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Hello from Nairobi.
Over the weekend, I had the pleasure of seeing Mahmood Mamdani launch his new book, Slow Poison, here in the city. The book traces Ugandan history, particularly the bizarre and violent reign of Idi Amin and the long rule of Yoweri Museveni (who entered his fourth decade in power in sham elections held just this month.) It’s a great read. Mamdani is one of East Africa’s most respected political scholars and, in a curious bit of trivia, he’s also the father of Zohran Mamdani, New York City’s new mayor.
My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.
With that, as we say in Swahili: karibu katika habari — welcome to the news.
U.S. pulls out of the WHO
The United States officially pulled out of the World Health Organization on Thursday, making good on the Trump administration’s yearlong pledge, Al Jazeera reports. (One complicating factor not in the Al Jazeera coverage: The United States still owes WHO roughly $260 million … money it’s unlikely to pony up.)
As a reminder, the WHO is the United Nations body that coordinates global disease surveillance, sets health standards, and helps countries respond to outbreaks.
Is the U.S. pullout mostly symbolic, or will it reshape global health in real ways? I reached out to Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University, to discuss.
Yamey is exceptionally clear: The pullout will “have major consequences for both the United States and the WHO itself.”
On the American side, “the U.S. has shot itself in the foot,” he says. “It has now made itself much more vulnerable to disaster and devastation when the next epidemic or pandemic hits. Outbreaks don’t respect national borders,” and now “the country will no longer have access to crucial data about emerging health threats.”
For context, before the exit, “if there was an overseas outbreak, the [U.S. Centers for Disease Control and Prevention] would play a critical role in the scientific discussions and deliberations convened by WHO on the status of the outbreak, the risk of spread, and the best way to contain and control the outbreak. Now, having left the WHO, the U.S. will be excluded from these crucial conversations,” blunting its ability to track fast-moving outbreaks and advise at home in real time, Yamey says.
On the WHO side, Yamey says the loss is twofold. The WHO is losing “some of the finest expertise in the world” at the CDC, but the deeper blow is financial. “The U.S. was the single largest donor to the WHO,” he says. Without American dollars, “the organization will be weakened in its ability to carry out its critical activities. And there is no other body on the planet that does, or can do, what the WHO does. There’s no other body that has the same global reach, representation, legitimacy, and ability to convene experts and determine best scientific practice. Its activities are the bedrock of global health,” he says. “By weakening the WHO, the U.S. has made the world less safe — which in turn makes the U.S. less safe.”
(I promised you, after last week’s optimistic report, we were in for a heavy dose of reality.)
But Yamey also wanted to make one other point explicit, especially for American readers: The United States is leaving WHO after weakening its own public health system. He says that Robert F. Kennedy Jr., the U.S. secretary of Health and Human Services, “arguably one of the world’s most extreme and dangerous anti-vaccine activists and conspiracy theorists … has spent the last year dismantling the U.S. federal public health system and its vaccination systems. He has fired hundreds of critically important federal public health workers, massively weakened the CDC, interfered with the CDC’s science-based guidance, and rolled back vaccination, even as vaccine-preventable diseases are returning.”
His takeaway?
“Even without exiting the WHO, the U.S. has over the past year greatly weakened its own domestic capacity to deal with health threats, and leaving the WHO makes a bad situation immeasurably worse,” Yamey said.
A Nipah virus outbreak
India is facing an outbreak of deadly Nipah virus in the eastern state of West Bengal, which borders Bangladesh, the Global Times reports. Authorities have quarantined nearly 100 people and confirmed five cases, including infections among health care workers at a hospital near Kolkata.
- Disease breakdown: Nipah virus is an animal-borne disease that typically originates in fruit bats and can either spread directly, through proxy animals such as pigs, or through close contact with an infected person’s bodily fluids. There is no treatment or vaccine. It can cause fever, muscle pain, and respiratory distress, which often moves to a deadly inflammation of the brain. In past outbreaks, 40% to 75% of those who contracted the disease died.
The outbreak has spooked several countries in the neighborhood across South and Southeast Asia. This includes Thailand, which has begun “screening air passengers arriving from India for possible Nipah virus infection;” Nepal, which “heightened nationwide alertness to prevent the possible entry of the Nipah virus;” and China, which is “strengthen[ing] quarantine and control measures for people entering China from India.”
Some context: Nipah is a scary disease, but it’s not new. It was identified in the late ’90s, and the virus has surfaced repeatedly over the past decades. In Bangladesh, for example, small spillover events appear “almost every year,” according to the WHO, and usually involve only a handful of cases.
The takeaway? The travel screening and alerts across South and Southeast Asia are not panic moves. They are the global health system clicking into gear. Nipah is highly deadly and so carefully treated and monitored … but history suggests outbreaks like this are usually stopped before they spread far.
Neither screw nor worm; still horrible
OK, fair warning: This next one is fairly gross.
As Healthbeat reported earlier this month, North America is experiencing a resurgence of a flesh-eating fly larva known as the New World screwworm. (Despite the name … it is not a worm.) The situation is dire enough that the United States Department of Agriculture has announced $100 million for “innovative projects” to fight the parasite.
The parasite is the larval stage of a blowfly that burrows into open wounds and feeds on living tissue. It was once endemic across much of the southern and southwest United States, Mexico, and Central America. It was largely eradicated from the ’60s through the late ’90s. Before that, the screwworm caused massive losses in livestock (the big threat) and, on rare occasions, infected humans.
How was it killed off? The eradication relied largely on a suite of partially U.S.-funded programs that released millions of sterile male flies to crash the wild populations. It worked so well that the insect all but disappeared … until now. The parasite has crept back through Central America and has reached as far north as about 70 miles below the U.S.-Mexico border.
Why is it back?
We lapsed in the sterile fly release program, essentially. According to a report published in September by the American Veterinary Medical Association, the Covid-19 pandemic disrupted sterile fly production in Panama, reducing the releases that normally keep wild screwworm populations in check. (The report also notes that the closure of U.S. and Mexican fly factories in previous decades left current control efforts with basically just the Panamanian facility.)
For the sake of all of our nightmares … let’s get these facilities up and running again.
A million missing midwives
The world is facing a shortage of nearly 1 million midwives across 181 countries, The Guardian reports. This data come from a new study in the science journal Women and Birth.
No surprise here, but the medical care shortage is not evenly spread. Nearly half of the global gap is in Africa, with large midwife shortages also concentrated in the Eastern Mediterranean and parts of the Americas. The report notes that the problem is not just a lack of training, but “a failure in many countries to employ trained midwives where they were needed.”
Why does this matter? Beyond childbirth, midwives handle much of the frontline work in pregnancy and postpartum care across much of the developing world. When they are absent, the researchers warn, preventable complications and deaths rise quickly.
The study does offer a small silver lining. It estimates a modest reduction in the roughly million-person gap by 2030 as more midwives are trained each year. The problem is that population growth in the hardest-hit regions largely keeps pace with those gains. Even under the researchers’ most optimistic scenarios, hundreds of thousands of midwives will still be missing, well into next decade.
What’s the takeaway? It’s hard to pick one. Obviously, this is a complicated amalgam of training and medical staffing issues across very different countries. Still, one conclusion is that this is a solvable problem the world is choosing to tolerate, even though midwives remain one of the most cost-effective ways to keep mothers and babies alive.
AI: Revolutionizing the ‘unsexy’ parts of drug development?
Artificial intelligence has yet to tackle the core of drug development: actually discovering new, breakthrough medicines. (To be fair to AI, it’s been busy with more important work, like producing goofy songs about Chimpanzees and Borsht.)
But AI is quietly speeding up some of the more banal parts of the drug R&D process.
According to a Reuters report from the JP Morgan Healthcare Conference, drugmakers are using AI to recruit patients for clinical trials, pick trial sites, and draft regulatory paperwork. This “unsexy stuff,” as the Israel-based Teva Pharmaceutical Industries CEO Richard Francis put it, is shaving weeks off slow and expensive work, and is where AI “makes a difference,” in the industry today, he says.
One interesting vignette from the article: Novartis said it used AI to cut a four- to six-week site-selection process for a massive heart-drug trial down to a single two-hour meeting. (Which, let’s be real, maybe says more about their corporate meeting culture than the power of AI.)
Of course, it’s still an open question of how much (or if!) these incremental time savings will actually translate into faster drug approvals or lower costs for patients.
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.
