Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.
Hello and welcome to the Global Health Checkup, Healthbeat’s new weekly report highlighting five of the week’s most important stories in public health from around the world. My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya.
We’re launching this report at Healthbeat.org – and soon as a newsletter; sign up here – with a few goals.
First, to cut through the dense world of disease outbreaks and global health policy to pull out what truly matters and why. Unless you’re steeped in the field, it’s easy to find this space repetitive or incomprehensible. To help, I’ll be bringing in experts to help us digest the news.
We want to help people understand how global health connects us all. When you strip away the jargon, you’re left with a story that everyone can care about. It’s about how humanity wrestles with our oldest agonies: sickness, survival, death, and care. As we saw in the last global pandemic, what happens in one place doesn’t always stay there. Outbreaks, shortages, and breakthroughs tend to ripple outward.
Second, to put it all in context. I’m a science and health journalist by training, but I spent the last 8 1/2 years as the head of communications for the U.S. Agency for International Development in Rwanda, Ethiopia, and Kenya. With the dissolution of America’s foreign aid agency and the broader retreat of global health funding from the world’s wealthier nations, I want to understand what the pullback really means. But I also want to resist catastrophizing, check my priors, and highlight the brilliant people across the developing world who are working to make their societies healthier, with or without outsiders’ help.
With that, as we say in Kenya: karibu katika habari — welcome to the news!
Ebola returns to Central Africa
The Democratic Republic of the Congo is facing the first outbreak of Ebola in three years, Al Jazeera reports. The United Nations confirmed 48 cases and 31 fatalities on Sept. 18.
- Disease breakdown: Ebola is a virus in the family of the deadly “hemorrhagic fevers.” It’s a disease that first occurred in 1976 and is contracted through infected animals, blood, or other bodily fluid. Because symptoms often end in organ failure and internal/external bleeding, the average fatality rate is around 50%. Ebola is a nightmare disease in all but one very important way: It moves slowly, because it requires direct contact with infected people or contaminated objects to spread.
The World Health Organization and other international partners have rushed in “more than 14 tons of essential medical equipment and supplies and [deployed] 48 experts.” Importantly, these supplies include a relatively new vaccine — approved in 2019 — and an antibody therapy — approved in 2020.
Will this be enough? I spoke with Dr. Paul Spiegel, the director of Johns Hopkins’ Center for Humanitarian Health, for his takeaway on this story and others.
Spiegel said the WHO has “done a good job so far, but the key is to watch how the outbreak response expands,” especially when it comes to the expensive, time-consuming task of contact tracing. “My biggest concern is that the WHO’s capacity has been decimated because of funding shortfalls, particularly the U.S. reduction in funding,” as has the U.S. Centers for Disease Control and Prevention, “which has historically been a major player in past [Ebola] outbreaks.”
We’ll be watching not just how this outbreak unfolds, but what it reveals about the world’s capacity to control epidemics.
Malnutrition deaths rising in South Sudan
In South Sudan hunger is worsening at an alarming rate. As is universally true, when hunger or famine hits, it is children who disproportionately suffer. The Associated Press reports that “about 2.3 million children under 5 in South Sudan now require treatment for acute malnutrition.” One source in the AP story reports that nearly a quarter of “children admitted for malnutrition [in the capital city’s] largest children’s hospital have died of hunger.”
What’s to blame? Conflict, corruption and climate change are factors, but the country has been especially vulnerable to the global retreat of foreign aid. Here’s an excerpt:
“Critics say years of aid dependence have exposed South Sudan. The government allocates just 1.3% of its budget to health — far below the 15% target set by the World Health Organization, according to a recent UNICEF report. Meanwhile, 80% of the health care system is funded by foreign donors.”
The AP cites closed malnutrition centers, layoffs for nutrition-focused medical workers, and dangerously low stocks of the therapeutic food (called RUTF) that are given to children on the brink of death. The crisis comes from two directions: Trump administration cuts to global malnutrition programs, and NATO allies shifting aid funds toward military budgets.
Spiegel said that unlike the acute crisis of Ebola, “what we are seeing is an exacerbation of some very long-term trends in South Sudan.” He concurs that partly at issue is the government of South Sudan’s failure to allocate funds to their health sector (despite their oil revenue.) But he notes that even a more willing and able government wouldn’t be able to match the “magnitude of the reduction in nutrition funding so quickly,” he says.
Coupled with severe flooding and a political crisis (particularly the ongoing trial of the vice president) that threatens to send the country into a severe phase of conflict and civil war, “this is an extremely serious situation that threatens to become much worse. Although it may not be hugely surprising, the scope of what is happening is horrifying.”
UNAIDS proposal: closure by 2026
Reuters reports that the United Nations may shutter its HIV/AIDS agency as it faces funding shortfalls. A draft plan from the U.N. Secretary-General calls for UNAIDS to “sunset” by the end of 2026, with its work folded into the wider UN system. The agency had already mapped out a transition with a 55% staff cut and possible closure after 2027. This new plan would accelerate that timeline.
What does this mean? Let’s turn to Eswatini in southern Africa, which has the highest rate of HIV among adults in the world.
The Times of Eswatini — the small landlocked country’s main daily — reported a stark reaction from the head of the Eswatini government body that coordinates non-governmental organizations: “I am beyond shocked myself at the fact,” Thembinkosi Dlamini said. In Eswatini, UNAIDS isn’t just a provider of technical support, he said. It underpins community testing campaigns and helps people stick to life-saving HIV treatment. Without it, he warned, new infections in Eswatini could climb again.
His appeal was for the government to begin budgeting to absorb some of UNAIDS’ functions. “We cannot rely on donors, especially at a time like this,” he said.
America first. Global health … after?
The U.S. State Department has unveiled a 36-page strategy that reframes U.S. engagement on global health under President Donald Trump’s “America First” agenda. This comes after the Trump administration has made a U.S. withdrawal from the WHO, a roughly 70% cut to U.S. global health spending (more than $9 billion), and the shuttering of USAID. An analysis by Think Global Health breaks down the document.
Let’s start with the good news: The strategy “emphasizes a continued commitment to the ambitious goals that have been set over the past decades for HIV/AIDS, malaria, polio, and TB,” Think Global Health reports.
How will the U.S. accomplish these ambitious goals after a 70% funding cut? The new plan offers no clear explanation of how (or if) those goals could be met beyond vows of “efficiency,” cuts to non-frontline work, foreign country “co-investment” to fill the gap, and some ominous silence on other longstanding U.S. commitments.
Which leads us to the bad news:
“The plan is silent on whether the United States will continue to support historically bipartisan investments in routine childhood immunization, nutrition, maternal and child health, family planning (aside from abortion), and pandemic preparedness (beyond surveillance and outbreak response)... [and] is also silent on [helping] low- and middle-income countries to manufacture vaccines, diagnostic tests, and countermeasures locally.”
The takeaway: Without a credible plan to backfill cuts, the strategy is less a roadmap to hit global targets for diseases like malaria or HIV, and more of a pivot that risks hollowing out other commitments.
More mosquitos, less problems?
The Independent reports that Brazil has just opened the largest biofactory in the world for producing mosquitoes purposely infected with a bacteria called Wolbachia. This human-friendly bacteria blocks the transmission of a suite of diseases from mosquitoes, including dengue, Zika, and chikungunya. Dengue is the main target of this effort.
- Disease breakdown: Dengue is a millennia-old mosquito-borne virus that’s sometimes called “break-bone fever” for the intense joint and muscle pain it causes. Although it has a very low fatality rate (less than 1%), it spreads quickly through mosquitoes that thrive in cities. That makes it extremely difficult to wall off and allows outbreaks to balloon to millions of cases — hence the need for inventive solutions.
Each week, the factory can churn out over 100 million mosquito eggs carrying the bacteria. After the mosquitoes are grown, “public health officials release laboratory-bred mosquitoes infected with Wolbachia to breed with local mosquito populations,” to pass on the virus-blocking ability.
The way this is actually rolled out sounds like it was designed by a cartoon supervillain:
“Cars laden with infected mosquitoes will pass through dengue hotspots and release the insects with the push of a button.”
In all seriousness, Brazil’s health ministry estimates the program could protect up to 140 million people over the next few years, and could provide a model for other countries facing current surges in dengue, like Bangladesh.
Thank you for reading. I’ll see you next week!
William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.
