While South Sudan veers toward civil war, the government of President Salva Kiir spent 12 times more on president’s office than health, agriculture and social services combined since 2020.

Grand corruption schemes siphoning billions in state resources to government-linked elites have crushed South Sudan’s health system as the country teeters between famine and a new civil war, UN investigators found.

The findings of a two-year investigation by the independent UN Commission on Human Rights in South Sudan published on Tuesday document how systematic corruption has created one of the world’s worst health crises, leaving the youngest nation in the world with just $7.9 million in health spending last year for 12 million people — comparable to what it spent on its 12-player men’s national basketball team.

South Sudan ranks second-to-last globally in universal health coverage. One in 10 children dies before age five, with three-quarters of these deaths being preventable with basic medical care and immunisation programmes.

Women and girls face the highest maternal mortality rates globally. Life expectancy remains frozen at 55 years, one of the lowest in the world and nearly 20 years below the global average, unchanged since independence in 2011.

Over 7.7 million people — 65% of the population — face acute food insecurity. Among them are 2.3 million acutely malnourished children and 1.2 million malnourished pregnant and lactating women. Several provinces and over 20,000 people are currently facing famine.

“Corruption is killing South Sudanese: preventable deaths from illnesses are due to available resources being diverted from government services,” the UN Commission found. “The country has been captured by a predatory elite that has institutionalised the systematic looting of the nation’s wealth for private gain.”

The health catastrophe is unfolding as political instability threatens renewed civil conflict. President Salva Kiir arrested former deputy Riek Machar in March and charged him with treason last week, effectively ending hopes for the 2018 peace agreement that halted the last civil war, which killed 400,000 people shortly following South Sudan’s independence.

“Unless it addresses corruption meaningfully, the Government will not be able to meet the most essential needs of South Sudan’s population, or its range of international human rights law obligations, nor prevent the escalation of armed conflict,” the UN commission concluded. “If these measures are not vigorously pursued, the human misery will continue, and South Sudan will risk failure.”

Diverted billions

Health sector spending has hovered between 0.4% and 1.1% of national expenditure since 2021.

The commission’s report, “Plundering a Nation,” found the Ministry of Presidential Affairs spent $557 million between 2020 and 2024, over 12 times the combined $43.7 million received by the ministries of health, agriculture, social services, and social welfare over the same period.

The Presidential Medical Unit, exclusively serving the president and his inner circle, received more funding in 2022-2023 than the entire national health system meant to serve 12 million people.

The men’s national basketball team received $6.5 million that same year, double the combined funding for humanitarian affairs, disaster relief and social welfare ministries, which include the arms of government responsible for children and women’s health.

“Corruption is not incidental, it is the engine of South Sudan’s decline,” said Yasmin Sooka, who chairs the UN Commission. “It is driving hunger, collapsing health systems, and causing preventable deaths, as well as fuelling deadly armed conflict over resources.”

South Sudan received an estimated $25.2 billion in oil revenues since achieving independence in 2011, including $8 billion since the 2018 peace agreement that currently governs the country.

The UN Commission found “deliberate redirection” and “plundering” of these state revenues were the main culprits for the nation’s precipitous economic decline, which has seen GDP fall to a quarter of pre-independence value, resulting in a near total absence of government funding for public services.

Meanwhile, the “Oil for Roads” program diverted $2.2 billion to companies linked to Benjamin Bol Mel, appointed vice president in February. These companies, consuming 60% of government contracts in certain years, delivered less than $500 million in actual roads, leaving $1.7 billion unaccounted for.

“South Sudan’s political economy is constructed around an entrenched rent-seeking patronage network, through which elites convert public resources into private power,” the UN Commission said. “The ensuing cycle of grand corruption aided by total impunity has produced a devastating humanitarian and human rights crisis.”

A five-year plan developed by South Sudan’s own health ministry to provide basic health coverage to 65% of the population  by 2027 would cost $325.5 million in 2024. Current spending covers 2.3% of that, or $7.49 million for a whole year of the national health system intended to serve over 10 million people, 70 times lower than what the Presidential office has spent on expenses since 2020.

“These figures fall drastically short of policy targets, public health needs, and regional commitments, including the 15 per cent target committed to by African States in the Abuja Declaration,” the UN added.

Limited funds, when they reach the Ministry of Health at all, are also frequently misspent. In 2022-2023, the ministry spent twice as much on vehicles as on salaries and purchased no pharmaceuticals.

South Sudan’s government rejected the UN report, stating it was “meant to smear the good image of the people of South Sudan and its leadership.” Government spokesperson and information minister Michael Makuei Lueth also dismissed the UN’s findings: “They don’t consult the government. They just write whatever comes to their mind in their hotel rooms.”

Dying without medicine

Trend of increasing humanitarian aid needs and dependency, 2011 to 2025.

At government hospitals visited by UN investigators, doctors described working without reliable salaries, medicines or basic supplies, effectively operating under “emergency” conditions year-round. Untrained midwives deliver babies without equipment. For survivors of sexual violence, access to health care is “practically non-existent,” the Commission found.

Lack of investment in core infrastructure further complicates the picture. Power outages cripple the few functioning hospitals. Where roads don’t exist, medicine must be flown in at costs no one can afford. Only 12% of rural households have access to improved sanitation. Most South Sudanese, 61%, practice open defecation, fuelling cholera outbreaks.

“Three-quarters of child deaths are preventable, yet funds go to patronage and private pockets, not medicine or clean water,” said Commissioner Carlos Castresana Fernández. “The diversions translate into preventable deaths, widespread malnutrition, and mass exclusion from education.”

The abdication of core government functions from health, to food, and infrastructure has led to a near-total dependence on international aid. Foreign donors fund 80% of South Sudan’s health system, with the United States providing health assistance worth 235% of what the government spends on its own people.

South Sudan now faces the spectre of over half its health spending evaporating under the Trump administration’s foreign aid cuts. It is the third most reliant nation on United States funding for its health services, second only to Afghanistan and Somalia.

“The Government’s expectation, if any, is that others will cover the shortfalls,” the commission found. “While a small group of powerful actors pillage and loot the country’s wealth and resources, enriching themselves, the state has effectively abdicated its sovereign responsibilities to its population, outsourcing critical services — such as the provision of food, health care, and education to international donors.”

“Individuals implicated in corrupt acts receive government contracts for their businesses, are retained as public officials, and even promoted to the senior-most State positions,” the UN added. “This collusion in corruption at the highest levels is reflected in the deliberate absence of all forms of accountability.”

Hunger by design

Agriculture and food security national budget allocations and expenditure, 2020-2025.

The crisis extends to food security. In 33 of 79 counties, food insecurity is at ’emergency’ levels, one tier below famine. Over 22,000 people are likely already starving, while nearly 60% of the population faces life-threatening food insecurity.

The Ministry of Agriculture received $11 million over four years, 7% of its promised budget. The Ministry of Livestock and Fisheries received only 20% of its budget allocation, amounting to 0.09% of total regular budget expenditure.

Beyond climate change and conflict, the hunger crisis is also driven directly by the government’s economic mismanagement. The government’s money printing to fund corruption drives food inflation at a one-to-one rate, according to the International Monetary Fund. Any depreciation of the South Sudan Pound is fully passed on as food inflation within six months.

“In practice, the Government’s official policy choices are fuelling inflation and directly driving up the cost of food, trapping families in a cycle where government action itself intensifies hunger,” the UN said.

UN map of the floods as of 12 September, 2025.

Malaria, the leading cause of death, struck 2.8 million people in 2022. Médecins Sans Frontières warned in August of a “severe shortage of essential malaria medicines in public healthcare facilities across South Sudan,” noting the crisis would worsen with the rainy season and flooding.

“In some areas, supplies have been completely unavailable for months, even as malaria cases continue to rise,” MSF said. “With the rainy season approaching, we expect cases to rise sharply.”

Following MSF’s warning, massive floods displaced 100,000 people in recent weeks across Jonglei, Upper Nile and Unity states. Unity State is 70% underwater. Up to 400,000 people may be displaced by year’s end.

“On the ground, we have seen the widespread deprivation and the absence of basic infrastructure and services: direct outcomes of corruption,” said Sooka. “When public revenue becomes private fortune, peace cannot hold.”

Image Credits: CC.

Cash transfers
Dr Mona Hanna (left), director of Rx Kids, with two Michigan parents who received the cash transfer.

In Flint, Michigan, mothers face some of the highest risks of adverse health outcomes in the United States. But a new intervention is changing the outlook of Flint babies for the better.

More than 10 years after the city uncovered devastating lead water contamination, Flint still struggles with the highest child poverty rate in the country – nearly 60%, which is triple the national average.

Dr Mona Hanna, a pediatrician who has spent her career tackling the persistent health disparities in Flint, knew this poverty impacted every aspect of her patients’ health: “Poverty is a pathogen. It is a root cause and social determinant of health. It makes kids and communities sick.”

Hanna now has a new prescription at her disposal: unconditional cash transfers to pregnant women and new mothers in the form of the organization, Rx Kids.

The program is offering a solution to alleviate poor maternal and child health: up to $7,500 in cash for new mothers with no strings attached. They can buy a crib, diapers, nasal spray for their baby’s runny nose. All pregnant mothers are eligible, making it the first community-wide prenatal and infant cash transfer in the US.

While cash transfers have enjoyed success in 140 countries, the US remains an outlier in investing in the most critical window of development during pregnancy and early infancy.

“As a society, we consistently under-invest in this window, which makes it really hard to have a healthy pregnancy and have a healthy newborn,” Hanna said in an interview with Health Policy Watch.

Michigan’s program joins a list of others, like those in Kenya, that show a direct correlation between cash transfers and improved birth outcomes.

“With global health budgets shrinking, we think directing cash to pregnant women is a cost-effective way to stretch those dollars and save more lives,” said Laura Keen, a program director at the non-profit GiveDirectly, which administers cash transfer programs.

Pregnancy and first year shape health for life

Rx Kids and other cash transfer initiatives have lasered in on resources for new and expectant mothers because of the outsized role the first year of life plays in a child’s health and development.

“Babies’ brains double in size in that first year of life,” said Hanna, who is also associate dean of public health at Michigan State University College of Human Medicine.

This means that babies’ exposure to poverty, undernutrition, or environmental chemicals in that critical window disproportionately impacts on their health into adulthood.

Conversely, a caring, low-stress environment, breastfeeding, and stable housing can all boost a person’s health across the life course.

Although this is the most critical window for development, it is also the most financially challenging for families. A 2020 study revealed that American family income drops sharply near the birth of a child, often because the mother leaves work without adequate family leave pay, and because costs rise for a baby’s needs.

Supporting pregnant women and new mothers can also benefit communities struggling with an overburdened healthcare system. A recently published study estimates that Flint could save up to $6.2 million each year based on fewer preterm births, underweight babies, and neonatal ICU (NICU) admissions.

The city of Flint has one of the highest child poverty rate in the US.

Cash infusion halves child mortality in Kenya

While the US has been struggling with domestic health funding cuts, notably Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), overseas aid has also been crippled. The reverberations are already expected to threaten decades of global health progress, including for child and maternal health.

But a massive experiment in villages in Western Kenya found that cash could be as effective, if not more, than the typical aid interventions of bed-nets and malaria medications.

Starting in 2014, the same non-profit that facilitated Rx Kids gave $1,000 to over 10,000 households in Kenya after the birth of a child. This resulted in a reduction of almost 50% in infant mortality, from about 40 deaths per 1,000 births to 21 deaths.

The researchers tracked mortality in infants born to families who received the money and those born without. They found that access to cash increased the use of healthcare facilities, especially when families lived near clinics or hospitals.

Thus, the benefits of extra cash were most pronounced for families who could already access some form of healthcare. The researchers speculated that, like in Flint, new mothers struggled with having to work right up to or right after the birth of their child, which puts physical and mental strain on the mother.

“Despite not being the main aim of the original program, we show that unconditional cash transfers in this setting may be a cost-effective way to reduce infant and child deaths,” the authors write.

Outcomes for Flint babies and their mothers improved with the cash transfer.

Birth outcomes improve

Extra money for strollers, cribs, diapers, and transport to check-ups all relieves stress on expectant mothers, which can improve birth outcomes.

Flint babies are nearly twice as likely to have a low birth weight as the rest of the state, and have higher rates of preterm births.

However, a study measuring the effects of Rx Kids on preterm births, low birthweight, and NICU admissions in Flint over the past year, since the cash transfer program was implemented, found that it is already saving lives.

Using both Flint statistics and a comparison with matched cities, researchers found that Rx Kids was associated with a 2.7% decrease in the preterm birth rate and a 4.4% reduction in admissions to NICU.

The US struggles with poor birth outcomes and maternal mortality relative to other high-income nations. Cash transfers could help bridge this divide, noted Hanna.

“We don’t have to continuously react to poverty; we can prevent poverty, like in other countries,” she said.

Researchers hope to continue tracking the kids who received money for things like gun violence, poverty, and educational success.

Evidence for success in the US

This is the first community-wide prenatal and infant cash program in the US, partly inspired by the COVID-19 era expanded Child Tax Credit (CTC). The pandemic spurred the federal government to increase eligibility and the amount of cash for families under the American Rescue Plan. With this expanded credit, the US joined the list of some 140 countries that offer child cash-transfer programs, and initiated a historic decline in child poverty.

Although the CTC has since expired, Rx Kids was inspired to give direct transfers of $1,500 to women during pregnancy, and $500 a month for the baby for six months or a year.

“During COVID-19, as a nation, we became like all those other countries in the world, and we gave millions of families unconditional cash allowances, and that dropped child poverty to its lowest level ever,” said Hanna.

“Millions of kids in the United States came out of poverty. All these outcomes improved: housing stability, nutrition security, decreased debt, less abuse and neglect, decreased parental stress. The list went on and on of all these amazing outcomes, and that was not renewed by one vote in the US Senate, and millions of kids went back into poverty.”

Maternal mental health and well-being improve

The unconditional cash transfers enabled pregnant women to take time off from work and to get regular health check-ups.

The cash transfers also reduced postpartum depression rates and boosted mothers’ self-reported feelings of hopefulness. Families also reported better trust in healthcare institutions, something that has taken a hit during the pandemic, especially in poorer communities. The study compared a cohort of Flint mothers and infants to three other Flint cohorts who did not receive the cash transfer.

“This money allowed me to take more time off work,” is a common refrain among the moms, said Hanna. “Or, ‘I could afford to catch up on rent.’”

Because the program is universal, and not just for low-income families, there isn’t the same stigma that is sometimes associated with welfare programs.

“We’re targeting poor places with this intervention, not poor people. And that focus on poor places is easily replicated,” said Keen.

GiveDirectly is launching a similar program in the Democratic Republic of the Congo, and hopes to expand beyond Michigan into neighboring states.

Other metrics also improved. Evictions fell by 91%, being behind on rent or mortgages dropped, and nutritional access improved. These are often key measures of future stability and success in a child’s life, said Hanna.

‘Moms know what they need’

Cash transfers improve maternal health
“We’re targeting poor places with [cash transfers], not poor people. And that focus on poor places is easily replicated,” said Keen.
Direct cash transfer programs do run the risk of participants spending the money in ways not intended by the program.

“There are understandable concerns for the unconditionality of these programs,” said Keen. “You may think that people will spend the money on alcohol or cigarettes.”

But Keen points to results that show a reduction in spending on those goods.

Preterm births also may have dropped in Flint because those mothers may have reduced smoking, commonly linked to poor birth outcomes. Flint mothers who received cash transfers saw a 1.7% drop in smoking while pregnant, and a 5.7% increase in seeking adequate prenatal care, compared to their peers.

Spending on harmful products are minor concerns when compared to the overall efficiency of the unconditional cash transfer model, Keen noted. Without work, education, or even income requirements, there aren’t many administrative costs associated with running this kind of program.

Indeed, a Michigan-based economic think tank published a piece in support of the program, saying “spending your own money on yourself” is the most efficient way to spend money, unlike many of the government welfare programs that restrict eligibility.

Public health is often criticized for being paternalistic, notes Hanna. “We think we know what’s best for you. But this uproots that notion and conveys a sense of trust and empowerment.”

“Moms know what they need,” she said. Furthermore, the program’s unconditionality has been a boon in participation. Nearly every eligible newborn has been enrolled, unlike some federal welfare programs, which may only have 50% intake.

The program has bipartisan support, largely because of its efficient model. It’s already expanded to 11 rural and urban communities in Michigan.

Over 3,000 families have since been enrolled in the Rx Kids program, totalling $14.5 million in direct cash transfers.

“Bringing a child onto this earth is hard for everyone, and as a community, we should come together and support people through that process,” said Keen.

Image Credits: Sipho Ngondo/ Unsplash, International Confederation of Midwives, Rx Kids .

IGWG co-chairs, Brazil’s Tovar da Silva Nunes and the UK’s Mathew Harpur.

Amid rising disease threats, it is “critical” that the World Health Organization (WHO) presents a completed pandemic agreement to the United Nations (UN) High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response in 2026, WHO Director General Dr Tedros Adhanom told member states at the start of negotiations on the final outstanding annex to the agreement on Monday.

“The next pandemic or major global health emergency is not a question of if, but when,” Tedros told the Inter-governmental Working Group (IGWG) meeting in Geneva to conclude talks on a Pathogen Access and Benefit-Sharing (PABS) system.

The PABS annex is due to be adopted by the World Health Assembly in May next year, and thereafter taken to the HLM, said Tedros.

According to Article 12 of the pandemic agreement, the IGWG needs to develop provisions to govern the PABS System, “including definitions of pathogens with pandemic potential and PABS materials and sequence information, modalities, legal nature, terms and conditions, and operational dimensions”.

The negotiation timetable is extremely tight, but the IGWG Bureau has drawn up a draft outline of what PABS needs to cover, suggested definitions and compiled a list of experts to guide the talks.

Some of these experts were suggested at an informal meeting of the IGWG last week. They include the Dr Farida Al-Hosani from the United Arab Emirates, who chairs the WHO’s Pandemic Influenza Preparedness (PIP) Framework Advisory Group; Australia’s Dr Jodie McVernon, director of Doherty Epidemiology and public health lead at the Doherty Institute; Italian pharmocologist Dr Marco Cavaleri, who heads the European Medicines Agency’s (EMA) office of biological health threats and vaccines strategy, and Thailand’s Professor Punnee Pitisuttithum, head of the Vaccine Trial Centre at Mahidol University in Bangkok.

Member states have acknowledged that the process needs expert guidance as the annex will need to harmonise with several international agreements covering intellectual property and trade, as well as the Nagoya Protocol, which determines how to share the benefits arising from the use of genetic resources fairly and equitably.

Standard contracts

The Third World Network called for legally binding contracts with manufacturers under PABS.

Several stakeholders who addressed the open session of the IGWG called for the annex to include standard, legally binding contracts for manufacturers who want to use pathogens to develop vaccines, diagnostics and therapeutics.

Drugs for Neglected Diseases Initiative (DNDi) proposed “model contracts that embed equity”, and “non-exclusive licencing approaches” to enable technology and knowledge transfer and capacity strengthening.

The Third World Network advocated for legally binding contracts and clear governance mechanisms.

The Coalition for Epidemic Preparedness Innovations (CEPI) “embeds contractual obligations for access in our agreements with partners developing pandemic products”, but said that this “only addresses access in one part of the value chain”.

PABS benefit-sharing provisions should not discourage innovative developers and manufacturers, CEPI stressed. 

CEPI is developing a biospecimen sourcing initiative of samples from survivors of infectious disease outbreaks, “which will provide a practical example of how to enable timely, ethical access to clinical specimens for immunoassay development and vaccine development”. 

Avoid ‘excessive obligations’

The IFPMA’s Grega Kumer warned against “excessive or unclear obligations” and “a complex legal maze”, which would undermine the “fragile” pandemic innovation ecosystem.

“Free and unhindered access to pathogens and their associated sequence information is fundamental to global health security,” said Kumer.

“This openness, regardless of origin or intended use, must be preserved to maintain the agility of the research and innovation ecosystem.”

The IFPMA also wants PABS to be operational for pandemics only and not public health emergencies of international concern (PHEIC).

Gavi, the vaccine alliance, called for clear definitions of terms, particularly pathogens with pandemic potential, and called for a PABS system that can “deliver an end-to-end solution, from access to materials and sequence data to the fair allocation and delivery of vaccines, therapeutics and diagnostics”

The EU’s Americo Zampetti (right)

The European Union’s (EU) Americo Zampetti stressed that the PABS system should “increase the availability and affordability of safe vaccines, therapeutics and diagnostics (VTDs)” during a pandemic emergency.  

It should also “enhance the ability of WHO and other key partners in the UN system and beyond to swiftly and effectively act to save lives by distributing relevant and safe VTDs to those most in need”.

However, he warned that the EU “will not support a system that negatively impacts the innovation ecosystem and disincentivises innovation”.

‘Not a business deal’

Addressing the open session, Bangladesh urged member countries to remember that they are “not negotiating a business deal, but an agreement to save lives”.

Malaysia, speaking for the Association of Southeast Asian Nations (ASEAN), said the association has made significant strides to safeguard members in pandemics, including through the ASEAN Centre for public health emergencies and emerging diseases, biological threat surveillance centre and Emergency Operation Centre network. 

However, the PABS system will provide a “more coherent and structured regional framework for pandemic preparedness and response”, enabling “a regional platform for technology transfer”, pool procurement of VDTs, and building regional research, laboratory, regulatory and manufacturing capacity “so that benefit sharing is translated into lasting resilience”. 

Tanzania, speaking for the Africa plus plus Egypt, Sudan and Tunisia (usually part of WHO Eastern Mediterranean Region), said the annex presents an opportunity to “operationalize equity in tangible ways”.

“The Africa region underlines the need for legal certainty and for the primacy of mutual trust, cooperation, accountability and transparency in the PABS system.”

Global Fund Executive Director Peter Sands at a press briefing this week in Geneva.

While deaths from malaria have fallen by 29% since over the past two decades, mortality could rise again this year due to the cuts in global health funding seen recently, says Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“There has been a significant impact…and I suspect that we may well see an increase in the number of children dying of malaria this year in part due to the reductions in funding,” Peter Sands,  told reporters in Geneva as the organization released its annual Results Report.

Progress in reducing deaths from the disease, which still kills about 600,000 people a year, had already stalled during the pandemic. Meawhile, climate change drivers of more warm and wet weather are facilitating mosquito breeding and parasite transmission, while regional conflicts make drugs, vaccines and bed nets harder to distribute.  And to make matters worse, more pockets of parasitic resistance to currently available drugs are emerging, according to the Global Fund’s 2025 report.

Standing water post hurricane
Standing water in flood zones, seen here in the aftermath of Hurricane Otis, creates ideal grounds for mosquitoes to breed.

The net result could lead to more than 100,000 additional malaria deaths this year, Sands warned, a huge setback in the historic gains seen. Three-quarters of the 608,000 malaria deaths in 2022, the latest year for which data is available, were in children under the age of five, with Sub Saharan Africa bearing the brunt of the mortality, the report says.

Malaria infection rates can rise dramatically and abruptly, Sands noted, warning that “malaria is a disease that reacts very quickly.. and it doesn’t react in small percentage changes.”

For instance, Pakistan’s massive flooding in 2022, led to a whopping 2.6 million malaria cases that year – as compared to only about half a million in 2021.Fragile and conflict ridden states that are home to some 16% of the global population, bear nearly two-thirds of the global malaria burden, as well as one quarter of TB cases and 17% of new HIV infections.

Impressive results – so far

Global Funds results report summary

Despite the serious threats on the horizon, the recent report still reflects impressive results archived since the organization’s inception in 2002. In less than a quarter century, the combined death rate from AIDS, tuberculosis (TB) and malaria has been reduced by 63% – saving an estimated 70 million lives. 

 “This shows that with the right tools, strong partnerships and sustained investment, we can change the course of global health for the better,” Sands also said. “But in today’s fast-changing geopolitical environment, there is no room for complacency. The global health community must move faster to reduce fragmentation, eliminate duplication and make it easier for countries to work with us.” 

As of 2024, a record number of people were on antiretroviral therapy (ARVs) for HIV, a record number of people were receiving treatment for TB, and the scale-up of malaria prevention efforts was at a peak, with new vaccines approved by regulators launched in high-priority Sub-Saharan African nations, the report states.

HIV and AIDS

Over 79% of people in Global Fund-supported countries were on ARVs in 2024.

In 2024, 88% of people living with HIV in Global Fund-supported countries knew their status, 79% were on ARVs, rising to 85% of pregnant women living with HIV –  the highest levels ever recorded. Use of pre-exposure prophylaxis (PrEP) for HIV prevention surged, with 1.4 million people in Global Fund-supported countries receiving PrEP in 2024 – a 325% increase from 2023. 

 Since the Global Fund was founded in 2002, the AIDS-related mortality has been cut by 82% and HIV incidence rate by 73% in the countries where the Global Fund invests. Even so, in 2024, 630,000 people still died of AIDS-related causes, and there were 1.3 million new HIV infections globally – around 3.5 times more than the global target of fewer than 370,000 new infections by 2025. But amongst all the diseases covered, Sands sounded the strongest notes of optimism around teh possibility of making further progress on HIV and meet a key 2030  Sustainable Development Goal. 

“We really have the oportunity to accelerate the elimination of HIV as a public health threat,” said Sands. “We now have tools available to really change the trajectory,” he noted, referring to the new long-acting injectable drug lenacapavir that can be administered every six months and is nearly 100% effective in preventing disease. At the end of 2024, the Global Fund committed to reaching 2 million people with lenacapavir, a promising injectable for HIV prevention.

And just last week,  US Secretary of State Marco Rubio said the United States  would make a pre-market commitment to purchase lenacapavir from the pharma manufacturer Gilead Sciences, to support distribution by Global Fund in some 8-12 high burden countries, with Undersecretary of State Jeremy Lewin, praising the partnership.  The announcement, honoring a Biden-era commitment to support the drug’s distribution, represented one of the few global health “wins” since US President Donald Trump took over at the White House.  

Tuberculosis

A trial participant is prepared for a blood test as part of a trial of new TB drugs that can overcome drug resistant pathogens.

In 2023, treatment coverage for all forms of TB reached 75% in countries where the Global Fund invests – its highest ever level, up from 45% in 2010; 44% of people with drug-resistant TB started treatment. Of those starting TB treatment, 88% were successfully treated and 91% of people living with HIV who had TB were on antiretroviral therapy. 

Since 2002, efforts to provide equitable access to prevention, testing and treatment services, find and treat “missing” people with TB, fight drug‑resistant TB and reduce prices for TB commodities have helped drive down the mortality rate by 57% and the incidence rate by 28%.

“In 2024, more people were diagnosed, more people were treated, and the treatment success rates were higher than ever before. So actually, 24 was a year of great progress, on TB,” Sands said. Here, too, innovation will prove crucial to further progress, he stressed, citing the development and scale-up of AI-powered TB detection and mobile digital chest X-rays stations, enabling faster and better diagnosis – a longstanding barrier to TB treatment. 

But TB is still the world’s deadliest infectious disease. It killed an estimated 1.3 million people in 2023, and drug-resistant TB remains a major threat to global health security. Fragile health systems, conflict and economic pressures threaten to reverse the gains made over the past two decades, Sands warned.

Malaria 

Tomnjong Thadeus with his 3-year-old daughter Gabriella in Soa, Cameroon. One third of people in Africa’s most malaria-endemic countries still don’t have bednets.

As for malaria, the target of elimination of malaria as a public health problem is now within reach, as demonstated by the experiences of both Suriname and Timor-Leste – both countries with wet, tropical  “mosquito friendly” climates that were certified as malaria-free by the World Health Organization in 2025.

“With sufficient political will and sufficient resources, We can, end malaria,” Sands said.

In countries where the Global Fund invests, access to an insecticide-treated net reached 61%, with 53% of people at risk using a mosquito net in 2023 – the highest levels to date. More than 95% of people with signs and symptoms of malaria were tested.

Strengthened access to testing, treatment and prevention options, as well as the scale‑up of dual active ingredient insecticide‑treated nets to fight drug and insecticide resistance have contributed to the reductions in disease incidence and the death rate. 

But rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides are also complicating those efforts, raising risks of resurgence in the most vulnerable groups – such as children under 5 and pregnant women. 

“With sufficient political will and sufficient resources, We can, end malaria,” Sands said. “However, in the places where malaria is biggest, and that’s almost all in, Africa, we’re not making the kind of progress we need to.

“In fact, progress has stalled, and we are facing significant challenges due to a combination of climate change, conflict in some of the most malaria-affected places; resistance, the malaria mosquitoes have become resistant to some of the most commonly used insecticides, and  we’re increasingly seeing resistance, to some of the most commonly used treatments. And frankly, inadequate funding.

“Because to beat malaria, you have to have a concentration of investment across a multiple set of tools in order to drive down, transmission,” he pointed out, citing newer, and the dual active ingredient bednets as an example.
“They’re 45% more effective than conventional insecticide-impregnated bed nets, and they only cost 70 cents more. The challenge we face is that we’re still in a position where only two-thirds of the people who could benefit from having a bed net actually have a bed net. So a third of the population in the malaria-endemic places are, sleeping without that basic protection.”

Health systems strengthening and global health security

Examining an expectant mother in Kisumu, Kenya. Since 2019, a partnership between the Global Fund, Takeda Pharmaceuticals and the Liverpool School of Tropical Medicine has supported training for health care workers to integrate HIV, TB and malaria services into antenatal and postnatal care .

While the story is “rather different” across the three diseases, the Global Fund has also stepped up its investments in health systems – for a total of $2.7 billion in 2024. Those investments yield cross-cutting benefits that “go way beyond HIV, TB and malaria,” Sands said.

For instance, strengthened laboratory and diagnostic networks have not only enhanced national responses to HIV, TB and malaria, but also enabled better detection and management of co-infections such as hepatitis B, hepatitis C and human papillomavirus, the Global Fund says. In addition, they have increased countries’ capacity to safely test for high-risk diseases including mpox, Ebola, Marburg virus and Crimean-Congo hemorrhagic fever.

“Over the last few years, and triggered by the experience of COVID, we have [also] invested over $600 million in improving the provision of medical oxygen in low- and middle-income countries. And this is often investing in what are called pressure swing absorption plants, PSA plants, which, about the size of this room, which essentially create medical oxygen out of the atmosphere,” he said that during the pandemic, 9 out of 10 hospitals did not have medical oxygen prior to the pandemic. Now, they have access for other services such as neo-natal treatmetns, material health, acute trauma and surgery.”

Eighth Replenishment drive 

The Global Fund’s Eighth Replenishment – launched in February 2025 – is a defining moment for the organization. It aims to raise some $18 billion by the end of November for the next three-year funding cycle, which runs from  2027 to 2029. 

So far, the Global Fund has raised close to $700m from countries, including Australia, Luxembourg, Norway and Spain, as well as private sector donors like the London-based Children’s Investment Fund Foundation.  At the same time, the US retreat from most global health funding commitments, and the downsizing of contributions from other traditional donors, is adding to an already challenging fiscal environment.

In July, the Global Fund confirmed that it was cutting $1.43 billion from the remainder of its 2025-2026 budget. And further adjustments are now being made to the “realities of the funding situation,” Sands admitted. Although the organization has released no data on staff cutbacks, Sands tacitly admitted these are happening, including termination of staff on short term contracts or COVID-related contracts in the Geneva headquarters, where some 1000 people have been employed.  

From the early days, the organization also made national self-reliance an integral part of its funding strategy. Since 2002, 52 HIV, TB and malaria disease programs across 38 countries have transitioned from the Global Fund. By 2026, another 12 programs from eight countries are expected to transition away from Global Fund support.

With a successful Replenishment, the Global Fund projects that it could help save up to 23 million lives between 2027 and 2029 and reduce the mortality rate from AIDS, TB and malaria by 64% by 2029, compared to 2023 levels, while strengthening health and community systems to fight new outbreaks and accelerate pathways to self-reliance.

At the same time, Sands admits, “this has been, a volatile year, let’s say, and there have been… has been significant disruption, to global health funding. And I think it’s important to recognize that we have a lot to gain and a lot to lose. We have made enormous progress, in improving the health of the poorest communities in the world. But that… those gains are fragile and could be reversed.”

Image Credits: Vincent Becker/ Global Fund, Global Fund , Direct Relief/Felipe Luna, The Global Fund/ Saiba Sehmi, TB Alliance, Brian Otieno /Global Fund.

Unhealthy diets are driving NCDs worldwide. Around 70% of primary school children in rural Mexican had a sugary drink for breakfast.

The final political declaration for the United Nations High-Level Meeting (HLM) on NCDs is substantially weaker than the zero draft, no longer referring to taxing sugar-sweetened beverages – while describing higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

However, targets for reducing tobacco use and increasing access to hypertensive management and mental health care have survived the negotiations.

Health Policy Watch can exclusively reveal the final declaration (see link below), after negotiations between the 193 UN member states were concluded last week. The declaration is due to be adopted  at the HLM on 25 September.

READ: Political Declaration of UN High-Level Meeting on NCDs

The zero draft target of “at least 80% of countries” implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages to levels recommended by the World Health Organization (WHO) by 2030 is completely absent from the final draft.

The declaration has also removed virtually all references to WHO recommendations. This is apparently at the insistence of the United States, which withdrew from the WHO when Donald Trump became president in January, sources close to the talks told Health Policy Watch.

The WHO has developed a wealth of evidence-based strategies to address the group of killer conditions – including cardiovascular disease, cancer, diabetes and hypertension – that are driving deaths globally.

Only 19 of the 193 UN member states are on track to achieve the earlier goal of reducing NCD mortality by one-third by 2030 (Sustainable Development Goal 3.4).

Tangible targets

Alison Cox, the NCD Alliance’s policy and advocacy director

Alison Cox, the NCD Alliance’s policy and advocacy director, told a media briefing on Wednesday that the alliance “warmly welcomes” the declaration’s “time-bound and tangible targets”, particularly 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030.

“The fact these targets have survived a tough negotiation progress is evidence that this declaration represents political commitment to faster action,” said Cox.

The three previous UN HLMs on NCDs (since 2011) “have stopped short of including this kind of specific measure”, she added.

She also welcomed two other targets related to access to NCD medicines and care, and financial protection policies to cover patient care.

The first aims for “at least 80% of primary health care facilities in all countries have availability of WHO-recommended essential medicines and basic technologies for non-communicable diseases and mental health conditions, at affordable prices, by 2030” (clause 63).

The second target is for “at least 60% of countries have financial protection policies or measures in place that cover or limit the cost of essential services, diagnostics, medicines and other health products for non-communicable diseases and mental health conditions by 2030.

“These two targets would be critical in delivering care while reducing the growing amount of out-of-pocket expenditure,” said Cox, adding that around 1.3 billion people have been pushed into poverty by health spending. 

Influence of health-harming industries

However, Cox decried the dilution and weakening of commitments to “well-established, evidence-based interventions”, particularly the removal of excise taxes on harmful products.

This was likely to be the result of “the health-harming industries, who lobby governments so hard – industries like tobacco, alcohol, ultra-processed food and sugar sweetened beverages, and indeed, fossil fuels”, said Cox.

“We’ve heard from early this year that representatives of these companies were seeking meetings with governments in their capitals and with their missions in New York, and it’s very frustrating because these interactions are often not documented and they’re not transparent, yet we can see these interests represented in the outcome of this negotiation process.”

Cox said that while the alliance did not know which countries had pushed for references to taxes to be dropped, many countries in the European Union opposed additional taxes on alcohol because they have a large wine industry.

The declaration also makes no mention of action against food high in salt, fat and sugar, which Cox described as “a missed opportunity”.

Government under-spending on NCDs

Dr David Watkins

Cox was speaking at the launch of an NCD Alliance report published on Wednesday on financing for NCDs, which found that most countries are “dangerously underspending” on the leading cause of death worldwide, according to the NCD Alliance.

Countries should spend 1.1% to 1.7% of their gross national income (GNI) on NCDs to provide universal coverage – but currently spend just 0.26% to 0.46% of GNI, according to the report.

The report, compiled by University of Washington researchers, exposes “the scale of the chronic underinvestment that we’ve seen in NCDs for decades”, said Katie Dain, NCD Alliance CEO.

A significant proportion of government spending on NCDs goes to medicines, with a wide variation in medicine prices across countries.

Dr David Watkins, lead author of the report, models potential cost-savings of 20% to 50% if the best prices were available globally. 

“Ministries of Health and Finance must act decisively on these findings,” said Watkins. “This analysis provides governments with data to support smarter investment on NCDs, mental health, and neurological conditions in their policies and budgets. It’s not just about increasing investment but about making health budgets go further.” 

Image Credits: Thomas Stellmach/Flickr, Unsplash.

US Health and Human Services Secretary Robert F Kennedy Jr at the MAHA strategy launch.

 After a month-long delay, the Make America Healthy Again (MAHA) Commission’s strategy to address child health was released by the White House on Tuesday – but it offers few concrete proposals and no curbs on ultra-processed food or pesticides.

“We are now the sickest country in the world,” said US Health and Human Services (HHS)Secretary Robert F Kennedy Jr at the launch of the event, revealing that 76.4% of Americans are suffering from a chronic disease.

“We have the highest chronic disease burden of any country in the world. Yet we spend more on healthcare than any country in the world. We spend two to three times more than  European nations,” added Kennedy.

The strategy is the follow-up to MAHA’s first report, released in May, which laid out the commission’s assessment of the drivers of the ill-health of America’s children. 

While the MAHA strategy was intended to outline how to address these drivers, instead it presents a shopping list of 128 recommendations. that focus on conducting more research. This includes for nutrition, one of the key drivers of the US epidemics of obesity and non-communicable diseases (NCDs).

Ironically, the MAHA report was published on the eve of a global UNICEF report on childhood nutrition, which blames obesity in children on the increased consumption of ultra-processed food high in sugar, refined starch, salt, unhealthy fats and additives.

Noting that 21% of US children are obese, UNICEF proposes “mandatory policies to improve children’s food environments”, such as front-of-pack labelling on unhealthy products, restricting marketing to children, and higher taxes on unhealthy products.

In contrast, all that the MAHA strategy proposes is three nutrition-related recommendations: a standard definition of ultra-processed food, possible revisions to “front-of-pack nutrition information” after public comment and “potential industry guidelines to limit the direct marketing of certain unhealthy foods to children”.

‘Waffle words’

Marion Nestle, Emeritus Professor of Nutrition, Food Studies, and Public Health at New York University, said that the strategy “states intentions, but when it comes to policy, it has one strong, overall message: more research needed”.

Nestle, one of the world’s leading researchers on the influence of Big Food on health, was reacting to a leaked draft of the strategy in August, which has remained essentially the same as that released this week.

“Regulate?  Not a chance, except for the long overdue closure of the GRAS loophole (which lets corporations decide for themselves whether chemical additives are safe),” wrote Nestle.

“Everything else is waffle words: explore, coordinate, partner, prioritize, develop, or work toward.”

She also highlighted contradictions, such as prioritising “whole healthy foods” in nutrition assistance programs and promoting healthy meals in child care settings – while the Trump administration has cut the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which give food support to low-income people, pregnant women, breastfeeding mothers and mothers of children under the age of five.

“It doesn’t look like this is anything more than voluntary (and we know how voluntary works with the food industry; it doesn’t).  None of this says how or has any teeth behind it,” Nestle concluded.

Pesticides: Industry has prevailed

One of the dangers that the first MAHA report identified is children’s exposure to chemicals – including “heavy metals, PFAS [“forever chemicals”], pesticides, and phthalates”.

It also highlighted that studies of the pesticide, glyphosate (marketed as Roundup), “have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances”, while experimental animal studies have shown that exposure to another pesticide, atrazine, “can cause endocrine disruption and birth defects”.

The US uses more than one billion pounds of pesticides annually, which linger in the soil and groundwater. A 2021 study reported that pesticides had been found in 90% of the 442 US streams sampled by federal scientists.

However, farmers’ bodies – part of Trump’s rural support base – asserted that restricting pesticides such as atrazine and glyphosate will push up their costs and reduce yields. 

Conflict over pesticides between MAHA supporters and Trump allies is likely to have delayed the release of the report.

Ultimately, lobbying by farmers and the chemical industry has worked, as the MAHA strategy makes no mention of either atrazine or glyphosate, and simply affirms support for the Environmental Protection Agency’s (EPA) process to control pesticides. 

“EPA, partnering with food and agricultural stakeholders, will work to ensure that the public has awareness and confidence in EPA’s pesticide robust review procedures and how that relates to the limiting of risk for users and the general public and informs continual improvement,” is the report’s only statement on pesticide control.

US Environmental Protection Agency (EPA) Administrator Lee Zeldin.

However, the EPA under Administrator Lee Zeldin has systematically removed environmental regulation over industries – from pollution controls to pesticide restrictions – since Trump assumed office.

Zeldin told Tuesday’s launch that the strategy “outlines the keys to success, from pro-growth policies that advance research to driving innovation, private sector collaboration, [and] increased public awareness”.

Moms Across America, an important part of Kennedy’s MAHA alliance, said it is 

“deeply disappointed that the committee allowed the chemical companies to influence the report”, describing the reference to the EPA improving its communication of its review process as “a pathetic attempt to assuage the American people”.

“Clearly, eliminating the words ‘glyphosate and atrazine’ (that were in the first report) is not a result of new science that shows these two most widely used herbicides to be safe, but rather a tactic to appease the pesticide companies,” the group said in a statement.

“Better words on the EPA’s website WILL NOT reduce childhood chronic illness, only bans and restrictions of pesticides will.”

Farmers are satisfied

In contrast, farmers generally expressed satisfaction with the strategy, particularly the powerful American Soybean Association, with almost half a million members who are massive consumers of glyphosate and atrazine, 

“Soybean farmers are thankful the MAHA Commission recognized EPA’s approval process as the global gold standard,” said ASA President Caleb Ragland. “Between the May report and today’s strategy, the Commission was accessible and open to learning more about modern farming practices. We truly felt like we had a seat at the table, and for that, we are incredibly appreciative.”

American Farm Bureau Federation President Zippy Duvall welcomed “a renewed focus on American-grown fresh fruits, vegetables and meat, along with reintroducing whole milk into the school meal programs”.

“Prioritizing voluntary conservation efforts for farmers and ranchers and optimizing EPA’s already robust pesticide regulatory process to accelerate innovation are welcome recommendations,” added  Duvall.

Vaccine pronouncements

The strategy also promises to “ensure that America has the best childhood vaccine schedule” by “addressing vaccine injuries, modernising vaccines with transparent, gold standard science, correcting conflicts of interest and misaligned incentives” and “ensuring scientific and medical freedom”.

The American Academy of Pediatrics, which has clashed with Kennedy over changes in access to COVID-19 vaccines, said that it “cannot ignore the fact that this report is being published in the context of other recent harmful actions by the administration and Congress that undermine many of the report’s recommendations”. 

“This administration’s unprecedented cuts to Medicaid and SNAP, along with its chaotic, confusing actions restricting vaccine access are worsening – not resolving—efforts to improve children’s health,” noted AAP, which represented 67,000 paediatricians.

Professor Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development, described the strategy as “more of the same wellness/influencer grift and pseudoscience that antivaccine activists have been pushing for years”.

Hotez, who is also Dean of the National School of Tropical Medicine at Baylor University, added that “medical freedom” is a “propaganda term that accelerated in the 2010s to deny kids access to life-saving vaccines, as announced in Florida last week”.

Action on medicines

The strategy has proposed a working group on prescriptions for medicines including selective serotonin reuptake inhibitors, antipsychotics and mood stabilisers.

Late Tuesday, President Donald Trump issued a presidential memorandum to ensure that “direct-to-consumer prescription drug advertisements are providing consumers with full and accurate information”.

The memorandum directs Kennedy to ensure that prescription drug advertisements increase the amount of information regarding any risks associated with the use of prescription drugs.

An Ebola responder in Butembo in the DRC’s North Kivu, during an outbreak in 2019.

The latest Ebola outbreak in Kasai province in southern Democratic Republic of Congo (DRC) is being hampered by lack of instructure, including roads and transport.

Samples from the index case and five other suspected cases took eight days to get to the National Public Health Laboratory (INRB) in Kinshasa, only arriving on 3 September.

The index case, a pregnant woman, died on 25 August – five days after seeking care at Bulape General Hospital in Kasai province with a high fever, bloody diarrhoea, haemorrhage and extreme weakness. 

At least 15 people, including four health workers, have died in the latest Ebola outbreak, according to the World Health Organization (WHO).

Meanwhile, some 28 suspected cases are being investigated in the Bulape health zone in Kasai province, which borders Angola.

Two of the health-care workers that had initially been in contact with the index case also developed similar symptoms and died. According to unconfirmed reports, a third health worker and lab technician in contact with the woman also died.

The DRC Health Ministry declared an outbreak on 4 September after laboratory tests confirmed the Zaire strain of Ebola Virus Disease (EVD) from the six samples.

All six samples were confirmed by GeneXpert and polymerase chain reaction (PCR) assays.

“The results obtained from whole genome sequencing suggest that the outbreak is a new zoonotic spillover event and is not directly linked to the 2007 Luebo or 2008/2009 Mweka EVD outbreaks,” according to the WHO.

The DRC’s Ministry of Health, with support from WHO and partners, is implementing public health response measures to contain the outbreak. 

The WHO has assessed the national public health risk posed by the current outbreak as high.

The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission.

This is the sixteenth Ebola outbreak in the DRC since 1976. The last case was identified in 2022. A large outbreak in 2018-2020,  killed almost 2,300 people in North Kivu and Ituri.

Image Credits: UN Photo/Martine Perret.

Wildfires in Canada and the Amazon have substantially worsened air pollution levels in the Americas as well as parts of central Africa and Siberia.

China saw a decline in overall levels of health-harmful particulate pollution (PM 2.5) in 2024 as compared to 2023 thanks to ardent mitigation efforts of leading pollution sources.

But India remained a global air pollution hotspot, while wildfire activity led to above average PM 2.5 levels in Canada, Siberia and central Africa, according to the latest Air Quality and Climate Bulletin of the World Meteorological Organization (WMO), released on Friday.

Highest rise in the Amazon  

The biggest anomaly, however, was in the Amazon basin where dramatic increases in air pollution, as compared to 2023 levels, were driven by record wildfires and drought-fuelled fires in northern Latin America. Both wildfires and droughts are being worsened by climate change.

Wildfires are a big contributor to particle pollution and the problem is expected to increase as the climate warms, posing growing risks for infrastructure, ecosystems and human health, warns the new WMO bulletin. It also underlines the “vicious cycle” that global warming is exacerbating.

As its title suggests, the report traces the complex interplay between air quality and climate, highlighting the role of tiny particles called aerosols in wildfires, winter fog, shipping emissions and urban pollution in climate trends – mainly warming, but some cooling as well. It stresses the need for improved atmospheric monitoring and more integrated policies to safeguard human and environmental health and reduce agricultural and economic losses.

“Climate change and air quality cannot be addressed in isolation. They go hand-in-hand and must be tackled together in order to protect the health of our planet, our communities, and our economies,” WMO Deputy Secretary-General Ko Barrett said.

A ‘complicated’ picture

Air pollution anomalies in 2024, as compared to 2023, as captured by three different sets of satellite and modelling exercises. Average annual PM2.5 levels rose in Canada, Siberia, South America, parts of Central and West Africa and India (red and orange). Levels were lower in other parts of Africa and China (blue and dark blue) than in the previous year.

WMO experts described the bulletin as presenting a “complicated” picture as there were both reasons for cheer and gloom.

The bulletin highlights the leading sources of PM2.5 releases as transport, industry, agriculture, wildfires and wind-blown desert dust. While not the only dangerous air pollutant, PM2.5 is a leading health hazard as the tiny particles, that are 1/28 of the width of a human hair, or smaller, penetrate deep into the lungs, the blood stream, and even the brain, increasing risks of heart attack, stroke, dementia and pre-natal conditions, as well as lung disease and cancers.

Both the burning fossil fuels and biomass also lead to large releases of black carbon, methane and nitrous oxide, the latter a precursor of  ground-level ozone. These “super pollutants” accelerate the effects of climate change causing the planet to even warm faster than CO2 emissions alone. The bulletin terms this as a “vicious cycle” when combined with climate change pressures.

“Climate impacts and air pollution respect no national borders – as exemplified by intense heat and drought which fuels wildfires, worsening air quality for millions of people. We need improved international monitoring and collaboration to meet this global challenge,” Barrett said.

In the Indo-Gangetic plain where nearly 900 million people live, air pollution is also worsening winter fog both in intensity and in length.

“Persistence of fog is no longer a simple, seasonal weather event – it is a symptom of escalating human impact on the environment. Addressing this requires comprehensive strategies, such as enforcing regulations on agricultural residue burning, and promoting cleaner energy for cooking, heating, lighting and public transport systems,” the WMO stated.

Spotlight on aerosols 

Lorenzo Labrador, WMO’s scientific officer, speaking at the press conference held ahead of the bulletin’s release.

The report placed special emphasis on aerosols, another term for tiny airborne particles of solids or liquids. Aerosols can have both a warming or a cooling affect depending on their composition.

Darker ones, such as the black carbon that is released from incomplete combustion of diesel fuel or biomass, can warm the atmosphere and accelerate ice and glacier melt by absorbing more radiant heat from sunlight. But the brighter aerosols such as sulphates tend to have a temporary cooling effect as they reflect solar radiation back to space before returning to the earth’s surface in the form of acid rain and snow.

In 2020, UN agency International Maritime Organization (IMO) put regulations in place capping the use of sulphur in shipping fuel. Reduced sulphur dioxide (SO2) emissions by vessels plying the world’s oceans has translated into lower atmospheric PM2.5 levels and a comparative decline in related impacts such as premature mortality as well as childhood asthma cases, particularly in South Asia and Africa, said Lorenzo Labrador, WMO’s scientific officer.

It also has had an unintended environmental consequence.

SO2 and other sulphur-containing aerosols were previously making cloud cover brighter and thus helped the clouds reflect more light into space, cooling off temperatures, Labrador explained.

“So that [reduction in SO2 emissions] results, or translates into a very slight increase in the temperature of 0.04 degrees in 2025 so what we have here, and this is very important to emphasize, is not an increase in temperature due to aerosols, but rather an unmasking of the true warming of greenhouse gasses as a result of the offset that these aerosols were having,” said Lorenzo Labrador, WMO’s scientific officer.

Bulletin underscores the importance of monitoring

The models draw on data from the European Union’s Copernicus Atmosphere Monitoring Service (CAMS), NASA’s Global Modeling and Assimilation Office (GMAO), and the Finnish-based System for Integrated Modelling of Atmospheric Composition (SILAM).

This is the first time that the WMO experts used estimates from three different amospheric models for its reporting, and while there were minor differences, all models had the same conclusion.

The Bulletin also underscored the importance of ramping up the atmospheric monitoring infrastructure, especially in developing regions. While satellites do provide critical insights for the globe, ground-based monitoring networks are also essential to validate that data. In developing countries, and particularly Africa, such infrastructure remains sparsely distributed, WMO experts said.

WMO experts also drew attention towards the positive finding of the report. “When we see that countries or regions or cities are taking measures to fight against bad air quality, it works, and we see in many areas, an improvement of the air quality,” said Paolo Laj who is the Chief of Global Atmosphere. “In regions where these measures have been taken, there is a great improvement of the air quality,” he said.

Image Credits: Mike Newbry/ Unsplash, WMO.

Carrying drinking water supplies in Srinagar where supplies have been contaminated by heavy flooding across Jammu and Kashmir, India.

SRINAGAR, INDIA – When record-breaking rains, landslides and cloudbursts lashed northern India in late August — across Jammu and Kashmir, Punjab and Himachal Pradesh — highways turned into rivers, homes collapsed and death tolls mounted. But beneath the visible destruction lies a quieter emergency: public health systems buckling under the strain.

In Kashmir, the Jhelum River, a lifeline for the region, swelled dangerously after days of relentless downpours. By the night of Aug. 26–27, its waters entered neighbourhoods in Srinagar, the largest city in Jammu and Kashmir, and a popular summer tourism destination known for its stunning lake and riverfront visages and houseboats.  Earlier in the month, on Aug. 14, a devastating cloudburst near Chisoti — the last motorable village en route to the Machail Mata temple in Jammu — had already triggered flash floods that killed at least 64 people.

Health experts warn these floods are not isolated disasters but part of a worsening cycle of extreme weather events that India remains ill-prepared to handle. From Kashmir to Punjab to Himachal, disrupted medical care, contaminated water, and surges in mosquito-borne disease are exposing how fragile India’s public health safety nets are in the face of weather extremes driven by climate change. Unless resilience is built into the health system, each new flood risks compounding existing crises — from mental health to infectious disease.

Life cut off, treatment interrupted

Maliha Zehra – her medicines were inaccessible due to flooding.

In Srinagar’s flooded Rajbagh neighborhood, 22-year-old student Maliha Zehra from Baramulla faced a harrowing wait for her psychiatric medication after landslides blocked the Srinagar–Jammu National Highway, delaying essential supplies from reaching the Valley.

“My mental health medicines were delayed,” she told Health Policy Watch. “Without them, the flooding felt even more suffocating.”

Normally, winter highway closures meant she could at least call her doctor or request an ambulance. But this time, there was no lifeline. For three days, mobile networks and internet services across much of Kashmir were down after flood damage, severing communication between patients and providers.

“I tried to go to a nearby hospital, but it was overcrowded, and without a phone I couldn’t contact the private clinic where my psychiatrist sees me,” Zehra said. “At least in the snow you can call for help. With the floods, there was nothing.”

Mental health needs in Kashmir are staggering. As Health Policy Watch reported earlier this year, a 2015 survey by Médecins Sans Frontières (MSF) found that 1.8 million adults in the Kashmir Valley — about 45% of the population — experience significant mental distress. Almost one in five showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed signs of depression.

Yet the system is woefully underprepared to cope with chronic disease conditions during a disaster. According to the 2011 Census, there were just 41 psychiatrists for Jammu and Kashmir’s 12.5 million people. Experts say that number has only modestly increased since, leaving much of the population without specialized care. Flood-related disruption, even for a few days, becomes catastrophic in this context.

Contaminated waters, sick communities

Aadil Dar a community science educator: flooding brought illness in its wake.

The health toll was not limited to delayed prescriptions. Aadil Dar, a science educator at a community education centre in southern Kashmir’s Anantnag district, said the flooding brought illness in its wake.

“After these floods, many people in my area fell sick with diarrhoea because of contaminated drinking water,” he said.

Such outbreaks are common.  Epidemiologist Dr. Shailesh told The Tribune that “stagnant and contaminated water becomes the primary source of infections in flood-affected areas.” He warned that diseases like cholera, diarrhoea, typhoid, hepatitis A and gastroenteritis are “very common after floods,” while stagnant pools also fuel malaria, dengue and chikungunya outbreaks. 

Flood-linked disease is not hypothetical. In the aftermath of the 2014 Kashmir floods, clusters of jaundice and diarrheal illness were documented within days of the waters rising 

This year, Punjab is already seeing a surge in dengue cases since 2023 ,  in  2023 11,000 infections were reported by mid-november). Flooding has only worsened mosquito breeding conditions.

Arshdeep Singh, 22, from central Kashmir, said his family has resorted to buying bottled water after past illnesses. “My elder sister and I both developed jaundice earlier. It took me months to recover, so now we don’t take risks,” he said. “But packaged water is expensive. Not everyone can afford it.”

Collapsing infrastructure

Srinagar is a popular summer tourism area due to its lake and river visages – but extreme weather is making the area more flood prone during monsoon season.

Health facilities themselves were not spared. Landslides cut off access to several district hospitals in Jammu and Kashmir. In Punjab’s flood prone  24  districts, floodwaters inundated primary health centres, forcing patients to travel long distances. Himachal Pradesh, already battered by landslides, reported damaged subcentres and stockouts of critical drugs.

According to the Indian Meteorological Department Jammu and Kashmir registered 612 mm of rain  in the last week of August. That is 726% above normal rainfall in the region during for this time of the year. 

“It is the highest rainfall in the region since 1950,” Mukhtar Ahmad, Director at the India Meteorological Department in Srinagar, told Reuters. 

Roads, bridges and power lines collapsed under the onslaught, crippling emergency services. Ambulances struggled to reach rural patients, especially pregnant women and children. Telemedicine, which proved vital during the COVID-19 pandemic, was rendered useless in Kashmir due to the communications blackout.

A broader and recurring pattern

Satellite derived map shows scale and intensity of 2025 monsoon floods in neighbouring Pakistan.

Across the wider Himalayan arc and Gangetic plain, severe monsoon flooding has hammered neighboring countries this year too. In Pakistan, hundreds of deaths and mass displacement have been reported this season, with national  and UN flash updates detailing widespread damage along the Indus River basin. Regional weather and climate agencies  warn the Hindu Kush mountain range west of the Himalayas, which extends from Afghanistan into northwestern Pakistan, is also facing increasingly frequent, intense rain events that heighten risks of floods and landslides across borders. Afghanistan has thus also seen repeated flash floods across its northern and eastern provinces.

In Afghanistan, this season’s floods were compounded by another disaster. On Aug. 31, a 6.0-magnitude earthquake struck Afghanistan’s eastern region, killing more than 1,457 people and injuring over 3,394, according to the World Health Organization (WHO). 

Afghanistan is dealing with the combined impacts of a recent earthquake as well as heavy seasonal Monsoon flooding.

More than 6,700 homes were destroyed, leaving thousands homeless and exposed to harsh conditions just as monsoon floods were already battering the country. Hospitals in Kunar, Nangarhar, Laghman and Nuristan provinces have been overwhelmed by trauma cases, while overcrowded shelters and limited sanitation are raising fears of cholera, diarrhoea and other post-disaster outbreaks.

“When we speak of casualties, we are speaking of families and communities in crisis,” said Dr. Mukta Sharma, deputy representative in  Afghanistan, which has launched a flash emergency aid appeal for $4 million. “Our teams are working around the clock to deliver lifesaving care in areas devastated by the earthquake. The needs are immense. We urgently require more resources to sustain our operations and prevent further losses.”

Kashmir’s 2014 floods were a historic benchmark 

Flooded homestead in some of the worst flooding seen since 2014.

In 2014, India-administered Jammu and Kashmir saw its worst flooding in sixty years: more than 500 lives were lost and tens of thousands displaced. Hospitals, water and power infrastructure, and communications were crippled, leaving health systems paralyzed. Outbreaks of diarrhoeal disease, jaundice and other waterborne illnesses were reported within days of the waters rising, compounding the humanitarian emergency.

A spatial analysis of the 2014 floods found that the provincial capital of Srinagar, which has nearly 1.7 million residents, also had one of the highest “Relief Deprivation Index” scores — showing that access to timely rescue and aid was uneven, and the poorest households were often last in line for assistance.

A decade later, the pattern is repeating in Jammu Kashmir and beyond, with increasing frequency.  Almost every year in the past ten years has seen significant flood events. The neighbouring State of Himachal Pradesh also has endured successive monsoon-triggered landslides and floods over the past five years. Punjab continues to battle back-to-back dengue waves, related to more rainfall.

Climate scientists link this to a warming atmosphere fueling increased rainfall, more intense rainfall and sudden cloudburst events.  A Srinagar based climate scientist told Health Policy Watch  that the Himalayan region recorded a 33% increase in extreme weather events compared to the previous decade. In addition, glacial lakes are expanding as glaciers shrink. Rapid urbanization and deforestation have undermined natural watershed drainage, while urban flood drainage is often deficient or non-existent.

Public health experts say that while disaster relief often focuses on food and shelter, health systems remain the weakest link.

Building resilience – what needs to change

WHO has repeatedly warned that health crises following floods can cause more deaths than the flooding itself if not addressed promptly.

Flood preparedness in India still centers on evacuation and rescue, but public health preparedness continues to lag.

“Health is always the weakest link in disaster planning,” said a senior official from a Srinagar-based NGO who asked not to be named. “We have evacuation drills, but no real disease surveillance system to catch cholera, hepatitis or dengue outbreaks early.”

Another challenge is ensuring medicines don’t run out. “We need emergency stockpiles of essential drugs — psychiatric medicines, insulin, oral rehydration salts, antibiotics,” said the official. “When the highway closes or communication lines are down, the delay becomes life-threatening.”

Health workers also stressed the need to strengthen facilities themselves. “Flood-proofing primary health centers and keeping backup power and communications should be non-negotiable,” said Shazia Bhat, a community volunteer in Anantnag. “Right now, one storm can knock out the only health unit for an entire district.”

Clean water remains an urgent priority. “Mobile water treatment units should be deployed within hours, not weeks,” said Arshdeep Singh, the young resident from central Kashmir who earlier described his family’s struggle with jaundice. “Boiling water is not enough when sewage has already entered the supply.”

“We Can’t Afford to Wait”

As floodwaters recede in parts of Jammu and Kashmir, Punjab and Himachal Pradesh, communities are left to confront not just destroyed homes, but the lingering health fallout.

“The government talks about roads and bridges,” said Aadil Dar from Anantnag. “But people are falling sick. We can’t afford to wait for medicines and clean water next time.”

For Maliha Zehra in Srinagar, the disruption felt deeply personal. “Even after the water goes,” she said, “the anxiety stays.”

Image Credits: Arshdeep Singh, Al Jazeera/Creative Commons Licensing, European Commission .

Patients undergoing chemotherapy for cancer.

ISLAMABAD – Cancer cases in Pakistan are on the increase, but patients and health advocates are caught in a struggle for access to life-saving treatment amid concerns about the quality of generic drugs and the rising cost of medicine.

Tahmeena Kausar Parveen, a 45-year-old resident of Islamabad, was shocked by the news that she needs to see an oncologist about a lump in her breast after a screening at the Breast Cancer Hospital at Pakistan Institute of Medical Sciences.

Although she knows that early diagnosis makes this disease treatable, she has many anxieties. She is wrestling with the challenges of finding a reliable oncologist, covering the cost of treatment, and accessing quality medicines.

“I have the courage to fight this disease, but I fear that the difficult journey to get treatment may wear me down,” said Parveen.

The shadow of substandard drugs

Pakistan faces an estimated burden of 185,748 new cancer cases annually, according to the latest data from the World Health Organization (WHO).

But the fight against this disease extends far beyond the hospital ward – it is a battle fought on the supply chain, in regulatory offices, and in the courts, where the integrity and affordability of essential drugs hang in the balance.

The country’s cancer crisis is multifaceted, with access to cancer medication being one of the most complex problems.

There are fears about the quality of generic drugs, particularly following a report on failures in generic chemotherapy drugs published in The Lancet in late July.

The report, which involved testing various generic versions of seven key cancer drugs distributed in four African countries, found that around 20% failed various tests, most commonly over their active pharmaceutical ingredients (API). 

Many of these generic drugs are distributed worldwide, including in Pakistan.

Dr Maqbool Ahmed, an oncologist at Deaconess Hospital in Evansville in Indiana in the United States, says that the stakes could not be higher.

“Patients may not get the correct dose in a timely fashion, allowing their cancer to progress,” he warned. Medicines with lower APIs may be ineffective, while those with too high doses could have “toxic side effects”, said Ahmed.

Ahmed said that Pakistan “does not apparently have the know-how to test the drugs and no political desire to open this can of worms.”

Regulation of medicine

There are fears that sub-standard generic cancer medicine may be being distributed in the country.

However, Dr Akhtar Abbas, a representative from the  Drug Regulatory Authority of Pakistan (DRAP) disputes this.

While DRAP has not had any specific complaints about failed generic cancer treatments, Abbas confirmed that, in the wake of the report on failed generics elsewhere, the authority has initiated “proactive sampling and laboratory testing of suspect products already in the market.”

Initial tests on samples of Doxorubicin and Methotrexate performed successfully, said Abbas, adding that DRAP’s mandate is to ensure quality through strict regulatory mechanisms, including a detailed evaluation of safety, efficacy, and quality before a drug can be registered.

The authority also regulates the storage and distribution of anti-cancer medicines at the manufacturer and importers level and this includes mandatory adherence to Good Distribution Practices (GDP).

He said cold chain compliance, storage conditions, batch tracking, and recall procedures are routinely checked through inspections and audits.

DRAP is also scaling up its post-marketing surveillance activities including risk-based sampling, increased coordination with provincial drug control units, digital pharmacovigilance platforms, and a National Quality Control Surveillance Plan, added Abbas.

“DRAP also works with WHO and other global partners to track international alerts and trace counterfeit or substandard drugs entering the supply chain and is also going to introduce a bar code reader app in near future for detection of Spurious and counterfeit medicines,” said Abbas.

Underlying anxiety

However, the assurances from the regulator have done little to end the underlying anxiety.

For institutions like the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), which treat a significant portion of Pakistan’s cancer patients, the reliance on a national regulatory body is not enough.

“We, at SKMCH, have strong institutional mechanisms to ensure the quality of the products we get,” said CEO Dr Faisal Sultan.

He detailed the hospital’s own rigorous process of comprehensive pre-qualification assessments, review of quality documentation, and, when necessary, chemical equivalency tests and facility inspections.

According to Sultan, breast cancer is the most common cancer in Pakistani women, accounting for 31.3% of all new cases. Ovarian cancer ranks third with 4,987 new cases and 3,492 deaths annually.

Manufacturing success, pricing failure

Alongside concerns over drug quality and regulation, a significant success story has been unfolding in Pakistan’s pharmaceutical landscape: the rise of local anti-cancer drug manufacturing.

Noor Mahar, a pharmacist and president Pakistan Pharmacist Lawyers Forum (PPLF), points out that companies like Pharmasol, Oncogen Pharma, and BF Biosciences are now producing a range of essential oncology medications locally.

These include drugs to treat breast and ovarian cancer, as well as leukemia, said Mahar, marking a “major milestone for public health” by reducing the nation’s reliance on foreign imports, mitigating supply chain risks, and potentially lowering costs.

It is also a testament to the country’s growing industrial capabilities and represents a critical step towards achieving self-sufficiency in a highly specialized field.

However, Mahar warned that this progress is being undermined by an unwelcome policy called “price decontrol”.

In 2024, the country’s caretaker government enacted a policy to remove the maximum retail price (MRP) cap on non-essential medicines, allowing pharmaceutical companies to set their own prices. This has resulted in huge price hikes for certain medicines.

This decision is currently being challenged in the Lahore High Court.

Mahar argued that decontrol is a “clear violation of the Drug Act 1976,” which mandates strict regulation of life-saving medicines. 

He described the government’s stance as one of deep insensitivity towards patients and warns that the unchecked increase in drug prices will render essential cancer treatments “unaffordable for the common man”.

However, DRAP’s Abbas said that “the prices of the anti-cancer drugs included in Essential Medicine List are fixed and regulated”.

System under strain

The struggle with drug quality and pricing is compounded by a larger, systemic problem, namely the lack of a cohesive national framework for cancer care.

While the number of women presenting with breast cancer in early stages has increased at Shaukat Khanum Hospital, CEO Sultan notes that many women still present late and there is not enough understanding about why this is.

A functional national cancer registry would provide the data necessary for informed policy and resource allocation.

The supply chain is also under significant stress with several essential cancer medications not locally registered, making timely procurement a challenge, added Sultan.

Several multinational pharmaceutical companies have scaled down activities in Pakistan, which has contributed to the scarcity of essential cancer medications, creating additional challenges in ensuring consistent and timely patient care.

“This precarious environment puts immense pressure on healthcare providers,” said Sultan.

His hospital procures drugs from approved sources that comply with international standards.

“However, institutions like SKMCH&RC can only do so much. The core problems – the lack of political will, the absence of comprehensive data, and the recent dismantling of price controls – require a national-level solution,” he said.

Image Credits: Roche, WHO.