From Albania to Zambia: List of Cancelled USAID Projects Provides Insight into US Influence 14/03/2025 Kerry Cullinan USAID assisted health workers in Guatemala to maintain antenatal services and social support for pregnant women during COVID-19. The list of United States Agency for International Development (USAID) projects that the Trump administration has cancelled runs to 368 pages and provides a rare glimpse of the extent of the US international influence. READ HERE: USAID Terminated Awards (6 March 2025) Projects vary from huge infrastructure support programmes (14 to unspecified countries worth $800 million each) to a $10 million investment in developing insect-resistant eggplants. They range from supporting famine early warning system networks (three projects worth $900 million each) to establishing an American Chamber of Commerce in Belarus. Almost every country is affected – from Albania to Zambia. A huge $520 million ‘Prosper Africa’ programme to foster trade between the US and Africa has been terminated, and so too have programmes to improve the soybean yield in sub-Saharan Africa and to assist African health ministries to deal with infectious diseases. There are some surprises. Venezuela received a few grants, including one to secure its agricultural sector. Although the communist government of Venezuela is a sworn enemy of the US, it was no doubt prudent for the US to try to support the country to stem the tide of immigrants. Grants were also made to Iraq and Syria for “technical assistance to repatriate families” and to assist with child immunisation despite the rancour between the US and those countries. Grants for “humanitarian assistance for persecuted people in Cuba” and to promote “religious and ethnic freedom” in Asia were also cancelled. Numerous projects aimed at bolstering food security, and combatting malaria, tuberculosis and HIV were also canned. So too were projects to combat corruption and cybercrime. The door is wide open for new donors – and criminals – to take advantage of the resource vacuum. HIV sector warns of millions of deaths Earlier this week, over 530 HIV doctors, researchers, scientists, and public health experts gathered at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco wrote to Rubio calling for “an urgent reversal of recent decisions by the Trump administration that are doing catastrophic harm to the global and US response to the AIDS pandemic”. The signatories wrote that the termination of projects on 26 February – “virtually eliminated” all US President’s Emergency Plan for AIDS Relief (PEPFAR) programming implemented by USAID, and US-supported malaria and tuberculosis programmes – will “result in millions of preventable deaths around the world while decimating global progress over the last 25 years”. They also expressed alarm at the defunding of clinical trials that have “stranded study participants without clinical support” and the stripping of scientific institutions of staff and funding. “Over time, these policy decisions may be proven illegal in US courts but the human suffering and loss of lives happening now cannot be reversed by any court order,” they note. Meanwhile, the US State Department has refused to comment on reports that over 700 diplomats have signed a letter addressed to US Secretary of State Marco Rubio condemning the cuts for endangering US security. An extract of the letter, said to have been filed on a staff channel that allows anonymous contributions, says: “The decision to freeze and terminate foreign aid contracts and assistance awards without any meaningful review jeopardizes our partnerships with key allies, erodes trust, and creates openings for adversaries to expand their influence.” An online group to track job losses from USAID closures, USAID Stop Work, estimates that over 50,000 US citizens and 100,000 global workers have lost their jobs. It has been able to confirm 14,762 US jobs and 64,910 global jobs lost so far. Image Credits: MSH. Marburg Outbreak Ends in Tanzania, but Africa Faces a Rising Tide of Health Crises 13/03/2025 Paul Adepoju Health workers contain the highly fatal Marburg virus during an outbreak. Tanzania has extinguished a deadly outbreak of Marburg virus, but elsewhere across Africa, an alarming surge of health crises continue to unfold – including expanding mpox infections in Uganda, a cholera outbreak in Angola and a first-ever cholera case in neighbouring Namibia. The Marburg virus outbreak in Tanzania has officially ended, Tanzanian health authorities declared Thursday, marking a pivotal achievement in the continent’s ongoing battle against highly lethal infectious diseases. The success reflects the effectiveness of the coordinated international health response, said Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), commending the Tanzanian government’s swift and decisive action at a press briefing on Thursday. Infamous for its haemorrhagic fever, Marburg virus kills up to 88% of those infected, posing a significant threat after it rapidly spread across Tanzania. The outbreak, declared on 20 January 2025, resulted in 10 fatalities – eight probable and two laboratory-confirmed cases. Tanzanian authorities implemented containment measures, with substantial technical and logistical assistance from the World Health Organization (WHO) and Africa CDC, including disease surveillance enhancements and extensive frontline health worker training. WHO’s Regional Office for Africa confirmed that the outbreak officially ended after 42 days had passed without new cases, meeting the criteria to declare an outbreak over; it commended Tanzanian authorities for prompt action in squashing the outbreak. WHO, Africa CDC cooperation to quell Marburg This marks Tanzania’s second successful containment of Marburg, following an outbreak in the same northeastern Kagera region in 2023. In this year’s outbreak, WHO said it collaborated with Tanzanian health authorities to scale up surveillance and response activities, training over 1,000 frontline health workers in contact tracing, clinical management, and risk communication, and delivering over five tonnes of essential medical supplies. Dr Jean Kaseya, Africa CDC Director General, commended Tanzania’s swift response. “While the outbreak has been declared over, we remain vigilant to respond swiftly if any cases are detected and are supporting ongoing efforts to provide psychosocial care to families affected by the outbreak,” said Charles Sagoe-Moses, WHO Representative in Tanzania. Kaseya also emphasized Africa CDC’s supportive role, including substantial assistance in laboratory reinforcement, provision of diagnostic kits capable of thousands of tests, and extensive healthcare worker training programs. These interventions enabled rapid case identification, isolation, and treatment – crucially preventing the virus’s broader spread. Persistent health emergencies across Africa A new and more deadly variant of Mpox continues to threaten 16 countries. But even as Tanzania celebrates its victory over Marburg, outbreaks of mpox, Ebola, cholera, and COVID-19 are placing immense pressure on healthcare systems across Africa, revealing systemic weaknesses and vulnerabilities, Kaseya emphasized. Uganda continues to face a troubling escalation of mpox – even though although recent weeks have seen no new cases of the even more deadly Ebola virus. Uganda’s mpox epicenter is in the country’s south-central region around the capital Kampala area. And nearby, on the shores of Lake Victoria, the overwhelmed Entebbe treatment center has seen most of Uganda’s mpox-related fatalities. Kaseya emphasized the urgent need for expanded isolation facilities, increased healthcare staffing, and strategies for home-based patient care to manage mild cases effectively. Meanwhile, the Democratic Republic of Congo (DRC) presents its own complex scenario, further complicated by continuing violence and instability in the North and South Kivu regions of Eastern DRC, where Rwanda-supported M-23 militia have made big inroads against government forces. Over 600 mpox patients fled treatment centers in the regional capital of Goma, Bukavu and other areas that were overrun by rebel forces, creating significant challenges in tracking and managing the disease. There are intensified efforts to establish humanitarian corridors, involving community health workers tasked with locating and reintegrating affected individuals into the health system. However, until a cease-fire is reached, insecurity will likely hamper those efforts, Kaseya said. Funding shortfalls threaten containment efforts Namibia reported its first cholera case in over a decade, highlighting vulnerabilities in the continent’s health infrastructure. Kaseya also revealed that funding shortages present a severe obstacle. Dramatic cuts to international aid, notably from traditional donors such as the United States and the United Kingdom, have only exacerbated the situation. These reductions, he said, significantly affect Africa’s capacity to manage public health crises effectively, creating urgent shortfalls in vital resources needed for outbreak response and containment efforts. “Mpox remains a serious concern,” Kaseya warned. “We are facing a critical risk. Without sufficient vaccines, we will inevitably see more cases.” The financial strain extends beyond mpox. Angola now faces an ongoing cholera outbreak, for which Africa CDC is providing emergency support, delivering 2,000 doses of oral cholera vaccines. Primarily affecting children, the cholera crisis in Angola highlights continued regional challenges in water and sanitation infrastructure. And neighbouring, Namibia recently reported its first cholera case in nearly a decade within a community near the Angola border – underscoring the interconnected fragility of public health systems across the region. Seeking sustainable solutions Amid these pressing challenges, Kaseya articulated Africa CDC’s commitment to fostering innovative and sustainable financing solutions. At the forthcoming World Bank and IMF spring meetings, African health and finance officials will participate in discussions with multilateral development agencies about how they can enhance national resilience and promote self-reliance in managing public health threats. Emphasizing the importance of national ownership, sustainable funding mechanisms, and strengthening local manufacturing capabilities, Kaseya advocated for sustained international engagement and solidarity. “Health security in Africa is global health security,” Kaseya reiterated. Image Credits: WHO, Africa CDC, Africa CDC. Switching from Biomass to LPG Failed to Show Health Gains in Four-Country Study of Household Air Pollution 13/03/2025 Disha Shetty Switching from biomass to LPG for cooking, reduced exposures to air pollution, but didn’t lead to measurably significant health gains, a four-country study found. A four-year, multi-country trial measuring health impacts of reduced indoor air pollution due to the shifting of households from biomass to Liquefied Petroleum Gas (LPG) has yielded mixed results – defying expectations that reduced indoor air pollution would yield significant health benefits. The study of 3,200 households in four Asian, African and Latin America countries showed that while the exposure to indoor smoke fell, the expected health gains did not follow. Despite improvements in air quality so that two-thirds of the households met WHO’s Interim Target 1 for household air pollution, the incidence of severe pneumonia among infants up to one-year “did not differ significantly” when compared to infants in those households that continued to use biomass, investigators with the Household Air Pollution Intervention Network (HAPIN), found. Nor did the birthweight of newborns rise significantly or incidence of stunting at 12 months decline – two other early childhood health impacts associated with poor household air quality. WHO Interim Targets 1 (35 µg/m3) and 2 (25 µg/m3) offer milestones for countries aiming to reduce high household air pollution levels, on the way to the recommended guideline level of 5 µg/m3 of PM2.5. WHO has set several interim targets to guide countries as they aim to reduce their air pollution levels. “Everybody kind of expected on the basis of observational studies that now we’re going to see some health benefits from this, even though, you know, a few other experimental studies were saying, well, we’re not seeing it,” Thomas Clasen, the trial’s principal investigator told Health Policy Watch. “So, people are really scratching their heads.” He is an epidemiologist and professor at Emory University. This also raises a core policy question: should countries push ahead with fossil fuel-heavy LPG or should they instead leapfrog to electric cooking powered by renewable energy like solar? The HAPIN trial was launched in 2017 and followed 800 pregnant women, 120 older adult women, and 800 infants in poor communities dependent on solid fuels across Guatemala, India, Peru, and Rwanda. One half of the 3200 households were provided access to LPG for 18 months and results were monitored. The trial was funded by the National Institutes of Health (NIH) and the Gates Foundation, among others. A woman in Guatemala cooks on an LPG stove that she received for free through the HAPIN study. Mix of positive and negative results The results showed a mix of positive and negative outcomes. “Intervention households used LPG exclusively 99.99% of the time,” said Kalpana Balakrishnan of Sri Ramachandra Institute of Higher Education and Research who led the India-leg of the trial. “That answered the question that if you remove the economic barrier, households are willing and able to use a clean energy source, i.e LPG exclusively,” she said. Average air pollution concentrations in two-thirds of the LPG households declined by half or more – less than 35 µg/m3 (micrograms per cubic meter), Clasen said. The control group that did not use LPG had household air pollution hovering around 70 µg/m3. “All the health improvements that we expected to see in the intervention compared to the control we did not see,” Balakrishnan told HPW. Muddying the debate over fuel switching The World Health Organization (WHO) has also avidly promoted LPG as a clean cooking fuel alternative – despite its climate impacts as a fossil fuel, derived from oil and gas production. These trial results now muddy the debate over whether LPG is still the best option as an “interim” clean fuel choice – or whether countries would be better off promoting electric cooking and heating options, which could reduce indoor emissions even more if they were powered by renewables – and not oil or coal generation. WHO, for its part, says that the issue will surely be a hot topic of discussion at a major upcoming meeting on air pollution – the Second Global Conference on Air Quality and Health, scheduled for 25-29 March in Cartagena, Colombia. “WHO is currently reviewing the results from the HAPIN trial and will integrate such evidence in the guidance and support we provide to countries to protect health from household air pollution,” Heather Adair-Rohani who leads the work on air quality, energy and health at WHO headquarters in Geneva told Health Policy Watch in an email response. “How best to use the results of HAPIN and other key studies to inform decision-making on household energy will be key topic at the upcoming second WHO global conference on air pollution, where WHO, in cooperation with the government of Colombia is calling on countries, cities and organizations to work together to cut the health impacts from air pollution in half by 2040,” she added. The curious case of lack of health gains despite reduced air pollution WHO estimates that around 2.1 billion people worldwide cook on open fires or inefficient stoves that use either kerosene, biomass or coal. Household air pollution was linked to 3.2 million deaths per year in 2020. And while poor air quality is linked to worsening health, improving air quality in the HAPIN trial did not translate to improved health gains. A majority of the world’s population still without access to clean cooking energy is in the developing world. The researchers have one key hypothesis as to why. “In a community where you have multi-dimensional poverty, if you give a clean fuel intervention for a short time, you may not be in a position to pick up the health benefits that result from it,” Balakrishnan said. “What you need is to follow them up for a much longer period of time where they continue to use LPG,” she added. Balakrishnan continued, “The way we have to approach this, … in these poor households, you need a package of interventions to achieve improvement in health.” Clasen too agreed, “We have to say, well, maybe this isn’t going to be enough by itself to achieve the benefits, the health benefits that you were after.” Households with the biggest declines in air pollution did see some benefits One other striking factor is that a small set of households with the biggest concentrations of air pollution before the trial, and thus the biggest declines in pollution from the shift to LPG – did experience more measurable health impacts. That could suggest that reductions in air pollution that are larger and more dramatic in order yield more measurable health impacts, at least short term. “When we look at the folks who had the biggest reductions in exposure, it does look like they’ve benefited…at least reductions in PM, 2.5 and black carbon,” Clasen said. However, at the lower end of the household air pollution scale, the precise relationship between pollution declines and improvement in health benefits – the so-called “dose-response curve” are not yet well defined, Clasen added “We do not have well-populated dose-response curves for HAP and [health] outcomes,” he said. “So we cannot rule out health benefits that might have been gained at very low levels of exposure.” But practically speaking, it’s going to be very difficult to push household concentrations further down in many low-income settings when other environmental and cultural factors such as high rates of smoking, as well as high levels of outdoor air pollution also come into play, he added. “It’s unlikely that any programmatically delivered HAP intervention is going to achieve lower levels of exposure than what we achieved here, when we had the benefit of free stoves and fuel – and thus nearly exclusive LPG adoption. So from a practical standpoint, we are not likely to improve these health endpoints by getting householders to lower levels of exposure than what we achieved in the trial.” What do these results mean for policy? Regardless of the mixed outcomes, Clasen stressed that the results should not be read as a signal to put brakes on transitioning to LPG in developing countries. LPG is significantly better for climate when compared to biomass because of its lower greenhouse gas emissions. Even if switching to LPG does not lead to expected health gains in the short run, it still is a significantly efficient fuel. It also lowers greenhouse gas emissions compared to biomass and thus has climate benefits apart from reducing the drudgery involved for women. LPG’s positive impact on women “When you’re cooking over a chulha (earthen stove), the drudgery from collecting the firewood or the coal or the gobar (cowdung) to prepare the chulha versus cooking on an LPG…the time it takes…there’s also an opportunity loss because of the time that’s lost in cooking and working around it,” said Neha Saigal, Director of the Gender and Climate Change programme with India-based Asar Social Impact Advisors. Women in the communities Asar works with expressed willingness to use LPG when it was an affordable option. Cooking on a traditional stove using biomass or coal also directly exposes women to even higher levels of air pollution than might be measured as ambient indoor levels, Saigal said. So shifting may have other health benefits that weren’t captured yet by the HAPIN trial. An Indian woman cooks with an LPG stove that she received as a participant in the HAPIN study. Beyond LPG: Staring at limited options LPG is increasingly affordable and accessible in many developing countries. India, the world’s most populous country, has made tremendous gains in improving LPG access among poor and rural communities though gaps remain. Around 99.8% households in the country now have access to LPG for cooking, according to government data from the year 2021. And while LPG is a fossil fuel, it is significantly cleaner than biomass. Alternatives to LPG are either not efficient enough for everyday and reliable use, like solar, or require reliable electricity. Clasen has two reservations about promoting electricity for household cooking in developing countries right now. “One is, is electricity going to do any better than LPG? Right, number two is that [the] electricity is usually generated using fossil fuels, so we may not actually be reducing the climate load by transitioning to electricity unless we also can figure out how to do it renewably,” he said. Other experts said the quest for better solutions should nonetheless continue. “I don’t see any other solution at this point of time, at scale other than LPG. But yes, there’s a lot of scope to demonstrate, to pilot with electric cooking, to come up with better chulhas that don’t give out smoke…solar cook stoves,” Saigal of Asar said. “But if we want to support women at the moment, we should make LPG available to them, because that is the thing that’s available now in the market,” she added. Balakrishnan also raises an ethical question – the poor should not bear the burden of waiting to transition to electric cooking when it is not the norm in urban and well off households. Given that LPG is a viable near-term clean energy choice, the poor too should have access to it right away, she said. Continuing long-term research will yield more answers For now, the HAPIN trial continues to follow children in three locations – Guatemala, India and Rwanda – until they reach the age of five. They want to see if delivering their mothers LPG access for 18 months has had any long-term health benefits that might become clear only later, like neurocognitive development or development of a child’s mental abilities. “It could be quite compelling from a policymaker standpoint,” Clasen said. Image Credits: WHO/Adobe Stock/Dennis Wegewijs, WHO, Guatemala HAPIN team, T20 Policy Brief, July 2023, India HAPIN team. USAID ‘Officially’ Gutted, but Administration Overstepped Constitutional Power, Judge Rules 11/03/2025 Sophia Samantaroy USAID staff offload emergency supplies. Secretary of State Marco Rubio announced that 83% of US international aid programs were “canceled” hours before a federal district judge ruled that the administration’s actions were an overreach of the Executive branch’s power. At risk are thousands of lifesaving humanitarian programs. In a refugee camp in Bangladesh, 500,000 Rohynga children depend on food treatment aid for their survival. One-year-old Mariam recovered from severe malnutrition after treatment in a UNICEF camp, but now her mother fears the clinic would shutter. “If you stop providing us with this therapeutic food, my child could die,” she told UNICEF. Thousands of US Agency for International Development (USAID) contracts have been terminated, after Secretary of State Marco Rubio signaled that the six-week review of the aid agency is “officially” complete. The remaining programs overseen by the six-decade-old USAID will now be part of the State Department, Rubio said. Late Monday, a federal district judge said that the Trump administration’s halt of foreign assistance overstepped the Executive branch’s authority. The judge ordered the administration to pay USAID partners for work already completed before 13 February, but stopped short of restoring the more than 10,000 contracts the administration has canceled. Separation of powers A vaccination site in South Africa co-sponsored by USAID. The judge ruled that the administration could not withhold the billions of dollars Congress had already approved for foreign aid, saying the president does not have “unbounded power” in foreign affairs. “The Executive not only claims his constitutional authority to determine how to spend appropriated funds, but usurps Congress’s exclusive authority to dictate whether the funds should be spent in the first place,” Washington DC district’s Judge Amir Ali said. Ali ruled in his preliminary injunction late Monday that Trump could not ignore the $60 billion Congress already allocated for foreign assistance to USAID. Congress alone has the power to allocate funding under the US Constitution. “The constitutional power over whether to spend foreign aid is not the President’s own — and it is Congress’s own,” said Ali. In response to a suit filed by the AIDS Vaccine Advocacy Coalition (AVAC), the Journalism Development Network, and the Global Health Council, Ali ordered the administration to pay aid groups the money owed for work completed up to 13 February, at a pace of at least 300 back payments a day. But he declined to restore contracts the administration canceled, saying it was up to the Trump administration to decide which organizations could win contracts. Ali’s ruling came after the Supreme Court cleared the way for a lower court to rule on the aid freeze. Trump ‘is not king’ “Today’s decision affirms a basic principle of our Constitution: the president is not a king,” said Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel representing the two organizations filing suit, in a statement. “But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount. “While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.” Whether Congress will act is yet to be seen, especially as the deadline to fund the federal government looms. The House passed a procedural measure for its funding bill Tuesday along party lines, which critics say is a “blank check” for the Trump administration’s agenda. Republican members of congress have voiced support for a narrower definition of US’s involvement in foreign development programs, and support Elon Musk’s Department of Government Efficiency’s (DOGE) efforts to cut back the federal government. Earlier in February, the House Foreign Affairs Committee held a hearing titled “the USAID Betrayal,” where chair Brian Mast (R-FL) argued that USAID programs “hurt America’s standing around the globe, and I think the fact is clear that America would have been better off if your money had been simply thrown into a fireplace.” ‘Reform’ completed After a 6 week review we are officially cancelling 83% of the programs at USAID. The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States. In… — Marco Rubio (@marcorubio) March 10, 2025 Rubio’s declaration that thousands of aid contracts were “officially” canceled came after the Trump administration’s six-week battle to gut USAID, calling the move an “overdue and historic reform.” His post was one of the few public comments on the swift dismantling of US policy of soft power and aid in developing countries. “The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” said Rubio on X. He said the remaining 1,000 contracts would be administered directly by the State Department. The Trump administration has made misleading claims that millions of taxpayer dollars were being used for diversity, equity, and inclusion (DEI) initiatives. Funding for many of these activities came through the State Department not USAID, at the request of embassies, according to independent fact checkers. “It’s been run by a bunch of radical lunatics,” Trump said last month. “And we’re going to get them out.” But the dismantling of USAID has meant a freeze on malaria, HIV, and tuberculosis aid, which combined protect millions of people in Africa, Latin America, and Southeast Asia from the leading infectious diseases. “Under President Trump, the waste, fraud, and abuse ENDS NOW,” the White House said in a February statement. Humanitarian groups offer dire warnings UNICEF personnel measure a Rohingya child’s arm for signs of malnutrition. Mariam and her mother are among thousands of Rohingya refugees at risk of malnutrition in the Cox’s Bazar camp, said Rana Flowers, UNICEF representative in Bangladesh. “Children in the world’s largest refugee camp are experiencing the worst levels of malnutrition since the massive displacement that occurred in 2017,” she said at a press briefing in Geneva on Tuesday. Other UN organizations echoed her warning that cuts to humanitarian aid would result in further devastation. The UN Commmision on Human Rights (UNCHR) has already shut down a US-funded program that worked with torture victims and families of disappeared persons. The US represented more than 40% of UNHCR’s budget in Colombia, meaning the agency’s work of “resolving” and “pre-empting” crises is threatened, said Ravina Shamdasani, UNCHR Chief Spokesperson at the Geneva press conference. The agency received USAID suspension letters for all projects in Equatorial Guinea, Iraq and Ukraine, as well as Bangladesh, Colombia, Ethiopia and Peru. ‘No replacement’ for USAID Rana Flowers, UNICEF representative in Bangladesh, speaking about the 500,000 children living in the world’s largest refugee camp. Although the US granted a waiver for UNICEF’s work to prevent malnutrition in refugee camps, there is no guarantee that the agency will be able to continue using the therapeutic food to treat and cure sick children with acute malnutrition. Flowers noted that the agency needs both the waiver and actual funding to continue the work. Funding for malnutrition treatments runs out in June. Unless additional funding is secured, only half of refugee Rohingya children will have access to treatment this year, Flowers warned. Without access to treatment, up to 7,000 children are at risk of severe malnutrition. UNICEF expects an increase in morbidity and mortality in these camps. “There’s no replacement for the valuable partnership with the United States,” said Flowers. “Until now, this community has survived thanks to the solidarity of the international humanitarian community,” she said. “But today, an aid funding crisis risks becoming a child survival crisis.” Additional reporting by Elaine Fletcher. Image Credits: USAID Press Office, USAID, UNICEF/Njiokiktjien. Despite ‘Rising Misogyny’, UN Commission Adopts Declaration on Gender Equity 11/03/2025 Kerry Cullinan Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, “The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday. The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. “Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. Declaration passed despite US, Russian objections The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and President of the General Assembly, that clause survived. So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago. Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports. Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” ‘Calculated cut’ to funds Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. “The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added. “We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed. Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.” The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine. Call for sanctions on Taliban Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes. “If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.” She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003. Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Marburg Outbreak Ends in Tanzania, but Africa Faces a Rising Tide of Health Crises 13/03/2025 Paul Adepoju Health workers contain the highly fatal Marburg virus during an outbreak. Tanzania has extinguished a deadly outbreak of Marburg virus, but elsewhere across Africa, an alarming surge of health crises continue to unfold – including expanding mpox infections in Uganda, a cholera outbreak in Angola and a first-ever cholera case in neighbouring Namibia. The Marburg virus outbreak in Tanzania has officially ended, Tanzanian health authorities declared Thursday, marking a pivotal achievement in the continent’s ongoing battle against highly lethal infectious diseases. The success reflects the effectiveness of the coordinated international health response, said Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), commending the Tanzanian government’s swift and decisive action at a press briefing on Thursday. Infamous for its haemorrhagic fever, Marburg virus kills up to 88% of those infected, posing a significant threat after it rapidly spread across Tanzania. The outbreak, declared on 20 January 2025, resulted in 10 fatalities – eight probable and two laboratory-confirmed cases. Tanzanian authorities implemented containment measures, with substantial technical and logistical assistance from the World Health Organization (WHO) and Africa CDC, including disease surveillance enhancements and extensive frontline health worker training. WHO’s Regional Office for Africa confirmed that the outbreak officially ended after 42 days had passed without new cases, meeting the criteria to declare an outbreak over; it commended Tanzanian authorities for prompt action in squashing the outbreak. WHO, Africa CDC cooperation to quell Marburg This marks Tanzania’s second successful containment of Marburg, following an outbreak in the same northeastern Kagera region in 2023. In this year’s outbreak, WHO said it collaborated with Tanzanian health authorities to scale up surveillance and response activities, training over 1,000 frontline health workers in contact tracing, clinical management, and risk communication, and delivering over five tonnes of essential medical supplies. Dr Jean Kaseya, Africa CDC Director General, commended Tanzania’s swift response. “While the outbreak has been declared over, we remain vigilant to respond swiftly if any cases are detected and are supporting ongoing efforts to provide psychosocial care to families affected by the outbreak,” said Charles Sagoe-Moses, WHO Representative in Tanzania. Kaseya also emphasized Africa CDC’s supportive role, including substantial assistance in laboratory reinforcement, provision of diagnostic kits capable of thousands of tests, and extensive healthcare worker training programs. These interventions enabled rapid case identification, isolation, and treatment – crucially preventing the virus’s broader spread. Persistent health emergencies across Africa A new and more deadly variant of Mpox continues to threaten 16 countries. But even as Tanzania celebrates its victory over Marburg, outbreaks of mpox, Ebola, cholera, and COVID-19 are placing immense pressure on healthcare systems across Africa, revealing systemic weaknesses and vulnerabilities, Kaseya emphasized. Uganda continues to face a troubling escalation of mpox – even though although recent weeks have seen no new cases of the even more deadly Ebola virus. Uganda’s mpox epicenter is in the country’s south-central region around the capital Kampala area. And nearby, on the shores of Lake Victoria, the overwhelmed Entebbe treatment center has seen most of Uganda’s mpox-related fatalities. Kaseya emphasized the urgent need for expanded isolation facilities, increased healthcare staffing, and strategies for home-based patient care to manage mild cases effectively. Meanwhile, the Democratic Republic of Congo (DRC) presents its own complex scenario, further complicated by continuing violence and instability in the North and South Kivu regions of Eastern DRC, where Rwanda-supported M-23 militia have made big inroads against government forces. Over 600 mpox patients fled treatment centers in the regional capital of Goma, Bukavu and other areas that were overrun by rebel forces, creating significant challenges in tracking and managing the disease. There are intensified efforts to establish humanitarian corridors, involving community health workers tasked with locating and reintegrating affected individuals into the health system. However, until a cease-fire is reached, insecurity will likely hamper those efforts, Kaseya said. Funding shortfalls threaten containment efforts Namibia reported its first cholera case in over a decade, highlighting vulnerabilities in the continent’s health infrastructure. Kaseya also revealed that funding shortages present a severe obstacle. Dramatic cuts to international aid, notably from traditional donors such as the United States and the United Kingdom, have only exacerbated the situation. These reductions, he said, significantly affect Africa’s capacity to manage public health crises effectively, creating urgent shortfalls in vital resources needed for outbreak response and containment efforts. “Mpox remains a serious concern,” Kaseya warned. “We are facing a critical risk. Without sufficient vaccines, we will inevitably see more cases.” The financial strain extends beyond mpox. Angola now faces an ongoing cholera outbreak, for which Africa CDC is providing emergency support, delivering 2,000 doses of oral cholera vaccines. Primarily affecting children, the cholera crisis in Angola highlights continued regional challenges in water and sanitation infrastructure. And neighbouring, Namibia recently reported its first cholera case in nearly a decade within a community near the Angola border – underscoring the interconnected fragility of public health systems across the region. Seeking sustainable solutions Amid these pressing challenges, Kaseya articulated Africa CDC’s commitment to fostering innovative and sustainable financing solutions. At the forthcoming World Bank and IMF spring meetings, African health and finance officials will participate in discussions with multilateral development agencies about how they can enhance national resilience and promote self-reliance in managing public health threats. Emphasizing the importance of national ownership, sustainable funding mechanisms, and strengthening local manufacturing capabilities, Kaseya advocated for sustained international engagement and solidarity. “Health security in Africa is global health security,” Kaseya reiterated. Image Credits: WHO, Africa CDC, Africa CDC. Switching from Biomass to LPG Failed to Show Health Gains in Four-Country Study of Household Air Pollution 13/03/2025 Disha Shetty Switching from biomass to LPG for cooking, reduced exposures to air pollution, but didn’t lead to measurably significant health gains, a four-country study found. A four-year, multi-country trial measuring health impacts of reduced indoor air pollution due to the shifting of households from biomass to Liquefied Petroleum Gas (LPG) has yielded mixed results – defying expectations that reduced indoor air pollution would yield significant health benefits. The study of 3,200 households in four Asian, African and Latin America countries showed that while the exposure to indoor smoke fell, the expected health gains did not follow. Despite improvements in air quality so that two-thirds of the households met WHO’s Interim Target 1 for household air pollution, the incidence of severe pneumonia among infants up to one-year “did not differ significantly” when compared to infants in those households that continued to use biomass, investigators with the Household Air Pollution Intervention Network (HAPIN), found. Nor did the birthweight of newborns rise significantly or incidence of stunting at 12 months decline – two other early childhood health impacts associated with poor household air quality. WHO Interim Targets 1 (35 µg/m3) and 2 (25 µg/m3) offer milestones for countries aiming to reduce high household air pollution levels, on the way to the recommended guideline level of 5 µg/m3 of PM2.5. WHO has set several interim targets to guide countries as they aim to reduce their air pollution levels. “Everybody kind of expected on the basis of observational studies that now we’re going to see some health benefits from this, even though, you know, a few other experimental studies were saying, well, we’re not seeing it,” Thomas Clasen, the trial’s principal investigator told Health Policy Watch. “So, people are really scratching their heads.” He is an epidemiologist and professor at Emory University. This also raises a core policy question: should countries push ahead with fossil fuel-heavy LPG or should they instead leapfrog to electric cooking powered by renewable energy like solar? The HAPIN trial was launched in 2017 and followed 800 pregnant women, 120 older adult women, and 800 infants in poor communities dependent on solid fuels across Guatemala, India, Peru, and Rwanda. One half of the 3200 households were provided access to LPG for 18 months and results were monitored. The trial was funded by the National Institutes of Health (NIH) and the Gates Foundation, among others. A woman in Guatemala cooks on an LPG stove that she received for free through the HAPIN study. Mix of positive and negative results The results showed a mix of positive and negative outcomes. “Intervention households used LPG exclusively 99.99% of the time,” said Kalpana Balakrishnan of Sri Ramachandra Institute of Higher Education and Research who led the India-leg of the trial. “That answered the question that if you remove the economic barrier, households are willing and able to use a clean energy source, i.e LPG exclusively,” she said. Average air pollution concentrations in two-thirds of the LPG households declined by half or more – less than 35 µg/m3 (micrograms per cubic meter), Clasen said. The control group that did not use LPG had household air pollution hovering around 70 µg/m3. “All the health improvements that we expected to see in the intervention compared to the control we did not see,” Balakrishnan told HPW. Muddying the debate over fuel switching The World Health Organization (WHO) has also avidly promoted LPG as a clean cooking fuel alternative – despite its climate impacts as a fossil fuel, derived from oil and gas production. These trial results now muddy the debate over whether LPG is still the best option as an “interim” clean fuel choice – or whether countries would be better off promoting electric cooking and heating options, which could reduce indoor emissions even more if they were powered by renewables – and not oil or coal generation. WHO, for its part, says that the issue will surely be a hot topic of discussion at a major upcoming meeting on air pollution – the Second Global Conference on Air Quality and Health, scheduled for 25-29 March in Cartagena, Colombia. “WHO is currently reviewing the results from the HAPIN trial and will integrate such evidence in the guidance and support we provide to countries to protect health from household air pollution,” Heather Adair-Rohani who leads the work on air quality, energy and health at WHO headquarters in Geneva told Health Policy Watch in an email response. “How best to use the results of HAPIN and other key studies to inform decision-making on household energy will be key topic at the upcoming second WHO global conference on air pollution, where WHO, in cooperation with the government of Colombia is calling on countries, cities and organizations to work together to cut the health impacts from air pollution in half by 2040,” she added. The curious case of lack of health gains despite reduced air pollution WHO estimates that around 2.1 billion people worldwide cook on open fires or inefficient stoves that use either kerosene, biomass or coal. Household air pollution was linked to 3.2 million deaths per year in 2020. And while poor air quality is linked to worsening health, improving air quality in the HAPIN trial did not translate to improved health gains. A majority of the world’s population still without access to clean cooking energy is in the developing world. The researchers have one key hypothesis as to why. “In a community where you have multi-dimensional poverty, if you give a clean fuel intervention for a short time, you may not be in a position to pick up the health benefits that result from it,” Balakrishnan said. “What you need is to follow them up for a much longer period of time where they continue to use LPG,” she added. Balakrishnan continued, “The way we have to approach this, … in these poor households, you need a package of interventions to achieve improvement in health.” Clasen too agreed, “We have to say, well, maybe this isn’t going to be enough by itself to achieve the benefits, the health benefits that you were after.” Households with the biggest declines in air pollution did see some benefits One other striking factor is that a small set of households with the biggest concentrations of air pollution before the trial, and thus the biggest declines in pollution from the shift to LPG – did experience more measurable health impacts. That could suggest that reductions in air pollution that are larger and more dramatic in order yield more measurable health impacts, at least short term. “When we look at the folks who had the biggest reductions in exposure, it does look like they’ve benefited…at least reductions in PM, 2.5 and black carbon,” Clasen said. However, at the lower end of the household air pollution scale, the precise relationship between pollution declines and improvement in health benefits – the so-called “dose-response curve” are not yet well defined, Clasen added “We do not have well-populated dose-response curves for HAP and [health] outcomes,” he said. “So we cannot rule out health benefits that might have been gained at very low levels of exposure.” But practically speaking, it’s going to be very difficult to push household concentrations further down in many low-income settings when other environmental and cultural factors such as high rates of smoking, as well as high levels of outdoor air pollution also come into play, he added. “It’s unlikely that any programmatically delivered HAP intervention is going to achieve lower levels of exposure than what we achieved here, when we had the benefit of free stoves and fuel – and thus nearly exclusive LPG adoption. So from a practical standpoint, we are not likely to improve these health endpoints by getting householders to lower levels of exposure than what we achieved in the trial.” What do these results mean for policy? Regardless of the mixed outcomes, Clasen stressed that the results should not be read as a signal to put brakes on transitioning to LPG in developing countries. LPG is significantly better for climate when compared to biomass because of its lower greenhouse gas emissions. Even if switching to LPG does not lead to expected health gains in the short run, it still is a significantly efficient fuel. It also lowers greenhouse gas emissions compared to biomass and thus has climate benefits apart from reducing the drudgery involved for women. LPG’s positive impact on women “When you’re cooking over a chulha (earthen stove), the drudgery from collecting the firewood or the coal or the gobar (cowdung) to prepare the chulha versus cooking on an LPG…the time it takes…there’s also an opportunity loss because of the time that’s lost in cooking and working around it,” said Neha Saigal, Director of the Gender and Climate Change programme with India-based Asar Social Impact Advisors. Women in the communities Asar works with expressed willingness to use LPG when it was an affordable option. Cooking on a traditional stove using biomass or coal also directly exposes women to even higher levels of air pollution than might be measured as ambient indoor levels, Saigal said. So shifting may have other health benefits that weren’t captured yet by the HAPIN trial. An Indian woman cooks with an LPG stove that she received as a participant in the HAPIN study. Beyond LPG: Staring at limited options LPG is increasingly affordable and accessible in many developing countries. India, the world’s most populous country, has made tremendous gains in improving LPG access among poor and rural communities though gaps remain. Around 99.8% households in the country now have access to LPG for cooking, according to government data from the year 2021. And while LPG is a fossil fuel, it is significantly cleaner than biomass. Alternatives to LPG are either not efficient enough for everyday and reliable use, like solar, or require reliable electricity. Clasen has two reservations about promoting electricity for household cooking in developing countries right now. “One is, is electricity going to do any better than LPG? Right, number two is that [the] electricity is usually generated using fossil fuels, so we may not actually be reducing the climate load by transitioning to electricity unless we also can figure out how to do it renewably,” he said. Other experts said the quest for better solutions should nonetheless continue. “I don’t see any other solution at this point of time, at scale other than LPG. But yes, there’s a lot of scope to demonstrate, to pilot with electric cooking, to come up with better chulhas that don’t give out smoke…solar cook stoves,” Saigal of Asar said. “But if we want to support women at the moment, we should make LPG available to them, because that is the thing that’s available now in the market,” she added. Balakrishnan also raises an ethical question – the poor should not bear the burden of waiting to transition to electric cooking when it is not the norm in urban and well off households. Given that LPG is a viable near-term clean energy choice, the poor too should have access to it right away, she said. Continuing long-term research will yield more answers For now, the HAPIN trial continues to follow children in three locations – Guatemala, India and Rwanda – until they reach the age of five. They want to see if delivering their mothers LPG access for 18 months has had any long-term health benefits that might become clear only later, like neurocognitive development or development of a child’s mental abilities. “It could be quite compelling from a policymaker standpoint,” Clasen said. Image Credits: WHO/Adobe Stock/Dennis Wegewijs, WHO, Guatemala HAPIN team, T20 Policy Brief, July 2023, India HAPIN team. USAID ‘Officially’ Gutted, but Administration Overstepped Constitutional Power, Judge Rules 11/03/2025 Sophia Samantaroy USAID staff offload emergency supplies. Secretary of State Marco Rubio announced that 83% of US international aid programs were “canceled” hours before a federal district judge ruled that the administration’s actions were an overreach of the Executive branch’s power. At risk are thousands of lifesaving humanitarian programs. In a refugee camp in Bangladesh, 500,000 Rohynga children depend on food treatment aid for their survival. One-year-old Mariam recovered from severe malnutrition after treatment in a UNICEF camp, but now her mother fears the clinic would shutter. “If you stop providing us with this therapeutic food, my child could die,” she told UNICEF. Thousands of US Agency for International Development (USAID) contracts have been terminated, after Secretary of State Marco Rubio signaled that the six-week review of the aid agency is “officially” complete. The remaining programs overseen by the six-decade-old USAID will now be part of the State Department, Rubio said. Late Monday, a federal district judge said that the Trump administration’s halt of foreign assistance overstepped the Executive branch’s authority. The judge ordered the administration to pay USAID partners for work already completed before 13 February, but stopped short of restoring the more than 10,000 contracts the administration has canceled. Separation of powers A vaccination site in South Africa co-sponsored by USAID. The judge ruled that the administration could not withhold the billions of dollars Congress had already approved for foreign aid, saying the president does not have “unbounded power” in foreign affairs. “The Executive not only claims his constitutional authority to determine how to spend appropriated funds, but usurps Congress’s exclusive authority to dictate whether the funds should be spent in the first place,” Washington DC district’s Judge Amir Ali said. Ali ruled in his preliminary injunction late Monday that Trump could not ignore the $60 billion Congress already allocated for foreign assistance to USAID. Congress alone has the power to allocate funding under the US Constitution. “The constitutional power over whether to spend foreign aid is not the President’s own — and it is Congress’s own,” said Ali. In response to a suit filed by the AIDS Vaccine Advocacy Coalition (AVAC), the Journalism Development Network, and the Global Health Council, Ali ordered the administration to pay aid groups the money owed for work completed up to 13 February, at a pace of at least 300 back payments a day. But he declined to restore contracts the administration canceled, saying it was up to the Trump administration to decide which organizations could win contracts. Ali’s ruling came after the Supreme Court cleared the way for a lower court to rule on the aid freeze. Trump ‘is not king’ “Today’s decision affirms a basic principle of our Constitution: the president is not a king,” said Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel representing the two organizations filing suit, in a statement. “But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount. “While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.” Whether Congress will act is yet to be seen, especially as the deadline to fund the federal government looms. The House passed a procedural measure for its funding bill Tuesday along party lines, which critics say is a “blank check” for the Trump administration’s agenda. Republican members of congress have voiced support for a narrower definition of US’s involvement in foreign development programs, and support Elon Musk’s Department of Government Efficiency’s (DOGE) efforts to cut back the federal government. Earlier in February, the House Foreign Affairs Committee held a hearing titled “the USAID Betrayal,” where chair Brian Mast (R-FL) argued that USAID programs “hurt America’s standing around the globe, and I think the fact is clear that America would have been better off if your money had been simply thrown into a fireplace.” ‘Reform’ completed After a 6 week review we are officially cancelling 83% of the programs at USAID. The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States. In… — Marco Rubio (@marcorubio) March 10, 2025 Rubio’s declaration that thousands of aid contracts were “officially” canceled came after the Trump administration’s six-week battle to gut USAID, calling the move an “overdue and historic reform.” His post was one of the few public comments on the swift dismantling of US policy of soft power and aid in developing countries. “The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” said Rubio on X. He said the remaining 1,000 contracts would be administered directly by the State Department. The Trump administration has made misleading claims that millions of taxpayer dollars were being used for diversity, equity, and inclusion (DEI) initiatives. Funding for many of these activities came through the State Department not USAID, at the request of embassies, according to independent fact checkers. “It’s been run by a bunch of radical lunatics,” Trump said last month. “And we’re going to get them out.” But the dismantling of USAID has meant a freeze on malaria, HIV, and tuberculosis aid, which combined protect millions of people in Africa, Latin America, and Southeast Asia from the leading infectious diseases. “Under President Trump, the waste, fraud, and abuse ENDS NOW,” the White House said in a February statement. Humanitarian groups offer dire warnings UNICEF personnel measure a Rohingya child’s arm for signs of malnutrition. Mariam and her mother are among thousands of Rohingya refugees at risk of malnutrition in the Cox’s Bazar camp, said Rana Flowers, UNICEF representative in Bangladesh. “Children in the world’s largest refugee camp are experiencing the worst levels of malnutrition since the massive displacement that occurred in 2017,” she said at a press briefing in Geneva on Tuesday. Other UN organizations echoed her warning that cuts to humanitarian aid would result in further devastation. The UN Commmision on Human Rights (UNCHR) has already shut down a US-funded program that worked with torture victims and families of disappeared persons. The US represented more than 40% of UNHCR’s budget in Colombia, meaning the agency’s work of “resolving” and “pre-empting” crises is threatened, said Ravina Shamdasani, UNCHR Chief Spokesperson at the Geneva press conference. The agency received USAID suspension letters for all projects in Equatorial Guinea, Iraq and Ukraine, as well as Bangladesh, Colombia, Ethiopia and Peru. ‘No replacement’ for USAID Rana Flowers, UNICEF representative in Bangladesh, speaking about the 500,000 children living in the world’s largest refugee camp. Although the US granted a waiver for UNICEF’s work to prevent malnutrition in refugee camps, there is no guarantee that the agency will be able to continue using the therapeutic food to treat and cure sick children with acute malnutrition. Flowers noted that the agency needs both the waiver and actual funding to continue the work. Funding for malnutrition treatments runs out in June. Unless additional funding is secured, only half of refugee Rohingya children will have access to treatment this year, Flowers warned. Without access to treatment, up to 7,000 children are at risk of severe malnutrition. UNICEF expects an increase in morbidity and mortality in these camps. “There’s no replacement for the valuable partnership with the United States,” said Flowers. “Until now, this community has survived thanks to the solidarity of the international humanitarian community,” she said. “But today, an aid funding crisis risks becoming a child survival crisis.” Additional reporting by Elaine Fletcher. Image Credits: USAID Press Office, USAID, UNICEF/Njiokiktjien. Despite ‘Rising Misogyny’, UN Commission Adopts Declaration on Gender Equity 11/03/2025 Kerry Cullinan Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, “The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday. The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. “Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. Declaration passed despite US, Russian objections The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and President of the General Assembly, that clause survived. So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago. Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports. Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” ‘Calculated cut’ to funds Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. “The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added. “We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed. Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.” The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine. Call for sanctions on Taliban Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes. “If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.” She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003. Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Switching from Biomass to LPG Failed to Show Health Gains in Four-Country Study of Household Air Pollution 13/03/2025 Disha Shetty Switching from biomass to LPG for cooking, reduced exposures to air pollution, but didn’t lead to measurably significant health gains, a four-country study found. A four-year, multi-country trial measuring health impacts of reduced indoor air pollution due to the shifting of households from biomass to Liquefied Petroleum Gas (LPG) has yielded mixed results – defying expectations that reduced indoor air pollution would yield significant health benefits. The study of 3,200 households in four Asian, African and Latin America countries showed that while the exposure to indoor smoke fell, the expected health gains did not follow. Despite improvements in air quality so that two-thirds of the households met WHO’s Interim Target 1 for household air pollution, the incidence of severe pneumonia among infants up to one-year “did not differ significantly” when compared to infants in those households that continued to use biomass, investigators with the Household Air Pollution Intervention Network (HAPIN), found. Nor did the birthweight of newborns rise significantly or incidence of stunting at 12 months decline – two other early childhood health impacts associated with poor household air quality. WHO Interim Targets 1 (35 µg/m3) and 2 (25 µg/m3) offer milestones for countries aiming to reduce high household air pollution levels, on the way to the recommended guideline level of 5 µg/m3 of PM2.5. WHO has set several interim targets to guide countries as they aim to reduce their air pollution levels. “Everybody kind of expected on the basis of observational studies that now we’re going to see some health benefits from this, even though, you know, a few other experimental studies were saying, well, we’re not seeing it,” Thomas Clasen, the trial’s principal investigator told Health Policy Watch. “So, people are really scratching their heads.” He is an epidemiologist and professor at Emory University. This also raises a core policy question: should countries push ahead with fossil fuel-heavy LPG or should they instead leapfrog to electric cooking powered by renewable energy like solar? The HAPIN trial was launched in 2017 and followed 800 pregnant women, 120 older adult women, and 800 infants in poor communities dependent on solid fuels across Guatemala, India, Peru, and Rwanda. One half of the 3200 households were provided access to LPG for 18 months and results were monitored. The trial was funded by the National Institutes of Health (NIH) and the Gates Foundation, among others. A woman in Guatemala cooks on an LPG stove that she received for free through the HAPIN study. Mix of positive and negative results The results showed a mix of positive and negative outcomes. “Intervention households used LPG exclusively 99.99% of the time,” said Kalpana Balakrishnan of Sri Ramachandra Institute of Higher Education and Research who led the India-leg of the trial. “That answered the question that if you remove the economic barrier, households are willing and able to use a clean energy source, i.e LPG exclusively,” she said. Average air pollution concentrations in two-thirds of the LPG households declined by half or more – less than 35 µg/m3 (micrograms per cubic meter), Clasen said. The control group that did not use LPG had household air pollution hovering around 70 µg/m3. “All the health improvements that we expected to see in the intervention compared to the control we did not see,” Balakrishnan told HPW. Muddying the debate over fuel switching The World Health Organization (WHO) has also avidly promoted LPG as a clean cooking fuel alternative – despite its climate impacts as a fossil fuel, derived from oil and gas production. These trial results now muddy the debate over whether LPG is still the best option as an “interim” clean fuel choice – or whether countries would be better off promoting electric cooking and heating options, which could reduce indoor emissions even more if they were powered by renewables – and not oil or coal generation. WHO, for its part, says that the issue will surely be a hot topic of discussion at a major upcoming meeting on air pollution – the Second Global Conference on Air Quality and Health, scheduled for 25-29 March in Cartagena, Colombia. “WHO is currently reviewing the results from the HAPIN trial and will integrate such evidence in the guidance and support we provide to countries to protect health from household air pollution,” Heather Adair-Rohani who leads the work on air quality, energy and health at WHO headquarters in Geneva told Health Policy Watch in an email response. “How best to use the results of HAPIN and other key studies to inform decision-making on household energy will be key topic at the upcoming second WHO global conference on air pollution, where WHO, in cooperation with the government of Colombia is calling on countries, cities and organizations to work together to cut the health impacts from air pollution in half by 2040,” she added. The curious case of lack of health gains despite reduced air pollution WHO estimates that around 2.1 billion people worldwide cook on open fires or inefficient stoves that use either kerosene, biomass or coal. Household air pollution was linked to 3.2 million deaths per year in 2020. And while poor air quality is linked to worsening health, improving air quality in the HAPIN trial did not translate to improved health gains. A majority of the world’s population still without access to clean cooking energy is in the developing world. The researchers have one key hypothesis as to why. “In a community where you have multi-dimensional poverty, if you give a clean fuel intervention for a short time, you may not be in a position to pick up the health benefits that result from it,” Balakrishnan said. “What you need is to follow them up for a much longer period of time where they continue to use LPG,” she added. Balakrishnan continued, “The way we have to approach this, … in these poor households, you need a package of interventions to achieve improvement in health.” Clasen too agreed, “We have to say, well, maybe this isn’t going to be enough by itself to achieve the benefits, the health benefits that you were after.” Households with the biggest declines in air pollution did see some benefits One other striking factor is that a small set of households with the biggest concentrations of air pollution before the trial, and thus the biggest declines in pollution from the shift to LPG – did experience more measurable health impacts. That could suggest that reductions in air pollution that are larger and more dramatic in order yield more measurable health impacts, at least short term. “When we look at the folks who had the biggest reductions in exposure, it does look like they’ve benefited…at least reductions in PM, 2.5 and black carbon,” Clasen said. However, at the lower end of the household air pollution scale, the precise relationship between pollution declines and improvement in health benefits – the so-called “dose-response curve” are not yet well defined, Clasen added “We do not have well-populated dose-response curves for HAP and [health] outcomes,” he said. “So we cannot rule out health benefits that might have been gained at very low levels of exposure.” But practically speaking, it’s going to be very difficult to push household concentrations further down in many low-income settings when other environmental and cultural factors such as high rates of smoking, as well as high levels of outdoor air pollution also come into play, he added. “It’s unlikely that any programmatically delivered HAP intervention is going to achieve lower levels of exposure than what we achieved here, when we had the benefit of free stoves and fuel – and thus nearly exclusive LPG adoption. So from a practical standpoint, we are not likely to improve these health endpoints by getting householders to lower levels of exposure than what we achieved in the trial.” What do these results mean for policy? Regardless of the mixed outcomes, Clasen stressed that the results should not be read as a signal to put brakes on transitioning to LPG in developing countries. LPG is significantly better for climate when compared to biomass because of its lower greenhouse gas emissions. Even if switching to LPG does not lead to expected health gains in the short run, it still is a significantly efficient fuel. It also lowers greenhouse gas emissions compared to biomass and thus has climate benefits apart from reducing the drudgery involved for women. LPG’s positive impact on women “When you’re cooking over a chulha (earthen stove), the drudgery from collecting the firewood or the coal or the gobar (cowdung) to prepare the chulha versus cooking on an LPG…the time it takes…there’s also an opportunity loss because of the time that’s lost in cooking and working around it,” said Neha Saigal, Director of the Gender and Climate Change programme with India-based Asar Social Impact Advisors. Women in the communities Asar works with expressed willingness to use LPG when it was an affordable option. Cooking on a traditional stove using biomass or coal also directly exposes women to even higher levels of air pollution than might be measured as ambient indoor levels, Saigal said. So shifting may have other health benefits that weren’t captured yet by the HAPIN trial. An Indian woman cooks with an LPG stove that she received as a participant in the HAPIN study. Beyond LPG: Staring at limited options LPG is increasingly affordable and accessible in many developing countries. India, the world’s most populous country, has made tremendous gains in improving LPG access among poor and rural communities though gaps remain. Around 99.8% households in the country now have access to LPG for cooking, according to government data from the year 2021. And while LPG is a fossil fuel, it is significantly cleaner than biomass. Alternatives to LPG are either not efficient enough for everyday and reliable use, like solar, or require reliable electricity. Clasen has two reservations about promoting electricity for household cooking in developing countries right now. “One is, is electricity going to do any better than LPG? Right, number two is that [the] electricity is usually generated using fossil fuels, so we may not actually be reducing the climate load by transitioning to electricity unless we also can figure out how to do it renewably,” he said. Other experts said the quest for better solutions should nonetheless continue. “I don’t see any other solution at this point of time, at scale other than LPG. But yes, there’s a lot of scope to demonstrate, to pilot with electric cooking, to come up with better chulhas that don’t give out smoke…solar cook stoves,” Saigal of Asar said. “But if we want to support women at the moment, we should make LPG available to them, because that is the thing that’s available now in the market,” she added. Balakrishnan also raises an ethical question – the poor should not bear the burden of waiting to transition to electric cooking when it is not the norm in urban and well off households. Given that LPG is a viable near-term clean energy choice, the poor too should have access to it right away, she said. Continuing long-term research will yield more answers For now, the HAPIN trial continues to follow children in three locations – Guatemala, India and Rwanda – until they reach the age of five. They want to see if delivering their mothers LPG access for 18 months has had any long-term health benefits that might become clear only later, like neurocognitive development or development of a child’s mental abilities. “It could be quite compelling from a policymaker standpoint,” Clasen said. Image Credits: WHO/Adobe Stock/Dennis Wegewijs, WHO, Guatemala HAPIN team, T20 Policy Brief, July 2023, India HAPIN team. USAID ‘Officially’ Gutted, but Administration Overstepped Constitutional Power, Judge Rules 11/03/2025 Sophia Samantaroy USAID staff offload emergency supplies. Secretary of State Marco Rubio announced that 83% of US international aid programs were “canceled” hours before a federal district judge ruled that the administration’s actions were an overreach of the Executive branch’s power. At risk are thousands of lifesaving humanitarian programs. In a refugee camp in Bangladesh, 500,000 Rohynga children depend on food treatment aid for their survival. One-year-old Mariam recovered from severe malnutrition after treatment in a UNICEF camp, but now her mother fears the clinic would shutter. “If you stop providing us with this therapeutic food, my child could die,” she told UNICEF. Thousands of US Agency for International Development (USAID) contracts have been terminated, after Secretary of State Marco Rubio signaled that the six-week review of the aid agency is “officially” complete. The remaining programs overseen by the six-decade-old USAID will now be part of the State Department, Rubio said. Late Monday, a federal district judge said that the Trump administration’s halt of foreign assistance overstepped the Executive branch’s authority. The judge ordered the administration to pay USAID partners for work already completed before 13 February, but stopped short of restoring the more than 10,000 contracts the administration has canceled. Separation of powers A vaccination site in South Africa co-sponsored by USAID. The judge ruled that the administration could not withhold the billions of dollars Congress had already approved for foreign aid, saying the president does not have “unbounded power” in foreign affairs. “The Executive not only claims his constitutional authority to determine how to spend appropriated funds, but usurps Congress’s exclusive authority to dictate whether the funds should be spent in the first place,” Washington DC district’s Judge Amir Ali said. Ali ruled in his preliminary injunction late Monday that Trump could not ignore the $60 billion Congress already allocated for foreign assistance to USAID. Congress alone has the power to allocate funding under the US Constitution. “The constitutional power over whether to spend foreign aid is not the President’s own — and it is Congress’s own,” said Ali. In response to a suit filed by the AIDS Vaccine Advocacy Coalition (AVAC), the Journalism Development Network, and the Global Health Council, Ali ordered the administration to pay aid groups the money owed for work completed up to 13 February, at a pace of at least 300 back payments a day. But he declined to restore contracts the administration canceled, saying it was up to the Trump administration to decide which organizations could win contracts. Ali’s ruling came after the Supreme Court cleared the way for a lower court to rule on the aid freeze. Trump ‘is not king’ “Today’s decision affirms a basic principle of our Constitution: the president is not a king,” said Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel representing the two organizations filing suit, in a statement. “But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount. “While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.” Whether Congress will act is yet to be seen, especially as the deadline to fund the federal government looms. The House passed a procedural measure for its funding bill Tuesday along party lines, which critics say is a “blank check” for the Trump administration’s agenda. Republican members of congress have voiced support for a narrower definition of US’s involvement in foreign development programs, and support Elon Musk’s Department of Government Efficiency’s (DOGE) efforts to cut back the federal government. Earlier in February, the House Foreign Affairs Committee held a hearing titled “the USAID Betrayal,” where chair Brian Mast (R-FL) argued that USAID programs “hurt America’s standing around the globe, and I think the fact is clear that America would have been better off if your money had been simply thrown into a fireplace.” ‘Reform’ completed After a 6 week review we are officially cancelling 83% of the programs at USAID. The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States. In… — Marco Rubio (@marcorubio) March 10, 2025 Rubio’s declaration that thousands of aid contracts were “officially” canceled came after the Trump administration’s six-week battle to gut USAID, calling the move an “overdue and historic reform.” His post was one of the few public comments on the swift dismantling of US policy of soft power and aid in developing countries. “The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” said Rubio on X. He said the remaining 1,000 contracts would be administered directly by the State Department. The Trump administration has made misleading claims that millions of taxpayer dollars were being used for diversity, equity, and inclusion (DEI) initiatives. Funding for many of these activities came through the State Department not USAID, at the request of embassies, according to independent fact checkers. “It’s been run by a bunch of radical lunatics,” Trump said last month. “And we’re going to get them out.” But the dismantling of USAID has meant a freeze on malaria, HIV, and tuberculosis aid, which combined protect millions of people in Africa, Latin America, and Southeast Asia from the leading infectious diseases. “Under President Trump, the waste, fraud, and abuse ENDS NOW,” the White House said in a February statement. Humanitarian groups offer dire warnings UNICEF personnel measure a Rohingya child’s arm for signs of malnutrition. Mariam and her mother are among thousands of Rohingya refugees at risk of malnutrition in the Cox’s Bazar camp, said Rana Flowers, UNICEF representative in Bangladesh. “Children in the world’s largest refugee camp are experiencing the worst levels of malnutrition since the massive displacement that occurred in 2017,” she said at a press briefing in Geneva on Tuesday. Other UN organizations echoed her warning that cuts to humanitarian aid would result in further devastation. The UN Commmision on Human Rights (UNCHR) has already shut down a US-funded program that worked with torture victims and families of disappeared persons. The US represented more than 40% of UNHCR’s budget in Colombia, meaning the agency’s work of “resolving” and “pre-empting” crises is threatened, said Ravina Shamdasani, UNCHR Chief Spokesperson at the Geneva press conference. The agency received USAID suspension letters for all projects in Equatorial Guinea, Iraq and Ukraine, as well as Bangladesh, Colombia, Ethiopia and Peru. ‘No replacement’ for USAID Rana Flowers, UNICEF representative in Bangladesh, speaking about the 500,000 children living in the world’s largest refugee camp. Although the US granted a waiver for UNICEF’s work to prevent malnutrition in refugee camps, there is no guarantee that the agency will be able to continue using the therapeutic food to treat and cure sick children with acute malnutrition. Flowers noted that the agency needs both the waiver and actual funding to continue the work. Funding for malnutrition treatments runs out in June. Unless additional funding is secured, only half of refugee Rohingya children will have access to treatment this year, Flowers warned. Without access to treatment, up to 7,000 children are at risk of severe malnutrition. UNICEF expects an increase in morbidity and mortality in these camps. “There’s no replacement for the valuable partnership with the United States,” said Flowers. “Until now, this community has survived thanks to the solidarity of the international humanitarian community,” she said. “But today, an aid funding crisis risks becoming a child survival crisis.” Additional reporting by Elaine Fletcher. Image Credits: USAID Press Office, USAID, UNICEF/Njiokiktjien. Despite ‘Rising Misogyny’, UN Commission Adopts Declaration on Gender Equity 11/03/2025 Kerry Cullinan Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, “The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday. The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. “Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. Declaration passed despite US, Russian objections The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and President of the General Assembly, that clause survived. So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago. Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports. Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” ‘Calculated cut’ to funds Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. “The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added. “We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed. Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.” The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine. Call for sanctions on Taliban Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes. “If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.” She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003. Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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USAID ‘Officially’ Gutted, but Administration Overstepped Constitutional Power, Judge Rules 11/03/2025 Sophia Samantaroy USAID staff offload emergency supplies. Secretary of State Marco Rubio announced that 83% of US international aid programs were “canceled” hours before a federal district judge ruled that the administration’s actions were an overreach of the Executive branch’s power. At risk are thousands of lifesaving humanitarian programs. In a refugee camp in Bangladesh, 500,000 Rohynga children depend on food treatment aid for their survival. One-year-old Mariam recovered from severe malnutrition after treatment in a UNICEF camp, but now her mother fears the clinic would shutter. “If you stop providing us with this therapeutic food, my child could die,” she told UNICEF. Thousands of US Agency for International Development (USAID) contracts have been terminated, after Secretary of State Marco Rubio signaled that the six-week review of the aid agency is “officially” complete. The remaining programs overseen by the six-decade-old USAID will now be part of the State Department, Rubio said. Late Monday, a federal district judge said that the Trump administration’s halt of foreign assistance overstepped the Executive branch’s authority. The judge ordered the administration to pay USAID partners for work already completed before 13 February, but stopped short of restoring the more than 10,000 contracts the administration has canceled. Separation of powers A vaccination site in South Africa co-sponsored by USAID. The judge ruled that the administration could not withhold the billions of dollars Congress had already approved for foreign aid, saying the president does not have “unbounded power” in foreign affairs. “The Executive not only claims his constitutional authority to determine how to spend appropriated funds, but usurps Congress’s exclusive authority to dictate whether the funds should be spent in the first place,” Washington DC district’s Judge Amir Ali said. Ali ruled in his preliminary injunction late Monday that Trump could not ignore the $60 billion Congress already allocated for foreign assistance to USAID. Congress alone has the power to allocate funding under the US Constitution. “The constitutional power over whether to spend foreign aid is not the President’s own — and it is Congress’s own,” said Ali. In response to a suit filed by the AIDS Vaccine Advocacy Coalition (AVAC), the Journalism Development Network, and the Global Health Council, Ali ordered the administration to pay aid groups the money owed for work completed up to 13 February, at a pace of at least 300 back payments a day. But he declined to restore contracts the administration canceled, saying it was up to the Trump administration to decide which organizations could win contracts. Ali’s ruling came after the Supreme Court cleared the way for a lower court to rule on the aid freeze. Trump ‘is not king’ “Today’s decision affirms a basic principle of our Constitution: the president is not a king,” said Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel representing the two organizations filing suit, in a statement. “But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount. “While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.” Whether Congress will act is yet to be seen, especially as the deadline to fund the federal government looms. The House passed a procedural measure for its funding bill Tuesday along party lines, which critics say is a “blank check” for the Trump administration’s agenda. Republican members of congress have voiced support for a narrower definition of US’s involvement in foreign development programs, and support Elon Musk’s Department of Government Efficiency’s (DOGE) efforts to cut back the federal government. Earlier in February, the House Foreign Affairs Committee held a hearing titled “the USAID Betrayal,” where chair Brian Mast (R-FL) argued that USAID programs “hurt America’s standing around the globe, and I think the fact is clear that America would have been better off if your money had been simply thrown into a fireplace.” ‘Reform’ completed After a 6 week review we are officially cancelling 83% of the programs at USAID. The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States. In… — Marco Rubio (@marcorubio) March 10, 2025 Rubio’s declaration that thousands of aid contracts were “officially” canceled came after the Trump administration’s six-week battle to gut USAID, calling the move an “overdue and historic reform.” His post was one of the few public comments on the swift dismantling of US policy of soft power and aid in developing countries. “The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” said Rubio on X. He said the remaining 1,000 contracts would be administered directly by the State Department. The Trump administration has made misleading claims that millions of taxpayer dollars were being used for diversity, equity, and inclusion (DEI) initiatives. Funding for many of these activities came through the State Department not USAID, at the request of embassies, according to independent fact checkers. “It’s been run by a bunch of radical lunatics,” Trump said last month. “And we’re going to get them out.” But the dismantling of USAID has meant a freeze on malaria, HIV, and tuberculosis aid, which combined protect millions of people in Africa, Latin America, and Southeast Asia from the leading infectious diseases. “Under President Trump, the waste, fraud, and abuse ENDS NOW,” the White House said in a February statement. Humanitarian groups offer dire warnings UNICEF personnel measure a Rohingya child’s arm for signs of malnutrition. Mariam and her mother are among thousands of Rohingya refugees at risk of malnutrition in the Cox’s Bazar camp, said Rana Flowers, UNICEF representative in Bangladesh. “Children in the world’s largest refugee camp are experiencing the worst levels of malnutrition since the massive displacement that occurred in 2017,” she said at a press briefing in Geneva on Tuesday. Other UN organizations echoed her warning that cuts to humanitarian aid would result in further devastation. The UN Commmision on Human Rights (UNCHR) has already shut down a US-funded program that worked with torture victims and families of disappeared persons. The US represented more than 40% of UNHCR’s budget in Colombia, meaning the agency’s work of “resolving” and “pre-empting” crises is threatened, said Ravina Shamdasani, UNCHR Chief Spokesperson at the Geneva press conference. The agency received USAID suspension letters for all projects in Equatorial Guinea, Iraq and Ukraine, as well as Bangladesh, Colombia, Ethiopia and Peru. ‘No replacement’ for USAID Rana Flowers, UNICEF representative in Bangladesh, speaking about the 500,000 children living in the world’s largest refugee camp. Although the US granted a waiver for UNICEF’s work to prevent malnutrition in refugee camps, there is no guarantee that the agency will be able to continue using the therapeutic food to treat and cure sick children with acute malnutrition. Flowers noted that the agency needs both the waiver and actual funding to continue the work. Funding for malnutrition treatments runs out in June. Unless additional funding is secured, only half of refugee Rohingya children will have access to treatment this year, Flowers warned. Without access to treatment, up to 7,000 children are at risk of severe malnutrition. UNICEF expects an increase in morbidity and mortality in these camps. “There’s no replacement for the valuable partnership with the United States,” said Flowers. “Until now, this community has survived thanks to the solidarity of the international humanitarian community,” she said. “But today, an aid funding crisis risks becoming a child survival crisis.” Additional reporting by Elaine Fletcher. Image Credits: USAID Press Office, USAID, UNICEF/Njiokiktjien. Despite ‘Rising Misogyny’, UN Commission Adopts Declaration on Gender Equity 11/03/2025 Kerry Cullinan Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, “The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday. The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. “Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. Declaration passed despite US, Russian objections The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and President of the General Assembly, that clause survived. So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago. Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports. Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” ‘Calculated cut’ to funds Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. “The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added. “We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed. Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.” The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine. Call for sanctions on Taliban Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes. “If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.” She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003. Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Despite ‘Rising Misogyny’, UN Commission Adopts Declaration on Gender Equity 11/03/2025 Kerry Cullinan Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, “The poison of patriarchy is back and is back with a vengeance,” United Nations (UN) Secretary-General António Guterres told the opening of the annual session of the Commission on the Status of Women (CSW) at the UN in New York on Monday. The CSW takes place amid a major global backlash against women’s rights, from the Taliban banning Afghan women from public life to the Trump administration in the United States pushing back against “diversity, equity and inclusion” (DEI) which has resulted in cuts to research on women’s health. “Misogyny is on the rise, and so, violence and discrimination,” said Sima Bahous, who heads UN Women, noting that “domestic and ODA [official development assistance] allocations to gender equality remain woefully inadequate and, in some cases, are being cut altogether”. Declaration passed despite US, Russian objections The CSW’s political declaration was adopted by consensus on Monday. And despite earlier reports that the US and Russia had tried to purge a clause that encouraged member states from nominating women candidates for the UN Secretary-General position and President of the General Assembly, that clause survived. So did commitments to “gender equality and the empowerment of all women and girls”, and the “accelerated implementation” of the Beijing Declaration and Platform for Action, the first global roadmap for gender equality that was adopted 30 years ago. Bahous also commended the 159 member states that have affirmed their support for the Beijing Declaration in national reports. Despite the backlash, there has also been progress in the past 30 years, she noted: “Today, more girls are in school. More women are in parliaments, in boardrooms, in the judiciary. Maternal mortality has fallen. Legal barriers have been dismantled. Policies to protect and advance women’s rights are advancing. Violence against women and girls is widely recognized as a global scourge.” ‘Calculated cut’ to funds Françoise Moudouthe, Chief Executive Officer of the African Women’s Development Fund, told the opening plenary that “the decision by several governments and philanthropic actors to cut funding for gender equality in the past few years is a calculated blow to women’s access to education, healthcare, economic independence, political participation and bodily autonomy”. “The recent funding cuts by just two governments and two private philanthropic donors to women’s rights organisations were recently estimated to around $730 million per year,” she added. “We must immediately commit to protecting protecting gender equality for all, not with words but with resources,” Moudouthe stressed. Bahous declared that: “We, the champions of gender equality, are not afraid of the pushback. We have faced it before. We have not backed down. And we will not back down.” The proportion of women killed in wars had doubled over the past year alone, added Bahous, pointing to women’s and girls’ rights being “systematically stripping away” by climate change and conflicts in Afghanistan, the Democratic Republic of Congo (DRC), Palestine, Gaza, Haiti, Myanmar, Sudan and Ukraine. Call for sanctions on Taliban Meanwhile, at the UN Security Council meeting happening at the same time, Afghan lawyer Azadah Raz Mohammad urged the body to impose sanctions on all Taliban leaders who have committed human rights violations against Afghan women and girls, and not to lift sanctions, including travel bans, on those who are guilty of such crimes. “If the people of Afghanistan had been able to hold the Taliban accountable in 2001 and earlier, perhaps we would not have witnessed the Taliban’s violent return to power 20 years later,” Mohammad said, concluding: “If impunity is the disease, accountability is the antidote.” She also urged all member states to assist the International Criminal Court to pursue charges against all senior Taliban leaders who have committed acts of “gender persecution and other crimes against humanity, and war crimes” in Afghanistan since 2003. Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Only Seven Countries Meet WHO Air Quality Standards; Most Polluted are Chad and Bangladesh – Northern India Also Dominates 11/03/2025 Chetan Bhattacharji Air pollution in Delhi, the world’s most polluted capital city, is caused by several factors including traffic, industry and stubble burning. Chad and Bangladesh ranked as the most polluted countries in 2024, while Delhi, India was the most polluted capital city, according to the 2024 World Air Quality report produced by the Swiss-based IQAir. But only seven countries worldwide met WHO air quality guidelines and Africa’s pollution levels remains under-reported. Pollution monitoring also fell victim to President Trump drastic cuts and rollbacks of environmental protections, as US embassies worldwide closed monitoring stations and disabled the US government’s airnow.gov data base. Seventy-four of the 100 most polluted cities and towns are in India, according to the latest World Air Quality Report 2024, a slight improvement from 83 last year. Levels of a key microscopic pollutant, PM2.5, declined 7% across the nation, averaging 50.6 micrograms/cubic metre or 10 times the World Health Organization’s (WHO) safe guideline. Despite having the most polluted cities, India ranked fifth, globally, after Chad, Bangladesh, Pakistan, and the Democratic Republic of Congo in terms of national pollution levels. Globally, only 17% of the almost 9,000 cities surveyed met the WHO air pollution standard, which is an annual average of 5 micrograms/cubic metre of the pollutant PM 2.5. This microscopic particulate matter, containing a cocktail of other pollutants that penetrate the blood and brain barrier, is the most widely tracked measure of air pollution. Nationally, only seven countries: Australia, New Zealand, the Bahamas, Barbados, Grenada, Estonia and Iceland met WHO annual air quality levels, IQAir said. However, a world map of pollution averages shows air pollution is primarily a Global South challenge. Most of the worst affected places are in Asia. Some in Africa, although only 24 out of 54 African countries or territories reported data in 2024. Still, this is a marked improvement since the first of these reports in 2017 had useable data from only three African countries. US State Department closes global air quality monitoring network The rankings were released days after the new Trump administration’s move to shut down air quality monitoring at United States embassies worlwide. In parallel, the State Department deleted 17 years of data from US government’s airnow.gov data base – which had been a valuable source of reliable air quality data in resource-strapped countries like Chad. This is likely to have a “profound” real-world impact on surveillance, according to the report’s scientists. “The information collected at 80 global US embassies and consulates have proven to help protect public health and inform air quality policy… when US embassies began tracking local air pollution, host countries took action,” said Dr Christi Chester Schroeder, IQAir Air Quality Science Manager. “IQAir estimates at least eight countries will completely lose access to all real-time air quality data because of this decision, nearly all of which are in developing countries.” In Asia, Iran and Afghanistan are not included in the report because of a lack of real-time data. The report is based on data from about 40,000 ground-level air quality monitors in 138 countries, although IQAir, a Swiss firm for air quality equipment, does not publicly provide a margin of error for PM2.5 concentrations used in this report. Caption: The world’s top-10 most polluted countries in 2024 Why India isn’t the most polluted While it dominates the top 100 most polluted cities and towns, India’s expansive air quality monitoring network also captures levels in more rural and less polluted aeras – and that brought it’s national average down in comparison to other heavily polluted coutries, experts said. So the reasons Pakistan and Bangladesh ranked higher in overall pollution levels may be related to the limited scope of their air quality monitoring network – which tend to capture urban areas only. Cities with high PM 2.5 concentrations thus have a disproportionate impact on the country’s annual average concentrations. Chad also returned to the 2024 rankings – after being excluded in 2023 for a lack of data. Regional airshed solution for South Asia Either way, the report makes for bleak reading for India and the rest of South Asia. Bangladesh, Pakistan, India and Nepal are ranked at 2, 3, 5 and 7. The capitals of all these countries are also in the top 10 most polluted cities. India continues to lead the region in government monitoring infrastructure, operating more than half of the total stations, the report points out. Despite this, many areas in India remain under-monitored, particularly in smaller cities and rural regions. Cities like Delhi and Lahore frequently experience hazardous conditions with seasonal spikes in pollution leading to emergency measures such as school closures and public space shutdowns. “Air pollution pays no regard to country borders. The trans-boundary nature of air pollution is a serious issue in many regions around the world, and is no different with India and Pakistan,” said Schroeder. “Airsheds need to be treated as regional international issues, not national issues. Cities in India and Pakistan, as well as Bangladesh and Nepal, share common sources of pollution – industrial emissions, agricultural burning, vehicle pollution, dust, etc. Despite years of evidence of trans-boundary pollution, regional cooperation has been underwhelming.” The 20 most polluted cities in 2024. Source: World Air Quality Report,Note: Delhi is the larger area and New Delhi is the capital area within it. The second position is Delhi’s highest ranking since this annual report began eight years ago. One of India’s foremost air quality government scientists, Dr SN Tripathi, believes that in South Asia, India will have to take the lead in proposing and establishing some kind of agreement or arrangement with other countries. Airsheds within India and ability to analyse how air pollution is moving from one region to another. Tripathi, Dean at Kotak School of Sustainability, IIT Kanpur, calls for a “multilateral airshed approach sooner than later to deal with this menace.” Delhi is the air pollution capital The report’s scientists point out that while India’s population is nearly identical to the entire African continent, it has significantly expanded its air quality monitoring network in recent years. Experts say more such data should help in tackling the crisis. The world’s most polluted place is Byrnihat, an industrial town in India’s north-eastern state of Meghalaya. The annual average PM2.5 concentration was 128.2 micrograms/cubic metre. However, 2024’s data puts the main focus back on Delhi. The capital area of New Delhi, which has a municipality separate from the rest of Delhi, was the world’s most polluted capital. The larger area of Delhi ranked second among nearly 9,000 places. This is Delhi’s highest rank since the annual report began in 2017. (Although this is the 7th World Air Quality report, IQAir has produced eight rankings since 2017 ,which have been shared with Health Policy Watch for this article.) In stark contrast to the national decline, the pollution level rose in Delhi by 6% to 108.3 micrograms/cubic metre last year, the highest since 2019. Ironically, that is the year India’s first national clean air programme (NCAP) was launched. The report attributes Delhi’s pollution to vehicular emissions, a leading contributor to fine particulate matter (PM2.5), exacerbated by traffic congestion and fuel adulteration, as well as industrial and construction activities and seasonal burning of agricultural residue. Northern India dominates global ranking All the 74 Indian cities in the top 100 list are in northern India with none from southern India. About 65 of these are in the northern plain called the Indo-Gangetic Plain (IGP), from Punjab in the west to Bengal 2,000 km in the east. This remains a pollution hotspot, where meteorological factors trap pollutants and exacerbate winter smog. The Indian government plans to coordinate air pollution control plans in the IGP with a population of about 600 million as one jurisdiction. While India’s PM 2.5 averages 50.6 micrograms (population-weighted), a back-of-the-envelope calculation of average pollution in the IGP states shows the level of PM 2.5 to be higher by about a fifth. The location of the 74 Indian cities in the top 100 most polluted ranking of 2024 World Air Quality Report. The challenge is that each state is a separate political entity but air pollution obviously moves across political boundaries. Tripathi advocates the airshed approach as the framework “to approach the problem with common or shared resources. To get more bang for the buck.” He estimates that pollution can come down by two-thirds if the burning of waste outdoors and of polluting fuels (like coal, dung and wood) inside homes is stopped. China’s Air Pollution Dips Pollution levels declined in over 320 cities in China, including major cities such as Beijing, Shanghai, Chengdu, Guangzhou, and Shenzhen. But levels rose in almost 130 other cities. Officials have set ambitious goals to lower the national annual average PM 2.5 concentration to below 28 µg/m³ by 2027 and below 25 µg/m³ by 2035. Special attention is being given to the Beijing-Tianjin-Hebei region at the provincial level. Warning for Southeast Asia’s most polluted country Air pollution in Indonesia’s captial of Jakarta. Air pollution in Indonesia decreased by 4% in 2024 compared to the previous year, averaging 35.5 micrograms. However, the report warns of a clean energy challenge. The country is the world’s leading producer of nickel, a vital mineral for clean energy and storage but to extract it takes a lot of energy. And for this, it’s increasing its coal power capacity which grew 15% over a year till July 2024. Coal burning generates two-thirds of Indonesia’s electricity. Despite declining pollution, it remains the most polluted country in Southeast Asia. Vietnam air pollution’s cost In Vietnam, air pollution has been estimated to cause a loss of around 4% of the GDP. Acute air pollution events in Vietnam have severely impacted daily life, with disruptions to air travel leading to flight diversions at multiple airports. In 2024, there was a small reduction in pollution from 29.6 to 28.7 micrograms. Vietnam’s government, international bodies and various organisations are empowering citizens through information campaigns to raise awareness, take preventive action and also expand air quality monitoring for public health action and academic research. Community initiatives are promoting sustainable agricultural practices, such as reducing straw burning, while advocating for responsible household waste disposal to minimize pollution. The cleanest air was found in Hawaii’s Honaka’a, in the United States. It is ranked 8,954th and the PM 2.5 average was one microgram/cubic metre of air. Image Credits: Raunaq Chopra/ Climate Outreach, IQ Air, IQ Air, IQAir, Google maps, Aji Styawan / Climate Visuals. Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Big Pharma Issues Global ‘Call to Action’ to Address NCD Crisis 11/03/2025 Kerry Cullinan A patient with diabetes attends a check-up at a district hospital in Kigali, Rwanda. Investment in NCD prevention, treatment and care at primary level can save millions of lives. Almost five million lives could be saved annually if low- and middle-income countries (LMICs) invested 1% more of GDP in public healthcare spending – and used at least 40% of this to prevent and treat non-communicable diseases (NCDs). This is according to Airfinity research commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which issued a “Call to Action” on NCDs on Tuesday. The research is based on “implementing existing cost-effective interventions such as cardiovascular disease management, diabetes screening, and respiratory care”, according to the IFPMA. “The data supports growing consensus that more funding is needed to bend the curve on NCDs,” the pharmaceutical body said, “urging collective action across the globe” ahead of the United Nations High-Level Meeting on NCDs in September. NCDs such as cancer, diabetes, cardiovascular disease, lung disease, mental health, and neurological disorders cause almost three-quarters of global deaths. Eight out of 10 premature NCD deaths take place in LMICs Investment in NCD prevention and control could yield an annual seven-fold return in LMICs within a decade, according to 2021 World Health Organization (WHO) calculations. Lifestyle interventions including healthy diet and exercise, and primary healthcare could lead to an expected $230 billion economic gain by 2030, the WHO found. But NCD prevention, early detection, treatment, and control “remain severely underfunded and under-prioritized by both governments and global donors,” according to the IFPMA. “Low awareness” by “decision-makers, affected individuals, and general population” and “fiscal challenges” were the main reasons for the underfunding, according to the WHO and the World Bank. As a result, on average some 60% of treatment costs are being carried by patients in LMICs. These out-of-pocket payments for NCD treatment and care push approximately 100 million people worldwide into extreme poverty every year, according to the NCD Alliance. Access to medicines The IFPMA noted that “over 1,400 medicines have been approved for NCDs in the past 10 years, which have transformed how we fight disease, and are improving the lives of hundreds of millions of people living with chronic conditions” and “a further 9,600 NCD medicines [are] at various stages of research and development”. However, there are “significant barriers and delays in ensuring these medicines and vaccines can reach the people who need them, and there are still NCDs for which there is not adequate treatment”, the IFPMA noted. The IFPMA is working with partners in Access Accelerated to assist governments to identify a “suite of sustainable financing mechanisms” for NCDs including “health taxes, private or community-based health insurance programs, debt-for-health swaps, health savings accounts, performance-based financing (social impact bonds), blended financing, and mobile health financing solutions”. Redirecting existing fossil fuels subsidies and increasing taxes on tobacco, alcohol, and unhealthy foods are options for LMICs to raise finances to address NCDs, the IFPMA report notes. Collective action It called for collective action to enable innovation, mobilise investment, drive implementation and ensure the accountability of government and key stakeholders to improve on prevention, treatment and care of NCDs and mental health. “A political declaration that includes these recommendations can drive a vision for 2050 forward where there are fewer premature NCD deaths, reduced health systems strains, and healthier societies everywhere,” according to the IFPMA. IFPMA Director General Dr David Reddy said that the UN High-Level Meeting “provides a real opportunity to refocus attention on how cross-sectoral partnerships can help increase access to cost-effective medicines and vaccines in a way that can transform – and even save – the lives of millions of people worldwide.” Supporting the call, Dr Kimberly Green, PATH Global Director for Primary Health Care, said that “improving accessibility of essential medicines and health products has been underrepresented in discussions” ahead of the High-Level Meeting. PATH acts as the Secretariat for the Coalition for Access to NCD Medicines and Products. Green said that action is needed to “reduce catastrophic out-of-pocket health costs for people living with these conditions”, and that additional investment was needed to treat NCDs “through strengthened primary health care”. Image Credits: G Lontro/ NCD Alliance, Airfinity, IFPMA. Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Who Decides? The Contraceptive Conundrum Facing Adolescent Girls in Africa 07/03/2025 Edith Magak Panellists during the session on ‘Reclaiming Control: Let’s Talk About Sexual and Reproductive Health and Rights’ Access to contraception must be lowered to allow teenage girls to make informed decisions about their bodies, relationships, and futures, say key African health stakeholders – including sexual and reproductive health workers and advocates. But are policymakers ready to adopt this change – particularly as the debate over sexual and reproductive health rights becomes ever more fraught and polarized? At the just-concluded Africa Health Agenda International Conference (AHAIC), experts highlighted a troubling contradiction: while contraceptives are widely available across the continent, teenage girls under 18 often cannot access them without parental consent—consent that is not commonly sought, and when it is, frequently denied. Easier to get an abortion than contraception Dr Samukeliso Dube, Executive Director of Family Planning 2030. Rwanda is one of the countries grappling with this issue. According to Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health and Executive Director of Medical Doctors for Choice, laws governing contraceptive access are often more restrictive than those regulating abortion. “In Rwanda, the law allows pregnancy termination up to 22 weeks if the person seeking the abortion is under 18, following an application by their legal representative. But to access contraception, girls under 18 still need parental consent,” she explained. “You can imagine if a girl falls pregnant at 15—she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem.” This ‘problem’, led to over 39,000 teenage pregnancies in the country in 2022, according to Rwanda’s census. Without access to contraceptives, many girls resort to unregulated and unsafe options, putting their health at serious risk. Alternatively, teenage girls opting to become mothers before they have finished their education or training, risk a lifetime of poverty and dependency on family members and others. Recognising the urgent need for reform, the Rwandan parliament is now considering a new bill that would allow girls as young as 15 to access contraception without requiring parental consent. Teenage mothers getting pregnant ‘again and again’ Although a decline in adolescent birth rates has been observed globally, sub-Saharan Africa continues to have twice the global average. But Rwanda is not alone in facing this challenge. Many African countries, including Kenya, have similar restrictions. Ritah Anindo Obonyo, Executive Director of Community Voices Network in Kenya, said policies drive young girls toward dangerous alternatives. “Teenage girls are unable to access safe contraception, so they’re using emergency contraception as a long-term birth control method, which is not recommended,” she explained. “They are also using ‘Sofia’ or ‘China pills’, which are sold in backstreets and contain unsafe components.” The lack of safe contraceptive options has led to a troubling rise in repeat pregnancies amongst teenage mothers, Anindo observed. “With our organisation, we’re seeing a new trend—teen mothers are getting pregnant again and again. You can imagine what this means for their lives.” Teenage pregnancy has a prevalence rate of over 25% in 24 African countries, a rate that reaches as high as 48% in Niger and 44% in Chad. The Fight for Autonomy For many advocates, the debate over contraception is about more than just access—it is about control over young people’s bodies and futures. Patriarchal systems continue to deny young people autonomy over their reproductive choices, said Dr Samukeliso Dube, Executive Director of Family Planning 2030. “I think patriarchy is exhausting because it manifests in so many different forms. It’s always about control—who can I control at any given time? Let’s control who has access, when they have access, and how they have access.” “Everyone has the right to decide if, when, how many, and with whom they want children. That is a fundamental basic right,” she said. BBC’s Namulanta Kombo(left), in conversation with Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation and Dr Meggie Mwoka, Innovations Manager, Amref Health Africa. With Africa facing dwindling health resources due to aid cuts, experts argue that expanding access to contraception and comprehensive sexual and reproductive health education is one of the most effective ways to both ensure girls’ and womens’ basic reproductive health rights as well as optimising existing funds. Professor Charles Okeahalam, Chairman of Amref Health Africa’s International Board of Directors, stressed the economic and social benefits of investing in women’s reproductive health and education. “If we educate girls and give them more sexual and reproductive health rights, population growth would slow, and with a lower population growth rate, the demand for [healthcare] resources would also decrease,” he said. “But even beyond that, better-educated mothers and empowered women are more capable of caring for their children. Investing in female education—particularly in reproductive health—is an essential part of preventive care and resource management. These are the people most directly involved in providing care within families and communities.” 30 Years After Beijing, Women’s Voices Are Still Being Ignored This year marks the 30th anniversary of the Beijing Declaration and Platform for Action, a landmark commitment by governments to advance gender equality and women’s rights. Yet, female health leaders at AHAIC noted that many of the issues raised in Beijing in 1995 remain unresolved. Dorothy Nyong’o, Managing Trustee of the Africa Cancer Foundation, reflected on the progress—or lack thereof—since attending the historic conference. “I was present at the meeting in Beijing, and what is intriguing today is that 30 years later, the more things have changed, the more they have remained the same,” she said. “It’s unfortunate that despite some progress, when I attend the Commission on the Status of Women (CSW) year in and year out, we are still discussing the same issues we raised in Beijing.” Image Credits: Edith Magak/HPW, Edith Magak/ HPW, African Union 2022. Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Mpox Testing Rate Plummets to 17% in DRC 06/03/2025 Kerry Cullinan Dr Ngashi Ngongo, Africa CDC led on mpox. Only 17% of suspected mpox tests in the the Democratic Republic of Congo (DRC) had been tested in the past week – a drop of almost 10%, Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) lead on mpox, told a media briefing on Thursday. Only seven of the DRC’s 26 provinces in are reporting on mpox cases, and efforts to address the epidemic are being undermined by conflict and the withdrawal of aid from the United States, he added. “With the US aid freeze, there is no money for the transportation of specimens,” said Ngongo. However, Africa CDC is assisting the country to decentralise its laboratory services to make testing available close to outbreaks. The country’s laboratories have been expanded from two to 21 between last July and February. “But the target was to reach 56 laboratories to be able to get all the health zones to have laboratories to then eliminate the need to transport samples,” said Ngongo, adding that the ongoing conflict, particularly in eastern DRC, had affected plans. Some two million people are displaced in the DRC due to conflict – most recently in the east, and health players have requested a humanitarian corridor to restore health services to North and South Kivu which have been taken over by M23 rebels. In better news, some 300,000 people have been vaccinated against mpox over the past 10 days in the DRC capital of Kinshasa – over half the target. The vaccination uptake has increased significantly since health authorities changed its focus from contacts and key populations to anyone living in geographic hotspots, said Ngashi. However, the new variant of mpox Clade 1A has also been identified in Kinshasa. The variant now has one of the same genes as Clade 1B that is linked to higher transmissibility, and this could also increase the infectiousness of Clade 1A. Ebola in Uganda Five cases of Ebola – three confirmed and two probable – have been reported in Uganda over the past week. The new outbreak was first identified in a four-year-old child, and has no apparent link to the outbreak involving nine people three weeks’ ago. However, genomic testing has established that it is the same strain. In that outbreak, a nurse was thought to be the index case but as she lived in a city and had no contact Ebola-carrying animals, the usual source of outbreaks, investigations are ongoing to see whether there is another index case, said Ngongo. Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Huge Risk of Drug-Resistant Tuberculosis in Wake of Abrupt US Funding Cuts 06/03/2025 Kerry Cullinan In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis. Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday. As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB. “Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey. Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. Impact of US ‘stop work’ orders on TB projects surveyed Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff. CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub. As a result of the collapse of funding for CHW, almost half the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment. USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. ‘We won’t walk away without a fight’ “[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”. “Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat. “Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.” No support for ‘most vulnerable’ In Thailand, a patient with multi-drug resistant TB receives his daily treatment. Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”. “Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde. Impact of US stop work orders on projects surveyed “In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA). “In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.” Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. “Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. “Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.” ‘Devastating impact’ Dr Tereza Kasaeva, WHO’s Global TB Programme director, The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO. “These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.” Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”. This was proven during the COVID-19 pandemic, she added, when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia. Posts navigation Older postsNewer posts