·         World Health Day (7 April)

·         One Health Summit (5-7 April, Lyon)

·         Global Health Reform (& International Development cooperation reform)

·         Coming up: World Bank/IMF Spring meetings

·         More on Global Health Governance & Financing/Funding

·         Bilateral health agreements & US global health strategy

·         Trump 2.0

·         PABS negotiations & more on PPPR

·         UHC & PHC

·         SRHR

·         Commercial determinants of health

·         Planetary Health

·         Conflict/War & health

·         Access to medicines, vaccines & other health technologies

·         Some more reports

·         Miscellaneous

World Health Day (7 April)

WHO – WHO calls for action: “Together for health. Stand with science.” to mark World Health Day

https://www.who.int/news/item/06-04-2026-who-calls-for-action—together-for-health.-stand-with-science.–to-mark-world-health-day

“The World Health Organization (WHO) today calls on people everywhere to renew their commitment to working together and supporting science as the twin engines driving better health, under the World Health Day 2026 theme: “Together for health. Stand with science.” The campaign marks the anniversary of WHO’s founding on 7 April 1948, launching a year-long public health campaign.”

“… In line with the World Health Day 2026 theme, WHO and the G7 Presidency of France are convening a One Health Summit in Lyon, France, from 5–7 April, bringing together Heads of State, scientists and community leaders to strengthen coordinated action. WHO [will] host the Global Forum of its Collaborating Centres network from 7–9 April with representatives from over 800 academic and research institutions from more than 80 countries. These Centres support WHO’s research, technical assistance and capacity-building work worldwide.”

These were indeed the two major moments anchoring this year’s World Health Day.

·         For the press release of the latter, see WHO – First-ever WHO Forum unites 800+ Collaborating Centres for stronger scientific collaboration 

One Health Summit (Lyon, France – 5 till 7 April)

WHO;  

Ahead of the summit, this was stated as the aim:  “The One Health Summit [took] place in Lyon, France, with the High-Level Summit on 7 April, coinciding with World Health Day. Hosted by the French Government as one of the flagship events of the G7 French Presidency, the Summit convene[d] Heads of State and government, international organizations, scientists, civil society, youth and local actors to advance global action on One Health.”

“The Summit highlight[ed] the interdependence of human, animal, plant and ecosystem health, and the need for coordinated, science-based approaches to address shared health threats. It showcase(d) the Quadripartite partnership between, FAO, UNEP, WHO and WOAH, as well as the role of the WHO Academy and WHO’s work across country, regional and global levels….”

“With four main priorities:  (1) Strengthening the role of science, research, and innovation, along with their practical applications to improve everyday health outcomes, (2) Promoting action-oriented multilateralism and international partnerships as the most effective way to advance a coordinated and inclusive One Health approach, (3) Reinforcing public-private partnerships, recognizing that broad ownership of One Health challenges is essential to address shared risks, (4) Ensuring inclusive participation from civil society, local authorities, and youth as a foundation for collective action.”

WHO – WHO and France shift One Health vision to action with new high-impact initiatives

https://www.who.int/news/item/07-04-2026-who-and-france-shift-one-health-vision-to-action-with-new-high-impact-initiatives 

Press release after the summit.

“On World Health Day, global leaders gathered in France for a milestone “One Health Summit”, where the World Health Organization (WHO) and partners announced a new wave of concrete actions to better protect people, animals and the planet from future health crises.  Hosted by France, the Summit marks a major step forward in turning the One Health approach – which recognizes that human health, animal health and the environment are deeply connected – into real-world action. This year’s World Health Day theme, “Together for health. Stand with science,” set the tone for the announcements.”

“The outcomes of the Summit will inform ongoing international discussions – including the G7 – on preparedness and coordinated responses to health threats at the human, animal and ecosystem interface…..”

WHO announced four major One Health actions: Joining forces with global partners, WHO has outlined the following specific actions:  A new global network of institutions on One Health;  Stronger science to guide global action; A new push to eliminate rabies by 2030; A unified strategy to tackle avian influenza threats…

PS: “WHO to lead global One Health coordination: WHO is also assuming the Chairmanship of the Quadripartite collaboration, taking on an enhanced leadership role for coordinated global action alongside FAO, WOAH and UNEP. Under WHO’s Chairmanship,  the Quadripartite partnership will prioritize delivering measurable impact at the country level, streamlining governance, and aligning efforts around a focused set of high-impact priorities, while further strengthening advocacy, norm-setting and evidence generation….. ”

HPW – Flurry of Pledges at G7 One Health Summit

https://healthpolicy-watch.news/flurry-of-pledges-at-g7-one-health-summit/

With more coverage and announcements from Lyon. “The European Commission announced that it will contribute €700 million to the next funding cycle of the Global Fund to Fight AIDS, Tuberculosis and Malaria at the G7 One Health Summit in Lyon on Tuesday.  This was one of several pledges made at the summit, as the World Bank, vaccine alliance Gavi, governments, philanthropies and private companies made commitments to improve the health of humans, animals and plants….”

“The World Bank intends to invest $750 million for One Health activities, its vice-president for development finance, Akihiko Nishio, told the summit.  The Bank will also strengthen the One Health implementation of regional health programmes in West and Central Africa…..”

“Gavi executive director Dr Sania Nishtar told the summit she would ask her board to approve up to $200 million for upstream support to boost African vaccine manufacturing at its July meeting. 

Gavi has already pledged $1 billion to the African Vaccine Manufacturing Accelerator (AVMA) to promote commercial vaccine manufacturing on the continent.   Gavi is also allocating $380 million to a “resilience mechanism to ensure that immunisation is at the heart of the response to crises in fragile settings”, Nishtar added….”

“Later in the summit, the South African generic drug company, Aspen, announced that it intends to prequalify two childhood vaccines, the hexavalent and pneumococcal vaccines, and start to manufacture these for the continent by the end of the year.  Aspen’s Dr Stavros Nicolaou said that his company would also start producing human insulin with Novo Nordisk by May to address the “sinister” explosion of type 2 diabetes…..”

“… Wellcome Trust CEO John-Arne Røttingen reported on a declaration on One Health developed by philanthropy.  This is based on three pillars, he added.  The first is to sustain investment in product development. The second is applying a One Health lens on this, particularly in the context of climate change. Third, while philanthropies “are really proud to play a role in the system that’s dear to our heart… our role is only catalytic, complementary and driving collaborations”, said Røttingen….”

Africa CDC Secures Over US$300 Million to Advance Africa’s Global Health Security Agenda at the Lyon One Health Summit in Lyon (France)

https://africacdc.org/news-item/africa-cdc-secures-over-us300-million-to-advance-africas-global-health-security-agenda-at-the-lyon-one-health-summit-in-lyon-france/

From the EU, Green Climate Fund, Global Fund & Pandemic Fund.

PS: “Africa CDC is proud to be a signatory to the “One Health & Beyond: Multi-stakeholder Declaration” that marks a critical step towards a coordinated global response to emerging health threats at the human-animal-environment interface, alongside a broad coalition of countries and partners, including Armenia, Botswana, Brazil, Cambodia, Cyprus, DRC, Egypt, France, Kenya, Mexico, Singapore, Thailand, Tunisia, United Arab Emirates, the WHO, FAO, and CGIAR.”

Global Agreement Announced at G7 One Health Summit to Accelerate Access to Diagnostics and Responses to Rising Health Threats

Biomerieux;

“A coalition of more than 20 international partners announced the Global One Health Diagnostics Access Compact (GO-Dx) during the G7 One Health Summit in Lyon, France. This new initiative serves as a catalyst for international leaders across different sectors to advance progress toward expanding diagnostics access, enabling early detection and better surveillance, and improving response against existing and emerging threats across human, animal, and environmental health. By aligning efforts, this group aims to strengthen global preparedness through science based One Health solutions…. GO-Dx Compact marks a critical, multi-stakeholder step across the One Health interface toward prioritizing diagnostics access and innovation, bolstering surveillance, and driving antimicrobial stewardship through education and training. …”

With 4 pillars.   See also the full press release.

Joint political declaration on the reform of the global health architecture.

https://www.elysee.fr/emmanuel-macron/2026/04/07/joint-political-declaration-on-the-reform-of-the-global-health-architecture

Also published in Lyon by a number of heads of state and organisations – more or less in the framework of France’s G7 hosting.

And some more links from Lyon:

·         European Commission announces new global health commitments at One Health Summit

“The European Commission intends to pledge €700 million to the Global Fund to defeat HIV, tuberculosis and malaria. It will also invest €46.5 million to strengthen health security in Africa and Europe with a focus on tackling antimicrobial resistance (AMR), and €50 million in research and development for AMR and neglected tropical diseases. Commissioner for International Partnerships, Jozef Síkela, made these announcements at the One Health Summit taking place today in Lyon, France. … The announcements are within the scope of the new Global Health Resilience Initiative, announced by President von der Leyen in the 2025 State of the Union address and which is expected to be launched before the summer. The initiative will offer the opportunity to clearly set out EU priorities and define concrete avenues for effective and efficient action on Global Health.”

·         WHO – Joint Statement FAO/WHO/WOAH Joint One Health Learning Taskforce :  “a coordination mechanism dedicated to strengthening One Health workforce capacity in support of effective One Health implementation at global, regional, and national levels.”

·         All Africa – Ghana, France Partner to Transform Digital Health Infrastructure   “French President Emmanuel Macron has announced Ghana as the inaugural beneficiary of France’s National Health Platform. The comprehensive digital framework is designed to establish secure, patient-centric health records, facilitate inter-professional messaging, and expand telemedicine infrastructure.”

·         PS: and as a reminder, on the One Health investment case (via the WB – 2022) for PPPR: Prevent Rather than Fight the Next Pandemic with a One Health Approach: World Bank  “…The report estimates that prevention costs guided by a One Health approach – which would sustainably balance and optimize the health of people, animals, and ecosystems – would range from $10.3 billion to $11.5 billion per year, compared to the cost of managing pandemics which, according to the recent estimate by the G20 Joint Finance and Health Taskforce, amounts to about $30.1 billion per year.  “

Global Health Reform (& International Development cooperation reform)

Accra Reset announces 18-member high-level panel to reform global health governance

https://www.myjoyonline.com/accra-reset-announces-18-member-high-level-panel-to-reform-global-health-governance/#google_vignette

“The Chancery of the Accra Reset has announced the formation of a high-level panel tasked with advancing reforms in global health architecture and governance, as part of efforts to strengthen equity and sovereignty for countries in the Global South.  “The Accra Reset, an African health and economic sovereignty initiative championed by President John Mahama, is positioning the continent to play a more decisive role in shaping global health systems and policies….”

“The 18-member panel will be co-chaired by the former Director-General of UNAIDS, Peter Piot, Chair of the Kofi Annan Foundation, El Hadj As Sy, Brazil Minister of Health Nisia Trinidade, and Indonesia Minister of Health Budi Gunadi Sadikin.  The panel has been mandated to produce concrete, actionable proposals aimed at restructuring a global health system often criticised for treating Global South governments as passive participants rather than sovereign actors…”

“According to the Chancery, the panel’s work will be guided by a High-Level Consultative Group, which will create a structured engagement pathway with key institutions within the existing global health system…..”

“… The initiative signals a renewed push to reposition African and Global South voices at the centre of global health decision-making, with a focus on fairness, accountability, and shared responsibility.”

·         For more, see the official press statement:   Accra Reset announces high-level panel on Global Heath architecture and governance  (also with the full list of names)

·         And a few links: Africa CDC Appoints Benedict Oramah, Christoph Benn, Troy Fitrell, and Pierre Delsaux as Senior Advisors to accelerate the implementation of Africa Health Security and Sovereignty

“The Africa Centres for Disease Control and Prevention is pleased to announce the appointment of Ambassador Troy Fitrell (USA) as Senior Advisor on International Cooperation, Ambassador Pierre Delsaux (Belgium) as Senior Advisor on Strategic Partnership, Dr. Christoph Benn (Germany) as Senior Advisor on Debt Swaps, and Professor Benedict Oramah (Nigeria) as Senior Advisor on Strategic Financing….”.

Africa CDC –  Africa CDC Appoints His Excellency Prof. Yemi Osinbajo as Senior Strategic Advisor to the Director General   

UN News – UN80 Initiative enters ‘delivery phase’, as Member States review progress on key work areas

https://news.un.org/en/story/2026/04/1167253

“Top officials updated Member States Monday on selected proposals under the UN80 reform initiative, including an initial assessment of a possible merger between gender equality agency, UN Women, and the UN reproductive health agency, UNFPA, as well as updates on the technology and data tracks. “

“Guy Ryder, Under-Secretary-General for Policy, said the broader reform effort is now moving into a new stage. “We are now entering the delivery-focused phase of our work, building on the momentum generated by recent achievements”.  “…. … A consolidated report set to be published next month, he added, will set out “a clear and comprehensive overview of where we stand on each work package, and the pathways and timelines for their completion.” 

PS: “Progress under the UN80 Initiative can be tracked through a public dashboard, which provides an overview of actions, timelines and implementation across the system….”

·         And via  Devex:    “On Monday, the U.N. had an informal briefing with member states on reform. On the agenda: the preliminary assessment on the proposal to merge U.N. Women and the U.N. Population Fund.  But countries had more questions than answers, arguing the document is short on details. They asked: How exactly will the U.N. safeguard the mandates of the two agencies? What will a “composite entity” look like, from its structure to its governance? How are the two agencies’ executive boards involved in the process? How will it impact staff? What are its implications on the ground and in country offices? What other options or alternatives are on the table, besides a merger? And, when will the full assessment be made available?….

“Several member states also felt the assessment lacked evidence – similar to the arguments rights advocates shared with me last week.   A representative from Uganda said the assessment “appears to rely more on opinion than on robust evidence based analysis.” South Africa, meanwhile, argued that “without clear elaboration on the evidence that justifies the reasoning in the report, it is difficult to concur with its final conclusions” — which state a merger is “technically feasible” if done with “clearly defined safeguards.” …   UNFPA Executive Director Diene Keita says the full assessment will be shared with member states “in the coming weeks.”

TGH – Global Health Reform for Communities Beyond Institutions

E Fleutelot; https://www.thinkglobalhealth.org/article/global-health-reform-for-communities-over-institutions

(Recommended read) “Much of global health progress has been driven by small teams, writes the head of Expertise France’s major pandemics cluster.”  Starting from “Transforming the Global Health Ecosystem for a Healthier World in 2026 “ (by M A Pate, D Kaberuka & P Piot). “… The question, … is not whether the global health ecosystem should be reformed—on that point the January 7 article is right—but how. Institutional alignment and coordination matter, particularly in times of constrained resources, but they are not substitutes for addressing demand, rights, workforce realities, and political economy.”

A few excerpts:

“… In a context of funding cuts and heightened scrutiny, consolidation risks becoming less a carefully assessed strategy and more a convenient response to crisis, one shaped as much by power asymmetries as by evidence. Without transparent criteria and clarity on where the new architecture is negotiated, and who is invited to shape it, efforts to streamline the global health ecosystem risk reinforcing existing hierarchies rather than improving outcomes, especially if patients, communities, and frontline health workers remain largely excluded from these conversations.”

“… The Think Global Health article of January 7 suggests reducing the number of international health organizations through mergers or institutional integration, for example, by consolidating certain global health initiatives or integrating partnership mechanisms into larger multilateral structures. In practice, however, larger organizations often entail higher coordination costs and more complex governance arrangements, absorbing political and managerial energy that can come at the expense of agility and innovation. Scale, in itself, does not automatically produce effectiveness.  By contrast, smaller or more specialized organizations have often been better positioned to experiment, adapt quickly, and respond to emerging challenges. Much of global health progress has been driven by small teams and community-based organizations inspired by what might be called realistic utopias, pragmatic yet ambitious efforts to overcome intellectual property barriers, expand access to treatment, or design services tailored to populations systematically left behind. For example, for more than two decades, the relatively small team behind Médecins Sans Frontières’ Access Campaign has played a major role in challenging intellectual property barriers and accelerating access to essential medicines in resource-limited countries. Treating consolidation as a technical fix rather than a political and organizational gamble risks overlooking these trade-offs….”   “Reform should therefore be judged not by how streamlined institutions appear on paper, but by how well they preserve the conditions that allow innovation and responsiveness to thrive where they matter most….”

“… Another striking omission in many discussions on global health reform, including the noted Think Global Health article, is the near absence of demand-side perspectives. Proposals tend to focus on how health services and products are financed, delivered, and coordinated but to pay little attention to how populations experience health systems or what they expect from them….

Failure to address this is increasingly difficult to justify. In many countries, particularly among younger generations, access to quality health services has become a visible social and political demand. …  …Closely linked to this trend is the limited attention paid to human rights. For decades, global health actors have acknowledged that legal, social, and political barriers—such as criminalization, stigma, discrimination, and exclusion—directly undermine access to prevention and care. Yet these structural barriers, including practices that deny access to evidence-based services such as safe abortion care or appropriate support for people who use drugs, remain marginal in reform discussions focused primarily on efficiency and alignment….”

“… The Missing Foundation: Human Resources for Health: Perhaps the most puzzling gap in current reform narratives concerns human resources for health. Although frequently acknowledged in principle, the health workforce remains largely absent from concrete reform proposals and strategic priorities.   …The contrast is striking when compared with the growing emphasis on health products and technologies..”

·         Via   Devex:  re MPP & the Pandemic Fund & global health reform

J Ravalo: “My colleagues and I have been reporting on changes and proposals to reform global health, including potential mergers between United Nations entities or multilateral funders. But as it turns out, the idea isn’t limited to big institutions.  The Medicines Patent Pool, the Geneva-based organization created more than a decade ago to help accelerate the introduction of patented medicines and make them more affordable in low- and middle-income countries, also tried — unsuccessfully — to find another organization to merge with, Executive Director Charles Gore told me when I asked how MPP is positioning itself amid changes to and calls for reform in global health.  He said the problem was finding another organization to match MPP’s remit, which now covers diagnostics and vaccines for a wide range of diseases, including noncommunicable diseases. 
But if a merger isn’t in the cards, Charles said he hopes they can find an organization to serve as a sort of “godparent” for MPP, one that understands its work and can receive donor funds on its behalf. By channeling funds through a godparent, donors can support MPP’s activities without managing a separate grant. Slashed official development assistance budgets, he said, mean fewer people in donor countries are also managing the grants — and thus a preference from donors to channel their money through fewer organizations. In the past, he said an obvious choice would have been Unitaid. But MPP has evolved to focus on vaccines and noncommunicable diseases, which are outside of Unitaid’s scope of work. Another option is WHO. But “WHO didn’t want to have licenses with pharma on its books,” he said. Plus, the U.N. agency already has a lot on its plate, along with a shrunken workforce and budget.  Whether a godparent could be found in 2026 isn’t clear. …”

“I posed the same question to Priya Basu, executive head of the Pandemic Fund, which last week announced a fourth call for proposals.   Basu argued the Pandemic Fund isn’t duplicating others’ work, and instead fills the need for pandemic prevention, preparedness, and response funding in the wake of the COVID-19 pandemic. She noted the fund also continues to operate with a lean administrative budget and team of less than 20 staff.  As for the proposal made by Nigerian health minister Muhammad Ali Pate, former African Development Bank President Donald Kaberuka, and former UNAIDS Executive Director Peter Piot for the fund to integrate with Gavi, the Vaccine Alliance and the Global Fund, and operate under one holding company with one governance structure and secretariat: “I would say that the risk of not having this kind of a dedicated institution [for PPR] is that you go back to the cycle of panic and neglect,” she told me. “At this point in the Pandemic Fund’s life … what we need to be held accountable for is producing results and impact on the ground.”

Lancet Comment – Transforming WHO: incremental reform is no longer sufficient

S Tang & M Merson ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00609-4/fulltext

Authors are linked to the Duke Global Health institute. 

“Today, WHO stands at a crossroads. The US Government has withdrawn its membership of WHO and, along with most European countries, has reduced funding for global health. Country health sovereignty is finally on the rise and requires a strong WHO enabler that reinforces this sovereignty. WHO is entering its first period of enforced contraction in decades. This creates a rare opportunity for the organisation to improve its efficiency and effectiveness through far more extensive institutional reform rather than incremental change. We offer recommendations for such reform and identify potential barriers and challenges that must be overcome for their implementation.”

With three recommendations.  

Lancet Editorial – The future of preconception health

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00707-5/fulltext

Also with a view on the post-2030 global health agenda.

This week’s Editorial concludes: “… As the 2030 deadline for the UN Sustainable Development Goals (SDGs) approaches, it is time to ask what the priorities should be for the global sustainable development agenda. Although the current SDG framework has rightly prioritised ensuring universal access to sexual and reproductive health-care services, it has not systematically treated preconception health as a distinct, measurable domain. Preconception health should be taken far more seriously in the post-2030 agenda. Not only because it aligns with the SDG-era shift towards “survive, thrive, and transform”, but also because it exemplifies the direction in which global health thinking will need to move after 2030: further upstream, more preventive, and more attentive to how health and inequity are shaped by gender, across the life course, and between generations.”

CGD Note – A Clear Vision for Official Development Assistance: Purpose, Principles, and Priorities

M Ahmed et al ; https://www.cgdev.org/publication/clear-vision-official-development-assistance-purpose-principles-and-priorities

“This CGD note draws on a year-long consultation with senior colleagues from the Spanish Agency for International Development Cooperation (AECID), the French Development Agency (AFD), the Belgian Ministry of Foreign Affairs, the Norwegian Agency for Development Cooperation (Norad), the UK Foreign and Commonwealth Office (FCDO), and the Gates Foundation, as well as experts from both the global North and South. The note reflects insights from these discussions.”

The Note concludes: “The time to reframe ODA is now:  International development cooperation is entering a period of profound change. Fiscal pressures, geopolitical competition, and growing demands to address global and national challenges are reshaping how governments allocate public resources abroad. Yet, these pressures don’t weaken the case for international cooperation; rather, they make clarity of purpose and discipline in the use of public resources more urgent….

“Governments invest public resources internationally for several reasons: to express solidarity with people facing hardship, to address global challenges that no country can solve alone, and to support partnerships that, at times, advance mutual interests. These motivations will continue to shape international engagement. But they do not determine how international public finance should be organised or what specific objectives it should serve. “  “One of the greatest risks to effective international development cooperation is the erosion of clarity about its purpose. When an expanding range of activities is labelled as development assistance, credibility is weakened and impact diluted. A clearer distinction is needed between the different purposes international public finance should serve: core development investment, humanitarian response, and the financing of global public goods. All are essential, but they pursue different objectives and should not be financed or evaluated as if they were the same.

“Within the broader financing landscape, ODA should remain focused on core development investment, consistent with its defining purpose of promoting the economic development and welfare of developing countries. Clarity of purpose must be matched by discipline in how ODA resources are used. This means directing concessional finance to where it adds the greatest value, aligning financing instruments with the nature of development challenges, and mobilising private investment only where it supports clearly defined development objectives. It also requires pragmatic choices about delivery channels, whether bilateral or multilateral, and partnerships grounded in transparency, country context, and support for nationally owned strategies.”

“Ultimately, sustaining political and public support for international development cooperation will depend on demonstrating that scarce concessional resources deliver the greatest possible development impact. At a time of fiscal pressure and expanding global demands, clarity of purpose is not a technical issue; it is a political necessity. Reaffirming the core role of ODA in financing development is therefore essential to ensuring that international development cooperation remains credible, effective, and sustainable.”

·         Related CGD Brief: https://www.cgdev.org/publication/clearer-case-aid  (by M Ahmed et al)

(must-read one pager) “Drawing on a year-long consultation with senior development officials and with independent experts from across the global North and South, we have developed a clearer case for aid—focusing on official development assistance (ODA), a small but distinct part of development finance, defined by its purpose. It sets out why governments invest public money abroad, what aid should be used for, and how it can deliver the greatest impact.”

·         Finally, via LinkedIn – an update on the Future of Development Coalition:

“We are delighted to announce the Commissioners of the Future Of Development Cooperation Coalition.   This is a group of leaders from across government, finance, the private sector, technology and civil society—brought together to help reimagine how development cooperation can evolve to meet the challenges and opportunities of the decades ahead.

Co-chairs:
• Arancha Gonzalez Laya
• Prof. Yemi Osinbajo ….”

 First meeting: April 13, Washington DC  (i.e. during the IMF/World Bank Spring meetings)

Coming up: the World Bank/IMF Spring meetings (13-18 April, Washington DC)

Some reads & analyses ahead of the Spring meetings.

CGD – The World Bank’s Self-Inflicted Crisis

C Kenny et al; https://www.cgdev.org/blog/world-banks-self-inflicted-crisis

Blog published ahead of the WB (/IMF) Spring meetings (13-18 April).

“The World Bank and IMF Spring Meetings arrive at a moment of increasing global disorder. Both the Bank and the IMF have an important role in helping client countries deal with the associated crises. But the World Bank could play that role far better without the distractions of a damaging internal reorganization that, at least to the outside world, is opaque as to purpose and details…..”

Bretton Woods Observer – Spring 2026

https://www.brettonwoodsproject.org/wp-content/uploads/2026/04/bw_observer_spring_26_screen.pdf

Well worth scanning!

Check out among others:

·         Banga’s decision to join US-led Board of Peace raises questions about World Bank’s commitment to multilateralism  

“….Widespread concerns that Board may undermine UN’s role and international law, with Bank’s European member states by-and-large declining to join. Civil society condemns Banga’s involvement and Bank’s role as trustee of Gaza Reconstruction and Development Fund.”

·         BWP – From donor to investor: The dangers of the development paradigm shift

“Major donors try to detract attention from ODA cuts with new rhetoric. World Bank and IMF continue to present private capital mobilisation as ‘win-win’ and only alternative. Reduced ODA and greater reliance on private finance risks deepening existing barriers to positive development outcomes.”

·         Challenging primacy of BWIs urgent as threats to UN and multilateralism deepen  

·         New report debunks World Bank and IMF’s claims that universal social protection is unaffordable

“New report by Development Pathways and Act Church of Sweden demonstrates the viability of locally financed and gradual provision of universal social protection. “

·         Britain as a global financial superpower: The UK’s 2027 G20 Presidency is a historic opportunity to fix the system

“The UK has unique structural influence over debt law, tax secrecy and international financial institutions. By championing reform at the G20, the UK could unlock development finance while reinforcing its own financial credibility and long-term prosperity.”

·         Global governance and development: Toward equitable burden sharing and agenda-setting   (by R De Negri)

·         Fuelling inequality: The gendered impacts of World Bank and IMF fuel subsidy removal 

 “ BWP’s new research provides evidence of the negative gendered impacts of fuel subsidy removal policies in Egypt, Kenya and Bangladesh….”

Project Syndicate –The IMF’s Spring Meetings Must Deliver Three Reforms

Attiya Waris;  https://www.project-syndicate.org/commentary/imf-spring-meetings-must-reform-quotas-give-more-votes-to-developing-economies-by-attiya-waris-2026-04

“Kenya’s recent decision to forgo funding from the International Monetary Fund illustrates the asymmetry at the heart of the multilateral financial architecture. As policymakers gather for the Spring Meetings, they have an opportunity to address these structural imbalances, starting with an overhaul of the IMF’s quota system.”

“In March, Kenya made a strategic push for economic self-determination when the Treasury announced that it did not need funding from the International Monetary Fund for the remainder of the fiscal year, which ends in June. Instead, the Kenyan government mobilized 588 billion shillings ($4.5 billion) through the Kenya Pipeline Company’s initial public offering, a stake sale in Safaricom, and the issuance of new Eurobonds. That is roughly five times what the IMF would have offered in a single year…..”

Waris sees   “… the need for three reforms. The first is a new quota formula that provides greater voting power to emerging and developing economies. Second, affected populations must be able to shape the structure of IMF programs, not merely be consulted after the terms are set. Lastly, there must be a shift from compliance-based to legitimacy-based fiscal governance. When program conditions fail to account for a country’s constitutional framework and political context, the problem is design, not compliance. A country’s fiscal framework must be treated as an expression of the compact between a government and its citizens, not as a technocratic checklist.”

And she concludes: “Kenya’s decision to stand on its own feet is not a rejection of multilateralism. It shows what multilateralism should look like: a system in which countries participate as sovereign partners, not dependents. Although it may seem like a procedural exercise, the 17th General Review of Quotas is a test of whether the system can still reform itself. Failure to achieve lasting reform by the extended deadline of 2028 would tell the world everything it needs to know about whose interests the architecture will continue to serve.”

CGD (blog)  – Protection for the Most Vulnerable: Debt Shock Absorbers for Poor Countries

N Lee et al;  https://www.cgdev.org/blog/protection-most-vulnerable-debt-shock-absorbers-poor-countries

·         Linked to a  new CGD Policy paper – Better Debt Shock Absorbers for Poor Countries: A Proposal

Proposal with five features.

More on Global Health Governance & Financing/Funding

HPW – China to Join WHO Executive Board – Among the Countries to Screen Candidates for Next Director General

https://healthpolicy-watch.news/exclusive-china-on-next-who-executive-board/

“Several WHO member states about to join the Executive Board have dubious human rights records, but they will shortlist Director General candidates at the Organization’s most consequential period in a generation.”

“…EB will select three DG candidates :  So why does any of this matter? The countries entering the Executive Board in 2026 will screen the Director General (DG) candidates and narrow the field to three finalists before the full WHA makes its final call in 2027.   That process begins this year. Any serious candidate already knows it. As Health Policy Watch reported in February, those with their eye on the top job are already touring capitals, working the conference circuit, and calling in favors – with exactly the countries now taking their seats on this board.   They still need the golden ticket: a formal nomination from their own Ministry of Foreign Affairs, and that clock starts the moment Tedros issues his call for candidates, anticipated later this month….”

The article also has the full overview of the EB countries (including all the new ones), per region.

OECD – International aid fell sharply in 2025, says OECD

https://www.oecd.org/en/about/news/press-releases/2026/04/international-aid-fell-sharply-in-2025-says-oecd.html

“International aid from member countries and associates of the Development Assistance Committee (DAC) fell in 2025 by 23.1% in real terms compared to 2024, the largest annual drop in the history of official development assistance (ODA), according to preliminary data collected by the OECD.”

“This contraction brings ODA to levels last seen in 2015, when the 2030 Agenda for Sustainable Development was adopted. ODA by DAC member and associate countries amounted to USD 174.3 billion in 2025, representing 0.26% of these countries’ combined gross national income (GNI), down from USD 214.6 billion or 0.34% of GNI in 2024.”

“The five largest providers in 2025 were Germany (USD 29.1 billion), which has become the largest provider of ODA for the first time, followed by the United States (USD 29.0 billion), the United Kingdom (USD 17.2 billion), Japan (USD 16.2 billion), and France (USD 14.5 billion). This was the first year on record in which the top five providers all reduced their ODA, accounting for 95.7% of the total decline in ODA overall. ODA provided by the United States declined by 56.9%.”

“Eight out of the 34 DAC members maintained or increased their ODA, while four countries exceeded the United Nations’ target of 0.7% ODA to GNI: Denmark (0.72%), Luxembourg (0.99%), Norway (1.03%) and Sweden (0.85%)….”

·                  Great analysis via Devex – ODA plummets by almost a quarter, driven by billions in US cuts

“OECD data reveals a record drop in aid led by the United States, slashing core development funding and raising fears of deepening instability across the global south.”

UN News – Development finance gap risks reversing decades of progress

https://news.un.org/en/story/2026/04/1167277

“Global fragmentation, deepening geopolitical tensions and conflicts are putting decades of development progress at risk, the UN warned in a report published on Thursday – calling for stepping up investment to meet internationally agreed goals.   The 2026 Financing for Sustainable Development Report assesses progress on the Sevilla Commitment, a 2025 agreement that aims to secure the $4 trillion needed annually to achieve the Sustainable Development Goals (SDGs) by the end of the decade. …”

“While a massive scale-up investment is needed to deliver the goals within the next four years, “regrettably, the financing gap is widening,” said UN Under-Secretary-General for Economic and Social Affairs (DESA) Li Junhua.   Development aid is falling sharply as developing countries – particularly the poorest and most vulnerable – face rising costs from environmental degradation and climate impacts, high costs of capital and mounting debt pressure.  Among the report’s findings is that Official Development Assistance (ODA) dropped by 6 per cent in 2024 and by another 23 per cent the following year.  Meanwhile, debt servicing burdens have hit 20-year highs. “

·         See also the press release – Fragmenting world worsens finance squeeze, reversing decades of progress on development, UN report warns

“Development financing trends are going in the wrong direction, the United Nations warned today. In many areas, progress has not only stalled but is reversing due to weakened global collaboration, rising trade barriers, increased geopolitical tensions, repeated climate-related shocks, and an alarming assault on multilateralism….”

World Bank – Investing in Health: Pathways for a Fiscal Pivot

C Kurowski, D Evans et al ; https://documents.worldbank.org/en/publication/documents-reports/documentdetail/099122225125512670

“This paper examines how low- and lower middle-income countries (LLMICs) can expand government health spending to accelerate progress toward Universal Health Coverage and other health-related Sustainable Development Goals. Despite long-term gains, growth in government health spending has markedly slowed, and many LLMICs face tightening fiscal space, declining external support, and rising competition for public resources. Pathways for a Fiscal Pivot sets out an agenda to expand government health spending across budget transfers, social contributions, and development assistance for health, combining political economy strategies with technical and operational measures to shape reforms, processes, and financing decisions. The pathways draw on the literature, case studies, and extensive consultations with government representatives and other experts. Rather than a blueprint, they offer a starting point for debate on a fiscal pivot for investing in health.”

“The fiscal pivot pathways respond to the challenging fiscal realities and address the institutional, technical, and operational challenges that influence government health spending. Together, they set out an agenda of what countries can do and how to do it. They comprise two components: political economy strategies that address institutional and political factors shaping reforms and financing decisions, and technical and operational measures that target policy design and implementation barriers to mobilizing government financing for health.”

Africa CDC – Senior Appointments — Advancing Health Security, Systems Strengthening and Innovation

https://africacdc.org/news-item/communique-senior-appointments-advancing-health-security-systems-strengthening-and-innovation/

“The Africa Centres for Disease Control and Prevention (Africa CDC) is pleased to announce the appointment of a new group of senior leaders to reinforce the institution’s capacity to deliver on its mandate and accelerate implementation of the Africa Health Security and Sovereignty Agenda.  The appointments strengthen priority areas across pooled procurement, immunization, pandemic prevention, preparedness and response, regional coordination, maternal and child health, and digital transformation. …” Check out the new people.

TGH – Why Every Country Needs a Public Health Agency

Chikwe Ihekweazu and Garry Aslanyan; https://www.thinkglobalhealth.org/article/why-every-country-needs-a-public-health-agency

“The WHO’s executive director of health emergencies outlines why more countries are launching national public health agencies.”

“Currently, 101 countries—about half the globe—have a national public health agency, according to an internal review done by the World Health Organization (WHO). In these countries, essential public health functions have been organized under a singular authority that’s been given scientific independence, infrastructure, and resources. Another 20 countries are in the process of establishing one. In countries without a central coordinating agency, public health functions such as surveillance, laboratory confirmation, and risk communications are typically scattered across government ministries, regional governments, and other agencies. … A national agency such as Ethiopia’s makes it easier to create political accountability and the chains of command that spur public health action. Fragmentation makes implementation less efficient and coordination more difficult. It complicates decision-making when every hour is critical…”

PS: “The WHO has recently published guidance to support countries in the process of identifying capacities that public health agencies can lead or support…”

·         Related read:   National public health institutes in Africa: a systematic review    (Feb 2026,  BMC Public Health)

HPW – Drastic UK Aid Cuts Hit Fragile African Health Systems

https://healthpolicy-watch.news/uk-aid-cuts-hit-african-health/

See also Devex a few weeks ago. This article focuses, among others, on the situation in Kenya.

“ frontline African health workers warn of a collapse in vital care. The sudden UK aid cuts are turning unpaid community health promoters into “shock absorbers of a shrinking system,” an immense burden that is ultimately unsustainable, warned Kristine Yakhama, a Kenya-based member of the Action for Global Health steering committee, during an interview with Health Policy Watch….”

Excerpt: “British policymakers argue that these UK aid cuts will force national governments to finally take ownership of their own domestic healthcare systems. Yet, many heavily indebted nations are incapable of filling the financial voids left by retreating Western donors.  However, instead of investing in clinics, the Kenyan government reportedly has to prioritise servicing its massive international debt, persistently failing to meet the Abuja Declaration target of allocating 15% of the national budget to health.  According to Action for Global Health, high-income donor nations often promote domestic resource mobilisation to overcome aid dependency, yet unjust global debt arrangements severely restrict this required fiscal space. Rather than offering genuine financial relief, G20 nations push for transactional debt swaps tied to African minerals or nature reserves instead of health investments.  Additionally, the International Monetary Fund (IMF) frequently imposes stringent economic conditions that often result in higher taxes, further squeezing impoverished citizens, warned Brenda Osoro, national coordinator for Fight Inequality Alliance Kenya, in a public statement in March….”

Tim Schwab – Buffett distances himself from growing Gates-Epstein scandal

https://timschwab.substack.com/p/buffett-distances-himself-from-growing

“Bill Gates’s scandalous ties to pedophile Jeffrey Epstein have propelled a wave of defections, as long-time supporters like Warren Buffett distance themselves from the embattled billionaire.”

Habib Benzian – Everything Looks Fine

Habib Benzian (on Substack);

“How health systems erase problems by narrowing language.”

“There is a comforting assumption built into modern health systems: if something matters or goes wrong, it will eventually show up in the data. If a problem is serious enough, it will be named, measured, tracked, and debated. Absence, in this logic, is reassuring. What cannot be seen must no longer be urgent. That assumption is wrong. What we are witnessing now, most clearly in the United States, is not a failure of evidence, nor a retreat from science. It is something more precise and more consequential: the deliberate narrowing of language as a mode of governance, narrowing what can be named in the first place….”

Why Market Shaping in Global Health Works—but Reshapes Power and Leaves Systems Behind

E S K Besson; https://www.linkedin.com/pulse/why-market-shaping-global-health-worksbut-reshapes-koum-besson-ja5fe/

“This piece asks a central question: can market-shaping institutions themselves become a form of market distortion—especially when governance power is asymmetrically located in the Global North? It explores how market shaping improves access but risks building dependency when systems are left behind—and why a focus on prices and products may reproduce a new form of verticalism in global health markets.”

See also the author on LinkedIn: “Recent publications from actors such as Unitaid, the Clinton Health Access Initiative, Inc. and MedAccess have reinforced my belief that #effectiveness alone is not sufficient to understand the broader implications of how these approaches are designed and implemented.   As the global community increasingly recognizes how #ownership, #sustainability, and #dependency are #interconnected, it feels important to look at solutions not only through what works—but through the lens of governance and authority…. …At its core, market shaping is not only about prices, volumes, or supply chains. It is about who organizes markets—and on whose behalf….”

European Union (Capacity4Development) – Key results from TESS MAV+

https://capacity4dev.europa.eu/library/key-results-tess-mav_en

Background: “TESS MAV+ supports Team Europe in strengthening its partnership on health with Africa in line with the EU’s Global Gateway Strategy, serving as the secretariat for the Team Europe Initiative on the AU-EU Health Partnership.”  Check out key results so far.

“Working behind the scenes, TESS MAV+ convenes a broad cross-section of European stakeholders and coordinates regular discussions between European, African and international actors, ensuring ongoing dialogue and alignment. While TESS MAV+ primarily focuses on supporting MAV+ in increasing manufacturing and access to health products in Africa, it has also been supporting the overarching AU-EU Health Partnership since 2025….”

PS: “The AU-EU Health Partnership mobilises more than 5 billion EUR across nearly 200 projects, with its local manufacturing and access portfolio accounting for more than EUR 1.9 billion across 80+ projects….”

Afro Barometer  – PP101: Pressure points: Africa’s health systems amid global aid contraction

J Asunka et al; https://www.afrobarometer.org/publication/pp101-pressure-points-africas-health-systems-amid-global-aid-contraction/

“Citizens struggle to access services, call for universal coverage.”

“…. Amid these dynamics in the health sector, we draw on Afrobarometer survey data to explore how ordinary Africans are experiencing their health systems in transition. … Across 38 countries surveyed…Africans rank health as the top policy issue they want their govs to address, dislodging  unemployment…7 in 10 say their govs should ensure all citizens have access to adequate health care even if that means they pay higher taxes.”

“In practice, persistent financing and delivery challenges in the health sector continue to  impact citizens negatively. Most Africans say they worry about their ability to obtain and  afford needed medical care. Among respondents who had contact with a public hospital or  clinic in the past 12 months, many report difficulties accessing medical care and cite shortages of medical supplies, long wait times, and high costs.  … Taken together, these findings reveal a continent undergoing a profound recalibration…”

Bilateral health agreements & US Global Health Strategy

With also a few new bilateral health agreements announced (in Cambodia, Tajikistan) – see below.

And for the latest overview, via the KFF tracker (updated on 8 April): KFF Tracker: America First MOU Bilateral Global Health Agreements .

Reuters – US upends global supply program for malaria and HIV amid warnings of gaps 

https://www.reuters.com/business/healthcare-pharmaceuticals/us-upends-global-supply-program-malaria-hiv-amid-warnings-gaps-2026-04-03/

From late last week. “US seeks to wind up health aid delivery mechanism from May 30; No clear replacement plan in place; State Department and sources warn of risks of rushed transition; Planned U.S. health pacts with African nations face hurdles; USAID had delivered $5bn in supplies to 90 countries, mainly in Africa and Asia.”

“The U.S. is upending the way it delivers medical supplies ​for diseases such as HIV and malaria to lower-income countries, according to seven sources and an internal email, risking a second dislocation of life-saving services in just ‌over a year.  The U.S. has until now managed its medical donations through the Global Health Supply Chain Program – Procurement and Supply Management – run by the private contractor Chemonics. From its establishment in 2016 to 2024, it delivered a total of more than $5 billion of HIV and malaria products to 90 countries, mostly in sub-Saharan Africa and Asia….”

“…The U.S. State Department asked U.S. staff in 17 African countries and Haiti in an ​email on Tuesday to cease implementing the supply program by May 30.  It said the contract with Chemonics was ending on September 30, in line with all USAID awards – although its official end date is in November…. The email, seen by Reuters and verified by two sources, also said there could be “immediate risks to service continuity if (the) transition is rushed or incomplete”.  It did not lay out a clear transition plan, instead asking each U.S. country office to set ​out how it would implement the handover, and to inform Washington of any risks or need for more time….”

PS: “… Six sources said the U.S. was talking to the Global Fund to Fight AIDS, Tuberculosis and Malaria about using its supply platform to procure ‌and deliver donations ⁠of global health products in future.  The Global Fund, a Geneva-based health initiative, already manages the purchase and supply of around $2 billion a year in health products for the three deadly infectious diseases, alongside partner organisations in the countries where it works. It also has an online procurement platform used by partners.  Two of those sources said earlier discussions between the organisation and the U.S. government had focused on a November 2027 transition…..”

·         Related:  Emily Bass – Country Deadlines for Emergency Closeout of US Global Health Supply Chain

“Seven countries reportedly on “immediate pause”.”

““Emergency closeout planning” for the US Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM), run by Chemonics International, has begun, according to an email sent by the Task Order 1 Director HIV/AIDS on Monday March 30 to recipients at Chemonics and the Bureau of Global Health Security and Diplomacy (GHSD) at the Department of State, including the Supply Chain Division Lead. The email, which I viewed and verified with two sources, refutes the State Department’s claim to Reuters, that GHSD had “not provided any technical direction to Chemonics to ​cease operations by May 30 or any other date.” Instead, the email details lays out a reactive, improvised plan based on cash-flow juggling, and program halts in eight countries by April 30 2026, with an additional 13 in the months that follow…..”

“… The emergency close out will bring fresh chaos to health services and laboratories that have only recently and partially stabilized their HIV and malaria programs after the sudden destruction of USAID and long-standing US approaches to global health foreign aid last year….. It also complicates implementation of the America First Global Health Strategy. In the countries for which Memoranda of Understanding are available, five out of seven stipulate the use of a US procurement mechanism. Though GHSC-PSM was not named in any MoU, it was the only extant mechanism at the time of signing…..”

WP – Trump administration’s secrecy on health deals alarms experts, governments

Washington Post;

“ To date, 28 deals have been negotiated with foreign governments, mostly throughout Africa. But in a break with precedent, the administration has refused to disclose their full terms publicly.  The veil of secrecy has frustrated partner countries and angered transparency advocates, who worry that billions of dollars in U.S. funding – money that’s intended to help combat disease – is being leveraged by the Trump administration as it seeks controversial concessions on unrelated policies in return.”

“Public Citizen, a government watchdog group, has brought a lawsuit demanding access to some of the administration’s global health agreements, arguing that the State Department’s failure to produce the records in response to a Freedom of Information Act request is “unlawful.”  The agreements’ public disclosure is essential “to understanding the new foreign aid structure” being built by the State Department and what the United States “expects, or extracts, in return,” said Peter Maybarduk, director of Public Citizen’s access to medicines group.”

“The State Department, which has led the overhaul of health-related foreign aid since last year’s dismantling of the U.S. Agency for International Development, said it does not comment on ongoing litigation but that it takes its transparency obligations “very seriously.”   In a statement, the agency vowed to disclose the terms of its agreements “once negotiations with all partner governments are complete,” saying its approach is consistent with applicable law and intended to protect “sensitive” conversations….”

“… Public Citizen’s Maybarduk said that the strategy seems to be “divide and conquer the partners of the United States.” The Trump administration, he said, “is treating its negotiating partners as hostiles, and treating health aid a bit like conflict, as though every bit of U.S. negotiating advantage must be preserved through secrecy.”…”

“There have been five signed agreements publicly released by the U.S. government thus far, though it appears that was done accidentally. The documents – outlining deals with Kenya, Uganda, Mozambique, Nigeria and Ethiopia – were published on an obscure government website in March, but a few days later, the zip file that contained copies of the agreements’ text was deleted. It was later republished without those documents.  The State Department, in its response to questions, said that the five agreements released on its website were posted in error. “We took them down to treat all partner countries consistently and will repost them – along with the rest – once the full set of agreements is finalized. That is a process fix, not a cover‑up,” the agency said.”

PS: “At least nine countries, including several with major HIV epidemics like Eswatini, have concurrently held negotiations with the Trump administration to receive third-country nationals deported from the United States.”

Via Devex Check-up – Jean Kaseya’s view on the bilateral health agreements

Devex; 

“I asked Africa CDC’s chief, Dr. Jean Kaseya if he thinks countries are getting a good deal.

It’s not a simple answer, he responded. Some countries think they’ve negotiated a good deal. Others aren’t entirely comfortable with what they’ve signed. Kenya is an example where the Supreme Court weighed in after the agreement was signed, he said.

And there are those who don’t like what the State Department is offering and want to ensure the agreement doesn’t impede upon their sovereignty. This is the case of Zambia.

“This is why I cannot really say if it’s good or bad. It’s mostly country-per-country,” he said.

He has heard, though, concerns around data and pathogen-sharing provisions. Part of that is technical — countries want clarity on what data is being collected and how.  But part of it is also emotional, he said. Countries are wondering why they’re being asked to sign lengthy data agreements with the U.S., some for 25 years, whereas the funding itself runs for only five years.
That’s prompting some to slow things down. Namibia, for instance, is still negotiating and pushing for greater clarity on the data terms, Kaseya said.

“My advice to countries is: Follow your national laws, be led by national interest and sovereignty, and communicate,” he said.”

Carnegie –  Kenya’s Health Deal Is a Stress Test for the America First Global Health Strategy

https://carnegieendowment.org/china/research/2026/03/kenya-data-protection-america-first-global-health-strategy

“U.S. agreements must contend with national data protection laws to make durable foreign policy instruments.”

“The AFGHS bilateral agreements follow a standardized template. If weaknesses around health data governance and public consultation are embedded in that template, Kenya’s response may have a demonstration effect. Most other African countries that have signed the agreements also have data protection laws, meaning similar legal tensions could emerge elsewhere…”

Amfar (Policy report) – Unmeasurable and unaccountable: HIV Metrics, Targets, and Accountability in Global Health MOUs

https://www.amfar.org/wp-content/uploads/2026/04/Unmeasurable-and-Unaccountable.pdf

“…. We engaged in this analysis to determine whether the HIV targets in the seven released MOUs have been set with the requisite care and precision that should be expected of the tens of billions of taxpayer dollars allocated to them. They have not. Both the outcome and process metrics in the MOUs suffer from at least four fundamental flaws that ultimately undermine accountability and oversight:  The outcome metrics established cannot be assessed at the level of precision expected in the MOUs… The process metrics are internally inconsistent, incoherent, and actively work against each other as a mechanism for accountability… the process metrics and performance provisions of the MOUs are ambiguous in terms of what direction they are even meant to be assessed…. The transition to country data systems and the confidentiality provisions of the MOUs are designed to prohibit independent or external oversight of the MOUs or programmatic performance…”

With a number of recommendations.

US State Department – Charting a New Phase of Trump Administration’s America First Global Health Strategy in Asia, Beginning with Cambodia

https://www.state.gov/releases/office-of-the-spokesperson/2026/04/charting-a-new-phase-of-trump-administrations-america-first-global-health-strategy-in-asia-beginning-with-cambodia/

“On April 2, the United States signed a bilateral health cooperation Memorandum of Understanding (MOU) with the Royal Government of Cambodia through the Trump Administration’s America First Global Health Strategy (AFGHS). This landmark five-year MOU is the first to be signed through the Trump Administration’s AFGHS in Asia, and advances shared global health goals, such as preventing the spread of infectious diseases like HIV/AIDS, malaria, and tuberculosis.”

“Working with Congress, the Department of State intends to provide more than $30.8 million to strengthen and sustain Cambodian infectious disease prevention and response capabilities and accurately identify pathogens of epidemic and pandemic potential before they spread internationally. Through the bilateral health MOU, the Royal Government of Cambodia has committed to increasing its own domestic expenditures by more than $5.3 million, assuming greater ownership of their commodity chains while continuing to rollout new innovative diagnostics, vaccines, drugs, and other life-saving interventions.  The jointly decided $36.1 million bilateral health MOU also includes $5 million in global health security funding to bolster and sustain a robust network of laboratories and aims to achieve malaria elimination in Cambodia, ultimately strengthening independent, locally led Cambodian leadership over its national health system. “

·         And from later this week:  Broadening the Trump Administration’s America First Global Health Engagement In South and Central Asia

“On April 6, the United States signed a bilateral health cooperation Memorandum of Understanding (MOU) with the Republic of Tajikistan under the Trump Administration’s America First Global Health Strategy (AFGHS). This breakthrough MOU marks the first bilateral health cooperation signed in the South and Central Asia region and aims to protect Americans from infectious disease threats while strengthening U.S.-Tajikistan relations. ….”

Devex – US deputy secretary of state stresses reciprocity in foreign aid

https://www.devex.com/news/us-deputy-secretary-of-state-stresses-reciprocity-in-foreign-aid-112251

“”We’re not going to be granting any privileges or benefits to any country that doesn’t grant them back to us,” said Christopher Landau, speaking in Washington D.C. on Thursday.”

Trump 2.0

CGD (blog) – The Washington Post’s Optimistic Read on Aid Cuts Doesn’t Hold Up

C Kenny; https://www.cgdev.org/blog/washington-posts-optimistic-read-aid-cuts-doesnt-hold

Recommended overall analysis, also on the health impact of the aid cuts (and why so far apocalyptic scenarios haven’t materialized).

Devex – Trump’s budget request calls for 30% cut to foreign affairs spending

https://www.devex.com/news/trump-s-budget-request-calls-for-30-cut-to-foreign-affairs-spending-112217

(3 April) “Global health, humanitarian assistance, food aid and international organizations are all targeted for cuts, with the America First Opportunity Fund and support for critical minerals on the rise.”

« U.S. President Donald Trump is seeking a 30% cut to the foreign affairs budget, as he looks to dramatically increase defense spending, according to a preliminary fiscal year 2027 budget request that he sent to Congress on Friday.  The request includes $35.6 billion for the State Department and other international programs, down about $15.5 billion from what Congress approved for fiscal year 2026, which ends Sept. 30. Many of the proposed cuts are to foreign assistance programs, including $4.3 billion less for global health and $2 billion less in humanitarian assistance.”

PS: “The president’s request seems a bit at odds with some of what the administration has articulated to date about its plans for U.S. foreign aid, said Tom Hart, president and CEO of InterAction, an alliance of NGOs and partners working on global development and humanitarian assistance.  “The request is both disappointing and sort of confusing or contradictory with what I understand the administration is trying to do,” he told Devex. “They’ve been clear that they want to focus more assistance on saving lives, and yet they have severely slashed two of the accounts that directly do that — global health and humanitarian assistance.”   …”

“… The budget includes $5.1 billion for global health, a $4.3 billion cut from what Congress approved in 2026.  “The President’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” the budget request says. It also proposes some specific changes to U.S. global health spending, including eliminating disease-specific accounts and focusing on new bilateral agreements with countries in an effort to “improve efficiency, cut red tape, and dismantle the bloated ecosystem of foreign assistance profiteers.” The budget request includes language to prohibit funding for abortion and unfettered access to birth control, and eliminates funding for circumcision as well as LGBTQ services. It does so to “better focus funds on life-saving assistance,” it says.”

PS: “The Council for Global Equality said in a statement that the administration is seeking to codify its Promoting Human Flourishing in Foreign Assistance Policy, or expanded global gag rules, which bar U.S. foreign aid funding from going to organizations that fund or even address abortion, diversity, or what it calls the administration calls “gender ideology.” The group warned that doing so would cost lives and discriminate against those who most need services.”

PS: “…The request includes a $2.7 billion reduction to international organizations and the United Nations, including the World Health Organization, the U.N. regular budget, and the peacekeeping budget….”

·         Related:  KFF –  Global Health Funding in the FY 2027 President’s Budget Request   (6 April) (full breakdown)

U.S. Global Health Spending Watch: A public dashboard tracking how the U.S. government obligates and spends global health funds

https://globalhealthwatch.org/?section=blog

New resource.

NYT – Trump’s foreign aid overhaul sent millions more dollars to US based contractors

https://www.nytimes.com/2026/04/06/health/trump-foreign-aid.html

“While organisations in the developing world were nearly shut out, the big aid agencies DOGE had called wasteful received huge infusions of cash, a new analysis found.”  That is, Chemonics, FHI 360 and Jhpiego…

“The new analysis, by a team of researchers from the Health Security Policy Academy, offers insight into the scope of disruption last year, which was felt in drug shortages, fired heath workers and missed rounds of malaria prevention and vaccinations…. “They did the exact opposite of what they said they were going to do,” said Dr. KJ Seung, a physician in the Division of Global Health Equity at Mass General Brigham, and a member of the team that conducted the funding analysis for the academy, a policy think tank affiliated with the medical center.”

Guardian – US accused of pressuring Latin America to cut ties with Cuban doctors program

https://www.theguardian.com/world/2026/apr/09/us-cuban-doctors-program?CMP=Share_iOSApp_Other

“Cuba accuses US of ‘extorting’ countries in pushing them to axe deals with Havana to send doctors on medical missions.”

“Cuba’s foreign minister has accused the United States of “extorting” Latin American countries by putting pressure on them to cancel decades-old deals with Havana for the supply of doctors. Bruno Rodríguez said the United States was trying to “strangle” the economy of the communist island, which earns billions from its foreign medical missions, after several countries stopped deploying Cuban doctors.  … Guatemala, Honduras, Jamaica and Guyana have all terminated their agreements with Cuba, which is teetering on the edge of economic collapse, partly due to a US energy blockade.”

Guardian – Public health takes center stage in US midterm campaigns: ‘It’s already been politicized’

https://www.theguardian.com/us-news/2026/apr/06/public-health-in-midterm-election-campaign

“Some candidates are making public health a central part of their midterm campaigns amid Trump’s war on science.”

“As public health has become increasingly politicized in the US, with a particularly chaotic year under the Trump administration, some political candidates are pushing back by making public health a central part of their campaigns – and the grassroots organization Defend Public Health has ideas about how to do it.  On Monday, the group launched guiding principles for campaigns to prioritize public health, called the People’s Health Platform, highlighting the importance of ensuring healthcare for all, protecting and expanding sexual, reproductive, and gender-affirming healthcare, preparing for the climate crisis and the next pandemic, and taxing billionaires, among other tenets…..”

“…Guaranteeing universal access to healthcare is the first item on the Defend Public Health platform. Jacobs noted to the Guardian that “by the end” of her career, she “realized that the most important thing to public health is to ensure that everybody has access to healthcare above everything else”.  Other suggestions include restoring funding for scientific research, ending attacks on contraception, abortion, and gender-affirming care, fighting against health inequality, and rejoining international health bodies like the World Health Organization.

·         For the full platform, see The People’s Health Platform 

PABS negotiations & more on PPPR

Geneva Health Files – Health as a Strategic Leverage: Navigating Chokepoints with Diplomacy 

I Kickbusch; https://newsletter.genevahealthfiles.com/health-as-a-strategic-leverage-navigating-chokepoints-with-diplomacy-guest-essay/?ref=geneva-health-files-newsletter

Must-read. “…Clear-eyed analysis from leading global health scholar, Ilona Kickbusch, who discusses opportunities for health diplomacy within the rubric of the on-going negotiations on the Pathogen Access Benefit Sharing (PABS) System at the World Health Organization. She argues that health has long been used as a leverage in international relations. And raises an urgent question on whether health actors will develop the strategic literacy to respond intelligently.  In this essay, Kickbusch draws upon the past as a guide, and refers to the challenges in the future, to map leverages in the present…”     On ‘chokepoint diplomacy’ and much more.   A few excerpts:

“For decades, global health has positioned itself as above geopolitics — a humanitarian domain governed by solidarity, science, and the shared imperative to protect human life. That self-image was always partially fiction, health has long been a bargaining chip in international relations. What has changed is the sophistication with which political actors play that game, and the reluctance of global health institutions to acknowledge it.”   “… Economic warfare moves to the center of geopolitical competition — weaponizing supply chains, financial systems, and technology monopolies. Yet global health governance is not prepared for this shift and remains organized around norms of universalism that powerful states have shown no intention of reciprocating….”

“… Powerful countries treat global health commitments as discretionary and show no interest in maintaining health related obligations as they bomb health centers and bloc humanitarian corridors; as they refrain from fulfilling binding transparency obligations in outbreak notification or as they pursue bilateral pathogen-sharing contracts that fragment multilateral architectures. These must be recognized as what they are: strategies by powerful actors to use health as leverage and let others be bound by universalist norms. …”

“The concept of the chokepoint can offer a clarifying framework.   …. … A parallel instrument for health data governance — one that conditions market access on binding equity commitments — would operate on the same logic. The pharmaceutical company that refuses PABS obligations would face restricted access to European procurement, public research infrastructure, or regulatory fast-tracking. Irresponsibility becomes costly not through moral suasion but through the deliberate construction of structural penalties that change the calculus. Creating those conditions requires health diplomats to think like trade negotiators and security analysts: to map dependencies, identify leverage points, and build coalitions capable of collective action at the chokepoint rather than managing consequences downstream. …”

Kickbusch discerns  “… one side holding every structural chokepoint — manufacturing capacity, intellectual property regimes, distribution networks, sequencing infrastructure — while the other side holds genuine leverage but has no institutional architecture to deploy it collectively. …”  None has yet made the explicit connection to chokepoint diplomacy as a strategic framework — the recognition that the solution requires not better norms, but structural conditionality organized around the assets that data-providing countries actually control. “

PS: Kickbusch focuses towards the end of the essay on the EU. Even making the link between pandemic preparedness and semiconductor policy. 

WHO – R&D roadmaps for pathogen families to reduce uncertainty about the next pandemic and boost coordinated global R&D preparedness

https://www.who.int/news/item/07-04-2026-r-d-roadmaps-for-pathogen-families-to-reduce-uncertainty-about-the-next-pandemic-and-boost-coordinated-global-r-d-preparedness

“In support of efforts to have safe and effective diagnostics, treatments and vaccines ready for distribution before the next pandemic strikes, WHO launched today, together with partners, research and development roadmaps for 10 groups or viruses and bacteria.  

The roadmaps were launched at an event, co-hosted by ANRS Emerging Infectious Diseases, the Coalition for Epidemic Preparedness Innovations (CEPI), the World Health Organization (WHO), and partners held during the One Health Summit in Lyon, France. “

“The event highlighted how a One Health and Pathogen Family-based approach can strengthen epidemic and pandemic preparedness, including through WHO’s Collaborative Open Research Consortia (CORCs), which bring together global research communities around priority viral families and core bacterial threats.  ….”

Accelerating Action for Pandemic Preparedness in 2026: Joint Statement by IPPS, CEPI, FIND and DNDi

https://ippsecretariat.org/news/accelerating-action-for-pandemic-preparedness-in-2026-joint-statement-by-ipps-cepi-find-and-dndi/

(2 April) Joint statement by the 100 Days Mission partners.

“We’re calling for action across six priority areas, from reaffirming the 100 Days Mission as the unifying global goal, to establishing a Therapeutics Development Coalition to address the therapeutics pipeline gap.”     “It starts this week at the One Health Summit in Lyon…”

“Member States have a critical opportunity in 2026 to strengthen readiness for future health threats at global, regional, and national levels. Partners of the 100 Days Mission (100DM) reaffirm our shared commitment to reducing the impact of future health emergencies by accelerating the discovery, development, and delivery of diagnostics, therapeutics, and vaccines (DTV) within the first 100 days of an outbreak…. We call on Member States to use the major political moments of 2026 to adopt a focused set of commitments that will: strengthen a reformed global health architecture that is more equitable, resilient, cohesive, and sustainable; enable more efficient use of resources; build resilient health systems; and accelerate development of, and equitable access to, DTVs….”

Plos GPH – Rebalancing power in infectious disease modelling: Toward inclusive and contextual approaches

J M Aheto, J Nonvignon et al ;  https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006220

“Why now? A critical time for global health equity:   Over the past several decades, infectious disease modelling has become a central tool in global health decision‑making, shaping financing decisions, vaccination strategies, and disease control policies; for measles alone, our review identified over 400 modelling studies published since 2000. However, many of the modelling analyses that have guided these decisions originate in high‑income countries (HICs), even when they intend to inform policy in low- and middle-income countries (LMICs). With the rapid expansion of Large Language Model (LLM)‑enabled modelling, concerns are intensified about analyses produced without adequate contextual understanding. Models developed at a distance can rely on assumptions that fail to reflect local epidemiology or realities, carrying real‑world consequences for feasibility, equity, and impact….” “LLMs, machine learning and other Artificial Intelligence (AI) tools are increasingly being applied in infectious disease modelling, offering rapid data processing and automated model generation—though this is an emerging area, their outputs still require careful validation and contextual interpretation. However, this raises an important question: if anyone can now generate a model using AI, how do we ensure ethics, relevance and local ownership?  …. a roadmap created by Chen et al. highlights that equitable adoption of LLMs in LMICs requires attention to five dimensions—People, Products, Platforms, Processes, and Policies—to avoid reinforcing existing disparities and ensure inclusivity in global health modelling…”

“… We present a case study of the Measles Analytics Hub (MAH), an initiative built around locally-owned models co-created with in-country experts and global partners to ensure contextual relevance and equity. The MAH, which was established at the end of 2024, exemplifies how modelling can reflect the principles of equity, inclusion, and shared ownership. Funded by the Gates Foundation, the MAH fosters collaboration across its network of members in >50 countries, including high burden countries such as India, Indonesia, Ethiopia, Nigeria, and the Democratic Republic of Congo. Local leadership is embedded in the governance structure rather than being merely symbolic. …”

El Pais – Richard Hatchett, epidemiologist: ‘The risk of a pandemic is greater today than it was in 2019’

https://english.elpais.com/science-tech/2026-04-01/richard-hatchett-epidemiologist-the-risk-of-a-pandemic-is-greater-today-than-it-was-in-2019.html

“The head of the Coalition for Epidemic Preparedness Innovations warns of the dangers of artificial intelligence and biodesign to global health, and advocates for dialogue with those who are wary of vaccines…”

UHC & PHC

Lancet (Letter) – War economies and collapsing health systems

Alhadi Khogali et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00544-1/fulltext

“Every 1% increase in military spending drives a 0·62% reduction in public health spending. This trade-off is more intense in low-income countries, where a 1% increase in military spending results in a 0·962% drop in health spending. As global defence budgets surge to historical highs amid escalating conflicts in the Middle East, Ukraine, and beyond, this is not an abstract equation; it is a daily reality for the one in six people worldwide now living under active conflict. Evidence from 1990 to 2017 links conflict to an estimated 29·4 million excess deaths from indirect causes alone, such as disrupted health services. These costs occur through specific and compounding means: … “First, through direct destruction… … Second, through supply chain collapse… … The final way these costs are incurred is through economic warfare (ie, sanctions). …”

“… Universal health coverage (UHC) frameworks remain largely blind to this reality. UHC indices measure coverage and financial protection against baselines that assume functioning economies. However, conflict-affected countries are penalised in these metrics for the direct fiscal consequences of war economics (appendix), as countries with higher conflict indices have greater reductions in health spending compared with countries not affected by war…. … Peace is essential for UHC. UHC should be maintained during periods of conflict, as this is when demand for medical services increases exponentially. Furthermore, we argue that sanctions and blockages should be recognised as quantifiable social determinants of health. Heath facilities must be protected, and access to humanitarian supplies must not be impeded. Health cannot—and should not—be overlooked in the economies of war.”

HP&P –  Primary health care–oriented reforms: the political economy dynamics underlying health-system shifts across nine countries 

A Kalita, F Khalid et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czag042/8626274?searchresult=1

“Using evidence from nine countries (Democratic Republic of Congo, Dominica, Egypt, Kazakhstan, Kenya, New Zealand, Thailand, Tunisia, and Uruguay), we analyze the political economy dynamics that emerged during implementation of primary health care (PHC)-oriented reforms. Across these cases, we identify 10 recurring health-system “shifts” toward stronger PHC orientation, which serve as a descriptive framework for examining the political economy challenges reformers faced and the strategies they used to navigate them…..”

SRHR

UN News – From misdiagnosis to medical bias: Why women are living longer but not better

UN Women ; https://news.un.org/en/story/2026/04/1167259

“For 25 years, the world has made significant progress in advancing women’s right to health, particularly in sexual and reproductive care. Women are living longer than ever before – but they are not living better.”

“Across the world, UN data shows, women are still less likely to be taken seriously, accurately diagnosed, or appropriately treated. From misdiagnosis to entrenched medical bias, gaps in healthcare systems continue to affect women’s health, safety and quality of life…  Women are more likely to have their pain dismissed, their symptoms misread and their conditions diagnosed too late. According to gender equality agency, UN Women, this reflects a “medical system historically designed without women in mind”.  …. From the tools used in examinations to the data that shapes diagnosis and treatment, these gaps are embedded in healthcare systems, with real consequences….”

With 6 uncomfortable truths.

Commercial Determinants of Health

Obesity Reviews – The Role of Physical Activity in the Prevention and Management of Obesity: A Position Statement From the World Obesity Federation

Z Gowers, K Buse et al;  https://onlinelibrary.wiley.com/doi/10.1111/obr.70103

“This position statement is intended to synthesize and interpret current consensus and salient developments regarding the relationship between obesity and physical activity. It draws from the latest evidence and guidelines to update and share the World Obesity Federation’s stance with policymakers, healthcare professionals, public health stakeholders, and civil society organizations. This statement identifies the critical role of physical activity in the prevention and management of obesity, highlights the lived experience of people with obesity, summarizes global recommendations, and considers the emerging connections between obesity, climate change, and physical activity.”

“… The World Obesity Federation (World Obesity) seeks to shift the narrative from individual blame and responsibility. Dietary and physical activity behaviors are strongly influenced by commercial, societal and environmental determinants, including structural inequities, that limit access to healthy food and safe and supportive spaces for physical activity. The systemic drivers of obesity and physical inactivity are the starting point for this position statement….”

Cfr Kent Buse on Linkedin:

“If we take that seriously, then the implication is clear: We need a more political approach to physical activity. One that:  confronts vested interests; prioritises regulation, not just programmes; invests in public space, active transport, and inclusive environments; addresses inequities in who has access to safe and supportive opportunities to be active.”

BMJ – Health partnerships risk legitimising harmful industries

https://www.bmj.com/content/393/bmj.s629

“The Pan American Health Organization’s partnership with Ferrero is yet another example of questionable corporate tactics, write Simon Barquera, Angela Carriedo, and Kent Buse.”

“The Pan American Health Organization (PAHO) recently announced a three year framework agreement with the Ferrero Group to support health initiatives and immunisation services in vulnerable communities across Latin America. While strengthening vaccination coverage is an undeniable health priority, achieving this through an institutional partnership with a transnational ultraprocessed food corporation is highly inappropriate. This PAHO-Ferrero partnership highlights a systemic vulnerability to industry influence in global health governance and represents a troubling contradiction in international public health leadership.”

“After considerable push back, PAHO recently dissolved the partnership and publicly responded to civil society organisations and academics who raised concerns about a partnership with a corporation which has in the past used corporate political activities to negatively influence public health policies in Latin America… … … This partnership was symptomatic of a broader global trend of corporations “health-washing” their reputations. Globally, transnational corporations are increasingly using initiatives to secure privileged positions in policy dialogues and formulation. For example, the World Food Programme, the United Nation’s lead agency on hunger, lists partnerships with major ultraprocessed food corporations such as PepsiCo, Mars, and Yum! brands to tackle hunger and malnutrition. Such alliances primarily serve as reputation management strategies for corporations. By associating with respected UN agencies, transnational companies attempt to legitimise their position as responsible social actors….”

Authors conclude: “… We strongly suggest that PAHO establishes definitive boundaries against corporate health-washing and urge WHO to update FENSA with more robust safeguards on engaging with ultraprocessed food corporations to protect its technical independence, ethical standards, and crucial role in defending health in Latin America.”

Planetary Health

Lancet – Life at the water’s edge: a Lancet Commission on sea-level rise, health, and justice

C Figueres et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00257-6/fulltext

“The Lancet Commission on sea-level rise, health, and justice… will analyse how sea-level rise reshapes health and wellbeing and deepens injustice, proposing actionable responses for governments, communities, and global institutions….”

·         Related:  Guardian –  World held hostage by reliance on fossil fuels, Christiana Figueres warns – and climate health impacts are ‘mother of all injustices’

  “Former UN climate chief to co-chair Lancet Commission examining how sea-level rise is reshaping health, wellbeing and inequality.”

“Christiana Figueres, an international climate negotiator who helped deliver the Paris agreement signed in 2016, made the comments as she was announced on Wednesday as co-chair of a Lancet Commission examining how sea-level rise is reshaping health, wellbeing and inequality…. ….  This commission will examine legal frameworks to hold countries accountable for the health harms of sea-level rise. It will report by September 2027.”

CEPA – Evaluation of the implementation and achievements of the ATACH 2024-2028 strategy and 2.0 structure: Alliance for Transformative Action on Climate and Health (ATACH)

https://www.atachcommunity.com/fileadmin/user_upload/ATACH_Evaluation_Final_Report_11.02__1_.pdf

Evaluation from early February by the Cambridge Economic Policy Associates Ltd (CEPA).

“CEPA was appointed by the Secretariat of the Alliance for Transformative Action on Climate and Health (ATACH) to conduct a joint evaluation of the first year of ATACH’s 2024-2028 strategy and the performance of its new governance and operating model, which began implementation in 2025. ATACH was established in June 2022 to realise the ambition set at the 26th Conference of the Parties (COP26) to build climate resilient and sustainable health systems. As of the end of 2025, ATACH had over 200 members comprising 103 country and areas members and 108 partners….”

Check out the findings.

Including eg: “ATACH has catalysed significant global achievements on climate change and health (CCH) and is widely viewed by members as a credible, high-value partnership. Members report that to date, ATACH has most significantly advanced priorities in: (i) advocacy, agenda-setting and commitment mobilisation; (ii) partnership-building and alignment; (iii) knowledge generation and sharing. By contrast, progress has been slower in supporting country implementation and access to financing, areas that members see as increasingly urgent in a constrained financing and fast-evolving global context.”

Guardian – A new economic superpower could spark a global retreat from fossil fuels

Mark Hertsgaard and Kyle Pope;  Guardian;

“Eighty-five countries have sought a roadmap to phasing out fossil fuels. A conference this month offers hope they could unite.”

“Many of those governments will gather in Colombia on 28-29 April for a conference to begin a global transition away from oil, gas and coal. Critically, the First International Conference on the Just Transition Away from Fossil Fuels will not be governed by UN rules, which require consensus, but by majority rule, thus preventing a handful of countries from sabotaging progress as petrostates did at Cop30. What’s more, the underlying terrain of this conference will no longer be principally politics, but economics: not the words that canny negotiators can keep in or out of a diplomatic text, but the implacable market forces that shape the world economy, including the potential emergence of a de facto economic superpower…..”

“The conference is co-sponsored by Colombia and the Netherland … …  The secret weapon of the “coalition of the willing” gathering in Colombia is its potential to function as an economic superpower.   At least 85 countries at Cop30 backed developing a roadmap to phase out fossil fuels…”

“…The goal of the conference is to agree on “actionable solutions” that follow-up meetings can refine so governments around the world can implement them. One area of focus will be how to phase out the $7tn a year governments spend subsidizing fossil fuels – but to do so without punishing communities, workers and tax bases that rely on such subsidies….”

Guardian – ‘Non-survivable’: heatwaves are already breaching human limits, with worse to come, study finds

https://www.theguardian.com/environment/2026/apr/08/extreme-weather-heatwaves-breaching-human-survival-limits-study-finds

Cfr a new study in Nature Communications. “Analysis of six extreme heatwaves found that when temperature and humidity were accounted for, all were potentially deadly for older people.”

“Extreme heat is already creating “non-survivable” conditions for humans in heatwaves that have killed thousands and likely many more, according to new research that warns people are more susceptible to rising temperatures than first thought.  Scientists re-examined six extreme heatwaves between 2003 and 2024 and found that when temperature, humidity and the body’s ability to stay cool were accounted for, all were potentially deadly for older people. “

“The absolute limit for humans to survive had been assumed to be a six-hour exposure to a wet bulb temperature of 35C – a measure that accounts for temperature and humidity but has rarely been observed on the planet at that level.  Heatwaves in Mecca (Saudi Arabia, 2024), Bangkok (Thailand, 2024), Phoenix (United States, 2023), Mount Isa (Australia, 2019), Larkana (Pakistan, 2015) and Seville (Spain, 2003) had seen thousands of deaths despite none approaching that wet bulb limit, the research found.”

Conflict/War & Health

HPW – World Health Organization Contractor Killed in Gaza by Israeli Fire in Murky Circumstances 

https://healthpolicy-watch.news/world-health-organization-contractor-killed-in-gaza-by-israeli-fire-in-murky-circumstances/

“The World Health Organization said it was “investigating” the circumstances around the Israeli shooting of a WHO contractor driving a vehicle in the southern Gaza city of Khan Yunis on Monday. Speaking at a UN press briefing in Geneva on Tuesday, a WHO spokesperson refused to confirm or deny Israeli military claims that the vehicle had been unmarked when it was targeted by nearby soldiers.  …  “WHO is devastated to confirm that a person contracted to provide services to the organization in Gaza was killed yesterday during a security incident,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post, on Monday. “

HPW – Generations of Damage: WHO Warns of Middle East Health Collapse Amid Funding Shortfall

https://healthpolicy-watch.news/massive-funds-shortfall-to-address-war-related-health-crises-in-middle-east/

“The World Health Organization (WHO) has only mobilised 37% of the funds it needs for the Eastern Mediterranean Region (EMRO) amid a “deteriorating health situation”, regional director Dr Hanan Balkhy told a media briefing on Wednesday.”

“Welcoming the two-week ceasefire between Iran and the United States-Israel, Balkhy called for the “permanent cessation of hostilities”, warning that the damage from the regional wars would take generations to address. She also called for the ceasefire to apply to Lebanon, which Israel claims is not covered.  Fourteen countries in EMRO are affected by wars, and over 4.3 million people have been displaced as a result. The damage in the region ranges from physical and psychological trauma to destroyed health facilities, and missed targets on maternal and child health and non-communicable diseases (NCDs), she explained.”

Lancet World Report – Iranian health facilities come under attack amid mounting obstacles to care

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00708-7/fulltext

“Attacks on hospitals and a communications blackout in Iran threaten access to essential care and complicate the humanitarian response. Sharmila Devi reports.”

Lancet Letter – Cancer, climate change, fossil fuels, and war: a call for action

Nancy Krieger; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00592-1/fulltext

“There is scant focus …. on who is accountable for climate change and its myriad adverse effects, including for cancer control across the cancer continuum. The connections could not be made clearer than by the current debacle of raging warfare in the Middle East. News accounts are full of reports of black rain, laden with carcinogens, falling upon Tehran and other areas in Iran, and caused by the bombing of oil depots, with the resulting environmental pollution posing immediate risks to health and for generations to come. Threats of oil spills in the Straits of Hormuz due to ships being bombed or destroyed by mines augur enduring environmental damage to ecosystems and heightened risks of cancer… “The common thread is control of fossil fuels and power, both literal and political. Yet literature on climate change and cancer has barely broached this topic….”

“… The time is now for any and all concerned about risk of cancer, whether researchers, clinicians, patients, or affected family members, to take action to mitigate the risk of environmental and multi-generational carcinogenic debacle in the Middle East—and link this to the broader risks of climate change literally fuelled by fossil fuels….”

Climate Change News (Comment) – Carbon accounting can help tackle the hidden emissions of war

https://www.climatechangenews.com/2026/04/06/carbon-accounting-can-help-tackle-the-hidden-emissions-of-war/

“The climate cost of war is not hypothetical. It is measurable, material and increasingly unavoidable.”

Access to medicines, vaccines & other health technologies

Stat (Opinion)- Subscription pricing could expand access to HIV prevention breakthrough while controlling costs

M Rose et al;  https://www.statnews.com/2026/04/03/lenacapavir-subscription-pricing-model-hiv-prevention/

“The ‘Netflix model’ has worked for hepatitis C treatment and can work for lenacapavir.”

« … The need for subscription pricing for lenacapavir is made clear looking back upon the implementation challenges faced by two other recent infectious disease breakthroughs, cabotegravir PrEP and hepatitis C antivirals….”

Re the Netflix model (for Hepatitis C treatment): « … Louisiana, Washington state, and Australia opted for a more innovative strategy. They implemented subscription pricing in which government insurers paid manufacturers a fixed fee in exchange for unlimited access to the drugs.  The structure was aptly nicknamed the “Netflix model.” Like the streaming service that revolutionized how the world watches movies, insurers negotiated a subscription payment to manufacturers in exchange for unlimited access to the cure. Because pricing is divorced from manufacturing costs, manufacturers can maintain profits while insurers pay a stable, predictable amount and per-patient costs fall. Analyses show the experiment succeeded at expanding access and controlling costs without bankrupting health systems or pharmaceutical firms….”

Euractiv – ‘Turning point’ for global pharma trade, industry warns after Trump tariff decision

https://www.euractiv.com/news/turning-point-for-global-pharma-trade-industry-warns-after-trump-tariff-decision/

“Tariffs risk disrupting supply and access to medicines.”

“After Trump announced tariffs on imports of innovative drugs, industry experts warn the move marks a major shift in how medicines are treated in global trade, with far-reaching consequences.”

“It is now official: the supply of medicines has been deemed a security issue by Trump, who set tariffs of 15% for patented medicines from Europe and some other countries, and up to 100% on products from elsewhere. The measures follow a Section 232 investigation that frames pharmaceutical supply as a national security issue. For analysts, this signals a departure from traditional trade logic.  “It is a fundamental shift in how pharma and biotech are discussed, that the US administration sees pharma and biotech as a sector that is of importance for national security”, says Diederik Stadig, healthcare expert from the Dutch banking group ING. He told Euractiv this is not just about reducing dependency on supply chains. These are heavily intertwined and, particularly for generics – which are exempt from the tariffs – production is unlikely to shift to the US anytime soon.  Instead, he sees a global race to lead in life sciences innovation, especially in biotech, where AI could play a pivotal role in discovering new pharmaceuticals. “Biotech has now become a sector of national security because both the US and China believe that AI is a must-win battle going forward.”…”

·         Related:  HPW – Small Companies to Bear Brunt of Trump’s 100% Medicine Tariff

“Smaller pharmaceutical companies and those outside countries with trade deals with the US will bear the brunt of President Donald Trump’s 100% tariff on imported patented pharmaceuticals and their active ingredients announced last week.”

“The tariff will be imposed on large companies 120 days from the announcement, and in 180 days for smaller ones.  Pharmaceutical companies from the European Union, Japan, the Republic of Korea, Switzerland and Liechtenstein will pay a 10% tariff and UK pharma companies are exempt from tariffs, thanks to earlier deals with the US. Meanwhile, 16 big pharma companies, including Pfizer, Novo Nordisk, Eli Lilly and Johnson & Johnson, will also escape the 100% tariff as they reached “onshoring agreements” with the US Department of Commerce last year. Some of these companies also entered into “Most Favored Nation (MFN) pricing agreements with the US Department of Health and Human Services (HHS)”.  Companies that have both onshoring and MFN agreements will pay no tariffs, while those with onshoring agreements only face a 20% tariff.  However, commentators warn that many smaller pharma companies don’t have the flexibility or capital to make such deals…..”

Stat – Merck’s experimental HIV prevention pill could be made for less than $5 a year, researchers say

https://www.statnews.com/pharmalot/2026/04/07/merck-experimental-hiv-prevention-pill-made-for-five-dollars-year/

“Advocates argue Merck should license its drug so poor countries gain easy access.”

“An experimental HIV prevention pill being developed by Merck could be mass produced for less than $5 per patient a year according to a new analysis. Advocates argue the low cost means the company should find it easier to license the drug so that low- and middle-income countries can gain easy access….”

“The pill, dubbed MK 8527, is currently undergoing a pair of late-stage clinical trials that are expected to determine whether the medicine can lower HIV transmission when given to people at high risk of infection. The results are due in the latter half of 2027, according to separate postings on ClinicalTrials.gov….”

HPW –War in Iran Threatens Helium Supplies for the World’s MRI Machines

https://healthpolicy-watch.news/war-in-iran-threatens-helium-supplies-for-the-worlds-mri-machines/

“The gas that keeps hospital MRI scanners running has been caught in the crossfire of the war in Iran, raising the prospect of diagnostic delays, rising costs and rationing of one of modern medicine’s most important imaging tools.”

“Roughly a quarter of all helium consumed worldwide goes toward cooling the superconducting magnets inside MRI scanners. While helium is the second most abundant element in the universe, on Earth, it is found only in trace quantities within certain natural gas deposits. It cannot be synthesised and requires highly advanced equipment to transport, making its supply chain so shaky that the global current helium shortage is the fifth in the past two decades….”

PS: “Helium is essential for the chip industry, which, propelled by the AI boom, is one of the most powerful forces in the global economy, underpinning the titans from Nvidia to Google, OpenAI, Meta and Oracle, buoying over a third of the United States GDP. It is also critical to drones, rockets, and all kinds of semiconductors underpinning everything with a microchip in it: cars, weapons, fridges, laptops, phones, and more.  Hospitals, already operating on regulated pricing and thin margins, cannot outbid that kind of purchasing power. In this shortage, medical uses risk being an afterthought….”

“The medical world has known this for some time. After five helium shortages in 20 years, researchers and MRI manufacturers have been racing to build scanners that do not depend on the gas at all. However, the vast majority of the world’s MRI fleet still runs on technology that needs helium…..”

Devex – AI is reshaping drug development — but who will benefit?

https://www.devex.com/news/ai-is-reshaping-drug-development-but-who-will-benefit-112237

“AI is accelerating drug discovery and reshaping pharma’s R&D — but gains in productivity may not translate into broader access to medicines.”  Analysis.

Devex Pro – Why NCD drug licensing lags behind

https://www.devex.com/news/why-ncd-drug-licensing-lags-behind-112229

(gated) “Medicines Patent Pool Executive Director Charles Gore tells Devex that one of his priorities in his last year on the job is to get a license for GLP-1 therapies. But he admits that expanding MPP’s portfolio of drugs for NCDs has been a challenge.”

Devex Pro – The Global Fund veteran building Africa CDC’s pooled procurement platform

https://www.devex.com/news/the-global-fund-veteran-building-africa-cdc-s-pooled-procurement-platform-112165

(gated) “Africa CDC tapped heavy hitter Mariatou Tala Jallow to build up its African Pooled Procurement Mechanism. In her previous job, she built the pooled procurement mechanism for the Global Fund from the ground up.”

“ The effort — the African Pooled Procurement Mechanism, or APPM — is moving beyond its initial 10-country pilot and into something much bigger: a continent-wide platform. And Jallow is tasked with leading that transition….” “The Africa Centres for Disease Control and Prevention is being selective, zeroing in on products where traditional markets consistently fall short — think insulin for diabetes and treatments for sickle cell disease. The final list is still being shaped in conversations with countries, but APPM does have a shortlist of diseases and product categories, and some tenders are already out the door….”

“There’s also a bigger play here. Beyond getting medicines where they’re needed, APPM is designed to give Africa’s still-fragile pharmaceutical manufacturing sector a boost. It will give preference to African-made products and use the platform as a market-shaping tool — a way to hopefully encourage manufacturers to feel confident about investments made in increasing their production levels….”

·         And a link:  The TRIPS non-violation moratorium has expired: What happened in Yaoundé, and what comes next  (by D G Gervais)

Some more reports

Corruption in health systems: context, incentives and the political economy of reform – A synthesis of research by the Anti-Corruption Evidence programme

A Hudson; https://ace.soas.ac.uk/wp-content/uploads/2026/03/ACE-HealthSynthesisPaper-2026-Final.pdf

PS: “The Anti-Corruption Evidence (ACE) initiative is funded by the UK Foreign, Commonwealth & Development Office (FCDO)’s Research and Evidence Directorate (2015–2027)…”

“This report synthesises 40 research papers funded by the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO) through its AntiCorruption Evidence initiative – specifically through the SOAS Anti-Corruption Evidence research consortium (SOAS-ACE) and the Governance and Integrity AntiCorruption Evidence programme (GI-ACE). The papers address health sector corruption in Bangladesh, Nigeria, Tanzania, Uganda and wider regional contexts, spanning four thematic areas: beyond ‘Good Governance’, health worker absenteeism, informal payments, and pharmaceutical procurement and pricing….”

Then coming up with an analytical framework.

ILO – ILO calls for stronger social protection for a changing world of work

https://www.ilo.org/resource/news/ilo-calls-stronger-social-protection-changing-world-work?s=09

“A new ILO report calls on Member States to reinforce social protection systems in response to evolving labour markets. Drawing on country experiences, it offers policy recommendations to ensure that all workers — across all types of employment — are protected against social risks and able to navigate profound labour market transformations.”

Quote: “…Strengthening social protection systems is no longer optional — it is essential. We need systems that reach everyone, provide adequate protection, and are financed in a fair and sustainable way. This is the foundation for resilience, social justice, and a just transition in the changing world of work.”

MSF Access – Shifting Global Health R&D Funding: Opportunities in a Changing Landscape

https://msfaccess.org/shifting-global-health-rd-funding-opportunities-changing-landscape

“Recent funding constraints for biomedical research in Africa have highlighted the urgent need to build a more sustainable and equitable research and development (R&D) ecosystem on the continent. On 19 February 2026, MSF Access convened a panel of leading experts to examine the broader implications of declining R&D investment and the emerging opportunities within a shifting global health landscape.”

“This report compiles and organises the insights shared during the webinar, drawing directly from speakers’ contributions to present the main barriers (4) and proposed ways forward for stronger and more equitable R&D partnerships across the continent. It also includes a dedicated section highlighting Africa’s roles in tuberculosis (TB) vaccine research as an example, and a call to action toward a coherent and equitable R&D future for Africa.”

Miscellaneous

Guardian – Sluts, simps and body shaming: the rise of Africa’s manosphere

https://www.theguardian.com/global-development/2026/apr/07/african-manosphere-misogyny-social-media

“Experts have been alarmed at the growth of deep misogyny dressed up as self-help on social media. We profile seven men from across the continent who are gaining traction…”

“The manosphere is a loose network of communities that claim to address men’s struggles such as dating and fitness, but often promote harmful misogynistic attitudes. …. Sunita Caminha, who leads UN Women on ending violence against women and girls in east and southern Africa, first started noticing its presence in Africa about five years ago, and believes it is on the rise. “Research and data that keeps coming out is very consistent [in] showing this is an alarming issue in different countries and contexts across the continent.”  Awino Okech, a professor of feminist and security studies at Soas University of London, also started noticing harmful digital content expanding about five years ago, but says falsehoods peddled against women in Africa predate the proliferation now online. “The ideas that shape the manosphere are linked to those of men’s rights organisations like Maendeleo ya Wanaume. Its big argument was that men and boys were being left behind as a result of all of the investments that had been made around girls’ and women’s rights.”  This view – know as the red pill theory – has been amplified by the manosphere, framing men as the victims of a society distorted by feminism. The men who populate the manosphere have made it their mission to redress the balance – through domination and intimidation…”

Guardian – ‘We fear the epidemic will return’: Senegal’s harsh anti-gay law puts decades of HIV progress in jeopardy

https://www.theguardian.com/global-development/2026/apr/07/senegal-harsh-anti-gay-law-hiv-progress

“Arrest toll mounts and gay men flee the country as new, harsher legislation cracks down on ‘promotion’ of homosexuality.”

·         Related:  Guardian – What’s behind the worrying rise in anti-LGBTQ+ laws across Africa?

“Rooted in colonialism, legislation backed by governments eager for popularity is obstructing real progress for queer minorities.”

Global health governance & Governance of Health

CGD – Stress-Tested by War: Modernizing IMF Support in a Volatile World

By Mary Svenstrup; https://www.cgdev.org/blog/stress-tested-war-modernizing-imf-support-volatile-world

“Last week, the IMF published a blog post with its first assessment of the economic fallout from the Iran war. The blog post carries immense institutional weight—co-authored by all the Fund’s area department directors, the chief economist, and the heads of monetary/capital markets and fiscal affairs. Despite the heavy-hitting byline, the blog post leaves me with two overarching questions:  First, is IMF surveillance agile and forward-looking enough to respond to today’s economic shocks?… Second, given the exceptional nature of this shock, what should the Fund do beyond regular business to support at-risk countries?…”  With some recommendations.

Devex – How UK aid spending fell sharply in 2025

https://www.devex.com/news/how-uk-aid-spending-fell-sharply-in-2025-112246

“The United Kingdom slashed aid by more than £1 billion last year — a steeper drop than anticipated.”

Policy & Society – The rise of Big Tech as super policy entrepreneurs

Shaleen Khana et al; https://academic.oup.com/policyandsociety/advance-article/doi/10.1093/polsoc/puag005/8540594?searchresult=1

“We utilize Kingdon’s concept of the policy entrepreneur, alongside the broader policy entrepreneurship literature, to examine Big Tech’s expanding role in the policy process. We conceptualize the super policy entrepreneurs as an ideal type capturing a distinctive configuration of roles across streams, stages, and subsystems, and analyses Big Tech as an empirical approximation of this ideal. We argue that Big Tech displays three distinguishing features: they are prominent entrepreneurs across all streams in the multiple streams framework; they exert influence across all stages of the policy cycle; and they operate across multiple policy subsystems and the broader policy universe, thereby able to influence cross-sectoral and transboundary policies. Together, these features enable Big Tech to emerge as super policy entrepreneurs, commanding unprecedented levels of influence in the policy process…”

Fiocruz redesignated as a WHO collaborating center in global health diplomacy and South-South cooperation

https://fiocruz.br/en/news/2026/03/fiocruz-redesignated-who-collaborating-center-global-health-diplomacy-and-south-south

(27 March).

Global health financing

Devex Opinion – Not all global health spending is aid — and that matters

T Cernuschi ; https://www.devex.com/news/not-all-global-health-spending-is-aid-and-that-matters-112233

« Confusing different global health activities is muddying the waters for future funding.”

« .. In my view, this debate would benefit from distinguishing three major categories of global health activities, each with its own justification and policy logic: collective action functions, humanitarian relief, and development aid. Without separating these categories, debates about global health funding — and development cooperation more broadly — quickly become confused….”

« … Collective action mechanisms are indispensable. They stop us from doing too much of a harmful practice, make us do what we would otherwise avoid, help us act in a coordinated way, and allow us to act at scale. We all benefit.  Humanitarian assistance remains ethically nonnegotiable. When people face conflict, disaster, or epidemic, immediate relief is a moral responsibility.  Development aid, however, deserves a much more honest debate. Despite decades of effort and constant policy reframing, it largely continues to resemble a “white man’s burden” — where best development intentions fail.  The reasons it persists? Domestic political signaling, foreign policy influence, moral comfort, and institutional inertia.  …”

« If current funding pressures force us to rethink priorities — and if development aid operates at the margins — then the question is not how much we spend, but more fundamentally whether development aid should remain at the center of our thinking at all.”

Plos GPH – Inequalities in financial burden of tuberculosis among affected families across 19 low- and middle-income countries

Gilbert Eshun et al; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006172

“Inequalities were assessed by drug resistance status, comparing drug-susceptible TB (DS-TB) and drug-resistant TB (DR-TB), using four summary measures…”

“The average percentage of TB-affected families experiencing catastrophic costs due to TB ranged from 19.2% in Lesotho to 80% in Zimbabwe. In 10 of the 19 countries, over half of TB-affected families faced catastrophic costs. When disaggregated, all countries reported higher catastrophic costs among DR-TB-affected families, except Burkina Faso. …”

“… The study showed substantial inequalities in the financial burden of TB on families across 19 LMICs, with DR-TB-affected families facing higher risks of catastrophic health cost than DS-TB families. There is an urgent need for targeted financial protection interventions, integrated within broader UHC strategies, to ensure that no TB-affected family is left behind…..”

UHC & PHC

Plos Med – The benefits of investments to combat HIV, tuberculosis, and malaria for primary healthcare from 2000 to 2023: An economic modeling analysis

Jiaying Stephanie Su et al; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005036

“Global investments to combat HIV, tuberculosis, and malaria (HTM) have delivered substantial health gains and may have reduced the burden placed by these diseases on the routine health system. We estimated the reduction in primary healthcare (PHC) utilization resulting from the scale-up of HTM services over 2000–2023 in 108 low- and middle-income countries.”

Among the findings: “… Investments in HIV, TB, and malaria services were estimated to have averted 6.9 billion primary healthcare outpatient visits, 3.9 billion hospital bed-days over 2000–2023, equivalent to US$135 billion in averted costs.  The largest effects were observed in low-income countries and in the sub-Saharan Africa region.”

Pandemic preparedness & response/ Global Health Security

Plos GPH – H5N1: How prepared are the US and UK for a pandemic?

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006068

By Samuel Read, Devi Sridhar.

Nature – Evolution of pandemic cholera at its global source

A Barton; https://www.nature.com/articles/s41586-026-10340-x?utm_source=bluesky&utm_medium=social&utm_campaign=nature&linkId=61186894

“The seventh pandemic of cholera, caused by the seventh pandemic El Tor lineage of Vibrio cholerae, was previously shown to have emanated in three global waves from the Bay of Bengal, bordering Bangladesh and India. However, the respective roles of the Ganges Delta and Basin regions in seeding these global pandemic waves were not known. Here we show that, although transmission events occur between Bangladesh and India, V. cholerae in the two countries has largely evolved separately over the past 20 years, apparently constrained by national borders rather than by hydrological features, such as the Ganges Delta and Basin. Evolution within Bangladesh was distinct from that seen in India, involving rapid gain and loss of genes and mobile genetic elements, particularly those involved in phage defence… … Here we show that the Ganges Basin, falling across Bangladesh and Northern India, rather than the Ganges Delta, probably acts as a global launch pad for pandemic disease. This shifts our understanding of Bangladesh as the purported global source of cholera and underscores the potential role of phage in controlling spread of lineages within the current seventh pandemic.”

Planetary health

Review of International Political Economy – The battle for plastic hegemony: the petrochemical historical bloc and the UN Global Plastics Treaty

Jack Taggart et al; https://www.tandfonline.com/doi/full/10.1080/09692290.2026.2642934

« Going beyond firm and industry-level accounts, we introduce the concept of a ‘petrochemical historical bloc’ to better capture the diverse alliances of state, corporate, financial, and civic actors that collectively sustain what we term ‘plastic hegemony’. The latter refers to the continued production and use of plastics, and also the structural, discursive, and institutional arrangements that normalize and defend plastic dependence while marginalizing and co-opting alternatives. Empirically, we analyze how this bloc has sought to shape negotiations over a UN Global Plastics Treaty through corporate-led multistakeholder partnerships. These initiatives promote a narrow vision of the circular economy centered on waste management, individual responsibility, and the financialization of plastic waste, thereby deflecting attention away from ‘upstream’ policies and caps on production…”

Nature Health – Global health benefits and cost-effectiveness of indoor air purification to mitigate PM2.5 from wildfire smoke

D Han et al ; https://www.nature.com/articles/s44360-026-00105-1

“Air purification could avert 60 million disability-adjusted life years (DALYs) from wildfire-related fine particulate matter (PM2.5) and 2.2 billion DALYs from all-source PM2.5 globally, according to a global assessment integrating health gains and economic feasibility.”

Covid

FT – Long Covid to cost OECD economies up to $135bn a year

https://www.ft.com/content/de4463af-093e-43e2-a928-c41429bccde8

“New research predicts impact of lower productivity and workers quitting because of long-term illness after Covid-19.” 

See also BMJ – Long covid’s £8bn bill: OECD report warns pandemic continues to cast a “long shadow”     (yes, the math sounds slightly different, but that’s due to the direct resp indirect cost)

·         Related: Science Politics –  What Long COVID Reveals About Fragmented Care  (by Rosemary Morgan et al)

Mpox 

AP – Congo says its mpox outbreak is over after 2 years and more than 2,200 suspected deaths

https://apnews.com/article/mpox-disease-health-congo-africa-outbreak-f1219ae63e5675aa74d1202e21b9035b

(2 April) “Congo on Thursday declared the end of a two-year outbreak of the mpox disease that’s believed to have caused more than 2,200 deaths in the country. Health Minister Roger Kamba told journalists that the government had made the determination that the outbreak was over and no longer a national emergency….”

Infectious diseases & NTDs

Independent – Climate change will push venomous snakes towards highly populated coastlines, study finds

https://www.independent.co.uk/climate-change/news/venomous-snakes-climate-change-b2950023.html

“Researchers say snake populations will broadly move towards higher latitudes and heavily populated areas as rising temperatures make their current habitats less suitable.” Cfr a new study in PLOS Neglected Tropical Diseases.

Plos Med – Urban and rural prevalence of tuberculosis in low- and middle-income countries: A systematic review and meta-analysis

S A Mortazavi et al;  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004779

“Between 2000 and 2024, TB epidemics have become increasingly urbanised, both in proportional and absolute terms, although with considerable variation in timing across countries and regions. Public health approaches tailored to urban and rural TB epidemiology and demography will be required to end TB.”

NCDs

Plos Med – Are ultra-processed foods too tasty? Toward a metabolic framework for diet and obesity

David S. Ludwig ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005025

“A recent lawsuit against “hyper-palatable” ultra-processed foods has amplified controversies over its effects on obesity-related chronic disease. Addressing this public health crisis requires a new framework, centered on the metabolic effects of food.”

·         And a link: The Conversation – Kidney disease is growing in Africa: big new study casts light on genetic risk factors

Mental health & psycho-social wellbeing

Lancet (Letter) – Sound mind, sound place: ibasho and post-disaster mental health

H Tamune et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00546-5/fulltext

« Although mental health responses after disaster often begin with symptom checklists, triage, and specialist treatment, evidence from Japan shows that this approach is necessary but not sufficient. After the Great East Japan Earthquake in 2011, disaster-related deaths were time-dependent, with nearly half occurring within 1 month and 78% within 3 months.  However, mental health needs often persist much longer in affected populations. Although acute mental health assessment matters, long-term recovery also depends on whether people can continue to live safely, sustain relationships, and recover social roles after displacement. In Japan, the concept of ibasho, a community-led place that embeds people within larger social networks and meaningful roles, can help with this recovery….”

« The Sphere concept provides a humanitarian framework for ibasho by setting out common principles and minimum requirements for survival with dignity, including the essential services and coordinated support needed after disaster…”

Sexual & Reproductive health rights

Plos GPH – Reporting maternal deaths in Anglophone West Africa: A media content analysis of articles published online between 2015 and 2025

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006254

By Kiran Roy, et al.

Adolescent health

Plan International (report) – Real Choices, Real Lives

https://plan-international.org/publications/real-choices-real-lives-final-report/

“For 18 years, Plan International’s Real Choices, Real Lives study followed 142 girls across 9 countries to understand how poverty, gender expectations and global pressures shaped their lives.” Check out the findings:  some progress, but fragile progress.

“The research, which gathered data annually from both the girls and their caregivers, offers the chance to look closely at the progress made and the challenges faced at different stages of their lives. The girls taking part in the study come from the lowest socioeconomic backgrounds and from nine different countries: Benin, Brazil, Cambodia, Dominican Republic, El Salvador, the Philippines, Togo, Uganda and Vietnam…”

Also with sections on health & wellbeing, and SRHR.

Access to medicines & health technology

The Conversation – Nigeria imports 70% of its medicines – why local manufacturing doesn’t meet demand

E Kofon;   https://theconversation.com/nigeria-imports-70-of-its-medicines-why-local-manufacturing-doesnt-meet-demand-276616

“Nigeria imports at least 70% of its medicines. This is striking for a country of over 230 million people and at least 120 active pharmaceutical manufacturers.  Domestic manufacturing is largely concentrated in lower-end medicines that require relatively simple production processes. The more complex and higher-value pharmaceutical products continue to be imported….”

“This pattern has persisted for decades. It reflects two things. First is the limited impact of policies aimed at reducing import dependence. The other is the entrenched interests across pharmaceutical companies. An incentive structure that favours imports over local production.

I recently completed my doctorate studies focusing on the political economy of pharmaceutical manufacturing in Nigeria, with comparisons to Uganda, Bangladesh and India. My research looked at how the industry had evolved and analysed how the distribution of organisational power and manufacturing capabilities has made it difficult for reforms to work.  I found that policy interventions have largely failed because weak institutions cannot influence manufacturers to expand their production capabilities. The biggest obstacles stem from how power and benefits are distributed across political, bureaucratic and pharmaceutical actors.”

TMIH – Global Donor Fatigue and Its Impact on Vaccination Coverage in Africa: Challenges and the Path Forward

Michael Sarfo et al; https://onlinelibrary.wiley.com/doi/10.1111/tmi.70139

“As donor priorities shift due to competing global crises and economic pressures, African countries face growing challenges in sustaining immunisation programmes and maintaining coverage gains without stronger domestic financing mechanisms.  …. … The sustainability of immunisation programmes in Africa is currently at a crossroads due to heavy reliance on declining donor support. Emerging donor fatigue has already resulted in financing shortfalls, disrupted cold chain systems and the resurgence of previously controlled diseases. While donor contributions have been instrumental in maintaining national programmes to date, proactive efforts are now required to prevent the reversal of decades of progress in child survival. Ultimately, transitioning toward greater reliance on homegrown funding sources including domestic revenue generation, social enterprises and national health financing mechanisms is the only viable pathway to sustain resilient immunisation coverage across the continent. »

Euractiv – Pharmaceutical logistics in demand as war rattles supply chains

https://www.euractiv.com/news/pharmaceutical-logistics-in-demand-as-war-rattles-supply-chains/

“The global pharmaceutical market could exceed 2.3 trillion euros by 2030.”

« According to healthcare data analytics firm Iqvia, the global pharmaceutical market could exceed 2.3 trillion euros by 2030, driven by the United States as well as major emerging markets…..”

Lancet Haematology – WHO resolution pushes for global equity in haemophilia care

E Nakkazi; https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(26)00074-8/abstract

“WHO has adopted a resolution to advance health equity for people with haemophilia and other bleeding disorders. Led by Armenia and co-sponsored by 12 countries across Europe, Asia, Africa, and the Americas, the resolution was approved by the WHO Executive Board (EB158) meeting on Feb 3, 2026, and aims to improve access to care and treatment worldwide. Armen Melkonyan, Head of International Relations at the Ministry of Health in Armenia, presented the resolution, which seeks to establish an international framework to improve care and treatment for people with haemophilia and other bleeding disorders.”

Conflict/War & Health

Stat Opinion – The Pasteur Institute of Iran illustrates important truths about global public health

C Chatterjee et al ; https://www.statnews.com/2026/04/09/pasteur-institute-iran-history-global-health/

The authors conclude: “…If there is a hook in the events unfolding in Tehran, it is this: War may command attention, but welfare is built in laboratories. The global history of Pasteur Institutes demonstrates that investments in science, when sustained across political regimes and geopolitical tensions, generate some of the highest social returns imaginable. In a fractured world, preserving and strengthening such networks is not merely a technical choice. It is an economic and moral imperative.”

Migration & Health

International Journal of Health Planning and Management – From Parallel Provision to Health System Integration: Exploring the Trajectory and Contextual Drivers of theHealthcare Response for Refugees in Six Low‐ and Middle‐Income Countries

https://onlinelibrary.wiley.com/doi/epdf/10.1002/hpm.70071

By Maria Paola Bertone et al.

AI & health

Lancet Primary Care – AI themed issue

https://www.thelancet.com/journals/lanprc/issue/vol2no3/PIIS3050-5143(26)X2003-9?dgcid=bluesky_organic_globalhealth_lanprc

“Exploring the growing role of AI in primary care—from chatbots to glaucoma screening—alongside key considerations on regulation, patient safety, and more.”

IHP – The AI revolution in African healthcare: Are we building castles on sand?

https://www.internationalhealthpolicies.org/featured-article/the-ai-revolution-in-african-healthcare-are-we-building-castles-on-sand/

New blog by Veronica Namaganda.

Papers & reports

Lancet Regional Health Africa – April issue

https://www.thelancet.com/issue/S3050-5011(26)X2002-8

Includes the Editorial – From burden to leadership: renewing the fight against malaria in Africa  (ahead of World Malaria Day, 25 April).  

Globalization& Health – An account of health systems resilience to emergencies in Africa: a scoping review

M Ankomah et al; https://link.springer.com/article/10.1186/s12992-026-01209-9

“This review emphasises the need for equitable, inclusive, and coherent strategies to strengthen resilient health systems in Africa. It calls for a shift from reactive, fragmented approaches to a long-term system-wide transformation grounded in inclusive governance, equitable social protection, robust digital health systems, a sustainable workforce, integrated and trusted community engagement, and adaptive physical infrastructure. Importantly, the review affirms that addressing deep-seated political, structural, and social inequities is crucial to ensuring resilience does not become an empty concept.”

SS&M – Tuition-Free Lower Secondary Education and Women’s Healthcare Decision-making in Sub-Saharan Africa

Bijetri Bose, J Heymann et al;   https://www.sciencedirect.com/science/article/pii/S0277953626003217

“… Women exposed to free education were more likely to have say in health decisions. Tuition-free education policies are an important investment for advancing health.”

Health Policy (special issue) – Health System Sustainability and Resilience

https://www.sciencedirect.com/special-issue/106LW75S7NM

“Health systems must continue to meet population health needs in the face of rising costs, ageing populations, and growing expectations, while also withstanding the shocks that inevitably disrupt them. How to pursue both objectives simultaneously is among the most pressing questions in health policy. This special issue brings together contributions that examine this challenge through various lenses, from analytical and measurement questions to governance and crisis response, drawing on evidence from health systems across a wide range of contexts and income levels. The issue offers insights on the valuation of resilience investments, the use and limitations of common performance metrics, prospective approaches to stress-testing health systems, and the compounding effects of sequential and long-term pressures on system capacity and financial protection. By addressing key gaps and highlighting future research priorities, this collection aims to advance the evidence base for building health systems that are both sustainable and resilient.”

·         Start with the Editorial – Health System Sustainability and Resilience: Navigating Perpetual Tensions?

·         Including also:  A method for testing health system resilience: Development, application and lessons learned

HP&P – The pervasiveness of racism in healthcare facilities in Latin America: A scoping review Open Access

Arachu Castro et al; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czag050/8637863?searchresult=1

« Racism in healthcare facilities across Latin America systematically affects Indigenous, Afrodescendant, and migrant populations….”

SSM-Health Systems – A liminal health system: Exploring the resilience strategies of healthcare providers and communities along the Thailand-Myanmar border

L DiStefano et al https://www.sciencedirect.com/science/article/pii/S2949856226000437?via%3Dihub#ab0010

“Amidst conflict and instability, an ecosystem of health services has emerged along the Thailand-Myanmar border.  The cross-border health system functions in a liminal space, navigated by both local service providers and community members. Unique strategies and capacities that underlie the resilience of this system are described.”

Blogs & op-eds

Speaking of Medicine –From metrics to meaning: using performance pathways to make health system performance assessment speak for policy

D Rajan & N Shuftan; https://speakingofmedicine.plos.org/2026/04/06/from-metrics-to-meaning-using-performance-pathways-to-make-health-system-performance-assessment-speak-for-policy/

“Health system performance assessment (HSPA) has long relied on quantitative indicators to describe how health systems function and whether they meet goals. While such metrics are essential, they often provide only a partial picture: they can reveal what is happening but far less about why performance looks the way it does or how it might be improved. As health challenges persist—ranging from demographic change and chronic disease to strained public health cooperation—there is an increasing need for approaches connecting data to the underlying mechanisms shaping health system performance.”

“To address this, we propose an approach combining quantitative indicators with structured qualitative insights to build performance pathways. These pathways make the connections between system functions, sub‑functions and health system objectives explicit, enabling clearer understanding of relationships between inputs, processes, outputs and outcomes. They bring qualitative depth to quantitative trends, allowing analysts and policymakers to move from measurement to actionable explanation….”

Easter saw much needed peace messages from the pope and even more heart-warming ‘We all just have one home’ videos coming from Artemis II astronauts, yet on World Health Day  (7 April) the current US president thought it appropriate to tweet an apocalyptic(/genocidal) threat against an entire civilization. Meanwhile, far away in Lyon, the  One Health Summit was taking place, highlighting the ‘interdependence of human, animal, plant ànd ecosystem health’. Doubt Samuel Huntington had foreseen that scenario decades ago.  Unbelievably revolting and scary times, even if ‘One Health’ is  ostensibly “rising on the global health policy agenda”.

On a more positive note, last weekend, the  Chancery of the Accra Reset announced an 18-member High-level panel to reform global health governance, in a further effort to reposition African and Global South voices at the centre of global health decision-making. 

Jean Kaseya (Africa CDC) clearly agreed, later this week in Lyon, tweeting: “Today, I joined President @EmmanuelMacron, President @JDMahama, President Duma Gideon Boko (@duma_boko ), and global health leaders with a clear message: Africa’s sovereignty is not negotiable. We are turning a page. Africa will no longer be spoken for — we will speak with one voice through the African High-Level Ministerial Committee on the Reform of the Global Health Architecture [ which will have its inaugural meeting in the margins of the World Health Summit Regional Meeting end of April, in Nairobi  ]. … Africa will shape its own future.  ….. At Africa CDC, we are working with AU Member States and partners to align financing, strengthen institutions, and ensure that the global health architecture reflects African priorities.  The next phase of global health must be built with Africa — not for Africa.”

Later this week, Kaseya also announced that Ghana’s “President Mahama agreed to serve as Patron of the African High-Level Ministerial Committee on the Reform of the Global Health Architecture (AHLMC).  “….Our discussions focused on advancing public health across Africa and accelerating implementation of the Accra Reset through the Africa Health Security and Sovereignty (AHSS) Agenda.  … I am pleased to announce that  he will engage with Ministers during the inaugural meeting in Nairobi this April and will host the Committee in Accra in the coming months. This sends a strong signal: Africa is organizing, aligning, and leading the reform of global health — on its own terms. “

That is all great news and indeed long overdue (even if Jean Kaseya’ s middle name is ‘bullish’). With one caveat, perhaps: it’s more than time to strengthen the structural input and real influence(/power) of the next generation in all these  global health architecture/reform discussions, High-Level dialogues and ‘likeminded’ panels. After all, they are the ones who will, statistically, still spend most time on this fragile planet of ours. Not Peter Piot , Michel Sidibé, Christoph Benn  or even Bill Gates himself…  Yes, some gatherings do better than others on this front (like the one currently going on in Bangkok), but by and large, there’s much room for improvement.  Gentle reminder: in the few remaining democracies on earth, people are actually allowed to vote from the age of 18.  And run for a seat slightly after.  (and some of us also think an age limit for decision makers also makes total sense these days… #deepsigh)

As for the backdrop of this global health ecosystem reform discussion: a recent Afrobarometer publication pointed out citizens in 38 African countries nowrank health as the top policy issue they want their governments to address on average, as they are facing health systems ‘in transition’….

We do leave you with some uplifting news from the US (yes, that exists). Earlier this week, the People’s Health Platform  was launched over there, highlighting “the importance of ensuring healthcare for all, protecting and expanding sexual, reproductive, and gender-affirming healthcare, preparing for the climate crisis and the next pandemic, and taxing billionaires, among other tenets…..”  While clearly focusing on the current public health and broader predicament in the US, the 10-point platform includes plenty of stuff with also broader global (health) appeal.

Starting with point 10 (well, you know me) : )

Enjoy your reading.

Kristof Decoster

·         Global Health reform & re-imagining

·         Latest PABS round  (Geneva, 23-28 March) : Final analysis & more advocacy

·         Coming up: World Health Day (7 April)

·         IMNHC Nairobi: Final coverage & analysis

·         More on SRHR

·         US Global Health strategy & bilateral health agreements

·         Trump 2.0

·         More on Global Health Governance & Finance/Funding

·         Debt crisis/reform, Global Tax justice & related issues

·         More on PPPR & Health Emergencies

·         HIV prevention

·         Trump 2.0

·         NCDs

·         Social, Political & Commercial Determinants of Health

·         Digital health & AI

·         Access to Medicines, Vaccines & other Health technologies

·         Conflict/War & Health

·         Planetary Health

·         Miscellaneous

Global Health reform & re-imagining

WHO – Have your say on transforming global health: Call for consultation

https://www.who.int/news-room/articles-detail/have-your-say-on-transforming-global-health

This call came out late last week.

“WHO has been requested by its Executive Board to convene relevant global health actors in the design of a proposal on a joint process to support transformation of the global health architecture (GHA).   Reform of the global health architecture and the UN80 Initiative    … To guide the design of the reform process, WHO invites stakeholders to share their views, comments and suggestions on a draft “skeleton”. … .  Input should be grouped under these headings:

• purpose, scope and principles
• functional areas for the proposed workstreams
• proposed approach to coordination of the process
• anticipated timeline and phases
• stakeholder engagement strategy.

Provide your input :   All input must be received before 18 April 2026.

Paper – Prosperity as Health—Recentring Care to Guide Health System Reform

https://cusp.ac.uk/themes/health/wp45/

By Tim Jackson. Need I say more?

“Health systems are struggling not because they are failing, but because they are being asked to manage illness generated elsewhere. Across advanced economies, rising chronic disease, early onset multimorbidity and widening inequalities reflect the conditions in which health is produced, not simply the performance of healthcare.

This paper (commissioned for Enlighten’s NHS 2048 initiative in Scotland) argues that these pressures arise from a deeper misalignment between a wealth-centred model of prosperity and the requirements of human health. It explores how the social and material conditions of modern economies become biologically embodied over time, generating an unsustainable demand for healthcare.  In response, the paper proposes a reframing of prosperity as health and offers a simple policy test to distinguish reforms that reduce future harm from those that merely seek to absorb it. Recentring care as essential infrastructure becomes key to aligning policy with long-term health outcomes.”

CGD (blog) – Is an IDA Health Window the Global Health Financing Solution?

P Baker;  https://www.cgdev.org/blog/ida-health-window-financing-solution-we-are-looking

“Current reform processes have shied away from a precise prescription for a new financing mechanism. Without this there can be no progress. They have also neglected to fully consider the role of the multilateral development banks (MDBs). Over the past six months, researchers at CGD have been exploring the future role of MDBs in health. Here, I summarise one of our key recommendations: that an IDA health window—open to MDB cofinancing—has great potential to resolve the challenges of the current architecture. It could efficiently target scarce aid resources to the poorest countries and provide on-budget funding that respects calls for sovereignty whilst defragmenting financing and promoting impactful health systems. It could be delivered rapidly with minimal downsides, alongside IDA22 that will go into effect in mid-2028….”

Baker then points out how an IDA health window could deliver on five key global health reform objectives.

UN80 (Brief) – Preliminary Findings from the Strategic Merger Assessment of UNFPA and UN Women

UN80;  

“Preliminary findings indicate that a merger is technically feasible under clearly defined  safeguards and disciplined sequencing. Among the structural approaches to a merger examined, the  assessment identifies a composite entity model as the most viable pathway to combine integration with continuity safeguards. The purpose of this brief is to present the preliminary findings to support continued dialogue with Member States…”

·         Coverage & analysis via Devex –   UNFPA–UN Women merger ‘technically feasible,’ according to UN80

“The five-page document tries to explain the rationale behind the merger proposal in the current political and financial context, its potential benefits and risks. But rights advocates say the U.N. needs to provide concrete evidence backing its arguments.”

“A long-awaited assessment on the benefits of merging UN Women and the United Nations Population Fund, or UNFPA, suggests that a merger “is technically feasible” if done with “clearly defined safeguards” in place. But many advocates argue it says nothing new and lacks the evidence needed to support the U.N.’s proposal….”

“The findings were published on Monday, March 30, in response to a request by member states under the UN80 initiative, the ambitious but controversial U.N. systemwide reform effort launched by Secretary-General António Guterres.  ….  It also estimated transition costs of the merger to be in the range of $56 million to $110 million, with annual savings of $32 million to $38 million as administrative and support functions across offices are consolidated….”

CGD – The New Compact in Action: What Would It Take to Align Aid and Domestic Health Financing?

A Demeshko, P Baker et al;  https://www.cgdev.org/blog/new-compact-action-what-it-would-take-align-aid-and-domestic-health-financing

“A new policy paper by CGD looks at what reform of health aid could look like in practice—specifically, how a New Compact for health financing can move from principle to practice. Until now, the discussion about the New Compact has focused on conceptual foundations, including implications for donor priority-setting, a case study in Ethiopia, and reforms for Gavi. The paper shifts the focus to the operational questions. It further develops a locally-led, evidence-informed approach to empower countries to set their own health priorities, enabling sustainable domestic financing for essential services while consolidating aid into complementary support. The paper examines how the New Compact could operate in practice at global and country levels, how it could emerge within different scenarios for global health reform, and what conditions and policy shifts may be needed for country adoption.”

·         Related Policy paper – A New Compact for Health Financing: From Principle to Practice

“This paper examines how the New Compact for health financing can be taken from principle to practice, both as a strategic guide for global reform and as a technical framework at the country-level. We analyse implications under three scenarios for global health architecture reform: maintaining the status quo; donor policy shifts but no architectural reform; and a consolidated multilateral financing mechanism. We draw on lessons from past global and country-level coordination efforts and assess opportunities for donor policy shifts to operationalise reforms aligned with a New Compact approach. A framework for country-level drivers for success is developed to guide transition plans. Taken together with ideas for action for donors and recipient countries, this paper positions the New Compact as an approach for strengthening country ownership, improving allocation efficiency, and building more resilient health financing systems amid fiscal uncertainty.”

Lancet Comment – Rethinking country classifications towards a more equitable global health future

E Charani et al;  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00457-5/fulltext

« The World Bank classification of low-income, middle-income, and high-income country groups, that uses gross national income per capita, shapes financing, research priorities, and political narratives. Existing evidence suggests that income alone is a poor proxy for health needs, system capacity, and vulnerability, particularly where rising national wealth coexists with persistent poverty and high disease burden. This gross national income-based classification that remains deeply embedded in global health governance obscures health system realities, masks inequities, and misdirects resources. In this system, low-income and middle-income countries (LMICs) are routinely treated as a homogeneous block, despite the fact that they represent nearly two-thirds of the world’s countries and 84% of its population, the majority of whom are in middle-income countries (MICs). National averages conceal profound heterogeneity driven by intersecting inequalities related to gender, race, geography, age, migration status, and the environment. These blind spots distort global priorities and systematically overlook vulnerable populations.”

« …Recent global health reforms increasingly acknowledge these failures. The Lusaka Agenda and related initiatives call for equity-focused metrics that better reflect disease burden, system capacity, and vulnerability…. … Income-based classifications continue to create systemic blind spots (panel). Challenges such as antimicrobial resistance, WASH inequities, and maternal mortality cannot be understood through income alone; they require multidimensional indicators of vulnerability and resilience. These pitfalls have tangible consequences, reinforcing donor–recipient hierarchies and mischaracterising countries as either responsible stewards or problematic hotspots….”

Authors argue for a multidimensional framework instead.

And conclude: « …In an era of recurrent pandemics, climate instability, and fragile health systems, reliance on income thresholds is no longer defensible. Moving beyond income-based classification is not a technical adjustment but a normative shift, essential to expose hidden inequities and align global health action with lived reality. »

Latest PABS round  (Geneva, 23-28 March) : Final analysis & more advocacy

WHO – WHO Member States agree to extend negotiations on key annex to the Pandemic Agreement

https://www.who.int/news/item/28-03-2026-who-member-states-agree-to-extend-negotiations-on-key-annex-to-the-pandemic-agreement

(28 March)  Press statement after the latest round.

“World Health Organization (WHO) Member States have agreed to extend negotiations on the Pathogen Access and Benefit Sharing (PABS) annex to the WHO Pandemic Agreement, with discussions to resume in late-April ahead of its scheduled consideration by the World Health Assembly (WHA) in May.   The decision to continue negotiations from 27 April–1 May, with informal intersessional discussions taking place in advance, reflects the commitment by WHO Member States to negotiate the PABS annex, a core component of the WHO Pandemic Agreement….”

GHF – Developing Countries: Unmoved; Developed Ones: Unyielding. PABS Negotiators Get a Week More To Grasp At Consensus.

P Patnaik; Geneva Health Files;  

Must-read analysis from 30 March.    “The negotiations on the Pathogen Access Benefit Sharing system at the WHO, is turning out to be a contest on “Who Blinks First“. Neither sides have.”

A few excerpts:

“On fundamental matters, including how countries would access the information on pathogens, and what kinds of benefits would be obligated under the PABS system, remain unsolved puzzles mired in many, but crucial technicalities. There is also a clear lack of firm political will, which is a bedrock of such a mechanism, that is expected to make a real difference on the ground. To be sure, countries remain committed to see this process to its logical conclusion to consensus, whether that will come to pass remains to be seen….”

“In this story, we provide an overview on the process and the politics shaping these negotiations; a few key substantive elements; and potential indications on what is coming. …. We also discuss a hybrid approach to PABS, an informal proposal doing the rounds…..”

“… An Additional Week, Or An Additional Year? At the beginning of the week, few countries spoke about getting an additional year to conclude the PABS negotiations. By the end of the week though, a rough assessment, based on numerous interviews, suggests that more countries than before are veering towards an extension of the mandate of the IGWG beyond May 2026…  … Such a number could be a growing minority. The majority appear to be keen on concluding this year as per original timeline.)

“… However, many also believe that it is political will to find solutions, and not additional time that could help reach consensus.  … “

“Delegations have lots of questions on how to ratify the Pandemic Agreement, without the specifics of contractual obligations for participating manufacturers, the terms and conditions of entities, labs, and other users of information in the PABS system. And most of all, the specific benefits, and points of trigger of these commitments, during health emergencies, and not only during pandemics….”  “ A swiftly changing geopolitical landscape; uncertainty and worsening crisis in the Middle East; a change in the leadership of the WHO with elections for the next DG; are all seen as factors that could close the window of opportunity in concluding these negotiations…..”

“… A Hybrid Approach?   The deliberations also saw the emergence of a new, informal proposal on a hybrid approach to access pathogen information that includes the different approaches that countries currently do not agree on….”

Politico – Pandemic deal hangs in the balance as countries deadlocked over vaccine details

https://www.politico.eu/article/pandemic-deal-world-health-organization-vaccine-pathogen/

(30 March) “A standoff between lower- and higher-income countries over sharing pathogen samples and vaccines risks derailing the agreement.”  Well worth a read as well. Some excerpts:

“At the end of last week’s talks in Geneva, there remained a “wide gulf” between higher- and lower-income countries, with “very little” progress on the issues, one EU negotiator told POLITICO. …  Negotiators agreed to try to overcome the impasse with an extra meeting at the end of April — the last chance for a deal ahead of the May deadline.  But the official was not upbeat on the chances of the deal getting done in time for the World Health Organization’s annual assembly, which begins May 18. “There is a small chance that we [will] get there if everyone gives their serious effort. However, it may be that we will need more time.”  Another EU official said the “whole week was a waste of time.”…” “ “…As the May deadline nears, one diplomat said another extension was “likely but the question is, if this is a forever extension or if there will be real intention and capacity to see it through.” …”

“…Negotiations are stuck on the same disagreements of principle between higher- and lower-income countries that first arose during talks over a waiver of intellectual property rights on Covid-19 vaccines. In the six years since, the underlying perspectives have barely shifted. ….”

“…But some still hope a deal can be reached.  …. … Another developing country negotiator agreed the talks this week had yielded little tangible progress but said some momentum started to gather in the final days. “It was the first time we really tried to work on language and you could hear more honest positions,” the negotiator said.    …. … There were some constructive informal talks on Friday, on monetary contributions from industry to support the upkeep of the system, the same official added, while Nordic countries presented a sketch of a “hybrid” model to try to solve the impasse.”

PS: “James Love, director of NGO Knowledge Ecology International, said the talks were struggling because they were based on a “fundamentally flawed approach” linking the sharing of pathogen samples and data with the sharing of benefits. A better idea would be to enforce the sharing of benefits from when a technology is patented, sold or published in academic research, and put the burden of enforcement on countries rather than the WHO, he said…..”

TWN – WHO: Efforts Intensify to Find a Compromise Framework on PABS

Nithin Ramakrishnan –   https://www.twn.my/title2/health.info/2026/hi260305.htm

Although published before the end of the latest round, also worth a read. “As hope fades  to find consensus on the negotiating text,  WHO Member States moved away from the text-based negotiations on the Pathogen  Access and Benefit Sharing (PABS) system  to explore a possible compromise framework on the 5th day of the 6th meeting of the Intergovernmental Working Group (IGWG). “

“The Co-Chairs suspended the evening drafting session and Member States organised informal discussions on a possible compromise framework for the PABS system of the WHO’s Pandemic Agreement (PA). This framework is then to provide a basis for the next round of negotiations.

“An informal meeting was organised in a smaller room in the evening of 27 March, which according to some delegates is a positive start, and according to some others an attempt to see if developing countries can be forced to agree to a compromise formula based on fresh conceptual discussions, rather than based on Article 12 of the PA. According to a few developing country delegates the idea to hold such a session has come up due to the opposition from a several developed countries to hold another round of negotiations based on the current on-screen text. These developed countries have informally conveyed their disinterest to hold another round based the current text and stated that a framework containing  consensus on the outcomes is necessary to continue the negotiations…..”

“…. … The informal discussion was attended by the  WHO Secretariat including the Director General Dr Tedros Adhanom Ghebreyesus.”

“According to sources, there is a two-column working document prepared for discussing a compromise framework; the first column discusses access-related obligations and second column discusses benefit sharing obligations. Interestingly the table only shows there is convergence on paragraph 6 of Article 12, but there is no convergence on Paragraphs 7 and 8 of Article 12.  However, sources state that no consensus has been reached on critical issues including benefit sharing commitments during a public health emergency of international concern (PHEIC)….”

PS: “… it’s clear that there are no compromises made by developed countries, other than leaving benefit sharing obligations not only to future negotiations by the COP but also to open-ended bilateral negotiations between WHO and recipients of PABS resources.  The WHO Secretariat, certain member states and non-state actors are also aligning with the EU and G6 proposals and are seen to be approaching developing countries to accept a model where contentious issues will be further subjected to the COP negotiations….” “ Accepting the G6/EU model means the PABS system will not be operational when the PA enters into force and it will be subjected to further negotiations in successive COPs. The entire IGWG Bureau text and secretariat documents circulated prior to IGWG6 backed this model of postponing operationalization of the PABS system.”

Geneva Health Files – Civil Society Organizations Ratchet Up the Pressure in The Negotiations of the Pathogen Access Benefit Sharing System

https://newsletter.genevahealthfiles.com/civil-society-organizations-ratchet-up-the-pressure-in-the-negotiations-of-the-pathogen-access-benefit-sharing-system/?ref=geneva-health-files-newsletter

( analysis from March 27) “ In this edition, we give you a flavor of the sustained advocacy by CSOs and the diversity of advice from relevant stakeholders on complex topics that define the terrain of these negotiations….”

“A section of relevant stakeholders, some civil society organizations, and other experts believe that user registration is important in tracking how pathogen information is accessed, and traced. And, as a result, how obligations on benefits are framed.  There are also practitioners and other experts who are relevant stakeholders who have a diametrically opposite view and insist that access to information should be frictionless, and any tracking of information has to be done downstream.  there are concerns that imposing conditionalities on the access to information would slow down research and development….”

Council Co-Chairs call for PABS deal that ensures access to medicines during a pandemic emergency

https://www.inequalitycouncil.org/council-co-chairs-call-for-pabs-deal-that-ensures-access-to-medicines-during-a-pandemic-emergency/

Important High-Level advocacy. “Not sensible or safe to rely on companies voluntarily sharing technology, warn Stiglitz, Geingos and Marmot, as world leaders debate how to overcome pandemics.”

“Reflecting on the discussions on the annexe on Pathogen Access and Benefit Sharing (PABS) currently being debated, the Co-Chairs of the Global Council on Inequality, AIDS and Pandemics have called on negotiators to agree a deal that will ensure that in a pandemic emergency medicines get to people across the world at scale without delay. “Leaders should agree to automatically wave global intellectual property rules on pandemic technology when a pandemic is declared,” advised Joseph Stiglitz, Monica Geingos and Michael Marmot.”

… “Leaders should agree to automatically waive global intellectual property rules on pandemic technology when a pandemic is declared. For the long-term, leaders also need to build an R&D model that treats pandemic health technology as public goods….”

Coming up soon: World Health Day (7 April)

https://www.who.int/campaigns/world-health-day/2026

·         For key messages: https://www.who.int/campaigns/world-health-day/2026/key-messages

WHO Bulletin – Editorial ahead of World Health Day

Meg Doherty, Dr Tedros et al; Editorial: WHO Collaborating Centres: a global scientific network   

In the Editorial, “Meg Doherty et al. detail the history and contributions of WHO’s collaborating centres.”

“Every year on 7 April, the world celebrates World Health Day, commemorating the date the Constitution of the World Health Organization (WHO)2 entered into force in 1948. This year, WHO has chosen the theme “Together for health. Stand with science” to highlight the role of science-led innovations in improving global public health and to reinforce evidence-driven action in a multilateral world.”

“… In 1949, the Second World Health Assembly adopted a policy that has been consistently applied since, stating that WHO should not establish its own research institutions but support, coordinate and use the work of existing institutions around the world. This approach was the framework for what years later became the WHO Collaborating Centres…..”

“… On World Health Day, WHO will convene its collaborating centres to celebrate their achievements and forge a path for greater and stronger collaboration at the first Global Forum of WHO Collaborating Centres. This collaborative model has stood the test of time for nearly 80 years. In a time of political instability, changing global health architecture, reduced health funding and an erosion of confidence in science, WHO will continue to rely on the WHO Collaborating Centres. …”

·         Scheduled for 7-9 April in Lyon, France: Global Forum of WHO Collaborating Centres: collaborating for a healthier future  

“With the theme “Collaborating for a Healthier Future”, the First Global Forum of WHO Collaborating Centres (WHOCC) will bring together global experts from hundreds of institutions designated as WHO Collaborating Centres across more than 80 countries, alongside WHO leadership and technical focal points to strengthen scientific and technical collaboration in support of the Fourteenth General programme of Work (GPW 14) and WHO’s commitment to Health for All.  Organized by WHO and held in the sidelines of the One Health Summit 2026, hosted by the Government of France, the Forum will provide a platform for dialogue, reflection, and forward-looking collaboration.”

BMJ –  Safeguarding evidence for health in the face of political pressure

K Buse et al; https://www.bmj.com/content/393/bmj.s628

“Science is not only being challenged but reshaped in ways that undermine how evidence informs health policy, requiring a shift from advocacy to institutional safeguards, argue Kent Buse and colleagues.”

“The theme of World Health Day 2026, on 7 April, is “Together for health. Stand with science.” It marks the beginning of a year long campaign “celebrating the power of scientific collaboration to protect the health of people, animals, plants, and the planet….”

With 5/6 suggestions for our dire times.

And concluding: “If we are to “stand with science,” we must stand up for the systems that make science usable: transparent evidence trails, protected data, independent regulators, and accountable platforms….”

IMNHC Nairobi: Final coverage & analysis

Africa Health Watch –  IMNHC 2026 ends with call for more ‘Accountability and Collective Action’ for Mothers and Newborns

Africa Health Watch;  

“As the International Maternal and Newborn Health Conference 2026 (IMNHC) drew to a close in Nairobi, the four-day conference highlighted that progress will not be measured by commitments made but by lives saved. At the closing plenary, conversations emphasised that the future of maternal and newborn health depends on collective action, accountable systems, and financing tied to measurable results.”

Devex@IMNC2026: Special issue on IMNHC 

Devex;

Some excerpts:

“Dr. Jean Kaseya, director-general of Africa CDC  …. headlined this year’s conference. One solution at the top of his mind is oxytocin — considered the first line of defense against post-partum hemorrhage. One thing that frustrates him? It’s not manufactured in Africa.   “Many women in Africa don’t have access to that,” he said. “We need to also manufacture that so that we can cut the price.”…”

“This theme echoed throughout the conference: Most deaths can be prevented with low-cost interventions that already exist….”

“…Making the money count:   Amid the drastic aid cuts, maternal, newborn, and child health donor funding was reduced by an estimated 58% in South Sudan last year, 55% in Kenya, and 52% in Uganda, according to a 10-country analysis by PATH. Cuts led to supply disruptions of essential medicines, workforce shortages, and disrupted community outreach. …”

“The new U.S. bilateral agreements are expected to include maternal and child health funding, but not every country is signing on, and many questions remain around the rollout.  ….
Given the bleak realities, countries must prioritize maternal and newborn interventions that work for their own contexts, experts in Nairobi said…..”

“In Nairobi, several financing options for commodities access were highlighted:…”

“… One innovation countries are preparing to roll out is the vaccine to prevent respiratory syncytial virus, or RSV, which affects almost all babies. Having the infection early in life can lead to long-term respiratory consequences. The vaccine is administered to mothers to pass along immunity to newborns.    It’s shown success in high-income countries, but the greatest burden of RSV mortality is in Africa. Not a single low- or lower-middle-income country has introduced this vaccine, but Gavi, the Vaccine Alliance is gearing up to support its introduction. Fifty-six countries are eligible to apply for support to introduce new vaccines. But this vaccine is within Gavi’s “discretionary” programs, so countries will decide if it’s a priority. And rollout is expected to start in 2028…..”

“… The ‘slow lane’ toward scale:    E U Hodges, assistant director of programs at Duke’s Global Health Innovation Center, told me her research showed some maternal and child health products take nearly 30 years to launch and scale in low- and middle-income countries, with the median timeframe being 17.5 years.   Maternal child health products, in particular, were slower to scale than products for infectious diseases and neglected tropical diseases, she said.  That’s why local manufacturing and pooled procurement dominated many conversations this week, as ways to strengthen supply and stabilize prices.   This includes the development of the Africa CDC’s Africa Pooled Procurement Mechanism. Kaseya told me that in recent months, Dr. Mariatou Tala Jallow joined his team to serve as the new director of this continental pooled procurement mechanism……”

Devex Pro – GFF to launch family planning, maternal, child commodity finance program

https://www.devex.com/news/gff-to-launch-family-planning-maternal-child-commodity-finance-program-112158

(gated)   “The Global Financing Facility is planning to launch a new financing program for family planning, and maternal and child health commodities at the bank’s Spring Meetings next month. It previewed how it is expected to work this week in Nairobi.”

“The World Bank’s Global Financing Facility is planning to launch a new financing program for family planning and maternal and child health commodities at the bank’s Spring Meetings next month. The matching program will also include financing for addressing bottlenecks that impact last-mile access, affordability, and quality.   Every $3 of domestic resources will be matched with $1 of grant financing — a relatively high leverage ratio — to incentivize increased domestic spending on commodities and the systems around them.  The financing program is in its final stages of development and doesn’t have a formal name yet. But Edward Llewellyn, GFF senior commodities and supply chain specialist, gave a preview at the International Maternal Newborn Health Conference this week in Nairobi. The program is expected to be launched as part of GFF’s broader 2026–2030 strategy and investment round.  …”

·         Related Brief: Financing Alliance for Health –    Gender-Transformative Health Financing: Achieving RMNCH Outcomes in Africa   

Science –  ‘We’re failing newborns’: The global push to reduce infant deaths is losing steam

https://www.science.org/content/article/we-re-failing-newborns-global-push-reduce-infant-deaths-losing-steam

“In 2015, as part of its Sustainable Development Goals (SDGs), the United Nations set an ambitious target for the world: Bring down neonatal deaths to 12 per 1000 live births or fewer by 2030. But with only 4 years to go, more than 60 countries are well off track. In Kenya, for example, neonatal mortality, defined as a baby dying within the first month of life, has declined by just one death per 1000 live births—from 22 to 21—since 2014.  “We’re failing newborns,” says Joy Lawn, a neonatal clinician and professor at the London School of Hygiene & Tropical Medicine (LSHTM).”

“Last week, policymakers, researchers, and advocates gathered here at the International Maternal Newborn Health Conference to discuss why progress has slowed down, especially in Africa, which has about 1.1 million newborn deaths annually, and how to get it back on track. Fixes as simple as better training and record-keeping can help, studies presented at the meeting show. But money and political will are often lacking. The dramatic cuts in global health aid, including the dismantling of the U.S. Agency for International Development, may undo progress made over the past 2 decades….”

PS: “Newborn health has long been underfunded compared with maternal and reproductive health, says Alice Tarus, a health economist and Ph.D. student at LSHTM who researches the cost of newborn care in African countries: “The assumption has been when you fund maternal health, by extension, you’ve already covered the baby, which is not true,” she says.  And things got a lot worse last year. A December 2025 report from the global health nonprofit PATH estimated that donor aid for maternal, newborn, and child health fell by 49% in 2025, from $1.66 billion to about $850 million. The report forecasts up to 8 million additional child deaths and more than 1 million maternal deaths by 2040 if the money isn’t replaced. Tarus says African governments must increase domestic budgets for newborn care, in part because it’s in their own interest: “Investing in newborn care is both a moral and economic imperative.”

More on SRHR

Chapter by Seye Abimbola – Unawareness, or What We Do Not (Want to) Know

https://www.taylorfrancis.com/chapters/oa-edit/10.4324/9781003540755-15/unawareness-want-know-seye-abimbola

Open-access chapter from the book “Epidemiological Obfuscation”.

“Why do researchers do empirical social research that they have reason to know not to do? Why do they sometimes pose research questions that sidestep what they (ought to) know about context and complexity or time and place? This chapter presents an analysis of publications from and about one such apparent research project; a prominent study (a randomised controlled trial of an intervention to improve safe childbirth in Uttar Pradesh, India), which was published in a prominent academic journal (New England Journal of Medicine), and which informed a prominent policy call (to move all childbirths around the world to hospitals). The analysis suggests a twofold hypothesis: first, motivated unawareness (things they know but act as if they do not know, given their discipline or career incentives); second, genuine unawareness (things they do not know because they were educated or socialised by their discipline or career to not know or seek to know). The chapter concludes with a call for radical transparency: researchers should systematically work through their (un)awareness of context and complexity and of time and place and should openly declare how they did so for each research project before (as part of its justification), during, and after the project.”

PS: relevant read, far beyond SRHR…

Lancet – Offline: The scandal of missing mothers

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00646-X/fulltext

Horton on the global scandal of missing mothers. “…missing because of entirely preventable deaths during pregnancy and childbirth. “

“The latest report of trends in maternal mortality, from the Global Burden of Disease collaborators, was published last week in The Lancet Obstetrics, Gynaecology, and Women’s Health. Although declines in maternal deaths might seem impressive—absolute numbers of maternal deaths fell from 423 000 in 1990 to 240 000 in 2023, a 43% reduction—these figures conceal a far darker story….”

Quote: “…The five countries with the highest absolute numbers of maternal deaths in 2023 were: Nigeria (32 900); India (24 700); DR Congo (22 300); Ethiopia (11 900); and Pakistan (10 300). These five countries are responsible for over two-fifths of maternal deaths worldwide. Surely national, regional, and global institutions should be holding the leaders of these countries accountable for their terrifying failure to protect the lives of their mothers. Where is the voice of WHO, the Africa Centres for Disease Control and Prevention, or the political leaders of these countries? The truth is that there is no accountability. Leaders operate with impunity. And should you imagine that high numbers of maternal deaths are confined to sub-Saharan Africa, think again. Indonesia, 8710 maternal deaths in 2023. Bangladesh, 7520 maternal deaths. Philippines, 2000 maternal deaths. Brazil, 1790 maternal deaths. And, outrageously, the USA, 1230 maternal deaths. …”

Plos GPH –The intergenerational legacies of research disinvestment, aid retrenchment and transactional compacts on global women’s health

R C Keynejad et al ; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006110

“…In this Essay, we outline the foreseeable, intergenerational harms of defunding initiatives which promote and enhance the health and safety of women everywhere or tie their funding to agendas which would erode women’s reproductive autonomy….”

US Global Health strategy & bilateral health agreements

As a reminder: implementation of MoUs was expected to start on 1 April….

Zambia Monitor – CSOs reiterate concerns over proposed $1 billion US health aid, say deal could undermine Zambia

Zambia Monitor;

“ A coalition of Civil Society Organizations (CSOs) has cautioned that the proposed US$1 billion United States health aid agreement could undermine Zambia’s interests if signed without full public disclosure, broad consultation, and parliamentary oversight….”

·         Meanwhile, in the US – via Devex: Ethically indefensible  (from last week)

“About 90 organizations have called on U.S. Secretary of State Marco Rubio to clarify and publicly reject any attempts by the State Department to withhold HIV and other lifesaving aid to Zambia as a means to pressure the country into signing a critical minerals deal with the U.S. government.” 
“We urge you to immediately clarify that the U.S. will not resort to this abhorrent tactic,” they write in a letter, adding that an estimated 1.3 million Zambians rely on the U.S. global AIDS initiative PEPFAR’s support to access HIV treatments, and tens of thousands more benefit from U.S. support in combating malaria and tuberculosis in the country.

ORF – Critical Minerals, Pathogen Data, and the New Turn in US Global Health Engagement

L Ramakrishnan; https://www.orfonline.org/expert-speak/critical-minerals-pathogen-data-and-the-new-turn-in-us-global-health-engagement

“As the US ties global health cooperation to strategic interests such as data and critical minerals, African countries are pushing back to secure more equitable and sustainable terms.”  Not that much new in this analysis, but a good overview nevertheless.

Devex – Faster, bigger, riskier: The new era of US foreign aid

D Kaliel et al ; https://www.devex.com/news/faster-bigger-riskier-the-new-era-of-us-foreign-aid-112157

(Deborah Kaliel served as a public health adviser at USAID’s Global Health Bureau from 2007 to 2025 with a focus on government-to-government partnerships and local capacity building in HIV/AIDS”

“The U.S. is moving billions in aid directly into the hands of partner governments. While this is potentially good news, it is doing so faster with less support systems than ever before. We have written a guide to inform those involved.”   With three key takeaways  for current and future decision-makers of the new U.S. government aid system.

TGH – The Expanded Global Gag Rule and the Case for Regional Solidarity

J Oga & M Mulumba; https://www.thinkglobalhealth.org/article/the-expanded-global-gag-rule-and-the-case-for-regional-solidarity

Important analysis.  “The anti-abortion policy undermines organizing principles, rooted in ubuntu, that keep African health systems coherent under stress.”

Excerpts: “…. Diversity, equity, and inclusion (DEI), read through an African lens, is not anchored in donor slogans or ideological exports. It is contemporary vocabulary for normative commitments long embedded in African law and practice, often articulated as ubuntu: communal accountability and a duty of solidarity across peoples and states. Ubuntu—also expressed as boho, unhu, or utu and meaning that a person is a person through other persons—is rooted in the Bantu-speaking civilizations across sub-Saharan Africa and reflected in precolonial traditions of communal governance, collective stewardship, and restorative justice…..”

“This principle in African health systems centers inclusion not as a fashionable complement, but as the operational meaning of relational personhood and shared obligation. Equity is the practical form of dignity in contexts where vulnerability is produced through poverty, coercion, and exclusion. Diversity is an acknowledgment that communities are never singular and that justice fails the moment health systems define some lives as less worthy of protection….”

“This is the frame within which the expanded Global Gag Rule should be read. It is not only a funding restriction but also an attempt to criminalize the organizing principles that keep African health systems coherent under stress. When policy targets what U.S. actors “label gender ideology and DEI,” it strikes at ubuntu-based governance itself: community accountability, inclusive service delivery, and equity-oriented prioritization. The policy, therefore, becomes a question of sovereignty. It asks whether African institutions will govern health through Africa’s normative and legal order, anchored in ubuntu and regional human rights duties, or be compelled to reorganize themselves to pass foreign ideological tests…..”

“… The expanded Global Gag Rule threatens not only the continuation of donor funding but also the organizational infrastructure that enabled these gains. By prohibiting DEI programming, the policy dismantles the communal accountability structures, inclusive governance mechanisms, and equity-oriented service delivery models that made reproductive justice advances possible….”

“… In effect, the policy functions as a coercive test of African public health governance, demanding compliance not only in spending, but also in organizational design, partnerships, and public reasoning. It is an attempt to govern African health systems through grant-based leverage. This is a strategic miscalculation. It assumes that Africa can be negotiated with as fragmented recipients, that institutions can be isolated and disciplined, one grant at a time. That assumption needs to be overturned. If external conditionality now targets the foundational principles of equity, communal accountability, and participatory governance through which African states design, finance, and deliver health systems, then Africa needs to respond at the same level. That response is regional solidarity, not as fragmented accommodation, but as a necessary counterweight.

The expansion of the Global Gag Rule is precisely why Africa should consolidate through pooled financing, joint procurement of reproductive commodities, and coordinated legal and diplomatic positioning….”

KFF – U.S. Global Health Country-Level Funding Tracker

https://www.kff.org/global-health-policy/u-s-global-health-country-level-funding-tracker/

(27 March)

Resource. “This tracker provides U.S. global health funding data by program area and country. It includes Congressionally appropriated (planned) funding amounts from FY 2006 – FY 2023, as well as obligations and disbursements from FY 2006 – FY 2025 (FY 2025 data are partially reported)…”

PS: companion tracker – U.S. Global Health Budget Tracker

Trump 2.0

Science – Is Trump killing the heralded U.S. effort to help the world battle HIV?

https://www.science.org/content/article/trump-killing-heralded-u-s-effort-help-world-battle-hiv

“The Department of State hasn’t given the Centers for Disease Control and Prevention all the money it needs to keep vital AIDS relief programs operating.”

“… “PEPFAR is seriously at risk,” says KJ Seung, a clinician at Brigham and Women’s Hospital who is a co-author of a recent analysis, “Is PEPFAR about to run out of money?” posted at the Health Security Policy Academy. Seung, who previously worked at nongovernmental organizations (NGOs) that helped run PEPFAR’s programs around the world, contends that the CDC budget shortfall is part of a larger problem that includes lost staffing and Trump’s effort to use HIV assistance as a bargaining chip with other countries. PEPFAR, Seung and global health analyst Vincent Lin of the nonprofit Partners In Health assert, could die by June. “[T]he program is being slowly starved, through budgetary choke points and administrative fiat rather than any open legislative decision,” they write.”

“.. The State Department so far has only transferred about $640 million of PEPFAR’s funds—about half this year’s budget—to CDC, and sources say it has told CDC to use reserve agency funds to sustain the program through 30 June. Worries are growing inside and outside CDC that the agency will never see the rest of the congressionally approved PEPFAR money. The middle of the fiscal year is 1 April, and Seung says “it’s ridiculous” to think any MOU agreements will lead new money to start flowing to countries by then. “We’re not even close to that,” he says….”

Stat – 7 big challenges for the next CDC director

H Branswell; https://www.statnews.com/2026/03/30/cdc-director-nominee-faces-problems-beyond-senate-confirmation/
“Staff distrust, vaccine policy fights, and more obstacles await the incoming agency head.”

Also including:  “Repairing the agency’s tattered credibility ….”

And “Restore sightlines on what’s happening globally:  Infectious diseases don’t give a hoot about borders — a lesson the world should have learned by now, after the massive West African Ebola outbreak in 2014-2016 or the Covid pandemic, or the global spread of mpox.  Knowing what’s happening elsewhere — learning about problems as they emerge, before they become catastrophes — is a key job for a national public health agency, especially for the CDC.. …. But Havers, Houry, and Jernigan, among others, are very worried that the U.S. withdrawal from the WHO and from international aid is limiting the country’s capacity to keep on top of disease threats. “I think that’s a huge concern,” said Havers, who spent substantial time in China during the start of the H7N9 bird flu outbreak. “There’s always a threat of novel pathogens emerging, and with the withdrawal from the WHO, I think CDC has reduced visibility in that space.” 

Guardian – Amnesty International warns Fifa World Cup risks becoming ‘stage for repression’

https://www.theguardian.com/football/2026/mar/30/fifa-world-cup-amnesty-international-donald-trump-ice-human-rights

“Amnesty International has warned that the World Cup, spread across three North American countries, risks becoming a “stage for repression”. The human rights organisation published a report on Monday – “Humanity Must Win” – calling on Fifa and the host countries, the US, Canada and Mexico, to take urgent action to protect fans, players and other communities. … Amnesty described the US as facing a “human rights emergency” under the Donald Trump administration, marked by mass deportations, arbitrary arrests and what it called “paramilitary-style” Immigration and Customs Enforcement (ICE) operations. The acting director of ICE said last month the agency would be “a key part of the overall security apparatus for the World Cup”…”

More on Global Health Governance & Finance/Funding

Guardian –UN’s landmark slavery ruling energises African Union’s fight for reparations

Eromo Egbejulein Abidjan;  https://www.theguardian.com/news/2026/mar/27/un-slavery-ruling-african-union-reparations-slavery-analysis

“ UN votes to describe slave trade as ‘gravest crime against humanity’.”

“Despite resistance from states who had role in chattel slavery, many feel this is an idea whose time has come…”

“All eyes will now be on the African Union, which has called 2026-36 its “decade of reparations” and named Mahama as its reparations’ champion, to find creative ways to extract reparatory justice even in the face of stonewalling from the west….”

“… Already, an African Union committee of experts is working on a framework for reparatory justice and engaging descendants of enslaved people all over the world….”

APA news – Tangier hosts flagship Africa forum on sustainable health financing

APA news

On the high-level forum on sustainable health financing held in Tangier on Wednesday.

“According to an official statement, the event brought together African ministers of finance and health, as well as representatives from international organisations and technical and financial partners.  Organised under the high patronage of King Mohammed VI and in partnership with the United Nations Economic Commission for Africa (ECA), the forum was part of the 58th session of the Conference of African Ministers of Finance, Planning, and Economic Development.”

“In his address, Minister Tehraoui emphasised the need to treat health as a strategic investment rather than merely a public expenditure. “The real question is no longer whether we can invest in health, but whether we can afford not to,” he said, underlining the central role of resilient health systems in Africa’s economic and social stability….”

“The Chairperson underscored that linking budget reform, innovative financing, digital governance, and regional integration can unlock a new paradigm. The AU’s Africa CDC and AfCFTA are central to this transformation, strengthening preparedness, reducing costs, and advancing pharmaceutical and vaccine sovereignty….”

African Business – Africa turns to philanthropists to fill gaps in health funding

https://african.business/2026/04/trade-investment/africa-turns-to-philanthropists-to-fill-gaps-in-health-funding

“Wealthy donors are being urged to step up in the wake of huge cuts to official development assistance, writes Lennox Yieke.”

Re the work of the Rockefeller Foundation in Africa (first), then Gates Foundation, …    Excerpts:

“Gates announced last year that the foundation will spend down its endowment by 2045 as part of his commitment to “give away virtually all my wealth”. Over the next two decades, the foundation expects to deploy a record $200bn, with the bulk of this earmarked for Africa.  Most of the funds spent in Africa will target healthcare, with Gates pledging to work alongside governments that “prioritise the health and wellbeing of their citizens”.  “Our foundation has an increasing commitment to Africa. Our first African office was here in Ethiopia about 13 years ago. Now we have offices in South Africa, Kenya, Nigeria and Senegal,” Gates told African leaders during a visit to Addis Ababa in June last year.”

“Primary healthcare is set to anchor the foundation’s work in Africa over the next two decades. “Investing in primary healthcare has the greatest impact on health and wellbeing,” Gates said. The foundation will also prioritise data systems and digital health tools such as AI-driven health services. Gates noted that in countries such as Rwanda AI adoption in healthcare delivery is already showing early signs of success.”

PS: “… In recent years there has been a notable increase in the number of foundations linked to African corporates, with healthcare routinely featuring as a top priority. Safaricom Foundation in Kenya, for example, invests heavily in maternal health, community clinics, and mobile health initiatives. The Dangote Foundation in Nigeria has made major investments in polio eradication, primary care, and nutrition…..”

The analysis concludes, though: “ While philanthropy will continue to play a vital role in African healthcare, particularly in the absence of foreign aid, domestic resource mobilisation and service delivery is likely to play a determining role in the success or failure of Africa’s health response.”

Fund Africa CDC from within—and hold it accountable: A call from a firm believer in its promise.

L Engelbert Bain; https://www.linkedin.com/pulse/fund-africa-cdc-from-withinand-hold-accountable-call-engelbert-bain-3tutf/

“institutions that matter must be examined seriously—not to weaken them, but to strengthen them. Africa CDC is indispensable. The question is not whether Africa should invest in it, but how to invest better, more strategically, and with clearer accountability so that its promise is fully realized.”

“With sustained domestic investment (Most importantly from African Union States), empowered leadership, trust and transparency, Africa CDC can – will – should deliver on its mandate…..

Concluding: “African philanthropy and public-private partnerships must step up. Africa CDC is uniquely positioned to be empowered to lead on this agenda.  With a clear mandate, Africa CDC can deliver—but only if we fund it from within and hold it accountable.  Holding Africa CDC to high standards is not criticism—it is belief in its future.”

HPW – Two-Speed Multilateralism: Breaking the Deadlock on Climate and Health

https://healthpolicy-watch.news/two-speed-multilateralism-debate/

Coverage of an interesting Graduate institute webinar from Monday.

“From stalled Pathogen Access and Benefit Sharing (PABS) negotiations to failing consensus in global climate policies, United Nations structures face a profound crisis. Diplomats are currently being forced to explore alternative governance models to bridge the disconnect between sluggish, power-driven diplomacy and the rapid, equitable action required in health and climate crises. This institutional rupture and the resulting emergence of two-speed multilateralism took centre stage during a critical panel hosted by the Global Health Centre in Geneva on 30 March…..”

“… There was clear unity among the expert panellists – ranging from global health researchers and climate adaptation advisors to international diplomats – that when traditional, consensus-based multilateralism stagnates, the international community must pragmatically turn to alternative, faster diplomatic channels. This “two-speed multilateralism” combines the universal legitimacy of consensus-based UN negotiations with the rapid implementation capabilities of smaller, highly ambitious “coalitions of the willing”, aiming at preventing single nations from vetoing desperately needed progress on environmental and public health protections…..”

PS: “WHO support for two-speed approach:   Notably, the WHO voiced clear support for this parallel approach. “If a certain subset of parties or countries can take a part of the agenda that moves things in a positive way, then you know that has to be supported,” said Dr Diarmid Campbell-Lendrum, WHO head of the climate change, energy and air quality.  He noted that the health gains from reducing air pollution would effectively cover the costs of transitioning away from fossil fuels, making a compelling, evidence-based case for this accelerated track.  This decisive backing for initiatives outside the formal UN architecture is unusual for an agency traditionally restrained by universal consensus.  However, in private discussions following the event, experts observed that the WHO is navigating new political dynamics. Following the US exit, the institution may be experiencing reduced diplomatic pressure, inadvertently allowing it to embrace more pragmatic, parallel agreements without its usual hesitation….”

Plos GPH – Aligning action across major infectious diseases in a dynamic global health landscape

N Ford et al;  https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006237

“In July 2025, WHO merged its Department of HIV, Viral Hepatitis and STIs with the Global Programme on Tuberculosis and Lung Health, creating a new structure – the Department of HIV, TB, Hepatitis and STIs. Although this decision was driven by unprecedented financial shortfalls, there is a strong underlying rationale, creating opportunities to identify synergies and efficiencies without losing the gains made in recent years. HIV, TB, Hepatitis and STIs account for around 3.5 million deaths each year…”

CGD (blog) –   The G20 Should Pay for Results—Not Promises—To Spur Health and Climate Innovation

R Glennerster et al ; https://www.cgdev.org/blog/g20-should-pay-results-not-promises-spur-health-and-climate-innovation

“The G20 has prioritized addressing antimicrobial resistance, scaling up investment in pandemic preparedness, and has committed to net-zero emissions by mid-century. Pull mechanisms can help deliver on these commitments by creating credible market incentives for the diagnostics (AMR), broad-spectrum antivirals (PPR), and other tools that these declarations call for…..”

Stop TB Partnership and UNOPS – The TB Community Must Demand Better

https://stoptbpartnership.substack.com/p/the-stop-tb-partnership-has-lost?utm_campaign=post-expanded-share&utm_medium=web&triedRedirect=true

“The UNOPS Stop TB Partnership can no longer credibly claim moral authority while serious, long-standing concerns about governance, accountability, and financial management remain unaddressed….”

Devex Pro – AfDB, Gates propose boosting government liquidity for health products

https://www.devex.com/news/afdb-gates-propose-boosting-government-liquidity-for-health-products-112160

(gated) “The African Development Bank, in partnership with the Gates Foundation, has previewed a proposed plan for a new financing facility for health commodities on the African continent.”

“The African Development Bank plans to partner with the Gates Foundation to increase access to affordable loans for countries to buy essential health commodities in a timely way. They are planning to pilot the Africa Medicines and Equipment Facility, or AMEF, this year in two countries. AMEF is being developed as a liquidity and execution platform that uses the bank’s balance-sheet strength and catalytic partner support to help countries procure medicines and medical equipment earlier, more predictably, and on better terms — and built into its design are affordability incentives tied to stronger procurement performance.  The Gates Foundation has proposed a $200 million contribution to AMEF, but this funding is contingent on completing the facility design and getting the necessary approvals….”

CNBC –  Epstein files: Buffett says he hasn’t talked to Bill Gates ‘since the whole thing was unveiled’

https://www.cnbc.com/2026/03/31/warren-buffett-bill-gates-epstein.html

“Warren Buffett said he has not spoken to Bill Gates “since the whole thing” with the Jeffrey Epstein files “was unveiled.” “I don’t want to be in a position where I know things … to be called as a witness,” Buffett said…..”

ODI- The IMF’s Resilience and Sustainability Facility: underused and under fire

J Pudussery et al ; https://odi.org/en/insights/the-imfs-resilience-and-sustainability-facility-underused-and-under-fire/

“the IMF is significantly downgrading its expectations for financing from the Resilience and Sustainability Facility (RSF).”

“The RSF has faced criticism from the current US administration and others who argue that the IMF is exceeding its mandate by venturing into long-term lending to address climate resilience and pandemic preparedness. We argue, however, that most RSF reform measures lie squarely within the IMF’s core expertise, notably fiscal policy and public financial management. The RSF can thus be seen less as a case of mission creep than an extension of the IMF’s existing toolkit to help countries adapt their polices and systems to build resilience to critical long-term challenges. Where RSF programmes have gone off-track, this is largely due to challenges with overall IMF support, not the RSF in particular….”

PS: “There are only four RMs on pandemic preparedness, all in Jordan’s RSF arrangement. These focus on establishing systems for emergency health financing, including defining and mandating an emergency-ready health benefit package, clarifying and codifying the arrangements for financing in public health emergencies and creating systems for monitoring and reporting emergency health spending. They demonstrate how IMF expertise in fiscal policy and PFM can support reforms to build resilience to pandemic threats, and the types of reforms that could be usefully included in other arrangements….”

Nature Health – A healthy population is a strategic advantage

Hans Kluge;   https://www.nature.com/articles/s44360-026-00110-4

“Health underpins defence planning, demographic strategy and economic reform.”

Habib Benzian – Part III: Why We Keep Declaring Things

Habib Benzian (on Substack) 

Part 3 in the series on global health diplomacy. “On the rituals, limits and unexpected value of global consensus texts.”

“…. what these texts really are. A declaration is never simply a set of commitments. It is the negotiated expression of what the system is willing to acknowledge at a given moment. It captures the convergence of interests, constraints and political appetites that have, for a brief time, aligned just enough to allow a statement of collective intent. Its authority stems not from enforcement power but from its ability to stabilise that narrow intersection of agreement.”

“… The recent near miss of the UN declaration on noncommunicable diseases underscores this dynamic. Even in failure, the process revealed the contours of the political moment. It showed which areas had traction, which were fragile, which were contested and which were stalled by forces far beyond the health sector. The episode did not diminish the value of declarations. It clarified it. … “

“… This incremental logic also explains why declarations named after cities continue to proliferate. They provide the scaffolding upon which more ambitious shifts can be built. They keep the conversation moving. They prevent regression. They offer advocates a foothold and governments a reference point. They are not the instruments that deliver change but the instruments that make change politically legible.”

“… In the end, we keep declaring things because declarations turn scattered intentions into shared reference points. They stabilise the possible, they extend the boundaries of agreement, and they leave behind a trace that others can build on. “

Debt crisis/reform, Global Tax Justice & related issues

The Conversation – Iran war: what African countries can do to get through the crisis and emerge in a better place

D Bradlow; https://theconversation.com/iran-war-what-african-countries-can-do-to-get-through-the-crisis-and-emerge-in-a-better-place-279689

“How should Africa respond?  African countries cannot avoid being harmed by the current Gulf war. Nevertheless, based on my work in international economic law and global economic governance, I think there are two lessons that, if followed, can help the continent emerge from the crisis in a better place…..”

“The focus of Africa’s efforts in the short term must be on minimising the negative effects of the war and on managing the state’s external debts in the most sustainable and effective way…..”  Check out what Bradlow suggests in the short term.

Also with a number of medium term objectives.

UN News – Developing countries are being priced out, in struggle for affordable finance

https://news.un.org/en/story/2026/03/1167219

Re the opening of an ECOSOC special meeting in Credit ratings.   “Developing countries are being priced out of the affordable finance they desperately need for sustainable development, with sovereign credit ratings often overstating risk and overlooking long-term economic potential, the UN said on Monday.”

“A credit rating is an assessment of how likely a borrower, such as a government, is to repay its debt on time and in full. For sovereign states, ratings influence how much countries pay to borrow in international markets: the lower the rating, the higher the perceived risk and usually the higher the interest costs.”

“The current system too often relies on “outdated and incomplete information”, leaving countries unfairly penalised in global capital markets, the deputy UN chief Amina Mohammed told the opening of the UN’s Economic and Social Council, ECOSOC, Special Meeting on Credit Ratings, delivering remarks on behalf of Secretary-General António Guterres.    “Adequate and timely finance is the fuel that drives sustainable development,” the Deputy Secretary-General said, warning that “today that fuel is running perilously low, and it’s getting more costly.” She pointed to nearly $1.4 trillion in annual debt servicing costs across developing countries, while more than 3.4 billion people live in countries that spend more on debt interest payments than on health or education.”

“… Ms. Mohammed also linked the credit ratings debate to wider efforts to reform the global debt architecture and pointed to new steps aimed at giving developing countries a stronger voice in debt discussions.  These include a borrowers’ platform, work on principles for responsible sovereign borrowing and lending, and a UN-led process bringing together debtor and creditor countries, private creditors, international financial institutions, academics and civil society. She also cited the planned African Credit Rating Agency as an example of efforts to improve data, transparency and risk assessment.”

“Ms. Mohammed urged a major shift in how sovereign ratings are designed, arguing that assessments should capture not only vulnerability, but also opportunity…. … “It’s time to turn credit ratings from barriers into contributors to long-term finance and sustainable development,” Ms. Mohammed said, urging a new approach that helps developing countries secure the financing they need.”

Guardian – Global super-rich may have hidden $3.55tn from tax officials, says Oxfam

https://www.theguardian.com/world/2026/apr/02/global-super-rich-hidden-355trn-from-tax-officials-oxfam

“Charity calls for a levy on the very richest and the closing of tax loopholes in its report on offshore wealth.”

“The global super-rich may have as much as $3.55tn hidden away from tax authorities, according to estimates by Oxfam.  The charity renewed its call for a wealth levy and urged governments to close tax loopholes as it published its latest analysis of the scale of offshore holdings.”

“Building on the work of academics including the French economist Gabriel Zucman and the EU Tax Observatory, Oxfam said total wealth held offshore had increased significantly, to $13.25tn (£10tn) in 2023 – the latest year for which estimates were available.  The share of these secretive holdings hidden from tax authorities has fallen sharply since the introduction in 2016 of a new system of automatic information exchange between jurisdictions.  But Oxfam estimates that perhaps $3.55tn is still shielded from tax – worth more than 3% of global GDP. Estimates from previous research suggest 80% of this wealth, or more than $2.84tn, is likely to be owned by the richest 0.1% of households.  That would mean this tiny group hold untaxed assets equivalent to the total wealth of the poorest half of the global population.”

“The research was released to mark 10 years from the publication of the Panama Papers, an investigation which exposed the inner workings of tax havens….”

PS: “Oxfam is part of a global campaign to mobilise calls for a global progressive wealth tax, including through negotiations at the UN on a framework for tax cooperation. It also called for countries in the global south to be included in the Common Reporting Standard – the system that allows for information exchange between jurisdictions….”

More on PPPR & Health Emergencies

Devex Pro – Pandemic Fund targets 15 countries in revamped funding round

https://www.devex.com/news/pandemic-fund-targets-15-countries-in-revamped-funding-round-112206

(gated) “Priya Basu, who heads the Pandemic Fund Secretariat, told Devex the fund will waive cash coinvestment requirements for some of the countries that are heavily indebted or at risk of debt distress.”

“The Pandemic Fund launched its fourth call for proposals  on April 1, but this particular round will work differently. Instead of a wide, open competition, the call targets 15 countries that have the highest pandemic risk and capacity needs, but have never received a single country grant from the multilateral funder.  The countries include Afghanistan, Benin, the Central African Republic, the Republic of Congo, Eritrea, Guinea, Haiti, Liberia, Madagascar, Mali, Mozambique, Niger, Nigeria, Sudan, and Uganda. Up to $244 million will be available in total, with each country assigned a preset allocation or a maximum amount it can request. Countries will also have a full year to work on proposals….”

“Priya Basu, who heads the Pandemic Fund Secretariat, told Devex that the countries will receive some support to ensure they’re able to submit a “high-quality proposal” for the projects they wish to be funded. The fund will also help match countries with external partners to help them cofinance the projects. There’s also scope for resubmissions of proposals…..”

Lancet Regional Health Africa – Decentralizing testing capacity of mpox in Africa: a narrative review

Y S Atrah, J Kaseya et al ;  https://www.thelancet.com/journals/lanafr/article/PIIS3050-5011(26)00027-1/fulltext

“Decentralized diagnostics are essential for the timely detection and control of mpox outbreaks. Burundi and the Democratic Republic of Congo (DRC) transitioned from centralized testing to decentralized models using GeneXpert platforms, mobile labs, and real-time feedback systems. … “ 

“   The mpox epidemic accelerated reforms, including continental guidelines for laboratory decentralization and the launch of a new initiative to expand testing, training, and local manufacturing. This article describes the mpox laboratory decentralization efforts, achievements, lessons, and best practices across Africa….”

WHO – Framework for health emergency preparedness and response capabilities for national public health agencies

https://pandemichub.who.int/publications/i/item/framework-for-health-emergency-preparedness-and-response-capabilities-for-national-public-health-agencies

“The Framework for Health Emergency Preparedness and Response (EPR) Capabilities for National Public Health Agencies (NPHAs) provides comprehensive guidance to help countries strengthen the institutions that lead and coordinate public health emergency functions. Developed through an extensive global consultation with over 120 countries and partner organizations, the framework responds to Member States’ request for clearer articulation of the essential roles NPHAs can play in preventing, preparing for, and responding to health emergencies.”

“Building on lessons from COVID‑19 and other crises, as well as global instruments such as the amended International Health Regulations (2005, 2024) and the WHO Pandemic Agreement (2025), the framework defines 12 core capabilities grouped into foundational and technical domains.  Foundational capabilities include legal authority, evidence generation and use for policy, and secure and flexible financing. Technical capabilities cover coordination, emergency management, workforce development, surveillance and intelligence, laboratory and diagnostic systems, risk communication and community engagement, public health and social measures, clinical care guidance, and countermeasure research and deployment.”

Nature Africa (News) – African initiative targets faster detection of disease outbreaks

https://www.nature.com/articles/d44148-026-00076-1

“Seven countries test collaborative surveillance model to improve early detection and response.”

“The effort, which includes Ethiopia, Kenya, Mozambique, Nigeria, Senegal and Tanzania, focuses on strengthening coordination and data sharing as disease outbreaks continue to rise across the continent. It is designed to complement existing surveillance systems…. … The US$2.2-million initiative, supported by Project ECHO at the University of New Mexico Health Sciences Center and funded by the Gates Foundation, was announced at the Eastern Africa Regional Global Health Security Summit 2026 in Nairobi, Kenya.”

“Each participating country will implement collaborative surveillance through its Ministry of Health and National Public Health Institute, setting national priorities within a shared framework….

HIV prevention

UNAIDS – New Access Framework for the new era of HIV prevention calls for scaled-up investments, expanded choice and sustainability to achieve 2030 targets

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2026/march/20260331_2030_prevention_access_framework

“With 1.3 million new HIV infections per year in both 2023 and 2024, the world remains off-track to end the pandemic. Yet, global HIV prevention targets are achievable. At the end of 2024, five countries—Lesotho, Malawi, Nepal, Rwanda and Zimbabwe—had achieved a 75% reduction in new HIV infections compared to 2010. New targets for 2030, co-developed with countries and communities, have informed the new Global AIDS Strategy 2026-2031.   The Global HIV Prevention Coalition (GPC), which was established in 2017 to strengthen and sustain political and financial commitment to primary prevention, has used these targets and the Strategy to develop the HIV Prevention 2030 Global Access Framework.”

“… The Access Framework outlines how, by 2030, countries can ensure that 90% of people in need of prevention services have access and that 90% of people living with HIV are virally suppressed. This, in combination, would lead to a 90% reduction in new HIV infections globally.   … This 2030 Prevention access framework focuses on one of those top-line targets, which covers primary prevention and requires that 90% of people in need of HIV prevention are using effective prevention options by 2030. This target is disaggregated into 15 second-line prevention targets for specific populations and programmes.”

“The 2030 Prevention Access Framework presents in greater detail the milestones and actions for achieving these targets––all of which are grounded in the three priorities of the Global AIDS Strategy: country-led, resilient and sustainable HIV responses; people-focused services, and community leadership.”

Stat – Doctors Without Borders calls Gilead ‘unconscionable’ for refusing to sell HIV prevention drug to organization

https://www.statnews.com/pharmalot/2026/03/30/doctors-without-borders-calls-gilead-unconsionable-refuse-sell-hiv-drug/

“The nonprofit says allocation from The Global Fund is capped and demand ‘far exceeds’ supply.”

“In the latest dustup over a groundbreaking HIV prevention medicine, Doctors Without Borders has harshly criticized the manufacturer for refusing to sell its treatment directly to humanitarian organizations.  The move came after months of talks in which Doctors Without Borders asked Gilead Sciences for a “limited” supply of lenacapavir. The drug has been in demand after studies showed a single set of injections every six months can offer virtually complete protection from infection, a form of prevention known as preexposure prophylaxis, or PrEP.”

“The organization currently obtains lenacapavir through The Global Fund to Fight AIDS, Tuberculosis and Malaria, a worldwide partnership of governments, civil society groups, and the private sector that, in late 2024, reached a deal with the company to distribute lenacapavir to 2 million people in low- and middle-income countries.”

·         For more, see  MSF – MSF wants to buy groundbreaking HIV prevention drug. Why won’t Gilead sell?

“Despite Gilead’s public claims that it can expand production of lenacapavir to meet needs, the company has refused requests from MSF to purchase a limited supply for use in our programmes. So far, only a handful of countries of the 18 eligible under the Gilead and Global Fund agreement, have received doses of lenacapavir, while millions of people remain at high risk of HIV acquisition worldwide.  Gilead has directed MSF to source doses through the Global Fund, even though their supply is fixed and insufficient – enough for up to 2 million people over 3 years, which is well below the global need. Furthermore, some countries where MSF works are not eligible to receive doses through the Global Fund due to restrictions put in place by Gilead….”

·         Check out also the related (recommended) thread on Bluesky by Melissa Barber 

Guardian – ‘No more than a drop in the ocean’: this drug could end new HIV infections in Eswatini – why isn’t there enough?

https://www.theguardian.com/global-development/2026/apr/02/scarcity-hiv-prevention-drug-lenacapavir-hampers-rollout-eswatini

“The southern Africa country has the world’s highest prevalence of HIV but the amount of lenacapavir reaching it is too small to reach all those at risk.”

“The Global Fund to Fight HIV, Tuberculosis and Malaria is providing the country with 6,000 doses in 2026; 4,200 have arrived so far, with the remainder due in April. A further US government-funded shipment is expected later this year….”

“In the US, lenacapavir costs $28,218 a year per patient. Agreements with the Global Fund mean that poorer countries such as Eswatini are paying about $60 a person per year. Generic versions are expected to become available at $40 a year from 2027 and in time, it could be made for $25 a year, given sufficient demand, according to researchers….”

“In some countries, US funding for lenacapavir is also being tied to controversial new bilateral agreements….”

“Eswatini is the only country in Africa to have met stringent HIV treatment targets, and Mark Edington, the head of grant management at the Global Fund, says “the world of HIV desperately needs a success story”.  This year, he admits, the limited volumes of lenacapavir will probably not result in a significant difference in infection rates. But if, once generics are available, “we’re not seeing it by the end of 2027-28, then we need to ask ourselves what’s happening”…”

Lancet GH Comment – The lenacapavir paradox: why a promising prevention tool raises difficult questions about African HIV response priorities

R Granich ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00033-1/fulltext

Must-read.

“African countries are facing a lenacapavir roll-out, while HIV epidemics remain incompletely controlled, with approximately 5·8 million people living with HIV not virally suppressed and health systems facing increasing fiscal and operational pressure. Decisions taken now will shape the trajectory of treatment scale up, viral suppression, and epidemic control for the coming decade. Despite the challenging context, the dominant framing of the discussion in the scientific literature emphasises lenacapavir access and implementation feasibility, with little attention to how the lenacapavir roll-out interacts with unresolved treatment gaps, constrained budgets, and competing health-system priorities….”  

“… Despite the severity of …. challenges, robust discussion of how lenacapavir should be prioritised within a finite global HIV response remains notably sparse in the scientific literature. ….… The literature largely treats prevention expansion as equally important and additive rather than competitive for finite resources, personnel, and political attention. This intellectual blind spot contrasts with both the need to prioritise expanding and sustaining treatment for decades and the lacklustre oral PrEP experience in Africa. These analytical gaps are especially consequential amid sharp HIV financing contractions. ….”

PS: “…the limited attention to these issues raises questions about the conditions under which policy debates occur. Resource allocation discussions are particularly constrained when they involve interventions strongly supported by major donors. Asymmetrical donor–recipient relationships often mean that funders can question priorities in public, whereas programme staff and African officials cannot. When external funders offer new interventions as aid packages, sometimes at the presidential level, recipient countries might have little ability to decline without jeopardising broader relationships or future grant renewals. Efforts to involve African colleagues with direct HIV programme experience in developing this Comment resulted in substantive engagement during private discussions, but named authorship proved difficult. This pattern suggests that publicly questioning wide adoption of lenacapavir-based PrEP could carry professional risk. The absence of African voices might reflect realistic assessments of career consequences in settings where donor funding, consulting opportunities, research grants, and institutional relationships depend on alignment with funder priorities….”

“… These observations do not diminish the scientific or public health importance of lenacapavir. Rather, they underscore the need for comprehensive, context-specific analysis before implementation as African governments are making consequential resource allocation decisions across treatment scale up, prevention expansion, and health-system strengthening…..”

Lancet GH – Inequities in HIV prevention: strategic access and equity in injectable PrEP distribution

C L Anyikwa et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00049-5/fulltext

“… In the context of lenacapavir, the collective action problem concerns whether governments and manufacturers will participate in coordinated pooled procurement and equitable licensing arrangements or instead pursue unilateral strategies such as exclusive bilateral purchasing or market segmentation to maximise short-term national or corporate advantage. The Prisoner’s Dilemma as a non-cooperative game theory, can be loosely used in explaining these dynamics but does not itself offer a path toward resolving them…”

“… Governments might publicly endorse equitable access while privately prioritising domestic supply or exclusive agreements. In such settings, cooperation is fragile and rational actors could continue to defect if they believe others will do the same. The dilemma, therefore, reflects a failure of credible commitment rather than a lack of dialogue…..” “ Cooperation yields mutual benefit, whereas unilateral defection maximises individual gain at the cost of the other party. If both parties defect, outcomes are worse for all involved than if both had cooperated. This possibility reflects what the Lancet Commission on Investing in health termed the “middle-income dilemma,” whereby these countries are neither wealthy enough to pay the prices high-income countries afford nor included in donor-supported programmes…..”

“These dynamics are further complicated by reductions in US Government funding for global HIV programmes and uncertainties surrounding WHO guidance and procurement support, which limit coordinated responses and exacerbate access gaps. Understanding this strategic logic emphasises the need for mechanisms that align incentives, such as pooled procurement…”

“… Drawing on existing models from regional and global health supply chains, this framework would offer a pathway for building a stable coalition capable of securing reliable and equitable access to lenacapavir. Options include existing mechanisms like the Pan American Health Organization Strategic Fund, the Global Fund, or UNAIDS-led initiatives. To address US Government funding gaps and WHO uncertainties, the secretariat could rely on a coalition of regional governments, philanthropic funders, appropriate market designs and international development banks to provide predictable financing and technical support….

NCDs

Africa CDC –  Africa CDC Rolls Out Continental SPARK-NCDs Programme as Noncommunicable Diseases Rise Across Africa

https://africacdc.org/news-item/africa-cdc-rolls-out-continental-spark-ncds-programme-as-noncommunicable-diseases-rise-across-africa/

“Nearly 2 million Africans die prematurely each year from complications related to hypertension and diabetes alone, and only an estimated10–20% of those living with these conditions receive regular care. In response Africa CDC has launched a major continental initiative to strengthen surveillance, improve integrated care, and transform the continent’s response to non-communicable diseases.”

“The SPARK–NCD Programme (Strengthening Public Health Surveillance and Resilient Knowledge for Non-Communicable Diseases in Africa) was officially launched in Zanzibar in collaboration with African Union Member States and partners. It is Africa CDC’s flagship initiative to strengthen surveillance systems, enhance NCD data generation, build workforce capacity, and advance integrated, people-centred care across Africa….”

“Delivered through existing national platforms, including the Field Epidemiology Training Programme (FETP) Frontline platform, the initiative is designed to embed NCD intelligence within health systems that countries already own and operate, building capacity from within rather than creating parallel structures….”

Guardian – Vaping likely to cause lung and oral cancer, Australian researchers find in new review of evidence

https://www.theguardian.com/australia-news/2026/mar/31/vaping-lung-cancer-risk

“‘There is no doubt that the cells and tissues of the oral cavity, the mouth and the lungs are altered by inhalation from e-cigarettes,’ academic says.”

“Vaping is likely to cause lung and oral cancer, researchers have found, as they urged regulators to act now rather than wait decades for a definitive level of risk.  Cancer researchers led by the University of New South Wales in Sydney analysed reviews of evidence from animal studies, human case reports and laboratory research published between 2017 and 2025, in one of the most detailed assessments to date of whether nicotine e-cigarettes could cause cancer.”

“There are early warning signs in the body strongly linked to cancer risk, including DNA damage and inflammation, co-author Adjunct Prof Bernard Stewart said. The review, published in the journal Carcinogenesis on Tuesday, found vaping is associated with these pre-carcinogenic changes….”

·         See also  HPW – Biggest review to date finds vaping likely to cause cancer.   

New Lancet studies on childhood cancer

·         Lancet – Global burden of cancer in children and adolescents aged 0–19 years, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023  ( GBD 2023 Childhood Cancer Collaborators )

·         Lancet – Progress towards the WHO Global Initiative for Childhood Cancer target of 60% 5-year survival for all childhood cancers combined, 1990–2019 (CONCORD-4): a Cancer Survival Index derived for 68 countries by analysis of individual records for 613 021 children from 307 population-based cancer registries (by C Allemani et al)

On the first, via an IHME news release: Childhood cancer is a substantial contributor to global childhood mortality and global cancer burden

“Findings show it’s the eighth leading cause of childhood deaths globally, more than measles, tuberculosis, and HIV/AIDS.

• While mortality has declined globally, children in low- and middle-income countries (LMICs) face the most severe consequences from cancer.
• Since 1990, new cases were relatively unchanged, and deaths decreased by 27%. However, the majority of childhood cancer burden in 2023 was in LMICs, with 85% of new cases and 94% of deaths.
• The WHO Western Pacific Region and African Region had the greatest numbers of cases in 2023, while the WHO African Region had the most deaths, which increased almost 56% from 1990 to 2023.
• During the same period, age-standardized mortality rates decreased globally and in all WHO world regions, with the most notable declines in high- and high-middle socio-demographic settings.
• In 2023, the WHO African and Eastern Mediterranean Regions were estimated to have the highest age-standardized mortality rates for childhood cancer.
• The cancer types with the greatest burden globally in 2023 were leukemias, brain/central nervous system cancers, and non-Hodgkin lymphoma.”

Related Lancet Editorial:  Childhood cancer: progress, but not enough

“According to the CONCORD-4 study, published in The Lancet, many countries are on track not just to achieve, but to surpass, the 2018 WHO Global Initiative for Childhood Cancer target of 60% survival at 5 years for all childhood cancers by 2030. Yet this achievement masks data gaps and deep disparities in cancer care worldwide, with children in the poorest countries likely to face far lower survival rates….”

Related Lancet Comment: Childhood cancer: an equity test for global health   

CGD (blog) –  Why Health Taxes Alone Won’t Fix Malnutrition in Poor Countries

E Kandpal; https://www.cgdev.org/blog/why-health-taxes-alone-wont-fix-malnutrition-poor-countries

“Health taxes on sugar seem to have captured the zeitgeist: Mexico’s soda tax, the UK’s sugar levy, South Africa’s Health Promotion Levy, a sugar tax in the Philippines, and so on. The evidence on these policies suggests real benefits: (1) reduced consumption of sugary drinks, (2) measurable revenue for governments, and, (3) in theory, a nudge toward healthier choices. But the conversation is increasingly moving past sugar with increasing calls for health taxes on so-called ultra-processed foods. Wealthier countries, including Denmark and Hungary, have imposed such taxes and increasingly, low- and middle-income countries (LMICs) like Colombia and Mexico are trying them out. The 2025 Economic Survey of India called for an across-the-board tax on ultra-processed foods….”

“But in my view, this discourse often skips past two critical questions: what exactly are you taxing–“ultra-processed foods” can mean many different things—and what alternatives are available, particularly in low- and middle-income settings? In this blog, I focus on this second question….”

“… the central problem I see with health taxes as an instrument of nutrition policy LMICs: the food environment is broken and health taxes cannot be sufficiently targeted to fix it…..”

“… Sequencing matters: This makes health taxes in high-burden LMIC contexts potentially regressive not only in the economic sense of taking a larger share of income from the poor, but regressive in nutritional terms, hitting hardest precisely where there is limited capacity to substitute. And those who are least able to respond to the price signal are likely the very populations at greatest risk of the intergenerational nutritional damage I described earlier.  None of this means governments should ignore the health costs of ultra-processed food consumption. But the sequencing has to be right. Governments must first make healthy food as available, affordable, and convenient—this means investing in cold chains, market infrastructure, fortification, and targeted subsidies for nutritious foods in underserved areas. Then, price signals have something to nudge people toward. Tax the bad by all means, but only after you have built the conditions under which the tax can actually work.”

Social, Commercial and Political Determinants of Health

Eurohealth – Tackling political and commercial determinants of health through policy and governance

S Galea, I Kickbusch et al; https://eurohealthobservatory.who.int/publications/i/tackling-political-and-commercial-determinants-of-health-through-policy-and-governance

Part of a special issue of Eurohealth, which accompanied the 18th European Public Health (EPH) Conference in Helsinki.

“Global health, including human and planetary health, is increasingly shaped by political, commercial, and geopolitical forces that determine who benefits from policy, markets, and cooperation. Once viewed as a shared human concern, health now reflects power dynamics and structural inequities. Political determinants shape governance and participation; commercial ones reflect corporate influence; and geopolitical determinants embed these within global power structures. Together, these interactions exploit fragmented governance, fuel health nationalism, and deepen inequities. Addressing this landscape demands transformative governance: transparent yet strategic leadership, well-being-focused economics, accountability, informed public engagement and interdisciplinary leadership through effective public health diplomacy.”

Concluding:  “Tackling the political and commercial determinants of health is no longer a  technocratic exercise; it has become  a geopolitical imperative. Vaccine  distribution, control of medical supply  chains, and health data ownership now  reflect strategic competition among global powers. Advancing health equity now requires diplomatic engagement and strategic alignment across rival blocs. Health must be recast as a domain for cooperation rather than confrontation. Health has historically been, and can be again, a shared interest capable of tempering rivalry. Doing so, however, demands confronting global power structures: the political systems shaping policy, the commercial interests driving production and consumption, and the geopolitical alignments determining who benefits from global interdependence. Re-anchoring health as a public good in a fractured world requires intentional collaboration, not neutrality.”

Lancet (Letter) – The public health response to the Epstein files

Nicholas Peoples et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00545-3/fulltext

“In 2019, revelations that American financier Jeffrey Epstein had orchestrated a powerful international network for human trafficking and sexual exploitation shocked the conscience of global society. As the Epstein Files Transparency Act, signed into law in the USA in November, 2025, directs the release of previously classified investigative records, this troubling picture continues to intensify. However, beyond the particulars of any individual case, these disclosures illuminate a broader and more uncomfortable truth: human trafficking is a global public health crisis in which trafficking networks themselves function as structural determinants of health.”

“The International Labour Organization estimates that 6·3 million people were trafficked for sexual exploitation in 2021  … …  When trafficking is framed through a public health lens, it clarifies the responsibilities of governments and health systems to protect their populations. Transparency and accountability can function as a meaningful prevention measure to exploitation in a world previously lacking in both. History shows that health institutions can catalyse accountability during public health crises. Clinicians and researchers helped expose the harms of tobacco and pressed governments to confront the HIV/AIDS epidemic. The same leadership is now needed to confront trafficking as a structural public health crisis.

BMJ – Religious determinants of health and foreign aid cuts: no thank you for your inattention

K Abbasi;  BMJ;

Concluding: “All of this, as we sit between the end of Ramadan and the beginning of Passover and Easter, serves to remind us of our neglect of the religious determinants of health. A helping hand to provide better health for poor and disadvantaged people, as the Pope rightly identifies, is a common theme among religions and a duty in our just pursuit of social peace.”

Nature Medicine – Quality health information for all is a fundamental determinant of health

L Gostin et al; https://www.nature.com/articles/s41591-026-04320-x

“As co-chairs of the Nature Medicine Commission on Quality Health Information for All, we argue that accurate, evidence-informed information is a major health determinant….”

Digital health & AI

TGH – Why India’s Digital Governance Model Matters for Global Health

I Kickbusch et al;  https://www.thinkglobalhealth.org/article/why-indias-digital-governance-model-matters-for-global-health

“India’s distinct approach to digital and AI governance centers on shared public infrastructure.”

“… global debates on the subject remain dominated by three competing visions: rights-based regulation in the European Union, market-led innovation in the United States, and state-centric techno-nationalism in China. These models shape how health data is regulated, how digital health markets evolve, and how AI is deployed in clinical and public health settings. However, no vision fully addresses fully the structural challenge of delivering equitable, large-scale, and financially sustainable digital health systems.  India’s approach constitutes a fourth paradigm of digital governance, particularly for global health. Over the past decade, India has developed a distinct approach to digital and AI governance centered on population-scale public infrastructure. This model integrates digital identity, payments, authentication, and data-sharing into welfare and health systems. It now underpins insurance enrollment, provider payments, disease surveillance, telemedicine, and pharmaceutical supply chains for hundreds of millions of people.”

“India’s approach constitutes a fourth paradigm of digital governance, particularly for global health. It demonstrates how AI and digital systems can be aligned with universal health coverage while strengthening capacity for administration and innovation. Its implications extend well beyond low- and middle-income countries (LMICs), offering lessons for health systems struggling with fragmentation and platform dependence.”

Access to Medicines, Vaccines & other health technologies

Devex – Health orgs warn of ‘dangerous’ supply shortages amid Middle East crisis

https://www.devex.com/news/health-orgs-warn-of-dangerous-supply-shortages-amid-middle-east-crisis-112192

(must-read) “The global health sector is warning that Israel and the United States’ war against Iran is creating major supply route disruptions for critical humanitarian supplies, including life-saving health products.”

“Organizations in the global health sector — including UNICEF, the Africa Centres for Disease for Control and Prevention, the United Nations Population Fund, or UNFPA, and the International Rescue Committee — are worried about the delivery of lifesaving products, and ensuring there’s affordable fuel to power medical equipment….”

PS: Africa CDC’s Kaseya emphasized this is a “wake-up call” for Africa to accelerate local pharmaceutical manufacturing.

HPW – New Open Source AI Platform Aims to Accelerate Malaria Drug Discovery

https://healthpolicy-watch.news/new-open-source-ai-platform-aims-to-accelerate-malaria-drug-discovery/

“Scientists working on new malaria drugs now have access to an open-access artificial intelligence (AI)-powered platform  aimed at accelerating drug discovery, thanks to a partnership between  Medicines for Malaria Venture (MMV) and deepmirror.”

“Drug Design for Global Health (dd4gh) uses “both predictive and generative AI to give researchers, especially those in the most resource-limited settings, access to cutting-edge technology that would otherwise be out of reach”, according to a media release from MMV.  The dd4gh platform was developed using input gathered during co‑creation workshops in Ghana and Switzerland with global drug discovery researchers. …”

Lancet World Report – Are India and China ready for a “chaotic surge” of generic obesity drugs?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00649-5/fulltext

“As patents on semaglutide expire, manufacturers are poised to introduce cheaper generic versions of blockbuster drugs, with far-reaching effects on the obesity crisis. Megan Tatum reports.”

“With the expiration on March 20 of Novo Nordisk’s patent on semaglutide in India and China—the molecule underpinning its behemoth brands Ozempic and Wegovy—a race began among domestic pharmaceutical firms to bring cheaper, generic GLP-1 receptor agonist alternatives to market.

Less than 24 h after the expiration of the patent, Hyderabad-based Dr Reddy’s Laboratories had unveiled Obeda, what it claimed was India’s first Drugs Controller General of India (DCGI)-approved semaglutide injection for type 2 diabetes. By March 23, a further seven Indian pharmaceutical firms had launched their own semaglutides, some costing up to 80% less than Novo Nordisk’s Ozempic.

China meanwhile is thought to have more than ten companies, including CSPC Pharmaceutical Group and Huisheng Biopharmaceutical, developing their own generic versions. Clarivate’s Life Sciences & Healthcare division told The Lancet it expects Hangzhou Jiuyuan Gene Engineering (Huadong Medicine) to be first across the line, having filed a New Drug Application (NDA) for its brand Jiyoutai in April, 2024….”

“Experts tell The Lancet the anticipated surge in generic or off-patent alternatives from domestic manufacturers in China and India is likely to provide a welcome boost to the affordability and availability of the drug for the management of obesity and type 2 diabetes, conditions prevalent in both Asian countries. However, there are also concerns that the influx could raise new safety concerns, fuelling the off-label use of semaglutides, and putting users at considerable risk….”

Journal of Pharmaceutical Policy and practice: From supply to strategy: leveraging central medical stores experiences and information for health system strengthening

M-Belen Tarrafeta-Sayas et al ; https://www.tandfonline.com/doi/full/10.1080/20523211.2026.2649302#abstract

“The availability and affordability of essential medicines and other health products are critical to building resilient health systems and achieving Universal Health Coverage (UHC). In many Francophone African countries, Central Medical Stores (CMS) play a key role in procuring and distributing medicines for the public sector. As such, they generate first-hand data and knowledge on availability, pricing, and the performance of national supply chains. This Comment argues that CMS should be recognised not only as technical providers, but as strategic partners in national pharmaceutical policy and health system governance….”

IJME – The quality challenge for generic medicines in India: An industrial policy-sensitive perspective

Dinesh Kumar Abrol, Rollins John, Nidhi Singh;  https://ijme.in/articles/the-quality-challenge-for-generic-medicines-in-india-an-industrial-policy-sensitive-perspective/?galley=html

“This article provides an industrial policy-sensitive understanding of the problem of quality of Indian generic medicines supplied both to the domestic market and to weakly regulated markets in Asia, Africa, and South America. Most of these medicines come from micro, small and medium enterprises (MSME). While all drugs manufactured in the country must comply with standards under the revised Schedule M of the Drugs and Cosmetics Act, 1945, the deadline for MSMEs’ compliance has been extended repeatedly, and even as of March 2026, drugs are manufactured in the country in two categories of manufacturing facilities — one compliant with the revised standards and another non-compliant with the revised standards.”

“While double standards are unacceptable, the policy discourse on medicine quality focuses entirely on uniformity of standards, and their regulation, without setting an industrial policy-sensitive context for the reasons for poor quality, and for developing an appropriate response.  We argue that the problem of medicine quality is closely connected to the structural changes in the industry after India signed the Agreement on Trade Related Aspects of Intellectual Property Rights. Large-scale enterprises depend on MSMEs — many of which are poorly equipped — for supplying branded generic medicines in the domestic market and poorly regulated markets abroad. Further, a sharp decline in the indigenous manufacture of raw materials and active pharmaceutical ingredients has left the industry vulnerable, because of its dependence on China for the import of these materials.”

Reuters – Cholera aid for African countries stalled by Iran conflict

Reuters;  

“Cholera supplies stuck in Dubai due to Iran conflict; Stocks needed for higher-risk rainy season in parts of Africa; Air freight rates soar 70% amid Strait of Hormuz closure…”

“Emergency cholera medical ​supplies for several African countries have become stuck in a logistical quagmire caused by the Iran ‌war, aid officials told Reuters, raising concerns about preparations ahead of the high-risk rainy season….”   “The stocks stranded in Dubai warehouses are contingency supplies placed in cholera-prone countries including Chad and Sudan ahead of the rainy months starting from May ​to curb any future outbreak of the fast-spreading, potentially fatal diarrhoeal disease.  … Both the World Health Organization ​and the International Federation of the Red Cross and Red Crescent Societies told ⁠Reuters that some of their African cholera supplies were stuck in a Dubai backlog. They are trying to either ​fly them out – at 70% above the normal rate – or buy replacements.

Guardian – UK ‘weeks away’ from medicine shortages if Iran war continues, experts say

https://www.theguardian.com/business/2026/mar/28/uk-weeks-away-medicine-shortages-iran-war-impacts-experts-warn

“Concern that supply chain disruption could hit health essentials – and prices – from painkillers to cancer treatment.”

The Wire – Who is Afraid of Non Violation Complaints?

K M Gopakumar;  https://thewire.in/trade/who-is-afraid-of-non-violation-complaints

Analysis (and worry) published ahead of the end of MC14 (WTO).  (29 March) “WTO members have long recognised this danger, maintaining a moratorium on TRIPS non-violation complaints since the Agreement’s inception and renewing it at subsequent ministerials. It expires when MC14 concludes on March 29.”

“Developing countries’ ability to issue compulsory licenses for generics is now under serious threat. The non-violation complaints moratorium expires today & without it, countries can be challenged at the WTO for using rights TRIPS grants them…. …  The timing could hardly be worse for developing countries. Official development aid is in retreat with the US pulling out of the WHO, where it was the single largest donor, and is cutting funding to GAVI, the vaccine alliance that has immunised more than a billion children in the world’s poorest countries. In this environment, the ability to use TRIPS flexibilities, from compulsory licences on medicines to agricultural inputs to educational materials, is not a luxury. It is a lifeline….”

·         PS: update (30 March)  MC14 Collapses as U.S. Strategy Derails Yaoundé Negotiations

·         And overall analysis on MC 14 outcomes via  IISD Insight –  World Trade Organization 14th Ministerial Conference Outcomes: Small wins, progress on reform, and digital trade as deal-breaker     (March 30)   Including on the IP rights moratoria.

“Another issue, quickly linked to the e-commerce moratorium, was a moratorium on non-violation complaints (NVCs) under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. NVCs are complaints that may be brought against a member even where the member is acting legally under WTO rules, but nullifies or impairs expected trade benefits for another member. The NVC clause prevents these kinds of complaints from being brought. Early in the conference, some developing countries linked the timelines of the two moratoria, so that if they were obliged to agree to a longer e-commerce moratorium, they would also get a longer TRIPS NVC moratorium. In the end, neither were agreed….”

·         And a link: HPW – Argentina Has Revoked Key Patentability Guidelines, Threatening Citizens’ Access to Affordable Medicine  

“Argentina took a step backwards last month when it revoked key guidelines that defined what could – and could not – be patented in its pharmaceutical sector.   For more than a decade, Argentina’s patentability guidelines have helped prevent pharmaceutical monopolies, enabling timely competition to enter the market, lowering prices of medical tools, and improving people’s access to treatment.   These guidelines were fully in line with the World Trade Organization’s (WTO) TRIPS Agreement, which allows countries to define patentability standards as based on public health needs. However, Argentina’s recent shift risks undermining access to medical tools by opening the door to broader, unwarranted monopolies….”

Conflict/War & health

Devex – WHO senior official warns of unseen health threats amid Middle East war

https://www.devex.com/news/who-senior-official-warns-of-unseen-health-threats-amid-middle-east-war-112203

“WHO is working with regional health ministries on surveillance and identifying intervention priorities, including how it can support countries in the event of water contamination risks from attacks on desalination plants.”  View from Dr. Hanan Balkhy, WHO’s regional director for Eastern Mediterranean.

TGH –  How the Iran War Is Straining Humanitarian Aid, in Three Charts

A Krugman; https://www.thinkglobalhealth.org/article/how-the-iran-war-is-straining-humanitarian-aid-in-three-charts

“Aid organizations face meandering shipping routes and soaring fuel costs beyond the price of gasoline.”

People’s Health Dispatch – Israeli attacks on Lebanon’s health system are a “health catastrophe,” health movement warns

https://peoplesdispatch.org/2026/03/25/israeli-attacks-on-lebanons-health-system-are-a-health-catastrophe-health-movement-warns/?ref=peoples-health-dispatch.ghost.io

“Israeli attacks on Lebanon’s health system echo systematic destruction of healthcare in Gaza, health activists and experts warn.”

Planetary Health

Devex – Green Climate Fund to expand into regional hubs, from Amman to Nairobi

https://www.devex.com/news/green-climate-fund-to-expand-into-regional-hubs-from-amman-to-nairobi-112185

“In an interview with Devex, GCF Executive Director Mafalda Duarte details a long-awaited regional rollout that will bring the fund closer to the countries it serves.”

·         See also  Climate Change News – Green Climate Fund picks locations for five developing country hubs

“The UN’s climate fund says new offices will boost developing nations’ access to climate finance as board accredits first Palestinian entity for direct access to funds. “

Climate Change News – Major oil producers among 46 nations joining fossil fuel phase-out summit

https://www.climatechangenews.com/2026/03/31/major-oil-producers-among-46-nations-joining-fossil-fuel-phase-out-summit/

“Canada, Australia, Brazil and Norway are set to attend the Santa Marta summit, but the world’s biggest fossil fuel producers are missing from the list.”

Climate Change News – Funding gap threatens next round of IPCC climate science reports, chair warns

https://www.climatechangenews.com/2026/04/01/funding-gap-threatens-next-round-of-ipcc-climate-science-reports-chair-warns/

“The latest IPCC session in Bangkok was clouded by persistent differences over when its flagship reports should be published and concern over cost-cutting proposals.”

·         See also Carbon Brief – IPCC: ‘Frustrating and disappointing’ meeting leaves AR7 timeline in deadlock   

Miscellaneous

LSTM – World-first discovery of noma-linked bacteria opens path to early diagnosis and prevention 

https://lstmed.ac.uk/news/world-first-discovery-of-noma-linked-bacteria-opens-path-to-early-diagnosis-and-prevention/

“Researchers at Liverpool School of Tropical Medicine (LSTM) have identified a bacterium strongly associated with noma disease, marking a major step towards earlier diagnosis and more effective treatment.”

“In a new study published in PLOS Neglected Tropical Diseases, a research team from LSTM, working with partners at the University of Liverpool, Médecins Sans Frontières and the Noma Children’s Hospital, Sokoto, Nigeria, used metagenomic sequencing and machine learning algorithms to analyse saliva samples from children with acute noma. They uncovered a previously undescribed species of Treponema bacteria, which may be responsible for the disease….”

Guardian – Urgent action needed to prevent surge in digital violence in Africa, experts say

https://www.theguardian.com/global-development/2026/mar/30/urgent-action-needed-to-prevent-surge-in-digital-violence-in-africa-experts-say

“A huge rise in internet users under the age of 30 has fuelled an increase in online violence against women and girls with devastating real-life effects, activists say.”

“… Activists and lawyers in Africa are calling for urgent action to protect women, girls and boys as digital violence surges across the continent.   A massive rise in internet users, coupled with huge numbers of people aged under 30, has fuelled an increase in gendered online violence across the continent, according to experts, by giving perpetrators new tools to control and silence women and girls, and influence boys.”

By the Sexual Violence Research Initiative, a global network looking at violence against women.

Global health events

Alliance for HPSR – Better questions, better health: rethinking research systems of knowledge production

https://ahpsr.who.int/newsroom/news/item/31-03-2026-better-questions-better-health-rethinking-research-systems-of-knowledge-production

Coverage of the launch of a new multi-year initiative, Better ways of knowing.

“Co-led by the Alliance and the Washington University School of Public Health and supported by the Robert Wood Johnson Foundation, this new initiative brings together researchers, community actors, funders and practitioners to examine critically how knowledge hierarchies influence whose questions are asked, whose realities are recognized, whose expertise is used, and how this shapes efforts to improve health inequities. As part of this initiative, the Alliance is focused on supporting civil society, social movements and community organizations in countries around the world to take leadership in generating knowledge on effective action to address health inequities. “

“Teams will apply health policy and systems research to capture community-led, disruptive, and innovative strategies addressing social determinants of health, and profile these insights and learning to help shape and create better ways of knowing reframing efforts to develop clearer messaging that resonates beyond public health and academic communities….”

Global health governance & Governance of Health

UN News – UN General Assembly adopts landmark resolution to strengthen the work of the UN system

https://news.un.org/en/story/2026/03/1167232

“The United Nations General Assembly on Tuesday adopted a landmark resolution to strengthen how UN mandates – the decisions taken by Member States that guide the Organisation’s work – are created, implemented and reviewed across the system. “

“The move marks a major milestone under the UN80 Initiative, a system-wide reform effort to make the UN more effective, coherent and better equipped to deliver results in a changing world. “

“The resolution introduces, for the first time, a more structured approach across the full mandate lifecycle – from design to implementation and review.  In practice, this means:…

“· Clearer and more focused mandates, supported by better information for decision-making from the outset; · Stronger and more coordinated implementation, with improved use of data, more user-oriented reporting and more effective use of resources; · More systematic review of results, helping ensure mandates remain relevant and deliver impact, reinforcing a culture of continuous improvement, grounded in evidence, accountability and results. · Increased transparency through improved digital tools, including through an expanded UN Mandate Registry, giving Member States more consolidated and comparable information on mandates, resources and results.”

“The resolution is intended to make it easier for Member States to navigate an increasingly complex mandate landscape, while helping the United Nations reduce duplication, fragmentation and inefficiency.”

·         See also IISD – UNGA Strengthens Mandate Creation, Implementation, and Review 

·         Related:  Global Governance Institute –  The UN80 Initiative as a Productive Failure: Between Geopolitical Disruptions and Organizational Path Dependency  (b R Patz)

The IMF, the World Bank and the Price of Power: Why Global Governance Is Rigged Against the Poor

Duncan Green; https://blogs.lse.ac.uk/activism-influence-change/2026/04/01/the-imf-the-world-bank-and-the-price-of-power-why-global-governance-is-rigged-against-the-poor/

“A new paper by Paula Druschke and Gastón Nievas shows that the international institutions supposedly designed to help developing countries are systematically tilted against them — and that this isn’t an accident of history. It’s baked into the architecture.”  Re their Global Inequality Lab working paper.

Devex – UK development minister: Campaign groups ‘wrong’ on Africa aid cuts

https://www.devex.com/news/uk-development-minister-campaign-groups-wrong-on-africa-aid-cuts-112174

“Jenny Chapman told the ONE Campaign to “play fair” in assessing U.K. aid cuts, but the group said it stands by its analysis.”

“ The United Kingdom’s international development minister pushed back against criticism that the country’s aid cuts will hit Africa hardest this week, telling lawmakers that NGOs are “wrong” to focus on shrinking bilateral funding and ignore multilateral investments.  Giving evidence to the U.K. Parliament’s International Development Committee Tuesday, just days after the U.K. government set out its aid priorities for the next three years, Jenny Chapman disputed an analysis by the ONE Campaign that bilateral aid to Africa will fall by 56% by 2028–29.”

“Also on the panel alongside Chapman were U.K. Foreign Secretary Yvette Cooper; Melinda Bohannon, director-general for global issues at the Foreign, Commonwealth & Development Office; and Nick Dyer, second permanent undersecretary at FCDO. Dyer said the U.K. was directing an additional “£1 billion plus” per year to Africa through multilateral development banks….”

“…At the hearing, Cooper pointed to three “central” funding streams for Africa — streams administered directly by FCDO rather than specific country offices: bilateral aid, a £650 million contribution to the African Development Bank, and £2 billion for the World Bank’s International Development Association, around 75% of which she said would be spent in Africa. At the same time, she confirmed that bilateral development funding to the continent will fall to £677 million by 2028–29 — which she linked in part to decisions to protect funding for Ukraine, the Palestinian territories, and Sudan….”

“Ian Mitchell, a senior fellow at the Center for Global Development, told Devex that he was initially disappointed by the cuts to bilateral aid for Africa but that he accepted that one of the reasons the decision was taken was to focus on multilateral banks. …”

·         And a link: CGD – Big Increases in Aid for the UK’s Overseas Territories, with Deep Cuts Elsewhere

“In this blog, we focus on the biggest winners from the recent FCDO allocation: the British Overseas Territories, islands which are largely self-governing but remain under UK sovereignty. This tiny group of islands—whose ODA-eligible population could fit into a small sports stadium—has received a 41 percent increase relative to the latest available year’s data, and are set to receive eye-watering amounts of ODA per person. We set out how this compares to other groups and why the UK prioritises these islands. We argue that ending aid programmes in countries with entrenched poverty and at the same time increasing aid to these comparatively wealthy islands is indefensible….”

Review of International Political Economy – Institutional layering as (counter-) hegemonic strategy: unpacking China’s global development initiative

J Taggart et al ; https://www.tandfonline.com/doi/full/10.1080/09692290.2026.2646945

« The People’s Republic of China has recently announced several global governance initiatives, with the Global Development Initiative (GDI) at the forefront. Launched in 2021, the GDI is simultaneously embedded within United Nations (UN) frameworks surrounding the Sustainable Development Goals and supposed to advance ‘true multilateralism’ aligned with China’s broader vision for world order. In doing so, the GDI complicates both ‘status quo’ and ‘revisionist’ interpretations of China’s engagement with global governance, alongside efforts to refine this binary. Bridging historical institutionalism and Neo-Gramscian political economy, we argue that the GDI constitutes a form of ‘institutional layering’ that serves as a component of a broader counter-hegemonic strategy: Rather than displacing existing frameworks, China seeks to embed new practices, principles, and alliances within them to advance its material, ideational, and organizational interests. We demonstrate how the GDI functions as a low-cost, low-risk component of a ‘war of position’ that leverages UN legitimacy while incrementally contesting liberal norms and assess its transformative potential for altering the nature of global (development) governance. »

Development Policy Review – Pathways to gender-transformative women’s health aid: Comparative evidence from five donors

Yoorim Bang et al; https://onlinelibrary.wiley.com/doi/10.1111/dpr.70065

“This study examines how gender-transformative approaches are operationalized within women’s health ODA and asks two questions: how do women’s health ODA projects integrate gender-transformative principles in practice, and what combinations of institutional, programmatic and participatory features are associated with improved women’s health outcomes?”

“The study analyses 100 completed women’s health ODA projects funded by five bilateral donors (Australia, Germany, Sweden, the United Kingdom, and the United States)…..”

European Journal of Public Health – Supplement : Co-benefits of Health

https://academic.oup.com/eurpub/issue/36/Supplement_2?login=false

·         Start with the Editorial : Co-benefits of health: from evidence to governance, politics and advocacy    (by Charlotte Marchandise, Scott Greer et al)

“From the foundational texts of public health, like Alma-Ata’s call for ‘Health for All’ and Ottawa’s Charter for Health Promotion, it has been clear that public health is everyone’s business. These landmark declarations recognized that health extends far beyond healthcare systems, demanding action across all sectors of society. Health represents a common good fundamental to Europe’s security, prosperity and democratic resilience.  Yet recent crises, from the pandemic to geopolitical instabilities, have exposed both the profound interdependence between health and other policy domains and the persistent fragility of governance arrangements meant to operationalize this foundational understanding. The contributions assembled in this special issue illuminate not merely the available policy options, but the critical strategic choices Europe confronts in bridging the enduring gap between public health principles and practice….”

“… In an era of polycrisis, where health, climate, economic, and geopolitical challenges intersect and amplify each other, the imperative for collective action becomes even more pronounced.  This context transforms public health from a primarily social concern into a security imperative. Resilience, preparedness, and security now dominate geopolitical agendas, and public health sits at their intersection. A population’s health determines its capacity to withstand shocks, from pandemics to supply chain disruptions. Health systems’ resilience becomes national resilience. The ability to respond rapidly to health emergencies translates directly into economic stability and social cohesion…..”

“The contributions to this issue collectively suggest three strategic imperatives for Europe: Reframe health as investment, recognizing it as a driver of equity, prosperity, and institutional trust rather than merely a budgetary obligation. Institutionalize intersectoral governance, this occurs when collaboration is embedded in laws, structures, budgets, data systems, routines, and organizational culture. This allows joint work to continue even when leaders change. Strengthen collective action for public health, building broad coalitions through meaningful stakeholder engagement, ensuring that diverse sectors and civil society unite in defending and advancing public health in an era of intersecting challenges….”

CGD – What Will It Take for Development Agencies to Stay Effective in a Changing Landscape?

R Calleja et al;   https://www.cgdev.org/blog/what-will-it-take-development-agencies-stay-effective-changing-landscape

“In a new paper, we explore the challenges and characteristics of long-term agency effectiveness in a changing development landscape, drawing on interviews with officials from four bilateral development agencies: France’s Agence Française de Développement (AFD), the Korea International Cooperation Agency (KOICA), New Zealand’s Ministry of Foreign Affairs and Trade (NZ MFAT), and the Norwegian Agency for Development Cooperation (Norad). By focusing on the internal processes, structures, and capabilities needed to deliver on shifting demands, our research moves beyond the international development effectiveness principles outlined in the Busan Agreement—which our previous work showed are often no longer top of mind, not least due to implementation difficulties. Instead, we probe how organizational processes and factors support or undermine effective practice. Ultimately, we find that being effective in the future will require agencies to grapple with four key questions that clarify their purpose, offer, willingness to partner, and ability to communicate impact….”

·         The related CGD Policy paper:  What Will It Mean for Development Agencies to Be Effective in the Years Ahead?

Global health financing

Devex – Is development finance failing? And how do we fix it?

https://www.devex.com/news/is-development-finance-failing-and-how-do-we-fix-it-112156

“A new Devex survey of more than 500 development professionals finds low confidence in the global finance system and broad agreement on what needs to change. The data points to blended finance, AI, and domestic resources.”

“A new Devex survey of more than 500 development professionals paints a stark picture of the global finance system: low confidence, a widening funding gap, and no single fix in sight.  The financing gap for the Sustainable Development Goals now stands at an estimated $4 trillion annually, up 60% from the 2015 estimate. Against that backdrop, 83% of respondents expect the gap to grow further over the next decade. Only 6% describe today’s global development finance landscape as “very effective.” More than a third consider it somewhat or very ineffective.

“What is driving the dysfunction? Respondents were clear: growing geopolitical tensions and fragmentation were identified as the most damaging trend by 60% of respondents. Declining ODA came second, cited by nearly half. Limited coordination across development finance institutions followed close behind….”

ODI (Research report) – Reforming multilateral development banks: perspectives from client countries

A Prizzon et al ; https://odi.org/en/publications/reforming-multilateral-development-banks-perspectives-from-client-countries/

Drawing on nearly 650 government and MDB officials.

“This report arrives at a moment of significantly reduced aid budgets, escalating financing needs, rising sovereign debt, geopolitical tensions and a fragmented development finance landscape.  Since the first MDB client survey in 2021, successive G20 presidencies and MDB shareholders have launched multiple reform initiatives. This study takes stock of their effects – from the perspective of the countries these institutions exist to serve.”  “The analysis covers financing, policy advice, technical assistance, development effectiveness, inter-MDB coordination, project pipeline quality and project-cycle speed.”

Check out the  Executive summary.  

The Conversation – Development finance in Africa: economist explains how private savings could be unlocked

https://theconversation.com/development-finance-in-africa-economist-explains-how-private-savings-could-be-unlocked-277204

“Africa holds abundant private savings, but much of it remains informal. As a result, its contribution to development financing is limited.”

“Researcher Florian Léon is one of the authors of a recent report on the potential of the “Caisse de dépôt” model – a financial management framework designed for long-term investment that bridges the gap between public funds and economic development. We asked him how this kind of public savings and investment fund could capture and channel these resources into productive investment, alongside development banks.  He outlines the institutional barriers, the reforms needed, and the paths forward for mobilising both local and diaspora savings.”

UHC & PHC

Plos GPH – Health technology assessment system in Tanzania: Is it a championing system or still a system lagging behind?

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004863

By M Mrisho et al.

Pandemic preparedness & response/ Global Health Security

GAVI – Meningitis deaths above 250,000 worldwide in 2023 despite decades of progress, study finds

https://www.gavi.org/vaccineswork/meningitis-deaths-above-250000-worldwide-2023-despite-decades-progress-study-finds

“Children under five and countries in the African meningitis belt continue to bear the greatest burden.”

“In 2023, meningitis caused around 259,000 deaths and 2.5 million cases worldwide, with more than a third of deaths in children under five, according to a new Lancet study.  The burden of disease remained disproportionately high in low-income countries, particularly in the African meningitis belt, where Nigeria, Chad and Niger recorded the highest death and infection rates.

Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases.”

“More than a quarter of a million people died from meningitis in 2023, according to the most comprehensive global analysis to date.   The study, published in The Lancet Neurology as part of the Global Burden of Disease (GBD) 2023 project, estimates that 259,000 people died from meningitis last year, while 2.5 million fell ill. Children under five accounted for over a third of those deaths….”

BMJ – MERS imported to France: a wake-up call to revamp preparedness, control, and research

https://www.bmj.com/content/392/bmj.s597

“The reports of two imported cases of Middle East respiratory syndrome (MERS) in France in December 2025, along with the 14 cases reported in Saudi Arabia earlier in 2025, are reminders of the need to keep MERS under scrutiny….”

“… European countries and other countries rich in resources will often have a low clinical suspicion for MERS, but should consider the possibility of MERS cases in travellers (and their close contacts) returning from countries with camel populations ….  “

“ … From a research perspective, two of the three candidate MERS-CoV human vaccines in development have entered clinical trials. A MERS-CoV virus isolate was also added to the WHO BioHub System in 2025, further facilitating research efforts. In addition to trials on human vaccines, research investment should go into developing a MERS-CoV vaccine for animals. Work on an inactivated rabies virus vectored MERS-CoV vaccine for camels is promising. Accelerating the development of a camel vaccine is a key pathway to deter zoonotic spillovers in slaughterhouses, markets, and camel husbandry programmes. … “Hear camel, think MERS” is a message that doctors and public health officials around the world must heed.”

Lancet Regional Health Americas (Health Policy) – Modernizing public health surveillance for global health security leveraging AI

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(26)00082-7/fulltext

By Kehinde O. Ogunyem et al.

Plos GPH – Reporting trends and seasonality in the World Health Organization’s Disease Outbreak News (DONs) across 1996–2023

K Quah et al;  https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004876

Concluding: « …As a collection of press releases which are selectively published by the WHO, the DON is not a complete representation of global disease outbreaks, and researchers should be aware of these reporting patterns and biases when using the DONs in outbreak surveillance and global health research.”

Planetary health

Plos Med (Perspective) – The future of medicine in a One Health world

J L Gittleman;   https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005042

“Integrating environmental subfields into medicine with One Health Practitioners.”

“Long recognized as a breakthrough approach, One Health has been slow and piecemeal to infiltrate medical fields. Growing evidence suggests that it’s time for change by taking on a new patient—the environment.”

“… below I outline recommendations for how a One Health approach can be facilitated, including through the engagement of “One Health Practitioners” (OHPs)….”

ODI (Expert Comment) – The COP30 goal to ‘triple adaptation finance by 2035’

S Wubet; https://odi.org/en/insights/the-cop30-goal-to-triple-adaptation-finance-by-2035/

“COP30’s mutirão decision called on countries to ‘triple adaptation finance by 2035’. While this outcome brings much needed hope to the international climate community and signals strong ambition around adaptation, the text was ambiguous. Language like ‘calls for efforts’ to triple adaptation finance and developed countries being ‘urged’ to increase the ‘trajectory’ of their provision make delivering this goal in practice unclear. Our Finance Working Group experts have been analysing the text and the current state of adaptation finance to better understand how this goal could be achieved.”

Carbon Brief – Analysis: UK is ‘halving’ its climate finance for developing countries

https://www.carbonbrief.org/analysis-uk-is-halving-its-climate-finance-for-developing-countries/

“The UK is roughly halving the climate aid it allocates to developing countries, when accounting changes and inflation are factored in, according to new analysis by Carbon Brief.”

Nature Medicine – An atlas to navigate environmental factors and health

https://www.nature.com/articles/s41591-026-04286-w

“We have systematically mapped the exposome onto health and disease risk to replace pervasive fragmented research. Although exposure associations are modest, these reproducible patterns reflect how our surroundings can affect our bodies and collectively shape our health. Our atlas provides a blueprint for integrating and evaluating environmental factors into precision medicine.”

Mpox 

Science – These small African antelopes may help mpox spread

https://www.science.org/content/article/these-small-african-antelopes-may-help-mpox-spread

“Researchers find evidence that duikers (i.e. small antelopes), hunted and eaten across sub-Saharan Africa, can harbor the deadly virus.”

Infectious diseases & NTDs

Nature Medicine (News) – Hope for control of a centuries-old epidemic

https://www.nature.com/articles/d41591-026-00019-1

“After decades of stagnation, a renewed push in tuberculosis research is expanding the drug and vaccine pipeline to bring one of humanity’s oldest and deadliest infectious diseases under control.”

International Journal for Equity in Health – Negating neglect: social scientific contributions on Neglected Tropical Diseases and global health

https://link.springer.com/article/10.1186/s12939-026-02824-z

“Global health actors, institutions, and communities are trying to respond to the unprecedented U.S. development aid cuts and the “America First” strategy to global health that focuses largely on HIV/AIDS, tuberculosis, malaria, polio, and global health security. Amid this normalized neglect of people and health issues, we argue that a social scientific lens is increasingly necessary to understand and improve conditions associated with Neglected Tropical Diseases throughout the world. “

“… Based on a review of social scientific research on Neglected Tropical Diseases, as well as other primary and secondary sources, this paper explores macro, meso, and micro themes ripe for social scientific research, including: 1) the social construction of disease categories; 2) the politics of agenda-setting and governance in the global health field; 3) political, economic, and commercial determinants of health and disease; 4) tensions between global disease initiatives and community realities; and 5) neglected disease treatment access and illness experiences….”

AMR

Cidrap News – Use of newer antibiotics for challenging infections is rising, but no improvement seen in death rates

https://www.cidrap.umn.edu/antimicrobial-stewardship/use-newer-antibiotics-challenging-infections-rising-no-improvement-seen

“A new study suggests that newer antibiotics designed for some of the most drug-resistant bacterial infections are being used more frequently but aren’t making a dent in survival rates.”

“The study, published in The Lancet Infectious Diseases, found that, among patients hospitalized with a difficult-to-treat (DTR) gram-negative bacterial infections, initial treatment with one of six antibiotics approved in recent years rose by nearly 300% from 2016 to 2023. But there was no observed reduction in mortality among the patients.  Furthermore, over the entire study period, more than three-quarters of patients with DTR infections received initial treatment with discordant antibiotics—defined as antibiotics that either weren’t active against the pathogen or to which the pathogen was actively resistant.  The authors of the National Institutes of Health (NIH)-funded study say the findings suggest that new antibiotics alone aren’t enough to improve survival in patients with highly resistant infections.”

NCDs

Stat – Proposed ‘preclinical obesity’ diagnosis ignites global debate among experts

https://www.statnews.com/2026/04/02/bmi-new-obesity-definition-endocrine-society-debate/

(gated)  “Endocrine Society says new framework mishandles diabetes and could delay care.”

Guardian –  ‘Prosthetics aren’t made for people like us’: the brothers creating innovative artificial limbs for Africans

https://www.theguardian.com/global-development/2026/mar/30/prosthetics-brothers-creating-innovative-artificial-limbs-for-africans

“According to the Global Health Observatory’s 2022 report on assistive technology, nine out of 10 people worldwide who need assistive devices such as prosthetics, wheelchairs or hearing aids do not have access to them.  The situation is especially difficult in low- and middle-income countries…”

“… Local manufacturing offers a promising alternative, enabling customisation to the climate, work environment and lifestyle of local communities….”

PS: “… For researchers such as Layton, the rise of African innovation marks a broader shift in global health technology. “Traditionally, advances have flowed from high-income to low-income countries,” she says.  “Now the trend is reversing, as innovations emerge from countries that must think creatively under constraints.”  These constraints, she says, can spur creativity. “Where systems have failed, people tend to be more innovative and flexible in the technologies they develop.” She adds: “The effects could reach the global prosthetics industry. If this technology can be produced more cheaply without sacrificing quality or functionality, its market could extend beyond Africa to the world.”…”

Nature Medicine – Global, regional and national burden of ischemic heart disease attributable to suboptimal diet, 1990–2023: a Global Burden of Disease study

Nature Medicine;

“GBD analysis found that in 2023, suboptimal diet was responsible for 4 million deaths and 97 million morbidity burdens from ischemic heart disease.”

Social & commercial determinants of health

South Centre & F-E Stiftung (report) –  “The UN Treaty on Business and Human Rights: Regulating Corporate Power in the Era of Deregulation”.

https://www.southcentre.int/wp-content/uploads/2026/03/The-UN-Treaty-on-Business-and-Human-Rights.pdf

“As we move toward the 12th Session of the OEIGWG in October 2026, the global community faces a choice between fragmented regimes and a rules-based international system. Despite a worrying trend of regulatory backsliding in some regions, the momentum from the 11th Session has shifted negotiations into a decisive phase….”

Key Focus Areas of the Paper:    – The “Boomerang Effect“: How corporate impunity now threatens the sovereignty and legal stability of developed and developing nations alike.  – Correcting ISDS: Utilising the Legally Binding Instrument (LBI) to prevent “regulatory chill” and ensure human rights take primacy over trade and investment agreements.  – The Human Rights Economy: Reframing accountability not as a burden, but as a prerequisite for fair competition and market stability. …”

Mental health & psycho-social wellbeing

Conflict & Health – Interventions addressing mental health in conflict-affected settings: A literature review

https://link.springer.com/article/10.1186/s13031-025-00746-1

By N Falkboll et al.

Lancet Primary Care – Scaling depression and PTSD care in primary care across LMICs: beyond feasibility to implementation and choice

Y J Lee et al; https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(26)00021-X/fulltext

Comment linked to a new study (re Kenya) in the Lancet Primary Care.

Sexual & Reproductive health rights

Devex – Did badly designed aid rules lead to a rise in child marriage?

https://www.devex.com/news/did-badly-designed-aid-rules-lead-to-a-rise-in-child-marriage-112152

“Observers say that in Yemen, aid rules that distribute aid by households have encouraged recipients to create more households by marrying off their daughters while they are still girls.”

Access to medicines & health technology

Guardian – Trump threatens 100% tariff on US drug makers that don’t strike deals to lower prices

https://www.theguardian.com/us-news/2026/apr/02/trump-100-tariff-us-pharmaceutical-drug-makers 

“New tax will hit branded drugs and active ingredients while exempting generics for at least one year.”   “Donald Trump is threatening 100% tariffs on pharmaceutical companies that have not struck deals to lower US drug prices….”

·         See also Stat+    Trump announces 100% tariffs on brand-name drugs, with plenty of carveouts

HP&P – Managing Public-Private Partnerships for Health Diagnostics: Challenges and Strategies 

S Bennett et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czag041/8552548?searchresult=1

“This paper draws upon a process evaluation of a public-private partnership (PPP) for diagnostics in three Sub-Saharan African countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing health PPP projects and potential solutions…”

Human resources for health

Brot für die Welt (Report) – Global Gaps: how Germany is externalizing its shortage of Health Care Workers

https://www.brot-fuer-die-welt.de/fileadmin/mediapool/downloads/fachpublikationen/analyse/Analysis_115_Global_Gaps_en.pdf

Analysis. “This commissioned research examines the migration and international recruitment of health professionals from Colombia and Brazil, aiming to inform public policy in both source and destination countries…..”

Decolonize Global Health

BMJ GH – How do global health research actors conceptualise inclusion in response to decolonisation calls? A scoping review

https://gh.bmj.com/content/11/3/e019194

by C Ewuoso et al.

Plos GPH – Implementation research can enhance health research systems and reduce dependency on external aid

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006144

By C Chunda-Lyoka et al.

Conflict & Health

SSM Health Systems – The role of non-state actors in health system resilience: exploring and developing their capacities in fragile and shock-prone settings

https://www.sciencedirect.com/science/article/pii/S2949856226000413

By S Witter et al.

AI & health

Devex – Can aid organizations use AI-generated imagery ethically?

https://www.devex.com/news/can-aid-organizations-use-ai-generated-imagery-ethically-112147

“With global development organizations facing budget cuts, AI images are an easy way to cut costs — but there are pitfalls.”

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

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00464-2/fulltext

By K Backholer et al.

Miscellaneous

MPPN – Is Aid Reaching the Poorest? Using the Global MPI to reassess ODA priorities

https://www.mppn.org/is-aid-reaching-the-poorest-using-the-global-mpi-to-reassess-oda-priorities/

“Analysis from the OECD shows that in 2023 the share of global ODA directed toward the core elements of the Multi-Dimensional Poverty Index (MPI) — health, education and living standards — declined to its lowest level since 2010 (28%) and that “contexts and regions with high rates of multi-dimensional poverty are increasingly being left behind.”

“In this interview with Dimensions, Julie Seghers (Team Lead) and Danielle Mallon (Junior Data and Policy Analyst) from the Organisation for Economic Co-operation and Development (OECD)’s Development Co-operation Directorate explain how the OECD is using the Global Multidimensional Poverty Index (MPI) as an analytical framework to assess how Official Development Assistance (ODA) is allocated. Their analysis sheds light on whether development finance is truly aligned  with multidimensional poverty reduction…..”

“Trends in total ODA reveal that contexts and regions with high rates of multidimensional poverty are increasingly being left behind.”

Papers & reports

WHO Bulletin (April issue)

https://pmc.ncbi.nlm.nih.gov/search/?term=((%22Bulletin+of+the+World+Health+Organization%22%5BJournal%5D)+AND+104%5BVolume%5D)+AND+4%5BIssue%5D

For the editorial, see the Highlights section.

·         Including among others: A call for inclusion of arthroplasty as essential surgery 

“In 2015, the World Health Assembly and the Lancet Commission on Global Surgery affirmed the need for equitable access to essential surgical care. Additionally, the World Bank’s Disease Control Priorities project identified 44 essential surgical procedures for health-care systems in low- and middle-income countries. These procedures address the global burden of disease, are cost-effective and are feasible to implement in resource-constrained settings. Notably, arthroplasty, specifically, hip and knee replacements, was excluded. A decade later, this omission warrants reconsideration. With improved control of communicable diseases, musculoskeletal conditions are now the second leading cause of years lived with disability globally, disproportionately affecting populations of low- and middle-income countries. Arthroplasty meets all the criteria for an essential surgical procedure:…. … As life expectancy and the noncommunicable disease burden increase, functional mobility interventions and pain relief will become a public health priority. Integrating arthroplasty into national surgical plans is essential to build resilient surgical systems that respond to evolving demographic and epidemiological trends. We call for the formal recognition of arthroplasty as an essential surgical procedure and for investment in workforce training, supply-chain infrastructure and funding models to meet unmet global surgical needs….”

WHO Bulletin – Data gaps affecting health-related sustainable development goal indicators

K Adib et al ; https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.25.294190.pdf?sfvrsn=b35128cb_3

Findings: “We observed pronounced data gaps and inconsistencies across WHO regions and over time. At the target level, about one third of targets (8 out of 27) had over 90% missing data points, while 41 of 43 indicators had more than 90% missing data in 2024, compared with 11 indicators in 2019. At least one form of disaggregation was present in 72% of indicators, yet missing data did not vary significantly by disaggregation level. Across regions, the number of indicators with over 90% missing data ranged from 12 to 16. Methodological differences also influenced data availability: indicators relying on estimates had substantially higher coverage than those based solely on empirical data; 49% relied on estimates, 35% on empirical data and 16% on a combination of both.”

Conclusion “This study underscores critical limitations in the availability, timeliness and consistency of health-related SDG data across WHO regions, highlighting the need for strengthened data systems to support the monitoring of global health progress.””

International Journal for Equity in Health – WHO launches global network of institutes to strengthen capacity for health inequality monitoring

Health Inequality Monitoring network;  https://link.springer.com/article/10.1186/s12939-026-02780-8

“This article introduces the global WHO-managed Health Inequality Monitoring Network, which is dedicated to strengthening and expanding health inequality monitoring practices at global, regional and country levels. Launched in 2025, the Health Inequality Monitoring Network consists of 12 inaugural institutional members, represented by over 140 affiliated individuals spanning all world regions. The Network aims to: strengthen capacities for health inequality monitoring; generate and disseminate evidence on health inequalities; and develop health inequality monitoring tools, resources and best practices. This article details the rationale for establishing the Network, as well as its current activities, anticipated impacts and future development.”

IDS – Tackling political exclusion is central to saving democracy, report finds

https://www.ids.ac.uk/news/tackling-political-exclusion-is-central-to-saving-democracy-report-finds/

“Urgent steps need to be taken to rebuild the relationship between citizens and state to stem the decline of democracy globally, a new IDS report warns.”

“The authors argue there is an urgent need to rethink democracy by centring people, power, and inequality, and put forward eight building blocks to strengthen democracy and resist democratic decline. “

“The eight building blocks put forward here suggest ways in which policymakers and other actors can work to support democratic changes within regimes of different hues. They include building and strengthening:   • active citizenship; • informal mobilisation; • digital agency; • civil society organisations; • de-polarisation; • accountability mechanisms; • political participation through informal institutions; • more effective donor support.”

Plos GPH –  Redefining social medicine from Latin America: Historical foundations and contemporary directions

F Ortega et al ;  https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006213

“This article examines the contemporary meaning of social medicine, a field marked by its porous boundaries, plurality, and contestation. Rather than offering a fixed definition, we trace its shifting forms across time, geography, and politics, positioning it as a “boundary object” that adapts to diverse contexts while retaining a minimal common identity. Comparative discussion with medical anthropology, social studies of medicine, global health, underscores social medicine’s distinct focus on structural determinants, inequities, and justice. We propose three elements that could be the basic common elements of social medicine, drawing on foundational tenets of Latin American Social Medicine for this classification: 1) political commitment to social justice, 2) the central role of social sciences, and 3) participatory methodologies rooted in community participation. We highlight how these elements informed transformative reforms while also noting how institutionalization sometimes diluted revolutionary impulses into bureaucratic logics. Finally, we analyze how these basic common elements of social medicine identified through the Latin American case are manifested in other historical currents within the field and in contemporary expressions of “protest medicine”.”

JCPH – Is there a place for hope in the imagined future of public health? A commentary building on Freire’s sociology of hope.

P Ward et al;  https://journalhosting.ucalgary.ca/index.php/jcph/article/view/81658

“By examining hope through a sociological lens, this commentary frames hope as a critical sociopolitical tool for public health to address structural inequalities and foster healthier communities. We draw on Paolo Freire’s pedagogies of oppression and hope, since they provide a ‘praxis of hope’. We explore the concept of hope – explaining what it is, to then consider what it enables – conveying the ways hope is imperative to human flourishing and imperative in the imagined future of public health. We present a case for public health engagement in developing ‘hope-based’ practices and policies which means working with communities to identify the factors acting as oppressive forces and then, through critical consciousness development, working towards overcoming these in a move towards hope (and health).”

MIT (open access book) – The Handbook of Social Protection: Evidence and New Directions for Low- and Middle-Income Countries

https://direct.mit.edu/books/oa-edited-volume/6103/The-Handbook-of-Social-ProtectionEvidence-and-New

Edited by R Hanna et al.

BMJ Injury Prevention –  Prioritising burn prevention within Sustainable Development Goals

V Keshri;  https://injuryprevention.bmj.com/content/early/2026/03/30/ip-2025-046024?rss=1

Via LinkedIn (author): “…In this paper, I argue that: We must reinterpret existing SDG targets through a burn prevention lens. Maps how existing SDG targets already align with burn prevention, care, and rehabilitation. Proposes burn-specific reinterpretations of SDG indicators.”

PS: “Burn injury remains a neglected global public health challenge, disproportionately affecting the poor, marginalised populations, children and women. While prevention and improved health system responsiveness have led to a significant reduction in burn mortality and disability in high-income countries, outcomes remain poor in many low- and middle-income countries. …”

Blog of the week

Speaking of Medicine – Diplomacy is not peripheral to public health—it is how public health gets done

K Bunka; https://speakingofmedicine.plos.org/2026/04/02/diplomacy-is-not-peripheral-to-public-health-it-is-how-public-health-gets-done/

By a Canadian diplomat. Warmly recommended, this blog.  “As a career diplomat with an educational background in international public health, I have come to see diplomacy not as an optional skill, but as a foundational one for global or public health practitioners. It can be learned, refined, and practiced—and in today’s world of fraying multilateralism, it is indispensable….”

Tweets  (via X & Bluesky)

Africa CDC

 “Addis Ababa Named Host of CPHIA 2026, Strengthening Africa’s Public Health Leadership: Addis Ababa has been selected to host the 5th International Conference on Public Health in Africa (CPHIA). Dr Jean Kaseya made the announcement following discussions with H.E. Ambassador Berhanu Tsegaye and the Government of Ethiopia…..”

Jean Kaseya

“40% of health resources in Africa are lost to inefficiency and poor governance. Fixing this could unlock billions for health — without asking for one more dollar. That was at the heart of my message today at the High-Level Forum on Sustainable Health Financing in Tangier….”

As Easter is fast approaching over here, I’ll keep the intro short this week.

Now that apparently 2-minute micro dramas (‘duanju’) are all the rage in China, with many people watching titles like ‘Saved by the sexy cowboy’ on their smartphones, I’m sure you will be pleased that over here, my wife and I are still firmly hooked on K-Drama. Lately, we’ve been watching ’Can this love be translated?’.  The concept is rock solid: it takes many, many episodes till the two protagonists, this time Joo Ho-jin and  Cha Mu-hee (+ her zombie alter ego Do Ra-mi), finally get to kiss each other passionately ( K-drama kissing is a genre in itself). Sometimes, in the few remaining episodes, things still go wrong for reasons only the scenario writers know. Not this time (spoiler!), though.

Anyway, just to let you know that like most of you, we also have a few  escapist strategies for the evening, to try to forget – briefly – the current, increasingly “zombie multilateralist” state of the world.

But back to Easter. Last week, Kamran Abbasi already zoomed in on the religious determinants of health in a BMJ Editorial. He started his reflection from Pope Leo who recently  called universal health care a moral imperative (“health cannot be a luxury for the few”). Sadly, these days, religious extremists are calling the shots in almost all world religions, certainly in political arenas – with the results we can all see on battlefields and far beyond. And so I hope the many moderates, present in all religions, will find a way to take the initiative back.  As unlike the extremists, they realize that human beings aren’t all that different, and that what unites us is far more important than what differentiates us. 

Enjoy your reading.

Kristof Decoster

–          World TB Day (24 March)

–          IMNHC 2026 (Nairobi, Kenya – March 23-26)  

–          PABS Annex negotiations: final analysis & advocacy ahead of the latest round

–          PABS Annex negotiations: coverage & analysis from this week (23-28 March)

–          More on PPPR

–          Global Health reform & re-imagining (+ post-aid)

–          US Bilateral health agreements & US global health strategy

–          Trump 2.0

–          More on Global Health Governance & Financing/Funding

–          Debt crisis & reform

–          More on the impact of aid cuts

–          UHC & PHC

–          More on Health Emergencies

–          Decolonize Global Health

–          NCDs & Commercial Determinants of Health

–          Human Resources for Health

–          More on SRHR

–          Planetary Health

–          Access to Medicines, Vaccines & other health technologies

–          Conflict/War & health

–          Migration & health

–          Some reports, supplements… of the week

–          Miscellaneous

World TB day (24 March)

The theme this year: “Yes! We can End TB!”.

WHO recommends new diagnostic tools to help end TB

https://www.who.int/news/item/24-03-2026-who-recommends-new-diagnostic-tools-to-help-end-tb

“On World TB Day, the World Health Organization (WHO) is urging countries to accelerate action to end tuberculosis (TB) and expand access to lifesaving services by using new innovations such as diagnostic tests that can be used near the point-of-care and tongue swabs that can help detect the disease faster, reaching more people….”

PS: “While new diagnostic tools represent a critical step forward, ending TB will require sustained investment in research and innovation. Global funding for TB research remains far below the estimated annual need of around US$ 5 billion, leaving major gaps in the development of new diagnostics, medicines and vaccines needed to end the epidemic….”

·         Coverage via HPW: Undetected Tuberculosis Crisis Plagues Europe; WHO Rolls Out New Diagnostic Tools   

“To address the global undetected tuberculosis crisis, WHO has now recommended near point-of-care nucleic acid amplification tests (NPOC-NAATs) alongside the use of tongue swabs for patients who cannot produce sputum. These portable, battery-operated devices deliver results in under an hour at a fraction of current costs, representing a major technological breakthrough for peripheral health clinics.  As global health programs face critical funding shortages in 2026, these newly recommended tests offer a vital economic lifeline, delivering rapid results at a fraction of current costs. ”…”

Lancet GH – Diagnostic innovations to find the missing millions with tuberculosis

Veronique Suttels et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00021-5/fulltext

The backdrop: “Tuberculosis is treatable and preventable, yet with the current diagnostic approach, almost 3 million people with tuberculosis are missed each year. One in four people living with tuberculosis do not have access to diagnostic services, and up to half of people with tuberculosis are asymptomatic. This diagnostic gap leads to ongoing transmission and increased downstream morbidity and mortality….”

“Considering the urgent need to identify the missing millions undiagnosed with tuberculosis, we highlight promising innovations in tuberculosis diagnostics…..”

·         See also the Lancet Infectious Diseases newsdesk :  New WHO recommendations for tuberculosis diagnosis

“In March 2026, WHO issued new recommendations on tuberculosis diagnosis, with the hope of closing tuberculosis detection gaps. Timothy Jesudason reports.”

Lancet (Comment) -Understanding where people with tuberculosis seek care to serve them better

Charity Oga-Omenka, M Pai et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00543-X/abstract

“… people with symptoms of tuberculosis typically delay seeking care for weeks due to factors such as low disease awareness, distance to facilities, self-medication, or age. When they do seek care, they are likely to first visit local primary care providers in their neighbourhoods, including pharmacies and private practitioners, or informal providers, such as drug sellers and traditional healers. Tuberculosis is rarely diagnosed on that first visit. What health systems typically record as “delayed care-seeking” often reflects initial symptom misattribution rather than patient inaction. Studies in India, Indonesia, Kenya, and Nigeria done before and after the COVID-19 pandemic show patients have between two and eight visits before tuberculosis diagnosis, with extremes reaching 21 visits in highly fragmented systems….”

“Research on health-care-seeking journeys across tuberculosis high-burden settings in India, Indonesia, Kenya, and Nigeria reveal gaps between ideal scenarios and lived realities. An important finding is that the private sector served as the primary entry point for 67–91% of patients yet rarely facilitated timely diagnosis or appropriate referral. People seeking care in the private and informal sectors are largely invisible in public tuberculosis programme databases. Patients without easy access to high-quality public health services typically seek care wherever it is convenient (eg, in pharmacies, informal providers, and private practitioners) and encounter fragmented pathways with multiple providers and delays before diagnosis, with economic consequences as well. Patient journey studies reveal distinct patterns….”

“… Dismissing the private and informal sectors as merely a problem to solve overlooks a fundamental reality: in low-income and middle-income countries (LMICs) with insufficient public health infrastructure, private providers, however informal or unregulated, are often the most accessible and convenient care option for people….”

“… Strategies to meet this challenge include engaging private pharmacies and informal providers where people go first, strengthening diagnostic capacity at bottleneck points, and addressing structural barriers that increase health system fragility. In highly fragmented systems, ecosystem-wide interventions become imperative: equipping pharmacies, informal providers, and private practitioners with point-of-care diagnostics paired with easy-to-collect samples, such as tongue swabs, recently endorsed by WHO;  standardised referral pathways to tuberculosis clinics; and digital case notification systems. In more coordinated systems, improving diagnostic capacity and provider awareness at the primary care level enables earlier diagnosis with fewer provider encounters, as gains are lost when front-line providers do not recognise tuberculosis symptoms early. In all these settings community health workers who can bridge fragmented care are essential.  

“The feasibility of this approach has been established…”

TGH – Sustaining Tuberculosis Innovations to Counter Foreign Aid Cuts

M Pai;  https://www.thinkglobalhealth.org/article/sustaining-tuberculosis-innovations-to-counter-foreign-aid-cuts

“A new World Health Organization policy allows for portable TB testing, which could help close massive gaps in disease surveillance.”

·         And a link:  Plos GPH –  The case for ambition: Why countries must move boldly on Near Point-of-Care TB Diagnostics

NEJM – Tuberculosis Cases and Deaths Averted by PEPFAR

JP Smith et al; https://www.nejm.org/doi/full/10.1056/NEJMc2506284?query=RP  

Must-read.

“Although the effect of PEPFAR on the HIV epidemic is well described, the relative contribution of this program toward the elimination of tuberculosis worldwide is unclear. In this study, we expanded on a previous statistical framework to estimate the numbers of tuberculosis cases and related deaths averted that could be attributed to PEPFAR.…”

Findings: “… From 2003 through 2024, indirect and direct interventions from PEPFAR averted an estimated 11.0 million cases of tuberculosis … and an estimated 2.1 million tuberculosis-related deaths … among persons with HIV. More than one third of the total cases averted (42%) would have occurred between 2020 and 2024. During this 5-year time frame, an estimated 32% of the cases averted were attributable to direct, tuberculosis-specific interventions. However, the annual contribution of direct interventions to the prevention of tuberculosis increased from 18% in 2021 to 46% in 2024…..”

“Although these results are subject to several important data and methodologic limitations, they suggest that the long-term investments made by PEPFAR to address the HIV epidemic have accelerated progress toward the elimination of tuberculosis worldwide….”

GAVI – New vaccines could help us consign tuberculosis to history: here’s how we can do it

Sania Nishtar^{; https://www.gavi.org/vaccineswork/new-vaccines-could-help-us-consign-tuberculosis-history-heres-how-we-can-do-it}

“This year’s World TB Day theme, “Yes! We can End TB!”, sends a welcome note of optimism that the tide may finally be turning when it comes to tackling the world’s deadliest infectious disease. With new TB vaccines in the final stages of clinical trials, it is a message with which I wholeheartedly concur.”

With some more info on these vaccines in the pipeline, and GAVI’s role in their future roll-out.

Telegraph – New therapies are transforming treatment for drug-resistant TB – so why aren’t people getting them?

https://www.telegraph.co.uk/global-health/science-and-disease/new-therapies-transform-treatment-for-drug-resistant-tb/

“Despite the advancements, breakthrough drugs remain out of reach to millions.”

“Experts say patients are unable to access treatment because of a combination of factors, including high costs, constrained healthcare systems and barriers to testing, and that an urgent race is underway to address these issues and stop people being left behind….

“… Drug-resistant TB kills at least 150,000 people each year – about a third of those infected – compared with just 5-10 per cent for TB that responds to normal treatments….”

Re Drug-resistant TB: “…  the BPaL regimen has slashed both treatment times and side effects.  …”

“… The burden of TB is highest in middle income countries like India, Pakistan, Indonesia, Nigeria, and South Africa, according to Dr Babak, and is concentrated among the “most disadvantaged, often malnourished populations”.   This creates a catch 22 for distributing treatment for drug resistant TB, which is often more expensive.   “That’s why the issue can fall a bit between two stools,” said Dr Babak. “These countries, because of their overall GDP, are often ineligible for substantial international development aid. But the people most affected by TB within those countries are among the poorest and most vulnerable.”…”

“Health systems that are already stretched also often lack the infrastructure to rapidly roll out the new treatments, train clinicians, and monitor patients for side effects…..”

IMNHC 2026 (Nairobi, Kenya – March 23-26)

This week, Kenya hosted the International Maternal, Newborn and Child Health Conference (IMNHC 2026), bringing together global leaders, policymakers, researchers and health experts to accelerate action towards improving maternal and newborn health outcomes.  The conference was expected to generate renewed commitments and strengthen collaboration among countries and partners to accelerate progress towards ending preventable maternal and newborn deaths. 

Africa Health Watch – IMNHC opens with push for a ‘New Deal’ on Maternal and Newborn Health

Via  Africa Health Watch 

Re the opening plenary. “The International Maternal and Newborn Health Conference (IMNHC) opened on 23 March 2026 under the theme “Moving forward. Together.” Held in Kenya’s capital, Nairobi, the four-day convening brought together government officials, global health agencies, and development partners under a shared goal: to accelerate progress on maternal and newborn survival. However, the conversations at the opening plenary signalled a shift from technical discussion to something more urgent: accountability, systems, and scale.”

“In his speech, Africa CDC Director General, Dr Jean Kaseya, emphasised that Africa is at a defining moment, shifting the conversation away from technical fixes to something more political and urgent.  Kaseya proposed a “New Deal” for maternal and child health in Africa. It was a call for system-wide transformation rather than incremental change, tied to a broader continental vision of health security and sovereignty, built on domestic financing, stronger primary healthcare systems, digital infrastructure, and local manufacturing of essential commodities….”

PS: “… Together, the messages from the opening plenary reflected a broader shift in African health policy. Maternal and newborn health is no longer being framed solely as a sectoral issue, but as a test of governance, financing, and state capacity. From universal health coverage to domestic resource mobilisation, from digital systems to local manufacturing, the agenda outlined in Nairobi ties maternal survival to the continent’s wider push for health sovereignty.”

And a link:

·         Africa Health Watch – IMNHC 2026: Early Findings Reveal Gaps in Maternal and Newborn Survival Progress

PABS Annex negotiations: final analysis & advocacy ahead of the latest round

This week, the  Sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement was scheduled (from 23-28 March, so ending tomorrow evening normally).

In this first PABS related section, we offer some final analysis & advocacy, as this last round was about to begin. In the next section, we then provide coverage & analysis from this week (via our colleagues from HPW, Geneva Health Files, Devex, …)

As a reminder (via GHF): “Negotiations are now at the final stages in developing the WHO’s new pathogen access and benefit sharing (PABS) system, as an Annex  to the Pandemic Agreement (PA), adopted last May 2025.  The PABS System aims to facilitate the rapid sharing of pathogens with pandemic potential and their genetic sequence information, while ensuring fair and equitable sharing of benefits arising from their use, on an equal footing, especially access to vaccines, therapeutics and diagnostics (VTDs)…..”

This sixth IGWG meeting is the last scheduled meeting before the May deadline to finalize the agreement.

Devex – African CSOs call for equity as pathogen access talks hit final stretch

https://www.devex.com/news/african-csos-call-for-equity-as-pathogen-access-talks-hit-final-stretch-112114

(23 March) “With major issues still unresolved, civil society groups are urging African negotiators to hold the line for a binding system that links pathogen sharing to fair access to vaccines, treatments, and diagnostics.”

“Resilience Action Network Africa, together with 38 other civil society organizations, called on African leaders and negotiators to continue “pressing for a robust PABS framework grounded in equity and legal certainty.”…”

“The latest draft of the PABS annex, released on March 9, shows agreement only on scope and objectives, with major issues still unresolved. Experts warn that the worst outcome for Africa would be adopting a partially negotiated annex. Nelson Aghogho Evaborhene, a global health security expert, told Devex this remains a real risk given tight timelines and the need for consensus among diverse stakeholders….”  “If key elements such as enforceable benefit sharing and predictable access are not sufficiently addressed, this could affect confidence in the system and its ability to deliver equitable outcomes during future health emergencies,” he said.  Conversely, a well-balanced agreement could significantly strengthen global preparedness and trust — but a lot depends on the outcome of the upcoming IGWG negotiations, he said.”

“In earlier discussions, the Group of Equity — comprising countries from Africa, the eastern Mediterranean, and Southeast Asia — pushed for stronger provisions on database governance, user registration, and benefit-sharing mechanisms. This includes demands for rapid access to 20% of vaccines, therapeutics, and diagnostics developed using shared pathogen data…..”

“… The Third World Network, an advocacy organization focused on the Pandemic Agreement, has also raised concerns. It says the draft annex fails to align key elements with the Convention on Biological Diversity and its Nagoya Protocol, particularly around defining the boundary between commercial and noncommercial use of pathogen materials and sequence information. This gap, it argues, could create significant legal uncertainty in implementing the PABS system….”

TWN – Civil society calls on WHO DG to adhere to access and benefit sharing norms

K M Gopakumar; https://www.twn.my/title2/health.info/2026/hi260304.htm

“More than hundred civil society groups and coalitions working at the national, regional and national level have written to the Director-General of WHO to adhere to the international norms and standards on access and benefit sharing (ABS).  The letter asks Director-General Dr. Tedros Adhanom Ghebreyesus to ensure that WHO does not place undue pressure on developing countries to dilute their positions simply to secure a quick conclusion to the ongoing Pathogen Access and Benefit Sharing (PABS) system.  The letter was sent just before the start of the 6^th round of negotiations on the PABS System (23 to 28 March).  …”

HPW – Pandemic Talks: Europe is Blocking Health Equity – And It Knows It

G Faviero & N Ramakrishnan;   https://healthpolicy-watch.news/pandemic-talks-europe-is-blocking-health-equity-and-it-knows-it/

“…. While initially guided by noble objectives, to ensure universal and equitable access to build a more resilient and equitable global health architecture, the EU’s negotiating position has hardly reflected these commitments to date.  … Despite months of good-faith efforts by many delegations to advance text-based negotiations, the European bloc has been resistant to common-sense proposals to operationalize equity and ensure that the commitments set forth in Article 12 of the Pandemic Agreement can be implemented on an equal footing. …”

“With time now running short, pressure has been mounting on developing countries to accept a stripped-down annex that is devoid of adequate benefit-sharing provisions and legal guarantees. As was the case in May 2025, the WHO – namely the Director General’s (DG) Office and Secretariat – has reportedly been applying pressure on developing countries to accept a deal while bearing the full burden of making multilateralism succeed at any cost, even at the expense of their own negotiating priorities.  Should a deal on the PABS annex not be reached, it should be clear to all that it is because the European bloc has chosen to act in opposition to basic health equity provisions rather than align its negotiating stance with its (now empty) rhetoric that “no one is safe until everyone is safe.”

“… The PABS System rests on two interconnected pillars: the rapid and timely sharing of PABS materials and sequence information, and, on an equal footing, the rapid, timely, fair and equitable sharing of benefits arising from the sharing or utilization of the PABS materials and sequence information for public health purposes, especially vaccines, therapeutics and diagnostics (VTDs). “

“While minimal percentages have been guaranteed in the text of the agreement with respect to pandemic emergencies, the 9 March Bureau’s text appears to abandon the critical minimum percentage of VTD supplies to prevent or respond to Public Health Emergencies of International Concern (PHEICS). The text instead relies on undefined “options”, which may be left to be determined by WHO and pharmaceutical manufacturers through bilateral negotiations. ….”

They conclude: “… We do not write this as adversaries of European governments. As civil society members, we believe it is important to make EU governments fully conscious of the choices they are making and the implications of the demands they put forward.   We take the EU’s stated values seriously – its commitment to multilateralism, to the Convention on Biological Diversity, to the Pandemic Agreement, and to health emergency preparedness. It is precisely because we take those commitments at face value that we urge the EU to align its negotiating positions with the values that it claims to uphold….”

Geneva Health Files – Needed: Greater Accountability on Pathogen Data Sharing, To Minimize Biosecurity Risks & To Boost Preparedness [Guest Essay]

Geneva Health Files;

Published last Sunday, as the last round was about to begin. “Legal expert Nithin Ramakrishnan from Third World Network, who has authored this essay, examines currently proposed ways to share data and pathogens as per existing practices. He cautions against the potential risks resulting from non-transparent procedures that may fail to achieve equity in the access to medial products during health emergencies.”

A few excerpts to provide you with a flavour from this must-read analysis:

“…It appears though that the negotiating  text prepared by the Bureau of Intergovernmental Working Group (IGWG), supported by the WHO secretariat, may not effectively address global health security risks, at least on two counts. First, the proposed model is not providing any legal guarantee that VTDs manufactured will be made available to people as benefit sharing, compromising global public health preparedness. Second, the proposed PABS model could result in unaccountable, and non-transparent ways of sharing data, and pathogens that cause dangerous diseases. This goes against fundamentals and objectives of Convention on Biological Diversity (CBD) and Nagoya Protocol (NP), compromising not only benefit sharing but also biosecurity….”

“… Because there are currently no contracts required to be signed before accessing PABS materials or sequence information, there is no guarantee that WHO would be able to conclude required contracts with pharmaceutical companies. Even if a contract is concluded, there are no guarantees that VTDs may be supplied to developing countries during an early outbreak or PHEIC, on priority basis, in accordance with CBD’s Article 19.  …”

“… WHO circulated a document during the previous round of  negotiations at the IGWG meeting in February 2026. The document stated that there are “at least” 15 networks of laboratories coordinated by WHO addressing various pathogens. However none of these networks, except Global Influenza Surveillance and Response System (GISRS), apply ABS contracts dealing with access, utilization and sharing of benefits arising from the utilization of pathogens and/or data….”

“The PABS Annex, as proposed by the Bureau, and WHO Secretariat do not help global public health preparedness, but appear to promote the interests of WHO’s major donor countries and their pharmaceutical transnational corporations.  …”

Concluding: “ Unfortunately, the current bureau proposal, which the IGWG bureau drafted with the help of WHO Secretariat, makes all these functions, objectives and principles stand infructuous. It risks perpetuating health inequities, discrimination, and worse, creating additional health security risks. The WHO processes that involve international transfer of biological resources and data in disregard of ABS laws would continue the extraction of resources from global south to north, undermining the ability of developing countries to self-determine access conditions to their resources, to improve research and science locally,  and to benefit from the scientific progress resulting from such resources….”

PABS Annex negotiations: Coverage & analysis of this week (23-28 March)

This section provides an overview of the discussions so far in Geneva, via Devex, HPW, Geneva Health Files, and TWN mostly.

With first some reads on the opening day (Monday 23 March).

HPW –  Tense Start to Final Pandemic Agreement Talks as Africa Rejects New Draft Text

https://healthpolicy-watch.news/tense-start-to-final-pandemic-agreement-talks-as-africa-rejects-new-draft-text/

(must-read on the opening day)   “Tension was palpable at the start of the sixth – and supposedly final – round of talks on an annex to the Pandemic Agreement, with the African region rejecting the latest draft text.”

“… The message from one African country after another was that they would not allow a repeat of the inequity seen during the COVID-19 pandemic, and would not compromise on certain issues – including that the countries sharing pathogens need guaranteed benefits, and that the PABS annex needs “legal certainty” including contracts for commercial users of pathogen information…..”

“… Leading Africa’s position, South Africa and Namibia proposed that the draft text circulated by the IGWG Bureau on 9 March should be disregarded in favour of the on-screen text considered at the end of the fifth IGWG meeting on 14 February.  African regional ambassadors had resolved to stick to this text as they had not had time to consult their capitals on the new draft, Namibia reported.  But an exasperated Ambassador Tovar da Silva Nunes, co-chair of IGWG, accused the African countries of attempting to “curtail the possibility of the Bureau to actually fulfil the mandate that it was given by the membership”….”

Check out what happened then (re the text used for negotiations).

PS:  re the EU stance:  “The European Union reminded IGWG that the PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics”.  “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited,” said the EU representative, on behalf of the 27 EU member states…..”

Tedros’ opening statements: “… However, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that “there is a dangerous temptation to think more time might mean a better outcome”.  He cautioned: “We must be realistic: more time will not change fundamental positions, and it will not enable every detail of the PABS system to be set in stone in the treaty. More time would mean trying to continue negotiations in an increasingly unfavourable climate – this will get harder, not easier.”  Instead, Tedros told delegates that “this week, is the best chance – and probably the only chance – to secure an outcome on PABS…. Now is the time to bring solutions, not to reinsert text that will not help to build consensus.”…”

(well, obviously, he’s thinking of his legacy too…)

TWN – WHO: Developing countries reject Bureau’s text as negotiation basis

L Paremoer & Rajnia de Vito ;  https://www.twn.my/title2/intellectual_property/info.service/2026/ip260303.htm

Excellent day 1 report as well.   “ Developing countries rejected the Bureau’s draft negotiating text (Bureau’s Text) as a basis for negotiation during the sixth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement. The negotiations are on the Pathogen Access and Benefit Sharing System (PABS) under Article 12 of the Agreement….

Geneva Health Files – “We Mean Business”: Key African Countries Force Recalibration of the Negotiations on Pathogen Access Benefits Sharing System at the WHO

P Patnaik & N Sirohi; Geneva Health Files

Also re the opening day, with more detail. “… My colleague Nishant has overnight, pulled together the proceedings and most statements made by countries. ….”

And a few complementary remarks from Priti:

“… Civil society actors have long pushed for greater transparency in these proceedings, but a range of member states have been reluctant. The limited public webcast of these proceedings revealed the dynamics in these closed-door negotiations. The political utility of open proceedings came to the fore….”

“… It was striking that most of the manoeuvres during the opening debate yesterday, were essentially done by women negotiators. That all of them were from developing countries from the African region, is a significance worth noting.   Decision-making in global health is increasingly contested along the lines of gender, race, and agency. That women negotiators set the tone for these proceedings this week, is emblematic of change. Some also read it as an indicator of the decolonisation of global health negotiations…..”

Development Today –  Déjà vu in Geneva: Rich and poor countries in tense conflict over final rulebook for next pandemic

A D Usher;   https://www.development-today.com/archive/2026/dt-2–2026/pandemic-agreement-11th-hour

(gated) “There is a deep North-South split in the 11th hour of negotiations in Geneva to finalise the global pandemic treaty. At stake are rules that will govern access to pathogens used to produce vaccines and medicines against the next pandemic. A draft text that largely reflects the EU and Norway’s concerns faces massive critique. Developing countries say they will not accept being last in line for vaccines again, as they were during covid. Diplomats tell Development Today that Norway is no longer acting as a bridgebuilder to the Global South….”

TWN – WHO: Developing countries should not be forced to accept unbalanced PABS system

L Paremoer;  https://www.twn.my/title2/health.info/2026/hi260303.htm

With a detailed view from CSOs at the opening session. “Civil society organisations (CSOs) expressed concerns over the attempt to force developing countries to accept an unbalanced Pathogen Access and Benefit Sharing (PABS) system during the opening session of the Sixth meeting of the Intergovernmental Working Group (IGWG), the negotiating body for the PABS system.”

“… CSOs that closely follow the negotiations process have been calling on developing countries to resist a one-sided PABS system, which goes against the international norms and standards on access and benefit sharing of genetic resources. Nearly 19 non-state actors took the floor to express their views on various aspects of the PABS system on Monday, 23 March. CSOs emphasised the need for concrete benefit sharing commitments as well as effective mechanisms for the enforcement of benefit sharing obligations, transparency and accountability….”

HPW –   Talks Deadlock: Should Pandemic Agreement Annex Go to a Vote?

https://healthpolicy-watch.news/talks-deadlock-should-pandemic-agreement-annex-go-to-a-vote/

“A snail would have a faster passage than the Pandemic Agreement talks currently underway in Geneva, according to a briefing on Wednesday by civil society observers – some of whom mooted the possibility of World Health Organization (WHO) member states voting on the outstanding annex to break the deadlock.”

“Only one portion of a single paragraph has been “greened” – fully agreed – since the sixth meeting of the Intergovernmental Working Group (IGWG) started on Monday, according to Third World Network’s KM Gopakumar…..”

With some interventions from the webinar, by a number of civil society people.

PS: “the vote” is an interesting idea.

More on PPPR

Lancet Comment – Elevating spillover prevention at the 2026 UN High-Level Meeting on pandemic prevention, preparedness, and response

A Finch, L Gostin et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00557-X/fulltext

“..The UN General Assembly had already agreed to hold a follow-up High-Level Meeting (HLM) on PPPR in 2026 to review implementation of its 2023 Political Declaration on PPPR and consider the amendments to the International Health Regulations (IHR), which were adopted in 2024, and the 2025 WHO Pandemic Agreement⁴ as related processes. The UN General Assembly is expected to adopt another Political Declaration as an outcome of the upcoming HLM in September. It is vital that this Political Declaration galvanise political, technical, and financial support for spillover prevention as a core pillar of pandemic governance.”

“… The 2026 HLM on PPPR could elevate spillover prevention to the highest political levels, building on these recent advances in global health law. As members of the Lancet–PPATS Commission on Prevention of Viral Spillover and civil society partners, we recommend that the resulting Political Declaration address five priority areas….”

Global Health reform & re-imagining (+ post-aid)

From what we heard (Bruce Aylward at a HEAR CSO webinar yesterday), a document will be posted online very soon on how WHO sees the WHO-hosted process on the GH reform. Will be posted for feedback. So stay tuned for that.  And then a ‘sprint’ is to begin till the WHA in May.

HEAR CSO – some new resources

https://mailchi.mp/1b799d670566/hear-cso-newsletter-1-consultation-summary-and-upcoming-survey-3573149?e=cfc03fb78f

As discussed at the webinar yesterday.

Among others:

·         The Discussion Draft of our synthesis report combining findings from regional consultations and the HEAR CSO Global Survey.

 With some key findings in the executive summary.

“Civil society and impacted communities engaging with HEAR CSO’s consultative processes strongly support three pillars of a transformed global health architecture reform…. …. Civil society and impacted communities engaging with HEAR CSO’s consultative processes are in alignment on the need for ambitious, holistic transformation, and hold diverse views on short-term, institutional reforms…. There is a significant gap between civil society and impacted communities’ interest and readiness to engage in global health architecture reform and their actual access to reform processes….”

·         The HEAR CSO Statement on Core Principles for All Global Health Architecture Reform Processes & Specific Considerations for the WHO-hosted Reform Process.

Based on analysis of inputs, themes and experiences from civil society and impacted communities. 

6-pager with two parts.

Partnership for International Politics and Diplomacy for Health – slide deck: What’s at Stake and What Comes Next for Global Health Reform

https://www.globalhealthdiplomacy.se/whats-at-stake-and-what-comes-next-for-global-health-reform

(20 March) “The Partnership for International Politics and Diplomacy for Health has developed a slide deck providing an overview of the ongoing global health reform discussions, covering major developments since mid-2025, the drivers behind the current momentum, and the obstacles that could prevent meaningful change.   … …The presentation draws on the Partnership’s ongoing series of Insights papers, which include more in-depth analyses of key reform trends and perspectives. It maps the evolving reform landscape, including prominent initiatives such as the Accra Reset and the emerging WHO-hosted process, and highlights four paradigm shifts that could help guide reform efforts.”

Telegraph – The aid system is ‘unfit for purpose’. So what comes next?

https://www.telegraph.co.uk/global-health/climate-and-people/aid-africa-uk-budget-cuts-donor-investor/

Coming back on the Wellcome Trust synthesis report from last week. “Major aid donors including the United States and Britain are overhauling their relationships with the developing world.”

“The global aid system is “unfit for purpose”.  That was the conclusion of a landmark report published last week by the Wellcome Trust, a UK-based foundation focused on health research, which warned that dramatic cuts to international aid have left the development ecosystem struggling to cope.  But the unprecedented downturn in Western largesse is both a crisis and a rare opportunity for major reform, it said.”

“So what comes next? What might a reformed global health model look like? And might today’s recipients of aid actually be better off tomorrow?”

“A blueprint has already emerged showing how the relationships between wealthier countries, and the poorer ones they have supported, will change.  Now, with less money being spent, many countries including the UK and US say they are pivoting from donors to investors to help poorer countries develop on their own terms.   “Our partners in the Global South tell us they want partnership, not paternalism. Investment, not dependency. They want to trade and build their own systems so they can thrive without aid. Our job is to help them do that,” (UK) Foreign Secretary Yvette Cooper said in parliament last week as she unveiled the UK’s revamped aid plan. 

Instead of traditional “bilateral” aid – direct grants to poor countries – Britain will now focus on offering technical assistance and encouraging investment from the private sector into countries in Africa and Asia to help them “graduate” from needing aid altogether. …”

“But will it work? Experts say the impact of the changes will be unevenly felt.   Developing countries at the upper end of the development spectrum – places like Sierra Leone, Ghana, and Kenya – may benefit from greater access to capital and expertise.  Yet others, particularly more fragile states, risk being pushed further into poverty, experts warn, particularly as private sector investment tends to lean away from areas like health and education – those hit hardest by aid cuts – and more into those with more direct returns like infrastructure, financial services, and digital innovation….”

PS: And a quote on the (US) bilateral health deals: “Many of the deals also require African countries to sign up to US regulatory approval before introducing new drugs and technologies.  While the administration of Joe Biden quietly struck individual deals with African countries – agreeing to provide aid to Nigeria and the Democratic Republic of Congo in exchange for access to data on diseases – many see the strategy of Trump’s administration as more overtly transactional, even exploitative…..

ODI – Dialogue #4: How to be a donor in a post-aid world

H Aly et al ; https://odi.org/en/publications/dialogue-4-how-to-be-a-donor-in-a-post-aid-world/

“Co-hosted with the Dutch Ministry of Foreign Affairs in the Hague on 27-28 January 2026, this dPAW fourth dialogue brought together donor officials from bilateral aid and multilateral policy departments, civil society actors, researchers and thinkers to explore how Northern donors must evolve their institutions and operations in a world where their partners seek greater autonomy and sovereignty, where aid is likely a smaller development finance flow, and where eventually donors may not need to exist at all.”

Excerpt: “ … both donors and their partners are converging on Country-Led Development (CLD) as an anchor for a future reset of the sector. The question animating our dialogue thus became: how should donors adapt to this moment? What will it take for donors to foster CLD in the short run, and what might this mean for the institutional design – or even existence – of Northern donorship in the long run? The two-day dialogue considered how donors might, in the long-term, re-imagine their roles in a post-aid world. Several potential ideas emerged: • Donors should robustly transition into ‘development partners’ (most already describe themselves this way) who work with countries in the Global South on a platform of shared interests. Partnership should rest on honest and transparent diplomatic relations that do not heavily rely on resource transfers. • Donors could work across government to harness a range of diplomatic and specialist skills and a much wider suite of financial and non-financial instruments to support development. • Donors could use their diplomatic and political capital to champion policy reforms and regulatory changes that improve the conditions for economic development in the Global South. • Adopt a set of more expansive roles that support CLD, including serving as advocates for local actors, building sustainable systems, co-learning and brokering knowledge exchange, convening and amplifying actors and networks….”

“…The dialogue (also) identified the following elements as potential steps in the pathway towards a world without ‘donors’, where development is driven by more equal partnership…”

Bilateral Health Agreements & US Global Health Strategy

PS: as a reminder:  Detailed implementation plans for each MOU are expected by March 31, 2026   …

Devex Pro – What role will the Global Fund play in the US bilateral health deals

https://www.devex.com/news/what-role-will-the-global-fund-play-in-the-us-bilateral-health-deals-112046

(gated) “With the shift in U.S. policies, “everyone” now looks to the Global Fund to ensure the continuity of critical health services.”

See “Global Fund is in the house”:

“Behind the scenes, sources say the fund has been in the proverbial room — with technical experts involved in negotiations, sitting in on implementation talks and positioning its procurement platform as USAID’s shutdown leaves major gaps in how health commodities are bought and delivered.”

“The Global Fund confirms that it has been involved, Devex Senior Reporter Jenny Lei Ravelo writes — but only as an observer. “This reflects our standard approach to supporting coordination and ensuring complementarity of external financing with national health plans and existing Global Fund investments,” a spokesperson says.   “

“The bigger question is what happens next — especially for services the U.S. may no longer prioritize.   In places such as Kenya, some PEPFAR-supported drop-in centers have already closed, and others are running on reduced funding — raising concerns about access for marginalized groups. 
“With the politics coming from the U.S. and their funding, and when you sign these documents, is this going to erase the gains we’ve made over the last 20 years?” Nguru Karugu, adviser to the Key Population Consortium in Kenya, tells Devex. “Personally, where I’m sitting, I’m not sure the government knows the answer to that, and I don’t.”…”

Chatham House (Expert Comment) – US pressure on Zambia shows that Western aid has become nakedly transactional

Mishal Khan;  Chatham House; 

“The US insisting on preferential access to minerals as part of health deal – and Zambia pushing back – highlights how aid is changing.”  Well worth a read.

The Hill – The US is sabotaging its own Africa strategy

C M Savoy;   https://thehill.com/opinion/international/5795831-zambia-health-aid-strategy/

Coming back on the “Zambia episode” from last week.   A few excerpts:

“The State Department memo is unambiguous. According to reporting in The New York Times, State Department staff advised Secretary of State Marco Rubio that the United States “will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale.” The priorities in question are preferential access to Zambia’s copper and cobalt reserves. The support being threatened is antiretroviral treatment for 1.3 million Zambians living with HIV. This is not a wise use of U.S. foreign assistance. It is coercion dressed in the language of strategy, and it will fail on its own terms.  … .. The question is whether threatening to cut global health funding is a rational way to secure long-term access to minerals. The answer, on strategic grounds alone, is no.”

“… What the Zambia memo reveals is not a bold negotiating posture. It reveals an administration that has not resolved the internal contradiction between its stated corridor strategy and its transactional instinct…”

Instead, “… The administration must establish a firm, permanent firewall between humanitarian and strategic assistance, and then direct the full weight of its economic tools toward building the conditions that make U.S. investment in Zambia viable in the long term. That is the return on investment the administration claims to want — and it is achievable without making global health funding a bargaining chip.”

Partners In Health Opposes Extractive U.S. Health-Financing Agreements

https://www.pih.org/press/partners-health-opposes-extractive-us-health-financing-agreements

“Partners In Health (PIH) vehemently opposes new extractive conditions being written into global health-financing agreements by the United States State Department. These memoranda of understanding (MOUs) clarify exactly what an “America First Global Health Strategy” looks like:   Prioritization of U.S. commercial interests over human life by withholding health funding in exchange for minerals and data.  Massive cuts to U.S. global health funding over the next five years – regardless of continued appropriations from the U.S. Congress. Establishing unachievable conditions to co-financing that manufacture failure. “

Trump 2.0

Devex – Waltz pushes UN cuts, mergers and foreign aid tied to votes

https://www.devex.com/news/waltz-pushes-un-cuts-mergers-and-foreign-aid-tied-to-votes-112127

“At a congressional hearing in New York City, the U.S. ambassador to the U.N. outlined his vision for a leaner, more focused multilateral system.”

“The United States ambassador to the United Nations laid out his ambitions for the future of the U.N. on Friday, telling lawmakers that he was pushing for job cuts and mergers at the institution, while expressing support of a plan to tie U.S. aid to countries that back America’s interests at the U.N.”

PS: “The president has also spoken out strongly against the institution as a whole, claiming the U.N. was ineffective at brokering peace. The country has also withdrawn or stalled multiple U.N. processes, from last year’s Financing for Development Conference to last week’s Commission on the Status of Women.  But for now, Waltz seems to have staked his place — and that of the U.S. — firmly at the U.N.  “I’ll just conclude with President Trump’s own words, as he said most recently at the General Assembly: the U.N. has tremendous potential,” said Waltz. “My charge from him is to help it realize that potential.”…”

Lancet editorial – Politicisation of the US FDA: eroding integrity and trust

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00600-8/fulltext

This week’s Lancet editorial.

Science News – Trump’s new science panel is stuffed with high-tech billionaires

https://www.science.org/content/article/trump-s-new-science-panel-stuffed-high-tech-billionaires

“The PCAST roster contains few academics and women.”

“U.S. President Donald Trump today unveiled a set of scientific advisers heavily skewed toward artificial intelligence (AI) and quantum computing, topics his administration has emphasized. The roster, unlike previous iterations of the President’s Council of Advisors on Science and Technology (PCAST), features some of the world’s wealthiest people and several of Trump’s biggest political supporters from high-tech industry—but only one academic scientist….”

“Today’s announcement named the first 13 members of what could ultimately be a 24-member body. They include multibillionaires Larry Ellison of Oracle, Mark Zuckerberg of Meta, Jensen Huang of Nvidia, Lisa Su of AMD, Sergey Brin of Google, and Michael Dell of Dell. John Martinis of the University of California, Santa Barbara, who shared the 2025 Nobel Prize in Physics for work fundamental to quantum computing, is the only current academic. And Su and Safra Catz, former Oracle CEO and financier, are the only women in the group.  In contrast, two-thirds of the 30 PCAST members under former President Joe Biden were members of the National Academies of Sciences, Engineering, and Medicine and 14 were women, including co-chairs Frances Arnold and Maria Zuber.”

More on Global Health Governance & Financing/Funding

Devex – Is PEPFAR about to run out of money?

A Green;  https://www.devex.com/news/is-pepfar-about-to-run-out-of-money-112112

“Though U.S. officials are extending HIV programs funded by the Centers for Disease Control and Prevention for three more months, they have not obligated new funding to cover the services.”

“After previously being told to shut down at the end of this month, HIV programs funded by the U.S. Centers for Disease Control and Prevention that assist tens of thousands of people globally can now continue to operate through June. But they will do so without new funding. Instead, the programs, which are operating under the President’s Emergency Plan for AIDS Relief, or PEPFAR, will rely on funds that were previously set aside for contingencies, according to a CDC spokesperson.

While the extension is a relief to the service providers and beneficiaries, researchers are warning that without an infusion of new money from the U.S. State Department, CDC might run out. Even as they are being extended, some programs are already being told to scale back their lifesaving services.”

Meeting of the Coalition of Governments on Global Public Investment

https://gpigovernments.org/coalition/

PS: this coalition was launched last year in Sevilla (July 2025).

“Last week in Bogota, governments took a major step forward to remake international financing. 
25 governments came together in a groundbreaking meeting of the Coalition of Governments on Global Public Investment. The meeting was hosted by the Government of Colombia at the CELAC-Africa High Level Forum. …”

“… The governments see global public investment (GPI) as a way to make financing fit for the twenty-first century. GPI, they point out, harnesses both the power of mutual interest – that we are interdependent – and the power of mutuality – that we achieve more by working together. It recognises that all countries benefit from shared solutions, to which all contribute according to their means, and in which all decide together as equals.  Regular convenings of the Coalition of Governments on Global Public Investment will take place across 2026 and 2027. The coalition continues to grow. Participation is open to all governments: interested governments can contact coalition@globalpublicinvestment.net….”

Devex Pro – Former AfDB president Kaberuka says global health ‘golden era’ is over

https://www.devex.com/news/former-afdb-president-kaberuka-says-global-health-golden-era-is-over-112148

(gated) “As donor funding declines and global priorities shift, former AfDB President Donald Kaberuka argues that the global health system must undergo reform — driven not by institutions themselves, but by the partners that created them.”

“The global health system that delivered decades of progress is entering a new phase, which countries had not adequately prepared for — leaving them “staring down a cliff.”   That was the stark message from Donald Kaberuka, the African Union’s special envoy on sustainable financing and former president of the African Development Bank, during a Devex Pro Briefing, where he laid out a case for fundamentally rethinking how global health is financed, governed, and delivered….”

“….the ultimate decision, Kaberuka said, should be made by those who created these (global health) institutions — which include governments and even philanthropists.”

“It is important for the people who set up the institution themselves to define what is the next level, what the sunset clause? You cannot depend on the institutions themselves to do that,” … He said organizations should be able to recognize when their mission is complete — and hand over responsibilities, ideally to countries. But he’s skeptical that bureaucracies can make that call on their own. “Bureaucracies auto-evaluate and then feel they can do things differently,” he said.”

BMJ (Analysis) – The United States is driving a public health emergency of international concern

https://www.bmj.com/content/392/bmj-2026-089474

First contribution in the new ‘Geopolitics of Global Health series’. And one of the reads of the week.

“Matthew Herder and colleagues call for broader mobilisation to avoid the deaths and morbidity in low and middle income countries likely to result from recent US policy changes.”