uncertain-future/

With a fair amount of blabla. “We gather in Paris today for the G7 France 2026 Conference on International Development Assistance at a critical juncture for international development and for global health…”

Sketching three pillars for reform. And a roadmap with 6 key commitments. “The G20-G7 Health and Development Partnership is committed to delivering on six key areas, including the creation of a global taxonomy for health investments and the development of the International Development Aid Council….”

CGD- Partnering with Philanthropy: Strategies and Lessons from Development Agencies

R Calleja et al ; https://www.cgdev.org/blog/partnering-philanthropy-strategies-and-lessons-development-agencies

“In early February, the Rethinking Development Cooperation (RDC) Working Group convened a meeting on how development agencies are engaging with philanthropic organizations as partners in development. At a time when official development budgets are declining and needs remain high, development agencies are increasingly looking to new forms of partnerships to make the best use of the resources available.”

“In this blog, we draw on our recent RDC conversation to highlight current approaches for partnering with philanthropy. Our discussion revealed that while most recognize that philanthropic funding is unlikely to fill the sizeable gap left by public sector withdrawal, the distinctive characteristics of philanthropic actors – including higher risk tolerance and greater flexibility – offer opportunities to leverage complementary strengths to support shared development aims….

Featuring three recommendations for working with philanthropy.

LSE (working paper) – Gender justice and the wellbeing economy: the feminist case for an alternative economic paradigm

Kabeer Naila et al ; https://researchonline.lse.ac.uk/id/eprint/138143/

Exploring the interactions between economic inequality, climate change and gender injustice.

Ecological Economics – An international plan for sustainable development

Adrien Fabre  et al; https://www.sciencedirect.com/science/article/abs/pii/S092180092600128X

“International cooperation on climate and taxation remains inadequate to deliver decarbonisation, reduce poverty, and finance sustainable development at the required scale. We propose a Sustainable Union among willing countries, combining carbon pricing, new taxes on wealth, polluting fuels, financial transactions, and corporate income, with international revenue-sharing and conditional cooperation mechanisms. Most revenues would remain with participating governments for domestic spending, while a defined share would be pooled internationally. Specifically, participating countries would contribute 1% of gross national income (GNI) to a common pool redistributed in proportion to population, generating net transfers from richer to poorer countries. Meanwhile, the remainder of the revenue would increase domestic fiscal space by on average 2.2% of GNI. ….”

WHO Bulletin – Systemic path to global health 2050

J Sturmberg, E Paul et al ; https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.25.293951.pdf?sfvrsn=7337b1bf_3

“In this paper, we approach the goal of improving global health from a foundation that is both epistemological (that is, how we know and understand health) and normative, in that it makes claims about how health systems ought to be designed and governed…..”

“In 2024, the Lancet Commission on Investing in Health proposed targeting investment in 15 priority conditions through 19 modular interventions to improve global health by 2050. While pragmatic, this approach may not fully capture the complex, adaptive nature of health and health systems, nor their social, economic and political determinants. In an iterative, interpretive analysis, proposed global health investment frameworks were mapped against complexity, systems thinking and health epistemology frameworks; five thematic areas were identified for further development: (i) health as emergent from interdependent, social–biological systems; (ii) the non-biomedical determinants driving inequities; (iii) health systems’ adaptive requirements; (iv) epistemic injustices that marginalize non-Western perspectives; and (v) the need for context-sensitive, community-led implementation of health measures. Recent major disruptions to international aid financing, while challenging, present a unique opportunity to redesign health investment on more sustainable and locally grounded foundations, where national governments deliberately invest in the social determinants of health as direct health improvement strategies rather than merely as adjacent social policy. To seize this opportunity, we propose five guiding principles for policy-makers: (i) community coproduction of interventions; (ii) adaptive governance structures; (iii) complex systems literacy in workforce training to navigate interdependencies and uncertainty; (iv) cross-sectoral partnerships to address determinants of health; and (v) context-sensitive metrics that incorporate community engagement to support learning within health systems. These are not optional enhancements to existing approaches; they are the foundations without which any health investment strategy will continue to treat the symptoms of inequity rather than its causes.”

A Roadmap for Eradicating Poverty Beyond Growth

https://www.neep-poverty.org/roadmap-for-eradicating-poverty-beyond-growth/

 “The Roadmap for Eradicating Poverty Beyond Growth (an advance copy of which can be downloaded here) is a project spearheaded by the UN Special Rapporteur on extreme poverty and human rights to expand the range of policy options available in the fight against poverty, beyond those that rely on economic growth…..”

With five pillars.

More on Global Health Governance & Financing/Funding

Devex –  US threatens UN funding halt unless conditions met

https://www.devex.com/news/exclusive-us-threatens-un-funding-halt-unless-conditions-met-112382

“Internal Trump admin memos demand deeper cost cuts, insist U.N. chief reject China funds.”

“The Trump administration has threatened to withhold hundreds of millions of dollars in funding to the United Nations unless it agrees to a slate of nine “quick win” reforms — ranging from deeper cost cuts to measures that would block China from channeling tens of millions of dollars each year to a discretionary fund housed in the office of the U.N. secretary-general. The threat is laid out in one of two diplomatic notes circulated by the U.S. over the past week to diplomats in Geneva and New York, both of which were obtained by Devex in recent days. “

“The documents detail Washington’s priorities at the world body through the end of 2026 — and while the U.S. acknowledges recent steps by the U.N. to reduce staff benefits by 15% and eliminate as many as 3,000 posts, it makes clear that more will be required if Washington is to meet its treaty obligations to pay its U.N. dues in full….”

“… conditions include overhauling the U.N. pension system, ending long-distance business class travel for some senior and all mid-level professionals, and imposing additional cuts in posts in the U.N.’s senior ranks….”

PS: “… The U.S. owes the U.N. $2.2 billion toward its regular budget, along with $1.8 billion for a separate budget to support U.N. peacekeeping missions. It also has accumulated well over $1.5 billion in long-standing arrears, the result of a congressionally-imposed 25% cap on U.N. peacekeeping contributions, below the rate assessed by the United Nations, according to the Better World Campaign.  …”

PS: “… One of the priorities — which appears in both lists — is to push the U.N. secretary-general to stop accepting single-donor trust funds held within his executive office and to relocate any existing trust funds out of his domain.  A well-placed diplomatic source told Devex the policy is largely aimed at the U.N. Peace and Development Trust Fund. Neither the U.S. Mission to the U.N. nor the U.S. State Department responded to requests for comment in time for publication. Still, the push fits squarely within the Trump administration’s broader strategy of countering China’s influence at the U.N., and would drive a key pot of Chinese money from a privileged perch inside the U.N. secretary-general’s office….”

CGD (blog) – Dealing With the Legacy of Billions to Trillions

C Kenny;  https://www.cgdev.org/blog/dealing-legacy-billions-trillions

Kenny concludes:  “Everyone involved in global development should by now understand that “we are going to leverage the private sector to deliver this” most often means “we are not paying to deliver this.” And especially if the outcome is in a sector like education or health or most of infrastructure, where the private sector isn’t already a dominant player, it nearly always means “this isn’t going to get delivered.””

“It is time for more than the odd acknowledgement that the billions-to-trillions slogan over-promised. The idea lives on even if the slogan is being left behind, causing immense harm to the effective delivery of aid finance and the credibility of climate agreements, as well as refocusing support away from where it can do the most good. It sets up a narrative of failure for an international system, reduces trust, and provides an excuse not to act.”

“We need an honest reckoning: about what is affordable, about where it makes more sense for the public sector to directly invest, about more realistic ways to spark structural transformation in the poorest countries—and about the role of development finance institutions. A real reckoning would accept that, especially in the countries that need both development assistance and a stronger private sector the most, the current donor model of private sector engagement isn’t working. As well as thinking through what that implies for engagement models, it suggests the need for realism about the level of public sector investment to meet sustainable development targets and how to find resources for that investment. The simple math of development finance suggests that public finance is more sustainable at scale. Such a reckoning seems a worthy subject for a G20 high-level panel…..”

SSM Health Systems – International Monetary Fund and World Bank influence on domestic health financing sources: A mixed-methods case study of Senegal

Frederik Federspiel et al;  https://www.sciencedirect.com/science/article/pii/S2949856226000139

“IMF/WB influence on health financing policy in Senegal has evolved from promoting cost sharing before 2002 to expanding government health spending and community-based health insurance after 2002.  General public sector austerity and promotion of private health service delivery has however been maintained over time.  Within this mixed IMF/WB influence, domestic government health spending has not increased in real terms between 2006 and 19, and user fees remain the predominant source of health financing.  Broad IMF social sector spending floors have been ineffective at raising real-term government health spending levels, and a specific government health expenditure floor at 10–15 % of general government expenditure could be considered.”

BMJ GH – Aid withdrawal: an event study of mortality, vaccine coverage and DALY following transitioning from Gavi support

K Ming Isabel Yan, Erin Bendavid et al; https://gh.bmj.com/content/11/4/e020781

“This study investigates the health impacts of transitioning from Gavi, the Vaccine Alliance, on vaccination coverage, infant and under-5 mortality, and disability-adjusted life years (DALYs) in low and middle-income countries between 2000 and 2021. “

“This study provides robust evidence that transitioning out of Gavi support leads to significant short-term and medium-term negative effects, including a 1.94 percentage point increase in children receiving no basic vaccines, rises in infant and under-5 mortality by 7.59 and 17.31 per 1000 live births, respectively, and an increase in disability-adjusted life years by 1264 units per 100 000 population, with the most pronounced impacts during the accelerated transition phase.”

Aidspan – “Transition” is the Word: What the Global Fund’s new allocation letters really mean

https://www.linkedin.com/pulse/transition-word-what-global-funds-new-allocation-letters-really-brwcf/

“Since 13 March 2026, the Global Fund to Fight AIDS, Tuberculosis and Malaria has been sending out its Grant Cycle 8 (GC8) Allocation Letters to countries around the world. These letters are not just routine paperwork; they are the roadmap for how countries will spend money from 2027 to 2029 to fight these three diseases. However, this year’s letters come with a stark warning: there is less money available, and the era of relying on foreign aid is coming to an end for many nations. This article breaks down what these letters say, what has changed, and what it means for people who are affected by the three diseases….”

The Lancet Commission on the European Health Union: strengthening the union for and through health

T Bärnighausen et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00807-X/fulltext

“We have thus formed the Lancet Commission on the European Health Union, bringing together 23 Commissioners from 15 countries with expertise spanning health policy, health economics, health systems research, clinical practice, public health, behavioural science, social and structural determinants of health, data science, innovation research, global health governance, economics, and ethics. The Commissioners are supported by a Secretariat at the Heidelberg Institute of Global Health, Heidelberg University, Germany. Working across a range of thematic areas, this Commission aims to make the case for a substantially expanded and strengthened European Health Union and recommend concrete policies and actions to implement it. Our work spans several broad themes ….”

Including:  “… the seventh theme addresses the responsibility and roles of the EU in global health, building on the EU Global Health Strategy (2022) and working with partners worldwide to boost health care and health in countries connected to Europe through history, trade, and shared health risk exposures…”

David Clarke – Accountability Systems Under Pressure

https://www.linkedin.com/pulse/accountability-systems-under-pressure-david-clarke-3g5ie/

“Two stories this week. Different sectors, different jurisdictions, different policy mechanisms. Together, they raise a question that governance practitioners across health systems are actively working on: how do accountability frameworks keep pace with complex, fast-moving industries?  … “How do accountability frameworks adapt as the industries they govern become more complex, more global, and more technically sophisticated? That is the tractable policy question this week’s evidence helps to sharpen.”…

More in particular, in this newsletter issue Clarke focuses on: “… Pharmaceutical bribery enforcement and AI health regulation are different problems. But they surface a related governance challenge that practitioners across health systems are actively engaging with: how do accountability frameworks, designed at a particular moment, for a particular set of conditions, adapt as the industries they govern become more complex, more global, and more technically sophisticated?…”

Focus 2030 (special edition) – French Presidency of the G7: what are its ambitions in terms of combating global inequality and promoting development?

Focus 2030;  

With  Evian approaching (15-17 June), this issue provides an overview of some of the priorities of the French G7 presidency. More in particular, re (1) Reducing global macroeconomic imbalances & (2) Reforming the global development framework.  Also exploring whether the G7 provides an opportunity to reform the international financial architecture.

 PS: a G7 Development Ministers meeting took place on 29 April.

The Conversation – Philanthropy is reshaping global health. Here’s how

A Littoz-Monet; https://theconversation.com/philanthropy-is-reshaping-global-health-heres-how-280942

With focus on: …”philanthropic organisations are increasingly producing the data, research, and knowledge infrastructures through which global health problems are known, prioritised and eventually governed. This shift is often presented as pragmatic, in the face of constrained budgets and an urgent global health crisis. Yet the expanding epistemic presence of philanthropic actors in global health is interrogating, when it shapes the very frameworks though which health issues are understood….”

Financing for Development Forum New York (20-24 April)

Took place last week.

IISD – ECOSOC Financing for Development Forum Reaffirms Sevilla Commitment

https://sdg.iisd.org/news/ecosoc-financing-for-development-forum-reaffirms-sevilla-commitment/

“The FfD Forum’s outcome document emphasizes the potential of actions listed in the Sevilla Commitment to close the SDG financing gap and accelerate the Goals’ delivery. It also prioritizes mobilizing private capital at scale and calls for blended finance to be more closely aligned with national priorities and development impact. The text recommits Member States to, inter alia: preserve the multilateral trading system; advance reform of the international financial architecture; strengthen developing countries’ voice in global economic governance; and improve data and statistical systems to support evidence-based policymaking.”

·         See also In brief – Forum on Financing for Development

“UN Member States concluded the Financing for Development Forum by adopting a consensus outcome document reaffirming the 2025 Sevilla Commitment as the global road map to fund sustainable development.  The agreement targets closing a $4 trillion annual financing gap and advancing the SDGs, with a focus on mobilizing private capital, reforming global financial systems and strengthening data capacity.  Contentious negotiations over language on conflict and tax cooperation were resolved through votes and amendments….”

·         And we already flagged this UN News report, in a previous IHP newsletter issue – Time running out on development goals as finance dries up, UN warns.  (20 April)

Global Policy – While Official Development Assistance collapses, work on alternatives is too slow

Bodo Ellmers; https://www.globalpolicy.org/en/news/2026-04-14/while-official-development-assistance-collapses-work-alternatives-too-slow

(15 April)   This analysis was written ahead of the Financing for Development Forum in New York.

“This month, the United Nations (UN) and the Organisation for Economic Co-operation and Development (OECD) almost simultaneously released reports on development finance. The OECD’s data on official development assistance (ODA) for 2025 revealed a dramatic 23.1 percent decline in a single year – the largest drop the world has ever seen. The UN’s Financing Sustainable Development Report 2026 explores whether other sources of finance might fill this growing development financing gap.”

“The Financing for Development Forum [is being] convened in New York from 20-24 April 2026. In preparation, the UN’s Financing for Sustainable Development (FSD) Report was launched on 9 April. The report focuses on three action areas of the FfD agenda, namely private finance, trade, and data and follow-up. …”

“Mobilising more private capital is often presented as an alternative to declining ODA. However, research carried out for the FSD report shows that private capital is not a viable alternative for low-income countries as long as borrowing costs remain at such an elevated level. … Private capital remains unaffordable for many countries as the price of money is simply too high. “

“Even foreign direct investment by transnational corporations – most of it in the form of equity investment where investors want to make profit but carry the risk – is on a downward trend. The Compromiso de Sevilla, the political agreement made at FfD4, contains commitments that aim to reduce the costs of capital – for example, by addressing the system of credit ratings and harmful financial regulation that put unnecessary burdens on banks and drive up the risk premiums for investments in the global South. 

Taxation – the other alternative to ODA – is making some progress, but it is very slowly indeed. In the 22 years from 2000 to 2022, the average tax ratio in LDCs increased by just two percentage points, from 10 percent to 12 percent of Gross Domestic Product (GDP). It remains a fraction of the ratio seen in OECD countries. To make things worse, tax systems in developed economies are around six times more redistributive than in developing countries. In other words, the tax system does little to transfer wealth or income from the rich to the poor, particularly in countries where a large part of the population lives in poverty. The Compromiso includes commitments to address tax evasion by the super-rich, and to improve tax transparency and international cooperation so that developing countries can collect more tax. …“

Impact aid cuts

NYT – AIDS Creeps Back in Parts of Zambia, a Year After U.S. Cuts to H.I.V. Assistance

https://www.nytimes.com/2026/04/25/health/pepfar-hiv-aids-zambia.html?unlocked_article_code=1.dlA.Yxc_.kc8erneqlZRC&smid=nytcore-ios-share

This article went viral over the weekend. “A once-robust H.I.V. treatment and prevention system, credited with saving hundreds of thousands of lives, has begun to crumble.”

PS: “…. The State Department is negotiating new health assistance funding agreements with countries that used to have U.S.A.I.D. support. These come with conditions, and Zambia’s has proved particularly thorny, because the State Department has tied support for the H.I.V. program to access to the country’s minerals.  The department has warned Zambia that if no agreement is signed by April 30, all U.S. support will end.  Zambia still has the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, but that fund is also heavily reliant on the United States and is cutting its budget….”

“… Without a deal, Zambia will have to take over buying and moving antiretroviral drugs, laboratory chemicals, and H.I.V. tests itself; it is entirely ill prepared to do so. “If the stocks we have are the last we will get, what will we do?” Ms. Lubwesha said. “I always think about it. It will mean death.”   … … Under the terms of a draft agreement seen by The New York Times, Zambia would agree to hire thousands of new health workers, to replace those once paid by the United States. Dr. Mulenga hopes many will be community health workers who can restore some of the outreach that kept people in care.”

Devex – Aid cuts and a failed deal: Zimbabwe’s frontline health care under strain

https://www.devex.com/news/aid-cuts-and-a-failed-deal-zimbabwe-s-frontline-health-care-under-strain-112357

“Deep U.S. foreign assistance cuts and the collapse of a $367 million health deal have disrupted the system sustaining Zimbabwe’s community health workforce.”  In-depth report.

CGD – Cholera Deaths Nearly Doubled in Africa in 2025. Cuts to Aid May Have Contributed

E Kandpal et al ; https://www.cgdev.org/blog/cholera-deaths-nearly-doubled-africa-2025-cuts-aid-may-have-contributed

“In October 2025, we published a blog documenting an emerging but as yet incomplete picture: cholera deaths were on the rise across several sub-Saharan African countries as US aid for water, sanitation, and hygiene (WASH) contracts were cancelled across the continent. Angola, the Democratic Republic of the Congo (DRC), Sudan, and South Sudan, alone, had accounted for over 3,500 deaths by mid-year. The full-year data are now in for 2025. The picture is, if anything, worse.”

“Across the continent, cholera killed approximately 7,500 people in 2025—nearly twice the roughly 3,800 deaths recorded in both 2023 and 2024. And while case counts are somewhat higher in 2025 than in 2023 or 2024, the death count is markedly higher: people who contracted cholera in 2025 were substantially more likely to die from it than in prior years. One likely reason: sick people are not getting the help they need. In 2023 and 2024 there were about 16 deaths per 1,000 cholera cases. In 2025, there were 23 deaths per thousand cases….”

PS: “Our original analysis of the link between cholera mortality and USAID cuts focused on WASH-specific US contract cancellations. This update takes a broader view, using Financial Tracking Service data on total humanitarian funding paid to cholera-affected countries from 2022 to 2025….”

Bilateral health agreements & US Global health strategy

Reuters – Ghana rejects proposed US health aid deal, citing data concerns, source says

Reuters;  

“ Ghana has rejected a bilateral health deal with the U.S., a source ‌familiar with the negotiations told Reuters, the latest stumbling block to the Trump administration’s effort to overhaul foreign aid.

The government of President John Dramani Mahama balked at terms requiring the sharing of sensitive health data, the source said….”

“… The ​same issue sank talks with Zimbabwe this year and also prompted a court to suspend implementation of ​Kenya’s deal pending the hearing of a case filed by a consumer protection ⁠group…..”

·         See also HPW – Ghana Rebuffs US Health Deal – But South Africa and Zambia Struggle Without Aid

“‘Trade over aid’: The terms of the Memorandums of Understanding (MOU) that the US is seeking with key countries, as part of its “America First Global Health Strategy” (AFGHSD), are overwhelmingly transactional. This week, the US entrenched this approach at the launch of its ‘Trade over Aid’ initiative at the New York Stock Exchange, asserting that the free market is the “surest route to economic prosperity””

“Ghana is Africa’s largest gold producer. It is unclear whether the US tried to use its aid offer to extract minerals, as it has in other countries. However, this is unlikely to have gone down well as Ghana is clamping down on foreign mining operations. In the past few weeks, the country’s Minerals Commission has given three international firms until the end of the year to transfer their gold mining operations to locals….”

“Ghanaian President John Mahama is also championing the “Accra Reset”, launched last year to encourage African countries to invest more of their domestic budgets in their health and depend less on aid. At the same time, Ghana is heavily indebted and recently held off paying newly recruited nurses as it lacked the finances….”

Devex Pro – Scoop: USAID watchdog launches system to flag diverted health supplies

https://www.devex.com/news/scoop-usaid-watchdog-launches-system-to-flag-diverted-health-supplies-112405

“For the first six months, the project will focus on the U.S. government’s Global Health Supply Chain project, an initiative whose future is still up for debate.”

“The USAID Office of Inspector General is launching a new partnership to detect diversion across the global health commodities that the U.S. ships abroad, creating a system that will flag medications if they show up in a place they aren’t supposed to be.  “This [memorandum of understanding] will strengthen USAID OIG’s investigations into diversion, fraud, and other risks to the pharmaceutical supply chain by leveraging technology to improve visibility, oversight, and coordinated action against the misuse or theft of U.S.-funded global health commodities worldwide,” Sean Bottary, the OIG’s acting assistant inspector general for investigations, wrote in a statement.

Trump 2.0

Devex – House foreign affairs funding bill takes aim at UN, 6% cuts overall

https://www.devex.com/news/house-foreign-affairs-funding-bill-takes-aim-at-un-6-cuts-overall-112412

(gated) “The House Appropriations Committee approved the NSRP appropriations bill on a party-line vote on Tuesday. The bill proposes $47.32 billion, with multilateral institutions, global health, and humanitarian assistance all taking a hit.”

Politico –  RFK Jr. is holding up $600M in vaccines for poor countries

https://www.politico.com/news/2026/04/28/rfk-vaccines-gavi-thimerosal-00893645

RFK Jr … “is holding up $600 million Congress appropriated for the vaccines to pressure the international humanitarian group, Gavi, that distributes them….”

“The U.S. co-founded Gavi a quarter-century ago to get vaccines to the world’s poorest nations and Congress has long provided a big chunk of its budget. But Gavi says it hasn’t received the money it’s due for the current and last fiscal years, which makes up about 15 percent of its budget. The funds are set to expire on Sept. 30 if the Trump administration doesn’t release them…. …. Gavi’s funding is officially controlled by the State Department, but Kennedy’s influence shows how his skeptical views about vaccines are still affecting government policy…..”

PS: “Kennedy told Shaheen that his health department and the State Department are also concerned Gavi would funnel U.S. funding to the WHO. Kennedy said Gavi has refused to say whether it would do that. Both Gavi and the WHO are based in Geneva, Switzerland. Gavi declined to comment on the issue. “We are continuing to engage with the U.S. government and cannot comment further at this stage,” Gavi said in its statement.”

“Sania Nishtar, its CEO, told the newswire AFP in an interview Friday that the lack of U.S. funding combined with cuts from other donors has hit Gavi’s malaria program the most. Gavi has helped deliver 39 million doses of a new malaria vaccine to 25 African countries where the disease is endemic and has been killing mostly children under 5 years old….”

Stat – AIDS group sues Trump administration over undisclosed agreement with Gilead

https://www.statnews.com/pharmalot/2026/04/28/aids-activist-group-sues-trump-administration-gilead-agreement/

“The agreement was at the heart of a settlement between the government and Gilead over patents for HIV prevention.”

“An AIDS activist group filed a lawsuit against the Trump administration for failing to disclose a research and development agreement that was at the heart of a settlement between the U.S. government and Gilead Sciences over patents for HIV prevention.  The settlement resolved a contentious lawsuit that was filed six years ago by the previous Trump administration after the Centers for Disease Control and Prevention maintained that Gilead infringed its patent rights. The agency had helped fund academic research that later formed the basis for two Gilead HIV pills, Truvada and Descovy.  The administration had alleged that Gilead ignored the contributions by CDC scientists, exaggerated its own role in developing HIV prevention drugs, and refused to sign a licensing agreement despite “multiple attempts” at reaching a deal after unfairly reaping hundreds of millions of dollars from research funded by taxpayers….”

Stat  – Fauci adviser David Morens indicted on charges of concealing emails, avoiding records requests

https://www.statnews.com/2026/04/28/fauci-adviser-david-morens-indicted-concealing-emails-avoiding-foia/

“Charges come after lengthy congressional probes related to the origins of SARS-CoV-2.” (well, you can’t expect anything less from Trump’s criminal henchmen)

“David Morens, a former top National Institute of Allergy and Infectious Diseases official, was indicted yesterday on allegations that he concealed records from Freedom of Information Act requests. In the legal filing, Trump administration officials claim that Morens hid and falsified records to undermine debate about the origins of the virus that spurred the Covid-19 pandemic — and received kickbacks for doing so. Morens’ indictment comes after lengthy congressional investigations into the Department of Health and Human Services’ handling of the pandemic — especially issues related to the origins of the virus. ….”

UHC & PHC

Lancet – WHO global rehabilitation indicators meet rising health needs

W de Groote et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00744-0/fulltext

“At its 158th Executive Board, the Director-General of WHO presented a report outlining global indicators to monitor the integration of rehabilitation into health systems. The indicators were selected following a member states consultation between November, 2024, and March, 2025. This milestone follows the 2023 World Health Assembly (WHA) 76.6 Resolution for strengthening rehabilitation in health systems, which calls for developing rehabilitation services at all levels of the health system to address huge unmet population needs…. “

“In response to the WHA Resolution’s request, an additional effective coverage indicator was developed, methodologically requiring the selection of a tracer health condition, to serve as a tracer indicator for health system performance assessment. The WHO global rehabilitation indicators are intended to shift the focus of global health assessment from mortality and morbidity to include functioning as a third fundamental health outcome…. … The WHA Resolution requests the WHO Director-General to publish the first global status report on rehabilitation and the global indicators could serve as a baseline. These metrics must be integrated into national health information systems with the support of WHO, non-state actors, development partners, and academic institutions. By adopting and funding data collection for these indicators, countries can make rehabilitation visible, ensuring that every person affected by disease or injury, every ageing person, and everyone experiencing disability has a measurable path to a life of independence and participation.”

TB Vaccine Accelerator Forum  (27-28 April) & more on TB

“WHO hosted the first global Tuberculosis Vaccine Accelerator Forum from 27-28 April 2026. The Forum [brought] together global, regional and country-level health leaders, stakeholders, funders, representatives of TB Vaccine Accelerator working groups and other vaccine development partners to review progress made, from product development through to implementation preparedness for novel TB vaccines for adults and adolescents…..”

·         For more, see WHO – Global forum takes stock of progress on new TB vaccines for adults and adolescents 

“Participants at a technical summit on progress to accelerate availability of and access to novel tuberculosis (TB) vaccines for adults and adolescents reviewed activities underway through the TB Vaccine Accelerator working groups and other initiatives.  “

…“For the first time in over a century, new, effective TB vaccines for adults and adolescents are within reach that have the potential to drive down illness and deaths and generate significant savings for health systems and households alike,” said Dr Jeremy Farrar, WHO Assistant Director-General for Health Promotion, Disease Prevention and Care, in his opening remarks at the Forum.  …”

BMJ GH – Orchestrating faster access to products of non-profit R&D: a case study of a novel regimen for drug-resistant tuberculosis

S Moon et al; https://gh.bmj.com/content/11/4/e021596

“Non-profit product development partnerships (PDPs) have succeeded in bringing nearly 80 new drugs, vaccines and diagnostics for neglected diseases through regulatory approval, but arrangements to ensure they reach patients are unclear since the usual commercial incentives do not apply. We conducted a case study of how unusually fast access was achieved to a new treatment regimen for drug-resistant tuberculosis (DR-TB) developed by the TB Alliance (TBA). Over 100 countries procured the regimen in quantities to reach 67% of global demand by 2024, 5 years after first regulatory approval and 2 years after the WHO recommended it for routine use. What interventions contributed to this rapid rollout, and what role did the PDP play?…”

·         And related press release:    TB Alliance – Academic Study Finds TB Alliance’s Access Approach Successfully Accelerated Uptake of New TB Treatments

“A new peer-reviewed study led by the Geneva Graduate Institute finds that TB Alliance’s approach to expanding access to new treatments for drug-resistant tuberculosis (DR-TB) has been highly effective, demonstrating how coordinated, nonprofit-led efforts can rapidly translate scientific innovation into real-world impact on people affected by TB.”

“Published in BMJ Global Health, the study examines how access to pretomanid and the BPaL/M regimens, developed by TB Alliance, expanded at an unprecedented speed. These newer regimens shorten DR-TB treatment, reduce the burden on people and health systems, and improve treatment outcomes. By 2024, more than 100 countries had ordered pretomanid in volumes sufficient to meet approximately 63% of global demand—just two years after the World Health Organization recommended the BPaL/M regimens for the treatment of most forms of DR-TB. This represented a significantly faster pace than had typically been seen in global health, where access to new innovations historically took 7-9 years to scale broadly.”

“… The study identifies TB Alliance as a central orchestrator in accelerating access, coordinating a wide range of interventions across regulatory, market, and country implementation domains. These included supporting regulatory and normative processes, shaping markets to ensure affordability and availability, and enabling countries to adopt and scale new regimens through knowledge generation, stakeholder engagement, and technical assistance.”

PS: “Lead author, Professor Suerie Moon, Co-Director of the Global Health Centre at the Geneva Graduate Institute, emphasized the broader implications of the findings, noting, “This study shows that nonprofit drug developers can deliver rapid patient access, but it’s far from simple. It requires orchestrating a complex set of interventions and actors across multiple levels over many years, starting already in the R&D phase. Nonprofit product developers, like TB Alliance, are well positioned to do so because of their knowledge, relationships, and public interest missions, but they need clear mandates and sustained support to do so effectively…..”

More on Health Emergencies

TGH –  Tracking Measles and the World’s Vaccine-Preventable Diseases

https://www.thinkglobalhealth.org/article/vaccine-preventable-disease-a-global-tracker

(IHME Resource)    “Think Global Health’s disease tracker allows people from all regions to follow how and where these outbreaks develop alongside global shifts in access to vaccines. This weekly map visualizes outbreaks of nine childhood diseases in collaboration with the International Society for Infectious Diseases….”

Covid

Stat – What happened to Covid?

Stat ;  

Interesting & recommended analysis. “The threat of the virus has clearly subsided, but opinions vary on how much and who remains at risk.”

“In 2020 and 2021, the SARS-CoV-2 virus killed an estimated 15 million people across the globe. Six years later, it’s mostly a political football. Over the past two winters, the flu sickened more people than Covid. So what happened? STAT’s Helen Branswell spoke with experts about the changing Covid landscape, including the latest on immunity, deaths, booster shots, and more.  “The patterns indicate that new strains are relatively more capable of overcoming our immune responses, but the infection outcomes are more mild,” virologist Vineet Menachery wrote in an email. While some experts believe that Covid has developed into more of a nuisance illness than a perilous threat, not everyone agrees. …”

“… Most experts suggested we and the virus have changed so much in the years since SARS-2 first emerged that, for many people, it’s effectively become one of the panoply of respiratory viruses that can sicken us, like flu or RSV or the viruses that cause what we call the common cold. But for some individuals, it still represents a significant risk….”

PS: “A further sign of the times: Gavi, the Vaccine Alliance, which helps lower-income countries purchase vaccines, discontinued its support for Covid vaccine purchases at the end of 2025….”

NCDs & Commercial Determinants of Health

WHO – Efforts to eliminate hepatitis delivers gains but more action needed to meet 2030 targets

https://www.who.int/news/item/28-04-2026-efforts-to-eliminate-hepatitis-delivers-gains-but-more-action-needed-to-meet-2030-targets

“Global efforts to combat viral hepatitis are delivering measurable progress in reducing infections and deaths, but the disease remains a major global health challenge, according to a new World Health Organization (WHO) report released today at the World Hepatitis Summit.”

“Viral hepatitis B and C – the two infections responsible for 95% of hepatitis-related deaths worldwide – claimed 1.34 million lives in 2024, the latest data show. At the same time, transmission continues, with more than 4900 new infections every day, or 1.8 million each year.”

“The 2026 Global hepatitis report documents significant gains made since 2015. The annual number of new hepatitis B infections has dropped by 32% and hepatitis C-related deaths have fallen by 12% globally. Hepatitis B prevalence among children under five has also decreased to 0.6%, with 85 countries achieving or surpassing the 2030 target of 0.1%….”

“ … Updated WHO estimates indicate that 287 million people were living with chronic hepatitis B or C infection in 2024.   That year, 0.9 million people were newly infected with hepatitis B. The WHO African Region accounted for 68% of new hepatitis B infections, yet only 17% of newborns in the region received the hepatitis B birth-dose vaccination.  …. A further 0.9 million hepatitis C infections were recorded in 2024. People who inject drugs accounted for 44% of new infections, highlighting the urgent need for stronger harm reduction services and safe injection practices.

“Of the 240 million people with chronic hepatitis B in 2024, fewer than 5% were receiving treatment. Only 20% of people with hepatitis C have been treated since 2015, when a new 12-week treatment with a cure rate of about 95% became available….. As a result of limited access to prevention and care, in 2024 an estimated 1.1 million people died from hepatitis B and 240 000 from hepatitis C.”

Lancet (Diabetes & Endocrionoly) series on Diabetes

https://www.thelancet.com/series-do/diabetes-in-sub-saharan-africa

“Diabetes is one of the fastest growing global health challenges of the 21st Century with the rate of increase projected to be highest in Sub-Saharan Africa in the coming years. This rise is driven by a combination of biological, social, and economic factors, many of which are unique to the region and contribute to distinct and emerging clinical phenotypes that require context specific approaches. Current challenges include a scarcity of high-quality country data sources, weak healthcare infrastructure leading to delayed diagnosis, limited access to essential medicines and devices, and a high burden of diabetes-related complications.  This four paper Series  ( in The Lancet Diabetes & Endocrinology )   builds upon our previous Series published in 2017 and examines the burden and determinants of diabetes in sub-Saharan Africa, diabetes-related complications and multimorbidity, and strategies to strengthen diabetes care.”

Lancet Editorial – Liver health: a neglected aspect of the NCD agenda

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00710-5/fulltext

Editorial linked to  the  second EASL–Lancet Liver Commission with the aim of moving from evidence to implementation to achieve improved and sustainable liver health in Europe. (EASL stands for ‘European Association for the Study of the Liver’)

PS: “… There is now an opportunity for concerted action. Countries should adopt the upcoming WHA resolution and incorporate liver health into their NCD strategies….”

·         Related Lancet Commission: Implementing sustainable liver health in Europe: a second EASL–Lancet Commission  

Lancet Letter – Ultra-processed food policy must regulate the screen as well as the street

Y Hu ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00686-0/fulltext

“Gyorgy Scrinis and colleagues make a strong case for moving ultra-processed food (UPF) policy beyond narrow reformulation agendas towards broader fiscal, labelling, marketing, and retail measures. Yet one policy domain remains underdeveloped in this discussion: the digital food environment….”

“I therefore suggest one addition to the policy agenda proposed by Scrinis and colleagues: treat digital food environments as a policy domain in their own right…”

Human Resources for Health

BMJ GH – No health without workforce: reinforcing public health capacity amidst global shifts

T Correia et al ; https://gh.bmj.com/content/11/4/e020402

“Global shifts in funding, geopolitics and health priorities are threatening the sustainability of public health systems. A resilient public health system depends on a skilled, professionalised workforce capable of delivering essential public health functions. National Public Health Institutes, academic institutions and associations play a critical role in strengthening workforce capacity. Urgent policy action is needed to embed public health workforce development into national health planning and investment agendas.”

Women Deliver (Melbourne)

Devex Pro – The CEO reshaping Women Deliver after its reckoning

https://www.devex.com/news/the-ceo-reshaping-women-deliver-after-its-reckoning-112373

(gated)  “Taking the helm after allegations of racism and harassment rocked the organization, Maliha Khan is steering a transformation — questioning power, aid, and who should lead gender equality efforts.”

“Maliha Khan arrived as president and CEO of Women Deliver in 2022 as a “direct result” and as part of an “existential transformation” following allegations of racism and harassment within the global advocacy organization, she said.  A queer immigrant woman of color and a Muslim, her candid acknowledgement of her sexuality from the first day in the job marked a milestone in her professional journey. Nearly four years on, as the group gears up to host its flagship conference in Melbourne from April 27-30, during a time of heightened global instability, growing attacks on women’s rights, and funding pressures, Khan said that the organization had to ask some hard questions and is now a very different organization as a result.    ….”

““Women Deliver became a little bit of a poster child for something that’s very, very endemic within the system, within so many institutions and organizations,” says Khan, a queer immigrant woman of color and a Muslim.   “I’m not saying that those things weren’t true,” she adds. “It was symptomatic of so many other institutions and organizations. It just became a lot more public for Women Deliver, and therefore became a lot more existential for the organization to radically transform.”…”

“… But Khan was clear about what she thinks large development organizations should deliver, stressing that it’s on local people and national governments to cement change.  “I hope that the time of asking an international organization that frankly has no business to have accountability or to do work in these contexts is gone, and we actually move the right question, which is how have those institutions that are grounded in Africa, that are run by Africans, have that accountability,” she says….”

Melbourne Declaration for Gender equality

https://womendeliver.org/wp-content/uploads/2026/04/The-Melbourne-Declaration-for-Gender-Equality.pdf

The Melbourne Declaration for Gender Equality was launched earlier this week at the Women Deliver conference:  “…. the result of that collective work, our shared vision for gender equality rooted in care, solidarity and justice. A commitment to centering States’ human rights obligations to all people and the planet in the work we all do. ….”

“Rebalancing the Ecosystem for Accountability, Rights, and a Future of Gender Equality A world where States respect, protect, and fulfill human rights; where feminist movements and civil society have the resources, space, and legitimacy to hold States accountable; and where the wider gender equality ecosystem aligns its resources and influence behind that work.”

SRHR

Reuters – Pope Leo signals shift away from Catholic Church’s focus on sex

Reuters

“Pope Leo says sexual ethics should not take priority for Church; First U.S. pope says Church should focus on inequality, justice; LGBTQ Catholics praise pope’s approach.”

“Pope Leo‘s four-nation Africa tour featured firm denunciations by the ​pontiff of despotism and war and also unprecedented attacks from U.S. President Donald Trump that grabbed headlines. But a smaller moment, in which the ‌pope said the Catholic Church should prioritise questions of inequality and justice over those of sexual ethics, may prove to be of longer-lasting importance for the Church’s 1.4 billion members, said experts….”

“”The unity or division of the Church should not revolve around sexual matters,” Leo, the first U.S. pope, said in a press conference on his flight home on Thursday, answering a question ​about how the Church considers same-sex marriage. “I believe there are much greater and more important issues such as justice, equality… that would all take ​priority before that particular issue,” he said.”

“Marianne Duddy-Burke, executive director of Dignity USA, a group that supports LGBTQ Catholics, called ⁠the pope’s remarks “a very significant and overdue reorientation of priorities“. Priests and bishops in the global Church have long emphasised as high priorities its teachings on sexual ​issues, including its bans on abortion, birth control and same-sex marriage….”

“… Rev. James Keenan, an academic at Boston College, called Leo’s approach new for the global Church.  The pope is “stating that the Vatican has a hierarchy of concerns and the perception that matters of sexuality have singular priority of place is not the case,” said Keenan, a Jesuit priest who founded a global network of Catholic academics focused on ethical issues. “This is clearly a prudential judgment by the pontiff… that issues of blessing gay marriage ought not eclipse more ​immediate challenges of dictatorships and war,” ​said Keenan….”

Lancet Offline – Ten lessons for women’s and children’s health

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00801-9/fulltext

Five lessons from the past from Horton (building on the work so far of the RMNCAH movement), and five for the future.

Must-read.

Guardian – Toxins plus climate harms likely cause of reduced fertility, study finds

https://www.theguardian.com/science/2026/apr/26/toxic-exposure-climate-crisis-study

“Researchers find ‘alarming’ effect on fertility across global species from simultaneous exposures.”

“Simultaneous exposure to toxic chemicals and climate change’s impacts likely generates an additive or synergistic effect that increases reproductive harm, and may contribute to the broad global drop in fertility, new peer-reviewed research finds.  The review of scientific literature considers how endocrine-disrupting chemicals, often found in plastic, coupled with climate change’s effects, such as heat stress, are each linked to reductions in fertility and fecundity across global species – including in humans, wildlife and invertebrates….”

Devex Pro – Who decides how midwives are funded?

https://www.devex.com/news/who-decides-how-midwives-are-funded-112350

(gated) “Global health agencies agree on the need for more midwives, but fragmented budgets, donor dependence, and fiscal constraints are shaping who actually gets hired.”

“When global health leaders gathered in Nairobi, Kenya, for the International Maternal Newborn Health Conference, discussions reflected a growing urgency to accelerate progress in maternal and newborn health — but also exposed persistent gaps in how health systems are financed and sustained. One area where that gap is particularly visible is the midwifery workforce. The latest estimates point to a global shortage of nearly 1 million, a deficit that continues to widen even as midwives are widely recognized as capable of delivering up to 90% of essential maternal and newborn health services. But this consensus on their value hasn’t translated into consensus on who pays….”

Santa Marta conference in Colombia  (28-29 April)

With some news snippets from the conference, and towards the end of this subsection, overall analysis.

Guardian – New global panel aims to accelerate move away from fossil fuels

https://www.theguardian.com/environment/2026/apr/25/new-global-panel-aims-to-accelerate-move-away-from-fossil-fuels

“A panel of global experts has been launched to provide scientific input for countries that want to reduce their dependence on fossil fuels and manage the growing risks of high oil prices, geopolitical conflict and extreme weather damage.  The initiative was announced on the opening day of a groundbreaking climate action meeting in Santa Marta, where the Colombian hosts set out a draft roadmap for their own national energy transition….”

“… The new science panel for global energy transition is intended to add intellectual weight to those efforts. Experts in climate, economics and technology will offer advice to policymakers looking to create roadmaps out of the fossil fuel era.   Based partly on the model of the UK’s climate change committee, it includes national and sector-level milestones for eliminating fossil fuels in line with scenarios that return global heating to 1.5C by the end of the century.”

“The panel will be chaired by Vera Songwe, the Cameroonian co-chair of the High Level Expert Panel on Climate Finance; Ottmar Edenhofer, the German director and chief economist of the Potsdam Institute for Climate Impact Research; and Gilberto M Jannuzzi, a Brazilian professor of energy systems at Universidade Estadual de Campinas…. the initiative …  has been convened by Johan Rockström of the Potsdam Institute for Climate Impact Research and Carlos Nobre of the University of São Paulo…..”

·         See also  Climate Change News – New panel of climate scientists calls for fossil fuel transition roadmaps

 “A new panel of experts, bringing together some of the world’s top climate scientists, has called on governments to develop roadmaps for phasing out fossil fuels “anchored in science and justice”.  Launched on Friday in Santa Marta, Colombia, along with a set of 12 initial policy recommendations, the panel’s appeal came ahead of a key ministerial meeting on equitable ways to reduce dependence on coal, oil and gas during next week’s “First Conference on Transitioning Away from Fossil Fuels”….

“Science is here to serve,” Rockström said. “We’re today launching the Science Panel for the Global Energy Transition (SPGET) as a service, as a global common good for all countries, all sectors, all regions to connect to the best science enabling a transition away from fossil fuels.”  …. The panel is urging countries to create “whole-of-government” plans to “dismantle legal, financial and political barriers” to the energy transition. Its insights are intended to inform top officials from 57 governments who will gather in Santa Marta for high-level discussions on Tuesday and Wednesday.”

“… Under the 12 insights for the Santa Marta process, the panel recommended banning new fossil fuel infrastructure, mandating “deep cuts” in methane emissions, implementing carbon levies on imports, and de-risking clean energy investments via interventions from central banks, among others.”

Geneva Solutions -Nations committed to fossil fuel exit to gather in Santa Marta as new climate diplomacy takes shape

https://genevasolutions.news/climate-environment/nations-committed-to-fossil-fuel-exit-gather-in-santa-marta-as-new-climate-diplomacy-takes-shape

re a new kind of multilateralism.

“Colombia’s Caribbean port city is hosting an experiment in climate diplomacy this week – excluding the nations most responsible for holding it back…..

PS: “Campaigners are also pushing for the conference to lay the diplomatic groundwork for a fossil fuel non-proliferation treaty – a binding agreement to halt new coal, oil and gas extraction while phasing out current production in a just manner.  The proposal has broad backing from civil society and international organisations, including the World Health Organization. But government support has been slow to follow. Only a few dozen nations, mostly small island states with the most to lose, have thrown their weight behind it. That may be shifting. Colombia became the first major oil-producing nation to join in 2023…..”

Guardian –  Middle East crisis could cost world $1tn while oil firms make ‘obscene’ profit, analysis finds

https://www.theguardian.com/environment/2026/apr/28/middle-east-crisis-oil-firms-profit-colombia-conference

“Climate group calls for urgent windfall tax on excess fossil fuel profits, as delegates tell Colombia conference their nations are suffering.”

“Even if the strait of Hormuz swiftly returns to normal operations, the burden of elevated oil and gas prices will reach about $600bn, according to recent International Monetary Fund figures analysed by the climate campaign organisation 350.org. Should the supply disruption continue, the economic hit to households, businesses and governments could surge above $1tn, it said.”

“350.org has called for an urgent windfall tax on excess profits, which could raise money for social protection and investments in renewables that are cheaper, cleaner and more reliable than fossil alternatives….”

Ps: “In the longer term, the Planetary Guardians group of former statespeople, scientists and activists warned against propping up industries that were a cause of many of the world’s problems. Even before the Iran war, they calculated governments were spending $1.9m every minute, about $1.05tn a year, subsidising the fossil fuel system. Mary Robinson, a former president of Ireland, said: “Citizens pay for this three times over: at the gas pump, through taxes, and through the damage fossil fuels cause to public health, the planet, and economies.”  The Planetary Guardians estimate that for every dollar spent on direct fossil fuel subsidies, the poorest 20% of households receive just 8 cents, while the wealthiest 50%, who use more cars, air conditioning and planes, capture nearly 75% of the benefits….”

Guardian – Clean energy switch must not be excuse to plunder Indigenous lands, say leaders

https://www.theguardian.com/world/2026/apr/27/clean-energy-switch-must-not-be-excuse-to-plunder-indigenous-lands-say-leaders

“Global conference told benefits should not come at expense of well-protected environments.”

PS: “…. The International Institute for Sustainable Development (IISD) published research at the conference showing the vast financial support planet-heating fossil fuels continue to receive. In 2024, the report says, fossil fuels globally received $1.2tn of subsidies and other forms of support from the public purse, in contrast to the $254bn of support that went towards clean energy….”

Global movements unite in Santa Marta to launch “People’s Declaration for a Rapid, Equitable, and Just Transition for a Fossil-Free Future” ahead of historic climate conference

https://fossilfreerising.org/declaration-press-release

“The Declaration frames the climate crisis as a direct consequence of a global system rooted in capitalism, colonialism, and militarism, explicitly linking fossil fuel dependence to geopolitical aggression. It issues an urgent call to governments to recognize the massive ecological debt owed by the Global North to the Global South. “  “The coalition demands that the upcoming “coalition of the willing” commit to concrete binding mechanisms for a fast, fair, and funded fossil fuel phaseout—one that rejects false solutions and delivers unconditional, non-debt-creating public finance and full reparations essential for the survival of communities and the planet…..”

The declaration outlines 15 principles for a just transition.

Climate Change News –   Santa Marta: Ministers grapple with practicalities of fossil fuel phase-out

https://www.climatechangenews.com/2026/04/28/santa-marta-ministers-grapple-with-practicalities-of-fossil-fuel-phase-out/

“Around 60 governments that want to make progress on transitioning away from coal, oil and gas are meeting in Colombia to work out how they can do it an equitable way.”

“Meanwhile, a group of 18 nations – made up mostly of small island states and the host country Colombia – called on the summit to recognise the “urgent need to negotiate a new international instrument” for leaving coal, oil and gas beneath the ground.   They are pushing for the conference to back a formal negotiation process for a binding “Fossil Fuel Treaty” and to make progress on new mechanisms for international cooperation and finance, including an importers-exporters club, a global just transition fund and a debt resolution facility. …”

Guardian – ‘Suicidal’ model of capitalism leading to war and fascism, climate summit told

https://www.theguardian.com/environment/2026/apr/29/capitalism-colombia-climate-summit-gustavo-petro

“Colombia president Gustavo Petro tells 57-country talks on a green energy transition that fossil fuel interests could destroy humanity … The world is threatened by a “suicidal” model of capitalism that is leading to war, fascism and the potential extinction of humanity, Colombia’s president has said….”.

“Gustavo Petro blamed fossil fuel interests for taking ever more desperate measures to prevent a transition to green energy. “There is inertia in the power and the economy of this archaic form of energy – fossil fuels – that lead to death. Undoubtedly, that form of capital can commit suicide, taking with it humanity and [other] life,” he said. “The question that needs to be asked is whether capitalism can truly adapt to a non-fossil energy model.” “

Ps: “Some countries have already started working on roadmaps to phase out fossil fuels. Colombia published its draft plan last week and, on Tuesday, France became the first developed country to release a national roadmap to phase out fossil fuels, which included a timetable to remove coal from its national grid by 2027, end oil dependency by 2045 and fossil gas by 2050.”

PS: “… As countries got down to detailed discussions of timetables for action, and boosting low-carbon technologies, one key message emerged from developing countries and finance experts: that addressing debt must be a central plank of any global platform of climate action.  Tzeporah Berman, founder and chair of the Fossil Fuel Treaty Initiative, said: “There are many fossil-fuel producing countries in the global south that are being pushed into expanding fossil fuel production just to feed their debt. “There is an expanding debt crisis in the global south. It is impossible for countries to even imagine a fossil fuel transition with such limited fiscal space.”  Debt in Africa alone has doubled in the last five years to more than $1tn. Rising interest rates, imposed by central banks to dampen inflation caused in part by fossil fuel crises, are adding to the burden, while soaring fuel and food prices are placing further demands on stricken economies….”

AP – Countries end Colombia fossil fuel summit with focus on next steps and financing

https://apnews.com/article/climate-change-fossil-fuels-colombia-takeaways-fa4bc18a9ca20abcb61b26ba3aa9717a

Overall analysis & recommended.

“A first-of-its-kind international conference on moving away from fossil fuels wrapped up in Colombia Wednesday with a clear message: the global conversation has shifted from whether to phase out oil, gas and coal to how to do it, with financing emerging as one of the biggest obstacles….”

·         See also the Guardian –  ‘Historic breakthrough’: Colombia climate talks end with hopes raised for fossil fuel phaseout

“Nearly 60 countries back voluntary roadmaps to wean world off coal, oil and gas, at conference prompted by frustration with UN climate summits.”

·         And for an overview of all the key outcomes in Santa Marta, see Carbon Brief – Key outcomes from first summit on ‘transitioning away’ from fossil fuels

“Countries attending a first-of-its-kind summit have walked away with plans to develop national roadmaps away from fossil fuels, along with new tools to address harmful subsidies and carbon-intensive trade.”

More on Planetary Health

Climate Change News – New loss and damage fund could run out of money next year

https://www.climatechangenews.com/2026/04/24/new-loss-and-damage-fund-could-run-out-of-money-next-year/

“Unless there are more donations, the Fund for Responding to Loss and Damage could give out all its money by the end of 2027.”

Devex Pro – Could the 2026 Brazilian election derail COP30’s crown jewel?

https://www.devex.com/news/could-the-2026-brazilian-election-derail-cop30-s-crown-jewel-112384

“With Brazil’s election looming, the Tropical Forest Forever Facility faces a race to secure $10 billion, formalize governance, and prove it can survive a political shift.”

“Brazil is heading toward an Oct. 4 election in which opposition candidate Sen. Flávio Bolsonaro — the son of the former President Jair Bolsonaro, whose administration was widely criticized for weakening environmental enforcement — is statistically tied with Lula, according to a BTG Pactual/Nexus poll released Monday. Now, some fear that under a Bolsonaro presidency, Brazil could pull out of TFFF, depriving it of its most fundamental leader.  With donor countries under fiscal pressure and aid budgets shrinking, TFFF’s coffers hold $6.7 billion — short of the $10 billion needed by the end of 2026. The vehicle meant to receive those funds has also yet to be formalized….”

Guardian – Critical minerals are ‘oil of 21st century’ as demand fuels poverty and pollution in poorer countries

https://www.theguardian.com/global-development/2026/apr/29/critical-minerals-are-oil-of-21st-century-as-demand-fuels-poverty-and-pollution-in-poorer-countries

“Rush for lithium, cobalt and nickel is ravaging livelihoods, water and health of world’s most vulnerable, UN study says.”

“Critical minerals such as lithium, cobalt and nickel are becoming the “oil of the 21st century” as the scramble for precious metals deepens poverty and creates public health crises in some of the world’s most vulnerable communities, a report by the UN’s water thinktank has found.  The investigation by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) concluded that the growing demand for lithium, cobalt and nickel used in batteries and microchips is draining water supplies, eroding agriculture and exposing communities to toxic heavy metals….”

“… The report found that while EVs may reduce emissions by consumers in North America and Europe, the environmental and health costs are borne by communities far away, in the mining regions of Africa and Latin America….”

Access to medicines, vaccines & other health technologies

Aidspan (on LinkedIn)- Lenacapavir and the real access test

C D Kamgain; https://www.linkedin.com/pulse/lenacapavir-real-access-test-aidspan-u8ntf/

Must-read analysis. With focus on South-Africa.  A few excerpts:

“For a country hoping to bend the curve of a generalized epidemic, a few hundred thousand doses are a beginning, not a solution. The practical concern raised by South African officials and advocates is therefore well founded: if the country is serious about ending AIDS as a public health threat, it needs a far larger, more reliable and more affordable supply base than the current arrangements provide.  This also explains why the licensing question has become so contentious. In 2024, Gilead granted six voluntary licences to manufacturers in India, Egypt and Pakistan to supply 120 low- and middle-income countries. No South African manufacturer was included, despite South Africa’s major role in the epidemic, its research contribution, and its existing pharmaceutical base. Reuters reported that Gilead later indicated it was open to an additional licence for a South African producer, subject to assessment of manufacturing standards. That matters, because the issue is not only fairness. It is whether supply can be expanded in a way proportionate to need….”

“…. There is of course a political dimension, and it resonates strongly in South Africa. The argument over Lenacapavir recalls the country’s earlier battle over access to antiretroviral medicines, when 39 pharmaceutical companies challenged the South African government over the 1997 Medicines Act in a case that became a defining moment in the global access-to-medicines movement. That history matters because it reminds us that South Africa has long had to fight not only the virus, but also the rules governing who may produce and distribute life-saving tools.…”

“But the present dispute is not a simple replay of that earlier struggle. South Africa today is not merely demanding lower prices for imported products. It already manufactures antiretrovirals and pays for most of its HIV response from domestic resources. The stronger argument, then, is not just that Africa should not remain dependent on others in principle. It is that South Africa has both the epidemic burden and the institutional basis to justify a more central role in production. Putting such a country at the mercy of limited external allocations makes little strategic sense for South Africa or for the wider African response….”

And re the Global Fund & market shaping: “…. market shaping has limits. It is most effective when there are multiple producers, expanding manufacturing capacity and a pathway from donor-supported introduction to durable, large-volume supply. In the case of Lenacapavir, the problem is that supply still originates from a tightly controlled licensing architecture, with too few producers and volumes that remain small relative to need in high-burden settings. The Global Fund can shape that market; it cannot by itself create full manufacturing pluralism or override the strategic choices of the patent holder. That is why South Africa’s push for local production matters so much. It is not an alternative to market shaping. It is what market shaping needs to become structurally meaningful…..”

And so, this is “… the real access test. If Lenacapavir remains scarce, centrally controlled and dependent on narrow licensing decisions, it will remain a breakthrough for some rather than a turning point for the epidemic. If, however, South Africa can secure reliable supply, build or prove manufacturing readiness, and integrate the product into a response it already largely finances itself, then Lenacapavir could become something more important: not just a scientific advance, but a practical tool deployed at the scale a generalized epidemic demand.”

A Biopharmaceutical Superpower: China’s Rise, Its Limits, and What Comes Next

Yanzhong Huang ; https://cirsd.org/horizon-article/a-biopharmaceutical-superpower-chinas-rise-its-limits-and-what-comes-next/

“…This essay examines how China became a biopharmaceutical superpower, the drivers behind its rise, the implications for global health governance, the limits of its model, and the policy choices facing China and the United States….”

·         And a link:  Canada becomes the first G7 country to approve a generic version of semaglutide

Conflict/War & Health

Guardian – Calls for humanitarian corridor through strait of Hormuz as Iran war hits vital aid

https://www.theguardian.com/global-development/2026/apr/29/humanitarian-corridor-strait-of-hormuz-iran-war-hits-vital-aid

“Soaring oil prices and the blockade are preventing food, fuel and medicine being delivered to millions of people in desperate need, say NGOs.”

AI & Health

Nature Medicine (News) – Who owns my health data?

https://www.nature.com/articles/s41591-026-04378-7

“The geopolitics driving artificial intelligence superpowers is reshaping biomedical datasets, and who has access to them.”

Lancet (Comment) – Targeted advertising in generative artificial intelligence chatbots: a new public health risk

K Backholer et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00464-2/fulltext

“OpenAI has announced plans to introduce advertising within free and low-cost versions of ChatGPT, alongside voluntary safeguards including separation of advertisements from responses, privacy protections, exclusion of users younger than 18 years, and limits on advertising around sensitive topics such as health. This shift was predictable, given the substantial losses associated with capital-intensive artificial intelligence (AI) models and the proven profitability of targeted advertising on digital platforms, and could signal a broader industry pivot, with other providers likely to follow. From a commercial determinants of health perspective, this development warrants urgent scrutiny. The change extends advertising infrastructures that have long shaped social norms and consumption of health-harming products into conversational systems increasingly relied upon for therapeutic support, companionship, and sensitive advice….”

Miscellaneous

WB – Regional Launch of “Fit to Prosper”: Investing in Health for Jobs and Development in Western and Central Africa

https://www.worldbank.org/en/news/press-release/2026/04/27/regional-launch-of-fit-to-prosper-investing-in-health-for-jobs-and-development-in-western-central-africa

Coming up next week (4 May):   “Countries in Western and Central Africa face growing pressure on their health systems as financing tightens and health needs expand due to population growth, disease outbreaks, climate shocks, and a rising dual burden of disease.  In response, the World Bank Health, Nutrition and Population strategy, Fit to Prosper: Investing in Health for Jobs and Development in Western & Central Africa—aligned with the Accra Reset, the Lusaka Agenda, and the World Bank Group’s commitment to Universal Health Coverage—provides a framework to help countries prioritize and make strategic shifts within constrained fiscal space, while advancing the Africa Initiative for Medical Access and Manufacturing (AIM2030) to support local manufacturing of essential health products, strengthen health security, and create jobs….”

“The World Bank Group, in partnership with the Government of Ghana and the Global Financing Facility (GFF), will convene a high-level regional launch of the Strategy on Monday, May 4^th, 2026, in Accra. The launch will be presided by H.E. John Dramani Mahama, President of the Republic of Ghana….”

Devex (Opinion)- Why don’t proven health interventions reach people who need them?

By Dr. Tom Frieden et al; https://www.devex.com/news/why-don-t-proven-health-interventions-reach-people-who-need-them-112315

“The “best buys” approach in global health has led to progress but is fragmented, inefficient, and incomplete. Investing in specific, accountable delivery platforms outperforms funding interventions alone.”

Reuters – HIV patients in Senegal skip treatment, fearing arrest amid anti-LGBTQ crackdown

Reuters; 

“Unpublished data shows drop in visits to HIV treatment centres; Scores arrested on suspicion of ‘acts against nature’. Anti-LGBTQ law passed in March doubles maximum prison term. Senegal seeing rise in new HIV infections.”

UN News – Afghanistan risks losing 25,000 women teachers and health workers

https://news.un.org/en/story/2026/04/1167389

“Restrictions on girls’ education and women’s employment in Afghanistan could leave the country with a deficit of over 25,000 female teachers and health workers by 2030, the UN Children’s Fund (UNICEF) warned on Tuesday. “

“The agency said the crisis is already depriving children of learning and healthcare, while also weakening Afghanistan’s economy and the essential services that depend on trained women professionals.”  Cfr A new UNICEF analysis, The Cost of Inaction on Girls’ Education and Women’s Labour Force Participation in Afghanistan…”

… The report says that Afghanistan faces a dual crisis: losing trained female professionals while preventing the next generation from replacing them. By 2030, the country could lose up to 20,000 women teachers and 5,400 healthcare workers, according to the analysis….”

Global health governance & Governance of Health

UN80 – Comprehensive Guide – UN80 Initiative: Progress and Next Steps

27 April;  https://www.un.org/un80-initiative/en/media/587

“This comprehensive guide brings together one-page summaries of all the work packages that together make up the UN80 Initiative Action Plan. It provides comprehensive coverage of all three UN80 Initiative workstreams. Its purpose is to provide Member States with a clear and practical overview of where work packages stand and the pathways to decision-making.”

·         Related: UN News – UN80 Initiative: Real progress made on tackling complex issues facing the UN system

WHO Bulletin – Diplomatic roles of regional coordinators for WHO Member States

Nikica Daraboš et al; https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.25.294847.pdf?sfvrsn=d2663e3d_3

Aim: “To examine the coordination functions, decision-making processes and consensus-building strategies of World Health Organization (WHO) regional coordinators of Member States in Geneva within the WHO’s federal governance structure.”

Authors identified eight main coordination functions.

UK Aid and Development Assistance in a Fracturing World: Strengthening Resilience and Cooperation

https://publications.parliament.uk/pa/cm5901/cmselect/cmintdev/1835/report.html#heading-0

International Development Committee report, with recommendations for the government.

The EU charting its course in a geopolitical world – Health and Security: New Perspectives on the EU’s Internal and External Action

L Bengtsson; https://link.springer.com/chapter/10.1007/978-3-032-18648-5_8

“This chapter explores the evolving role of the European Union (EU) at the intersection of health and security in the wake of the COVID-19 pandemic. It analyses how the health crisis was followed by deepened integration and a new geopolitical and security-oriented discursive shift, leading to the emergence of the so-called European Health Union, a new Global Health Strategy and recent initiatives to combat hybrid threats, such as health disinformation and cyberattacks on hospitals. The chapter draws on both integration theory and securitisation to gain a deeper understanding of the EU’s increased involvement in health governance. The findings highlight the geopolitical dynamics of this development, including the EU’s concern for strategic autonomy when it comes to pharmaceuticals as well as the use of the Team Europe model and the Global Gateway to strengthen strategic partnerships with the Global South. The chapter concludes by reflecting on the balance between EU’s strategic interests and its commitment to global development and equity in a turbulent world with widening financing gaps and soaring humanitarian needs.”

Journal of Political Studies – Exploring Health Policy as a Critical Mechanism of Expression of Right-Wing Government Policy

AM Sandoval; https://scarab.bates.edu/cgi/viewcontent.cgi?article=1065&context=bjps#page=329

Chapter with focus on Trump’s US and Bolsanaro’s Brazil.

Global health financing

Devex – Money Matters: What’s happening at the EU’s main aid funder?

https://www.devex.com/news/money-matters-what-s-happening-at-the-eu-s-main-aid-funder-112259

“We bring you a new analysis of funding from the EU Directorate-General for International Partnerships, or DG INTPA…   Money flows into the commission from member states, and is then disbursed by any number of different directorates, including the Directorate-General for International Partnerships, commonly known by the not-especially-catchy moniker DG INTPA, which we’ve reviewed in a new analysis published today…. …. There are two other important directorates, both seem to have been named by someone with a bit more of an ear for words — the humanitarian aid directorate, known as DG ECHO, and the directorate responsible for dealing with the EU’s neighbors, known as DG NEAR. ….”

“One thing to say is that INTPA seems no more immune to cuts than anywhere else, after being subject to recent spending reductions aimed at funneling more cash to Ukraine.  So where does the money go? Looking at funding disbursed over a period up to early 2025, which predates those spending reductions, we can see that it mostly went to other bilateral and multilateral aid funders. The biggest recipient was Gavi, the Vaccine Alliance, which received €1 billion in the period, but the second- and third-largest recipients were, respectively, GIZ, one of Germany’s key development agencies, and AFD, the most important French development agency. The majority of the other large recipients were U.N. agencies….”

UHC & PHC

The African Review – Foreign Policy as a Tool for Health Negotiations in Promoting Universal Health Coverage in Kenya

S Nyaga et al;  https://brill.com/view/journals/tare/aop/article-10.1163-1821889x-bja10173/article-10.1163-1821889x-bja10173.xml

“Universal Health Coverage (UHC) is increasingly recognized as a global public good, requiring international cooperation and strategic negotiation. Kenya has actively engaged in health diplomacy to secure external technical and financial support for UHC, leveraging multilateral institutions, bilateral partnerships, and regional frameworks. This article examines Kenya’s negotiation strategies within global health governance, focusing on its role in international health protocol negotiations, challenges in mobilizing domestic resources, and external support mechanisms…”

Uganda Launches Unified Health Financing Framework to Tackle Funding Gaps

Nilepost; 

“The Ministry of Health in Uganda has launched the One Plan One Budget One Report framework to streamline sector planning and resource management. Developed with support from Seed Global Health this initiative integrates domestic and external funding into a single coordinated resource envelope. The strategy employs joint performance and financial reviews to address funding gaps and improve service delivery across the national health system…..”

Vox Dev – Understanding China’s huge expansion of health insurance

Hui Ding et al ; https://voxdev.org/topic/health/understanding-chinas-huge-expansion-health-insurance

“A government-endorsed supplemental insurance scheme in China expanded coverage for hundreds of millions of people, but also crowded out private insurance purchases, suggesting that enrolment growth alone overstates the true gains in risk protection.”

Pandemic preparedness & response/ Global Health Security

WHO – Practicing today for tomorrow’s emergencies – WHO convenes countries and partners to simulate response to major disease outbreak

https://www.who.int/news/item/27-04-2026-practicing-today-for-tomorrow-s-emergencies-who-convenes-countries-and-partners-to-simulate-response-to-major-disease-outbreak

“The World Health Organization (WHO) wrapped up Exercise Polaris II, a 2-day high-level simulation exercise, based around an outbreak of a fictional new bacterium spreading across the world. Bringing together 26 countries and territories, 600 health emergency experts and over 25 partners, the exercise, which took place on 22 and 23 April, allowed countries to test their preparedness for pandemics and other major health emergencies, including activating their emergency workforce structures, information flow and coordination with each other, partners and WHO.”

“…The simulation put two key WHO frameworks into practice, the Global Health Emergency Corps (GHEC) framework and the National health emergency alert and response framework, and explored the use of AI-enabled tools to support workforce organization and planning.”

GAVI – Scientists have found a safer way to hunt for the next pandemic virus

https://www.gavi.org/vaccineswork/scientists-have-found-safer-way-hunt-next-pandemic-virus

“Scientists are learning to spot pandemic threats without touching dangerous pathogens.”

Plos GPH – Implementing public health emergency operations centres according to an international framework in Ethiopia, Nigeria, and Senegal: Best practices and achievements, 2021

S T Fekadu et al ; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006211

« A public health emergency operations centre (PHEOC) is a hub for effective coordination of information and resources. Countries have established PHEOCs as part of the effort to strengthen their emergency management capabilities. However, there is limited documented evidence of best practices in PHEOC implementation in accordance with the world health organization PHEOC framework. A survey was conducted to document best practices and experiences in implementing PHEOCs in Ethiopia, Nigeria, and Senegal….”

Planetary health

Lancet Planetary Health – March issue

https://www.thelancet.com/issue/S2542-5196(26)X2003-4

·         Editorial –  Reendangerment  

re the US.

PS: most articles already appeared online before.

Health-framed messages are twice as effective at shifting people’s attitudes and policy support on climate change than non-health climate messages, study finds

Global Climate and Health Alliance; 

“ Evidence of the increasingly severe health impacts of climate change increases public concern and support for government action across Brazil, India, Japan and South Africa according to a major study conducted for Wellcome by the Climate Opinion Research Exchange (CORE).
Public concern around climate change and support for climate action shifts people’s attitudes twice as often when people are informed about climate change’s impacts on their health, compared to when they receive other information about climate risks.”

Lancet Regional Health Africa – Extreme heat, ageing, and the blind spots in South Africa’s health system

Solomon D. Danga et al; https://www.thelancet.com/journals/lanafr/article/PIIS3050-5011(26)00037-4/fulltext

« Extreme heat is emerging as a major but under-recognised public health threat in South Africa, with disproportionate consequences for older adults. South Africa’s population is ageing steadily, with the number of individuals aged 60 years and older increasing, thereby expanding the population at risk of climate-sensitive health outcomes. At the same time, climate projections indicate rising temperatures and more frequent heatwaves across southern Africa, intensifying exposure to extreme heat events. Despite this convergence of demographic and environmental risk, South Africa’s the health system remains poorly equipped to detect, monitor, and respond to heat-related illness. …»

New Political Economy – Financing ‘sustainable welfare’: a critical review of the options

Nicholas Langridge et al; https://www.tandfonline.com/doi/full/10.1080/13563467.2026.2659887

“The literature on ‘sustainable welfare’ argues that meeting everyone’s needs within planetary boundaries requires the financing of welfare to become independent from economic growth. However, it remains contested how this is possible given the mutual dependency between growth and welfare in current economies. …  To address this gap, this article conducts a systematic literature search to identify proposed options for financing welfare in a post-growth context. It then critically assesses these options against four sustainble welfare criteria: growth independence, redistribution, needs satisfaction and reduction of ecological harms. We find that while the proposed financing options perform differently against the latter three criteria, none of them, on their own, fully resolve the current growth dependency of welfare provision. However, this could be addressed by combining some of these options, extending the revenue base, balancing the supply of financing and demand for welfare, adopting preventative approaches to reduce ‘unnecessary’ welfare demand, and redistributing economic resources towards needs satisfaction. Overall, this will likely require a more fundamental reorganisation of the economy.”

SSM Health Systems – Strengthening institutional coordination for climate resilient health systems: Comparative experience from Bangladesh, Nepal and Pakistan

https://www.sciencedirect.com/science/article/pii/S2949856226000607

By Kate Gooding, S Witter et al.

Plos GPH – An international and interdisciplinary framework for nature prescribing in healthcare: A modified Delphi study

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006361

By N A Struthers et al.

Covid

Global Public Health – Who writes the pandemic? State power, individual subjectivity, and the history of the present in China’s COVID-19 response

Xu Liu; https://www.tandfonline.com/doi/full/10.1080/17441692.2026.2665873

“In this article, I employ Michel Foucault’s notion of the ‘history of the present​​​​​​’ to examine how state power and individual experiences intersected during China’s COVID-19 pandemic….”

Infectious diseases & NTDs

Science – How an HIV/AIDS tragedy spurred human evolution

https://www.science.org/content/article/how-hiv-aids-tragedy-spurred-human-evolution

“Before antiretroviral drugs reached South Africa, high death toll shaped immune system genes.”

“Before the arrival of powerful anti-HIV drugs, AIDS took such a heavy toll in one region of South Africa that, in just over a decade, it left a mark on the human genome, changing the frequency of immune-system genes, a new study shows. As access to the drugs increased 2 decades ago, those evolutionary forces eased, and the genetic changes slowed.  The study is a striking glimpse of rapid human evolution. “It’s fantastic,” says Michael Worobey, an evolutionary biologist at the University of Arizona who studies HIV and was not involved with the work. “It’s such a clear demonstration of natural selection in action, and then natural selection being stopped by a drug intervention.” The researchers assessed gene changes in the population of KwaZulu-Natal, the hardest hit province in South Africa, a country that today is home to 20% of the estimated 40.8 million people worldwide living with HIV. …”

PS: The University of Oxford led the study in the Proceedings of the National Academy of Sciences. 

Guardian – ‘Astonishing’ discovery could help save children from deadly disfiguring condition

https://www.theguardian.com/global-development/2026/apr/25/discovery-children-fatal-disfiguring-disease-noma-unknown-bacteria

“A previously unknown species of bacteria found in patients with noma could be key to creating treatments for the neglected tropical disease.”   See also a previous IHP newsletter issue.   Coming back on the study in Plos NTDs from a few weeks ago from the Liverpool school of Tropical medicine.

NPR – Long a dream, it’s now real: a fast and accurate TB test that doesn’t need phlegm

https://www.npr.org/2026/04/29/nx-s1-5802789/tb-tuberculosis-rapid-test

Coverage of a new study in NEJM – Pulmonary Tuberculosis Detection with MiniDock MTB Using Swab Samples

“…. the Chinese company Pluslife announced a new tuberculosis test called the MiniDock MTB. It works by taking a sample of someone’s phlegm or — if the patient is unable to produce phlegm — a mere tongue swab, heating and spinning it down, and then machine scanning it for DNA from the TB bacteria. It’s faster than conventional tests and is portable, allowing health workers to use it in a wider variety of settings. “It’s cheaper than a microscope,” says Cattamanchi, since swabs are easy to process. He explains that the device itself costs $300, and the fee per test is $3 to $4. “So it’s more affordable, it’s more accessible.”

And it’s more accurate, according to a new study that Cattamanchi, Andama and their colleagues published in the NEJM.”

NCDs

Lancet Editorial – Creating a smoke-free generation

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00854-8/fulltext

This week’s Lancet Editorial, with focus on the related UK Bill.

GAVI – Eight vaccines linked to a lower risk of dementia

https://www.gavi.org/vaccineswork/eight-vaccines-linked-lower-risk-dementia

“A growing body of research is beginning to reveal the impact that regular routine vaccines could be having on the likelihood of conditions like dementia. Here are the jabs with the strongest evidence so far.”

“Multiple large observational studies have found that routine adult vaccines are associated with a reduced risk of dementia, with some showing risk reductions of 25% to 40%.  The strongest evidence exists for shingles, flu, RSV, pneumococcal and diphtheria, tetanus and pertussis-containing (DTP) vaccines.  Researchers believe vaccination may reduce dementia risk by preventing infections that cause brain inflammation, though some evidence points to a more general immune effect.”

Stat –New obesity tool aims to predict risk of 18 serious complications

Stat News ;

“Model goes beyond BMI, using range of signals to say who might benefit from GLP-1 drugs.”

Cfr a new study in Nature Medicine.

Social & commercial determinants of health

Global Public Health – Rural-urban disparities in population practising open defecation across 47 African countries: a secondary analysis using the WHO health equity assessment toolkit

Augustus Osborne et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2026.2666958

“Access to safe sanitation is a human right, yet millions in Africa practice open defecation, risking disease and environmental harm. Despite global efforts, rural-urban disparities remain, especially in low-income countries. This study examines these disparities to inform policies for equitable sanitation access. ….”

Sexual & Reproductive health rights

Health Research Policy & Systems – Advancing knowledge translation practices to accelerate change in adolescent and youth sexual and reproductive health practice: a scoping review

https://link.springer.com/article/10.1186/s12961-026-01481-6

By A Musau et al.

Economist – A treatment for pre-eclampsia may be on the horizon

https://www.economist.com/science-and-technology/2026/04/27/a-treatment-for-pre-eclampsia-may-be-on-the-horizon

“Blood filtering has performed well in early trials.”

Human resources for health

Human Resources for Health – Rehabilitation in primary health care: workforce and pathways toward 2030

https://link.springer.com/article/10.1186/s12960-026-01067-x

Study in Brazil.

AI & health

Lancet Comment – From prediction to navigation for artificial intelligence in medicine

Girish N Nadkarni et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00756-7/fulltext

“Whether estimating the probability that a disease is present or forecasting risk of deterioration, readmission, or death, most contemporary clinical artificial intelligence (AI) systems are designed to predict and estimate clinical status and outcomes. These systems include applications in diagnosis and medical image interpretation, which is important, but only provides information about what is present or what might happen and does not support clinicians in decision making about how best to help the patient. Selecting the right action from a set of potential clinical actions requires synthesising patient characteristics, trajectory, and context, which is a cognitively demanding task in time-constrained clinical settings. For example, an AI model might suggest diabetic retinopathy without indicating which treatment approach is most likely to benefit a specific patient. Similarly, a model could indicate that a hypotensive patient is at high risk of death but offer no guidance on whether, in that moment, the patient is more likely to benefit from fluids or vasopressors, and in what dose. Thus, what is required is a transition from predictive to navigational AI, in which we move beyond estimating risks to providing decision support for clinical actions. As clinicians use data to make decisions, these systems should support clinical judgement by highlighting actions most likely to help a particular patient at a particular time, rather than merely identifying who is at risk….”

Lancet Viewpoint – Who’s really in the loop? Rethinking oversight in AI-assisted health care

R Abulibdeh et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00204-7/abstract

“Human-in-the-loop oversight is widely invoked as a safeguard against potential harm from artificial intelligence (AI) used in health care, yet it functions more as symbolic reassurance than substantive protection. We argue that human-in-the-loop fails for three interconnected reasons: AI used in health care can amplify existing structural inequities at unprecedented scale, intersectional harms elude detection by oversight models premised on neutral singular reviewers, and clinicians operate under constraints that preclude meaningful interrogation of algorithmic outputs. Drawing on actor–network theory, feminist epistemology, and political philosopher Iris Marion Young’s social connection model of justice, we show that current governance individualises responsibility while obscuring institutional complicity. We propose three pathways towards more substantive accountability…”

Miscellaneous

IISD – UN Reports Shine Spotlight on Africa’s Sustainable Development

https://sdg.iisd.org/news/un-reports-shine-spotlight-on-africas-sustainable-development/

“The ‘Summary of the Report on African Progress Towards Achieving the Goals of the 2030 Agenda and Agenda 2063’ focuses on the five Goals undergoing in-depth reviews at HLPF 2026. The 2026 edition of UNECA’s flagship Economic Report on Africa focuses on the theme, ‘Growth Through Innovation: Harnessing Data and Frontier Technologies for Africa’s Economic Transformation’. The UN Secretary-General’s report titled, ‘United Nations System Support for Agenda 2063: The Africa We Want,’ provides an update on the UN’s efforts to enhance the coherence of development cooperation in Africa, with a particular focus on climate action.”

Devex – Global hunger is becoming more concentrated and more severe, UN says

https://www.devex.com/news/global-hunger-is-becoming-more-concentrated-and-more-severe-un-says-112378

Coverage of the 2026 Global Report on Food Crises. “Ten countries account for two-thirds of all people facing high levels of acute hunger in 2025, and conflict was one of the biggest reasons.”

Devex – A parasitic wasp saved papaya crops in East Africa. Here’s how

https://www.devex.com/news/a-parasitic-wasp-saved-papaya-crops-in-east-africa-here-s-how-112328

“An invasive pest known as the papaya mealybug arrived in Kenya in 2016 and devastated farms. To combast the pest, scientists turned to a tiny biocontrol agent: a parasitic wasp.”

Papers & reports

Nine lessons from 40 studies on corruption in health systems

Anti-Corruption Evidence (ACE) Research Consortium – SOAS; https://www.linkedin.com/pulse/nine-lessons-from-40-studies-corruption-bqjqe/

“Corruption in health systems causes serious harm — yet conventional responses have repeatedly fallen short.  Drawing on 40 studies across Africa and Asia, a new research synthesis authored by Alan Hudson, brings together a substantial body of evidence on how corruption actually works in health systems — and what effective reform might require….”

This LinkedIn post provides 9 lessons for anti-corruption strategies based on the synthesis.

SSM Health Systems – Evolution of Health Policy and Systems Research (HPSR) capacity in West Africa and authorship pattern: A bibliometric analysis from 2015-2024

S Defor, U Lehmann et al; https://www.sciencedirect.com/science/article/pii/S2949856226000589

“The generation of HPSR evidence in West Africa has historically been driven by external institutions, with limited leadership from local researchers. Recent investments, including the establishment of the West African Network of Emerging Leaders in Health Policy and Systems Research (WANEL), aimed to strengthen local research capacity. The objective of this study was to assess how authorship patterns and publication outputs have evolved over the past decade….”

International Journal of Development & Sustainability – Post-COVID health system resilience in Sub-Saharan Africa: Policy priorities for advancing sustainable development goal 3 (good health and well-being)

Beauty Zindi; https://isdsnet.com/ijds-v15n3-01.pdf

“This chapter examines how rebuilding health systems in the post-COVID era can serve as a strategic pathway to achieving Sustainable Development Goal 3 (SDG 3) (Good Health and Well-being) in the region. The article explores the multidimensional impact of the pandemic on healthcare delivery, financing, human resources, and access to essential services, particularly for vulnerable populations. Drawing from a regional narrative synthesis & countries such as South Africa, Kenya, Nigeria and Zimbabwe the article identifies innovative recovery strategies, including investments in primary healthcare, digital health solutions, localized manufacturing of medical supplies, and strengthened health governance. It further discusses the role of international cooperation, regional integration, and community engagement in reinforcing system-wide resilience….”

Book – Policy Innovations from the Global South: Will the North Ever Learn?

A Kemmerling et al; https://link.springer.com/book/10.1007/978-3-032-11061-9

(open access)

·         You might want to start with the  Introduction: The Global South, East, North: Asymmetries in International Policy Learning and Transfer

·         Also with this chapter – The Paradox of So-Called Weak Governance: What West African Experiences in Fighting Pandemics Can Show to the Global North (by L O Ceesay)

“ In this chapter, I argue that the Global North has yet to capitalise on Africa’s entrepreneurial and exemplary experience in adopting the prominent One Health approach to develop sustainable health care systems…..”

Nature Health – A global survey on trust, digital health literacy and health information quality

R Piltch-Loeb et al; https://www.nature.com/articles/s44360-026-00102-4

“An online cross-sectional survey across 30 countries, including 31,000 adults, explores perceptions of quality health information, with respect to source type and inclusion of AI-generated content.”

Plos GPH – Health service responses and help-seeking for women experiencing violence during outbreaks in low- and middle-income settings: A scoping review

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004482

By R Burns et al.

It’s the 1^st of May today, a holiday in my country – and an important one. Nevertheless, as I get older and perhaps a bit more rigid, I prefer to send out this newsletter on Friday morning : ) 

I still want to celebrate May 1^st properly, though, and so I suggest you read the following interview  between Dirk Holemans and Céline Marty in the Green European Journal,   “To save the planet, we must liberate time”: “…The capitalist emphasis on working hard as the key to success comfortably ignores an ugly reality: that the workforce faces worsening conditions and increasing precarity, while extractivism has brought the planet to the verge of ecological collapse. From the teachings of André Gorz to Gen Z’s quest for work-life balance, liberating time is at the centre of endeavours to achieve a better life – not just to consume freely as individuals, but to come together as a community.”   

A quote from the article: “….If we can put forward serious environmental projects that assert that the environmentally friendly way forward is working less, then that’s a very attractive idea. I think this idea of “work austerity” is one of the most appealing proposals that can be made as part of the ecological transition. It feels good when you take a break from work or work less, and that’s something we need to stand by…..”

Let’s call it our small contribution to ‘global health reimagining’ for this week : )   

But that’s the world “as it should be”. As we know from the past, in order to reach this eco-social nirvana, people have to fight, and fight really hard, in social movements and otherwise. And all this while some trends are clearly  going in the opposite direction. Just mentioning one here: what experts tend to call ‘tail-end AI scenarios’, and common people like me, “Hey, we didn’t sign up for the Matrix  ànd Black Mirror !”.

Over to ‘the week in global health’ then.

This week’s issue focuses obviously on the latest (and all-important) PABS round in Geneva. The WHO DG himself called for a ‘landing zone’  (see also last week’s issue) at the start of the round. But for some reason, that old band ‘Status Quo’   also kept popping up in my rusty brain.  Civil society and some delegations  seemed to agree by the end of the week (i.e. that Status Quo is a rubbish band).  

We also zoom in on the regional World Health Summit conference   in Nairobi. Feeling slightly under the weather recently, the ‘changemaker/thought leader’ in me (ahum) tried to follow some of the key action from a distance. Under the theme “Reimagining Africa’s Health Systems: Innovation, Integration and Interdependence,” the opening session in Nairobi already set a clear focus: moving from dialogue to coordinated, practical action. It was amilestone event, no less. You can read all about it in this newsletter.

Still in Africa, yet another country (Ghana) rejected the bilateral health agreement with the US this week, citing data concerns.  And on the way back from his tour in 4 African countries, pope Leo once again positively surprised us (though arguably, these days it’s not that hard to positively impress for an American, at least against the “benchmark” of the peculiar American blend of Benito, Louis XIV & Hermann Göring that is currently occupying the White House).

We also cover the Women Deliver conference in Melbourne,  the World Hepatitis summit in Bangkok (with a related new WHO report) and, more extensively, the Santa Marta conference in Colombia, where “the UN Deadlock and Iran Oil Shocks Push(ed) 54 Nations to Chart a Fossil Fuel Phase Out”. Santa Marta was also an interesting experiment in climate diplomacy  by the way,  excluding the nations most responsible for holding it back. “…Coincidence or not, the US, China, Russia, India and Saudi Arabia are not attending. Neither are the battalions of fossil fuel lobbyists who’ve turned Cops into networking events….”      Sounds like a brilliant idea.

And oh yes, I almost forgot: the WHO DG race has now really kicked off. Let the ‘WHOsplaining’ begin (or rather continue) : )

Enjoy your reading.

Kristof Decoster

·         World Immunization Week

·         Run-up to the World Health Assembly

·         Global Health Reform & Reimagining

·         Wrap-up Spring meetings IMF/WB

·         More on Global Health Governance & Financing/Funding

·         Global Tax Justice

·         Debt crisis

·         UHC & PHC

·         US Global Health strategy & bilateral health agreements

·         PEPFAR data: fierce debate

·         Trump 2.0

·         PPPR

·         AMR

·         More on health emergencies

·         World Malaria Day

·         NCDs

·         Social and Commercial Determinants of health

·         SRHR

·         Run-up to Santa Marta conference, Colombia

·         Planetary Health

·         Migration & Health

·         Conflict & Health

·         Access to Medicines, vaccines & other health technologies

·         AI & Global Health

·         Lancet Commission on Sepsis

·         Miscellaneous

World Immunization week  (April 24-30)

“At the start of World Immunization Week, Gavi, the Vaccine Alliance, UNICEF and WHO announce[d] progress on the Big Catch-Up, a historic, multi-year, multi-country effort launched in 2023 to close immunity gaps and strengthened health systems to reach un- and under-vaccinated children. “    “The 36 participating countries across Africa and Asia account for 60% of children missing out on any vaccination – so-called zero-dose children. Pandemic-related immunization programme disruptions exacerbated this issue, adding millions more zero-dose children to those who already chronically miss out.”

“To address this issue, the Big Catch-Up looked beyond infant immunization and for the first-time ever made deep inroads into the accumulated global cohort of older children between the ages of 1 to 5 who remain vulnerable due to missed routine vaccinations. “

·         See the WHO press release:  Largest catch-up initiative delivers over 100 million childhood vaccinations  “The Big Catch-Up, launched during World Immunisation Week 2023, has delivered over 100 million vaccine doses to an estimated 18.3 million children across 36 countries.

Around 12.3 million were “zero-dose children” who had not previously received any vaccines and 15 million who had never received a measles vaccine. 

The initiative concluded in March 2026 and is on track to meet its target of catching up 21 million children – but agencies warn that many infants still miss out on lifesaving vaccines through routine immunisation every year.”

Run-up to the World Health Assembly (18-23 May)

It’s still a while, but flagging here already a few debates around resolutions for WHA79.

But we start this section with WHO’s Results report, released annually ahead of the WHA.

WHO’s Results report – WHO reports measurable health impact in 2025 amid transition to new strategy

https://www.who.int/news/item/23-04-2026-who-reports-measurable-health-impact-in-2025-amid-transition-to-new-strategy

“The World Health Organization (WHO) today released its Results Report, highlighting measurable improvements in people’s health worldwide in 2025, despite funding cuts affecting both the organization and the broader global health sector. “

“Published at a pivotal moment for global health, the Results Report demonstrates that WHO’s impact was strongest in areas where its technical leadership and comparative advantage were fully leveraged.   The report finds significant progress across all three “Triple Billion” targets under WHO’s Thirteenth General Programme of Work (GPW13) for 2019-2025:   

• An estimated 567 million additional people were covered by essential health services without experiencing catastrophic health spending in 2025, compared with the baseline in 2018 – an increase of 136 million since 2024;
• An estimated 698 million additional people were better protected from health emergencies in 2025, compared with the baseline in 2018 – an increase of 61 million since 2024; and
• An estimated 1.75 billion additional people living healthier lives in 2025, compared with the baseline in 2018 –an increase of 300 million since 2024.

Despite this progress, the report cautions that important ambitions remain unmet, leaving with the world off track to meet the health‑related Sustainable Development Goals by 2030….”

TWN – WHO: Developing countries seek actions on inequities in international recruitment of health workers

Lauren Paremoer and Nithin Ramakrishnan; https://www.twn.my/title2/health.info/2026/hi260402.htm

“A Resolution on the Global Code of Practice on the International Recruitment of Health Personnel is scheduled to be adopted at the 79th Session of the World Health Assembly (WHA79) to take place from 17 to 23 May at the WHO headquarters in Geneva. This resolution attempts to address structural inequities faced by source countries caused by the uneven progress in the application of the different provisions of the Code.  … In ongoing negotiations, developing countries have called for concrete measures such as ring-fenced taxation to address inequities, emerging from the migration of workers. The developed countries continue to oppose….”

“Ring-fenced taxation is a proposal to address the brain drain from developing to developed countries due to the migration of health workers. According to this concept the tax gains from migrant health works in destination countries are to be used proportionately for the strengthening of health systems in the source countries. A core group of countries including Bangladesh, Germany, Pakistan and the Philippines are taking the lead in the negotiations for this draft resolution, following the decision made in the 158th Session of Executive Board (EB158).”

“… According to sources familiar with the discussions, developed countries, in particular European countries, are opposing both the mention of ring-fenced taxation, as well as the entire paragraph urging financial contribution towards source countries.   …”

“…. ring-fenced taxation has emerged as a particularly contested yet important proposal. Properly understood, this does not imply imposing additional taxes on migrant health workers. Rather, it refers to allocating a defined portion of tax revenues already generated from migrant workers’ income within destination countries toward supporting health systems in their countries of origin, as part of mutually agreed intergovernmental arrangements. This approach aligns with WHO guidance and represents one of several tools to operationalise co-investment in a measurable and equitable manner….”

PS: the backdrop: “The geopolitical context: Intensification of push factors…”

·         Related: Geneva Health Files – The Code for Recruitment of Health Workers Under Review at the WHO: A Moment of Promise or Just Status Quo? [WHA79]  (by M Iskarous & P Patnaik)

With two parts: “Part 1: An introduction to the code and the significance of this review. Part II: On the dynamics in the current negotiation on the resolution.”

“My colleague, Maged Iskarous, a health systems specialist, has laid out why the review of the code is a significant opportunity to strengthen the operationalisation of the code. …     He argues that “these efforts should not be seen as a mere procedural footnote but as a political inflection point. The WHO has formally moved from celebrating the Code’s principles to interrogating its implementation failure.”

PS: The WHO Global Code of Practice on the International Recruitment of Health Personnel is now 16 years old.

There’s “…a growing recognition among Member States that voluntary norms, untethered from material responsibility, have struggled to withstand the pressures of recurrent health emergencies, fiscal contraction, and widening workforce inequities….”

Health Affairs Forefront – A Global Resolution To Bring Liver Health Into The NCD Mainstream

J V Lazarus;  https://www.healthaffairs.org/content/forefront/global-resolution-bring-liver-health-into-ncd-mainstream

“In February 2026, the World Health Organization’s executive board proposed a World Health Assembly (WHA) resolution on steatotic liver disease (SLD), an umbrella term covering some of the most common chronic liver conditions worldwide. If adopted by member states, it would mark the first time these diseases are explicitly recognized within the global noncommunicable disease (NCD) framework.”

“The timing reflects a broader shift. In late 2025, liver health was included in the political declaration of the United Nations General Assembly’s fourth high-level meeting on NCDs. Soon afterward, the World Economic Forum highlighted metabolic dysfunction–associated steatotic liver disease (MASLD) in its briefing on the global NCD crisis. Together, these developments signal growing recognition that liver disease is not a niche specialty concern but a central component of the global metabolic disease burden.

PS: “For much of the past two decades, global liver efforts have focused on viral hepatitis. That work achieved major successes, including curative therapies and ambitious elimination targets. But as hepatitis-related mortality began to plateau in some countries, another trend became increasingly visible: a rapid rise in SLD, driven by the same forces fueling type 2 diabetes, obesity, cardiovascular disease, and chronic kidney disease. Policy frameworks did not keep pace with this epidemiologic transition….”

Global Health Reform & reimagining

WHO – Consultation on the process to reform the global health architecture – round two of written consultation

https://www.who.int/news-room/articles-detail/consultation-on-the-process-to-reform-the-global-health-architecture

(21 April)  “WHO invites Member States and other global health actors and stakeholders to input into a joint process to support transformation of the global health architecture (GHA). Based on feedback from the first round of consultations that were completed on 18 April, stakeholders are invited to contribute to this second round.  Before providing your input, please see the presentation on an updated proposal that includes feedback from the first round of consultations.

Input should be grouped under these headings:

• Purpose, principles and objectives
• Process governance and set-up
• Stakeholder participation
• Timeline and phases
• Resources and risks.

Provide your input

All input must be received by 28 April 2026.”

TGH –  No One Wins If Multilateralism for Health Loses

C Carlsson & A Nordström; https://www.thinkglobalhealth.org/article/no-one-wins-if-multilateralism-for-health-loses

“Inaction on the global health reform agenda is not a neutral choice; it is a decision to impede or even undermine progress.”                     Some excerpts:

“Ahead of the World Health Assembly in May, the question is whether political and institutional leaders will act on what they have long observed.  What is urgently needed is not another diagnosis but an ambitious roadmap. Reform will not happen through a single grand decision. It will emerge from a series of coordinated political decisions by different actors on institutions’ roles and functions, financing, structural changes, and leadership. But those actions should be shaped by a shared vision: a simpler, more focused, and more legitimate international system for health….”

“Subsidiarity should guide reform: global institutions should only perform functions that cannot be delivered effectively by countries or regions alone. Following this logic, the international system for health should be radically simplified….”

“What is urgently needed is not another diagnosis but an ambitious roadmap… To streamline the international system, mandates should shrink, and institutions should merge, transform, or disappear. The goal is a system that does less, but better….”

“… Domestic financing should drive the next generation of health gains. In a reformed system, ODA should be targeted to contexts where other forms of finance are unavailable capacity, including to build capacity in fragile and low-income settings and when needed emergency support. Further, ODA should be used to accelerate a transition to national ownership and financing…..” “ Global public goods for health that reflect shared benefits, interests, and responsibilities should be financed by all governments and not perpetuate dependencies on external aid. …”

“To catalyze those changes, governments should acknowledge that international health cooperation serves all countries, not just low- and middle-income ones….”

“Reform should move beyond the false dichotomy between national sovereignty and multilateral cooperation. Those are not opposing forces. A well-functioning international system strengthens, rather than undermines, countries’ abilities to protect their populations….

“… Yet the reform debate is at risk of stalling without a clear pathway to implementation. No shortage of discussions, reports, or high-level commitments exists. What is essential now are concrete decisions about mandates, financing, and governance. Amid rising geopolitical tensions, the current momentum will dissipate, and the opportunity for meaningful change will be lost. The World Health Assembly will be an opportunity to ensure that countries do not lose that momentum….”

TGH – How African Regional Agencies Can Shape Global Health Reform

B Impouma, M Janabi et al ; https://www.thinkglobalhealth.org/article/how-african-regional-agencies-can-shape-global-health-reform

“WHO Africa regional specialists explain why continental players need to be coauthors in the reform of global health architecture.”  A view from WHO Afro authors.   Well worth a read.

“Global health reform …… presents an opportunity for the continent to own its narrative.”

APPG sets out vision for a more equitable global health architecture

https://globalhealth.inparliament.uk/news/appg-sets-out-vision-more-equitable-global-health-architecture

Five-pager from the UK from last week.  “…. Following two expert discussions convened by the All-Party Parliamentary Group (APPG) on Global Health & Security with multilateral leaders, regional experts, civil society representatives, and academic specialists, a clear set of reform priorities has emerged. These discussions point toward a streamlined architecture with clearer institutional mandates, stronger regional leadership, and sustainable financing, anchored by a revitalised, lean and focussed World Health Organization.”

Calling for: “ A lean WHO, re-focused on its global mandate, and empowered to steward the global system; A simplified set of agencies, focused on their mandates; Financing that focuses grants on low income countries, and loans for MICs, whilst backing national priorities and national health sovereignty; Domestic health financing of top priorities, with aid topping-up; Greater investment in global public goods.”

WHS Perspectives – “America First” Global Health Strategy: A Seismic Rupture in Solidarity and Global Health Governance

Commentary by Lawrence O. Gostin and Sam F. Halabi; WHS

“…The future of global health must instead be built on genuine solidarity, equitable burden-sharing, and a renewed commitment to the central coordinating role of the WHO. This requires stronger coordination, targeted resource allocation, and innovative financing.”

A few excerpts:  “…the global community—governmental and non-governmental alike—must recommit to solidarity, with a strengthened WHO at its core. Three priority measures could advance this vision. …

“(1) Stronger coordination  : First, the proliferation of global health institutions since 2000 has generated substantial overlap in mandates and functions. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Unitaid, United Nations Children’s Fund (UNICEF), Gavi and the WHO—among others—should establish a joint working group to identify opportunities for financial and operational efficiencies, including clearer division of labor and pooled service delivery. The Gates Foundation, given its longstanding engagement across these institutions, could play a catalytic role in financing and convening. …” (yeah, right)

“(2)… Tailored allocation of resources : Second, rationalizing overlapping mandates must be grounded in a realistic assessment of the capacity of LMICs to assume greater responsibility for health programs historically financed through development assistance. The World Bank routinely evaluates country capacity using a range of fiscal and health system metrics that could guide more tailored allocation of responsibilities—identifying priority areas and sustainable levels of domestic investment. Many countries have already established benchmarks for health spending and system strengthening, providing a foundation for differentiated and strategic approaches to global health financing. ….  (3) Innovative resource mobilization …. “

Global Health Solidarity project – website

https://www.globalhealthsolidarity.org/

PS: the project started in 2022 – funded by Wellcome.

“Our project aims to shift the understanding and practice of solidarity in global health. We are studying how solidarity is understood and practised among different people on five continents. We aim to design metrics or actionable tools to rank how global health actors practice solidarity.”

Includes a  workshop report  What does it really mean to move solidarity beyond rhetoric in global health?  (21 April)

“Our new report, Perspectives on Solidarity Principles for Global Health, captures key reflections from the Convivial Solidarity Workshop, where participants from across research, funding, multilateral institutions, and civil society came together to refine a shared framework for embedding solidarity in the global health ecosystem. “

With 9 principles for embedding solidarity in the global health ecosystem.  “The Principles are organised into a 3-3-3 Framework addressing three core dimensions of solidarity in the global health funding ecosystem: what solidarity entails, how it is enacted, and to what ends it is directed. Together, they form a foundation for reshaping how actors relate, make decisions, and work toward justice and more equitable health outcomes.”

Devex – The Gates Foundation’s outgoing policy and advocacy lead on what comes next

https://www.devex.com/news/the-gates-foundation-s-outgoing-policy-and-advocacy-lead-on-what-comes-next-112326

(gated) “As she steps down from one of the most difficult and influential roles in development, Gargee Ghosh reflects on leading through a period of crisis and change — and why the future of development will depend less on new ideas than on the ability to scale what works.”

Reflections/Questions as the ODA Landscape for Health Evolves

B Orya; https://www.linkedin.com/pulse/reflectionsquestions-oda-landscape-health-evolves-breshna-orya-criue/

On the shifting global health financing conversation.

She asks, against the backdrop of all the changes and debates ongoing, a “more basic question. Not which model is best, but what actually makes a financing model work, or fail, in a particular context, when a country is trying to absorb functions into its own systems….”

With five reflections, and then seven questions.

Wrap-up Spring meetings IMF/WB

Washington Post – Trump administration warms to IMF and World Bank, in rare nod to global bodies

Washington Post; 

“A year after harshly criticizing these pillars of globalism, the Trump administration has found them valuable to U.S. interests.”

“… the two financial organizations have avoided the president’s ire by adapting to his demands, an evolution that was on display last week during the annual spring meetings of the IMF and World Bank.  Under pressure from the administration, the IMF and World Bank have modified their policies, de-emphasizing issues that irk the president such as climate change and taking steps to support key U.S. foreign policy objectives in places like Argentina and Ukraine. The World Bank last year abandoned its long-standing refusal to finance nuclear power development and moved closer to the Trump administration’s preferred “all of the above” energy policy, which makes room for fossil fuels including coal….”

In short, they’re showcasing “a shift in tone toward economic stability and energy access over climate initiatives, aligning more closely with U.S. geopolitical priorities. “     

Devex – World Bank weighs mergers and shareholder power

Devex

Also coming back on the World Bank/IMF Spring meetings, with focus on the World Bank reorganization and lack of governance change of WB and IMF.

BWP – Spring Meetings 2026 Wrap-up: America First exacerbates global instability as war on Iran leads to latest economic shock

https://www.brettonwoodsproject.org/2026/04/spring-meetings-2026-wrap-up-america-first-exacerbates-global-instability-as-war-on-iran-leads-to-latest-economic-shock/

The Bretton Woods project wrap-up of the Spring meetings.

Key messages: “Bank and Fund’s initial response to latest crisis inadequate to deal with global food and energy shocks. Flawed governance of Bretton Woods Institutions hamstrings response to war amid ‘geopolitical rupture’. World Bank’s restructure appears uncoordinated with recent reform commitments, while IMF’s toolkit retains austerity bias amid ongoing reviews.”

·         Do check out also BWP’s Development Committee ministerial statements analysis Spring Meetings 2026

And a few final snippets on the Spring meetings via RANI’s newsletter

https://mailchi.mp/rani/under-pressure-resilience-action-playbook-23-april?e=da8439b1d4

“A long-championed initiative to allow countries facing epidemic and pandemic-related shocks to temporarily defer debt service advanced during the Spring Meetings, via the London Coalition on Sustainable Sovereign Debt.”

“The European Investment Bank announced a €75 million quasi-equity investment in Biovac to support Africa’s first end-to-end multi-vaccine manufacturing facility in South Africa. The project will expand vaccine manufacturing for key diseases, and help create more than 340 skilled and 7,000 indirect jobs to boost regional health resilience. “

More on Global Health governance & financing/Funding

With info on some of the ‘usual suspects’, but also some updates on Multilateral development banks, development finance trends… 

Africa CDC – AU and EU reinforce their Health Partnership | Launch of three new initiatives at Africa CDC

https://africacdc.org/news-item/au-and-eu-strengthen-their-health-partnership-launch-initiatives-under-global-gateway/

On Tuesday, “… three new initiatives within the AU-EU partnership were launched, for over 100 M EUR, aiming at reinforcing Africa’s public health institutes, strengthening health security and supporting digital health solutions for pandemic preparedness and primary healthcare.”

“The new initiatives represent a shared commitment to advancing health security, pandemic preparedness, and equitable access to healthcare across the African Continent in line with the EU’s Global Gateway initiative and the Africa Health Security and Sovereignty agenda….”

·         Coverage (also the HL event launch on Tuesday), via  HPW – Africa and Europe Announce €100 million Health Initiatives

“The African Union and the European Commission have concluded three agreements worth €100 million aimed at strengthening Africa’s health systems.”

“The first initiative supports the national public health institutes of 10 African countries to enhance disease surveillance, early warning systems, emergency response, research and laboratory services.  The second, announced at the One Health Summit in Leon earlier this month, involves addressing antimicrobial resistance (AMR) and developing a workforce trained in a ‘One Health’ approach to detect and prevent health threats in animals, humans and the environment. The third involves expanding digital health solutions for pandemic preparedness and stronger primary healthcare systems in six African countries.”

“The initiatives were officially launched at the African Union headquarters on Tuesday by Jozef Síkela, European Commissioner for International Partnerships, and Dr Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention, which is the operational partner for the initiatives….”

PS: “Sikela told the launch that the EU and AU are also working on a global health resilience initiative, with the aim of launching it in May.  “This will be a powerful tool, bringing together research with medical technology and innovation programmes, knowledge transfer and systematic cooperation with regulatory agencies, health systems and highly skilled workforces,” he said. “The aim is to equip and empower health systems worldwide so that they are in a better position to prevent and respond to future crises,” he concluded, adding that this includes European investment in the local manufacturing of vaccines and medicines “to avoid health dependency.”

GFO (new issue) – Scaling Back, Stepping Up: The New Political Economy of Global Health

https://aidspan.org/Blog/view/32609

(recommended read) “This new issue of the GFO examines a Global Fund in transition, facing reduced resources and more political choices under GC8, with significant equity implications for the most vulnerable. It highlights tensions between innovation and access, particularly in South Africa, as well as evolving accountability dynamics through the case involving Sandile Buthelezi. Finally, it underscores the challenges of transitioning toward self-reliance and the strategic importance of African representation.”

“… Ultimately, one conclusion stands out: GC8 is not merely another funding cycle. It marks a structural inflection point, steering the Global Fund toward a more demanding, more differentiated, and potentially more sustainable partnership model, but also one that carries greater risks. The promise of autonomy and health sovereignty will only materialize if it is matched by real capacities: financial, industrial, institutional, and political.…”

“This issue 470 thus explores a fundamental question: how can the transition from an aid-based model to one of shared responsibility be achieved without deepening inequalities or undermining hard-won gains?….”

·         The issue includes among others:  African representation in the Global Fund Strategy Committee – Why is it important?

“While the need for African voices in global health governance is widely acknowledged, their presence and participation within the most influential technical bodies remain paramount. This article states that the Strategy Committee, as the central ‘brain’ of the Global Fund, is the most critical arena for African influence. We demonstrate that when African experts like Dr Mele Djalo and Dr Gerald Gwinji have a seat, they successfully shift policies to serve continental priorities better, proving that effective representation is the cornerstone of sustainable impact.”

WSJ – Gates Foundation to Cut 20% of Staff, Review Epstein Ties

WSJ;  

“The Gates Foundation is cutting up to 500 jobs, or roughly 20% of its staff, over the next several years, and the philanthropic giant has also opened an external review of engagement with the late Jeffrey Epstein.  The moves were announced Tuesday in an email to staff that was reviewed by The Wall Street Journal. The foundation and its co-founder, Bill Gates, have been reeling from disclosures about the Microsoft billionaire’s association with Epstein….”

“The foundation, which has a 2026 budget of about $9 billion, plans to cap operating expenses at $1.25 billion, which would require reducing its workforce by up to 500 positions by 2030, according to the memo. …”

“Along with the restructuring, Suzman said he has commissioned an external review related to the foundation’s engagement with Epstein and policies for vetting and developing new philanthropic partnerships. The review is underway, and the foundation expects to receive an update in the summer, the memo said. Suzman told employees that a recent board meeting in London included a session on the impact of the Justice Department’s Epstein files and how they relate to the foundation’s work and reputation…..”

IFFIm returns to market with US$1 billion 5-year bond to support global vaccine programs

https://iffim.org/press-releases/iffim-returns-market-us1-billion-5-year-bond-support-global-vaccine-programs

(22 April)  “The International Finance Facility for Immunisation (IFFIm) today announced the pricing of a US$ 1 billion fixed-rate bond with a 5-year maturity, further mobilising vital resources to support global immunisation efforts through Gavi, the Vaccine Alliance.”

“The transaction reaffirms IFFIm’s long-standing role in transforming long-term donor commitments into immediate funding for life-saving vaccines, helping protect children in the world’s lower-income countries. IFFIm’s vaccine bonds provide predictable, flexible financing that enables Gavi to expand access to immunisation and strengthen health systems globally. Significant IFFIm investments to date have included funding for 15 vaccine introductions including significant investments in the Ebola, COVID-19, HPV and malaria vaccines.”

“… As IFFIm celebrates its 20th anniversary of its inaugural bond issued in 2006, this latest transaction reaffirms its continued role as a trusted and effective financing platform for global health….”

BMJ (Opinion) – Feminist leadership in global health: moving beyond tokenism

https://www.bmj.com/content/393/bmj.s778

“Calls for gender equality in global health leadership are widespread but without feminist leadership change can be superficial, say Lynsey Robinson, Kent Buse and colleagues.”  With a 5-point agenda for feminist leadership.

“We propose a framework for measuring feminist principles at organisational level. Rather than focusing on who occupies leadership positions, the framework focuses on observable structural policies and practices across five domains…”

FT – G7 citizens overstate foreign aid spending by 20 times, survey suggests

FT;  

“People in G7 advanced nations believe that nearly one-fifth of their national budgets are spent on overseas development aid, according to a new survey — more than 20 times the actual figure.”

“The survey, commissioned by France as part of its G7 presidency and seen by the FT in advance of publication this week, shows that Americans on average think that 25.4 per cent of their national budget goes on overseas co-operation. The real figure in 2025, when US official development assistance (ODA) fell by more than half compared with 2024 to $29bn, was well below 1 per cent. Even in Europe, where estimates were marginally more accurate, respondents overestimated aid by a factor of roughly 15. In France, those surveyed thought on average that 14.7 per cent of the national budget went on international co-operation, with the British believing it to be 15.2 per cent. The real figure in both cases for 2025 was about 1 per cent.”

““There is a massive misperception of the scale of what we are doing that is absolutely striking,” said Rémy Rioux, who is stepping down as chief executive of the French Development Agency (AFD) after a decade. “We need to explain much better the actual scale.””

“The survey, conducted by French polling company Ifop in April, follows the sharpest reductions of aid in years, with the main donor countries cutting their ODA contributions by 23.1 per cent compared with 2024 to $174.3bn in 2025, according to the OECD. The report defined international co-operation as “aid or solidarity-based investments made . . . in developing countries”.

The Ifop survey confirmed that the public saw international co-operation as “a mix of altruism and self-interest”, Rioux said, arguing that “the idea that it is also a long-term investment in one’s own interest is coming back very strongly”. He added that Italy and Spain, which are at the forefront of Europe’s immigration crisis, had increased spending on international co-operation last year.”

PS: “Leslie Maasdorp, chief executive of British International Investment (BII), the UK’s development finance institution, said there had been a shift away from traditional aid towards an “investment-centric model”. 

“… The Ifop survey, which was conducted online with more than 7,000 adults, found that 64 per cent of respondents believed events in developing countries affected their lives while 49 per cent believed that international co-operation was “a waste of public money”.”

Euractiv –  Climate scrubbed from G7 meeting to appease US, host France says

https://www.euractiv.com/news/climate-scrubbed-from-g7-meeting-to-appease-us-host-france-says/?utm_source=eac&utm_medium=bluesky&utm_campaign=euractiv.com

“The office of France’s ecology minister said the two-day meeting would focus on “less contentious issues” in an effort to appease the most powerful G7 member…”

“A meeting of G7 nations on the environment begins in Paris on Thursday but climate change has been left off the agenda to avoid a row with the United States. …”

C7 Health declaration – Achieving Global Health Equity: A Call to Solidarity, Resilience, and Inclusion

https://www.actionsantemondiale.fr/app/uploads/C7-Global-Health-WG-standalone-declaration.pdf

Civil society declaration, ahead of the G7 Leaders meeting in Evian, France (15-17 June).

With a number of recommendations addressed by the C7 Global Health Working Group to G7 leaders.   “255 civil society organisations from 80+ countries are coming together with a clear message: Global health equity must remain a guiding compass….” 

Do read what they suggest, re UHC, strengthening health financing and One Health.

David Clark – The Values renaissance

on Substack; 

“Why reclaiming what health is for is the governance fight we keep avoiding.”

“Something has been quietly extracted from health systems over the past three decades. Not budget lines, not infrastructure, not even equity, though all of those too. What’s been taken is the idea that health systems exist to care for people. That underneath the policy language, they are a human institution built on human values. In its place we got a different story. Markets as the organising principle. Health as a commodity to be priced and consumed. The private sector not as a partner to be governed but as a model to be copied. And somewhere in that transformation the patient became secondary to the transaction….”

Clarke then argues  why 2026 is the moment for a values renaissance and lists 5 principles of a movement for a values renaissance in health governance.

Lancet Offline – President Trump—it is not too late

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00790-7/fulltext

Horton comes back on “…A report by Physicians for Human Rights (PHR), published this week, (which) sets out the emerging scale of calamity facing nations that have been past beneficiaries of American financial support. In Wasted Investments, Looming Crisis: the Impact of US Global Health Funding Cuts on HIV in South Africa, PHR describes the oral histories of those with lived experience of HIV services in a country facing the world’s largest HIV/AIDS epidemic. …”

“A global tragedy is unfolding. Withdrawal of the US Government from the fight against HIV/AIDS is causing thousands of preventable infections and deaths worldwide….”

And Horton argues: “WHO, in particular, must not shrink from holding the US administration accountable for the violence it has perpetrated on communities in South Africa and elsewhere. WHO is entering the final year of its current administration. The agency has the authority to speak out about the atrocities being committed by President Trump. And they are atrocities. Cutting access to life-saving treatments is nothing less than cruelty. “

TGH – China’s Health Silk Road and Soft Power

B Burgess; https://www.thinkglobalhealth.org/article/chinas-health-silk-road-and-soft-power

“Understanding China’s previous engagement on health development can inform its future strategy as the United States pulls back.”                 Interesting read – some excerpts:

“The Health Silk Road is more of a branding exercise than a meaningful addition to China’s long-term health strategy. By the time it introduced the plan in 2015, the country’s funding to health projects in low- and middle-income countries had already been increasing for 15 years, from $44 million in 2000 to $344 million in 2015. A teaser period for new projects ran from 2014 through 2017 but was not sustained. In 2017, new investments in health jumped to $681 million before dropping to $399 million in 2018. The number of new activities followed a similar pattern. The tally of new projects globally jumped 30% in 2017 before declining again by 2019. The main driver of China’s increase in health aid was in a few, high-value contracts—principally loans to build health-care infrastructure. The decrease in funding for those projects mirrored cross-sectoral trends in Chinese development finance, for which the peaks of activity ran from 2015 to 2017, after which Beijing was much more restrictive toward high-value and sustained projects…..”

“The true shift and expansion for the Health Silk Road occurred during the COVID-19 pandemic. During 2020, the number of new health projects Chinese actors engaged in increased nearly eightfold to a portfolio of more than 1,300 new projects in one calendar year. This temporary priority in the face of the crisis did not translate into programmatic shifts. By 2023, China’s finance to health-related initiatives had dropped to $140 million across 184 projects, and the deliveries of COVID-specific supplies had begun to taper off. Although data for 2024 and 2025 is not yet available, it appears that China deprioritized health financing after 2023, reducing its capacity to rapidly fill in for the United States or other donors.”

“China leverages a range of decentralized methods to enact health projects….”

“… Despite the growth in projects under the Health Silk Road, the plan’s diffuse nature and singular composition limit China’s capacity to replace the capacity and reach of Western donors. Health projects account for less than 1% of Beijing’s overall development portfolio from 2000 through 2023, which rose only to 6% at the peak of its COVID-19 response in 2020. … The composition of this funding is noteworthy. Nearly one-third of Chinese health funding (31%) was signed over as market-rate debt—loans carrying interest rates and repayment periods comparable to those offered by commercial banks—rather than the grants or concessional loans that made up nearly all of U.S. health assistance….”

“… China sees health aid as a powerful tool to influence elites and media narratives, so it is unlikely that the country will walk away from its Health Silk Road toolkit anytime soon. That raises the question of where the project may go next, particularly in the wake of dramatic defunding by Western donors….  A few clues indicate how China might pursue global health leadership in a U.S. vacuum. …

“…The first is a history of deep but narrow focus on specific diseases.  … …. It could similarly focus on specific medical technologies where it has a proven advantage, such as vaccines, where its medical academies and Sinovac have innovated in inactivated virus vaccines to combat enterovirus type 71, polio, and influenza in addition to COVID-19.  … … Beijing will also likely continue to leverage the Health Silk Road’s language of cooperation and exchange to build educational and institutional ties.  … … Finally, China will expand its role in shaping global health governance through greater influence in the worlds’ multilateral institutions. By default, U.S. withdrawal has given China a greater share of voting and decision-making power in entities such as the World Health Organization (WHO). Beijing has already begun a push to elevate more of its diplomats to senior UN leadership roles. The next elections for WHO director general are expected in 2027, and though it would be unlikely that China would put forward a nominee so recently after Margaret Chan’s tenure, Chinese diplomats will certainly lobby for a candidate they view as favorable to the Health Silk Road.”

“The greatest outcomes of the initiative are unlikely to be achieved through finance, but rather through strategic efforts to remake the architecture and norms of global health governance.”

KFF factsheet – Breaking Down the U.S. Global Health Budget by Program Area

https://www.kff.org/global-health-policy/breaking-down-the-u-s-global-health-budget-by-program-area/#113f80b3-617d-4275-afbb-25b19d875c65

“This fact sheet provides a historical overview of U.S. funding for global health by program area over the past decade. …” 

UN News – Time running out on development goals as finance dries up, UN warns

https://news.un.org/en/story/2026/04/1167334

“Rising conflicts, the climate crisis and shrinking development finance are putting growing pressure on the poorest and most vulnerable countries – pushing development goals further off track. The warning comes in the Financing for Sustainable Development Report 2026 (FSDR), a new UN report launched on Monday, which finds that with just four years left until the 2030 deadline for the Agenda for Sustainable Development, progress has stalled – and in some cases reversed – following the shocks of the COVID-19 pandemic, rising geopolitical tensions and growing climate impacts…..”

“According to the report, development finance is being squeezed at a critical moment: one quarter of developing countries still have lower per capita income than before the pandemic, and some 3.4 billion people are living in countries that spend more on interest payments than on health or education. ….”

“… The authors stress, however, that progress will not be sustained without urgent action, identifying a financing gap of up to $4 trillion annually for developing countries and calling for accelerated implementation of the Sevilla Commitment (a 2025 global agreement to scale up developing financing) as the best – and only – realistic path to get back on track.  Key priorities include increasing investment, strengthening multilateral cooperation, modernising the international financial system to give developing countries a stronger voice, and building resilience to better withstand future shocks.”

PS: “… The UN chief identified three broad areas of focus for cutting into the $4 trillion financing gap.   First, by “revving up the machinery of finance” (leveraging the Multilateral Development Banks, creating new public-private finance initiatives); second, by reforming debt (including mechanisms for debt relief and a “reimagining” of the credit ratings system); and third, through a reform of the international financial architecture, so that it reflects today’s global economy.”

OECD(report) – Multilateral Development Finance 2026

https://www.oecd.org/en/publications/multilateral-development-finance-2026_0720370a-en.html

“The multilateral development system is being reshaped by growing geopolitical fragmentation and tightening aid budgets. After decades of expansion, funding to the system fell sharply in 2024, with further reductions expected through 2027. This downturn has exposed longstanding structural challenges, including funding vulnerabilities and institutional proliferation, that were easier to overlook during years of growth. Although outflows from multilateral development organisations remain high for now, pressure is mounting, and sustained delivery cannot be maintained without stable, predictable funding. Moreover, the risks posed by funding cuts depend not only on their scale, but also on where they occur: reductions in critical parts of the system can weaken functions on which the broader architecture depends. Against this backdrop, this fifth edition of the Multilateral Development Finance report highlights concrete opportunities for reform and for more strategic engagement with the multilateral system. It emphasises the importance of preserving the features that make the system greater than the sum of its parts, including its leverage, global reach, and ability to support the poorest and most vulnerable countries.”

Devex – Rethinking the architecture of development finance

https://www.devex.com/news/rethinking-the-architecture-of-development-finance-112341

“As official development assistance declines, development finance is undergoing a structural shift. At a Devex event with Boston Consulting Group, leaders outlined what it will take to navigate the shift and ensure sustainable impact.”

“A new financial architecture: At the heart of that transition is a rebalancing of power. For decades, development finance has been shaped largely by decision-making in the global north, ranging from how resources are allocated to which priorities are funded. But that model is beginning to change. “There is much more agency in developing countries in Africa to say, ‘well, we cannot be dependent,’” Dhanani said. “The decision-making, the allocation, and the resourcing has to be local.” That shift is no longer theoretical. In recent infrastructure transactions across Africa, he noted, financing is increasingly coming from regional and institutional capital — sometimes without the involvement of multilateral development banks or aid agencies….”

Re “The evolving role of multilateral banks”: Multilateral development banks remain central to the system, but expectations are shifting. Increasingly, their effectiveness is measured not just by how much they lend, but by how much private capital they can mobilize alongside it.  Recent progress suggests that change is underway. In the past nine months, the World Bank has mobilized $73 billion in private capital — a 53% increase from the previous year. But scaling that further will require both new tools and new incentives….”

“… Closing the financing gap will require more than incremental reform. It will mean mobilizing new sources of capital, rethinking institutional incentives, and strengthening partnerships across public and private players.  It will also require a shift in mindset — from viewing development as aid-driven to treating it as a system of capital flows that must be structured, de-risked, and scaled…..”

Lancet GH (Comment) – Nutrition-sensitive social protection saves money and lives

Mia Blakstad (World Bank) et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00053-7/fulltext

“Social protection programmes have grown immensely in the past decade; they now reach 4 billion people and distribute trillions of dollars to the poorest households each year. Social protection systems—cash transfers, school meals, in-kind food aid, public works, and labour market programmes—are how governments help manage risk, avoid harmful coping strategies, and stabilise consumption patterns during humanitarian shocks. In low-income and middle-income countries, these systems are increasingly financed by domestic budgets, representing substantial yet sustainable financing flows that can be tapped to achieve nutrition objectives.

Investments in social protection and nutrition programming are separate means towards a shared end: human capital and resilience for the most nutritionally vulnerable populations…”

“… in the past 3 years, initiatives have been building momentum for change. The Global Alliance against Hunger and Poverty and the N4G Global Compact for Nutrition Integration are two examples. With support from the Children’s Investment Fund Foundation, the Government of Norway, and the Gates Foundation, the World Bank and its clients are integrating nutrition across a US$30 billion social protection portfolio.  These examples highlight three crucial steps of integration: embedding explicit nutrition objectives in social protection strategy and designs, engaging nutrition experts as early as possible in the process when building or restructuring programmes, and tracking key nutrition outcomes and using the data for adaptive management….”

Devex: Share and share alike

https://www.devex.com/news/devex-newswire-how-development-innovation-looks-to-endure-without-usaid-112334

Re donor collaboratives:   

“The MacKenzie Scotts of this world are an anomaly among billionaires. Ultra-high-net-worth donors — those with at least $500 million in assets — aren’t exactly ultra-generous, donating a penny-pinching 1.2% of their wealth annually, according to The Bridgespan Group.   That’s why the social impact advisory firm is championing donor collaboratives, which bring funders together around shared priorities…..”

“Nidhi Sahni, who leads Bridgespan’s U.S. advisory services and counts Scott among her clients, described collaboratives as “a huge unlock,” both for spurring more giving and for reshaping how philanthropy navigates an era of plummeting official development assistance. “This moment gives us an opportunity to actually ask different questions, and do things differently,” she said in an interview at Devex’s Capital Summit on the sidelines of the World Bank-IMF Spring Meetings. 
Sahni said now is the time to shift both the conversation and the capital away from how philanthropy can “increase access to contraception, increase access to education, or increase access to vaccines,” and toward “how can philanthropy enable and support governments and countries to increase access to — fill in the blank.”  

“Donor collaboratives can propel that shift, said Sahn…  …  To that end, Bridgespan is encouraging donors to work through collaboratives such as Co-Impact, which focuses on systems change and has launched initiatives such as its Gender Fund, aiming to raise and deploy $1 billion globally…..”

Global Tax Justice

Guardian – Number of billionaires globally could reach 4,000 in next five years

https://www.theguardian.com/news/2026/apr/23/billionaires-super-rich-global-wealth-gap-economy

“There are now 3,110 billionaires but analysis shows ‘deep structural acceleration’ in wealth creation around world.”

“There are now 3,110 billionaires globally, according to analysis by the estate agent Knight Frank. This is forecast to rise by 25% over the next five years, taking the total to 3,915.”

“The multimillionaire class is also expanding rapidly, with the number of people worth at least $30m (£22m) around the world rising from 162,191 in 2021 to 713,626 today – an increase of more than 300%, Knight Frank found.”

“Liam Bailey, the head of research at the estate agent, said billionaire and millionaire wealth had been “supercharged” by profits from the world of tech, particularly artificial intelligence.”

PS: “Bailey added that political volatility, tax reform and tighter regulation were pushing the super-rich to a smaller group of cities that offer “opportunity and predictability”….”

Debt crisis

Devex – The debt crisis, overshadowed by other crises, is worse than we thought

https://www.devex.com/news/the-debt-crisis-overshadowed-by-other-crises-is-worse-than-we-thought-112335

“Eric Pelofsky of The Rockefeller Foundation says new research shows “the degree to which this went from a two-alarm fire to a four-alarm fire.”  Just over 90%. That’s how much the cost of borrowing surged for African countries between 2020 and 2024. Some countries were locked out of capital markets altogether. And all forms of financing got more expensive, whether from the World Bank or from China.”

“Those are the sobering conclusions of a new report published by ONE Data with support from The Rockefeller Foundation. The findings reinforce the urgency of a longstanding debt crisis that, in many ways, has taken a backseat to more immediate crises such as the Iran war and the collapse of the U.S. Agency for International Development.  Eric Pelofsky, vice president and senior adviser at The Rockefeller Foundation, hopes the data lends momentum to tackling the soaring price of debt for countries in the global south….”

Devex – Jubilee US chief optimistic Trump administration will tackle debt crisis

https://www.devex.com/news/jubilee-us-chief-optimistic-trump-administration-will-tackle-debt-crisis-112336

“Eric LeCompte, the executive director of the Jubilee USA Network, says the White House has an appetite for helping poorer countries restructure their debt.”

“While the Trump administration has shown no hesitation in gutting U.S. foreign assistance, Eric LeCompte, the executive director of the Jubilee USA Network, believes it has shown a willingness to tackle the debt burdens saddling many global south countries, especially in Africa.   “I think it’s clear that the U.S. government has remained committed to dealing with debt issues under the leadership of Treasury Secretary Scott Bessent and Republican leaders like [Rep.] French Hill. They’re looking at debt issues front and center, and they do want to have them addressed,” LeCompte told Devex during the World Bank and International Monetary Fund Spring Meetings last week.  LeCompte cited Bessent’s support for preemptive or efficient debt relief, whereby if a country’s debt is unsustainable, relief should happen preemptively rather than waiting for a total economic collapse or successive rounds of additional IMF lending.”  ““Bessent has also pushed for reforms to the G20 Common Framework for Debt Treatments to make it faster and more predictable.””

“… “there still is an appetite for spending some money that the administration sees has an impact,” noting its pledges to the International Development Association, or IDA, the World Bank’s concessional lending arm for the poorest countries.   Likewise, on the G20 Common Framework, which has been heavily criticized for being too slow and small in scope in restructuring debt, LeCompte is optimistic that conversations and efforts are underway to improve it.”

“And while LeCompte doesn’t foresee a wave of debt forgiveness akin to the global movement in the 1990s known as HIPC, or the Heavily Indebted Poor Countries initiative, he sees some version of an “international bankruptcy regime” as inevitable over the next five years, given the scale of the debt crisis — which is being exacerbated by the war in Iran.”

UHC & PHC

The Monitor – How shrinking aid is reviving national health insurance drive

https://www.monitor.co.ug/uganda/news/national/how-shrinking-aid-is-reviving-national-health-insurance-drive-5427778#story

With focus on Uganda in this article.

UN News – UN Forum puts spotlight on healthcare for Indigenous Peoples

https://news.un.org/en/story/2026/04/1167337

“Ensuring Indigenous Peoples’ access to healthcare, including during conflict, is the theme for a major meeting that opened at United Nations Headquarters in New York on Monday. More than 1,000 participants are expected to attend the latest session of the UN Permanent Forum on Indigenous Issues (UNPFII) – the platform that has placed their concerns at the centre of international debate over the past 25 years. “

“… Ms. Kotierk (Inuit leader from Canada, and chair of the forum) explained that for Indigenous Peoples, “health and well-being is more than just physical and mental health. It is interconnected with our culture, spirituality, languages, our lands and our environment. … She argued that health systems and understanding around health “must be decolonized to acknowledge this interconnectedness and incorporate the holistic, self-determined approaches to health by Indigenous Peoples.” 

US Global Health strategy & bilateral health agreements

We first start with a few “new additions”.

Trump Administration’s America First Global Health Strategy Fights Infectious Diseases Through Bilateral Health Memorandum of Understanding with Bolivia

US State department

(21 April)  “On April 17, 2026, the United States and Bolivia signed a three-year Memorandum of Understanding through the Trump Administration’s America First Global Health Strategy. Under the bilateral health MOU, the United States intends to establish a collaborative framework through December 2028 that directs resources toward interrupting the transmission of Neglected Tropical Diseases, procuring life-saving HIV medicines, and supporting Bolivia toward health system autonomy and self-reliance.”

“The more than $12 million health MOU builds on decades of gains made through U.S. global health assistance in the joint fight against infectious diseases in Bolivia, helping create a safer Western Hemisphere and reducing the risk of infectious disease outbreaks from reaching our shores. Through the jointly decided MOU, the United States plans to provide $10 million to strengthen global health security programs and protect our own region from the spread of infectious diseases. Bolivia plans to increase its own domestic global health expenditures by more than $2 million through 2028.”

United States Forging a Healthier Oceania Through Trump Administration’s America First Global Health Strategy Through Bilateral Health Memorandum of Understanding with Papua New Guinea

US State government; 

(23 April) “Working with Congress, the United States intends to provide $15 million through December 2030 through the jointly decided health MOU, building on decades of progress in reducing HIV infections and transmissions in Papua New Guinea. The government of Papua New Guinea intends to allocate up to $3 million to disease control programs and strengthen health systems at the national and provincial levels. Up to $5 million under the health MOU will directly support global health security funding, advancing our shared commitment to health security in the region….”

Politico Pro – State Department official resigns over disagreement with the administration’s global health approach

https://subscriber.politicopro.com/article/2026/04/pepfar-state-department-resign-global-health-00881295

“Mike Reid, PEPFAR’s chief science officer, said he objected to America conditioning health funding for poor countries on access to their resources.”

·         For all the detail, see  Emily Bass (on Substack) – PEPFAR’s Chief Science Officer Resigns on Matters of Public Health Principle                  A few excerpts:

“Today mike Reid, Chief Science Officer for PEPFAR at the Bureau of Global Health Security and Diplomacy, announced his resignation in a Substack post in which he called the Trump Administration “authoritarian” and confessed, “I no longer trust myself to continue this work without accommodating changes that I believe are fundamentally at odds with its purpose.”

“An award-winning infectious disease specialist who still sees patients at San Francisco General Hospital and prefers his first name to go uncapitalized, Reid took up his role prior to Trump’s election and, as recently as January, had defended the Administration’s new strategy. Even in today’s announcement, he holds out hope that the past 18 months’ work will result in positive change. But he is unable to reconcile the work of the State Department’s global health bureau with the broader America First foreign policy agenda, writing, “We cannot, on the one hand, press partner governments to absorb hundreds of millions of dollars in health costs, while on the other direct vastly greater sums toward military actions that result in civilian harm.” “

“… Reid’s resignation is the first public departure of a career global health professional from the Bureau of Global Health Security and Diplomacy. Up until now, the “careers” have publicly followed the lead of these Trump cronies, staying in post without a single outraged departure like the ones that occurred at CDC. …. ….… Reid’s departure isn’t an isolated incident, it’s an instance of a growing crisis of confidence in the America First Global Health Strategy that the State Department is aware of, and seeking to mitigate. While that mitigation is mostly public bloviation, there’s also some evidence of substantive, if incremental changes, in its approach to areas of public critique.

… A couple of weeks ago, GHSD sent a Congressional Notification to Capitol Hill that it intended to transfer another quarter’s worth of funding to Centers for Disease Control and Prevention and the Department of Defense to implement Bridge Plan activities through June 30 2026. …”

“… As I’m writing this, I’m thinking of Reid’s departure, and of the point at which compromise becomes complicity. It seems as though he could no longer tolerate being inside of an entity controlled by an administration that refuted the “anti-fascist” principles of solidarity, human rights and equity that underpin global health work.”

Foreign Policy – Can Trump Export Zambia’s HIV Success?

A Green; Foreign Policy;  

“Years of investment made certain provinces resilient to aid cuts, but replicating that system is another story.”

Quick summary Green: “… What I found (in these 4 provinces in Zambia) confirmed the strategy’s claims: The transition has mostly been a success. In an article out today in Foreign Policy, I examine, first, what made it work, including money, the careful deployment of experts, extensive data collection systems and, above all, time. Then I considered whether those lessons are reflected in the Trump administration’s approach. Spoiler alert: Not entirely.”   A few excerpts:

“The clinic’s resilience is not accidental. It is the product of a yearslong shift in how Zambia’s Southern Province provides HIV services. In 2019, the U.S. Centers for Disease Control and Prevention (CDC), which administers PEPFAR funds in four Zambian provinces, began channeling money directly to those provincial governments instead of routing it through nongovernmental organizations (NGOs). The funds were administered via cooperative agreements, or CoAgs, which define who receives HIV funding, how it will be spent, and how the CDC will implement and monitor those programs.  …. For most of PEPFAR’s history, NGOs served as the backbone of its operations, implementing lifesaving services on behalf of governments that often lacked the capacity to do so. Across Africa, however, a handful of places are experimenting with using PEPFAR money to directly fund partner governments instead of NGOs.  It was Zambia’s approach that caught the Trump administration’s attention. …”

“… But experts involved in Zambia’s transition warn that direct government financing is being introduced without a full understanding of what made their approach successful….”

Do read on, and make sure you also read Green’s addendum (in his own newsletter, the Forsaken) where he writes about the Zambian provinces that tried a similar financing transition but failed.

·         See The Forsaken – Lessons learned?

“ What Washington can learn from a failed transition in how it funds HIV services.”

Down to the Wire in Zambia: What Happens When Health Aid Becomes Leverage

J Ratevosian;  https://ratevosian.substack.com/p/down-to-the-wire-in-zambia-what-happens?utm_campaign=post&utm_medium=email&triedRedirect=true

“Negotiation over U.S. support could trigger disruption in Zambia’s HIV response—and call into question the future of US global health partnerships.”

“Zambia is approaching a critical deadline. According to sources, government officials have less than a couple weeks to decide on the terms of a new bilateral agreement with the United States—one that may condition continued health assistance on broader economic concessions….”

“… For more than two decades, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has operated with a clear premise: lifesaving health services should not be contingent on unrelated political or economic objectives. That approach has enabled scale, trust, and measurable results. Zambia is a clear example. The country has made substantial progress toward epidemic control, expanded access to treatment, and improved life expectancy over the past two decades.  At the same time, Zambia has emerged as a leader in the next phase of HIV prevention. ….”

Do read on.

PS: and a quote: “I can’t help but feel that the heavy emphasis on lenacapavir is starting to outpace a broader strategy—leaning into future innovation while some of the core service delivery challenges in front of us remain unresolved.”

Devex Check-up – Have a little faith
Devex;  

“One thing that’s clear in the “America First” global health strategy is the U.S. government’s keen interest in partnering with faith-based organizations.  This isn’t entirely new. The U.S. has worked with faith-based groups for decades to deliver health assistance, and many FBOs run extensive networks of facilities across African countries where Washington has bilateral health agreements.
But there seems to be a gap between the strategy’s aspirations and the realities on the ground.”

“A survey across 18 African countries conducted by the Africa Christian Health Associations Platform and seen by Devex reveals that while some countries engaged FBOs in the MOU development process and implementation planning, others did not. And in cases where consultations were conducted, “that did not consistently translate into operational planning roles.” 

“And it’s not just about engagement. There are still big questions around the money. How, exactly, will U.S. funding under these deals trickle down to FBOs?…  Take Kenya. There are no clear legal or budgetary pathways for the government to directly transfer operating funds to privately owned faith-based hospitals and health centers, according to Doug Fountain, executive director of Christian Connections for International Health, a U.S.-based nonprofit. Even where these facilities can be reimbursed through national health insurance schemes, payments are often delayed — sometimes significantly….

PEPFAR data: fierce debate

Sparked by, first of all, a NYT article from late last week.

NYT New PEPFAR Data Show Worrying Declines in Testing and Treatment for H.I.V.

https://www.nytimes.com/2026/04/17/health/hiv-testing-treatment-data-pepfar.html?unlocked_article_code=1.blA.4dvg.npuBPylVrjad&smid=url-share

Published late last week. “The numbers are the first to quantify the effect of the Trump administration’s shutdown and restarting of a program that has saved millions of lives worldwide.”

“The United States-funded H.I.V. program that is credited with saving 26 million lives worldwide suffered big blows to its impact after the Trump administration’s abrupt stop and restart of its activities last year, according to the first tranche of data from the program since 2024.  Overall, the President’s Emergency Plan for AIDS Relief, or PEPFAR, treated about as many people in the last quarter of 2025 as in the same period in 2024, according to a report released on Friday by the State Department. Jeremy Lewin, acting under secretary of state for foreign assistance, humanitarian affairs and religious freedom, framed the report as a victory, saying at a conference this week that “the numbers are very, very good.” But the data showed sharp decreases in the numbers of people newly tested, diagnosed and treated for H.I.V., declines that will have long-term consequences, several public health experts and patient advocates warned….”

“In the last quarter of 2025, PEPFAR supported testing for 17.2 million people, a steep drop from the 21.9 million people tested in the same period in 2024. Diagnoses also fell, to 307,000 from 385,000, a predictable consequence of less testing. The numbers also showed a worrying drop in treatment of infants with H.I.V., who tend to become ill rapidly and die.”

“The situation may not be as dire as many experts had feared in the weeks after the Trump administration froze all foreign aid, but it is nevertheless grim, said Charles Kenny, an economist at the Center for Global Development who analyzed a subset of the data that were briefly available online before being taken down…..”

PS: “The new numbers are consistent with a separate report in November from the Clinton Health Access Initiative. Concluding that “recovery is limited and uneven,” that report found a drop of 22 percent in new H.I.V. diagnoses in the first half of 2025, and 20 percent in the diagnosis of infants. The number of people taking oral pills to prevent H.I.V. fell by 37 percent….”

·         PS: The US State department didn’t agree, see  PEPFAR Data Release   (20 April)

(for what it’s worth…)   :“… What is misrepresented as a significant decline in the number of children on HIV treatment is actually a sign of the tremendous progress that has been made reducing the incidence of mother-to-child transmission of HIV and is consistent with historical trends. Over the past four years, the number of children on treatment has declined from 643,627 in 2022 to 508,703 in 2025—declines of 7 percent, 7 percent, and 9 percent over the past three years respectively. We are optimistic these declines will continue, especially with the U.S. Government’s funding of Lenacapavir, which can further prevent mother-to-child transmission (not reflected in this point-in-time data from last year). The lower number of positive tests is a sign of the progress that has been made battling the HIV epidemic and is consistent with historical trends. Over the past four years, positive tests declined from 1,693,349 in 2022 to 1,136,488 in 2025—declines of 14 percent, 12 percent, and 11percent over the past three years respectively. This data does not include the impact of the bilateral agreements we have signed and the broader strategies being implemented under the America First Global Health Strategy.  The message is clear: we cut overall spending by 30 percent while preserving critical frontline HIV care and eliminating wasteful programs. This proves the America First Global Health Strategy works. In the coming months, we expect the data to show more lives saved per taxpayer dollar. The narrative will shift as our strategic approach demonstrates that ending the HIV/AIDS epidemic requires fewer taxpayer dollars—not more.”

HPW – Researchers Dispute US Government’s Upbeat Data About PEPFAR’s Impact on HIV

https://healthpolicy-watch.news/researchers-dispute-us-governments-upbeat-data-about-pepfars-impact-on-hiv/

Update from Wednesday, featuring also new research.

“Researchers have challenged several upbeat claims made by the United States government about the continued impact of the US President’s Emergency Plan for AIDS Relief (PEPFAR). The US State Department claims that PEPFAR has sustained its impact on HIV despite the service disruptions and funding cuts introduced by the Trump administration….”

“In a data release covering 1 July through 31 September (the fourth quarter of the US budget cycle) (from 20 April), the US government reports that PEPFAR supported 20,6 million people in over 50 countries on anti-retroviral (ARV) treatment. They note that this is “stable from the same FY 2024 reporting period”.   “Three million people now receive treatment from national governments rather than external PEPFAR implementers,” with two million “successfully transitioned” during the fourth quarter alone, according to a statement from the US State Department’s Bureau of Global Health Security and Diplomacy (GHSD).  PEPFAR initiated 103,000 pregnant and breastfeeding women on pre-exposure prophylaxis (PrEP), “more than double the 43,000 from a year ago”, according to the GHSD. PrEP involves HIV negative people taking ARVs to prevent infection. While the GHSD acknowledges a decline in the number of children on HIV treatment – from 643,627 in 2022 to 508,703 in 2025 – it attributes this to “tremendous progress” in prevention of mother-to-child transmission (PMTCT)….”

“… But researchers – from AmFAR, the Foundation for AIDS Research, and the International AIDS Society (IAS) – argue in a preprint article that there have been “substantial disruptions across PEPFAR service areas”.  Their analysis is based on both the newly released fourth quarter figures plus ​​data from “an earlier inadvertent release [that] included all four quarters.”….”  Check out the detail.

·         See also a Devex Analysis–  PEPFAR data shows drops in HIV prevention as US claims success

“The figures are the first to measure the impact of the Trump administration’s shutdown of foreign aid — including its ripple effects on a program known for saving 25 million lives.”

“The latest data on the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, tells two very different stories. On paper, the program appears steady — and even resilient, when it comes to top-line numbers. But beneath the headline figure, sharp declines in testing, prevention, and diagnoses suggest cracks that could reshape the global HIV response, especially as America’s flagship HIV/AIDS program evolves in the years ahead….”

·         And KFF analysis – What We Know from the Latest PEPFAR Data: Analysis of FY 2025 Quarter 4 Results  (23 April)  “KFF analysis of newly released data from the President’s Emergency Plan for AIDS Relief (PEPFAR) reveals mixed outcomes on key program-level metrics….”

Reuters – US aid cuts undermine HIV prevention in South Africa, report finds

Reuters

“U.S. had invested millions in HIV prevention services in South Africa; Community outreach and counseling have been dismantled due to aid cuts; First doses of new drug lenacapavir arrived in ​South Africa this month.”

“U.S. funding cuts to South Africa ‌have dismantled HIV prevention programmes just as they are needed to support the roll-out of the new prevention drug lenacapavir, a report said on Tuesday. … The report by ​Physicians for Human Rights, a U.S.-based NGO, said that Washington effectively wasted billions of dollars ​of investment by abandoning research infrastructure and health delivery platforms which it had spent years building in South Africa. In the near term, that will hinder the rollout of lenacapavir, a twice-yearly injectable HIV prevention ​drug which arrived in South Africa this month, the report said.”

“”We have a product that’s ​really powerful, but we don’t have a programme to fit it into anymore,” said Emily Bass, a ‌co-author ⁠of the report.  The U.S. had funded community-based outreach and peer education programmes about different HIV prevention options, for example, without which they may not know lenacapavir exists, she said…..”

Trump 2.0

Devex Pro – Ex-official who saw USAID torn down asks Congress to reestablish it

https://www.devex.com/news/ex-official-who-saw-usaid-torn-down-asks-congress-to-reestablish-it-112296

(gated) “Nicholas Enrich, the former USAID official who became a whistleblower, says the agency was not torn down so the new administration can create a better system, but only to “satisfy the ego of a billionaire.””

·         And a link (new blog) re USAID, via CGD – USAID Spending at the Country and Sector Level: What Happened in Fiscal 2025?  (by C Kenny et al)

Science – After long wait, Trump nominates a CDC director

https://www.science.org/content/article/after-long-wait-trump-nominates-cdc-director

“White House taps physician and lawyer Erica Schwartz to lead struggling health agency.”

·         Related: Stat –  Optimism for Trump’s CDC pick is tempered by questions about RFK Jr.’s role   

“Even supporters fear Erica Schwartz won’t be given free rein to run the agency under RFK Jr.”

·         Related:  NYT –   Kennedy Refuses to Commit to Backing New C.D.C. Director on Vaccines

“In a tense congressional hearing, the health secretary also said he bore no responsibility for the measles outbreak in the United States.”

Lancet Editorial – The US CDC on the brink

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00799-3/fulltext

This week’s Lancet Editorial.

“The CDC was once the gold standard for public health leadership. Today, it is struggling to maintain scientific excellence, trustworthiness, and relevance, a result of the actions of the Trump administration and the US Department of Health and Human Services that have undermined the agency….”

Overview of the current state of affairs, and some predictions on what the future might look like for the agency.

Stat – Former tobacco executive joins CDC senior leadership, raising concerns over industry influence

https://www.statnews.com/2026/04/22/newly-appointed-cdc-official-has-tobacco-industry-ties/

“Stephen Sayle’s appointment is ‘letting the fox into the henhouse with open arms,’ said a former health official.”

Guardian – Inside the CDC’s leadership vacuum: work at a ‘standstill’ and low morale as 80% of top posts remain vacant

https://www.theguardian.com/us-news/2026/apr/17/cdc-rfk-jr-leadership-positions-empty

“Current and ex-officials at the CDC warn Americans’ health security in danger under RFK Jr’s direction.”

Devex –  The upside of Trump’s travel and visa bans

Dr. Aly Kassam-Remtulla; https://www.devex.com/news/the-upside-of-trump-s-travel-and-visa-bans-112282

“The silver lining of keeping African scientists out of the U.S. may well be the increase in domestic expertise and long-term development outcomes.”

He makes, among others, the “case for foreign investment or philanthropy directed at African research ecosystem. “

PPPR

Next week (April 27-1 May), countries gather for a resumed session of the PABS negotiations in Geneva. Informals have been ongoing for the past few weeks, since the last round.

Via RANI’s newsletter, on PABS’ “last dance”:

• “Three issues, one deadline. An agreement broadly hinges on three issues. On benefits, delegates are exploring their scope and configuration both during public health emergencies, pandemics, and between pandemics. On access, landing zone proposals are gravitating toward a hybrid approach to database rules to allow countries to choose between open and closed access, while defining the right checkpoints to ensure data users are obligated to share benefits (e.g. accountability and compliance). On contracts, divergences continue to be about the level of detail that should be included in the annex and how much flexibility should be allowed, or not, when negotiating contracts. “

GHF – Striking a Balance: Standardization and Flexibility in Pandemic Contracts

Adam Strobeyko; https://newsletter.genevahealthfiles.com/striking-a-balance-standardization-and-flexibility-in-pandemic-contracts/?ref=geneva-health-files-newsletter

“What a comparison of PIP Framework benefit-sharing agreements shows for PABS negotiations.”

Intro by P Patnaik: “…In our sponsored guest edition today, legal expert Adam Strobeyko at the Geneva Graduate Institute’s Global Health Centre, lays out an analysis on what could work in this twilight zone of the negotiations. Using the Standard Material Transfer Agreements of the Pandemic Influenza Preparedness Framework, and principles from contract law, his team at the Global Health Centre has parsed out the level of detail countries will need now, and those that can be left for later. This would be helpful in understanding what a PABS contract can look like. …”

Some excerpts from Srobeyko’s analysis (which has a double focus):

“I argue that PABS contracts should be more standardized than PIP SMTAs on core legal issues such as enforcement, benefit-sharing, dispute settlement, and force majeure. But does that require negotiating every clause in advance and treating it as fixed? Not necessarily. A closer look at PIP SMTA2s reveals that strong standardization on core provisions has coexisted with flexibility…..”

“A separate and an equally pertinent question, largely unexamined so far, is what happens when such contracts are embedded not in a WHA resolution, as with PIP, but in a treaty requiring ratification. I explore below the experiences of the Plant Treaty that needed domestic ratification of the international agreement that included contracts…..”

PS: “…The PIP Framework is not a legally binding instrument. Rather, benefit-sharing commitments are formalized through private-law contracts known as SMTAs. SMTA2s are negotiated and concluded between WHO and companies. They generally do not preclude companies from seeking intellectual property rights on products, while requiring them to provide benefit-sharing commitments selected from an annexed menu ….”

On focus two: “There is a further dimension the PABS debate has not yet fully reckoned with. The PIP Framework is a non-binding instrument adopted by the WHA under Article 23 of the WHO Constitution and never had to pass through national ratification. The Pandemic Agreement, negotiated under Article 19 of the Constitution, is a treaty. If its PABS Annex includes standardized contracts between WHO and private manufacturers, its success will depend on the success of both legal instruments taken together….  “

Srobeyko argues: “… This calls for a two-step approach: the treaty sets out the mandate, core principles, and minimum parameters, while the detailed contract template gets adopted later by the COP, as the Plant Treaty did with its SMTA. Thus, the template can evolve without reopening the treaty, which reflects how PIP’s own SMTA2 provisions have shifted across successive rounds of negotiations…. … A treaty text that establishes the mandate for standardized contracts, sets out core principles, and defines minimum benefit-sharing floors gives parliaments something concrete to approve without requiring them to parse commercial fine print. The detailed contract template can then be developed by the COP, drawing on technical and legal expertise.”

Development Today – Norway’s position in pandemic agreement negotiations: a response to Usman Mushtaq

https://www.development-today.com/archive/2026/dt-3–2026/norways-position-in-pandemic-agreement-negotiations-a-response-to-usman-mushtaq

(gated)   “Over 100 civil society organisations, including Third World Network, wrote to the Norwegian Prime Minister and authorities last month expressing concern about the positions taken by Norwegian diplomats in the on-going negotiations in Geneva on Pathogen Access and Benefit Sharing System (PABS). Norway’s Secretary of State for Health Usman Mushtaq responded to these concerns in his comments to Development Today.”

This article (by Nithin Ramakrishnan (TWN) & Lauren Paremoer (PHM) ) is a response to these comments.

Nature Medicine (World View) – Africa’s moment for health security

Jean Kaseya; https://www.nature.com/articles/s41591-026-04330-9

“Advancing pandemic readiness to secure Africa’s health sovereignty.”

“To advance this agenda, I recommend the following five interrelated actions….”

Lancet GH (Health Policy) – Research priorities for improved pandemic and epidemic intelligence

B Tornimbene et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00024-0/fulltext

“…the WHO Hub for Pandemic and Epidemic Intelligence, in collaboration with global partners, conducted a research prioritisation exercise to identify key research gaps and opportunities. Using a structured consultation process and expert-driven scoring, based on a modified Child Health and Nutrition Research Initiative approach, we identified 23 priority research statements across eight thematic domains including data preparedness, quality standards, analytical frameworks, artificial intelligence and technological advances, multisectoral approaches, community-centred approaches, governance, and evidence-to-policy translation…..”

AMR

Front Page Africa – Liberia: Nine Out of Every Ten Women in Survey Take Antibiotic Every Month: Experts Describe Findings as ‘Catastrophic’ For All Liberians

Frontpage Africa;  

“In a widespread but misinformed practice more than nine out of 10 women in a FrontPage Africa/New Narratives survey said they take antibiotics every month to “cleanse” themselves after their menstrual cycle. Antibiotics are available without prescription. Experts said the findings are frightening, suggesting an unseen public health crisis that will fuel antibacterial resistance in the country that is already leaving many people without treatment options and leading to thousands of deaths….”

More on Health Emergencies

Africa CDC, WHO and Partners Review Progress on Mpox Response

https://africacdc.org/news-item/africa-cdc-who-and-partners-review-progress-on-mpox-response/

“ Africa is strengthening its response to disease outbreaks through faster, more coordinated and more predictable action, building on lessons from the continental Incident Management Support Team (IMST) activated during the mpox response.  Leading public health institutions, partners and representatives from 30 member states convened at the Africa Centres for Disease Control and Prevention (Africa CDC) headquarters to conclude a high-level review of the IMST, marking a significant step in advancing collective outbreak preparedness and response across Africa.”

“The five-day meeting brought together officials from Member States, Africa CDC, the World Health Organization (WHO), UNICEF, the International Federation of Red Cross and Red Crescent Societies (IFRC), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and other partners to assess performance, capture lessons and identify priorities to strengthen coordination mechanism in future outbreaks, drawing on lessons from the mpox response.   The current IMST was established in August 2024 in response to the mpox outbreak and has since served as a time-bound coordination mechanism to align partners under a unified operational approach. Co-led by Africa CDC and WHO, the IMST operates under a unified “4-Ones” framework – one team, one plan, one budget and one monitoring and evaluation framework – ensuring alignment, shared accountability and coherence across all response pillars….”

“… Since its activation, the IMST has delivered measurable results. More than US$1.1 billion has been mobilised, over five million vaccine doses deployed, and coordinated risk communication and community engagement activities have reached 50 million people across 33 countries. These efforts contributed to an increase in vaccine acceptance from 44 per cent to 87 per cent in targeted settings.  Despite the end of the mpox Public Health Emergency of Continental Security and the Public Health Emergency of International Concern, partners agreed that sustained coordination remains critical. Cholera continues to pose a significant threat, with 14 countries currently managing outbreaks…..”

·         And a link: Lancet Letter – Unusual measles mortality in Bangladesh signals an immunisation emergency

“…the current outbreak is not just an upswing in case counts, it is a severity crisis, with hospitals taking on a rare burden of hypoxic, malnourished, and acutely ill children.”

“The culprit driving the disease is probably not measles biology, but immunity failure. Almost 5 million children in Bangladesh were not fully immunised in 2025, including 70 000 children with zero doses and more than 400 000 children who were underimmunised. UNICEF, WHO, and Gavi, the Vaccine Alliance warned of major gaps among children living in urban slum settlements and other underserved settings. Given normal levels of two-dose coverage and catch-up systems, measles outbreaks are predictable, as herd protection requires very high levels of population immunity. For Bangladesh, therefore, it is not enough to have a reactive campaign….” “..this outbreak serves as a timely reminder that routine coverage data alone are inadequate. Severity-linked measles surveillance is now required in Bangladesh to avert preventable deaths.”

World Malaria Day (25 April)

Some key stats via WHO (on the current state of the fight)  –   World Malaria Day      

Nature (Editorial) –Vaccines mean malaria deaths should be falling — not rising

https://www.nature.com/articles/d41586-026-01253-w

“The tools exist to end this killer disease. It is the money and the will that are lacking.”

“There will be little to celebrate on World Malaria Day on 25 April. Global malaria cases, which stood at 238 million in 2018, had climbed to 282 million by 2024, the latest year for which figures are available. Deaths from the disease rose from 575,000 to 610,000 over the same period. Malaria remains endemic in 80 countries. Ending malaria epidemics by 2030 is a target of the United Nations Sustainable Development Goals, but progress has clearly stalled….” ““Deplorably, this is happening despite the advent of vaccines….”

“In October, it will be five years since the World Health Organization (WHO) recommended the world’s first malaria vaccine, RTS,S. This was hailed at the time as a tool that would “change the course of public health history” by WHO director-general Tedros Adhanom Ghebreyesus. A second vaccine, R21, was recommended two years later.  Since the WHO endorsed these vaccines, 25 countries have begun rolling out immunization programmes. But the vaccines are not reaching some of the populations that are most at risk, particularly in Africa, where more than 90% of malaria cases occur. Tanzania, for example, accounted for 4.3% of global malaria deaths in 2024, but has not yet introduced vaccines….”

“… The biggest problem, however, is obtaining funding for malaria control. Gavi, the Vaccine Alliance, is the main funder of malaria vaccines for children in the poorest countries. Last year, governments and philanthropic funders raised some US$9 billion of Gavi’s target of around $12 billion for the 2026–30 period. Funding might be lower in future years, because US health secretary Robert F. Kennedy Jr has said that the United States will no longer contribute to Gavi. And it is not only investments for vaccines that are down, but also funding for malaria control in general. In 2023, total global funding for tackling the disease reached $4 billion, less than half of the WHO’s target of $8.3 billion….”

“… This year’s World Malaria Day slogan is “Now we can. Now we must.” “‘Now we can’, because we have the tools,” says Charles. “And ‘Now we must’ because it’s unacceptable that in the twenty-first century, 600,000 children are losing their lives from a disease that is preventable and curable.”

Science News –  Severe malaria may affect children’s cognitive abilities more than a decade later

https://www.science.org/content/article/severe-malaria-may-affect-children-s-cognitive-abilities-more-decade-later

“Children who had cerebral malaria or severe malaria anemia have lower scores on tests measuring general cognition and math achievement.”

“Malaria may cause long-term brain damage, according to a study that followed nearly 1000 children in Uganda for up to 15 years after their infection. The research, presented today at the Congress of the European Society of Clinical Microbiology and Infectious Diseases and published in JAMA, found that children who survived cerebral malaria or severe anemia caused by malaria scored lower on cognitive tests and math achievement many years after the infection. More than 1 million children experience these severe forms of malaria each year….”

HPW – Africa Needs Urgent Action to Protect ‘Miracle’ Malaria Drugs 

https://healthpolicy-watch.news/africa-needs-urgent-action-to-protect-miracle-malaria-drugs/

“Resistance to a key drug used to treat malaria in Africa is spreading. Experts warn action is now urgent and any delay will cost lives and create economic misery. “

“Artemisinin-based combination therapy (ACT) is the main first-line malaria treatment used in Africa and the best available option, according to the World Health Organization (WHO).  ACT has saved millions of lives, but the parasites that give you malaria are becoming resistant to one of the two drugs in the treatment, artemisinin. “  …” … This is known as partial resistance to ACT because the parasites can still be killed and have not developed resistance to the other drug used with artemisinin, most often Lumefantrine.”

“The WHO reports that this has happened in Rwanda, Uganda, Eritrea and Tanzania. Resistance, Resistance is suspected in at least four other countries, and tests are being carried out in these and further countries as it is likely that the problem is spreading. 

The article then goes on describing what should/could be done.

HPW – Indigenous Brazilian Children Are First in World to Get Paediatric Malaria Treatment

https://healthpolicy-watch.news/indigenous-brazilian-children-are-first-in-world-to-get-paediatric-malaria-treatment/

“Brazilian children from the Yanomami indigenous community will be the first in the world to get a single-dose paediatric treatment for relapsing malaria.  The introduction of paediatric tafenoquine, developed by Medicines for Malaria Venture (MMV) and pharmaceutical  company GSK, marks a “major step” towards closing the treatment gap for children at risk of relapsing Plasmodium vivax (P. vivax) malaria, according to MMV….”

·         And a link: Global Fund – Global Fund Launches Regional Malaria Grant for Southern Africa, Bolsters Response to Rising Risk from Extreme Weather Events in Mozambique

“Regional MOSASWA partnership anchors US$24 million catalytic investment as emergency funding responds to malaria surge following floods.”  “The MOSASWA initiative – spanning Mozambique, South Africa and Eswatini (formerly Swaziland) – anchors a coordinated, cross-border effort to eliminate malaria, recognizing that transmission moves with people, parasites and, increasingly, extreme weather events….”

NCDs

Lancet Global Health (Health Policy) – Factors shaping the priority of cancer in global health: a qualitative policy analysis

Kristina Jenei, et al   https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00056-2/fulltext

“Despite its rising epidemiological and economic burden, cancer remains under-prioritised in global health. This Health Policy examines the determinants that have shaped the global response to cancer. Drawing on interviews with key global health stakeholders, we identify recurrent patterns of fragmentation, donor-driven agendas, commercial influence, and the privileging of cancers and interventions that align with vertical delivery models. Our analysis also foregrounds radiotherapy and surgery as emblematic system-dependent modalities that struggle to gain traction despite strong economic and clinical evidence for investment. The complexity of cancer further constrains global prioritisation. This Health Policy advances understanding of why cancer remains unevenly prioritised compared with other global health issues and why cancer is an increasing health burden. Addressing cancer as a global health priority requires a unified governance platform, coherent narrative across institutions, stronger drive for domestic resource mobilisation and international financing, and alignment between global initiatives and the capacities and priorities of diverse health systems.”

Lancet – Announcing the Lancet Commission on colorectal cancer: addressing the rising global burden

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00418-6/fulltext

In case you missed this.

Social & Commercial Determinants of Health

Science News –  This simple house may help prevent multiple fatal diseases in African children

https://www.science.org/content/article/simple-house-may-help-prevent-multiple-fatal-diseases-african-children

“Randomized controlled trial shows the $8800 design can reduce cases of malaria, diarrhea, and respiratory infection.”

“In Southern Tanzania, scientists hired contractors to build 110 simple two-story houses designed to reduce the risk of a slew of diseases for their residents and then randomly selected families to live in them. Children in those buildings suffered less often from malaria, diarrhea, and respiratory infections—diseases that together kill more than a million children each year in sub-Saharan Africa—than those living in traditional mud-and-thatch houses in the same villages, the scientists report today in Nature Medicine.”

“Researchers say the study could guide the design of inexpensive, basic homes, which Africa will need lots of the coming decades. The United Nations expects the continent’s population of around 1.5 billion people to double by 2070.  “This is the first experimental study to investigate whether an improved house design can reduce multiple causes of child deaths in sub-Saharan Africa,” says Lucy Tusting, a malaria researcher at London School of Hygiene & Tropical Medicine (LSHTM) who wasn’t involved in the work. “This exciting finding shows the potential of novel house designs to improve children’s health and survival on a wide scale.”

UN News – Long hours, stress and harassment are causing hundreds of thousands of early deaths, says UN labour agency

https://news.un.org/en/story/2026/04/1167356

“More than 840,000 people die each year from health conditions linked to risks such as long working hours, job insecurity, workplace harassment and bullying, according to a new report by the International Labour Organization (ILO). “

“The way that jobs are designed, organised and managed has a major effect on the health and safety of workers, and, according to the study, – The psychosocial working environment: Global developments and pathways for action – the impact is growing, manifesting itself in rising rates of cardiovascular disease and mental disorders, including suicide. “

“The report’s authors looked at three interrelated areas of work: the nature of the job (including the demands, responsibilities and tasks), how it is organised and managed and the broader workplace policies in place (such as performance and reward processes and rules preventing violence and harassment)….”

Lancet World Report – Outrage over UN–Nestlé partnership

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00797-X/fulltext

“An open letter calls for an end to a recent agreement with the UN University, based on Nestlé’s history of promoting infant formula. Udani Samarasekera reports.”

SRHR

Devex – How’s Trump’s push to transform the global social and moral order going?

https://www.devex.com/news/how-s-trump-s-push-to-transform-the-global-social-and-moral-order-going-112372

“In Washington’s bid to restrict sexual and reproductive rights, money, rather than persuasion, is proving the most valuable lever.”

Recommended – wide-ranging – analysis.

HPW – Sexual and Reproductive Health Rights Include Access to Safe Abortion Services

Maggie de Block; https://healthpolicy-watch.news/sexual-and-reproductive-health-rights-include-access-to-safe-abortion-services/

“Although the World Health Organization (WHO) recognises comprehensive abortion care as an essential health service, countries all over the world are tightening access, inspired by the United States. But all this means is worse outcomes for women’s health.”

“… Safe abortion is a basic human right:  Access to safe abortion is grounded in international human rights law, including the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Elimination of All Forms of Discrimination against Women.  In Africa, the Maputo Protocol provides an especially important regional anchor for women’s reproductive rights….”

“What governments and donors must do:

·           Reform laws and regulations that criminalise or unduly restrict abortion care. Criminalisation of abortion must end.  Punitive laws on women and service providers drive delay, secrecy and unsafe methods. 

·           Make mifepristone and misoprostol reliably available and affordable. …

·           Integrate abortion into primary health care and universal health coverage packages. Abortion should not be separate from routine sexual, reproductive and maternal health services.

·           Expand provider training and task-sharing. …

·           Guarantee access to post-abortion care. Even in restrictive settings, treating complications is an absolute minimum standard.

·           Invest in information, privacy and building trust. Women need accurate information and safe pathways into care, with compassion, and without stigma….”

Guardian – Condom prices could rise 30% due to Iran war, says world’s top producer Karex

https://www.theguardian.com/society/2026/apr/22/condom-prices-iran-war-cost-price-rise-karex

“Karex produces more than 5 billion condoms annually and is a supplier to leading brands like Durex and Trojan, as well as the NHS and global aid programmes run by the United Nations.”

PS: “Karex has enough supplies for the next few months and is looking to boost output to meet growing demand, as global stockpiles of condoms have dropped significantly after deep spending cuts in foreign aid, particularly by the US Agency for International Development last year.”

Run-up to Santa Marta conference, Colombia

Guardian – Colombia convenes climate ‘coalition of the willing’ to break global fossil fuel deadlock

https://www.theguardian.com/environment/2026/apr/17/colombia-convenes-climate-coalition-of-the-willing-to-break-global-fossil-fuel-deadlock

Analysis ahead of the “… Santa Marta conference born out of frustration at Cop summits, where renewable progress has been stalled by major polluters.”   The conference is scheduled for 28-29 April.

“… While 54 countries have confirmed their attendance at the conference, some of the world’s biggest economies and biggest polluters, including the US, China, India, Russia and the Gulf petro states, will be missing. … The 54 countries confirmed represent about a fifth of global fossil fuel production and about a third of demand. They include the UK, the EU, Canada, and Australia and Turkey, which will jointly preside over the next UN climate summit, Cop31, this November. Among the dozens of developing countries confirmed are some of the most vulnerable to the impacts of the climate crisis, such as Pacific islands, but also major fossil fuel producers, such as Nigeria, Angola, Mexico and Brazil…..”

·         See also  Carbon Brief – Revealed: Scientists tell Colombia fossil-fuel transition summit to ‘halt new expansion’

“Countries attending a first-of-its-kind fossil-fuel summit have been asked to consider “action recommendations” such as “halting all new fossil-fuel expansion” and “reject[ing] gas as a bridging fuel”, according to a preliminary scientific report seen by Carbon Brief. A preliminary scientific “synthesis report” circulated to governments attending the talks and seen by Carbon Brief offers 12 “action insights” for countries to consider, along with a wide range of “action recommendations”….”

“These recommendations range from “phase out subsidies on fossil-fuel production and consumption” to “kick-start a forum to develop a legal framework to ban fossil-fuel advertisements”….”

“… The preliminary report will be further debated and refined by scientists attending the “pre-academic segment” of the Santa Marta talks.  This is taking place from 24-26 April, ahead of the “high-level segment” involving ministers and other policymakers from 28-29 April.  The pre-academic segment will also separately see the launch of a new advisory panel on fossil-fuel transition and a scientifically led roadmap for how Colombia can transition away from fossil fuels, Carbon Brief understands.”

PS: “… At the end of the conference, countries are due to release a report featuring a “menu of solutions” for transitioning away from fossil fuels, according to Colombia’s environment minister Irene Vélez Torres.  This report is in turn set to inform a global “roadmap” on transitioning away from fossil fuels being developed by the Brazilian COP30 presidency, which is due to be presented at COP31 in Turkey this November….”

Climate Change News – To phase out fossil fuels, developing countries need exit route from “debt trap”

https://www.climatechangenews.com/2026/04/22/to-phase-out-fossil-fuels-developing-countries-need-exit-route-from-debt-trap/

“New research from the Fossil Fuel Treaty Initiative shows that the Global South’s debt crisis is slowing down the pace of the energy transition and supporting fossil fuels.”

“High levels of national debt in parts of the Global South could hinder efforts to move away from fossil fuels, a new report warns, as more than 50 countries gather this week in Colombia for the First Conference on Transitioning Away from Fossil Fuels.  The report, published by the Fossil Fuel Treaty Initiative in the lead-up to the flagship conference, argues that the current debt architecture is trapping developing countries in a “feedback loop” in which fossil fuel revenues are needed to service debt, while fossil fuel expansion locks countries into borrowing even more.”

“The cycle, according to the report, leaves very little fiscal space for highly indebted countries to end their reliance on coal, oil and gas revenues, even when their leaders want to phase out fossil fuels. This is the case for some first-mover countries such as Colombia, which is hosting the conference in Santa Marta….”

More on Planetary Health

Guardian – Heatwaves, floods and wildfires pose rising threat to democracy, report finds

https://www.theguardian.com/global-development/2026/apr/22/climate-change-extreme-weather-heatwaves-floods-wildfires-threat-democracy-elections

“Research shows natural hazards linked to climate crisis disrupted 23 elections in 18 countries in 2024.”

“Democracy is under mounting threat from the climate crisis, with new analysis documenting how elections are increasingly shaped not only by political forces but also by floods, wildfires and extreme weather.  At least 94 elections and referendums across 52 countries have been disrupted by climate-related impacts over the last two decades, researchers found.  As risks intensify, the pressure on already fragile democratic systems – particularly in Africa and Asia – is forecast to grow.”

“The findings, from the International Institute for Democracy and Electoral Assistance, an intergovernmental organisation that aims to support democracy around the world, is the first global analysis of how natural hazards are affecting elections….”

UN News – Extreme heat pushing global food systems to the brink, UN agencies warn

https://news.un.org/en/story/2026/04/1167352

“Extreme heat is pushing global food and farming systems to the brink, threatening the livelihoods of over a billion people as rising temperatures and more frequent heatwaves redefine how food is produced worldwide, a new UN report warns.”

“The joint report by the Food and Agriculture Organization (FAO) and the World Meteorological Organization (WMO) finds that extreme heat is already causing half a trillion work hours to be lost each year, with impacts set to intensify as temperatures rise.  “Extreme heat is increasingly defining the conditions under which agrifood systems operate,” said WMO Secretary-General Celeste Saulo, warning that it acts “as a compounding risk factor that magnifies existing weaknesses across agricultural systems.”  The report highlights how heatwaves – prolonged periods of unusually high day and night temperatures – are affecting crops, livestock, fisheries and forests, while also putting agricultural workers at serious risk.”

HPW – “A Unique Moment”: New Regional Air Pollution Plans Aim to Cut Health Burden Across Latin America

https://healthpolicy-watch.news/a-unique-moment-new-regional-air-pollution-plans-aim-to-cut-health-burden-across-latin-america/

“The Pan-American Health Organization (PAHO) will soon unveil a new Roadmap on Air Quality and Health, following on from a meeting with countries and other stakeholders in February in Mexico.  The PAHO strategy dovetails with an ambitious new regional action plan by the UN Environment Programme – which supports the work of environment ministries. “

Project Syndicate – To Strengthen Climate Resilience, Focus on Social Protection

Ana Toni and Kevin Watkins;  https://www.project-syndicate.org/commentary/climate-crisis-intensifying-poverty-social-protection-can-help-by-ana-toni-and-kevin-watkins-2026-04

“The international community is increasingly trying to distinguish between climate, development, and humanitarian finance—as if they can be neatly compartmentalized. But this siloed approach overlooks how social-protection programs providing cash transfers to vulnerable households can strengthen resilience to climate shocks.”

Carbonbrief – State of the climate: Strong El Niño puts 2026 on track for second-warmest year

https://www.carbonbrief.org/state-of-the-climate-strong-el-nino-puts-2026-on-track-for-second-warmest-year/

“The first three months of 2026 have been the fourth warmest on record, with each successive month surpassing historical averages by a greater margin.”

“While weak La Niña conditions pushed down temperatures at the start of the year, scientists expect the development of a strong – and potentially “super” – El Niño event by early autumn.  … …the development of a strong El Niño event later this year would substantially increase the chance that 2027 will be the warmest year on record….”

Migration & Health

BMC Health Services Research – Self-care strategies among Arabic-speaking refugees and the Australian Mental Health Stepped Care Model: a Delphi consensus study

Mehjabeen et al Self-care strategies among Arabic-speaking refugees and the Australian Mental Health Stepped Care Model: a Delphi consensus study

“This three-round Delphi study examined consensus on the perceived relevance of 73 mental health self-care strategies for Arabic-speaking refugees and migrants across four settings of the Australian Mental Health Stepped Care Model, including informal community care and formal health services. … … findings suggest the relevance of integrating culturally and community-grounded self-care strategies across stepped care settings.”

Conflict/War & Health

People’s Dispatch – Fighting for healthcare means fighting against war, activists declare

https://peoplesdispatch.org/2026/04/22/fighting-for-healthcare-means-fighting-against-war/?ref=peoples-health-dispatch.ghost.io

“Solidarity with health systems under attack requires reconnecting with anti-imperialist, anti-colonial struggle legacy, activists warned on World Health Day.”

Globalization & Health – WHO’s 2026 emergency appeal and global health security

Y H Abdi et al ; https://link.springer.com/article/10.1186/s12992-026-01211-1

« The World Health Organization’s 2026 global appeal seeks nearly US$1 billion to sustain life-saving health interventions amid escalating humanitarian crises. This Letter highlights persistent funding shortfalls affecting fragile and conflict-affected states, including Somalia, Sudan, and Yemen, where service suspensions and outbreaks have compounded morbidity and mortality. Despite WHO and partners reaching millions in 2025, financing remains insufficient, jeopardizing maternal and child health, outbreak response, and health system resilience. We argue that predictable, front-loaded financing is critical to support local actors, strengthen health systems, and safeguard global health security. Integrating climate-resilient infrastructure, One Health surveillance, and equity-focused strategies can mitigate preventable deaths and stabilize vulnerable populations. The 2026 appeal represents a strategic investment in global health and security, and by mobilizing front-loaded, flexible support alongside sustained assessed contributions requires urgent international solidarity and collective action. »

Guardian – US spending on ‘reckless’ Iran war could have saved 87m lives, says UN

https://www.theguardian.com/world/2026/apr/20/us-spending-on-reckless-iran-war-could-have-saved-87m-lives-says-un

“Head of UN’s humanitarian agency frustrated that $2bn weekly cost of conflict comes amid big cuts to aid budgets.”

“The $2bn (£1.5bn) a week that Donald Trump was spending on his reckless war in Iran could have funded saving more than 87 million lives, the head of the UN’s humanitarian agency, Tom Fletcher, said on Monday.   He also warned the normalisation of violent language, such as threatening to bomb Iran back to the stone ages, was very dangerous since it encourages every “wannabe autocrat” to use similar threats and tactics, including the destruction of civilians and civilian infrastructure…..”

Access to medicines, vaccines & health technologies

We are managing HIV with selective lenacapavir roll-out, not ending it

By Tian Johnson, African Alliance, and Fatima Hassan, Health Justice Initiative; https://health-e.org.za/2026/04/20/managing-hiv-selective-lenacapavir-rollout/

Focus on South-Africa.

 “Ending AIDS by 2039 will require tens of millions of doses of lenacapavir. The current approach as set out by SANAC and the Health Minister, with Gilead, The Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID and others, delivers a fraction of what is required.    …. … Modelling suggests that South Africa, the epicentre of the global HIV epidemic, requires at least two to four million people on effective prevention to interrupt HIV transmission. ….

“That means that Gilead’s global goal to get lenacapavir to three million people is a tragic admission.   The arbitrary ceilings set by South Africa’s government and by Gilead also represent the point at which exposure is deemed acceptable. It’s an eerie repetition of the scenario that unfolded during COVID-19. A United Nations expert opinion reached the conclusion that when urgency collides with inequality, African lives are the ones most often managed rather than saved. HIV is beginning to follow the same pattern. The people most impacted by the epidemic are once again told to wait, to accept pilots, to be grateful for partial protection. In a country with the knowledge, infrastructure, and experience to do better, this cannot be explained away as a technical limitation.”

·         Related:   Who controls South Africa’s lenacapavir rollout? Not South Africa    (by T Johnson et al)

“The government’s recent call under the auspices of the South African National AIDS Council (SANAC) for expressions of interest to manufacture lenacapavir locally is being framed as a decisive step forward. In reality, it is the beginning of a long and uncertain process that uncritically hands immense power to the monopoly holder of lenacapavir: Gilead Sciences. …”

Nature Medicine – The future of diagnostics in Africa

Yenew Kebede (Africa CDC) et al;

https://www.nature.com/articles/s41591-026-04308-7

“… In this Perspective, we present a set of priority systems strengthening interventions based on expected impact and feasibility. These include the need for efficient and integrated testing networks, the establishment and implementation of national essential diagnostic lists, modernized procurement and supply chain practices, improved digital health standards and targeted strengthening of testing infrastructure for epidemic-prone diseases.”

Devex – The oxygen crisis didn’t end with COVID-19 — it evolved

P Adepoju;  https://www.devex.com/news/the-oxygen-crisis-didn-t-end-with-covid-19-it-evolved-112349

“Years after COVID-19 exposed the oxygen crisis, patients are still dying without it.”

“The global response to COVID-19 transformed oxygen from a neglected therapy into a central pillar of emergency care. Before the pandemic, even major global health institutions paid limited attention to oxygen systems. That shifted rapidly in 2021, when an international oxygen emergency task force, including the World Health Organization, World Bank, and The Global Fund to Fight AIDS, Tuberculosis and Malaria, mobilized more than $1 billion to support over 100 countries.  According to Leith Greenslade, coordinator of the Every Breath Counts Coalition, the scale of investment was unprecedented. Countries expanded production, installed pressure swing adsorption, or PSA, plants, and distributed concentrators and pulse oximeters at speed. In Nigeria alone, more than 100 oxygen plants were installed during and after the pandemic, said Alex Losneanu, whose organization studies oxygen delivery systems across Africa….”

“But the surge in supply has not translated into universal access. Despite the influx of equipment, over 90% of patients who need oxygen in sub-Saharan Africa still do not receive it. Much of the infrastructure is already under strain or no longer functioning. The reason, experts said, lies in how the response was designed.  “The focus was on production and equipment,” Losneanu, who is the director of Oxygen CoLab, told Devex. “But the ecosystem around these plants, the systems, the people, the logistics, was never fully built.” “

“If COVID-19 exposed a global oxygen crisis, the years since have revealed something more complex. There is a breakdown across the entire system that delivers oxygen to patients…”

“… In response, a growing number of African entrepreneurs are rethinking oxygen delivery, not as a product, but as a service that places responsibility for the entire delivery chain with a single provider…   …. But  oxygen-as-a-service operates in a fragile business environment….”

“… Addressing this requires a shift in how oxygen systems are financed. Historically, global health responses have relied on aid-driven models, funding equipment and short-term interventions. While this enabled rapid scale-up during COVID-19, it has proven less effective in sustaining access.  Stakeholders are now calling for investment-based models that treat oxygen as a service ecosystem requiring continuous financing….”

“Oxygen is just one example of a broader shift from aid to investment…”   “

AIM -Press Release: Fairer Medicine Prices Could Save European Union 27€ Billion a Year

https://www.aim-mutual.org/mediaroom/press-release-fairer-medicine-prices-could-save-european-union-27e-billion-a-year/

“Europe could save up to €27 billion a year on new medicines if prices were better aligned with real costs and therapeutic value, according to new research using AIM’s Fair Pricing Model. The peer reviewed study, published in PharmacoEconomics, found that applying fair prices to the ten medicines studied would have reduced money spending on medicines by 73% across the participating countries. In one medicine, the fair price was 97% lower than the list price.”

And a link:

·         CEPI and Pasteur Network partner to advance regional vaccine R&D and outbreak preparedness 

AI & Global Health

Plos Digital Health – New Study Warns AI Could Widen Global Health Inequities Without Urgent Action on Governance and Guidelines

https://georgetown.app.box.com/s/oxdfp4hwf95g75qf46osj2iavoqhvp1w

“Dual review published in PLOS Digital Health finds AI holds promise for strengthening research capacity in lower-income countries—but risks deepening existing power imbalances without equitable guardrails.”

“The study, conducted by researchers from the Yale School of Public Health, Georgetown University, Queen Margaret University, Spark Street Advisors, and the World Health Organization, reviewed the existing academic literature on the use of AI for strengthening research capacity. The authors found that AI can help researchers in low-resource settings overcome barriers in data analysis, literature management, and scientific writing. The authors also warned that the development of these tools remains concentrated in high-income countries….”

The Lancet Commission on sepsis: transforming sepsis care and outcomes

M Shankar-Hari et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00648-3/fulltext

“… considering the profound and consequential global health burden of sepsis, we announce the Lancet Commission on Sepsis. … …. The Commission will systematically appraise the epidemiology of sepsis and sepsis survivorship, elucidating health-system, clinical, and biological determinants that constrain the ability of health-care services to effectively prevent, diagnose, and treat sepsis and deliver high-quality follow-up care. Our collective vision is that an effective sepsis framework must address all aspects of the sepsis continuum: population-level prevention of infections, equitable access and early identification of sepsis across all tiers of care (primary, secondary, and tertiary), and structured post-sepsis survivorship care adapted for geographical differences between health-care systems. Achieving this vision requires a fundamentally disruptive, system-level redesign.”

Concluding: “…. An approach that frames sepsis as a tracer of health system performance at the intersection of universal health coverage, health security, and equity is needed, bringing sepsis outside the confines of intensive care. Additionally, horizontal integration across public health, community, and clinical systems spanning primary to secondary care offers greater opportunities for prevention, resilience, and quality improvement than vertical, disease-specific strategies. Only through such a globally inclusive life-course strategy will we be able to change sepsis incidence and transform sepsis care and outcomes worldwide.”

Miscellaneous

Amnesty International – Annual report

https://media.amnesty.org.uk/documents/Amnesty_International_-_The_State_of_the_Worlds_Human_Rights_Annual_Report_2026.pdf

Cfr an Amnesty UK press release  :   “Amnesty’s annual report warns the world is moving towards a dangerous phase of systemic breakdown, driven by states acting with increasing impunity.  This is the most dangerous moment for human rights in generations and the UK now faces a defining test of its commitment as a new era of ‘predatory’ power takes hold globally, Amnesty International warned today….”

“The organisation’s annual report on the state of human rights in 144 countries finds that powerful governments, corporations and anti-rights movements are accelerating attacks on international law, multilateralism and fundamental freedoms. … “

Nature News – ‘Staggering’ number of people believe unproven claims about vaccines, raw milk and more

https://www.nature.com/articles/d41586-026-01285-2

“Survey results suggest a rise in questioning of scientific evidence.”

“More than two-thirds of the public believe at least one false or unproven health claim — such as the idea that taking paracetamol during pregnancy causes autism — a new survey finds. The results hint that a large, and potentially growing, number of people are questioning scientific evidence.  The survey, of more than 16,000 people across 16 (mostly HIC) countries, asked whether they believed claims that are not supported by research, including that the ‘risk of childhood vaccinations outweighs benefits’, ‘fluoride in water is harmful’ and ‘raw milk is healthier than pasteurized’.”

“…The findings, which have not been peer reviewed and were published today by the Edelman Trust Institute in New York City, were described as ‘staggering’ in an accompanying article by the think tank’s chief executive, Richard Edelman….”

UN News – Why lower fertility does not have to mean economic decline

https://news.un.org/en/story/2026/04/1167315

“Globally, most people say they want two or more children, but many are having only one, or none at all. According to a senior UN economist, fears of a demographic timebomb are unwarranted.”

“There’s no getting away from the fact that in many countries around the world, populations are ageing and fertility is declining.    The latest State of World Population report from the UN sexual and reproductive rights agency (UNFPA) shows that around one in five adults worldwide believe they will not be able to have the number of children they want, largely because of economic insecurity, inequality and lack of support….”

Re ‘demographic resilience’:  “… Michael Herrmann, an economist and demographer with UNFPA, cautions against panic. “Demographic change is not a crisis in itself,” he says. “It’s a reality we need to understand, plan for, and adapt to.”….”  “ Mr. Herrmann, who spoke on the sidelines of the Commission on Population and Development, which is meeting this week at UN Headquarters in New York, is advocating for a concept that is gaining attention: demographic resilience.  This means helping societies to anticipate population change, adapt their institutions and make better use of their human potential – an approach that is applicable to developing and wealthy countries, whether their populations are growing, shrinking, or ageing.  Some countries experience a “demographic dividend” when a growing working-age population boosts economic growth.   Others, further along the demographic transition, can benefit from a “second dividend” by investing in education, health, skills and technology to raise productivity…..”

Nature Africa (Comment) – Listening to health care users in Africa is not enough

E Bedingar;  https://www.nature.com/articles/d44148-026-00096-x

“Community engagement has become routine, but what people say rarely shapes how health care is delivered.”

Science Politics – What Will Bring the Next Generation of Global Health Students Hope?

M Pai:   https://sciencepolitics.org/2026/04/17/what-will-bring-the-next-generation-of-global-health-students-hope/

“Students can learn from past social movements so they can rebuild global health creatively and without restraint.”

Global health governance & Governance of Health

Development Today – Rethinking aid for a new era

https://www.development-today.com/archive/2026/dt-3–2026/interview-with-carsten-staur

(gated) “Carsten Staur, who oversees OECD aid, reflects on the massive rollback, the challenges ahead and how development assistance can be reset in a new global political landscape. In an in-depth interview with Development Today, he says a new paradigm is emerging. He argues that aid should be integrated more closely with foreign and security policy.”

New Political Economy- Why Africa turns to China: colonial legacies and the new politics of development finance

https://www.tandfonline.com/doi/epdf/10.1080/13563467.2026.2653235?needAccess=true

By M A Rivera- Quinones.  Focus on Zambia here.

Foreign Policy – How to Prevent 9 Million Deaths

R Shah; https://foreignpolicy.com/2026/04/13/international-aid-food-humanitarian-crisis-usaid-development/

“Rich countries must understand foreign aid can actually be popular—if people see the results.”

Telegraph – Britain’s £8bn bet on the developing world

https://www.telegraph.co.uk/global-health/climate-and-people/britains-8bn-bet-on-the-developing-world/

“Initiative led by British International Investment aims to make returns for the UK taxpayer while also driving global development.”

“Britain will invest up to £8bn in companies across the developing world over the next five years, in a bid to make a return for the UK taxpayer while driving global development. The initiative is being led by British International Investment (BII), a government owned UK investment vehicle founded in 1948 to boost agricultural production across the empire….”

UHC & PHC

Nigeria Health Watch – As Things Fall Apart with ODA, Can Nigeria Finally Fund Its Own Health System?

https://articles.nigeriahealthwatch.com/as-things-fall-apart-with-oda-can-nigeria-finally-fund-its-own-health-system/

By Y J Bakar et al.

SS&M – Equity of financial protection for health care in high-income countries: a systematic scoping review

https://www.sciencedirect.com/science/article/pii/S0277953626003825

by Edward Xie et al.

Lancet Primary Care – Social prescribing and UK austerity

Kate Mulligan; https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(26)00027-0/fulltext

Comment related to a new study  in the Lancet Primary Care.

“Social prescribing has rapidly become a core component of UK primary health-care policy. In their multisite qualitative study including 130 diverse social prescribing stakeholders in Scotland and England published in The Lancet Primary Care, Eddie Donaghy and colleagues provide a timely look at how the social prescribing link worker (SPLW) role is enacted in practice. Considering the global expansion of social prescribing, their findings offer key lessons on social prescribing as a highly context-specific intervention….”

“The authors found that, although originally aimed at connecting patients with community assets, SPLWs are increasingly working with patients with complex needs, including aiding them with fundamental socioeconomic issues such as debt, housing, and food insecurity. This shift supports concerns that UK social prescribing has become a frontline response to the erosion of the welfare state……”

·         See  Lancet Primary Care – Embedding social prescribing in primary care in England and Scotland: a qualitative study of experiences, roles, challenges, and sustainability   (by E Donaghy et al)

Pandemic preparedness & response/ Global Health Security

Nature (News) – ‘Bat feast’ animal videos at African cave offer clues to how deadly viruses spread

https://www.nature.com/articles/d41586-026-01259-4

“Researchers filmed 10 species eating or scavenging bats at known Marburg-virus hotspot — and caught hundreds of humans visiting.”

·         Related:   GAVI – Inside a Ugandan bat cave: how the deadly Marburg virus jumps from animals to humans

International Journal of Infectious Diseases – Measuring capacities to advance global health security and bioeconomic development on the African continent

M M Dunne et al ; https://www.sciencedirect.com/science/article/pii/S1201971226003103

Authors analyzed the health security capacities of 54 African countries using data abstracted from the Global Health Security Index (versions 2019 and 2021) and Joint External Evaluation reports published since 2021.

Planetary health

Science (Policy)- New demand goals for energy and climate resilience

https://www.science.org/doi/10.1126/science.adz3492

“Current climate goals, largely focused on energy supply, should be complemented by targeting demand.”

HPW – Regions with Worst Air Pollution Receive Least Amount of Philanthropic Support

https://healthpolicy-watch.news/regions-with-worst-air-pollution-receive-least-amount-of-funding/

“Less than 0.1% of all philanthropic funding has gone to the fight for clean air. Yet globally, nearly eight million deaths are attributed to the particles and gases that pollute the air – making air pollution the second biggest risk factor for premature death after high blood pressure.”    ““Air pollution is one of the world’s largest public health threats,” said Dr Christa Hasenkopf, senior fellow at the Clean Air Fund (CAF). “And not only do we underfund it, we’re not directing the funds available to where they’re needed most. Africa has twice the population of North America and more than twice the air pollution, yet it receives 35 times less philanthropic air quality funding.”

“CAF’s report on philanthropic funding in air pollution reveals steep disparities in funding, where regions suffering from the worst polluted air receive the least amount of funding.   … Africa and Latin America received only 1% and 2% of funding, respectively. ….

Public Health (Editorial) – Aiming for transformation: Moving beyond adaptation to enabling environments for climate resilient health systems

Susannah H. Mayhew et al; https://www.sciencedirect.com/science/article/pii/S0033350626000557

Editorial of a Collection.  

“… We launched this special issue of Public Health to bring together studies to better understand the range of health system vulnerabilities to climate-related events and strategies to increase system resilience (defined here as the capacity to absorb, adapt or transform systems when faced with climate stressors or disturbances), and sustainability, to assure long-term health system performance. Following our call for papers, 14 articles were selected through peer review. The papers in this special issue provide valuable insights into both the impacts of climate change on health systems and the opportunities for creating enabling environments to make health systems more resilient and sustainable. They also reflect a continuing scarcity of empirical studies evaluating concrete actions….”

Nature Africa – Warning on ‘forever’ chemicals in Africa’s drinking water

https://www.nature.com/articles/d44148-026-00100-4

“Gaps in data, and poor regulation obscure the scale of exposure and potential risks to health.”

Infectious diseases & NTDs

The Conversation –One in three young women in Africa have never tested for HIV – new study shows where the gaps lie

O Bolarinwa et al ; https://theconversation.com/one-in-three-young-women-in-africa-have-never-tested-for-hiv-new-study-shows-where-the-gaps-lie-279227

“We analysed Demographic and Health Survey data from 28 sub-Saharan African countries. The surveys were conducted between 2010 and 2022. Our sample included more than 58,000 adolescent girls and young women aged 15 to 24.   Our study looked at whether they had ever tested for HIV. We then examined which social, economic and behavioural factors were linked to testing.”

“Across the 28 countries, 63% of young women reported having tested for HIV. This means more than one in three had never tested. There were also wide variations – between countries as well as between age groups and different social and economic groups….”

PS: “Our findings show that HIV testing among young women in sub-Saharan Africa has increased markedly, from around 13% in the early 2010s to a regional average of 63% in our study. While this may appear encouraging, it masks deep inequalities. In countries like Mali (7%), Chad (14%) and Benin (25%), fewer than half of adolescent girls and young women have ever tested for HIV.  This makes it harder to reach global HIV targets. It also means many young women may not know their status….”

Nature Medicine – The ghost of tuberculosis past

A Trajman et al; https://www.nature.com/articles/s41591-026-04356-z

“The analysis of the 100 Million Brazilian database reveals that a past tuberculosis diagnosis increases the risk of death up to 14 years later regardless of treatment outcome, which should prompt urgent prioritization of global prevention efforts.”

AMR

Cidrap News – Antibiotic-resistance genes detected in babies within first 3 days of life

https://www.cidrap.umn.edu/antimicrobial-stewardship/antibiotic-resistance-genes-detected-babies-within-first-3-days-life

“New research presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global 2026 conference in Munich suggests antibiotic-resistance genes (ARGs) are present in newborns shortly after birth….”

Plos GPH – Engaging communities in addressing antimicrobial resistance: Co-producing locally relevant public health messages

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006212

By Winifred Maduko et al.

Plos GPH -Measuring vaccine effects on antibiotic use and antimicrobial resistance in low and middle-income countries: A scoping review of methodological approaches, data sources, metrics, and limitations

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006106

By Chinwe Iwu-Jaja  et al.

NCDs

Lancet Primary Care –  Integrating non-communicable disease care into primary health systems in the Horn of Africa: opportunities and challenges

A A Falobi et al  on behalf of the Health Systems Network for the Horn of Africa;  https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(26)00040-3/fulltext

“Non-communicable diseases (NCDs) account for nearly three-quarters of global mortality, with low-income and middle-income countries (LMICs) bearing the greatest share of premature deaths. Sub-Saharan Africa, long characterised by a predominance of communicable diseases, is undergoing a rapid epidemiological transition, resulting in a persistent double burden of disease. The Horn of Africa—comprising Ethiopia, Somalia (including the self-declared Republic of Somaliland), Djibouti, and Eritrea—illustrates this transition, as rates of cardiovascular disease, diabetes, cancer, and chronic respiratory disease rise amid fragile health systems, conflict, displacement, and food insecurity.  “

“Previous estimates suggest that NCDs account for approximately 40–50% of all deaths in the region, with a substantial proportion occurring in working-age adults.  This pattern magnifies economic consequences through lost productivity and catastrophic health expenditures. Yet NCD surveillance remains weak, and sparse routine primary care data imply that the true burden is likely underestimated. These trends demand a strategic shift from episodic, hospital-centred care towards resilient systems capable of delivering long-term, people-centred chronic disease management.  NCD risk in the Horn of Africa is shaped by powerful social and commercial determinants of health…. “

Nature Health – Smoke-free nicotine products can accelerate the end of the smoking epidemic

R Beaglehole, T Pang et al ; https://www.nature.com/articles/s44360-026-00121-1

“Increased use of smoke-free nicotine products such as vapes could help to achieve an ambitious global goal of reducing smoking prevalence below 5% by 2040.”

“… The rapid emergence of regulated non-combustible (smoke-free) nicotine products has created a historic opportunity to accelerate the end of the smoking epidemic. We argue that tobacco harm reduction should be formally integrated into FCTC implementation and propose a global smoke-free 2040 goal of adult daily smoking prevalence below 5% by 2040 as a realistic, measurable and equitable target. Achieving this goal will require combining established FCTC measures with wider access to regulated smoke-free nicotine alternatives….”

Social & commercial determinants of health

HPW – Bangladesh Tightens Control Over Tobacco But Excludes Smokeless Products

https://healthpolicy-watch.news/bangladesh-tightens-control-over-tobacco/

“Bangladesh’s new government has approved a wide-ranging anti-tobacco law that bans advertising, promotion and display across print, electronic, digital and social media, entertainment platforms and points of sale.  The Smoking and Tobacco Usage (Control) (Amendment) Law, 2025 also prohibits corporate social responsibility initiatives from using tobacco brand names, logos or trademarks.  Cigarette packs have to carry pictorial health warnings covering at least 75% of their surface and include the contact numbers of the national quit line.  It also expands smoke-free public places and bans the sale and use of tobacco products within 100 meters of schools, hospitals, clinics and playgrounds. “

“This is one of the first laws passed by the government of Prime Minister Tarique Rahman, who was sworn in last month after winning elections in February. … “

“… The law does not cover newer tobacco and nicotine products, including vapes, heated tobacco products, electronic nicotine delivery systems and nicotine pouches. …”  “ This is despite almost 25% of people using smokeless tobacco products, according to the Tobacco Atlas.”

Sexual & Reproductive health rights

Plos Med – Quality of antenatal and delivery care and postnatal care use: A multi-country observational study of 400,000 births

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005055

By Jan E. Cooper et al.

Neonatal and child health

Cidrap News – Recommended antibiotics for neonatal sepsis largely ineffective in low-resource nations, study finds

https://www.cidrap.umn.edu/antimicrobial-stewardship/recommended-antibiotics-neonatal-sepsis-largely-ineffective-low-resource

“New data presented at the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) in Munich highlight the challenge of treating a deadly infection in newborns in low- and middle-income countries (LMICs).  The data are from the BARNARDS (Burden of Antibiotic Resistance in Neonates from Developing Societies) II study, a prospective study investigating antibiotic use and clinical outcomes in newborns with sepsis in Pakistan, Nigeria, and Bangladesh. An estimated 200,000 newborns die each year from sepsis, which occurs when bacteria or fungi enter the bloodstream and trigger a systemic, overwhelming inflammatory reaction. More than 90% of those deaths are in LMICs. “

“The World Health Organization (WHO) recommends the combination of ampicillin plus gentamicin for empiric treatment of neonatal sepsis. But the first BARNARDS study, conducted from 2015 through 2018, found extremely high rates of resistance to the combination therapy, raising questions over whether the WHO should revise its recommendations.  The findings from BARNARDS II, a prospective study led by researchers from the University of Oxford’s Ineos Oxford Institute (IOI), are no different…”

Access to medicines & health technology

Nature Health – The WHO Essential Medicines List can help to unlock access to GLP-1 therapies for metabolic syndrome

Kevin Pottie et al.  https://www.nature.com/articles/s44360-026-00114-0#:~:text=Publish%20with%20us%20*%20Comment.%20*%20Published:%2017%20April%202026.

“Developing transparent, evidence-based allocation strategies for essential medicines is especially critical in low- and middle-income countries, where affordability and equity challenges are most acute.”

Pharmacy Practice – Essential Medicines List and Health Technology Assessment. Two complementary strategies to prioritize medicines in health systems

P M Boschiazzo et al ; https://www.pharmacypractice.org/index.php/pp/article/view/3420/1403

“This article describes two strategies for incorporating medicines into national health coverage programs: the use of the WHO Essential Medicines List (EML) as a model for National Medicines Lists, and the implementation of Health Technology Assessment (HTA)…”

WP – Moderna launches mRNA bird flu vaccine trial after HHS cancels funding

https://www.washingtonpost.com/health/2026/04/21/mrna-bird-flu-vaccine-trial-rfk-cuts/

“The Department of Health and Human Services had canceled hundreds of millions of dollars in funding previously committed to help develop mRNA vaccines. ….   The Coalition for Epidemic Preparedness Innovations, a global partnership to speed up the development of vaccines and other countermeasures, is investing up to $54.3 million to support the bird flu vaccine. On Tuesday, Moderna said the first participants in the large-scale clinical trial have received the vaccine in both the United States and Britain…. … Stéphane Bancel, Moderna’s CEO, called the launch of the trial a milestone for efforts to “strengthen global pandemic preparedness.”…”

Human resources for health

Frontiers in Psychology – The hidden toll of colleague absenteeism: exploring its impact on emotional strain and burnout among frontline health workers in Nigeria

O C Eze et al ; https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2026.1768286/full

Related tweet by co-author M McKee:  “Health worker absenteeism is usually framed as a governance failure. But what about its hidden costs for those who still show up? Our new study with @dinabalabanova.bsky.social and Nigerian colleagues shifts the lens to the frontline workers left behind….”

Health Policy Open – Global health worker visit time variation: A systematic review

P Murphy et al https://www.sciencedirect.com/science/article/pii/S2590229626000092?via%3Dihub

« The average consultation time (excluding procedures) is 19.2 minutes — but this varies significantly by country income level, health worker type, service delivery platform, and telemedicine use.   – There is meaningful variation by region and clinical setting, with meta-regression revealing statistically significant drivers of that heterogeneity.   Critically, 80% of the evidence comes from high- and upper-middle-income countries, leaving a substantial evidence gap for lower-income settings where health system pressures are often greatest….”

AI & health

The Future of Global Health and AI: From Promise to Public Architecture

Alain Labrique;  https://www.linkedin.com/pulse/future-global-health-ai-from-promise-public-alain-labrique-3asje/

« I had the privilege this week of delivering a keynote at the Johns Hopkins Bloomberg School of Public Health — where I was trained — for Global Health Day. I am on my way to World Health Summit Regional Meeting 2026 to meet with Health Ministers on AI governance in health systems. The convergence felt apt.”

Quote: “The next divide in global health will not be between those who have AI and those who do not. It will be between those who can govern it — and those who cannot….”

“… The future of global health and AI will not be determined by the number of applications we deploy. It will be determined by whether we build the public architecture required to support them.  By public architecture, I mean the often invisible systems that make safe, equitable, and sustainable use of technology possible: data systems that are interoperable and governed with clear rules of stewardship; evidence-based guidelines that distinguish promise from proven value; regulatory frameworks that extend beyond approval to include ongoing oversight, transparency, and accountability; a workforce able to critically assess where and how AI should be used; and financing models that align innovation with public value rather than short-term adoption….”

Miscellaneous

Devex Pro – World Bank unveils jobs metric years in the making — but questions remain

https://www.devex.com/news/world-bank-unveils-jobs-metric-years-in-the-making-but-questions-remain-112340

(gated) “The “more and better paid” jobs indicator will roll out over time, but the details thus far have left some critics worried it fails to capture critical aspects of good jobs, including whether they pay a living wage.  It took the World Bank two years — but last week it finally unveiled its jobs indicator, the metric it plans to use to track what’s become its central mission….”

Geneva Solutions –  “Anti-rights groups”: why we need a smarter politics of naming

N Agostini; https://genevasolutions.news/human-rights/anti-rights-groups-why-we-need-a-smarter-politics-of-naming

« As movements working to undermine universal human rights protections become more influential, the language used to call out these “anti-rights” groups also needs closer scrutiny, or else risks being self-defeating, writes Nicolas Agostini, human rights advocate and researcher. »

Papers & reports

Lancet Global Health – May issue

https://www.thelancet.com/journals/langlo/issue/current

Start with the Editorial –  Resistance is not futile   (with focus on the current, dire situation in the US)

“Altogether, these policies introduce a hostile and extractive environment at odds with the basic principle that all human beings are born free and equal in dignity and rights. People who had started to feel that their peers recognised their right to an equal place in society, work, and government suddenly feel a chill wind blowing from a place that they thought had been consigned to history. This comes at a time when people of colour in the USA are legitimately fearful of being seized from their own homes and detained, regardless of their immigration status. Meanwhile in Europe, once-fringe conspiracy theories around Muslim people taking over White majority populations freely circulate on social media, buoyed by populist far-right political figures. Jewish people across the world face vicious hate crimes as collective punishment for the actions of one nation. Several African countries have doubled down on immoral laws rendering same-sex relationships illegal. And trans people are being stripped of their humanity and reduced to mere bodies by legislation supposedly aimed at protecting cisgender women. The health consequences of long-term exposure to social and economic adversity and discrimination—the so-called weathering effect—are well known.”

The editorial concludes: “…  Global health organisations, businesses, researchers, and health professionals must not lose sight of the purpose of similar equity commitments. The urge to over-comply should be resisted: capitulation, watering down, and rowing back produce no guarantees in the face of such a capricious administration. Those who safely can, should speak out. And progressive governments should develop counter-legislation now that appealing to morality is no longer enough.”

But do check out also some Comments related to new studies in the Lancet GH:

·         Comment – Projected costs to human life of ODA defunding and implications for aid transitions in LMICs  (linked to a previously published study)

·         Comment –  Beyond measuring coverage: how timeliness could transform routine childhood vaccination programmes 

“ Coverage, the traditional indicator, records whether a child received a vaccine by a specific age but does not capture whether doses were delivered during the recommended window. Consequently, high coverage can coexist with substantial untimely vaccination, leaving populations with suboptimal immunity levels…”

·         Comment – Antenatal care in LMICs: what the data reveal  

Health Research Policy & Systems –  Reframing knowledge translation for health policy in Kenya: actors, practices and the constitutive role of context

Fatima Guleid et al; https://link.springer.com/article/10.1186/s12961-026-01482-5

“This study argues for a reframing of KT for policy as an embedded and politically situated process. “

“…. The findings show that KT was enacted by a range of actors, including policy-makers themselves. These actors practised both so-called structured and fluid forms of KT and mobilized evidence to inform, advocate, justify or contest policy positions. In addition, KT happened in both formal and informal spaces. Strategic framing of evidence and other relational activities were central to mobilizing evidence. The outcomes of these practices were often relational and incremental. Importantly, context constituted KT by shaping what counts as evidence, whose voices were influential, and where action was possible. “  Conclusions: “This study offers a practise-based understanding of KT by reframing it as a contextually-constituted, situated practice that requires adaptive system-oriented approaches.

ODI (Working paper) – Anti-gender & anti-climate politics: exploring converging agendas in Global Majority countries

https://odi.org/en/publications/anti-gender-and-anti-climate-politics/

“Politics today is marked by accelerating global backlash against both gender equality and action on the climate crisis. This new working paper exposes how these two agendas are increasingly converging in Global Majority countries.”

“… This ODI Global working paper is based on a deep dive into the political motivations, conditions and outcomes that shape this heightened opposition at both the national and multilateral level. The evidence explores ways in which anti-gender, anti-climate and authoritarian politics combine in eight countries: Argentina, Brazil, Chile, Türkiye, India, Indonesia, Saudi Arabia and the UAE, surfacing three main categories of political opposition to progressive gender and climate policies.”

“Countries marked by authoritarian politics have increasingly turned to anti-gender and anti-climate policies. How these issues converge in government positions can be categorised in three main ways: Explicit Resistors, Pragmatic Resistors or Selective Resistors. There are three enabling conditions that underpin this convergence between anti-gender and anti-climate politics, namely: civic space restrictions, economic and/or political ideology, and transnational political networks. Feminist and climate movements need support to counter these authoritarian trends and address the intersection of these issues. Data and evidence will be crucial for crafting progressive narratives that align with public values and resonate with mainstream perceptions at the national and local level.”

Politics & Governance – The Politics of Pro-Poor Policies in the Global South

https://www.cogitatiopress.com/politicsandgovernance/issue/view/465

Issue in progress. 

Elgar Advanced Introductions series – Advanced Introduction to the Right to Health

L O Gostin; https://www.e-elgar.com/shop/gbp/advanced-introduction-to-the-right-to-health-9781035346417.html

“This Advanced Introduction provides an accessible overview of the right to health, exploring its meaning, significance and practical applications in contemporary real-world contexts….”

SSM Health Systems – Advancing the evaluation of Learning Health Systems: a commentary

https://www.sciencedirect.com/science/article/pii/S2949856226000541

Commentary by T Cowan et al.

Conflict & Health – From discovery to delivery: a systems-based pathway for translating science into global and humanitarian health impact

Ben Ramalingam; https://link.springer.com/article/10.1186/s13031-026-00778-1

“…. This Commentary argues that breakdowns at ‘baton pass’ handover points – just as much as challenges within each stage of the pathway – are a major source of unrealised impact. It proposes an end-to-end ‘science-to-health’ pathway framework to help actors identify where progress is stuck, diagnose underlying vulnerabilities, and select targeted systems-based leverage points to strengthen these baton passes. The leverage points are the 6Rs: Resources, Roles, Relationships, Rules, Routines and Results. Four case examples – antimicrobial resistance, oral cholera vaccine deployment, mpox response in Africa and an illustrative donor health portfolio – show how the tool can guide strategic and operational decisions across diverse health and institutional contexts….”

Tweets  (via X & Bluesky)

Africa CDC

https://africacdc.org/events/cphia-2026/

“The 5th International Conference on Public Health in Africa (CPHIA 2026) will take place from 1st to 5th November 2026 in Addis Ababa, Ethiopia.”

Hans Kluge

“Health remains one of the strongest bridges for dialogue, trust and cooperation. That was clearly on display today at the 9th Meeting of Health Ministers of the Shanghai Cooperation Organization (SCO) in Bishkek, Kyrgyzstan. My thanks to Kyrgyzstan and to Minister Damir Osmonov for the invitation and for bringing us together around the right priorities: prevention and public health management, more sustainable health systems, and the smart use of digital innovation. I welcome Kyrgyzstan’s initiative to establish the SCO Dialogue Platform for exchange of competencies in the field of health management. …  Kyrgyzstan’s chairmanship slogan — “25 Years of the SCO: Together Towards Sustainable Peace, Development and Prosperity” — is highly relevant to today’s discussion. It reflects an important truth: health is not separate from peace, development and prosperity. It is an essential part of all three. As the SCO marks its 25th anniversary, the importance of this platform for global health is undeniable: its 10 member states span 4 WHO regions, including 5 countries from WHO/Europe, and are home to around 42% of the world’s population. From Astana to Xi’an and now to Bishkek, health is taking a more central, practical and structured place on the SCO agenda – through collaboration on epidemic preparedness, emergencies, health systems, digital health and traditional medicine. That is a welcome sign that we are moving in the right direction.”

Podcasts 

Global Health Matters – Is it the end of the NGO as we know it?

https://www.buzzsprout.com/1632040/episodes/18978859

“For decades, international NGOs have been central pillars of global health and humanitarian response efforts. But with aid budgets shrinking, trust eroding and local civil society organizations demonstrating the power of proximity every day, the model is under scrutiny. Who gets to lead? Who gets to decide? And what would more equitable, locally grounded  international cooperation actually look like? In this episode, host Garry Aslanyan explores these questions with two guests who bring deeply complementary perspectives. Deborah Doane is a Partner at Rights CoLab and the convener of The Ringo Project, an initiative dedicated to reimagining international NGOs so that civil society everywhere can be more equitable. She is the author of The INGO Problem: Power, Privilege and Renewal. The second half of the episode features Angela Oduor Lungati, Executive Director of Ushahidi, a Nairobi-based nonprofit technology organization and open-source advocate with over a decade of experience advancing inclusive technology for historically marginalized communities.”

Although the ninth meeting of the Ministers of Health of the Shanghai Cooperation Organization (SCO) member states took place in Bishkek, Kyrgyzstan this week, and Africa (CDC) & (Team) Europe announced €100 million Health Initiatives in Addis,  strengthening their health partnership, it’s clear that in the coming days/weeks, “Global Health” is really gearing up.  

Starting today and this weekend with among others,   World Malaria Day    (April 25) (WHO & partners are launching the campaign “Driven to End Malaria: Now We Can. Now We Must.“) and  World Immunization Week (April 24–30), under the motto “For every generation, vaccines work“. Good one for RFK jr, I hear you think. Early this morning, rather uplifting results  of the ‘Big Catch-Up’ were published.

The next PABS round is also scheduled for next week (27 April-1 May) in Geneva. From where I sit,it will require a fair amount of diplomats well-versed in the ‘Art of the Deal’ (ahum), as well as heaps of kerosine, to get to equitable “landing zones”  : ). 

Next week, the regional World Health Summit in Nairobi  (27-29 April) also takes place, themed “Reimagining Africa’s Health Systems: Innovation, Integration, and Interdependence”. Easier said than done, reimagining in an age of polycrisis, a new era of ‘predatory power’  and ever more “major risk multipliers’ and ‘chokepoints’. It’s as if you imagine yourself to be in a misty-eyed episode of the K-drama “Still Shining” , while in fact you happen to play in the grim late-capitalist season 2 of Beef.  

There’s also the upcoming Santa Marta Conference in Colombia (28-29 April), which convenes a climate ‘coalition of the willing’ to break the global fossil fuel deadlock. The aim: to begin the long-awaited “transition away from fossil fuels”.  The ‘billionaire death cult’   (in the words of Monbiot) isn’t helping much in this respect, but on the bright side, these days the ‘coalition of the willing’ is aided quite a bit by the current war in the Middle East – about the only advantage of the crazy global crisis sparked there. But given the existential risks of tipping points, mankind better hurries up. In case we get distracted by the neverending Trump sh**sh*w, by autumn a potentially “super El Niño” is already awaiting us.  

Meanwhile, the 79th World Health Assembly  (18-23 May) is already looming on the not too distant horizon, with a rather packed agenda. Yesterday, WHO’s Results report was published, showing some progress on the ‘triple billion targets’.  The new EU  Global Health Resilience Initiative will  probably also be launched in May (bracing myself for that one…).

You’ll find much more in this newsletter issue, including  fierce discussions  on worrying  PEPFAR impact data; a high-profile US State Department official resigning over disagreement with the Trump administration’s global health approach; andmore analysis/advocacy on the Lenacapavir rollout. We also briefly come back on the IMF/WB Spring meetings and learned about‘embedded global health solidarity’  in a webinar on Wednesday.

Finally,the Gates Foundation started – at last – an external review of the Epstein ties (though you might wonder why the ‘third-party investigators have not been publicly named’). Meanwhile, the Foundation already seems to be “working diligently on the future”. As Themrise Khan  noted on LinkedIn, ““So the Gates Foundation is now trying to court the wealthy oil rich Arab world in hopes of more funding. Specifically the Saudis. A billionaire courting other billionaires.  If no one in the #philanthropic and #globaldevelopment industries finds this disturbing, then I have truly lost all hope.”       

But maybe, ‘evidence-based’ as they are, the Foundation had anticipated the latest  billionaire trends? Yesterday, it was reported in the Guardian that according to research from the estate agent Knight Frank, “the number of billionaires is expected to grow the fastest in oil-rich Saudi Arabia.”

What could go wrong, indeed.

Enjoy your reading.

Kristof Decoster

·         Read of the week

·         Spring meetings IMF/World Bank: Primers, reports & analysis ahead of the meetings

·         Spring meetings: coverage & analysis

·         Global Health Reform & Reimagining (+ post-2030)

·         WHO DG race

·         More on Global Health Governance & Financing/Funding

·         PPPR & GHS

·         US Global Health Strategy & bilateral health agreements

·         Trump 2.0

·         UHC & PHC

·         NCDs

·         Mental health

·         Commercial Determinants of Health

·         SRHR

·         Planetary Health

·         Human Resources for Health

·         Update on roll-out Lenacapavir

·         More on Access to Medicines, Vaccines and other health technologies

·         Conflict/War & Health

·         Miscellaneous

Read of the week

The Management of Voice in Global Health: How global health learned to include and listen, without redistributing power

Habib Benzian & Fidel Strub; Substack;  

Absolute must-read, also with a view on the ongoing ‘global health reform’ discussions & processes.

“This essay is written from two vantage points. One traces the structure of global health systems and the institutional arrangements through which priorities are set, knowledge is validated, and resources are allocated. The other draws on lived experience of navigating these same systems from the outside, and being invited into them only intermittently.”

“Fidel Strub, the guest co-author for this essay, is a noma survivor, advocate, and founder of Elysium. His work has helped bring noma into global policy discussions and public attention, including international recognition such as the TIME100 Health list. His experience reflects not only the realities of a neglected disease, but also the conditions under which lived experience is included, interpreted, and often excluded again in global health processes.

This essay brings these perspectives together. It reflects both how global health systems are designed, and how they are experienced.”

Spring meetings IMF/World Bank (13-18 April, Washington DC): Primers, reports & analysis ahead of the meetings

In a first section related to the Spring meetings, we provide some primers, reports & analyses published ahead of the meetings. The second section will focus on the Spring meetings itself (coverage/analysis).

Devex Pro Insider: Spring Meetings stress test amid Middle East shock

https://www.devex.com/news/devex-pro-insider-spring-meetings-stress-test-amid-middle-east-shock-112221

(gated) “Amid a war in the Middle East, this year’s World Bank-IMF Spring Meetings feel less like a forum for big new ideas and more like a real-time stress test.”

“The overarching backdrop is the shift to development finance as donor foreign assistance undergoes a historic revision. Will multilateral development banks step up? It was the biggest question at last year’s World Bank-IMF spring and annual meetings as the traditional aid architecture crumbled. Today, it’s still top of mind as everyone continues to sort through the wreckage of 2025 while also confronting stubborn challenges — unsustainable debt, fraying multilateralism, internal reforms — and fresh crises — namely, the U.S. and Israeli war against Iran.”

“The good news? The World Bank is well-capitalized and has myriad resources at its disposal to tackle these crises. The bad news? It’s unknown whether it has the willpower to deploy its financial firepower….”

PS: “… My main wish here, or aspiration for these institutions, is that, frankly, they take more risk and work in riskier countries,” Clemence Landers (CGD) said.  She added that the World Bank’s tightly guarded AAA credit rating hampers its risk appetite….

Devex – Special edition: Everything to know ahead of the World Bank-IMF Spring Meetings

https://www.devex.com/news/special-edition-everything-to-know-ahead-of-the-world-bank-imf-spring-meetings-112254

“How will multilateral institutions respond to a global economic shock amid ongoing reforms and political tensions?”

A few excerpts:  

“In recent years, the World Bank has used the Spring Meetings and annual meetings to roll out big-ticket initiatives, often in partnership with others, aimed at tackling global challenges. Think Mission 300 for electricity in Africa, health care for 1.5 billion people, and AgriConnect to accelerate investments in farming and agribusiness.  This week, the bank will launch Water Forward. The initiative is aimed at strengthening global water security and ramping up investments for water services, sanitation, and more…..”

·         See also Devex: The World Bank’s water shift  : “The World Bank’s water shift: The World Bank’s new water strategy shifts from infrastructure to systemwide management, but weak incentives and governance may limit its impact…..

Re the debt crisis: “Beating a debt horse: At the risk of sounding like a broken record, don’t expect much on debt. … What hasn’t changed: the cost of servicing debt for African countries has basically doubled, and new shocks keep hitting countries that already have very little fiscal space to maneuver. Debt will still be discussed, of course, but I’m told real progress may have to wait until next year because there is no clear political avenue for success. McNair tells me the U.K. is already looking ahead to its leadership of the Group of 20 largest economies next year, and how it could set up a modular debt response system that creates different responses for different countries depending on their needs and type of debt distress…..”

CGD – IMF-World Bank Spring Meetings 2026: What We’re Watching

R Glennerster et al ; https://www.cgdev.org/blog/imf-world-bank-spring-meetings-2026-what-were-watching

“…CGD experts share what they’re watching this week….”

“Balancing crisis response with long-term challenges; Will creditors step up for debt suspension? Food prices, food markets, and who pays the price; As aid collapses, Africa’s $4 trillion in domestic capital can’t afford to sit idle; Navigating the 2026 G20 “gap year”? Will the IMF deliver for Africa? What the Ukraine financing deadlock means for developing countries…”

Devex – Why the World Bank’s mission moment needs more than ambition

M Mazzucato et al ; https://www.devex.com/news/why-the-world-bank-s-mission-moment-needs-more-than-ambition-112284

“The World Bank’s shift toward mission-driven development signals real progress — but without deeper changes to how it finances, designs, and delivers, ambition risks falling short of impact.”

“This week, as policymakers, development practitioners, and finance ministers gather in Washington for the IMF–World Bank Spring Meetings, the conversation about the future of development finance is shifting in important ways. The World Bank has begun to organize its work around missions, from delivering electricity to 300 million people across Africa — Mission 300 — to securing water access for hundreds of millions more. At the same time, the bank’s latest flagship report on industrial policy marks a significant departure from decades of skepticism about the role of governments in directing investment and shaping structural transformation. These are welcome and meaningful steps….”            But… (do read on)

·         See also Devex –   Bjerde: World Bank tests crisis response amid overhaul, debt fears 

“… the World Bank is doubling down on a new operating model built around large, sector-wide initiatives designed to focus attention, crowd in private investment, and coordinate partners across the development system.”

“The latest example, launched this week, is Water Forward, a global effort to tackle water insecurity — which affects an estimated 4 billion people — by framing water not just as a basic need, but as an economic driver linked to growth, jobs, and resilience. The World Bank, along with partners, including a bevy of multilateral development banks, has said it would improve water security for 1 billion people by 2030. Water Forward follows two other flagship initiatives: AgriConnect, which aims to boost jobs by investing in agribusiness, and Mission 300, which aims to bring electricity to 300 million people in sub-Saharan Africa by 2030.”

“The approach marks a shift from traditional project-based financing toward platform-style programs that bundle public and private resources. Under the model, countries develop “compacts” that set out their own sector strategies and investment priorities, with the aim of attracting private capital alongside multilateral and philanthropic support. “The client is in fact in the driver’s seat,” said Bjerde, describing the compacts as country-led strategies that translate global challenges into operational plans on the ground.”

“Crucially, the bank is also seeking to position itself as a coordinator of a broader ecosystem — bringing together other multilateral development banks, private investors, and philanthropies around shared priorities….” “That outward-facing shift is being matched by internal reforms aimed at breaking down longstanding silos between the bank’s public and private arms…”

Guardian –  Don’t mention the climate: Trump creates ‘beyond absurd’ situation at global finance talks

https://www.theguardian.com/environment/2026/apr/13/dont-mention-the-climate-trump-creates-beyond-absurd-situation-at-global-finance-talks

“Developing countries face possible shelving of crucial green action plan at IMF and World Bank spring meetings.”

“The International Monetary Fund (IMF) and the World Bank Group (WBG) spring meetings take place this week amid a fragile ceasefire in Iran and upended geopolitics. One of the priorities was to forge a new “climate change action plan” (CCAP) for the world’s biggest provider of funds to developing countries, to replace the current strategy, which expires in June.  Now, it looks like the new plan may be shelved, along with substantive discussion of the climate crisis….”

Guardian – Iran war could plunge 32 million into poverty, says United Nations

https://www.theguardian.com/society/2026/apr/13/iran-conflict-poverty-united-nations-development-reverse

“‘Development in reverse’ taking place involving rising energy and food costs and weaker economic growth.”  Coverage of a new UNDP report.

“More than 32 million people worldwide could be plunged into poverty by the economic fallout from the Iran war, with developing countries expected to be hit hardest. In a report issued amid doubts over a fragile ceasefire, the United Nations Development Programme (UNDP) said the world was facing a “triple shock” involving energy, food and weaker economic growth.  The agency tasked with tackling poverty said the conflict was reversing gains in international development, with the impact expected be felt unevenly across regions.”

“Alexander De Croo, administrator of the UNDP and former prime minister of Belgium, said: “A conflict like this is development in reverse.  ….  “   “Publishing its report as world leaders gather in Washington for the IMF’s spring meetings, the UNDP said a global response was required to support countries hardest hit by the economic fallout. It said targeted and temporary cash transfers were needed to protect the most vulnerable households in developing nations, at a cost of about $6bn to neutralise the shocks for those falling below the poverty line. De Croo said international agencies and development banks could provide the financial support….”

Project Syndicate – Will the IMF Ever Learn?

T Kaldas; https://www.project-syndicate.org/commentary/imf-spring-meetings-opportunity-to-reform-lending-practices-by-timothy-kaldas-2026-04

“From austerity to taxation, the International Monetary Fund has consistently failed to incorporate its own findings into its lending programs. The Fund’s once-a-decade Review of Program Design and Conditionality, which is now underway, offers a critical opportunity to change this.”

Also with application on Egypt.

Global Development Policy Center – Toward More Effective IMF Programs: Learning from the Evidence on Conditionality

T Hirschel-Burns et al ; https://www.bu.edu/gdp/2026/04/09/toward-more-effective-imf-programs-learning-from-the-evidence-on-conditionality/

“As the IMF reviews its design of programs and conditionalities, it is important to base this evaluation on the best available evidence. A new policy brief by Tim Hirschel-Burns and Marina Zucker-Marques summarizes evidence from 21 recent peer-reviewed academic studies and the IMF’s own research. Recognizing that IMF programs and external conditions have evolved over time, they place stronger emphasis on recent research published between 2015 and 2025.  The authors focus on three main sets of questions. First, do programs help overcome the problems that led countries to seek financial assistance? Second, are there unintended consequences and negative spillovers from IMF programs that could be destructive of national prosperity? And third, is conditionality applied uniformly among IMF members, in line with the IMF’s commitment to neutrality?”

Main findings:

• IMF programs fall short of their stated goal of resolving countries’ balance-of-payments problems: The literature suggests that IMF programs have improved their ability to increase growth but still underestimate the negative impacts of contractionary policies and struggle to change borrowing countries’ export structures.
• IMF programs create collateral damage: They are associated with increased poverty, inequality, neonatal mortality and deforestation.
• IMF programs suffer from a lack of evenhandedness: Countries aligned with Western shareholders are more likely to receive IMF loans with less stringent conditionalities.”

Oxfam – Wealth largely absent from IMF tax guidance, benefiting the rich

https://www.oxfam.org/en/press-releases/wealth-largely-absent-imf-tax-guidance-benefiting-rich

“Only 3 percent of the more than 1,000 tax recommendations made by the International Monetary Fund (IMF) to governments in recent years focus on taxing wealth and income from wealth, new analysis by Oxfam reveals ahead of the IMF and World Bank Spring Meetings in Washington, D.C.”

“Oxfam examined the IMF’s tax advice to 125 countries between 2022 and 2024. Despite the rapid growth of extreme wealth ―billionaire wealth has surged by 81 percent since 2020― just 30 of 1,049 tax recommendations focus on net wealth taxes and the taxation of income from wealth, namely capital gains…..”

“… Oxfam’s analysis exposes two striking discrepancies in IMF guidance depending on a country’s income level. First, 52 percent of tax advice to high-income countries was progressive, while 59 percent of tax advice to low- and lower-middle-income countries was regressive.  …… Second, while the IMF publicly acknowledges that tax policy is a critical tool for addressing inequality, it links its tax advice to inequality far more often for high-income countries (34 percent) than low- and lower-middle-income countries (8 percent)……”

CGD – Health Taxes and the IMF: Are Support and Reform Aligned?

S Gupta et al ; https://www.cgdev.org/blog/health-taxes-and-imf-are-support-and-reform-aligned

“…. While health policy is not a core focus, the IMF advises member countries on raising domestic revenue in ways that are fair, efficient, and administratively feasible. As part of its tax policy guidance, it recommends health taxes—where appropriate—as a component of a balanced and well-functioning tax system. This advice is reflected in its three core activities: surveillance of member country policies, lending, and capacity development.”

“We previously discussed the IMF’s surveillance advice on health taxes during 2010–2024 in detail. This blog focuses instead on health taxes in IMF-supported lending arrangements and capacity development in tax design and administration during the same period. We find that these two activities differ markedly in their regional focus, and that conditionality in particular bears little relationship to countries’ estimated revenue potential. It appears that reform commitments are concentrated in lower-income countries, while technical support is more visible elsewhere.”

Concluding (bottom line): “Health taxes remain one of the clearest opportunities for countries to raise revenue while improving public health. Yet this analysis suggests that how these reforms are supported matters as much as whether they are adopted.   The current pattern—where reform commitments are concentrated in lower-income countries, while technical support is more visible elsewhere—raises a practical concern: complex excise reforms may be pursued without commensurate design and implementation support. Given the technical demands of these reforms, this gap could affect both their durability and effectiveness.”

“Better alignment between IMF-supported reform commitments and capacity development could help close this gap. Strengthening support—particularly in countries undertaking reforms under IMF programs—would increase the likelihood that health taxes deliver sustained revenue gains and meaningful health outcomes.”

IMF/WB Spring meetings: coverage & analysis

Devex Invested: Spring Meetings memo — corridors are hot, climate is not

https://www.devex.com/news/devex-invested-spring-meetings-memo-corridors-are-hot-climate-is-not-112309

Recommended overview of the Spring meetings’ main highlights & lowlights. “Iran war fallout in Africa, no (fossil fuel) subsidy U-turns, and a big push on economic corridors.”

On the latter: “The Trump administration might be cold on African aid, but it’s certainly hot on African corridors.  These large, cross-border infrastructure routes linking ports, rail, energy, and industrial zones have become a priority for the U.S. government, tied closely to critical minerals, supply chains, and its broader “trade, not aid” approach. U.S. officials said in February that they’re seeking input on which cross-border project to back under a new U.S.-AU infrastructure working group…..”

Re climate change: “ climate change felt far less central than in previous years. That shift comes at a consequential moment. The World Bank’s Climate Change Action Plan — which has guided its work since 2021 — is set to expire at the end of June after a one-year extension. As my colleague Jesse Chase-Lubitz has reported, there’s growing pressure, particularly from the U.S., to scale back or scrap parts of it altogether.  That pressure was made explicit yesterday. In his public remarks, U.S. Treasury Secretary Scott Bessent said he welcomed the plan’s “long-overdue expiration” and urged the World Bank to shift away from what he described as a “myopic focus on climate and financing volumes” toward “high-quality, durable projects” that better support growth and poverty reduction.  He also called for the bank to abandon its 45% climate finance target, arguing it is “distortionary” and undermines its effectiveness….”

·         On the latter, see also Climate Change News  –  US pressure puts World Bank’s climate plan at risk

“Closed-door talks over the World Bank’s climate agenda have stalled, as the US pushes to scrap green targets and expand support for fossil fuels.”

HPW – Africa’s Clean Cooking Gap Leaves 1 Billion Without Access

https://healthpolicy-watch.news/africas-clean-cooking-gap-leaves-1-billion-without-access-world-bank-warns/

“Lack of access to clean cooking fuel and technologies has extensive impacts on health, environment, economy, and women’s equality, say experts at the World Bank Group Spring Meeting.”

Update on where things stand on this issue.  “Since a pivotal 2024 summit, $2.2 billion has been mobilised for clean cooking in Africa. Thirty countries have joined the initiative through national energy compacts in a push to alleviate the one billion Africans who still lack access.  With ministers of energy from around the world in attendance, a World Bank Group (WBG) civil society event at the yearly Spring Meetings highlighted the urgent matter of a transition to clean cooking – placing the economic, health, environmental, and gender implications of unhealthy fuels and stoves on full display….”

Guardian – Iran war escalation could trigger global recession, IMF warns

https://www.theguardian.com/business/2026/apr/14/iran-war-global-recession-imf-uk-growth-forecasts-oil-prices

“A further escalation in the Iran war could trigger a global recession, spiralling inflation and a sharp backlash in financial markets, the International Monetary Fund has warned….”

“…With the pressure on the global economy mounting, the IMF set out three possible scenarios for the war in its World Economic Outlook (WEO) – in which even a short-lived conflict would dent growth and stoke inflation relative to its previous forecasts made last autumn….”

A reference forecast, an adverse scenario, and a severe scenario.

Reuters – Middle East conflict and aid drop push more African nations to IMF

Reuters;

“Foreign aid to sub-Saharan Africa fell sharply in 2025, worsening fiscal pressures; 27 of 45 sub-Saharan African countries now rely on IMF-supported programs; IMF’s Selassie optimistic about long-term regional growth potential.”

Reuters – ‘Blend’ countries pay billions extra as access to cheap multilateral loans narrows

Reuters;  

“Blend countries face higher costs due to limited MDB lending, report by ONE Data and Rockefeller Foundation finds; Donor aid cuts worsen funding gaps; Report urges expanding MDB capacity, faster loans, and safeguarding IDA funding.”