Healthbeat

Why the hantavirus cruise is getting so much attention – and how much to worry

2026-05-14T11:00:00+00:00

Hello from Nairobi.

This week’s report is heavy on the ongoing hantavirus outbreak. I’m fascinated by this story. Not because the virus itself looks like it will become a global emergency (I strongly believe it won’t), but because the story around it has taken on a force of its own. We’ll also cover Indonesia’s push to eliminate a type of cancer, fake rumors of shrinking genitals in central Africa, and the spiraling health crisis in Cuba.

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.

The hantavirus outbreak … breaks out of health news

Last week, I wrote about the hantavirus outbreak as a marginal item. An interesting story, but not quite a major event.

Since then, I’ve been gobsmacked by how far this story has traveled. Not only are most major media outlets covering the outbreak from dozens of angles and follow-ups, but it’s moved well beyond the usual lane of global health stories into full zeitgeist-meme territory.

The outbreak is clearly catching the broader public’s attention, eliciting no small amount of fear and anxiety… so what gives? Was I wrong to dismiss it?

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. The strain at play here is Andes virus, one of the few hantaviruses known to spread from person to person, as seen in South American outbreaks going back decades. It can cause severe respiratory illness, with symptoms appearing up to 42 days after exposure. There is no specific treatment or vaccine, so care is mostly supportive.

First off, I won’t argue that the story isn’t captivating. It has all the ingredients of a thriller movie: a rare and deadly disease. A cruise ship unable to reach port. Wealthy, international passengers who had already disembarked and scattered across the globe. The ongoing scramble to contain and quarantine.

And yet, even with all of this, the World Health Organization and national public health agencies globally have been in full-on reassurance mode.

Despite the attention, you can’t find serious global health professionals in panic over this outbreak. Not only has the WHO said that it “assesses the risk to the global population posed by this event as low,” but even for the people stuck on the actual cruise(!), “the risk for passengers and crew on the ship is considered moderate.”

It’s worth taking a big step back here, to break down what actually makes an infectious disease objectively frightening in an outbreak. And why this ain’t it.

(Fair warning: What follows is my own aggressive oversimplification, but a sound and useful one.)

Let’s imagine a mad scientist had created a disease-making box with four dials that control how “scary” an outbreak gets. And the way you tweak those settings will determine whether your virus, bacteria, or parasite is a local headache or a global nightmare. Those dials are:

Deadliness: What are the straight odds this disease kills you?
Existing medical defenses: Do we already have vaccines, treatments, or diagnostics that can fight the illness, or blunt the damage?
Infection window: When and how long will someone spread this disease? Are apparently healthy people passing it around for days, is it just a brief affair that requires someone to be visibly ill?
Finally, contagiousness: How easily does the infection spread? Are we looking at something that hangs in the air for hours like measles, or does it require close contact with infected fluids or tissues, like Ebola?

Now, if the Andes virus came out of our imaginary disease-making box, here’s where our objective fear dials would be set.

On deadliness, the dial is set to… “nightmare”! We’re looking at a fatality rate around 40%. No, not the deadliest disease we know of, but let’s not split hairs. Nobody sane would ever willingly risk those odds.

On medical defenses, the dial is also set to “maximum fear.” There is no specific treatment and no vaccine currently available for this virus, so care is mainly supportive.

Ok, so we’re off to a terrible start.

But the infection window setting is mixed. The bad news is that symptoms can appear as late as 42 days after exposure. That long incubation period means infected people can travel far before anyone knows they are infected, potentially seeding new clusters. But (!) there’s a crucial caveat: People are not contagious that whole time. In fact, the evidence we have suggests that people with the Andes virus are infectious only once they are visibly sick. So we’re setting this dial down to “mild alarm.”

This all brings us to the most important dial: contagiousness. And this one is set way down to “low-grade unease.” Ultimately, this is the big reason health officials are cautious, but not sounding alarms. Yes, the Andes virus is unusual among hantaviruses because it can spread from person-to-person. But the word “can” is doing a lot of work.

As Ion Genomics has reported, the virus does not appear to be some strange new mutant. So, as in older outbreaks, person-to-person spread is largely limited to close contact with a sick person, including direct physical contact, for prolonged periods of time in an enclosed space, or exposure to body fluids. (You can see why a cruise ship is the perfect incubator.) Simply put, it just does not appear to move easily through casual contact.

That’s reassuring, because this type of spread is laggardly enough that competent public health responses can typically move faster than the virus. If officials can identify contacts, monitor them, isolate anyone who gets sick and quarantine people at highest risk, there is a very high likelihood of containing this outbreak. Yes, that containment still requires vigilance, real work, and potentially more deaths. After all, this virus spreads and creeps in ways that do not quash instantly. But “quashing” is nevertheless where we’re headed.

Admittedly, Andes virus sounds terrifying. And for the unlucky people who get sick, it absolutely is. But scary as a disease is not the same thing as scary as an outbreak.

And so, my big takeaway here: The objective risk and threat of this outbreak is incommensurate with the news coverage it has received.

Now, I’m not wagging my finger at the coverage. People are interested, and I get why. But don’t mistake the amount of coverage, or the, uh, “cinematic focus” of it, for a measure of how concerned you should be.

As a threat, this hantavirus is not obviously more alarming than, say, Nipah virus: a comparably deadly infection with similar dynamics, which causes recurring outbreaks every few years in South Asia… all without a fraction of the spotlight.

What the hantavirus panic gets right

To gut-check that read, I reached out to Dr. Ronald Nahass, a clinical professor of medicine and president of the Infectious Diseases Society of America.

He agreed with the assessment that the epidemiology here does not justify outsized worry, but argued the outbreak still revealed something real. “A public health fire drill,” as he put it, and one that showed how important clear communication still is.

First off, we spoke about why this, of all outbreaks, has captured so much attention given the reality of the disease dynamics. My imperfect theory has been that the outbreak mirrors a lot of the media dynamics of a celebrity death. Deaths of course happen every day, but certain deaths break through because the person or circumstances make them feel unusually vivid and close. And this story has vividness in spades. After all, “cruise from hell” is narratively almost too good.

Also, at a certain point, public interest starts feeding on itself. The more coverage a story gets, the more it signals that this is something worth paying attention to, and so the more people want to hear about it.

Nahass broadly agreed that the narrative setting was doing a lot of work (granted, neither of us are media theorists) but he added another factor I had underweighted: the memory of Covid.

Nahass likened the event to a kind of public “PTSD” from the early days of the last pandemic. With a ship at sea, passengers trapped in uncertainty, people dying from a transmissible disease, “that is extraordinarily similar to some of the stories we heard during the Covid outbreak, and so obviously that brings back those images,” he said. “And so we all feel that.”

Still, his greater point was this: Put aside the science for a moment, public health is about people, and the public’s reaction and interest should matter as much as the underlying epidemiology. If people are worried this could be Covid 2.0, meet them where they are.

Sure, he said, “the biology doesn’t necessarily rise to the level of a SARS virus or a novel influenza virus.” But the anxiety is real, and that “emotional toll, or anxiety toll,” he said, and the practical questions people have about what this means for them, well, that’s more than enough to make the focus worthwhile.

And there’s a clear upside. This response is an opportunity for public health organizations to build trust, he said, and to show what a competent outbreak response actually looks like before the next real crisis arrives.

Now … as for how this moment has initially been met, Nahass was blunt enough to assign grades. He gave the WHO decent marks, especially given that no single country, and not even the WHO, had clear authority over a ship at sea. “I’d give them a B, or maybe a B-minus,” he said.

His assessment of the U.S. Centers for Disease Control and Prevention was harsher: “The CDC certainly gets a failing grade. They were absent,” he said, noting that it took the organization almost a week to put out a public response, and to Nahass, that silence fit a larger problem. Behind the scenes, the United States was missing from the kind of global outbreak response it once helped lead.

In the end, Nahass framed the ongoing hantavirus outbreak as “a public health fire drill,” one that showed how much that we still have not learned from the last pandemic. “God forbid this had been something more transmissible,” he said, noting that “we had potential vectors across the United States before we knew what it was.”

Nahass thinks the United States’ takeaway should be a wake-up call about the cost of pulling back from global health, such as departing the WHO. “We’re all interconnected,” he said, “we have to be able to respond to these kinds of events globally.”

As for the rest of the world, I think this “fire drill” is also a useful warning at a moment when the WHO’s global pandemic treaty is still sitting unfinished, as we’ve covered extensively.

Because next time might not be another drill.

Fake rumors of shrinking genitals… no laughing matter!

We’ve gone long on hantavirus coverage, so I’ll be brief with the other stories of the week.

Reuters covered a story about a fake disease conspiracy theory in the Democratic Republic of Congo that has become a real public health crisis.

Last year, rumors of a mysterious illness causing men’s genitals to shrink spread through social media, local outlets, and churches in a province in the center of the country. The rumors elicited “angry mobs [which] attacked and killed four health workers conducting vaccination research,” among other damage and deaths. “In all, at least 17 killings related to the atrophy rumor have been reported,” although Reuters could not independently verify all of them.

The story is grotesque (enough so that I’m not even attempting the obvious jokes), with a broader, painfully familiar warning. Misinformation is not background noise in public health. And it can create new dangers of its own, turning ignorance or confusion into fear and violence, directed at the very people trying to deliver much needed health care.

Cuba: an ‘epidemic of flies, rats, [and] waste’

The Guardian has a depressing follow-up on Cuba’s deepening health crisis, which we’ve reported on before.

As a U.S. oil blockade chokes off fuel supplies, the capital city of Havana has been forced to cut back on trash collection, leaving waste piling up across the city and residents burning trash in the streets. One resident described it as “an epidemic of flies, rats, waste, and foul odors.”

The piece tracks the obvious health risks of all that uncollected and burning waste: toxic smoke, vermin, flies, and gastrointestinal diseases. One Havana doctor told The Guardian, “at the hospital, we’ve seen an increase in hygiene-related illnesses and gastrointestinal issues.”

Less obvious, but just as worrying, trash heaps can collect rainwater in discarded plastic and other debris, causing fears of rising “mosquito-borne illnesses, with the Aedes aegypti [mosquito] species proliferating." That mosquito is one of the primary vectors for many infectious diseases, like dengue, Zika, chikungunya, and yellow fever.

It’s a rough story, and Cuba’s crisis has many causes. But right now, the U.S. fuel blockade is plainly a driving force, enough so that two members of Congress wrote in The New York Times this week after visiting the island, calling for the blockade to end for medical and humanitarian reasons, even while acknowledging the failures of the Cuban government.

Indonesia’s shot at curing [a type of] cancer

We’ll finish today with an inspiring piece in Think Global Health on Indonesia’s push to eliminate cervical cancer, a disease that still kills more than 20,000 women there each year.

This cancer is unique because it’s a form of the disease where most cases are caused directly by a virus. In this case, the human papillomavirus, or HPV.

In countries like Indonesia, HPV is responsible for an estimated “94% of cervical cancer deaths.” So screening and vaccination efforts against this virus are dramatically effective at cutting cancer deaths.

The hard part, as always, is reaching the people you most need. Indonesia’s “285 million people are spread across 17,500 islands,” with a third of the government’s districts classified as remote. So the story here is ultimately about whether an ambitious national health program can reach people on the outskirts of the country.

– William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Why it’s so hard to get better drugs for neglected diseases

2026-05-07T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The weekend brought in a bit of natural chaos: rains torrential enough to bring down trees near my home, and marauding Sykes’ monkeys in numbers sufficient to convince me I may never eat the soursops growing in my back yard. (I have long since given up on the mangoes.)

This week we’ve got a proper hodgepodge. A story on why it’s still so hard to get better drugs to people with neglected diseases, even after real medical advances. A damning investigation into an AI-driven health insurance system. Updates on both the widening health toll of conflicts in the Middle East, and the stall in a global pandemic treaty, and, finally, a rare virus trapped on a quarantined cruise ship.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some 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.

The neglected disease trap for better drugs

We’ll start with a story out in Nature that cleanly captures the maddening challenge to treat and cure some of the world’s most neglected diseases.

Enter our hero: moxidectin.

It’s a drug that’s both safe and proven since 2018 as a dramatic improvement for preventing and treating two widespread parasitic diseases (river blindness and elephantiasis).

The problem for moxidectin? The uptake has been an uphill battle.

Disease breakdown: River blindness, also known as onchocerciasis, is a parasitic disease that’s spread by biting blackflies, which breed in rapidly flowing rivers. The nightmarish parasites grow in the skin and eyes, which cause intense itching, scarring, and lesions that can lead to permanent blindness. There are an estimated 20 million cases of this disease, almost entirely on the African continent, and 250 million people require preventive treatment.
Disease breakdown: Elephantiasis is another terrifying parasitic disease, this one spread by mosquitoes. It can cause extreme swelling in limbs or other tissues (commonly in the breasts and genitals) and skin thickening. Hence the name, which is Greek-derived for “elephant-like disease.” There are an estimated 51 million cases of this disease across the equatorial world, and over 650 million people require preventive treatment.

To be clear, moxidectin’s efficacy is not in question.

For river blindness, clinical trials have shown that it lasts longer in the body and appears to clear parasites “86%” more effectively than the current treatment, an anti-parasite drug called ivermectin. The same is true for elephantiasis. In one small trial referenced in the article, the drug cleared parasites in about 95% of patients, compared with 32% for existing treatments.

The drug itself also has a unique backstory. It was invented in the ‘80s for livestock use, but it wasn’t until last decade that it jumped the expensive hoops for human clinical trials.

Those decades of lag is largely because there’s not a lot of commercial incentive for pharmaceutical companies to invest in something like moxidectin. (Even if the World Health Organization says nearly 900 million total people can use it!) After all, its target market is mostly the very poorest people in the world. And for both diseases, other treatments already exist, even if moxidectin appears to work better.

Instead, it took the altruistic efforts of an organization called Medicines Development for Global Health, a non-profit pharmaceutical company that focuses on neglected diseases, to run the trial gauntlet. And they made history doing so.

As the article outlines, this “development, regulatory approval, and [rollout] without involvement of a commercial pharmaceutical partner…” was “a first-of-its-kind achievement for a non-profit company.”

Where are we now?

While moxidectin was finally approved for river blindness in 2018, its first real-world rollout is only now underway in Ghana, “where around 120,000 people received the new treatment last year.”

Part of the delay is pure regulatory bureaucracy. Countries and the WHO still have to review the data and issue guidance. Part of it is also logistical. After all, someone has to manufacture, buy, and distribute the stuff.

But the cruelest delay is, again, financial: Ivermectin, the older and weaker drug, is donated for free by the pharma company Merck. Moxidectin’s nonprofit maker can offer it at a reduced cost, but not for free. So, as you might imagine, competing with a free pill… makes for a hard sell, especially in an era of tightening budgets.

What’s my takeaway? I said this at the top, but this is a maddening story. The layers of systems built around neglected diseases, even in the face of medical advancements, still seem almost designed to make success as hard as possible.

Still, if there is a silver lining, it’s that there are organizations like Medicines Development for Global Health nevertheless trying to exploit the various cracks in that broken system to get better drugs, slowly, into people’s hands.

Stalled pandemic negotiations, part 2

A month ago, we covered the stalled global pandemic treaty, and noted the sticking point to progress: “one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.”

The issue basically being that: Poorer countries are being asked to quickly share samples, but they want guarantees that they won’t be last in line for the vaccines, tests, and treatments made from them… like, uh, they were last time.

Well, Reuters is reporting that WHO member states have now even further extended talks on this same unresolved section, “casting doubt on when a pandemic treaty adopted last year can ‌come into effect.”

To be clear, until these final negotiations finish, there is no active treaty (even though the unfinished treaty was technically signed in 2025).

It’s a terrible limbo of inaction. If another pandemic were to emerge tomorrow, we’d still be at the same place we were in early 2020: no settled rulebook on how we work together as a global community, and (assuredly) plenty of consternation to go around.

What’s to be done? I came across a useful essay by three global health law experts, published almost exactly one year ago. And their argument, today, is all the more salient: This final, unresolved section is buckling because it’s trying to solve two extremely hard problems at once.

“Pathogen and data sharing [and] pharmaceutical supply and distribution… both are vital activities that would be more effectively addressed separately,” they write. But, (and here’s my favorite quote from the essay) “exactly why member states think they can resolve the most contentious issues of the preceding three years simply because it is in a separate annex… is rather baffling.”

Ultimately, their sharper point is that these negotiations are being asked to do too much political work. Because the fight isn’t really about technical details anymore, it’s about trust.

The world needs countries to share dangerous pathogens quickly. And poorer countries need some assurance that they won’t once again help create lifesaving tools they can’t access. But both of these issues may be easier to solve if they are not forced into the same all-or-nothing negotiation.

The takeaway? Break up the negotiations!

Counting global conflict’s health toll

There are two data-heavy stories worth your time this week on the widening fallout from conflicts in the Middle East.

First up, Reuters reports that attacks on health care workers and health facilities are rising globally, with the recent Middle East conflicts driving a clear jump.

By the numbers: Before the outbreak of fighting in Iran and Lebanon, the WHO said “attacks globally on such facilities and staff averaged about 3.7 per day.” But that has now risen to an average of 4.3 attacks per day.

“This is clearly showing that health care is the target,” Altaf Musani, the WHO’s director of emergency health, told Reuters

And that’s not even the bleakest figure in the story!

Here are several more: Since March, Lebanon alone has seen 149 attacks on health care, according to the WHO. Gaza is down to just one fully functioning hospital. In Sudan, only half of hospitals are fully operational. As Musani put it, where “health care is needed most, it is being attacked.”

Meanwhile, The Guardian has a figure-filled story on how the blockade in the Strait of Hormuz has disrupted the global supply chain for humanitarian aid.

To be clear, only part of the issue is food and medicine that’s directly stuck in the strait. For example, how the International Rescue Committee told The Guardian that $130,000 worth of supplies for 20,000 people in Sudan is still stranded in Dubai.

Rather, the big killer is fuel shortages and rising prices, which are in full swing. Like in Nigeria and Ethiopia, where “government oil rations meant the emergency relief body [the International Rescue Committee] was having to limit generator use in its health clinics.”

Save the Children also estimates that every $5 increase in the price of a barrel of oil is costing the charity an additional “$340,000 a month” in shipping, fuel, food, and medical supplies. And if oil stays around $100 a barrel through 2026, that could mean an extra $27 million in costs this year.

In response, humanitarian leaders are calling for a humanitarian corridor through the Strait of Hormuz to freely move food and medical supplies, alongside fuel to address these humanitarian crises. (Which is, let’s be real, an extremely unlikely resolution.)

This is clearly an ongoing story, and one we’ll keep watching.

HealthInsuranceGPT

Sorry, but it’s dealer’s choice for this next one. (When a global health story lands in Nairobi, I’m going to cover it!) The Guardian just published a damning investigation on Kenya’s new national health insurance program.

In short: That program is based on an “AI system used to predict how much Kenyans can afford to pay for access to health care,” but which has “systemically driven up costs for the poor.”

(If you’re tempted to skip this because you’re not especially invested in one country’s health insurance system, fair enough. But you can read this as a broader, cautionary tale about handing off messy human decisions to opaque artificial intelligence systems.)

According to the report, the 2-year-old AI system has been, from the start, “systematically overcharging the poorest Kenyans … while undercharging the wealthiest by underestimating their incomes.”

The core issue is that the “system is structured on a decades-old World Bank bugbear: proxy means testing,” which is “a way of estimating the incomes of the poor based on their possessions and other life circumstances, such as how many children they have or whether they live alone.”

In practice, “this has meant deploying government volunteers … across the country to register their roofing materials, livestock, and children – and feeding those details into an opaque algorithm to decide how much they earn and how much they must pay.”

The end result, according to the reporting, is a widespread mess of misclassification: with “critically ill people who cannot get treatment,” and families “facing a sum of between 10% and 20% of meager incomes.”

“People are dying, people are suffering,” said one of the officials registering families under the system in Nairobi.

Ultimately, The Guardian reports that there is “not a single reason” for these inaccuracies. “Poverty is a fluid category – and using factors such as an iron roof or a pit toilet to estimate a family’s wealth is an intrinsically imprecise undertaking.”

There is one last point worth noting: As development economist Stephen Kidd told The Guardian, failures like this don’t just get numbers wrong and cost lives, they also reduce public faith in government services. “It feels like a lottery,” he said. “The lottery is not a great way of building trust.”

The Hantavirus cruise

I’ll leave you with a story I initially dismissed as too small, but which I’ve come across enough times in enough outlets that I just have to flag.

The BBC reports that a Dutch-operated cruise ship (the MV Hondius) was moored off Cape Verde after a suspected hantavirus outbreak killed three people and left another passenger seriously ill. The ship was sailing from Argentina to the Canary Islands.

In port, two more cases were confirmed. On Wednesday, the ship departed Cape Verde was heading to Spain’s Canary Islands with nearly 150 people on board, the Associated Press reported.

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. It can cause severe respiratory illness, with symptoms appearing one to eight weeks after exposure. (A lag that can allow cases to silently accumulate.) Human-to-human spread is rare, but has been documented with the Andes virus in South America. There is no specific treatment or vaccine, so care is mostly supportive.

One source at the WHO told the BBC that in this case, some person-to-person spread may have happened among close contacts sharing cabins, but the first infection could also have come from rodents before the ship left Argentina, or during one of its stops.

Still, there’s more questions than answers as of yet.

(Only modestly related here, but this news reminds me of a story I wrote about 12 years ago for Popular Mechanics. I was helping at my father’s automotive shop and we found rats living in a Porsche’s cabin air filter. A Centers for Disease Control and Prevention ecologist told me that was “an ideal way to spread an airborne virus,” since the car’s vents were blowing particles from rodent droppings or urine straight into an unlucky customer’s face.)

Anyhow… a rare virus, a stranded cruise ship, several deaths, and no clear answer yet on where the outbreak began?

Fine. It gets the closing slot!

I’ll see you next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Scientists find clue to cause of noma, an illness that disfigures children across Africa

2026-04-30T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we’re following some remarkable medical advances: a potential breakthrough in a long-neglected disease, and new treatments and tests for the world’s deadliest parasite. We also have an update to last week’s story on American HIV aid, and, at the end, a sci-fi-meets-Ken-Kesey story that combines psychedelic toad-licking, ayahuasca, tobacco, and genetically engineered bacteria.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

‘Astonishing discovery’ for a little-studied, disfiguring disease

Scientists believe they may have finally found the root cause of noma, a disfiguring illness in the sad bucket of “neglected tropical diseases,” The Guardian reports.

Disease breakdown: Noma is a rare but rapidly progressing disease of the mouth and face. It’s largely a children’s disease of poverty, with no single, proven cause, but an estimated 30,000 to 140,000 cases a year. Most cases are in children under 6 years old, across a belt of African countries from Mauritania to Nigeria to Ethiopia. Untreated, it kills 90% of those affected, and even with treatment the heartbreaking disease often leaves lifelong facial deformities and scars.

The new discovery was a bit serendipitous. Researchers at the Liverpool School of Tropical Medicine set out to map the bacteria living in the mouths of 19 children with noma across Nigeria. In the process, they uncovered a previously unknown species of bacteria, now called Treponema A.

The obvious question followed: Could this be the cause of the illness? To make sure it wasn’t a fluke, the researchers went back to “reanalyze older samples from other noma patients” and found the same bacteria there, too.

As The Guardian reports, this “astonishing discovery” doesn’t necessarily prove that the new bacteria cause the disease, but it certainly gives scientists something concrete to chase. As one researcher put it, “we don’t know if [Treponema A] can colonize a noma wound, because of the architecture and the environment, or if it causes the noma wound.”

Still, it’s an incredible starting point.

I reached out to Stuart Ainsworth, an infection biology and microbiome expert at the University of Liverpool, and part of the team behind the discovery. We discussed what this finding means and what it shows about the value of researching neglected diseases.

I started by asking Ainsworth how a disease this severe could still have such basic unanswered questions, and how a lead like this could have gone unnoticed for so long. Ainsworth was frank: “There has hardly been any research on noma at all,” he said.

He pointed to a 2021 review of the history of noma research, which found that there have only been 147 studies done on the disease since the year 1850. “In comparison, there were around 650 papers on rabies in 2021 alone,” he told me.

The core issue is that noma, Ainsworth says, “is the quintessential neglected disease. It only affects the very poorest in society and typically occurs in remote rural regions.” And because those who aren’t killed by the disease are often “left debilitated and scarred and generally hidden from society,” he said, “there is little impetus globally to invest in research.”

It’s a brutal dynamic, and one that cuts to the core purpose of medical research. “The goal with all diseases is to eradicate them, or at least control them to the point where they are no longer an issue.” And yet, “all of these things are impossible if you do not have at least a very basic understanding of what is the cause of the disease,” he said.

But that bleak starting point is also what gives this kind of scientific work such an incredible upside. “We know so very little” about noma that even “simple targeted research could potentially have a huge impact,” he said.

Looking forward, Ainsworth says further research could help move beyond the current treatment for noma, which is a shotgun approach of broad antibiotics, and that “we hope that these types of studies will eventually enable us to develop the targeted prevention, diagnostic, and treatment options to eradicate or prevent noma.”

A stalling fight against HIV, part 2

Last week we covered new data that showed U.S.-funded HIV treatment holding steady on paper, but testing, prevention, and case detection dropped sharply, raising fears about a surge in new infections.

Well, there are a few follow-on stories that are worth your time.

(First, we’re owed a correction. I flagged the State Department’s claim that “20.6 million people” are on HIV treatment, but it appears that the official figures don’t actually match the underlying data, which puts the number closer to 20.3 million.)

Second, the person in charge of the science behind that data just left. Mike Reid, the HIV program’s chief science officer, stepped down. He blames a system where American HIV aid is being “entangled with access to critical minerals or geopolitical positioning,” to the detriment of the work, Reuters reports.

Reid posted a full essay on Substack upon his departure, and there are a few sections worth pulling out to understand why he walked.

Reid starts with the core shift:

“When life-saving health assistance, often beyond the immediate capacity of partner countries, is conditioned on unrelated commercial or strategic objectives, something essential is lost … That is not a marginal adjustment. It is a different model. And I do not believe that model is consistent with the purpose of global health. I do not believe it serves patients, or countries, or ultimately even the long-term interests of the United States.”

He follows with a strikingly blunt assessment, which directly contradicts the State Department’s framing, and echoes what many HIV experts have been warning about.

“We have asked partner governments to take on substantial new responsibilities despite constrained fiscal space, high levels of sovereign debt, and growing demographic pressures, all while programs themselves have been weakened by recent U.S. funding cuts. In places like Zambia, which I care about deeply, the consequences of stepping away too abruptly could be devastating, and avoidable. I have to take that possibility seriously.”

Ultimately, Reid casts his resignation as a break with the core idea of the field itself. “I’ve believed that global health — at its best — is a form of solidarity. Not charity. Not strategy.” And now, that very belief “is why I am resigning my post as chief science officer at PEPFAR in the U.S. State Department.”

A malaria drug for newborns

For the first time, there’s a malaria drug for newborns, Deutsche Welle reports.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

The treatment was just approved by the World Health Organization for “babies weighing less than 5 kilograms (11 pounds).” Its development closes what was previously a “medical care gap for 30 million babies born each year in malaria-endemic areas" across Africa, which is by far the hardest-hit continent.

Technically, it’s a new formulation of two existing treatments: artemether and lumefantrine, which were developed thanks to a secret Chinese military project in the ’60s and ’70s to aid the North during the Vietnam war. (Really!)

Together, the drugs hijack the malaria parasite’s eating process, so that the blood molecules (hemoglobin) that should feed it actually end up destroying it.

You may be asking: If this is the first ever treatment, how have sick infants been treated until now? Well, routinely “infants have been treated with drugs developed for older children,” an imperfect workaround, as these drugs can “expose newborns to risks of dosing errors and toxicity.”

My takeaway: It’s encouraging that medical science keeps providing tools to fight and treat this disease. Earlier this month, the WHO also approved three new rapid tests for “malaria parasites [that] have evolved to become harder to detect,” as they stopped producing the molecule that older tests relied on.

Very timely! In some countries in the Horn of Africa (like Ethiopia, Djibouti, and Somalia), those tests started missing “up to 80% of cases.”

India’s largest pharma deal

India’s largest drugmaker, Sun Pharmaceutical Industries, has just made the country’s “largest pharma deal,” Reuters reports.

The company has agreed to buy the U.S.-based Organon & Co. It’s an $11.75 billion all-cash deal, the most expensive overseas acquisition ever by an Indian company.

Why does this matter?

Let me pepper in a bit of context: As we’ve written before, India, the “pharmacy of the world,” is where a fifth of all generic drugs and well over half of all vaccines are manufactured. And Sun Pharma is India’s biggest drugmaker by revenue, churning out over a thousand separate medicines and drug ingredients. A true generics giant, those drugs include everything from diabetes treatments and psychiatric drugs to cancer therapies and dermatology medicines.

Meanwhile, Organon (which started as an insulin producer over 100 years ago) makes specialty medicines: contraceptives and drugs for pregnancy and menopause, along with a variety of other hormone-based therapies. Although it’s a minnow in the American market, it produces “70 women’s health and general medicines sold across about 140 countries.”

If you scan through the link you’ll see that the Reuters story is a business one, full of debt figures and deal details. What’s more interesting is what this deal reflects about India’s pharma sector more broadly.

The big takeaway is this: India’s pharmaceutical sector is enormous, and only growing. Many projections have the entire sector doubling in value from 2025 to just 2030. Much of that growth is expected to come from a shift out of cheap generics into specialty medicines, and so this is exactly the kind of deal that will help make that shift real.

Whatever you do, don’t smoke this

Let’s end on a fairly wild story from New Scientist: A research group based at the Weizmann Institute of Science in Israel has "engineered tobacco plants to produce five powerful psychedelic compounds,” all in a single plant.

As the authors argue, this could offer a more sustainable way to produce psychedelic drugs, “which are increasingly in demand for research and medical uses.”

What I find particularly interesting about this story isn’t just the tie dye-inducing tobacco plant. It’s the fascinating technique the scientists used, which lands just shy of permanent gene-editing.

Here’s the explainer from the story:

“[The scientists] modified Nicotiana benthamiana plants using a technique called agroinfiltration, which involves using a bacterium to introduce genes from other organisms into a plant. The modified plant then makes the proteins encoded by those genes, but the DNA isn’t incorporated into the plant’s genome, so the effect is short-lived.”

Ultimately, those bacteria induced the tobacco plants to produce psilocin and psilocybin, two compounds found in “magic mushrooms”; DMT, which is found in the psychoactive drink ayahuasca; and bufotenin and 5-methoxy-DMT, which are secreted by Colorado river toads.

The researchers argue that their method is a much easier way to produce these molecules for medical testing than, say, raising cages full of toads. And it’s doing it across biological kingdoms, creating compounds from fungi, plants, and animals in a single organism.

The takeaway: As the article outlines, “the idea of growing drugs through pharmaceutical farming, or ‘pharming,’ certainly isn’t new.” As far back as 2002, we’ve had corn engineered to produce trypsin, a digestive enzyme. But doing it temporarily, without forever altering the plant’s genome, limits the risk of these traits escaping or persisting in the wild.

And heck, it makes the infamous “Simpsons” “tomacco” plant look as everyday as a steamed ham.

Until next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

PEPFAR snapshot after funding cuts: Less HIV testing means more cases

2026-04-23T11:00:00+00:00

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Hello from Nairobi.

This week we’re heavy on the Africa news. We’ll cover two important HIV stories, one about new U.S. data, and one on South Africa. Together, they offer a clearer read on the global HIV response and, I hate to say it, they undo some of the cautious optimism I’d started to feel. We’ve also got a hopeful malaria story from Eswatini, and a broad snapshot of vaccination across the continent.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some 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.

New data: a stalling fight against HIV

The U.S. State Department finally released new data Friday on PEPFAR, the two-decade-old U.S. President’s Emergency Plan for AIDS Relief at the center of the global fight against HIV/AIDS.

As Reuters reports, this was the first public update in 16 months, and the only official snapshot of the program after the widespread disruptions in 2025 and a roughly 30% drop in funding. (Worth noting: The data are also incomplete. The update only covers the final quarter of 2025.)

What’s the topline?

The Trump administration is pointing to a single figure: that 20.6 million people are still on HIV treatment. Taken alone, that’d be fine news, because it’s nearly level with the figures from both 2024 and 2023.

But, as Reuters notes, that treatment figure relies on some funky accounting. It includes about “3 million people whose care was provided by their own governments.” And even setting that aside, advocates are worried for a simpler reason: Treatments may be steady, but the data indicate significantly more new HIV infections are slipping through.

The data paint a clear picture.

From 2024 to 2025, 4.7 million fewer people were tested for HIV (a drop of about 22%). About 78,000 fewer people were diagnosed with HIV (20%). And 2 million fewer people were taking preventive treatment (10%).

It’s a fairly shocking downturn, and portends a future of more HIV, not less.

As Charles Kenny, a senior fellow at the Center for Global Development who has been tracking the data, told Reuters: “If people aren’t tested, they can’t know if they’re positive. If we don’t know they’re positive, they cannot be put on drugs … We’re building up problems for the future."

Or, as Kenny told the New York Times, “the long-term trajectory could be back to as depressing as I thought it was going to be last year.”

Inside South Africa’s HIV slowdown

Ok, so that new PEPFAR data give a global view.

But this week Physicians for Human Rights, a U.S.-based non-profit, also zeroed in on what these changes look like with a report from one country: South Africa, home to the largest HIV epidemic in the world.

South Africa is a fascinating case to focus on, because there are several reasons you could expect it would be better positioned to absorb the shock of the HIV funding cuts than many other countries.

Why? For one, it’s an upper-middle-income country that spends a hefty 16.8% of its budget on health. And in recent years, the United States covered just 17% of its overall HIV response, with the majority managed domestically. (That’s far less than in countries like Uganda, Tanzania, or Lesotho, where international funding has historically paid for the vast majority of those programs.)

But in the report, the interviews with health workers, researchers, and patients across South Africa tell a different story: a system where “a future surge in otherwise preventable new HIV infections [is] all but inevitable,” and where “catastrophic” cuts to HIV research are already having global effects.

I reached out to the co-authors of the report: Karen Naimer, the director of programs at Physicians for Human Rights, and Emily Bass, an author and HIV/AIDS expert, to understand what’s actually breaking here.

First, we talked about the hit to laboratories.

As Naimer explained, for years South Africa has been a global center for HIV research, with both a large number of cases and the advanced, scientific infrastructure to study them. That’s one reason why before 2025, South Africa was the largest foreign recipient of funding from the U.S. National Institutes of Health — America’s federal medical research agency. Roughly $400 million went into studies that shaped how HIV is treated worldwide.

But, as she explained, much of that work has been cut off.

Alongside a pullback in dollars, a new NIH rule has blocked U.S. funding from reaching overseas research partners, leaving “terminated studies, the loss of clinical trial capacity, and the attrition of skilled personnel,” she said. And this isn’t just a South Africa problem, “that dismantling of the clinical research infrastructure in South Africa will have global implications.”

What about on the ground – how is everyday HIV prevention and care in South Africa faring?

The report really paints the picture of why testing is falling and fewer HIV cases are being found.

As Bass explained, while the United States funded a minority of South Africa’s overall HIV response, it covered a majority share of the front-line prevention work, especially the more intensive and expensive programs like community testing and outreach. “And virtually all of that investment ended overnight in South Africa,” she said, adding that much of it still hasn’t been replaced.

Ultimately, HIV prevention depends on reaching people who feel fine and aren’t thinking about HIV. They’re not seeking medical care, so the system has to go to them. (Think mobile testing vans or having social media influencers chat about HIV prevention).

Take that away, and you’re left with clinics. And if that’s the whole strategy, it’s no wonder it’s falling short. As Bass put it, “people are not going to regularly elect to go to a clinic and wait hours to get a test, just to find out if they are HIV negative.”

One final note: These cuts to preventive care are hitting just as lenacapavir (the breakthrough HIV prevention drug we’ve been covering extensively) was about to be rolled out.

So, instead of hitting the ground with speed, Bass tells me, the very systems meant to deliver this new drug have been dismantled. “We destroyed that platform, and it really is destruction,” she said.

Holding the line on malaria

The Guardian has an interesting story out of Eswatini (the small, landlocked country between South Africa and Mozambique) that is seemingly close to eliminating malaria altogether.

How close? Well, in 2024, the country of 1.2 million recorded only “362 confirmed malaria cases.” A feat all the more impressive given that “cases have risen globally for six consecutive years,” even in neighboring countries.

As the story shows, part of what’s made the malaria response so effective is the tight disease surveillance system in Eswatini, where individual infections are treated with immediate house-to-house testing and spraying.

There is some peculiarity here worth mentioning. The last mile is often the hardest and most expensive in disease control (polio is a classic example). But malaria is a little different because the symptoms are so visible, and the disease spreads very locally.

What this means is that once malaria cases get very low, a country can concentrate resources on each infection with remarkable efficiency. (This is the very dynamic that allowed the United States to pull off malaria elimination in 1951.)

Unfortunately, Eswatini’s progress nevertheless sits right up against a very different reality in neighboring Mozambique, where there are more than 11 million cases a year. It’s an ever present challenge that, well, mosquitoes don’t care much for borders.

And there are other looming challenges, too. As Mark Edington, the head of grant management at the Global Fund, told the Guardian:

“If you look at the combination of decreased malaria funding, from us and probably from the U.S.; you look at increased resistance towards both drugs and insecticide; you look at population growth; you look at extreme weather events, which are increasing; and you put that all in a mixing bowl, the result is not good … It is worrying.”

What’s the takeaway?

Certainly Eswatini deserves kudos for this heroic effort. But the real question is whether it can hold the line. With 11 million cases just across the border, a lasting elimination of the disease is just not possible, and keeping numbers this low will require the same constant, expensive vigilance year after year.

Immunization across Africa

The World Health Organization has released a new snapshot on the state of vaccinations across the African continent. As the AP reports, it’s both the “first-ever comprehensive analysis” of its type and a mixed bag of news.

Let’s start with the positive, which is the long view. The data in the report make a strong case that vaccination efforts on the continent have been one of the most consequential humanitarian achievements in modern history.

Think I’m overselling it?

Consider that over the last 50 years, vaccination efforts have “saved more than 50 million lives.” Even just since 2000, routine programs have reached “more than 500 million children,” preventing more than “4 million deaths each year.”

Zooming in a bit, there have been some very specific successes, too. Wild polio has been eliminated from the continent (the last case was in 2016). And tetanus infections during childbirth, once a major killer, have also been largely eliminated as a public health threat.

What’s the worse news?

The report outlines that most vaccine-preventable diseases have been mired in stalled vaccination coverage, and in many cases for more than a decade.

For example, only half of children on the continent are receiving two doses of the measles shot, which is the only sure-fire preventative for the disease. HPV vaccination sits at just 28%. And the hepatitis B shot, which is given at birth, reaches only 17%.

The WHO’s target for all these vaccines is 90%. We’re not even close.

And, unfortunately, we’re on track to see things worsen.

The funding behind these programs is shrinking, with the AP noting that “the U.S. withdrawal from WHO in January resulted in the loss of about 40% of the agency’s overseas development funding,” and the Gavi Vaccine Alliance is also “experiencing a financial crunch.”

What’s the takeaway? I have mixed feelings. It’s worth appreciating the extraordinary amount of human suffering we’ve reduced through vaccination. But it’s not enough, and it’s frustrating to realize we may be stuck at an arbitrary high-water mark well short of what we’re capable of.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Half the world still doesn’t have a national public health agency

2026-04-16T18:32:06+00:00

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Hello from Nairobi.

I had a fascinating last week! I drove up to Ol Pejeta wildlife conservancy in central Kenya, and saw the last two northern white rhinos on Earth. I was a bit surprised to find that the story wasn’t exactly the tragedy I was expecting. While the last male rhino died in 2018, there’s hope. Scientists preserved his sperm, and now there’s a few dozen embryos that are being kept frozen in a lab in Italy.

The researchers are attempting to implant those embryos into females of a sister species (because they’re not willing to risk pregnancy complications in the final two) in a last-minute bid for de-extinction.

The last two white rhinos on Earth are at the Ol Pejeta wildlife conservancy in central Kenya.

Anyhow, this week’s stories are a bit more of an emotional mix; some genuinely hopeful, others tougher to sit with. We cover some surprising resilience in setting up national public health agencies around the world, the spread of measles in one of the world’s most densely populated countries, and the shadow of war on health systems in Gaza and Sudan, among other stories.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Public health agencies … rarer than you’d think

Our first story starts with a stat that genuinely surprised me: Of 195 countries, only 101 have a national public health agency, like the U.S. Centers for Disease Control and Prevention. Naively, I had thought them to be nearly universal.

Sure, all countries have something akin to ministries or agencies responsible for health and well-being. (Nobody’s truly flying blind.) But in about half the world, there is still no single institution that oversees disease surveillance, labs, or outbreak response during emergencies, like a pandemic.

That’s a core point of a Think Global Health essay by two World Health Organization officials who are advocating for more of these agencies. The WHO officials argue that they are often the deciding factor in whether outbreaks are contained early in a given country.

They cite Ethiopia’s rapid response to the Marburg outbreak last year, which was centrally coordinated by The Ethiopian Public Health Institute. As we covered in January, within just weeks, Ethiopian authorities “conducted 3,800 diagnostic tests, airlines screened 4.8 million travelers, and health officials ran a prevention-awareness campaign that reached more than 20 million households.” In sum: It was wildly successful.

In countries without a single public health agency, all those functions may have been scattered across various ministries, regional or state governments, or even research institutes. That fragmentation can slow decision-making at exactly the moment when speed matters most. As the authors write:

“It complicates decision-making when every hour is critical. In a scenario when a virus with pandemic potential suddenly emerges in a country, leaders need to do everything they can to stop the disease from spreading before it becomes uncontainable. Whom would the president or prime minister call?”

I reached out to Chikwe Ihekweazu, one of the authors and the head of the WHO’s health emergencies program, to ask whether the crunch in global health funding has slowed the momentum behind building these agencies, and what it takes to stand one up.

First, they thankfully haven’t slowed down. “Despite the current global health landscape” of funding cuts, Ihekweazu said, his team is helping “20 countries” establish these agencies right now. It’s a geographically diverse list that includes “Kuwait, Namibia, Sri Lanka, and Zimbabwe,” among others.

That’s steady progress, especially given that back in 2000, only 51 countries had one of these agencies.

Today, “the majority countries without a national public health agency are small island states in the Caribbean or the Western Pacific” that have historically banded together to share a regional health body, like the Caribbean Public Health Agency, he told me.

I was surprised to learn that the biggest deciding factor for these agencies isn’t so much about funding, Ihekweazu says, but countries recognizing what they’re missing after a crisis. In many ways, the latest countries on the docket are part of the long tail of Covid.

As for what it takes to stand up one of these agencies, Ihekweazu pointed me to a framework the WHO published just this year, which lays out 12 things countries need to get right, from leadership and funding to the nuts and bolts of detecting and stopping outbreaks. (It’s classic WHO: dry, quite lengthy … but technically excellent.)

Strip down that framework, and it points to something simple: In a crisis, a country has to be able to act as one. As Ihekweazu put it, “the next pathogen is sure to emerge, and either clarity or confusion will define the response. For the sake of the world’s health, let every country have the public health agency it needs.”

A measles outbreak in Bangladesh

Bangladesh is scrambling to contain a fast-moving measles outbreak that has killed more than 100 children in less than a month, the Associated Press reports.

The country, which is one of the most densely populated in the world, has launched an emergency vaccination campaign targeting “children age 6 months to 5 years old” in several high-risk districts. So far, “900 cases of measles have been confirmed … since March 15.”

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

It’s worth noting that the current emergency surge of vaccinations is essentially the only path forward for the country. (Well, the only path that’s not a downward spiral.)

As Healthbeat has been reporting, measles’ level of contagion means outbreaks can take off quickly wherever vaccination rates slip. In the United States, cases have surged past 1,600 this year, with officials warning that infections are likely being undercounted and continuing to spread across multiple states.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

In Bangladesh, the outbreak is likewise exposing deep gaps in immunization coverage, “particularly among zero-dose and under-vaccinated children, while infections among infants under 9 months, who are not yet eligible for routine vaccination, are especially alarming,” Rana Flowers, UNICEF’s representative in Bangladesh, told the AP.

Troublingly, the outbreak is also colliding with political fallout from an uprising last year, where “the vaccination campaign for measles was disrupted.”

My takeaway? What’s particularly terrifying about this story is the math.

Measles requires about 95% vaccination coverage to stop the spread of the disease. Bangladesh has come a long way, from 2% coverage in 1979 to 81.6% today. But with a virus this contagious, that remaining gap is everything.

Gaza: amputees and hypothermia

This week there are two health stories out of Gaza that are worth reading.

The first, from The Guardian, follows Palestinians who managed to leave for treatment in Egypt after losing limbs in the war. The story has both dramatic photos and some fairly shocking figures.

“More than 6,000 adults and children have undergone amputations since October 2023,” including children who were, at one point, losing legs at a rate of 10 per day. But the story isn’t just about the horrors of those injuries. It’s also about what comes after.

Many amputees are currently stranded in Egypt, without legal status, unable to work, and cut off from long-term care. As one patient put it (which put a pit in my stomach,) “I want to return to Gaza because my daughters are there … When I am allowed to leave, I will go back to my daughters.”

The second story, from Think Global Health, is not much better. A health worker from Project HOPE describes this year’s winter in Gaza, where children died of hypothermia in tents, and where wet blankets and fuel shortages turned cold snaps into repeated medical emergencies. Part of this exposure stems from the fact that “81% of all structures in the Gaza Strip” are estimated to be damaged.

The author writes that hypothermia “acts not in isolation but as a deadly multiplier,” worsening malnutrition and disease in a system where most hospitals no longer function, even after the fighting has ceased.

I thought about both these stories when I listened to a podcast Tuesday morning, on a conversation about the “permanent” state of Palestine between commentator Ezra Klein and political scientists Marc Lynch and Shibley Telhami.

Ultimately, the medical situation in Gaza is no longer some acute crisis. The children freezing in tents, amputees stranded across the border, families packed into ruins, and endless limbo with no real horizon for relief…

That is now the baseline. It is daily life.

Famine in Sudan

I’m always a little hesitant about where to draw the line between humanitarian crises and global public health in the Checkup. But I have to include this next story, because I don’t think we truly appreciate what’s unfolding in Sudan right now.

According to Reuters, “millions of people in Sudan are surviving on just one meal a day” as the country’s war grinds into its third year. All told, nearly 29 million people, about 62% of the population, are unable to consistently access enough food to live a normal, healthy life.

The reporting draws on a new analysis from a group of aid organizations, including Action Against Hunger, CARE International, and the International Rescue Committee.

“In the two areas worst hit by the conflict,” the aid organizations found that millions of families often “miss meals for entire days,” with many people resorting to “eating leaves and animal feed to survive.”

The takeaway (and the trajectory here) is unmistakable. It’s the “f” word.

Famine thresholds have already been crossed in parts of the country, with child malnutrition rates “nearly double the famine threshold” in some areas.

This is shaping up to be a catastrophe on a scale the world has not seen in years, potentially decades, if conditions continue to deteriorate. It’s worth noting, the three NGOs I linked to above are taking donations, and saving lives with them.

‘Molecular surgery’

I’ll leave you with an op-ed published in the New York Times, written by Jeff Coller, a scientist who works on gene-editing technology. It is a hopeful-but-frustrated letter on what Coller says may be “the most important medical story of the decade.”

Coller opens with a striking vignette from last year.

A baby is born with a rare and deadly genetic disorder, stemming from a single DNA error. A liver transplant could fix the issue, but only after many months, and likely after “irreversible neurological damage” had set in.

So, instead, doctors and medical researchers designed a custom, DNA-altering therapy specifically for the rare disease in this one child. The drug was injected into his blood and the DNA error was permanently rewritten.

Coller’s point is that the age of truly personalized genetic medicine is no longer theoretical. It has already begun. And today, we are capable of eliminating entire categories of rare genetic diseases, most of which still have no approved treatments.

Ok ok, that was the hopeful bit. Now for the frustration.

As Coller sees it, even if the constraint today isn’t technological, “I believe that the biggest obstacle, however, is structural,” he says. Globally, our medical approval systems simply aren’t built for these kinds of custom treatments. In the United States, each one is treated like a brand-new drug, requiring its own approval process. As he puts it:

“Our regulatory and commercial infrastructure was built for blockbuster drugs that treat millions of patients with the same pill. It was never designed for diseases for which each patient may need a bespoke correction to a unique mutation. But we already have a model for individualized, high-stakes interventions that correct specific defects in specific patients. We call it surgery. Consider a surgeon who performs a heart valve repair. No one asks that surgeon to run a clinical trial before operating on the next patient with a slightly different anatomy.”

That’s the shift Coller is calling for. To stop treating these therapies like traditional drugs, and start approving them more like a platform, or even like a kind of “molecular surgery.”

After all, “radically new science demands radically new thinking about how we regulate, manufacture, pay for, and deliver treatments,” he says.

Ten years from now, if children are still dying of conditions we know how to correct, it will not be because the science wasn’t ready.”

Until next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

2026-04-09T11:00:00+00:00

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Hello from Nairobi.

We had a lovely, long Easter weekend. (Both Good Friday and the Monday after Easter are national holidays here.) And later this week, I’m planning on driving some visiting family upcountry to the foothills of Mount Kenya, where we’ll see the last two northern white rhinos in the world.

This week’s stories cover some (déjà vu triggering) disruptions to U.S. medical aid, the rollout of a promising HIV prevention drug, the growing damage that war is inflicting on Iran’s health system, among a few other stories.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A proposal for more U.S. medical aid disruption

The United States is preparing a major, disruptive overhaul in how it delivers HIV and malaria aid, Reuters reports. The proposed changes represent an “upheaval likely to cause more medicine shortages” and risk “a second dislocation of life-saving services in just over a year,” across Africa and Asia.

Some background: For the last 10 years, the United States has routed a fairly astonishing volume of medical supplies through one large program called the Global Health Supply Chain Program – Procurement and Supply Management, which is run by the for-profit company Chemonix. Just how much? Between 2016 and 2024, that program “delivered a total of more than $5 billion of HIV and malaria products to 90 countries,” making the United States by far the largest funder of these tests and medicines worldwide.

But, according to the Reuters investigation, State Department leadership has asked “staff in 17 African countries and Haiti in an email [on March 31] to cease implementing the supply program by May 30.”

The program will theoretically be replaced by new systems set up under “bilateral agreements with other countries” and private distributors, which would have to be negotiated extremely quickly.

All told, the month-and-a-half timeline is raising concerns about “immediate risks to service continuity if the transition is rushed or incomplete,” with potential shortages of HIV drugs, malaria treatments, and other basic health supplies that millions of people rely on. As the article outlines, ordering and shipping medical supplies to remote clinics can take many months.

The directive “did not lay out a clear transition plan, instead asking each U.S. country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.”

I reached out to a senior, overseas State Department official with direct knowledge of the program, who agreed to speak on background to provide context.

My source confirmed the broader uncertainty around the transition. To their knowledge, even basic guidance on the proposed upheaval (including the email referenced in the Reuters report) has not yet circulated across all countries served by the program.

They echoed the strong concerns in the Reuters report that such a severe and rapid disruption could leave patients without lifesaving medicines. But what I found most interesting is that they noted that even if the United States ultimately shifts medical procurement to the international organization the Global Fund (an option that we reported on last week) simply purchasing medical supplies is only part of the coming challenge.

What remains dramatically unclear is the rest of the supply chain: warehousing, logistics, and actually getting drugs into clinics.

At the risk of getting too in-the-weeds: These risks may be especially acute in countries where the State Department did not inherit parallel supply systems from the now-defunct U.S. Agency for International Development that could temporarily absorb the shock. (In other words, some countries have backup systems to keep medicines flowing. Others do not.)

My takeaway: It’s still unclear how much of this proposal will actually move forward, or whether the State Department may walk back the plan or timeline. I’ll be following this story closely.

Is there enough of this game-changing HIV prevention drug?

Late last year, a new injectable drug to prevent HIV infection called lenacapavir began rolling out in several African countries. The drug has generated enormous excitement because a single injection protects people for about six months, and it provided close to perfect protection in clinical trials.

But that early rollout is already raising questions. In Eswatini, which received the drug first and has the world’s highest rate of HIV, clinics are already running through their tiny initial shipments, The Guardian reports.

One clinic only “received 130 doses.” Nationally, only a few thousand people have started the drug so far. (Keep in mind, a quarter-million people in Eswatini are HIV+). As one source in the story put it, “The coverage so far has been very, very, very low. But my impression is that interest is extremely high.”

The story raises an obvious question, and also had me wondering if this goes beyond one country: Is lenacapavir’s wider rollout already being hampered by supply limits? To ask, I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition, who we last spoke to about lenacapavir in October.

To start, Warren told me to pump the brakes. It is still early days. While “the initial deliveries are quite small to each country … it is actually too early to tell about the actual supply constraints (if any),” he said.

Warren noted that countries like Kenya, Nigeria, and Zimbabwe only just received their first shipments last month. “So we don’t yet know that demand is truly outstripping supply – yet.”

Still, Warren said the bigger picture for HIV prevention is far from reassuring amid the broader pullback in global health aid.

As he put it: “This continues to be a moment of cruelest irony – our best opportunity in HIV prevention coming at the worst time politically and economically.” While there is enormous potential for this new drug, “the foundational programs [which would deliver it] have been severely curtailed, and in some cases entirely decimated.”

Warren also left me with one note that’s often missing from lenacapavir coverage. HIV prevention, he says, “has always been more than a product — it is a program.” And without outreach, testing, and health systems that bring people back every six months, even a “miracle drug” (as the Guardian piece put it) won’t stop the epidemic.

Iran’s civilian health system under fire

For the third week in a row, we’re returning to the Iran war. Granted, it’s been evolving on a fairly volatile timeline, so much of what we know will likely change in the coming days.

Early Wednesday, a fragile cease-fire was holding after U.S. threats to attack Iranian power plants, bridges, and other civilian infrastructure if Iran did not reopen the Strait of Hormuz. Iran had threatened similar retaliation to neighboring countries. Under international law, these are war crimes, and the potential consequences for civilian health and survival could be enormous.

To some extent, that damage is already underway. Al Jazeera reports that U.S. and Israeli strikes have already hit major parts of Iran’s health system. This includes a psychiatric hospital, a pharmaceutical company, and the Pasteur Institute of Iran, “the oldest and most prestigious research and public health center in Iran,” which has “played a central role in fighting endemic diseases such as smallpox and cholera.”

The World Health Organization says it has verified “over 20 attacks on health care in Iran,” resulting in “at least nine deaths,” including an infectious diseases health worker and a member of the Iranian Red Crescent.

More broadly, WHO Director-General Tedros Adhanom Ghebreyesus warned that “the conflict in Iran, and the region, is impacting the delivery of health services and the safety of health workers, patients, and civilians present at health facilities.”

Argentina: easier monopolies for medicines?

After pulling out of the WHO last month, Argentina has made another significant policy shift. The government has scrapped guidelines that limited which medicines could qualify for pharmaceutical patents, according to an essay in Health Policy Watch by leaders in the affordable-medicines advocacy arm of Doctors Without Borders.

Put simply, the essay argues that Argentina has essentially made it easier for pharmaceutical companies to stretch out monopolies by re-patenting small tweaks to existing drugs. (Imagine a company simply rejiggering a new dose of an existing drug, and then re-patenting it just as the original patent was about to expire.)

Ultimately, these patent extensions push generic competitors out of the market for longer, and keep prices much higher. As an example, the authors reference a hepatitis C treatment that dropped from “$147,000 to $120 per person” once generics were allowed to compete.

You may be asking: Why is this (admittedly niche) policy shift for a single country worth covering?

Well, the authors argue that Argentina’s previous “more disciplined system” of patent rules showed how governments could apply strict standards, while still rewarding real innovation. By rolling those rules back, they warn, Argentina risks weakening a model other countries have looked to when trying to limit pharmaceutical monopolies.

As for my takeaway? This story touches on a tension I run into constantly covering global health. Alongside government-funded R&D, private companies are our greatest engine of drug innovation. The big question is how and where we should draw the line between incentivizing companies to invent lifesaving medicines … and demanding those medicines remain affordable once they exist.

Honestly, I’m reluctant to even, say, cast drug patents as a “necessary evil.” As uncomfortable as they are, monopolies ultimately allow companies to recoup the enormous cost of developing new medicines. And there’s nothing shameful in that. When there’s no profit to be made (as we see constantly with the entire field of “neglected tropical diseases”), the results often fall between grim and hopeless.

Human greed is a powerful force! Companies should see value in investing in the medicines we all rely on. But keeping that greed in check is just as important, and I think Argentina is failing in the latter to serve the former.

A ‘mysterious skin disease’ in Pakistan

We’ll finish on a small but worrying report out of Pakistan that’s worth flagging. At least nine children have died in the country’s southeast Sindh province from what officials have described as a “mysterious skin disease,” though the cause has not yet been identified, Pakistan Today reports.

On Monday, “samples from eight affected children had been sent to Karachi [the capital of the province] for testing,” but results have not yet been released.

It’s too early to know what this actually is, although the big worry is a novel outbreak. Local officials have suggested possibilities including chickenpox or mpox. (Although additional reporting suggests that while mpox has been detected in some of the cases, health officials say it was not the direct cause of the deaths.)

With no diagnosis yet and only local reporting so far, this may ultimately turn out to be a familiar disease rather than something new. Still, unexplained childhood deaths are always worth watching closely, and I’ll keep an eye out for further reporting.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Iran war threatens systems that keep drinking water flowing in Gulf

2026-04-02T11:00:00+00:00

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Hello from Watamu.

I’m spending a few days on Kenya’s sunny Swahili coast with family and a few friends (it’s an easy one-hour flight from Nairobi). A highlight so far has been a sunset trip on an old wooden dhow, the sailing boats that merchants have plied the Indian Ocean with for over a thousand years.

This week’s newsletter, like last week’s, circles back to some of the biggest geopolitical crises shaping global health right now. We’ll look at more effects from conflict in Iran, the medical consequences of a fuel blockade on Cuba, along with a few other stories on broader global health funding and treaties.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

What happens if the water stops flowing

The ongoing Iran war is leaving a lot of industry at risk. Like oil and fertilizer production, global shipping, and even (as we discussed last week) medicine. But an interview in Think Global Health last week highlights what is arguably the most vulnerable piece of infrastructure: the plants that turn seawater into drinking water.

It’s a fact that Arabian Gulf nations depend more on desalination than anywhere else on Earth. In total, they produce between “45% to 50%” of the world’s desalinated water. It’s a necessity in a broader Middle East that has “6% of the world’s population but less than 2% of renewable fresh water.”

That water, as the article notes, “underpins households, hospitals, schools, hygiene, and sanitation services.” And several early attacks and threats on desalination plants are raising alarms.

The article breaks down how Iran has accused “the United States of attacking a freshwater desalination plant on Qeshm Island,” Bahrain has said that “Iranian drone strikes damaged one of the country’s 103 desalination plants,” and “after President Donald Trump threatened to obliterate Iran’s power plants, [Iranian leadership] vowed to retaliate against Gulf water and energy facilities.”

And on Monday, Trump escalated further, threatening to blow up “possibly all desalinization [sic] plants” in Iran if no peace deal is reached.

Now to be clear, the vast majority of the desalination plants in the Arabian Gulf are currently unharmed. But the story, and taking seriously the threats that the war could spiral toward these systems, has me wondering: How bad could it get if this war starts knocking desalination offline?

To discuss, I reached out to Peter Gleick of the Pacific Institute, one of the world’s leading water resource experts, and Kaveh Madani, director of the United Nations University Institute for Water, Environment and Health, and a former senior Iranian policymaker. The conversations were grim.

“If major desalination plants are attacked and damaged,” Gleick said, “there will very quickly be serious ramifications for public health,” with the worst effects in “countries with the greatest dependence on desalination for public supply, especially Qatar, Bahrain, and Kuwait.”

The issue isn’t just the fragility of these systems, Gleick says. It’s that for many nations, there is no real Plan B if they are destroyed. “Very few nations that rely on desalination have sufficient storage or backup alternatives if those plants were to be attacked,” he says. The logical alternative is groundwater, which has “long been seriously overpumped and overdrafted,” and is now “limited, typically of lower quality, and often not easily accessed in the volumes and locations that would be needed.”

Madani was largely in agreement, and said that generally speaking, “the smaller the state, the more vulnerable it is in this situation.” In countries like Bahrain, where 103 desalination plants provide more than 90% of drinking water for the population of 1.6 million, “in some cases the smaller states have only a few days or few weeks of water reserves” available if those plants are forced offline.

And Madani said some of the most important risks are still being overlooked. For example, “to put a desalination plant out of service, you don’t have to directly attack it,” he said. A power blackout can cripple these systems just as effectively as a bomb.

“And another risk we don’t hear much about is water quality disruption,” Madani said. Few environmental disasters rival a major oil spill. If the conflict leads to more “oil tankers being sunk or attacked,” the resulting spills will contaminate coastal waters and could force desalination plants offline.

Together, the experts I spoke with had a few clear takeaways: First, this conflict must change future water supply planning. Many Gulf nations’ reliance on a small number of massive desalination plants creates an enormous vulnerability. As Gleick put it, the best way to reduce that risk in the future will be to sacrifice some of the efficiency of those large systems and build “smaller, decentralized, and redundant systems,” instead.

And of course, the rising threats to these facilities are also a reminder that drinking water systems are protected under international law. Under the Geneva Conventions, deliberately attacking civilian water systems (which is being actively threatened by both American and Iranian leaders) can constitute a war crime.

Stranded cholera aid

Last week we discussed how the Iran war is scrambling the movement of some global medicines.

This week a Reuters report shows those consequences already bubbling up. Cholera aid for countries across Africa is now snarled in the disruption.

According to the article, “emergency cholera medical supplies for several African countries have become stuck in a logistical quagmire," with vital “stocks stranded in Dubai warehouses.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. It largely spreads through water contaminated with feces, and thrives where basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The timing here matters quite a lot. Cholera is a waterborne disease that often surges during rainy seasons. In some high-risk countries like Sudan and Chad, those rains begin around May.

What’s stuck? The supplies in Dubai warehouses are essentially “mini field hospitals … with rehydration treatments, as well as chlorine to treat sewage and drinking water to prevent further spread.”

The good news is that the cholera situation on the continent is no longer as dire as last year, so this delay is less catastrophic than it might have been even just a few months ago. Last year I reported on how Africa was facing “the worst cholera outbreak in a quarter-century, with cases surging in countries as disparate as Sudan, Burundi, and Angola.” But Reuters reports that “so far in 2026, the number of cases is down by about 50% versus 2025.”

Still, progress on cholera can reverse quickly without a sustained medical response. As one World Health Organization official told Reuters, "We’re talking [about] an explosive disease … If you don’t have the time or the resources to control it in a matter of days or even hours, you would have an extreme contamination."

The Global Fund: doing more with less

(Fair warning. We’re about to dive back into some well-trodden Checkup territory: the wonderfully boring budgeting mechanics of global health finance.)

According to an early report of several background sources in Devex, the Global Fund (the international organization that bankrolls over $11 billion in programs fighting AIDS, tuberculosis, and malaria in more than 100 countries) is being tapped to play an increasingly important role in stabilizing global health programs after last year’s funding shortfall.

As one advocate told the outlet, “Everyone now looks to the Global Fund to ensure the continuity of critical health services.”

At least rhetorically, even U.S. officials are boosting the Global Fund. Jeremy Lewin, the senior State Department official tasked with foreign assistance, has called the Global Fund a “critical partner” in advancing the “America First Global Health Strategy.” (For reference, Lewin has been notably critical of international aid organizations; casting the United States as “suckers of the global system for so long.”)

The report describes a few early examples of this dynamic. In several U.S.–Africa bilateral health negotiations, the Global Fund has been asked to join the negotiations to provide technical guidance on programs it supports. Some of those bilateral agreements also purportedly reference its procurement platform, wambo.org, suggesting the United States may increasingly look to the fund to purchase medicines and keep programs running.

What’s my takeaway?

It’s a bit of a surreal moment. As we covered in December, the Global Fund’s latest fundraising round came up nearly $7 billion short of its target (!) and “a quarter less money than the fund received in the previous cycle.” The largest missing chunk of that shortfall was American dollars. If the Devex report is accurate, donor countries like the United States could be increasingly leaning on the fund … even as they cut the money that powers it.

Cuba: no electricity, no health care

Cuba’s fuel crisis is grinding the country’s health system to a halt, according to reporting in The New York Times.

Some background: A tightening U.S. oil blockade (and the sudden loss of Venezuelan oil shipment) has nearly eliminated fuel shipments to the island, triggering rolling, multi-day “nationwide outages.”

The story opens with a vignette that’s really stuck with me over the last few days. Jorge Pérez Álvarez, a 21-year-old Cuban man with a genetic lung disease, survives only because a ventilator keeps him breathing. But power outages keep putting that machine onto a backup battery that’s repeatedly pushed to the brink. And when it dies … he does too.

“His life depends on electricity,” his mother says.

And what does Jorge’s story look like … expanded across an entire health system? (Excuse the length of the following quote, but it really shows how widely the blockade is unraveling basic medical care.)

“Hospitals are canceling surgeries and sending patients home because doctors and nurses can’t commute to work. Clinics are struggling to administer treatments like chemotherapy and dialysis because of power outages. Many ambulances are parked because drivers can’t find gas. Pharmacies are largely empty because the virtually bankrupt state is struggling to buy medicine. Production of medicine has been mostly halted because factories run on diesel. Vaccine makers are searching for ingredients because flights that once carried them are canceled because of a lack of jet fuel. And refrigerated vaccine stocks could soon spoil if the blackouts continue.”

It’s a brutal reality for the people living in Cuba.

What’s the takeaway? Over the weekend, my mind kept wandering back to Jorge (and how his family could possibly cope.) So, for me, the story is a reminder that cold geopolitical decisions always land on real people. Surprisingly, late Monday the New York Times also reported that the United States just allowed a Russian oil tanker to break the blockade, which hopefully keeps Jorge alive.

Stalled pandemic negotiations

We’ll end this week at the WHO headquarters in Geneva, where Health Policy Watch reports the negotiations over the final piece of a global pandemic treaty have stalled.

“A snail would have a faster passage,” the article quips.

The sticking point is one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.

At the risk of oversimplifying it, the concern from many poorer countries is a repeat of Covid-19, where these countries found themselves last in line for newly developed tests, vaccines, and treatments. As the article notes, they “want the assurance that if they share [information on the next pandemic], they will be able to benefit from any vaccines, therapeutics, or diagnostics that are developed as a result.”

Meanwhile, several wealthier countries, including “those with powerful pharmaceutical industries … argue that compulsory benefit-sharing will stifle research and development.” And, to put a bit more bluntly, they are also reluctant to lock themselves into binding rules that might limit supply of lifesaving medicines in the future.

So what now?

It’s not clear. Some civil society observers are floating an uncomfortable option: forcing a vote to break the impasse. (Rather than wrapping up the treaty with unanimous consensus among member states.) That could push the agreement forward ahead of the World Health Assembly deadline in May… but it would also risk splitting the fragile consensus behind the pandemic treaty.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How the Iran war is disrupting the world’s medicine supplies

2026-03-26T11:00:00+00:00

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Hello from Nairobi.

This week we start with a reminder that the world’s conflicts rarely stay confined to the map. The Iran war is scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals.

That said … we’re feeling the energy squeeze, too! Rumors of fuel rationing started circulating in Nairobi early this week, which was enough to send me out late at night to fill up my tank just in case.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The Iran war is a drug shipping fiasco

The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world.

To be clear, it’s not that the Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not. It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States.

For reference, this is a region whose “pharmaceutical industry is worth $23.7 billion,” but where roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through.

And right now both ways these medicines largely transit, the sea shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.”

Where will the shocks be felt first?

I reached out to one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains to ask.

Right now the biggest risk is cold-chain medicines, which he writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range; largely “between 2°C and 8°C,” 35-46°F.

Most cold-chain medicines move by air cargo, Yadav told me, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said.

When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”

Also at risk is helium supplies, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar.

Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).

Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area’s high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.

The good news is that, for now, "short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system.

I also asked Yadav whether the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think. “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” he said. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.)

But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.

But other cost implications are coming fast. A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.”

Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit.

A rare campus outbreak

The UK is facing an outbreak of meningococcal disease among university students in Kent, which is in England’s southeast. It has already killed two people, the BBC reports. The outbreak has drawn serious attention in British media, because while the disease is rare, it strikes with a fairly shocking speed and quickly becomes deadly.

Disease breakdown: Meningococcal disease is an illness caused by a bacteria called Neisseria meningitidis. It spreads through respiratory droplets, similar to Covid, and often starts with flu-like symptoms, followed by patients developing a distinct red and purple rash. It is largely preventable through vaccination, and can be treated with antibiotics, although it can leave survivors with permanent disabilities. Confusingly, outbreaks are sometimes referred to more broadly as “meningitis” in mass media, which is a condition that refers to the often-deadly inflammation of the tissues surrounding the brain and spinal cord.

A Scientific American report on the situation framed the outbreak as a reminder of why vaccination programs matter. William Schaffner, an infectious disease physician at Vanderbilt University Medical Center, told Scientific American that “this outbreak is a very unusual event,” and underscored “how routine, comprehensive vaccination has had a profound effect on really dramatically reducing the occurrence of what was once an extreme, ordinarily feared infection.”

Reading that, my immediate question was if the UK outbreak might portend something broader: like a smaller equivalent of the measles resurgence, where slipping vaccination coverage is allowing outbreaks to return?

Ultimately, that seems unlikely. The Kent outbreak was caused by a rarer strain of meningococcal disease known as strain B. While many children are routinely vaccinated against it, vaccine boosters for strain B are often offered only selectively in places like the UK and United States because cases are so uncommon. That means the gap that appears on college campuses is usually not missed shots but fading protection as immunity wanes over time.

I also reached out to Schaffner directly, who told me that “the outbreak in Kent does not portend similar outbreaks elsewhere.” He emphasized that the disease holds “very little risk to the general public for two reasons,” he said. First, because it needs close, repeated contact to spread. The illness spreads “most readily amongst semi-confined populations such as university students” who share classrooms, dorms, and nightlife, he said. (The epicenter of this spread is believed to have been a bar).

Second, containment is relatively straightforward. In Kent, “the public health response has been brisk and comprehensive,” he said, with health officials quickly giving antibiotics to people who may have been exposed.

Vaccine side effects (... good ones!)

A senior infectious disease reporter I follow, Helen Branswell, just published an interesting article in STAT News that sits somewhere between op-ed and straight news. She walks readers through vaccine by vaccine to explain a simple but often overlooked point: Immunization programs rarely benefit just one person against one pathogen.

Pure speculation on my part, but I’m imagining this story originated as a sort of professional self-care for a veteran health reporter. After watching the maddening vaccine debate circle the bowl of conspiracy-land too many times, maybe you just need to reset the conversation. Anyhow, I’m here for it!

I won’t walk through the whole list here, but three examples really jumped out to me:

Rubella vaccination in kids has essentially eliminated a once-devastating birth defect in mothers that left many babies “deaf, blind, or with developmental delays.”

The meningitis vaccine has helped decimate gonorrhea infections, with surprising studies suggesting the shot offers about a “30% to 40%” spillover protection against the sexually transmitted infection.

And Human Papillomavirus vaccination has turned into what one expert called “one of the most elegant herd immunity stories that we have” in public health, reducing several cancer rates broadly… even in men who were never the original targets of the vaccine program.

Argentina, out of the WHO

Argentina has finally made good on its year-old promise to withdraw from the World Health Organization, Al Jazeera reports. It is the second country to ever do so, after the United States. It may sound symbolic, but the move cuts off Argentina from the United Nations agency which (as we’ve covered extensively) “monitors health trends, tracks disease, promotes health care access, and trains medical providers.”

So why’d they do it?

Argentina’s President Javier Milei has framed the move as a matter of national “sovereignty,” criticizing the WHO’s “health advice during the Covid-19 pandemic,” and saying Argentina will pursue “international cooperation in health through bilateral agreements” instead.

Do those arguments sound familiar? They should, as both the criticisms and the shift toward bilateral deals echo the exact complaints and policies we’ve heard from the Trump administration. So, it’s clearly Argentina’s model.

Not to quibble, but it’s worth noting one key point: The WHO does not control countries’ health policies, and its Covid-19 recommendations were never strong-armed on Argentina. It is an advisory body. (Just ask Sweden, or Argentina’s neighbor Uruguay).

My takeaway? Ultimately, unless this move somehow triggers further exits, I’m not seeing it as a dramatic new fracture in global health cooperation. It’s another aftershock of far-right domestic politics that have been spilling into health policy since 2025.

Secret jungle medical school

Let’s finish this week with a remarkable story from The Guardian, which followed a group of nursing students in Myanmar who just graduated from a “secret jungle school” of medicine built during the country’s civil war.

The background: After the military coup in 2021 destroyed large parts of the public health system, an underground network of clinics emerged. This “parallel secret health system” surfaced to treat injured pro-democracy fighters and “those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.”

Eventually, the effort expanded beyond treating patients to training the next generation of nurses. One nursing teacher “contacted colleagues in the U.K., and together nurses in Myanmar and Britain arranged video masterclasses,” for a full curriculum.

All told, “dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum, and “the Phoenix Bachelor of Nursing Science” degree was born.

The article describes how lectures were “smuggled on memory sticks across the country,” and how the students completed their training under extraordinary conditions: like studying in remote classrooms while dodging drone surveillance and airstrikes. As one organizer put it, “safety is never guaranteed.” Another described bombs landing “right next to the classroom.”

It’s a powerful read, and the new graduates say the program represents something larger than medical training. “The name Phoenix itself is powerful for us. It symbolizes rising from the ashes of the destruction the coup has caused … We are the living proof that education and hope cannot be extinguished by violence.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How to win the war of narratives in global public health

2026-03-19T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we start with an incisive essay on how global public health might win back the narrative war around vaccines, trust, and misinformation. After that, well… let me just say that I really do try to take the “global” in global health seriously. I know that the United States is not the center of the world.

But several of the most important stories I’m tracking follow the health consequences of Trump administration policies playing out across Africa, the Caribbean, and Iran. So, buckle up for a red, white, and blue edition.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Global public health can win the narrative war

Measles is having a comeback. Vaccine skepticism is rising. And during the global pandemic, millions quickly turned against even basic public health protections. It’s pretty clear that somewhere along the way, public health started losing the narrative war.

The question is, how does the field fight back?

That’s the focus of a fascinating essay by Steve Hamill in Health Policy Watch, one which I haven’t been able to stop thinking about since I read it. Hamill is a senior marketing and comms executive at Vital Strategies, which is a nonprofit focused on global disease prevention.

Part of the problem, Hamill argues, is that for decades public health officials worldwide assumed that rational arguments, data, and scientific evidence would be enough to persuade the public. (And hey, for a time, it was!) But the era of institutional trust “dominated by elite opinion makers driving consensus” is over, he writes. And now, as we face a media landscape “driven by algorithms, influencers, and coordinated narrative warfare,” public health must take a new approach. And that includes borrowing several, highly effective tactics from public health’s worst detractors.

I reached out to Hamill about his essay, and we discussed what the field needs to do differently to win back trust and attention.

In our conversation, Hamill pointed to two realities about the modern media environment that ring especially true to me. One is that “we’re in an era of AI slop, where authenticity and trust in who the messenger is now matters even more than the message.” The other is that many persuadable people increasingly form their views about public health by “following culture, not evidence.”

Accepting those realities means recognizing that the battleground for public health is much less likely to be found in press conferences or government PSAs … and more likely to be found on TikTok, YouTube, or the broader “content creator sector.” And that, Hamill argues, is exactly where public health agencies need to start showing up.

Thankfully, Hamill says that engaging in this ecosystem is actually easier than ever. As advertisers have poured money into influencer marketing this decade, “the content creator sector has become much more formalized,” he says. Today, there are several platforms (like CreatorIQ, for example) that can connect public health agencies directly with a stable of appropriate influencers, at scale.

Now, you might ask: Will YouTubers deliver perfectly calibrated public health messages, the way officials might hope? Of course not. But Hamill argues that perfection isn’t the point. More important is that “we have to trust imperfect messengers who have social capital in the communities that we’re seeking to reach,” he says.

That gets to another of Hamill’s points: Public health organizations worldwide must begin staffing the experts and allocating the budgets needed to compete in this new media environment.

Specifically, that means staffing public health institutions worldwide with staff excelling in “public relations, community engagement, advertising and paid media, digital media production,” among other technical expertise, he says. For a field where “communications is rarely seen as a strategic competency,” that would be an enormous shift.

Hamill’s last point is that, offline, public health must stop broadcasting messages from the top down and start working through trusted voices inside communities. A major effort should be focused on “finding people in the communities that believe in the information that we are trying to propagate and working with them to give them the resources to bring that to scale within their community,” he says.

In many ways, this mirrors a key tactic of the MAHA movement: identifying communities that already share a concern and amplifying those voices until they dominate the conversation. The difference is that Hamill argues public health should use that same approach in service of accurate information and public good.

And crucially, he argues, these voices are in the majority. “There are more moms who are scared that their kids are going to go to school with unvaccinated people than there are moms who are scared that the vaccine is going to give their kid autism,” he says.

A battle over Cuban doctors

The Trump administration has been ratcheting up a pressure campaign on one of Cuba’s most valuable exports: doctors.

Guyana and Jamaica just announced that they will pull the Cuban doctors from their countries this year, the Miami Herald reports.

What’s the context here?

For decades, the Cuban government has sent hundreds of thousands of medical workers abroad through state-run medical missions. These programs have operated across the world but are particularly critical in parts of the neighboring Caribbean, where you can find Cuban clinicians staffing everything from hospitals to rural health clinics. Today, the program has more than 24,000 doctors working in 56 countries worldwide.

Why is the United States concerned about these doctors? Money.

Governments hosting Cuban medical missions typically pay Havana directly, with the Cuban state then passing along only a portion of the salary to the doctors. While the Trump administration is framing the issue partly about “labor exploitation” of the doctors, most observers see the campaign as an attempt to squeeze one of the (financially beleaguered) Cuban government’s most reliable sources of foreign currency.

Last year, the Trump administration began leaning hard on the foreign governments hosting Cuban doctors, threatening to cancel visas for anyone working with or supporting the Cuban programs, alongside other consequences. And the threats are working beyond just Jamaica and Guyana. Honduras also cancelled its program this year, and Guatemala has begun winding down its mission.

But the health care reality is brutal. As Al Jazeera reported last year:

“For many Caribbean nations, the short-term consequences could be devastating. Training local doctors takes years, and trained professionals often migrate to other countries, leaving behind a persistent shortage.”

That reality prompted unusually blunt pushback from Caribbean leaders. The prime minister of Barbados has called the U.S. pressure “unfair and unjustified,” and the prime minister of Saint Vincent and the Grenadines noted, “I will prefer to lose my visa than to have 60 poor and working people die.”

My takeaway?

The reporting suggests that this is a cold, geopolitical pressure campaign applied with little regard for the health care void it will create. (For example, the threats are not being paired with resources to replace those doctors.)

Two things can be true at once: Cuba’s medical missions may enrich a terrible government in Havana, while the Cuban doctors themselves provide lifesaving care to communities that will be worse off without them.

Black rain in Iran

New Scientist is reporting that recent strikes that set oil facilities ablaze near Iran’s capital, Tehran, have produced an unsettling phenomenon: black rain.

These “catastrophic scenes have raised concerns about threats to civilian health in Iran,” with “local people complain[ing] of their throats aching and their eyes burning.”

What exactly is black rain? It’s a byproduct of rain falling through heavily polluted air. Or, as Stanford University atmospheric scientist Mark Jacobson told me, it’s rain drops “filled with health-damaging, toxic air pollutants.” He says the drops themselves appear black because the concentration of “soot particles is so high in Tehran’s rain that no light penetrates” them, which is a sign of just how polluted the air above the city has become. (Keep in mind, this is a city with a population roughly equal to New York City’s.)

Ultimately, the toxic rain itself isn’t actually the biggest health worry for the city’s residents. As the article notes, “the biggest threat may be the smoke rather than the black rain.”

One researcher quoted in the article put it plainly: “If you get raindrops on your skin, yes, there will be some potentially carcinogenic compounds on your skin, but you can wash that off … but very fine smoke particles in the air can penetrate deep into the lungs and potentially get into the bloodstream.”

A flawed flu forecast

Two weeks ago, we talked about the strange annual ritual behind the flu shot. Which is how each year the World Health Organization tries to predict which flu strains will dominate in the upcoming winter, so that vaccine makers can aim for that educated guess.

Well, the Associated Press is reporting new data that shows that last year’s guess was … a bit of a flop.

U.S. health officials say the 2025 to 2026 flu vaccine was only about “25% to 30% effective” in preventing adults from getting sick enough that they needed to go see a doctor. All told, it was “one of its worst effectiveness rates in more than a decade.” For reference, “officials generally are pleased if a flu vaccine is 40% to 60% effective.”

What went wrong?

Oddly, this is actually a bit of good news. The culprit is exactly what we discussed two weeks ago: a fast-spreading branch of “the H3N2 flu strain,” which experts have already updated in next season’s vaccine. So, the problem has already been patched.

One final takeaway: It’s worth noting that even a mediocre flu shot still matters. In the United States, at least 101 children have died so far this flu season. Of the deaths where vaccination status was reported, about 85% weren’t vaccinated. That’s not a coincidence. As Vanderbilt University vaccine expert William Schaffner told the AP, that flu shot may not stop every infection, “but it can prevent people from becoming severely ill and dying.”

Health aid as a cudgel

Sorry folks, not ending on a happy note this week.

Two weeks ago, we covered the state of the Trump administration’ s new “America First” global health deals in Africa. I had spoken with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health, who, as I wrote back then, “warned about turning health aid into what is openly described by Washington as a transactional exchange.”

Well, this week the New York Times published a staggering example of what that approach could look like in practice, in Zambia.

According to a draft State Department memo obtained by the paper, U.S. officials are considering withholding HIV assistance to Zambia unless the country expands access for American companies to its mineral sector. (For reference: Zambia is one of the countries most affected by HIV in Africa, with about 1.3 million people relying on daily treatment supported by the United States’ PEPFAR program.)

Here are two quotes from the memo (prepared for Secretary of State Marco Rubio) that really illuminate just how the officials view lifesaving HIV medicines as a raw, political cudgel.

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale” … “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy.”

My takeaway? When we spoke with Spiegel, we talked about why transactional aid deals make for fragile and ineffective public health policy. That’s still true. But beyond the practical consequences for individual programs, he also made a broader point about what we lose when we treat lifesaving programs as bargaining chips: the trust and goodwill that once made global health “one of America’s most powerful forms of soft power,” he said.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How new weight-loss drugs may offer hope for curbing addiction

2026-03-12T11:00:00+00:00

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Hello from Nairobi.

Last week was an interesting one for me, as I had the chance to moderate a panel hosted by the French Chamber of Commerce here in Nairobi. I focused on a question I’ve been circling in my reporting for months: As global health aid retreats, who fills the gap? The panel included development experts and health care businesses, all wrestling with how and where the private sector can realistically step in.

On to the news: This week we take a look at an unexpected (and unexplained) benefit of GLP-1 weight-loss drugs, a reality check on artificial intelligence tools hunting down antibiotics, and a few other stories on social media bans, the Iran war, and … a drug trial for turkeys?

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A shot at fighting addiction

It’s hard to overstate how much GLP-1 drugs like Ozempic have upended weight-loss treatment and sparked an ongoing pharmaceutical gold rush.

Drugmakers are racing to develop ever newer versions of the drugs, and regulators around the world are approving them at an equally rapid clip. (China, for example, just cleared Pfizer’s newest injection Xianweiying last week.) But their explosive popularity aside, what I find most striking about this moment is just how little we actually understand about the ways these drugs affect our bodies and brains.

Take, for example, results from a new study of health records from more than 600,000 patients in the United States. As reported by the Associated Press, patients taking these GLP-1 drugs showed something remarkable and seemingly unrelated to weight loss: lower rates of substance use disorders.

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. In general, they influence the body’s hunger and digestion signals, though researchers are still working to understand exactly how these effects unfold in the brain and body. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

The study found that those on the drugs were less likely to develop addictions “to alcohol, nicotine, cocaine, opioids, and other substances” as compared to patients on other diabetes medications. And for patients already struggling with addiction, the drugs were also “linked to lower risks of [addiction-related] hospitalization, overdose, and death.”

What is going on here? Why would a drug designed to control blood sugar and appetite also seem to affect cravings for alcohol, nicotine, or other drugs? To find out, I reached out to two addiction science researchers not involved in the new study to help me parse the connection.

First, the idea that these drugs might affect addiction did not appear overnight, Dr. Joseph Schacht, an addiction scientist at the University of Colorado told me. Animal studies going back to last decade have found that drugs in this class can reduce alcohol consumption. And as millions of people began taking the drugs this decade, similar reports kept surfacing with doctors. “I became interested in this area when a medical colleague told me that some of her patients [taking GLP-1 drugs] for weight loss had reported they found themselves drinking less alcohol and experiencing less craving for it,” he said.

Still, scientists don’t fully understand the basic biology behind “exactly how these drugs affect the brain’s reward pathways,” he said. What we do know is that the brain contains specific docking points for GLP-1 molecules in several regions involved in motivation and craving. “It is possible that GLP-1 [drugs] cross the blood-brain barrier and bind directly,” to those sites, he said. But that’s not actually been proven yet. Another possibility, he said, is that the drugs act elsewhere in the body and send some other signals that ultimately influence how the brain processes cravings. We simply don’t know yet!

I also reached out to Dr. Anna Lembke, an addiction medicine specialist at Stanford University, who said the research raises the possibility of new, preventative therapies.

After all, if these drugs truly quiet the brain signals tied to craving, they might reduce the risk of the disorder developing in the first place. “But lots of questions remain, including whether short- and long-term benefits outweigh the risks, especially when you’re thinking about giving the drug to people who don’t yet have a disorder,” she said.

Still, “addiction is a massive and growing problem across the globe. We need more tools to help combat it. The GLP-1s hold promise for a novel strategy to combat addiction, and we need all the help we can get,” she said.

AI: An antibiotic breakthrough … or dead end?

One issue I keep returning to is a coming crisis in antibiotic resistance: Essentially, existing antibiotics are failing faster than scientists are discovering new ones.

This is both a “today” and “tomorrow” problem. Already, antibiotic resistance is linked to roughly 5 million deaths a year worldwide as routine infections become harder to treat. And if nothing changes, we will eventually reach a failure point where we no longer stop many common infections … with enormous implications for everything from cancer therapies to simple surgeries.

Now, as we’ve covered before, there are reasons to be optimistic. A big one is artificial intelligence, which is speeding up the earliest stages of antibiotic discovery, as covered in a new essay in STAT News. The authors, an antimicrobial researcher and a drug developer, cite a study from last October in which AI tools discovered “hundreds of [new] molecules with promising anti-bacterial activity.”

That said, this essay is not one of optimism.

As the authors write, even as these early leaps in AI dramatically improve new antibiotic discovery, the economic incentives for actually developing them remain heartbreakingly weak. Put simply: “The antibiotic market does not reward innovation — it often punishes it.”

Why? Because the way we use antibiotics makes it extremely difficult for companies to recoup the enormous costs of clinical trials and later-stage development.

Consider that antibiotics are meant to cure infections over a matter of days instead of, say, lucratively managing a chronic disease for years. And because doctors want to slow resistance, the newest drugs are often used sparingly and held in reserve. It’s “a practice known as stewardship”, which “benefits future patients but crushes commercial prospects. Even a truly novel, lifesaving antibiotic will be used sparingly, priced modestly, and ultimately displaced by generics.”

What’s the takeaway? If “no amount of algorithmic brilliance or predictive learning can overcome a business model that guarantees financial failure downstream … only policymakers are empowered to remedy what ails antibiotic R&D,” the authors argue.

They propose a few solutions, including “subscription-style reimbursement models, in which governments pay for access rather than volume,” or lump-sum government payments “that provide predictable returns for truly innovative antibiotics.”

The alternate solution, they say, is watching helplessly as “world-class laboratories … keep generating promising AI-sourced discoveries that end up in the dustbin of academia.”

Two conflicts with hospitals under fire

We have a few updates on two not-so separate crises, in Iran and Gaza.

First, the World Health Organization says at least 13 hospitals and health facilities in Iran have been hit since the U.S. and Israeli bombing campaign began, The Guardian reports. While the WHO has not provided many details (nor attributed blame), Director-General Tedros Ghebreyesus has gone on record to say that “under international humanitarian law, health care must be protected and not attacked.”

Meanwhile, in Israeli-occupied Gaza, Reuters is reporting that “medical supplies [are] running critically low despite Israel’s reopening of a key crossing.” How low? “Supplies of some items such as gauze and needles have already run out,” and “fuel shortages continue to limit hospital operations.” Hospitals without needles and gauze? It’s a fairly condemnable state of affairs, especially considering that there has been a ceasefire for two months now.

What’s the connection? As Reuters is also reporting, “key humanitarian air, sea, and land routes are being constricted ‌by disruption from the [Iran war], delaying life-saving shipments to some of the world’s worst crises,” which includes Gaza. As the report puts, quite pointedly: “Aid to Gaza and Sudan is grinding to a halt and costs are soaring for help to the hundreds of millions suffering hunger crises around the world.” And that we should expect care to get even worse.

The takeaway? Honestly, I’m worried. If the past two years in Gaza have shown anything, it is that the Israeli and American-backed bombing campaign displayed a total disregard for humanitarian protections around hospitals and medical infrastructure.

That record should make the world prepared for the possibility of a similar humanitarian crisis unfolding in Iran’s health care system, if this war escalates.

Share, like, and subscribe to social media bans?

India’s state of Karnataka has become the latest government to move against youth social media use. It just announced a ban on social media platforms for children under 16, Reuters reports. (The tech-hub state is home to 61 million people and the capital city of Bengaluru, widely known as the “Silicon Valley of India.”)

The policy follows similar efforts across the world: Australia recently approved a nationwide social media ban for under-16s, and several European and U.S. jurisdictions are likewise debating or testing age restrictions.

What does the most up-to-date research actually say about the effects of limiting social media? Well, let’s look at two separate ways researchers combine results across lots of studies. (Fair warning: We’re about to go full data-nerd.)

We can start with an “umbrella review” of youth social-media research from 2025, organized by researchers in Canada, Ghana, and Ireland. (An umbrella review is basically a review of reviews, looking across dozens of previous research summaries to see what the field as a whole is finding.) In this case, they looked at 43 reviews that covered over 1,000 papers.

What did they find? Broadly, higher social media use among adolescents is linked with worse mental health outcomes, particularly on depression, anxiety, and other “psychological distress.” But the picture is complex. The harms appear strongest with heavy or “problematic” use (like passive scrolling or addictive behavior), and some studies found clear benefits for teens, including social support and reduced isolation.

It’s also worth looking at a recent “meta-analysis,” which is when researchers pull out data from many separate papers, and then crunch it all together. In a 2025 meta-analysis, Australian researchers combined 10 randomized controlled trials to understand what really happens when people (adolescents and adults) reduce or stop using social media.

The results? They found that people who cut back on social media have a small but statistically significant drop in depressive symptoms. The effect was modest, but research shows that limiting social media use can improve mental health … but reduction in use was about as effective as total abstinence.

(Honestly, together it’s less of a slam dunk case against social media than I would have thought!)

Turkeys on trial

We’ll end this week with a funky story. Scientists in the UK have launched what is essentially one of the world’s first clinical trials on turkeys, the BBC reports.

Researchers will vaccinate thousands of turkeys and monitor them for about six months, in an effort to see whether a new bird-flu vaccine can safely protect the poultry from the virus.

It’s big news for birds, but don’t just take it from me. Here’s an incredible quote from Mark Gorton, the founder of Traditional Norfolk Poultry, which is leading the trial:

“This is probably one of the biggest days in my poultry life and I think this is one step for poultry but one giant step for poultry kind."

So … why turkeys?

Well, chickens are already vaccinated against bird flu in many parts of the world, and France has been vaccinating ducks for several years. But British researchers chose turkeys for this study because they are particularly susceptible to the disease. In other words, if a vaccine can protect a turkey, it’s a pretty good sign it could work for other poultry, too.

And there’s significant money on the line. “Annual bird flu outbreaks cost the UK government and industry up to £174m each year,” or about $230 million. And as Gorton told the BBC, “it could be a huge economic cost to [turkey farmers] if we catch this disease and we have to have all of our birds culled.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

‘Maximum disruption, minimal clarity’: How ‘America First’ aid deals are playing out in Africa

2026-03-05T12:00:00+00:00

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Hello from Nairobi.

We’ve begun the long rainy season here (we get two each year), which means three months of brisk mornings and muddy shoes. Unfortunately, an influx of mosquitoes will soon follow. But this city sits at a higher elevation than Denver, Colorado, so the malaria risk is extremely low. (It’s too cool for the parasite to reliably develop inside mosquitoes!)

Today we’ve got a hodgepodge of news: from the fragile state of America’s new health deals in Africa, to a one-pill breakthrough, and the latest chapter in the story of the woman whose cells changed medicine. We’ll close with a story whose comedic headline left me no choice but to include it.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

America’s health pivot, finally coming into focus

First up: The United States and the Democratic Republic of the Congo “signed a $1.2 billion health partnership” on Feb. 26, the Associated Press reports.

While the full text of the agreement is not public, it’s noteworthy because this is the 19th one-on-one health agreement the United States has signed directly with an African government since dismantling the U.S. Agency for International Development last year.

It also follows news from last week, with Zimbabwe and Zambia backing away from similar deals.

Some background: Generally speaking, these country-by-country agreements are meant to move U.S. health funding away from non-profit aid organizations and United Nations agencies, and into an “America First” framework of direct partnerships with national governments. While these deals represent a dramatic cut in funding from previous years (at least 25%, but potentially more, depending on how many countries end up without deals), the United States nevertheless remains the largest global health donor on paper.

I covered the first of these deals with Kenya back in December (which is still mired in a legal dispute about the data-sharing demands imposed by Washington). But I’ve largely held off on covering the rest.

Why? Because it’s so early and the implementation has been so chaotic that even my sources inside the State Department struggle to explain how these agreements will (or are) functioning in practice.

Thankfully, I was able to speak with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health for some much needed context. Few people have a clearer view of how global health systems are actually working in today’s crisis settings, and we discussed what he’s seeing and how to make sense of these deals so far.

I started by asking Spiegel frankly: Are these 19 deals a sign of stabilization from the chaos of 2025? While he acknowledged some upsides (which we’ll get to) his overall assessment of the deals, and the year ahead of us, was grim. “No. I think things are going to get a lot worse before they get better,” he said.

Spiegel described “maximum disruption right now with minimal clarity,” and that reality on the ground for lifesaving aid programs is still chaotic, with supply chains disrupted and local partners unsure whether funding will continue month to month. He blames the rushed transition “from the old architecture to something so new, so quickly,” he said. “In the meantime, so many people are going to die and suffer.”

We also zeroed in on what worries us both most. The new U.S. strategy is publicly built around channeling major funding directly to governments that (at best!) lack robust oversight and, in some cases, rank among the worst globally on corruption. And the admittedly cumbersome bureaucracy that once helped curb fraud, waste, and abuse has been functionally stripped of many of its guardrails. (That said, let me acknowledge that it’s difficult to judge the concrete risks, because so few of the agreements’ terms have been made public.)

Spiegel also warned about turning health aid into what is openly described by Washington as a transactional exchange. Beyond the moral argument that “humanitarian assistance should follow need and evidence,” Spiegel said there is a hard practical reality. These programs take years to build, and when funding becomes contingent on unrelated political demands or can be withdrawn overnight, systems unravel quickly. As we’re seeing now, the human cost is immediate, and rebuilding takes years.

What are the upsides? Spiegel acknowledged a “kernel of truth” behind the new strategy, which requires both parties to pony up funds. For years, he said, donors failed to ensure governments built the capacity to manage their own systems. Requiring countries to put in more of their own money is “hugely necessary.”

This is (no longer) spinal tap

Europe has approved a new and simple oral medicine that may finally help win the fight against sleeping sickness, the AP reports.

Disease breakdown: Human “trypanosomiasis” is a highly fatal parasitic disease that’s spread by blood-sucking tsetse flies. Symptoms start flu-like, but as the parasites multiply and attack the nervous system, victims often find their sleep-wake cycle flipped (hence the illness’ common name). Without medicines, coma and death usually follow. Thankfully, treatments developed in the early 2000s slashed infections from many tens of thousands a year to today, where fewer than 600 cases are reported annually.

The new, single-dose pill is called acoziborole. To understand why it could be a game changer, it helps to understand two things: Why we don’t just have a vaccine, and the limits of the treatments we’ve relied on for two decades.

First, the worm-like sleeping sickness parasite has long evaded vaccine efforts thanks to its tricky and unique ability to alter the makeup of its “skin” (technically, its outer protein layer). This shapeshifting both helps the parasite stay ahead of immune defenses, and creates a frustrating, moving target for a hypothetical vaccine.

Second, current treatments for the illness are burdensome. They “can take 10 days,” and “require difficult trips to hospitals from remote villages,” with many patients needing to “undergo spinal taps to help doctors understand the stage of infections,” and which drugs to treat them with.

Keep in mind, many of the people affected by this illness live in incredibly rural or remote areas in equatorial Africa. So, when your nearest hospital is a 10-hour drive away, and may not even have the diagnostics you need … you can see the issue.

The new pill (technically three medicines compounded together) obviates spinal taps, and is highly effective against the disease at a range of stages. The most recent study found that “95% of treated patients were considered cured 18 months later.”

Granted, one powerful drug is not enough on its own to meet the WHO’s elimination goal for the disease of 2030. Ending sleeping sickness also means continuing to find new cases quickly, reducing the number of infected tsetse flies, and stopping the disease from spreading again through animals.

Still, the pill may be the breakthrough needed to make that deadline.

The immortal settlement(s) of Henrietta Lacks

In 1951, doctors at Johns Hopkins Hospital took cancer cells from Henrietta Lacks, a young Black woman in Baltimore, Maryland. They were taken without her knowledge or consent, and she would die months later.

Those cells, dubbed HeLa (for her name), became the first human cells to be grown indefinitely in a lab. It is a fascinating story, one detailed in Rebecca Skloot’s best-selling book The Immortal Life of Henrietta Lacks. Which, if you have not read it yet, this is your reminder.

Lacks’ cells helped unlock the polio vaccine, advance cancer therapies, and grounded decades of other biomedical research. (There’s an obvious benefit to having a standard set of cells you can use to compare or replicate work in various labs worldwide.) And they are still used today: I actually have a personal friend in the UK whose cancer research right now is entirely underpinned by this woman’s cells.

Why is this relevant today? Some 75 years later, Novartis, the Swiss multinational pharmaceutical company, has settled a lawsuit brought by her estate over the use of those cells, the AP reports.

The terms of the settlement were not disclosed. But the case is part of a broader reckoning over who profits from the scientific discoveries that followed Lacks’ death. While “Johns Hopkins said it never sold or profited from the cell lines … many companies have patented ways of using them,” including Novartis.

The settlement follows another “in 2023, [when] Lacks’ estate reached an undisclosed settlement with the biotechnology company Thermo Fisher Scientific Inc.” And the AP reports that “there are other pending lawsuits by the Lacks estate.”

The flu vaccine’s own annual booster

Every year, the World Health Organization convenes a panel of flu experts to make a high-stakes prediction: which versions of the virus are most likely to dominate next winter. Once the experts make their call, vaccine makers lock in that recipe and get to work.

But … it’s a strange ritual when you think about it. We do not rewrite most vaccines annually.

That’s because unlike most viruses, flu evolves gradually *and* abruptly. Flu doesn’t just slowly accumulate small mutations as it spreads. It can also trade whole chunks of its genetic material when two different strains infect the same person, creating entirely new combinations almost overnight.

That brings us to the news: Last week, the expert panel updated the recipe for the Northern Hemisphere’s 2026 to 2027 flu shots, Health Policy Watch reports. And it’s a fuller reset than usual. (Although like last year, the panel is recommending three different flu variants targeted in each shot.)

The biggest shift is in one of the three targets from last year, the H3N2 strain, where a newer genetic branch has taken over globally. As I’ve covered previously, in these strains, the “H and N numbers refer to the shape of two important proteins on the outside of the virus.” Hemagglutinin, or “H,” helps the virus latch onto cells. Neuraminidase, or “N,” helps it break free and spread.

It’s news worth noting for two reasons. One, “there are around a billion cases of seasonal influenza annually,” so hitting or missing the mark on the vaccine, while a (let’s be honest) boring bureaucratic process, could prevent millions of cases or fail to address tens of thousands of deaths. That is not small stakes.

Second, it’s a reminder of something important. No matter where you live, the flu will touch you, your family, or your workplace this year. And experts are clear: Vaccination remains a safe and effective way to blunt the damage.

I applaud you, headline writers

Ok, ok. Please allow me to end on a story whose incredible headline alone forced its way into this report.

It is: “Chimp urine test study bolsters ‘drunken monkey’ theory,” Reuters reports.

(Right? How could I not include it!?)

What’s the story? Actually, something rather fascinating. Researchers studying wild chimpanzees in Uganda’s Kibale National Park have found evidence supporting the so-called “drunken monkey” hypothesis: the idea that primates, including early human ancestors, may have evolved a taste for alcohol because it helped them find calorie-rich ripe fruit.

In tests of 20 urine samples from chimps, collected from puddles on the forest floor, nearly all contained a metabolic marker of ethanol. This is a compound that both chimps and humans produce after drinking alcohol. Some of the ethanol levels were roughly equivalent to having thrown back a few beers, or a single cocktail.

Narrowly, the findings suggest that at least some chimps, our closest primate relatives, regularly consume naturally fermented fruit and metabolize the alcohol in it. More broadly, the study adds support to the speculation that our attraction to booze may precede the human inventions of beer, wine, cider, or spirits.

What’s my takeaway? Ultimately, this story is not just about tipsy chimps. It is about why we are drawn to alcohol in the first place, and how deep that relationship runs in our evolutionary wiring. I brew and adore craft beer (and have no plans on stopping), but we know that alcohol use and abuse today drives millions of deaths annually, from liver disease to injuries to cancer. Understanding whether our attraction is cultural, biological, or both is not just trivia.

But also… tipsy chimps!

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How milder winters are luring mosquitoes – and the diseases they carry – beyond the ‘tropics’

2026-02-26T12:00:00+00:00

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Hello from Nairobi.

This week’s news is heavy on drug trials and some groundbreaking scientific research – two subjects I try to cover cautiously, because scientists, research institutions, and others have incentives to hype early findings. Anyhow, in global health terms, it is a good issue to be grappling with. It means there wasn’t some new outbreak I had to research.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Mainland Europe: a mosquito’s tropical getaway?

There’s a whole rogues gallery of tropical, mosquito-borne diseases that have long been relegated to the warmer and poorer parts of the world. For example: malaria, dengue, Zika, and chikungunya virus.

But global warming and roving mosquitos are rapidly blowing up the traditional boundaries of what counts as “tropical.” A new study in the journal Royal Society Interface finds that many of these diseases can now be transmitted by mosquitoes across most of southern and central Europe, The Guardian reports.

To be clear, the study isn’t just a speculative forecast. For some of these diseases, the shift has already happened.

Take chikungunya. “Up until last year, France had recorded 30-odd cases of chikungunya over the last 10 years or so. [In 2025], they had over 800,” said Steven White, one of the scientists at the UK Centre for Ecology and Hydrology that was behind the new study.

Disease breakdown: Chikungunya (a particular focus of the new study) is a virus first identified in Tanzania in the 1950s. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

One of the study’s most unsettling findings for chikungunya was that the virus can incubate inside the increasingly invasive Asian tiger mosquito at much lower temperatures than previously believed. Specifically, “the study found the cut-off temperature for transmission is 13 degrees C - 14 degrees C,” or about 55 to 57 degrees F.

That dramatically expands the map of where outbreaks are possible, “meaning infections can occur for more than six months of the year in Spain, Portugal, Italy, and Greece, and for three to five months of the year in Belgium, France, Germany, Switzerland, and a dozen other European countries.”

What’s the takeaway?

First, it’s increasingly hard to see the northern spread of these tropical diseases (across North America, too) as anything but inevitable. As winters grow milder and warm seasons stretch longer, the conditions that allow these viruses to circulate are expanding … and exponentially!

I reached out to Flavia Riccardo, an independent infectious diseases researcher at the Italian National Institute of Health. She shared a recent study she co-authored that adds an important nuance. For now, the main risk is not these viruses becoming permanently established in Europe. It is infected travelers bringing them in during mosquito season, and triggering local outbreaks that can flare out of control.

My second takeaway is this: If there’s a morbid upside, it may be that once these diseases begin affecting wealthier countries, they could finally attract the sustained research funding and political urgency they need.

Guinea-Bissau stomps out a controversial vaccine trial

Last week, I mentioned in passing that World Health Organization Director-General Tedros Ghebreyesus publicly condemned a controversial U.S.-funded vaccine study on infants in the West African nation of Guinea-Bissau. Now, the country has shut it down, Reuters reports.

Guinea-Bissau’s foreign minister ultimately said, “It’s not going to happen, period,” after scientists, health bodies, and U.S. lawmakers raised alarms.

The trial, backed by the U.S. Centers for Disease Control and Prevention, would have tested the timing of the hepatitis B vaccine in newborns. Some “critics had said it was being used to test theories linking vaccines to autism,” and others (including the WHO chief) decried it as unethical because only half of infants would receive the life-saving shot at birth.

The threat here is clear: “90% of babies exposed to hepatitis B at birth or in their first year of life develop a chronic infection, and 15% to 25% of these die early of related liver failure or cancer as a result.”

To be perfectly fair to the researchers, “under the [proposed] trial, half the infants would receive [the vaccine] at birth,” and “the remainder at 6 weeks,” which is when infants normally receive the vaccine in the formal health care system in Guinea-Bissau. So the researchers hadn’t planned on taking anything away from vulnerable infants. The African nation “plans to introduce the dose at birth only in 2028.”

Still, at 6 weeks, “many infants whose mothers have hepatitis B are already infected,” and as I wrote last week: It is just hard to imagine a similar trial within the United States surviving legal/ethical challenges.

Magic mushrooms go mainstream

Magic mushrooms are having a bit of a clinical moment.

Compass Pathways, a British pharmaceutical company, announced that its synthetic psilocybin (which is the psychoactive chemical found in magic mushrooms) treatment hit its “major goals” in a large, late-stage trial for hard-to-treat depression, Reuters reports.

The report says that the company now plans to meet with the U.S. Food and Drug Administration and could seek approval for the treatment as early as 2027. (Keep in mind, this would be the first approved psychedelic therapy cleared in the United States.)

What’s my takeaway? Before we all start penciling psychedelics into the next generation of antidepressants, I’d strongly recommend reading this thoughtful essay published in STAT last week.

Erica Rex, a writer who participated in an early magic mushroom trial, warns that the rush to commercialize psychedelics is stripping away the therapy, community, and careful supervision that made those early studies feel safe and transformative. She argues that the drug alone is not the treatment. And profit incentives may directly clash with the slow, human elements that made psychedelic therapy work for her.

A ‘clock’ for Alzheimer’s symptoms

A new study published in the research journal Nature Medicine suggests we may soon be able to do something Alzheimer’s researchers have long dreamed of: Detect Alzheimer’s disease early and estimate when symptoms will begin, the Washington Post reports.

The study describes how to use blood draws to “build a ‘clock’ for Alzheimer’s disease that could roughly predict when symptoms will develop.” The core of the work revolves around tracking the levels of “one specific protein, called p-tau217,” in the blood.

This protein is important, because it is a hallmark sign that Alzheimer’s has started. More specifically, it shows that “clumps of misfolded proteins called amyloid plaques [have] begun to build up in the brain.”

Now just measuring that protein in blood draws isn’t enough on its own.

The bloodwork data has to be fed into a computer model that contains information about the patient, such as their age, which is then used to “forecast symptom onset within a margin of three to four years.”

So, yeah… it’s a wide error range. And practically speaking, this kind of prediction isn’t precise enough yet to guide individual treatment decisions.

But (and here’s the important part!) it could matter enormously for the potential, future use of novel drugs. That’s because two big Alzheimer’s studies underway are testing if newly developed “anti-amyloid” drugs can slow or prevent the disease if they’re given early enough.

If those drugs truly work best early, then knowing when “early” begins would be incredibly important.

The quest for a universal vaccine

I want to tread very, very carefully here. This next story is genuinely fascinating, but I’ve covered enough “breakthroughs” to know how easy it is to get carried away. The bigger the claim, the more skepticism we should hold.

The journal Science has just published a paper describing a provocative new approach to developing a “universal vaccine,” the BBC reports. That is, a vaccine that doesn’t just target one virus, but puts the entire immune system on high alert against many.

The paper is not theoretical. Stanford University scientists developed a nasal spray vaccine that they tested on mice against infections that attack the lungs. The end result was a “three-month effect” in which the mice’s immune systems were in a “heightened state of readiness” that “led to a 100- to -1,000-fold reduction in viruses getting through the lungs and into the body.”

This included effective immunity against a medley of cold and flu viruses, among other would-be invaders.

That is big news! So what’s the actual science here? To understand it, it helps to step back and look at what traditional vaccines are actually designed to do.

Traditional vaccines all use different strategies to teach the immune system to recognize a specific virus or bacteria. This is done by either by exposing the body to a weakened, dead, or fragmented germ … or by delivering instructions for the body to make a harmless piece of it (this last one is the new mRNA method, developed during the Covid-19 pandemic.)

This even newer approach is totally different. Instead of teaching the immune system to identify attackers, the vaccine artificially mimics the signals “immune cells [use to] communicate with each other” in the midst of an infection. Normally, when an infection begins, immune cells send out chemical signals that trigger a system-wide defensive response. And when on high alert, immune cells become more active and better able to contain invading viruses or bacteria.

This vaccine recreated that early alarm. It did this by introducing a molecule that flips the sensors inside some immune cells, pushing them into that heightened state of readiness.

Yes, it absolutely does sound like an incredible breakthrough. So … let’s move on to my beloved caveats.

First: This has not been tested in humans. It worked on mice, which is not nothing, but many, many fascinating mouse studies have failed to translate into people.

Second: The researchers now have to run the clinical trial gauntlet. That starts with Phase 1 trial to test safety, Phase 2 to figure out dosing and immune response, and Phase 3 to see whether it actually works in large numbers of people. Historically, only about 10% of drugs that start these trials end as an approved drug. Most are found to be unsafe or ineffective. Even at Phase 3, roughly half still fail.

Still, it’s promising.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

AI therapy can help in countries with scarce care, but experts urge regulation

2026-02-19T12:00:00+00:00

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Hello from Nairobi.

This week we’ve got interesting news about AI therapy, new gene-editing medicines, and other topics … but before that, I have to mention that TIME magazine just published its 100 most influential people in global health. It’s great for a laugh!

The list includes Chris Hemsworth, for being exceptionally good looking while talking about Alzheimer’s, and some very stilted wordsmithing around Robert F. Kennedy Jr., who is labeled a “Titan of Health.” Conspicuously absent are any of the heroes who responded to last year’s Ebola outbreak. But hey, there’s always next year.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Your therapist, ChatGPT

The Guardian just published a fascinating article on the global use of artificial intelligence chatbots as therapy tools, featuring vignettes from Nigeria.

As the story states, “AI platforms offering first-line mental health support have proliferated over the past year.” And for Nigeria in particular, there is an obvious appeal in easing access to mental health care in a country with just “262 psychiatrists for 240 million people” (!).

The article starts with a very compelling story about a woman named Joy Adeboye in the capital, Abuja, who turns to an AI chatbot out of desperation and need. The result? “For the first time in months, Adeboye says, she felt less alone.”

Still, in most countries regulation on this use of AI is basically nonexistent, and that makes several basic, open questions all the more pertinent: Do these tools actually work as therapy, are they safe, and should they be trusted with vulnerable people?

I reached out to Briana Vecchione, a researcher who studies this topic at the Data & Society Research Institute, a nonprofit focused on social implications of automation and AI. Vecchione provided some striking insight on both the history of chatbots for therapy (which, surprisingly, dates back to the 1960s), and how to think about the tension between potential harm and help.

We covered much more than I can fit here, but luckily for you, she’s moderating a talk on this very topic on Feb. 26.

On how or if these tools actually work: Vecchione was careful to balance where the research stands (outside of a few narrow contexts, “I don’t believe chatbots are as effective as talk therapy,” she said) with what many users report their lived experience to be. “We have definitely seen that people feel some sort of relief after using these systems,” she said.

“But you need to really be careful about what forms of other care you’re displacing,” and ultimately, she says, “I do not think it’s a replacement for therapy."

When it comes to potential harms, she points to the incentive structures of many of the companies making these AI systems. “These [tools] are typically optimized for engagement. They’re not typically optimized for helping you close the loop and step away, which is actually bad for the companies. They want you to come back,” she said. In Vecchione’s research, she hears users frequently say they “feel unsure when to stop,” or at worse, “feel overly dependent on these systems,” and feel significant shame about that dependence.

Another potential harm is privacy, which I acknowledged to Vecchione I’ve always thought of as an abstract or general concern. But Vecchione points out that the risk here is extremely acute. “These things have no fiduciary duty in the same way that therapists do. They are not protected by HIPAA,” the U.S. Health Insurance Portability and Accountability Act, which protects a patient’s sensitive information, or patient confidentiality, she said. This means that in many countries (the United States included) there is nothing stopping an AI therapy tool from immediately selling your data to a prospective health insurer.

Still, with the prospect of AI therapy filling what would otherwise be an incredible void in many developing countries, Vecchione is clear that “these kinds of supplements to care can be useful,” she said. “Is it better than nothing? Maybe, if it’s being used responsibly.”

What’s the takeaway? At least in the United States, Vecchione and her colleagues have authored a detailed public comment to the U.S. Food and Drug Administration on their recommendations for the future of these technologies. They argue that relevant AI systems should fall within the FDA’s “medical-device” definition for mental health, should be treated as such, and regulated as such.

Diet, exercise, and… gene editing?

We cover a lot of tropical diseases on the Checkup. But zoom out to the global picture, and the biggest threat to health is far less exotic. Heart disease remains the top killer.

As a disease, it’s a bit of a catch-all. A range of factors like high blood pressure, diet, and smoking can damage the heart in different ways. But all told, the major risk for heart disease lies in high LDL cholesterol, which is made by your liver. With too much of this waxy fat, it can build up in blood vessels and block blood flow.

But in what feels like a glimpse of science fiction, clinicians are increasingly experimenting with new gene-editing techniques to reduce LDL cholesterol production, the AP reports. These trials are early, but are showing shocking improvements in patients who did not respond to regular medicines.

How does it work? Basically, a patient is injected with an IV of microscopic fat bubbles, which the liver naturally absorbs from the bloodstream. The trick is that these bubbles are carrying a clever DNA-cutting protein (part of the gene-editing tool CRISPR) along with a short RNA “instruction” that tells it exactly what piece of DNA to cut out.

The clinicians are specifically targeting a gene called ANGPTL3 to edit away, and only in specific cases. In some people this gene goes haywire, and causes an overproduction of “LDL cholesterol and another bad fat, triglycerides.”

It’s a one-time therapy, because when the edited liver cells reproduce … the deleted gene can’t carry onward. These are of course early trials, and the article does a great job couching the caveats.

There are major safety questions to be answered, cautioned Dr. Joseph Wu of Stanford University, who wasn’t involved in either study. CRISPR-based therapies for any disease haven’t been used enough to know long-term safety — and the particles carrying the gene-editing tool can irritate or inflame the liver, he said. Another unknown is whether gene-editing hits only the intended target. That’s why for now, studies largely target people at very high risk.

The who’s who of the next WHO

The World Health Organization director-general’s term does not expire until August 2027, but the race to succeed Tedros Ghebreyesus is already heating up. Nominations formally open in April, and Health Policy Watch is tracking the top contenders circulating in the “rumor mill.”

These include would-bes from the reform-minded Budi Gunadi Sadikin, Indonesia’s minister of health, all the way to Sania Nishtar, the CEO of Gavi.

I’ll be honest, seeing this much speculation so early is a little funny. (The article has some strong “The Bachelor” season premiere vibes.) Still, this is a five-year term that often turns into 10, and is the most important job in global health. So, if we’re being fair, the early speculation is more a la papal conclave than reality TV.

Jokes aside, the job earnestly matters more now than ever. Even beyond the global funding shortfall, the article paints a rough picture of the current state of affairs inside the WHO:

“Internally, the organization is struggling with a 25% cut in staff following the loss of United States support, leading to a low in staff morale. The layoffs, a lack of transparency, sexual abuse scandals, and a fear of retaliation among staff who have raised claims of harassment and damaged trust in the organization’s leadership.”

The real question is, who can right the ship? We will see.

(One last note on the incumbent: It’s too early to assess Ghebreyesus’ tenure. He will be remembered for steering the WHO through Covid and the 2025 wave of austerity. How well did he do? Hard to say. Still, credit where it is due. This week he publicly condemned a controversial U.S.-funded hepatitis drug trial involving newborns in Guinea-Bissau. It is hard to imagine a similar trial within the United States surviving legal/ethical challenges.)

A new polio vaccine

The WHO has cleared a new polio vaccine for global use, Reuters reports.

Disease breakdown: Polio, or poliomyelitis, is a gut virus that spreads largely through feces. While most infections pass without symptoms, the worst cases can wither limbs or invade the spinal cord to cause paralysis or death. Importantly, the disease can’t hide in animals, and vaccines stop it cold. Although polio is ancient enough to have been carved into Egyptian hieroglyphs, two strains of the virus were eliminated in 1999 and 2020, and only two more remain.

We covered this back in October. Despite a 30% cut to the effort, humanity is on the verge of eliminating this disease altogether. (That would make it only the second disease eradication, after smallpox in 1980.)

As I wrote then, “the last wild strain of the virus (still hanging on in Afghanistan and Pakistan) is now expected to be stopped by 2027,” and a second “strain of the virus that bubbled up from earlier vaccine drives, and which is largely pocketed across the African continent,” is on track for elimination by 2029.

What’s the focus of this new, oral drug? It targets that second variant, the vaccine-derived strain behind the African outbreaks. The key upgrade here is that this new vaccine is far more stable, so it’s less likely to mutate and accidentally seed new outbreaks while we work to stop existing ones.

And it can’t come fast enough.

Last week, Malawi launched a new campaign with about 1.7 million doses of the older oral vaccine, after the second variant showed up in sewage in the country’s second largest city, Blantyre, ABC News reports. (You have to love sewage sampling for both its grossness … and its effectiveness at monitoring hundreds of thousands of people to catch diseases early.)

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

A warning on the price of aid cuts: 9.4M preventable deaths

2026-02-12T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

It’s been an interesting week. On Tuesday I joined a panel hosted by the American Foreign Service Association to talk about why taxpayers across Western countries don’t see the benefits of aid, or really see its reduction or absence either. It was a great chat, and on a topic I can’t help but be annoyingly sincere about!

This week we have a few stories that feature philanthropies, which are a small but increasingly important part of global aid, especially as Western government funding continues to shrink.

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.

9.4 million: the death toll of aid cuts

The science journal The Lancet Global Health just published a rigorous analysis on how last year’s global aid cuts are translating to deaths, reports the (sadly beleaguered) Washington Post.

The topline? Staying the course, we should expect about 9.4 million additional preventable deaths through 2030.

If aid funding drops even further, the researchers say that deaths could easily rise to 22.6 million; roughly equal to the entire death toll from WWI. (To be clear, I’m internalizing this more severe scenario as a warning, rather than an earnest forecast.)

We’ve previously covered models that have pointed in this direction, but this new paper is the most comprehensive yet. It was also partially funded by a philanthropy, the Rockefeller Foundation, which I reached out to. After all, as aid contracts, the funding that hasn’t retreated is more important than ever.

Eric Pelofsky, the foundation’s vice president for global economic recovery, spoke with me about the findings and about how philanthropies like his see their role in this moment.

First off, “the takeaway here is that any sort of assertion that this aid reduction could be done without [a high] cost of human life is just not grounded in the facts,” Pelofsky told me. He also stressed the immediacy of the findings. “If you came away thinking this is a problem that we can deal with in four years, I think the answer is absolutely not. The urgency is too great,” he said. We are, after all, talking about over 9 million human lives.

Where do philanthropies like the Rockefeller Foundation fit in this moment?

First, at the big-picture level, it’s worth remembering that only about 5% of humanitarian and development aid comes from private philanthropy. So, after last year’s cuts, “even if we were all to drop everything and try to fill the holes, we couldn’t do it,” Pelofsky said.

Instead Pelofsky sees their advantage right now elsewhere: in taking risks governments won’t with taxpayer money, backing analysis (like this paper), and working at financial plumbing of global development, rather than just writing checks. This includes “incredibly boring and incredibly important,” work like what his foundation has done to help development banks restructure their balance sheets so they can get more money out the door where it’s needed.

Still, Pelofsky was clear: They’re facing the same hard tradeoffs as everyone else, weighing what needs desperate attention right now against “where our dollar can make the biggest impact.”

Can philanthropy save us?

On this very topic … the world’s biggest philanthropy is likewise signaling that it can not play savior. The Gates Foundation told the AP it will “not change course in the face of massive foreign aid cuts.” (Disclosure: The Gates Foundation funded the launch of Healthbeat).

Instead, the foundation’s CEO Mark Suzman said the foundation will focus at least 70% of its money toward preventing maternal and child deaths and fighting key infectious diseases, while trimming or winding down other lines of work. “Not only will we not be taking on new priorities, we’re actively narrowing our priorities,” he said.

Why? As we discussed with Pelofsky, the scale of aid cuts simply does not allow even the best funded foundation to replace vanished government aid, and this is the Gates Foundation’s acknowledgement of that reality.

Second, Suzman says they are choosing to concentrate where they think the life-and-death returns are clearest. This means winding down less-urgent programs like ones “that aimed to give more people in sub-Saharan Africa and South Asia access to digital financial services.”

My takeaway? The Gates Foundation is betting that we will not see a quick rebound in aid generosity. They are planning for a world where the active threat is … 9.4 million additional preventable deaths by 2030.

A resurgence of cholera … vaccines!

A little background here: About four years ago, cholera vaccine production shrank to just one producer in South Korea. With a vanishing supply, this effectively brought pre-emptive global vaccination to a halt. (Countries could use what little was left to react to outbreaks, rather than trying to prevent them.)

The vaccine shortfall helped fuel a resurgence of cholera in Africa, which as we reported in October, became the worst outbreak on the continent in about 25 years.

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

But the World Health Organization just announced that the vaccine shortage is ending, France 24 reports. Since 2022, “global supply of oral cholera vaccines [has] doubled”, and now the WHO is doling out 20 million doses to Mozambique, Bangladesh, and the Democratic Republic of the Congo to get vaccination campaigns rolling again.

So what happened? The WHO and organizations like the Gates Foundation basically scrambled to help get the lone South Korean producer, EuBiologics, to ramp up supply. This included backing a simplified new vaccine that can be manufactured more quickly at a massive scale.

My takeaway: This shows exactly why the WHO matters. When pharma companies do not see a profitable market, it’s this global body that steps in to push lifesaving vaccines into production.

Taking ‘addictive’ snacks seriously

I’ve read a lot of scientific papers over the 15 years as an on-again, off-again science journalist. Let’s be real, even on fascinating subjects … they’re usually a bit of a slog. So trust me when I say it’s actually worth your time to read this paper on ultraprocessed foods in full, which was covered by The Guardian. It reads like part nonfiction book, part provocative essay.

The paper compares ultraprocessed foods and tobacco products to a somewhat shocking effect. The authors’ walk through how each is deliberately designed (from the dosing of ingredients and the engineering of sensory cues) to tap into reward pathways in the brain. For the foods, this is to deliver fast, reinforcing hits of refined carbs and fats.

For example, they describe how food engineers intentionally design snacks so the taste does not linger, which nudges you to take another bite. One put it bluntly in a TV interview: This is “so that you want more of it,” the engineer said, and when pressed on whether that is about addiction, he replied, “that’s a good word.”

Effectively, these foods and snacks are “engineered to encourage addiction,” just like cigarettes. And the takeaway is clear: If they’re made like cigarettes, perhaps they should be regulated like cigarettes.

I have long been wary of the impulse to ask governments to micromanage personal food choice. I think personal responsibility still matters, and that you should be able to have chips and a Coke without the state wagging its finger at you.

… but if you are like me (skeptical of soda taxes yet convinced that tobacco regulation has saved countless lives) it’s worth hearing the argument on how many of today’s ultraprocessed foods may have crossed a line in the design for addictive consumption.

As the lead author of the study, Ashley Gearhardt, told me over email: “We regulate thousands of tobacco and alcohol products differently based on risk. Most alcoholic beverages are mostly water, yet it’s clearly labeled because once it’s engineered to alter mood and seed cravings, it’s no longer about hydration. Ultra-processed foods operate similarly. They’re not about nourishment so much as craving and mood effects.”

Just enough WHO funding

Let me end on a bit of good news.

The WHO is now reporting that it “has mobilized about 85% of the resources” needed for this and next year’s core budget, thanks in part to countries agreeing to increase their mandatory contributions. That is not nothing!

“Eighty-five percent sounds good – and it is,” said WHO Director- General Tedros Ghebreyesus, with a “deeper crisis averted.” That said, he warns that the remaining 15% will be “hard to mobilize,” which I’m giving you permission to read as “absolutely not going to happen.”

What’s missing in that 15%? At least in part, it’s the WHO’s work on “emergency preparedness, antimicrobial resistance, and climate resilience.”

Still, this is a partial stabilization in a still fragile moment for global health.

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.

When conspiracy theories dictate global vaccine policy

2026-02-05T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The realities of public health hit home for me this weekend. My daughter just started pre-K, a touching milestone I was repeatedly warned would bring more illness into our home. (I took this to mean perpetual sniffles.) Instead, after about a week, she shared a lovely bout of norovirus with me.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Vaccine conspiracies as global health policy

Gavi, the global organization that finances and distributes vaccines in poorer countries, finds itself in a funding standoff with the United States, Reuters reports.

For reference, “the U.S. previously contributed around 13% of Gavi’s funding,” and still has outstanding funds owed to the organization from the Biden era.

The issue at hand?

You might assume this is tied to America’s broader reworking of the global health budget, but… it is not. Instead, the Trump administration has told the global vaccine group “to phase out shots containing thimerosal as a condition of providing the group with funding.”

If you (like me) have made it this far in your life without needing to know what thimerosal is, let me present you with the disappointing news: It is a benign preservative at the center of several vaccine/autism conspiracy theories.

I reached out to Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, and one of the world’s foremost experts on vaccine development and vaccine misinformation to get his take.

He cautioned against “sanewashing” conspiracy claims or even detailing them next to mainstream vaccine science, which creates a “false equivalency,” as if both sides deserve equal weight.

“The thimerosal/autism link was debunked many years ago through both large epidemiological studies and even nonhuman primate neurodevelopment studies,” Hotez said, with the overwhelming fatigue of somebody who has explained this several hundred times before. “Many of these false links were popularized by [U.S. Health and Human Services Secretary Robert F. Kennedy Jr.’s] discredited 2005 article published in Rolling Stone and Salon magazines, since retracted by the editors.” As for the ultimate impact on Gavi, it remains to be seen whether the administration follows through, or whether Gavi decides to cave to the anti-science demand.

But “it’s tragic for the world’s children that now their access to vaccines and immunizations could be imperiled by this kind of pseudoscience,” Hotez said.

We’re winning the worm war

Guinea worm disease is on the verge of eradication, with just 10 infections reported worldwide last year, the Washington Post reports.

Disease breakdown: Guinea worm (also known as Dracunculiasis) is a parasite that spreads through drinking contaminated water, or eating infected animals. I’ll spare you the gory details (because this one is a true stomach turner), but it forms a terrible worm-filled blister. Though not lethal, at its peak in the 1980s, it was endemic across 20 countries and infected about 3.5 million people per year. Four decades later, there is still no treatment beyond pain meds.

The global effort to eliminate the disease has been led by the Carter Center since the 1980s. Last year’s total caseload is a drop from 15 cases in 2024 and consists of “four human cases … reported in Chad, four in Ethiopia, and two in South Sudan.”

The organization reports that the global aid pullback “has not stopped the Guinea worm program at ground level.”

What’s particularly incredible about the ongoing elimination project is that there is no vaccine or cure for guinea worm. This global effort’s success is largely the byproduct of sustained, committed gruntwork, with decades of programs to “educate the public, train volunteers, and distribute water filters in affected areas.”

I have two takeaways: First, we are clearly winning this war against the worm. If Guinea worm cases reach zero, it would be only the second human disease ever eradicated, after smallpox. (That said, I’m still hopeful we’ll first eliminate polio before the decade is out.)

Second, the last mile will be the hardest. Unlike polio or smallpox, Guinea worm also has animal hosts. Officials say the grunt work must continue, even after zero human cases. The disease can bounce back unless animal transmission (including dogs, domestic cats, and freshwater fish) is stopped, too.

Still, if Guinea worm fades into history, the credit belongs to the community health workers and volunteers who kept at the slow, quiet work for decades, moving village by village.

ChatDNA

Last week I was admittedly a bit flippant about a story on artificial intelligence helping pharma companies speed up the “unsexy” side of drug trials. Well, this week brings a more humbling piece on AI’s promise in driving real medical advancement.

Smithsonian magazine reports that researchers at Google DeepMind have unveiled a new artificial intelligence tool called AlphaGenome.

The tool leverages what AI does best (processing and learning from enormous datasets) to crunch the full book of our DNA. Essentially, it’s meant to help scientists predict how the parts of DNA we still cannot fully explain help tell our cells what to make, and when and how to make it.

The piece has a world-class explainer on the fundamental science:

“DNA is made of four different units called nucleotides: adenine (A), cytosine (C), guanine (G), and thymine (T). These letters pair up and act as an instruction manual for cells, yet only 2% of human DNA tells our cells how to build proteins, the building blocks of life. The remaining genetic code was long dismissed as “junk DNA,” but now, scientists know it plays an important role in regulating gene activation. Certain variants and mutations in the genome can lead to disease — and AlphaGenome’s goal is to predict what those changes are.”

So what’s the promise? The designers of the AlphaGenome believe the tool “can help experts develop new genetic therapies and ways to diagnose rare diseases.” Especially by pointing human researchers toward complex genetic links that are hard to spot on their own. Best of all: “The new resource is freely available to other researchers, who can modify the program based on their own needs.”

The tool has limitations, of course, including issues predicting the impact of DNA regions that influence each other at a great distance (meaning the segments are several hundred thousand letters away).

Still, I will be looping back in the coming months. As Pushmeet Kohli, vice president of science at Google DeepMind, put it: “I think we are at the start of a new era of scientific progress, and AI is going to enable a number of different breakthroughs.”

I have to admit … I believe it.

We. Declare. ‘Water bankruptcy!’

The United Nations says the world has entered a new kind of water crisis, one it calls “global water bankruptcy,” Health Policy Watch reports. That means rivers, lakes, and underground sources that once bounced back after droughts or heavy use are being drained faster than they can recover.

Perhaps the starkest example is the Aral sea in central Asia. In the late ’80s it was still the world’s fourth-largest lake. Today it barely exists.

Not to lay it on thick, but the report hits you with some staggering facts:

“More than half of the world’s large lakes have lost water since the early 1990s, over 30% of glacier mass since 1970 has disappeared in certain regions, while about 410 million hectares of natural wetlands — a land mass nearly equal to that of the European Union — have been destroyed over the past five decades.”

And the human impact?

Today about “4 billion people — nearly two-thirds of the global population — face severe water scarcity for at least one month every year.” The report particularly points to farmers in dry regions who pump groundwater for irrigation year after year, a practice that physically cannot continue indefinitely.

What’s my takeaway?

I find these reports largely overwhelming, because the solutions are not mysterious. National governments across the world need to act to protect water sources, manage them better, and plan for scarcity. Will they? Not anytime soon.

Tangent here, but I’m reading What We Can Know by Ian McEwan, which is set in a future Britain after a climate collapse. In the book, historians look back on our current era as a period they call “The Derangement,” when people had clear knowledge of climate change but failed to act at the needed scale.

With this report it is, uh … uncomfortably on the nose.

Mosquitoes keep moving

I’m leaving you this week on a story with a somewhat fascinating twist.

Chile is on high alert after finding an Aedes aegypti mosquito in the capital of Santiago, reports El Mercurio, the country’s largest newspaper.

Why is this such bad news? The mosquito, which is still absent from large parts of the country, is known as a major vector for a host of highly transmissible diseases including dengue, chikungunya, Zika, and yellow fever. Enough so that it’s commonly called the “dengue mosquito” or “yellow fever mosquito.” It also particularly thrives in cities, breeding in locations like flower vases, plastic bottles, gutters, and even old tires.

As we reported in October, this is an insect that sticks around. “Once Aedes aegypti mosquitoes establish themselves in an area warm enough for them to survive the winter, it becomes extremely difficult to eliminate them,” Dr. Marietjie Venter, an animal-borne virus expert, told me last year.

Granted, this is not the first time the mosquito has appeared in Chile. But as climate change makes the country increasingly habitable for it, health officials are worried sightings this year could signal the mosquito establishing a foothold … and introducing a perpetual risk of terrible tropical diseases. It would not take much. After all, as Chile’s head of health emergencies, Ester Alywin, warned on Friday, “a single female mosquito can lay up to 1,500 eggs in her lifetime.”

What’s the twist?

The singular mosquito was identified by eye by an airport staff member at a warehouse in Santiago International, then caught and then sent for analysis at a public laboratory.

Readers, I’ve searched for more detail on how staff could possibly be trained well enough to recognize and capture a single, specific mosquito (!) rather than just swatting it … but I’ve come up empty. Apparently, someone took their annual public health briefings seriously.

Anyhow, you’re my hero of the week, anonymous Chilean airport warehouse worker.

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.

What the U.S. leaving the WHO means for health in America and the world

2026-01-29T12:00:00+00:00

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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.

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.

What’s going well: Marburg virus winding down. A cheap malaria defense. The future of antibiotics.

2026-01-22T12:00:00+00:00

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Hello from Nairobi.

This week’s news has an unexpected but welcome throughline: optimism! From effective outbreak control to promising new research, we have a few stories that suggest key parts of the global health system are still functioning well, even under strain. (For the disappointed masochists out there, don’t worry. I’ll likely be back with some bummer news next week.)

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Marburg virus: Not too early to celebrate

We’ve been covering how Ethiopia is faring during its first-ever outbreak of Marburg virus, an Ebola-like hemorrhagic disease with no vaccine.

How this outbreak unfolds matters beyond this one country and one disease. For me, it’s the second real test after last year’s Ebola flare-up in the Democratic Republic of the Congo of whether the international order still has the muscle to contain deadly outbreaks in an era of austerity.

Oddly, there has been very little sustained reporting on how the outbreak is actually progressing. (And, mea culpa, my cynic’s heart usually assumes no news means bad news!) So as I promised last week, I’ve followed up. I reached out to International Medical Corps, one of the organizations leading the Marburg fight, and spoke with Lawrence Mutharia, its country director for Ethiopia. What’s the state of play?

An unambiguous success.

“We are now at day 36 with no confirmed new cases,” Mutharia told me on Monday. He reports that the focus has shifted from an active response to making sure systems are in place if the virus resurfaces, “while waiting for the outbreak to be officially declared as over.”

This outcome was not guaranteed. The virus hit the outskirts of Jinka, a remote, under-resourced area with no prior experience handling a disease this lethal. I’ve hesitated to describe that reality too vividly in past updates, partly to avoid sliding into lazy stereotypes or misleading ideas about what “rural Africa” looks like. But the truth is that the communities surrounding Jinka follow culturally and socially traditional ways of life, with Indigenous conceptions of medicine that are far removed from modern biomedical practice. Without putting too fine a point on it: I have attended only one meeting in my life where participants arrived in full body paint, scarification, and feathered headdresses. It was in Jinka.

You could imagine this could be a tough setting for an outbreak response built on community cooperation with foreign medical guidance.

Nevertheless, Mutharia says that early, effective outreach to local communities was actually one of the response’s key strengths. That, a rapid influx of funding, early deployment of medical teams, and clear leadership from Ethiopia’s federal Ministry of Health. “Timely and coordinated efforts are crucial” for stopping fast-moving outbreaks like Marburg, he noted, and in this case they were deployed close to a best-case scenario.

Perhaps more importantly, and beating another one of my nagging fears, Mutharia told me that donor support for the response was “quite adequate.” That support included, to their credit, rapid funding from the U.S. State Department. Given the tightening of purse strings globally and America’s pullback last year, this was all the more striking. As Mutharia put it, “we are currently in a situation of trying to do more with less.”

My takeaway?

First, you have to applaud the responders to this crisis. And taken together with last year’s Ebola response in the DRC, this outbreak offers clear proof that the international community has lost neither the will nor the ability to respond to serious global health risks. For viruses like Marburg and Ebola (truly nightmare diseases) each day of delay makes them exponentially harder and more expensive to contain. At least for now, that lesson has not been unlearned.

Who controls Europe’s medicines?

Two stories out this week focus on Europe’s drug supply problem. (No, not the Ibiza kind.)

First, the Financial Times is reporting that U.S. pharmaceutical companies are openly threatening to withhold new medicines from Europe if governments refuse to pay higher prices.

Speaking at the JPMorgan health care conference, Pfizer CEO Albert Bourla framed the choice starkly: “When [we] do the math, shall we reduce the U.S. price to France’s level or stop supplying France? We [will] stop supplying France.” Other executives said they were considering delaying or skipping European launches altogether as they try to offset revenue lost from Trump-era price cuts in the United States.

At the same time, on Tuesday the European Parliament moved to shore up Europe’s pharmaceutical defenses. Lawmakers adopted proposals to rebuild manufacturing capacity inside the European Union and coordinate national stockpiles. Ultimately, the EU is pushing a “Buy European” approach that prioritizes security of supply and production within the bloc.

The takeaway? Europe is caught in a squeeze. Drugmakers are signaling they are willing to use access as leverage to raise prices, just as European lawmakers are trying to reduce their dependence on those same companies.

How the economics and politics will play out next is unclear, so I’ll be following up on this story.

Antibiotic optimism (with caveats)

A lot of modern medicine rests on a very fragile assumption that our antibiotics will keep working … and, uh, we know they won’t.

Drug-resistant infections kill millions of people globally each year, and new antibiotics are not being developed fast enough to keep up with the spread of resistance. (A large part of the issue is that antibiotics rarely recoup their R&D costs. In fact, biotech companies that specialize in them have a bad track record of going bust.)

But in an essay in the Washington Post, biochemist and antibiotic researcher Andre Hudson argues that the future may be a hopeful one. His case for optimism rests on the idea that (putting aside our laggardly development of new drugs) other scientific advancements may catch up to the threat.

He makes four main points: First, faster and more precise diagnostics are increasingly reducing unnecessary antibiotic use. Second, antibiotics are no longer the only tool in town. Hudson outlines how researchers are developing alternatives, including genetically engineered viruses (!) that hunt bacteria and gene-targeting tools to “disable resistance genes” in bacteria.

Third and fourth, Hudson finds hope in a clearer understanding of how resistance moves through entire systems, and in policy solutions meant to fix the economics behind antibiotic development. (Being frank here: This is where I feel the optimism is less earned.)

On the systems side, Hudson argues that drug resistance is finally being understood as more than a hospital problem. Antibiotics move through farms, food, wastewater, and trade, and that matters. But understanding the problem is not the same as controlling it. On policy, he points to ideas meant to fix the broken economics of antibiotics, including draft U.S. legislation that would pay companies for having lifesaving drugs available rather than selling more of them. It is a sensible fix. It has also been stuck in Congress for three years.

Still, a hopeful take!

American dollars … revisited?

Two stories out this week clarify what last year’s U.S. pullback in global health funding really amounted to, and what may come next this year.

The damage? All told, in 2025 the United States (still the world’s largest funder of global health) slashed its spending by roughly 66%, according to new end-of-year estimates reported in Think Global Health. It took months for this picture to come into focus, and “the cuts are bigger than we expected, not less,” said Joseph Dieleman, who leads financing tracking at the Institute for Health Metrics and Evaluation, a research group that analyzes health spending worldwide.

We’ve reported extensively on earlier data of the pullback, but it’s worth reading this article, particularly for the data visualization on where the cuts landed.

Looking forward, things are murkier … which is better than bad.

Devex is reporting that a draft, bipartisan foreign assistance bill for 2026 would allocate $9.4 billion for global health. That is still well below recent highs (down a quarter from the $12.4 billion in 2024) but far more than many expected after last year’s upheaval. The bill preserves core funding for HIV, malaria, tuberculosis, and polio, and includes unexpected support for the vaccine funding organization GAVI, alongside family planning money, and dollars for several U.N. agencies the administration had tried to zero out.

One takeaway is that this is a signal that the U.S. government is not ready to walk away from global health. Another is that the bill exposes a sharp divide between the majority Republican Congress and the Trump administration on global health funding.

Mitchell Warren, executive director of the HIV nonprofit AVAC (and a friend of the Checkup!) raises the most trenchant questions in the article: “Will both houses of Congress approve the bill? Will the president sign it? And, perhaps more importantly, will the president actually spend congressional appropriations and accept at last that it is Congress, and not him, who has the power of the purse?” he said.

What do these two stories mean together? “Bottom line is that while most programs have been gutted, most of the budgets are being preserved. Where and how those funds get spent remains to be seen,” Dieleman told me.

A ‘dirt cheap’ malaria defense

We’re going all in on optimism today, so why not end on a high note?

A clever new study suggests malaria prevention may already be woven into daily life, The Guardian reports. Researchers found that treating baby-carrying cloth wraps with insecticide cut malaria cases in infants by roughly two-thirds in parts of western Uganda.

The idea is brilliant. In many communities, babies spend much of the day tied to their mothers’ backs in cloth wraps. (I can’t stress enough just how ubiquitous this is in East Africa.) Treating those wraps with permethrin, the same insecticide used in bed nets, adds protection during hours when nets are not in use.

Anecdotal, but as one mother told the researchers: “I’ve had five children. This is the first one that I’ve carried in a treated wrap, and it’s the first time I’ve had a child who has not had malaria.”

The best part? “It’s dirt cheap,” reports one of the researchers.

As mosquitoes increasingly bite outdoors and earlier in the evening, treated wraps could help close one of malaria prevention’s most stubborn gaps. They won’t replace bed nets or vaccines, but they add protection exactly where infants already are, in a way that fits seamlessly into daily life.

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.

Consolidation may be the answer to more austere global health funding

2026-01-15T13:43:48+00:00

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Hello from Nairobi.

It’s a new year and I’m happy to be back home, where the vanilla orchids in my garden are blooming. (They’re beautiful, but won’t form beans unless I get on a ladder and pollinate them by hand!) This week’s report ranges from a big proposal to remake global health institutions to a very concrete, “cynical” decision shaping health care in a humanitarian disaster.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Big structural reforms (try not to get too excited!)

Looking ahead to 2026, there are zero signs that last year’s global health cuts will revert. If anything, deeper reductions this year look like the more likely scenario.

And that leads us to the central challenge facing global health right now: Unless the goal is to just do less with less, this winter of austerity is a moment for the largest organizations in global health to reform. Either by slimming/changing their structures, or tightening their mandates. (As we’ve reported, the Global Polio Eradication Initiative deserves credit for being among the first to grapple seriously with this in practice.)

With that in mind, our first story this week is an essay in Think Global Health by Muhammad Ali Pate, Nigeria’s minister of health; Donald Kaberuka, the African Union’s top financing official; and Peter Piot, the former director of UNAIDS. Together, they argue that global health’s largest institutions should make changes that would have seemed unthinkable just a year ago.

Their proposal is deliberately severe.

At the center is a serious overhaul of institutions with overlapping mandates. The authors argue that GAVI and The Global Fund (the two biggest international funding organizations in global health outside the World Health Organization) should be merged into a single entity, writing that “financing institutions should form a holding company with a single governance and secretariat.” Under this model, that body could also absorb various other smaller organizations, including the “Pandemic Fund, Unitaid, and the Global Drug Facility for TB.”

The consolidation would not stop there. Other “single-disease entities that were created at the start of the millennium — such as Roll Back Malaria and Stop TB” could be folded in as offices under the same structure, or potentially into WHO itself. Ultimately, it’s hard to argue with their logic that in a world of shrinking budgets, funding parallel institutions built for an era of expansion is increasingly hard to justify.

Cost cutting is explicitly part of their vision, and the authors note an initial target: “The expensive Geneva presence should be minimized.” (It’s worth noting that Geneva is one of the most expensive cities in the world to house and support international staff.)

To gauge how this idea is landing among policy insiders, I reached out to Pete Baker, deputy director of global health policy and policy fellow at the Center for Global Development, a leading think tank tackling these ideas. Baker welcomed the proposal. “This is an important contribution to the current global health reform debate,” he told me, adding that consolidation could do more than cut costs. In his view, “one institution with a broader mandate could improve efficiency and be better at building health systems.”

But Baker is also clear-eyed about the obstacles. “However, this kind of merger will be very time consuming,” and cautioned that because we are talking about massive staffing redundancy, “each organization’s board and secretariat may resist it.” (I am reading this as a massive understatement.)

He leaves us with a set of open questions that will hang over global health reform throughout the year: “This will also consume a huge amount of effort from global health leaders. Will it be worth it?” he asks. “Or will it be easier to close existing institutions, and set up a new financing mechanism? One that is aligned to the multilateral development banks, broadly supports health system development, funds on-budget and backcountry priorities — and crucially — also provides loans as well as grants as countries get wealthier?”

A ‘cynical’ ban of health aid groups in Gaza

Let’s turn to what, despite a ceasefire, is still one of the world’s worst man-made humanitarian disasters: Gaza.

Israel has moved to ban dozens of international aid organizations from Gaza, which the British Medical Journal reports will sharply reduce an already abysmal state of medical care.

Under new registration rules, NGOs must hand over personal information on Palestinian staff to Israeli authorities or lose their ability to operate. Groups including Doctors Without Borders, Oxfam, and the Norwegian Refugee Council say the requirements put workers at risk and violate humanitarian principles. Israel argues the measures are necessary to prevent armed groups from infiltrating aid operations, an accusation the organizations strongly deny.

The potential impact of the bans is severe. “Overall, around 60% of Gaza’s field hospitals are run or supported by such international non-governmental organizations,” and Doctors Without Borders alone backs about a fifth of hospital beds and a third of births.

This is in the context where “more than 500 humanitarian workers [and] at least 1,700 health workers have been killed” in Gaza since October 2023, making demands for staff lists especially fraught.

Doctors Without Borders calls the policy a “cynical and calculated” move that could leave Palestinians without lifesaving care, at a moment when winter conditions, flooding, and aid restrictions are already proving deadly. Taken together with Israel’s earlier ban on UNRWA (the U.N. agency for Palestinian refugees), the decision signals a further, deadly contraction of humanitarian space in Gaza.

I reached out to Elisabeth Mahase, who reported the story, to ask how she sees this move in the context of years of grim news for Gaza’s health system. She emphasized that “considering how inadequate the health care capacity already is compared to the need, any loss in this space will have a devastating impact on Gazans. Palestinians in Gaza desperately need more aid and more health care, not less,” Mahase said.

Burning plastic indoors is surprisingly common

A new study has put numbers on a historically under-reported health risk: burning plastic inside the home for heat or cooking. One in three people in poor urban communities have seen it, and one in six say they have done it, The Guardian reports.

As you probably know: Burning plastic releases a noxious mix of pollutants, including “dioxins, furans, and heavy metals.” These are all chemical classes linked to respiratory disease, heart problems, cancer, and developmental harm.

Researchers have also found these toxins in soil and food near burn sites, raising concerns about longer-term contamination of local food chains. No real surprise here, but the practice is most common where waste collection is weak, and cleaner fuels are unaffordable or unavailable.

What’s the takeaway? The authors argue this is a major blindspot in global health and environmental policy. (On a personal level, I agree. I’ve seen a lot of burning plastic in my decade on the African continent, but even I find this rather surprising. What I’ve seen is usually outside, and done as a way to dispose of trash.)

Household plastic burning rarely shows up in official pollution data, yet plastic waste is expected to nearly triple by 2060. Without investment in basic waste services, cleaner cooking options, and public awareness, this is a health threat that will keep growing.

More funding for Marburg?

The European Union has announced $1.4 million in new funding for the ongoing outbreak of Marburg virus in Jinka, southern Ethiopia (a city I last visited in 2022 for work.) The new funding will be split among the WHO and two of the biggest organizations working on the ground: the International Medical Corps and the Red Cross.

Disease breakdown: Marburg virus is a high-fatality fever that is similar to Ebola, and often leads to hemorrhaging and organ failure. Untreated, about 9 in 10 people who contract the disease will die. The disease exists endemically in bats, allowing it to spread and occasionally spill over into humans. While this ongoing epidemic is Ethiopia’s first record of the disease, the WHO says the strain matches those seen in past regional flare-ups. There is, unfortunately, no vaccine.

What makes this announcement notable, and a little odd, is the timing. Just last week, the Ethiopian Ministry of Health announced the country had gone 21 days without a new Marburg case, essentially putting the outbreak halfway to epidemic control. That’s the kind of milestone that is usually announced, or at least echoed, by the WHO. Yet an International Medical Corps briefing Friday painted a very different picture, describing a ramping up of the response effort in Jinka.

This matters because, like the Democratic Republic of the Congo’s Ebola outbreak last year, Marburg in Ethiopia is shaping up to be an early test of how well the world can control one of its deadliest viruses in an era of global health austerity. Right now, the funding announcements and official signals don’t fully line up. It’s unclear whether they reflect caution and bureaucratic lag, or if there’s genuine concern that the outbreak is not as contained as it appears. I’ll be following up with independent reporting next week to try to sort out which story is closer to the truth.

Parenthood only needed this 13% tax

Let’s end this week’s report with a story that I’m sharing because, well, it just gets stranger the longer you sit with it. As Reuters reports, China has scrapped “a three decade-old tax exemption on contraceptive drugs and devices … to spur a flagging birth rate.”

Condoms and contraceptive pills are now subject to a 13% tax. Of course, this is not China’s first attempt to centrally engineer fertility decisions, though it may be one of the more delicate nudges. (The country, after all, enforced the one-child policy from 1980 to 2015.)

Yes, this move is just one of several recent efforts aimed at pushing China’s birth rates upward. But … I just can’t fathom how a 13% tax is really meant to nudge would-be parents in the direction of a newborn! A 130% price hike? Maybe at the margins. A 1,300% increase? Sure, I could see that.

But as a parent whose child just entered pre-K this week, let me say: Kids are incomparably expensive to a one-time tax. They’re more of an uncancelable subscription service that has a very aggressive pricing model.

Condoms in China are already extremely cheap by global standards, costing just a few cents at the low end (yes, I looked up a Chinese condom industry report.) So… I’d like to meet the person staring at a half-cent price increase and thinking, “Well, that settles it. Let’s just have the baby.”

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

There’s more to the measles comeback than misinformation

2025-12-18T12:00:00+00:00

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Hello from Sydney, Australia.

I arrived on Sunday to spend the holidays with my in-laws. It has been an odd and heavy start. We landed just hours after the attack at Bondi Beach, a short distance from where we are staying. At the same time, this is Australia at Christmas, with its familiar rituals. Shrimp, shorts, and sunburns.

This week, I am finally catching up on a disease I have largely avoided covering: measles. I have tended to see its resurgence in the West as a misinformation problem with American roots. But as we’ll see, that framing falls short.

My name is William Herkewitz, and I’m a journalist (usually) 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.

Blaming misinformation isn’t enough to explain measles’ return

Follow measles across the West and you find an uncomfortable trail of resurgence. For example: Europe is seeing record cases, and Canada just officially lost its measles elimination status. For developed countries, this rise is most often blamed on vaccine misinformation. Basically, that widespread distrust and conspiracy-minded thinking (supercharged by a Covid-era backlash) is increasingly hollowing out vulnerable, unvaccinated pockets of people for the virus to spread between.

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

In the United States, it is especially easy to believe this explanation right now. As Healthbeat reports, America’s chief public health official and renowned anti-vaxxer Robert F. Kennedy Jr. is actively undermining “the ability of public health officials to prevent and contain outbreaks” of the virus. But is that the full story?

Australia is the strongest test of this explanation (and, conveniently, I’m here). That’s because it’s a country with one of the world’s most robust public health and vaccination systems, free childhood vaccines, and historically high coverage. And measles cases are rising here, as well, Medscape reports.

I reached out to Julie Leask, a professor of public health at the University of Sydney and one of Australia’s leading experts on what people think, feel, and do about vaccination. I asked if vaccine misinformation is simply eroding confidence in the same way here, too.

Leask surprised me. In Australia, she said, while “the clickbaity idea that [measles resurgence] is all about vaccine refusal” absolutely dominates local headlines, the data do not fully support that explanation. She pointed to Australia’s National Vaccination Insights Project, a vaccination surveillance system that tracks the real-world reasons children miss doses. “Vaccine refusal is absolutely a problem,” she told me, “but it’s not the only problem.”

Leask notes that two other forces are doing at least as much work to recirculate the disease in Australia. One is rising measles cases in developing countries like Vietnam, Thailand, and Indonesia, where people may travel and return with an infection. The other is a mix of everyday practical barriers that Leask calls “social determinants of vaccination.” These range from hard-to-reach clinics and staff shortages to families who missed routine shots during the pandemic and never fully caught up, which have left pockets of children without vaccines or only partially vaccinated. Together, she said, those factors can pose as much risk as anti-vaccine sentiment alone.

The larger lesson, she argued, is that across the developed world, measles control depends as much on keeping vaccination easy, accessible, and routine as it does on countering misinformation.

Is misinformation rising, and should we be wary of it? Without question. But focusing on it alone misses where other real gaps are opening.

Kenya court pauses ‘America First’ health deal

Over the weekend, Kenya’s High Court halted the new U.S.-Kenya health aid deal that we discussed last week, Kenya’s The Standard reports. The agreement was meant to lock in $1.6 billion in American funding, and was the first test case of Washington’s new “America First” health aid model.

The issue? Data.

Tucked into the agreement was a provision committing Kenya to share population-wide health data with the United States and U.S. companies for up to 25 years, a scope and timeline that critics say were never clearly explained to the public or debated in parliament.

Last week I wrote that I “initially didn’t read this as a nefarious data grab,” but rather as a clumsy fix for the surveillance gap the United States created by exiting the World Health Organization. (But, as The Standard notes, the agreement “requires Kenya to share extensive medical data, including HIV/AIDS, tuberculosis, malaria, maternal and child health,” in addition to data purely on “disease surveillance,” which frankly makes my more charitable interpretation harder to sustain.)

Certainly, this ruling is an early embarrassment for the Trump administration’s flagship health agreement, though its practical impact on the deal will remain unclear for quite a while. The case isn’t even due in court until Feb. 12.

What’s the takeaway?

Well, it’s worth revisiting my conversation with John Kuehnle, who ran America’s health programs for the U.S. Agency for International Development in Kenya from 2020 to 2024. We discussed the data clause last week, well before the court intervened, and Kuehnle walked through potential rationales for why U.S. negotiators wanted the data in the deal at all.

A generous interpretation is that the information could “be mutually beneficial if it’s used to develop medicines and medical devices that are tailored to the needs for Kenyans and other Africans,” he said. But Kuehnle noted that this business case is thin at best. “What’s the point of making a drug tailored to a population that can only afford it if a donor buys it, when the donor funding runs out in five years?”

Even if the courts allow the data sharing to go through, Kuehnle cautioned that political consent is unlikely to outlast the money. “If no material gains come from Kenyans giving their data to the U.S. in the first five years, I would not be surprised if this fizzles after five years and the funding runs out,” he said. “I don’t see Kenyans continuing to share data for 20 years after the funding runs out simply because a politician in 2025 agreed to do so.”

An HIV surge in Papua New Guinea

Papua New Guinea is facing one of the fastest-growing HIV epidemics in the world*, The Guardian reports. New infections have roughly doubled since 2010, with nearly half occurring among children and young people. This has prompted the government to declare HIV a national crisis, as overstretched health services buckle after the loss of international funding.

Over a third of people living with HIV in Papua New Guinea don’t know they are infected, and mother-to-child transmission of the virus remains “one of the highest globally.” At the same time, prevention and outreach have weakened as international funding has fallen away. The Guardian story notes that hundreds of clinics run by the government and churches have cut back services or shut down entirely.

Luckily, Australia has moved to plug part of the funding gap, increasing its annual HIV funding to about $6.6 million. UNAIDS says this will keep its Papua New Guinea office operating for another two years. But this intervention only buys time. One source in the article says what when U.S. funding stopped this year, there was “no second plan given to us, and we were told to close down the clinic,” said a social worker in the capital, Port Moresby.

The takeaway: Even senior Papua New Guinean officials concede that there is no clear plan for the HIV outbreak if foreign funding doesn’t return. Foreign minister Justin Tkatchenko warned the country needs a “fallback position,” adding: “The long-term strategy is doing it ourselves. We can’t continually rely on other donor partners to help us.”

(*Worth noting: Papua New Guinea’s doubling of HIV cases is still dwarfed by the wild surges currently seen in the Philippines, Fiji, or Madagascar.)

Your lungs on airplane mode

Air travel has a dirty little secret … what passengers are breathing.

A new study in the journal Environmental International finds that airline passengers can be exposed to extremely high levels of ultrafine air pollution while flying, Oman’s The Arabian Stories reports. This is especially true during boarding, taxiing, and landing.

The findings are new here, but so too was the research approach. The researchers basically brought air-quality monitors onto real flights and measured what was in the cabin air at each stage of the trip, instead of relying on estimates or airport data.

The key point is that jet engine pollution can seep into cabin air before the plane reaches cruising altitude, when filtration systems work best. The particles the researchers measured are small enough to reach deep into the lungs and even enter the bloodstream, raising concerns for flight crews and airport workers who face this exposure repeatedly.

So the takeaway … is never fly again?

No, not exactly. While the pollution spikes were striking, the researchers also found that when you average exposure across an entire flight, overall ultrafine particle levels inside planes are actually lower than what people experience in many everyday settings, like sitting in heavy road traffic. The researchers say the risk is less about any single flight than about repeated exposure, and the findings point to specific moments on the ground where pollution is entering the cabin and could, in theory, be reduced.

Yes, we’re ending on poop

Let’s end this week’s edition with some optimistic news somewhere unexpected: the sewer.

Public health officials in the UK are expanding wastewater testing to spot outbreaks by analyzing what people flush away, the Financial Times reports. When people are infected, they shed viruses and bacteria in their waste, often days before symptoms appear. Sewers gather this, uh, trove of data, turning treatment plants into incidental health monitors for entire cities.

What I found striking in the Financial Times reporting isn’t the UK’s plan itself, but how fast wastewater surveillance is proliferating and diversifying worldwide.

The EU launched a Global Consortium for Wastewater and Environmental Surveillance for Public Health last year, while local projects are popping up elsewhere. In Houston, researchers detected measles virus in sewage 10 days before any cases were officially reported, a result that Anthony Maresso of Baylor College said “underscores the high sensitivity of the method.” In Nevada, scientists are using artificial intelligence to scan wastewater for flu, RSV, mpox, measles, gonorrhea, and drug-resistant fungi.

Gross? Absolutely. But incredibly cool? Oh yeah.

It’s a reminder that even as traditional disease surveillance faces challenges, new tools are emerging in unlikely places. And sure, wastewater is messy and unglamorous … but after the flush, the data are hard to spin!

Healthbeat will be on a holiday break for the next two weeks. I’ll see you next year.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Kenya signs first U.S. aid deal – but can it afford to pay its share?

2025-12-11T12:00:00+00:00

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Hello from Nairobi.

Last weekend I went to an ugly-sweater holiday party at the start of the dry season and learned something important about hubris. There is hot, there is very hot, and then there is “woolen knitwear in equatorial sun.” I will choose differently next time.

What’s new this week? Some big moves on American foreign aid, plus we’ve hit the point in the year when the consequences of the past 12 months are starting to show up in the data. Some of what follows is tough reading, but I promise we will end on something light.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Kenya signs the first ‘America First’ health deal

Allow me start this week’s opening story with a short rewind on what happened this year to America’s aid bureaucracy. (Bear with me, the background really does matter.)

Earlier this year, the Trump administration shut down America’s foreign aid agency, the United States Agency for International Development. While most American aid programs ended with it, about 17% of USAID’s former contracts survived. These included some (though not all) lifesaving global health programs. By July, those programs were all transferred to the State Department, which has been quietly rehiring former USAID staff as temporary contractors to keep them running. Still, for months the ultimate fate of that remaining health aid was anybody’s guess.

Finally, in September, the State Department announced a new plan for American health aid moving forward, which was presented under the banner of “America First.” The heart of the new approach would be country-by-country deals. But the announcement left huge questions about actual funding and long-term commitments unanswered.

Still with me? This brings us to the latest news.

The United States finally signed the first of those global deals here in Kenya last week, Health Policy Watch reports. The agreement promises “$1.6 billion over the next five years,” for priorities like malaria control and disease surveillance, and hinges on Kenya committing to raise its own health spending by $850 million. Moving forward, American officials say as many as 49 more agreements could follow in Africa alone.

There has been some hubbub in Kenya about one clause in the deal, which requires the Kenyan government to share health surveillance data with the United States for 25 years, including providing U.S. businesses with genetic data. (I initially didn’t read this as a nefarious data grab, but instead as Washington trying to patch the disease reporting gap it opened when it pulled out of the World Health Organization.)

Meanwhile, Secretary of State Marco Rubio praised the agreement’s new approach by saying, “We are not going to spend billions of dollars funding the NGO industrial complex while close and important partners like Kenya either have no role to play or have very little influence over how health care money is being spent.” It’s worth noting: That framing is flat-out inaccurate, since USAID historically co-designed Kenya’s health programs with the Kenyan government, and routed much of its funding through local Kenyan organizations.

This all gets to my bigger question: How much is actually different in practice, once you sift past the rhetoric? I reached out to John Kuehnle, my old colleague who actually ran America’s health programs for USAID in Kenya from 2020 to 2024, to ask. (Today Kuehnle is the CEO of the American NGO Partners for World Health).

Kuehnle welcomes the effort to persuade Kenya to invest more of its own money, which he says mirrors what USAID and the Centers for Disease Control and Prevention had pushed for years. But he warns that “the challenge that we always had was that we knew that even if we got the Kenyan government to agree to increase spending over time, fiscally that would be very difficult for them to actually do. I don’t think that has changed,” he said. (It’s worth noting that the agreement is, uh, non-binding.)

“I think that the Kenyan government signed this agreement out of desperation to guarantee funding for the next five years, and buy time in the hopes that their financial situation improves, or that there is a regime change in the U.S. that is open to renegotiating [the agreement] when it ends,” Kuehnle said.

As the agreement rolls out, Kuehnle points to a few key signals to watch.

For one, “the U.S. government currently does not have enough staff in Kenya to manage an [agreement] like this. Keep an eye on ... the amount of funding that actually moves.” And perhaps most importantly, Kuehnle raised the specter of the c-word that had constrained many of USAID’s earlier attempts to route money more directly through governments like Kenya’s: corruption. “I think many Kenyans outside of the Kenyan government do not believe that their government can be trusted to manage funds directly,” he said.

Preventable childhood deaths are increasing

For the first time in 25 years, childhood deaths from preventable diseases are rising globally, TIME magazine reports. (This is according to University of Washington researchers in the Gates Foundation’s annual report on global health.) All told, an additional 200,000 children under 5 are expected to die in 2025, bringing the total to about 4.8 million. (Disclosure: The Gates Foundation is a funder of Healthbeat).

To be clear, these are deaths that could have been entirely avoided “with vaccines or other [existing] treatments.” In the report (which can be downloaded here) Bill Gates himself puts this compound tragedy fairly succinctly: “There’s something especially devastating about a child dying of a disease we know how to prevent.”

Regular readers of the Global Health Checkup probably won’t be surprised by what is being fingered as the primary driver of this reversal: “significant cuts to spending in global health from the world’s largest donors.”

What’s the takeaway?

For one, it’s worth noting that the report largely presents this year’s rise in deaths as a short-term bump rather than a lasting reversal. Even without reversing the global cuts, the projections show child deaths falling again in most future scenarios, even as soon as next year. At the same time, the report warns that child survival is now more fragile than before, and that progress against preventable diseases can be increasingly pushed off course by shocks like conflict, climate disruption… or a further drop in funding.

Malaria is on an ominous path

The World Health Organization just published its yearly report on the global state of malaria, Euronews reports. (One note up front: Like the tuberculosis data we covered three weeks ago, WHO’s reporting speed is glacial, so the “2025” report only describes 2024.)

How was last year? Ominous.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

Even before this year’s aid cuts, malaria cases ticked up in 2024 over 3%, reaching an estimated 282 million total cases. Deaths also rose upward to 610,000 in 2024, with the majority being young children in “11 African countries.”

Malaria is one of the rare tropical diseases with a well-funded advocacy community and decades of scientific focus, so it’s worth asking, why we were losing ground last year?

There are really two answers, according to the WHO. One is rising resistance to malaria drugs and insecticides, and the other is a familiar foe, climate change, which is giving various mosquito species more places to survive and more months each year to spread the parasite.

My takeaway: Looking “forward” to this past year, malaria is the disease I’m most worried about on the continent I call home. That’s because malaria moves fast (the incubation period is tiny), and once you let off the brakes, or conditions shift, cases can explode. As we covered in early October, in places like Cameroon, aid agencies are already saying the clock has rolled back 20 years due to the aid pullback. If we were already losing ground, the worst may still be ahead.

Exit ebola, enter cholera

It’s been a week of whiplash in the Democratic Republic of the Congo. As we reported last week, the country announced the end of the Ebola outbreak on Dec. 1. But UNICEF, the U.N. Children’s agency, just confirmed that DRC is now contending with its worst cholera outbreak in 25 years, Reuters reports.

Just by the numbers, there’s been more than 64,000 cases and roughly 1,888 deaths since the start of the year. But one, smaller line hit me particularly hard: “In one case, a quarter of the children in a Kinshasa orphanage … died days after the disease swept through.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The conditions driving this disaster are painfully familiar: “Only 43% of people in Congo have access to at least basic water services [like basic plumbing or just treated water], the lowest rate in Africa, and just 15% use basic sanitation,” like toilets or sanitized latrines. Combine that with ongoing conflict, displacement, overcrowding, and crumbling infrastructure, and cholera is spreading through many communities with ease. Unsurprisingly, UNICEF is calling for “more funding” to help contain the crisis, which is unlikely to come unless it is diverted from elsewhere.

The takeaway: It is encouraging to see what the world can do when it focuses on a threat like Ebola. But if that focus is built on rerouting and draining support from other crises, and if the plan for this cholera outbreak also just moves money from one emergency to the next … it’s hard to celebrate a system that’s only moving the danger around.

Expert advice from Scandinavians on winter darkness

Admittedly some tough news in today’s report, so let’s end with something light. With the solstice around the corner, the Associated Press published a story that sums up advice from Nordic health professionals on coping with winter darkness.

As far as I could tell, the advice seemed sound: You should get morning light, keep your routines, stay social, and lean into winter. That said, there’s a famous adage in journalism on the importance of verifying whatever anyone tells you, even from trusted sources: It’s “if your mother says she loves you, check it out.”

So I passed on the article to three close Scandinavian friends of mine for, uh, let’s call it fact checking. I asked them to be unvarnished, and boy were they!

Generally, my Nords concurred with the AP. Ragnar, a Norwegian-Swede, stressed just how central the cultural value of coziness (“hygge”) really is for managing the enduring dark, along with a steady drumbeat of holiday festivals and “small cozy moments and traditions,” he said. Although … he noted that a certain triumvirate of important and traditional Scandinavian winter staples was entirely missing in the AP story. That’s alcohol, caffeine, and salty Christmas food. But “I’m not sure if these are the best tips to put into a global health newsletter,” he acknowledged.

Miriam, a Swede, challenged the central premise of the article. “I’m not sure we, as a population, know how to deal with the winter darkness,” she said. “Yeah, we do a lot of things, but also a lot of people just go depressed.”

But my favorite takeaways came from Théo (also Swedish) who wrote to me from Kuala Lumpur, Malaysia. “My best remedy for managing Nordic winters is not living there,” he said.

He also took umbrage with one particular line in the AP story. “The saying ‘there’s no such thing as bad weather — only bad clothing’ is a scam invented to force preschool kids to play outside even in the rain and freezing cold,” he said, channeling what sounded like a long-held grievance. “Ice on the sidewalk and horizontal rain mixed with snow 100 % qualifies as bad weather.”

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.

How the Global Fund might cover a $6.7B shortfall in donations

2025-12-04T12:00:00+00:00

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Hello from Nairobi.

This week’s edition has an unexpected through-line. Several stories reveal how the global health system is preparing for a long season of austerity: from staff cuts at the World Health Organization, to a disappointing funding cycle for AIDS, tuberculosis and malaria control, to functioning drugs being abandoned over limited profit prospects. I’m trying to follow where bold pivots are being made, or where tough decisions are just being avoided.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The big fundraiser with small donor energy

Since we’ve last checked in, the Global Fund wrapped up its odd, tri-yearly fundraising conference. (I’ve previously described it as “the part telethon, part diplomatic speed-date,” which decides how much money the fund will actually have to work with.)

So how did it go?

Not great. Health Policy Watch reports that the conference ended with $11.3 billion, a full third short of its $18 billion goal. That’s also more than a quarter less money than the fund received in the previous cycle. While not exactly a worst-case scenario, the shortfall is a shocking drop for one of the central institutions in global health.

A bit of context: The Global Fund is a massive, 23-year-old organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria in more than 100 countries. It sits at the center of the global push against all three diseases. For example, about 60% of all international financing for malaria control still moves through this one institution.

There’s plenty of blame to spread around, but the drop is largely a reflection of a pullback from the fund’s largest historical donors. The UK cut its contribution by 15%, Germany by 23%, Canada by 16%, and Japan by more than half. But by far the largest hit comes from the United States, which went from $6 billion last cycle to $4.6 billion this time, a 23% drop. (France and the European Union are TBD; they didn’t pledge in the conference.)

There’s a lot to be said about the impact this shortfall will have on real lives and real illnesses, which we’ve covered before. But for now I’m left wondering: Is there any path forward that isn’t just … doing less with less money?

I reached out to Janeen Madan Keller, the global health policy deputy director at the Center for Global Development (which is a leading global development think tank) about this shortfall and what the fund should do now.

Keller and her colleagues have written a policy paper about just this, where they “propose a new funding model that protects grants for the poorest countries and provides loans to wealthier countries,” she says.

One advantage of their proposal is that it “helps shield the poorest countries from funding cuts, and the reflows from these loans provide a financial cushion for the Global Fund, making it less reliant on donors as the sole source of funding,” Keller says. It’s a bold path forward that could help the Global Fund survive a long winter of donor austerity.

In a blog accompanying the paper, Keller and her colleagues note that “a combined grant and loan model at the Global Fund could generate up to $1 billion each year in new financing by 2033 without reducing grants to the poorest countries.” That would be roughly enough to reset the organization’s finances back to its last funding cycle.

Still, the approach would leave some tough questions to be answered. “Would middle-income countries … borrow for health?” Keller and her colleagues ask.

Rising toll in Ethiopia’s first Marburg virus outbreak

Since we last checked, the death toll from the Marburg outbreak in southern Ethiopia has climbed to eight confirmed fatalities, with a total of 12 lab-confirmed infections (including the dead), the African Press Agency reports. Ethiopian authorities say that while only four patients remain under treatment, almost 400 contacts have been traced and monitored.

It is a grim but unsurprising escalation for the Ebola-like virus, which has no vaccine and kills over 90% of untreated patients. What’s the takeaway?

Honestly, it’s not really possible to distill from these numbers whether we are seeing an unrivaled success, a fumbling failure, or something in between. Even a sharp dip in reported cases in coming weeks might signal control … or just a widening blind spot. Still, officials insist field teams are moving quickly. But it’s just too early to assess how well the contact tracing and containment efforts are working.

Hope lies in the fact that Monday marked the official end of the Ebola outbreak (!) in the Democratic Republic of the Congo, a victory I’m choosing to read as evidence that the international community can muster the resources and urgency needed to respond effectively in Ethiopia.

Bird flu’s pandemic potential

The medical director of one of Europe’s top labs for studying flu and other airborne viruses — France’s Institut Pasteur respiratory infections center — has just raised a public warning about bird flu, Reuters reports.

Marie-Anne Rameix-Welti says the ongoing bird flu epidemic, which is tearing through bird populations globally, carries the very real risk of evolving human-to-human transmission. That shift could spark a global outbreak “potentially even more severe than the [Covid-19] pandemic we experienced,” she warns.

Right now, the virus remains largely confined to birds with only rare spillovers into humans. For example, while Washington state reported a case last month, it was the first in the United States since February.

The danger in bird flu lies in the fact that humans have no immunity to either of the major strains, which are H5N1 and H5N5. (The H and N numbers refer to the shape of two important proteins on the outside of the virus.) “People have antibodies against common H1 and H3 seasonal flu, but none against the H5 bird flu affecting birds and mammals, like they had none against Covid-19,” Rameix-Welti says.

The good news? Researchers say the odds of that evolutionary leap, as best we can estimate, are small. And the last pandemic dramatically improved our preparedness. Compared to Covid-19, “we have specific preventative measures in place. We have vaccine candidates ready and know how to manufacture them quickly ... we also have stocks of targeted antivirals that, in principle, would be effective against this avian influenza virus,” she says.

WHO to cut a quarter of its workforce

I’ve worked in international development long enough to hear plenty of moaning about the slow, recursive bureaucracies of the United Nations and the WHO (and yes, about the U.S. Agency for International Development, as well). And after a decade inside a government machine, my inner libertarian has learned to trust most complaints about inefficient or downright dysfunctional systems.

That said, I have to offer a small mea culpa.

Since starting the Global Health Checkup, I’ve gained a profound appreciation for just how much the WHO quietly holds together. From the big stuff, like detecting and containing disease outbreaks or moving supplies for global health crises, all the way down to the quotidian work of publishing the data and guidelines everyone else relies on.

But that brings us to The Guardian’s reporting that the WHO is preparing to cut roughly a quarter of its global workforce.

Is there any silver lining here? In theory, any contraction can sharpen priorities and make an institution more efficient. Sometimes a budget squeeze is the only thing that forces real reform.

But it’s impossible to read this report and come away thinking the outcome will be a net positive — or that it’s being managed in a thoughtful, strategic manner. The cuts fall heaviest on global and Africa-based staff: the very people who run surveillance systems, support ministries of health, and coordinate emergency responses when things go sideways.

As one expert told The Guardian: “Now, more than ever, WHO needs a clear, strategic vision to navigate its new fiscal reality. Instead, these cuts are aimed at global and Africa-based staff, at a time when WHO should be doubling down on its global work ... The loss of expertise will leave the world less healthy and less safe.”

A cure in search of a company

This week Science magazine reports a bizarre twist in the hunt for a new dengue drug.

The story starts two years ago, when a new antiviral called “mosnodenvir” was pushed into several rounds of clinical testing by its maker, Johnson & Johnson. Last week, the results from those trials were published in The New England Journal of Medicine. They showed astonishing results in preventing infection in two groups: purposefully exposed volunteers and close contacts of confirmed dengue cases.

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. Three vaccines exist for the disease, but no treatments.

Lest you think I’m setting up a neat, hopeful ending for this week’s report … think again.

Johnson & Johnson walked away from the drug last year, shutting down its entire infectious-disease division just as the data turned promising. Part of the reason: “The profit potential for dengue treatments is limited.”

What makes this move especially frustrating is that while dengue already has three vaccines, all are constrained in different ways. One has been discontinued, another can’t meet global demand, and the third is limited to Brazil and only recently approved.

And the new trial data indicated that mosnodenvir could work as a very early treatment, a therapy that dengue has never had.

Still, there may be hope that another pharma company could buy up the drug and continue testing. As Anna Durbin, the infectious disease specialist at Johns Hopkins University who led one of the studies, put it: “There is a market, and I think there will be a company that picks it up.”

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.

How to climate-proof the world’s health systems: Brazil offers a roadmap.

2025-11-20T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The approach of the Thanksgiving holiday is a delightful reminder of just how wildly enterprising Kenyans are. Cranberry sauce and pecans? On the supermarket shelves! Orange pumpkins? Sweet potatoes? A close-enough local fowl called the kienyeji turkey? All at the market right now!

(If you don’t understand my excitement, you may need to endure a few chicken-and-potato holidays before you really appreciate these things.)

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Global climate talks meet health crises

The United Nation’s Climate Change Conference is wrapping up this week in Belém, Brazil, a city at the mouth of the Amazon. Last year was the hottest in our species’ recorded history (again!), so as you might imagine… there is plenty to discuss.

Which is why it’s especially striking that global health policy (generally) and the surge of yellow fever and dengue cases across Amazon-adjacent countries (specifically) found its way onto the main agenda. In fact, the organizers designated Nov. 13 as the conference’s first ever “Health Day.”

As a rule, I try to steer clear of stories that amount to “UN bureaucrats invent a theme day to juice visibility.” But I am making an exception here, because this wasn’t just theater.

As The Guardian reports, the conference and the government of Brazil released an action plan to “help countries … deal with climate-fueled health issues” and a 100+ page roadmap on how to implement that plan. This marks the most serious the international community has ever been about proactively addressing climate change as a force that scrambles global health systems.

The authors (including leading researchers from eight universities) spell out the scale of the issue in a way that’s impossible to ignore. “Climate change is one of the most urgent global health challenges of the 21st century,” they write. “Nearly half the world’s population … live in highly climate-vulnerable contexts, and about 1 in 12 of the world’s 200,000 hospitals faces the risk of total shutdown from extreme weather under high-emissions scenarios.”

What does this mean in practice … and how should we read these recommendations during a moment when global health investments are retracting at their fastest pace in a century? I reached out to Dr. Kristie Ebi at the University of Washington, one of the world’s foremost experts on the health risks of climate change, to help break it down.

The heart of the roadmap is not a list of shiny new, expensive programs. Instead, it is a dramatically unsexy push to make health systems more flexible and more anticipatory.

For example, the authors outline for countries how to structurally reinforce their hospitals and overhaul the power, water, and other systems that keep them running, so they don’t buckle during heat waves or floods. They also spell out how to link climate and health data and train a workforce that can catch climate-driven risks before they spiral. As Ebi noted, “climate change remains relatively new for most ministries of health, with limited internal expertise,” which makes even the basic work of adding climate data to surveillance harder than it looks.

The most difficult part of the plan, Ebi noted, is the future-facing analysis it demands. Plenty of countries have reviewed how climate change could hurt their health systems, but many still don’t have the tools to actually predict what those risks will look like in the years ahead. And that gap is not academic. If a given country’s ministry/department of health cannot anticipate how heat, rainfall, supply chains, or migration will shift over the next decade, they are basically driving without headlights. The roadmap is trying to force a shift away from emergency response and toward planning for the risks that are already coming into view.

And then, of course, there is the money question. Yes, this work is coming at an inopportune financial moment. But the report is blunt that costs will rise sharply the longer countries wait. And Ebi is clear that this is not optional.

“Nearly everywhere experienced extreme weather ... often with devastating consequences. Increasing preparedness to these events will save lives,” she said.

A second cholera vaccine?

Some good news this week: South Africa has begun clinical trials for the first cholera vaccine to be manufactured on the continent, South Africa’s Sunday Times reports.

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The trials are a joint effort between Biovac, a local pharma firm, and the South African government. To be clear, this is not the first vaccine of its kind. A firm called EuBiologics in South Korea makes the only other cholera vaccine. Two doses of that vaccine protect about 70% of recipients for about two years, but … there’s not enough of the vaccine to meet demand.

This shortfall comes as cases rise globally, fueled by overlapping climate shocks and conflicts. It’s a squeeze that Health Policy Watch says “has severely constrained the global supply of cholera vaccines, leading to rationing and global shortages.”

Africa is the hardest hit. The continent is going through the worst cholera outbreak in a quarter-century, with cases surging in countries as disparate as Sudan, Burundi, and Angola, Al Jazeera reports. So this new vaccine is timely.

That said, let me be a realist/downer for a moment. Clinical trials usually move through three phases, and this is only the first one. (Phase 1 is where researchers check basic safety, not even whether the vaccine, uh, stops cholera.) Only about 10% of vaccines make it out of this early stage, but because this is not some brand-new medical advancement, the odds here are likely much higher. Still, there is a long, unsure road ahead.

But the upside is real. Even just myopically, shoring up the cholera vaccine supply will save tens of thousands of lives. But what South Africa is doing here is bigger than one product. During (and immediately after) the pandemic, many multinational pharma companies announced various expansion plans to manufacture drugs or tests on the Africa continent, with many of those plans scaled back since.

Today’s news shows that, just maybe, durable manufacturing gains will come from homegrown institutions.

Marburg virus in humanity’s cradle

Ethiopia has just confirmed its first ever outbreak of Marburg virus after nine suspected hemorrhagic fever cases in the country’s southwest were sent for testing this week, Bloomberg reports.

Disease breakdown: Marburg virus is functionally Ebola’s first cousin. A very similar high-fatality fever that often leads to hemorrhaging and organ failure. Untreated, about 9 in 10 people who contract the disease will die. The disease exists endemically in bats, allowing it to spread and occasionally spill over into humans. While this is Ethiopia’s first record of the disease, the World Health Organization says the strain matches those seen in past regional flare-ups. There is, unfortunately, no vaccine.

The epicenter of this new outbreak is a town called Jinka, which I last visited in 2022. It is one of the most fascinating places I have ever been. It sits in a region where some of the earliest hominid fossils have been unearthed, and where dozens of strikingly unique Indigenous communities live in close proximity. The town itself is the gateway to the Mago and Omo National Parks, themselves part of a wider UNESCO World Heritage Site because of the extraordinary cultural and ecological diversity. Most relevantly here, I remember the Indigenous peoples’ access to even basic government services being shockingly poor.

The latest news is that containment is underway, and that Ethiopia is reportedly “moving rapidly.” (Although it’s worth noting that the Ethiopian government has its hands full with various other conflicts and crises … some of them directly of Prime Minister Abiy’s own making.)

Here are my biggest questions right now:

Will the outbreak stay limited to this initial cluster, or spiral? As with the Ebola outbreak still wrapping up in the Democratic Republic of the Congo, will emergency appeals for funding be enough? Finally, without a vaccine to provide a robust buffer, how effective will contact tracing and containment be in such an underdeveloped area?

Mind the funding gap, part 2

A month ago, we followed some UK political drama about British donations to the Global Fund: the massive, 23-year-old organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria in more than 100 countries.

Back then, the rumor was that the UK, under Prime Minister Keir Starmer, was mulling a 20% cut in the country’s £1 billion pledge. Now it’s been announced that the UK will instead commit £850 million (over $1.1 billion) for the next funding cycle, representing a roughly 15% reduction, The Guardian reports.

While not as bad as the rumors, this is a bit of a gut punch for a few reasons.

First, Starmer’s party is ostensibly the pro-foreign aid face of the UK. (The opposition Conservative Party has promised to further reduce all foreign aid by another two-thirds when next in power.) The fear is that this reduction eases the geopolitical pressure on other leaders. “There is a danger that this drop in its pledge will lead to reductions in other donor commitments, with real risks for people’s lives,” says John Plastow, executive director at Frontline Aids, a global partnership.

Secondly, while the £850 million pledge is still enormous by any standard, the impact of any cut will be directly measured in lives. Per the Guardian article: A previous study showed that “a 20% cut to the overall Global Fund would result in 330,000 additional deaths by 2040 from malaria alone,” let alone the impact on HIV and tuberculosis cases, as the “fund provides 59% of international financing for malaria.” And with malaria cases now surging again in places like Myanmar, after years of decline, the risks of even a modest funding pullback look even starker, the Financial Times reports. (Sorry, paywall.)

It’s still too early to say how this will impact the total funding picture. I’ll be following up next month after the Global Fund closes its “replenishment conference,” the part telethon, part diplomatic speed-date that decides how much money the fund will actually have to work with.

Tuberculosis declined in 2024. Good thing nothing has happened since.

In the fight against tuberculosis, we finally brought a reversal of the pandemic-era spike that interrupted decades of steady declines. New cases fell by about 2%, Euronews reports .

(Why the rise in the first place? The tuberculosis researchers and modelers I’ve spoken with largely blame that Covid-era spike on people increasingly staying indoors — where tuberculosis spreads more easily — and on a diagnostic choke point. Basically: During the pandemic, if you had a bad cough, you got tested for Covid, and if the test came back negative, you were basically told congratulations rather than being screened for something else.)

Unfortunately I can’t, in good conscience, appreciate this as the good news story it should be. Blame the WHO’s reporting bureaucracy or the glacial pace at which governments release their health data, but our global tuberculosis picture is always about 12 months out of date. And this year was a doozy!

Tuberculosis is especially exposed to this year’s global funding crunch, and today’s report warns that “cuts from wealthy countries could lead to up to 2 million additional deaths from [tuberculosis] and 10 million new illnesses over the next decade.”

My read: In all likelihood, the progress we’re seeing in last year’s data has already slipped away in the year since.

We’re off next week, so see you in December!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Who in the world will get access to new weight-loss pills?

2025-11-13T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week’s stories zigzag across global health: money chasing weight loss, the heartbreak behind a potential Ebola victory, governments stuck on repeat, and scientists quietly pushing the boundaries of what medicine can conquer. Still, think I’m missing something big? Email me!

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The risk of slimmer margins

An economic gold rush is rippling through global health, and it’s powered by GLP-1 weight-loss drugs.

In just the past week, Reuters reports that pharma giant Eli Lilly’s injectable GLP-1 weight-loss drug Mounjaro became India’s top-selling drug, overtaking antibiotics that have long dominated the market. At the same time, the corporation announced a new, $3 billion plant in the Netherlands to mass-produce a new pill form of the drug, a sign that the market is expected to grow significantly faster than existing factories can keep up. (The Financial Times has an excellent story on the scientific and economic race to make these new pills; I have a syndicated, non-paywalled link here.)

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. Essentially, the medicine signals fullness to your brain and slows down digestion. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

My big question here: Is this a zero-sum boom?

Global health aid is shrinking, so as factories ramp up to make billions of GLP-1 pills, are they pulling resources away from other essential medicines? I reached out to Prashant Yadav at the Council on Foreign Relations, who is one of the foremost authorities on global drug manufacturing.

There is indeed a drug-shortage risk, says Yadav, albeit a narrow one. To understand why this is, first you have to know two things about GLP-1 drugs, and what makes the pills different from injectables.

First: Unlike say, aspirin, GLP-1 drugs don’t just require cooking up inert chemicals in a lab. Instead, as part of their manufacturing process, they involve corralling living creatures. In particular, coaxing a genetically tweaked beer yeast — yes, this is true! — to produce molecules. Importantly, this is also how insulin is made.

Second: The pills require a lot more of the active compound than the injection. About three to four times more, says Yadav. The reason why isn’t complicated … it’s basically because your gut destroys most of what you swallow.

Combine these factors, and you could get a classic market squeeze: limited manufacturing capacity chasing the highest profit margin. “This shift could ultimately put pressure on the global insulin supply, particularly in developing countries,” Yadav says.

But Yadav says I’m missing the bigger issue. Shortages are not a sure thing, but the fight over who gets access to these drugs is already here. About two-thirds of the world’s 1 billion obese adults live outside the developed world, and Yadav says the real question is whether or how people in “India, Mexico, Nigeria, South Africa, the Philippines, and other countries” with sizable obese populations will get these same medicines.

And as the new pills are deployed, that’s where to watch.

A window into the Ebola outbreak

We’ve been following the Ebola outbreak in the Democratic Republic of the Congo, where just a few days after our last check-in, the World Health Organization declared that responders discharged a (potentially) final patient.

That restarted the official countdown (42 days, which is twice the incubation period of the virus) for the outbreak to be declared over. Materially, not much has changed since our last update, which Dr. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health, called “promising and precarious.” Promising, because the speed and effectiveness of the response bucked the worst-case fears that we’d lost the money and muscle to contain such a crisis. And precarious because, as I wrote then, we’re relying on a new world of “reactive, one-off appeals that pull resources from other crises” rather than steady support.

Why the update? Because The Guardian just published a deeply reported snapshot of what that response looked like up close, largely told through one man’s story. The piece is worth the full read: For me, it transformed an abstract story about case counts and funding gaps into a vivid, human window into the outbreak.

I’ll try not to ruin the story, but it follows Bope Mpona Héritier, an Ebola survivor from the remote village of Bulape who “lost his wife, daughter and mother” before realizing he was infected, too. Inside his isolation tent, Héritier remembers, “there were three other patients. I watched them all die, one by one.”

It’s heartbreaking, of course. But what stood out most was how the story reveals what responders actually mean when they talk about the challenges of vaccinating, tracing, and operating in “hard to reach” areas … and how that same isolation became a quiet blessing in slowing the spread. “It took some of us four days to reach Bulape from the capital, Kinshasa, because we had to cross forests,” recalls Chiara Montaldo of Médecins Sans Frontières. (For reference: These locations are only about 430 miles apart, about the same distance between Chicago and Atlanta, or Paris and Berlin). And “we had to bring everything from outside, including medicines, materials for building tents, and water decontamination supplies.”

The price tag to preempt the next pandemic

I don’t know about you, but I loathe talking about the Covid-19 pandemic. For me, the topic dredges memories of isolation and social distancing, anxiety, and those mean little nasal swabs … and ultimately still getting walloped by the virus three times. (Honestly, I usually try to change the subject when it comes up.)

So I find it a little odd that this next story — which starts with the upsetting news that scientists estimate there’s roughly a 50-50 chance the world will face another global pandemic in the next 25 years — is actually rather empowering.

Writing in Vox, Stephanie Psaki, who served as the first U.S. coordinator for global health security under the Biden administration, argues that the next pandemic isn’t by any means inevitable. In fact, “scientific and medical advances have made it possible to detect, treat, and stop the pathogens most likely to sweep across continents and cause widespread death” in perpetuity within the next 10 years, she says.

Psaki does not float this flippantly. In a long but impressively methodical essay, she lays out exactly what’s needed over the next decade: The steps to reduce the odds of a virus ever jumping from animals to humans. Then how to build the kind of global surveillance and rapid diagnostic capacity that can catch outbreaks early. And how we can use existing tech to develop vaccine and drug platforms that can be tailored to a new pathogen within weeks.

What makes Psaki’s argument so striking is its practicality and specificity. She even gives a price tag.

“Conservatively … $30 billion annually” over a decade could be enough, she writes, “to take the top pandemic threats off the table.”

Bangladesh’s annual dengue lesson, still unlearned

Bangladesh is months into a crisis of dengue virus, one that health experts warned in October was “worsening rapidly with infections and deaths climbing sharply across the country.” They cautioned the disease could spiral if urgent and coordinated mosquito control efforts were not launched. That spiral now appears to be happening, the WHO reports.

Disease breakdown: Dengue is a millennia-old mosquito-born 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.

To put today’s crisis in perspective: Dengue cases in Bangladesh are tracking close to the country’s devastating 2022 and 2024 outbreaks, which were the second and third worst years on record. It’s still not nearly as catastrophic as the record-setting 2023 epidemic (which had four times more cases than any other year on record) but hospitals are once again overwhelmed as the virus spreads beyond the capital city Dhaka into rural districts.

The question: Why is this happening again?

You can place part of the blame on warmer temperatures and heavier monsoon rains, which are both intensified by climate change and are expanding the mosquito breeding seasons. You can also lay blame on newly endemic mosquito species. But in an absolutely blistering op-ed in Bangladesh’s independent newspaper New Age, political columnist M.A. Hossain argues the real cause isn’t nature, it’s political negligence.

He accuses local authorities of repeating the same cycle of inaction every year: slow mosquito control, poor drainage, and a lack of political accountability until the crisis peaks. His essay lands less as commentary and more as an open-handed scolding.

In his words, “mosquitoes have become symbols of our administrative failure.” Hossain writes that despite years of warnings, “city authorities act only when the situation turns dire,” and that the government’s seasonal clean-up drives have become “a yearly ritual of denial and blame.”

His conclusion: “Dengue has not defeated us. We have defeated ourselves by refusing to learn.”

Immune system, meet self-control

We’ll end the week with something genuinely promising. The Associated Press just published a pair of powerful stories on autoimmune diseases: the broad, 100+ family of poorly understood conditions caused when the body begins attacking itself. That family includes lupus, type-1 diabetes, multiple sclerosis, and rheumatoid arthritis. Like the Ebola coverage earlier, the AP reporting really zooms in on the lived experience of people navigating those illnesses.

Why is this hopeful? Because, as New York University Langone rheumatologist Dr. Amit Saxena put it, “this is probably the most exciting time that we’ve ever had to be in autoimmunity” research.

As the story reports, researchers are using new tools and “discoveries from cancer research and the Covid-19 pandemic” vaccines to decoding the wiring “behind these debilitating illnesses.” While some treatments are moving faster than others, researchers are increasingly uncovering links between diseases once thought unrelated and testing new ways to bolster the immune system.

One such experimental treatment retrains immune cells instead of merely suppressing them, and is called CAR-T therapy. How it works is wild: Researchers extract a patient’s immune cells, splice the cells’ DNA to add a new gene that helps them recognize a specific threat, and then infuse them back into the body by the millions. “The first lupus patient was treated in Germany [with CAR-T therapy] in March 2021 and remains in drug-free remission, the researchers said last month.”

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.

Why mpox is persisting around the world

2025-11-06T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The short rainy season has settled over the Kenyan highlands, and the orchids and vanilla vines in my back yard are fully in bloom. (After a decade, I think I’m finally used to “seasons” being marked by precipitation, rather than temperature.)

A little warning here: This week’s report doesn’t shy away from the heavy stuff — a virus on the move, a heating planet, and a worsening war — but it ends with two hopeful breakthroughs in the fight against drug-resistant disease. So stick around.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Mpox’s next act

The World Health Organization has announced a new tangle of worrying trends for the viral infection mpox. First up, cases are on the rise with over 44,000 detected infections this year. And a new, faster-spreading strain has just been discovered in locations including Malaysia, Namibia, Italy, the Netherlands, Portugal, Spain, and my home state of California, The Guardian reports.

To complicate things, all this comes as we are exiting a major outbreak of the disease, which crested and broke in 2022 and 2023. So what exactly do all these new reports mean? Are we moving backward, or seeing something else entirely?

Disease breakdown: Mpox (formerly known as monkeypox) is a virus first detected in the 1950s in lab monkeys in Denmark. The first known human case occurred in the 1970s in central Africa, and for about 50 years the virus quietly circulated on the continent through contact with infected animals. That changed in this decade, when in 2022 a strain of the virus made an evolutionary leap, and started spreading through physical and sexual contact between people. The mpox illness can cause flu-like symptoms and pus-filled lesions, and in a minority of cases, death. Luckily, an effective vaccine exists!

I reached out to Dr. Michael Marks, a researcher at the London School of Hygiene & Tropical Medicine to understand how to digest this news.

The first thing Marks explained is that the appearance of mpox in new places or new countries isn’t all that unexpected, even with a brand-new strain in the mix. This is partly because close-contact transmission thrives especially well in “sexual networks where there are multiple partners and rapid partner change,” he said. In practice, that’s meant mpox will continue to spread in fits and starts, erupting when it leaps to a new network. (Especially among networks of gay and bisexual men, who remain most at risk purely from behavioral factors.)

While the 2022–23 outbreak largely subsided due to vaccinations and community awareness, Marks says the virus never really went away, and “mpox continued to be transmitted at low levels.” Moving forward, “we’ll likely have ongoing transmission in many countries, with periodic outbreaks when mpox reaches a new susceptible community,” Marks explains.

What should you know about the newest strain?

As Healthbeat has reported, it’s called clade 1b, and it’s a potentially deadlier branch of the virus, which has independently evolved the same trick as the 2022 strain, spreading efficiently from person to person. Scientists say the risk of that combination (higher severity and better transmission) is what has them worried.

The takeaway? For most people, the risk remains low. But if you’re in networks where hookups are frequent and partners change often, there is an increasing risk of catching and spreading the virus.

Looking forward, Marks was blunt about our long-term outlook. “Elimination isn’t meaningfully on the cards,” he said. The virus survives in wild animals, and there’s little appetite or funding for the mass vaccination it would take to entirely stop it. “Mpox isn’t going away [so] we need to move from a mindset of ‘there’s an outbreak’ to ‘this is an ongoing, persistent issue that needs a sustained response.’”

That response, he said, will hinge on vaccination, the best tool by far.

Planet with a fever

The world just logged its first year above 1.5 °C of warming, and the health toll is catching up. That is, according to TIME magazine’s report on The Lancet Countdown, an annual global assessment that tracks how climate change is affecting human health.

How bad is it?

Not great. “Twelve of the 20 indicators for the health risks and impacts of climate change in the report set concerning new records.” For example, last year the average human being experienced 16 more dangerously hot days than would have occurred without climate change.

Most stark: That heat is now driving a 63% rise in annual heat deaths since the 1990s, killing roughly 546,000 people each year. That’s more than one person every minute. “The health impacts caused by our changing climate have reached unprecedented levels that cannot be ignored.”

The research team also warns that the world is tracking toward “2.7°C of heating by the end of the century — if not more — and emissions keep rising,” which would be a catastrophe well past what human systems can adapt to.

But there are bright spots. “One thing that’s often overlooked is just how much progress even limited climate action has already achieved in terms of saving lives,” the report’s lead author, Dr. Marina Romanello, told me. For example, “the shift away from coal in high-income countries between 2010 and 2022 is estimated to have prevented around 160,000 premature deaths each year from air pollution.”

“These stories of success and solutions deserve more attention,” she adds. “They show that climate action is not only possible, but already underway — with enormous health benefits.”

Hospital falls under attack in Sudan’s overlooked war

I’ll level with you, readers. I’m flagging this next story not just for its health angle, but because it deserves far more international attention than it’s getting.

As background: Sudan’s civil war, well into its second year, is pitting the country’s armed forces against a powerful paramilitary group called the Rapid Support Forces. Throughout the conflict, the fighting has been marked by mass displacement, starvation, and widespread civilian killings and human rights abuses. All of this is happening with no end in sight, and zero international appetite to forcefully intervene on behalf of civilians. But while the conflict has been ongoing for years, several foreign correspondents who cover Sudan have told me this week that even they’re alarmed at how fast things are unraveling, and how sharply the death toll is rising.

This leads us to our story: On Thursday, the WHO announced that “the last functioning hospital in the Sudanese city of al-Fashir was raided, and hundreds are feared to have been killed there after a paramilitary force overran the city,” Reuters reports. The death toll for the hospital has been reported as high as 430 people, with additional medical workers being held for ransom. The destruction has effectively obliterated the region’s final lifeline for trauma care. On Monday, the International Criminal Court announced it is probing these reports.

It’s a horrifying report. If this story leaves you with anything, let it be a reason to pay attention. Sudan’s crisis is deepening while the world effectively looks away. Maybe awareness alone will not be enough, but it’s the smallest act that still matters.

This virus is on our side

On to decidedly cheerier news.

A research team led by Dr. Loren Miller of Harbor-UCLA Medical Center has just shown that bacteria-hunting viruses (known as bacteriophages) can help treat deadly bloodstream infections caused by Staphylococcus aureus, an organism notoriously resistant to antibiotics, Reuters reports.

The trial was on 42 patients, all of whom were given antibiotics. Two-thirds were also “treated intravenously with a ‘cocktail’ of [bacteriophage] viruses.” The study showed that the virally infected patients had fewer relapses, shorter stays in intensive care, and quicker recovery. While this is not the first time bacteriophages have been used in clinical trials, Miller says the trial serves as a “potential paradigm shift in how we treat antibiotic-resistant infections.”

(It’s worth noting that the study was a “phase II clinical trial,” which means it’s still early in the testing process. Phase II trials usually involve a relatively small group of patients and are designed to see if a treatment seems to work and is safe enough to keep studying. It’s a crucial step, but not final proof.)

Still, if this approach succeeds in larger trials, it could meaningfully extend the lifespan of our current antibiotic arsenal and provide a new weapon in the fight against multidrug‐resistant bacteria.

For once, I’m on team virus.

Antibiotics in the dirt

In even stranger multidrug‐resistant bacteria news: Scientists just dug up a new, powerful antibiotic … quite literally.

The journal Nature reports that a research team at the University of Warwick in the UK discovered a breakthrough while studying a soil bacteria called Streptomyces coelicolor (which is famous for churning out a well-known antibiotic.)

When the scientists looked at one of the bacteria’s unfinished chemicals, which is produced midway through making its usual antibiotic, they found something shocking: That new compound obliterated otherwise drug-resistant bacteria at microscopic doses.

The scientists (who could have conceivably unearthed a better name) are calling this novel compound “premethylenomycin C lactone.”

For now, the researchers don’t even know how this stuff works, only that it does. “We still don’t really know where it targets. We think it targets the cell wall in some way,” says Lona Alkhalaf, a chemical biologist with the research team. Next up is tests to see whether it’s safe for human cells and continuing research for how to make it in bulk.

Who knew? The next great medicine might not come from good old-fashioned mud.

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.

Polio can still be eliminated – it just may take longer with $1.7B shortfall

2025-10-30T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

Winter may be coming elsewhere ... but certainly not here! I’m nursing a sunburn from a warm weekend getaway and a long swim in a spring-fed river with my toddler. (She’s fine; I dipped her in sunscreen like a SPF-50 Achilles.)

This week’s report brings a few stories that buck the fear that, as the tide of global health financing recedes, we’re headed for the worst possible outcomes. Still, if you think I’m missing the takeaway, or just spotted a story I should have, let me know: wherkewitz@healthbeat.org.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Polio vs. the clock

There’s big news in the decades-long fight to wipe polio from the planet. First the bad: the Global Polio Eradication Initiative’s budget is shrinking by 30% starting next year, purely due to global health budgets tightening. All told, that’s a $1.7 billion shortfall through 2029.

The good news? Officials say the cuts aren’t a death knell. Global elimination remains in sight, even if it will take longer to reach, Reuters reports.

Disease breakdown: Polio, or poliomyelitis, is a gut virus that spreads largely through feces. While most infections pass without symptoms, the worst cases can wither limbs or invade the spinal cord to cause paralysis or death. Importantly, the disease can’t hide in animals, and vaccines stop it cold. That’s why although polio is ancient enough to have been carved into Egyptian hieroglyphs, today we are on the verge of its eradication. In fact, two strains of the virus were eliminated in 1999 and 2020, and only two more remain.

I reached out to Steven Lauwerier, director of UNICEF’s polio eradication team (note: UNICEF works under the World Health Organization on the global effort) to understand how to digest this news.

First, while “the cuts are serious,” Lauwerier says, he makes it clear that the new game plan isn’t just kicking the deadline down the road. The Global Polio Eradication Initiative is taking a genuine effort to do more with less: to squeeze out inefficiencies in existing programs, stretch out vaccine supplies with smaller doses, merge vaccination drives with other programs like Gavi, and refocus on the few places where the virus still hides. (My take, not Lauwerier’s: Anyone who’s worked with the bureaucratic shoggoth that is the WHO knows that there are efficiencies out there to be claimed, so it’s excellent that the polio campaign is taking the challenge so seriously.)

As for timing, the last wild strain of the virus (still hanging on in Afghanistan and Pakistan) is now expected to be stopped by 2027, a year later than planned. Meanwhile a strain of the virus that bubbled up from earlier vaccine drives, and which is largely pocketed across the African continent, now has a new 2029 target.

Lauwerier notes that one of the biggest challenges is the “wild polio virus in Afghanistan, where we are not allowed to do house-to-house campaigns,” he says. That’s because of a ban under Taliban rule, which is a lingering consequence of the CIA’s 2011 fake polio vaccine plot to find Osama bin Laden in neighboring Pakistan.

Still, Lauwerier reminds me that the initiative has “had bigger challenges in the past and [has] shown that we can overcome them.” He notes incredible progress fighting polio in the Democratic Republic of the Congo, Madagascar, and hard to reach communities across south eastern Africa. “If we can do it there, we can do it everywhere.”

The heartening takeaway? “Eradication is still fully achievable,” he says. “We will go full speed until we reach interruption everywhere.”

Bird flu, big in Europe

Bird flu is sweeping across Europe. Outbreaks have hit 10 European Union countries plus Britain since August, including major poultry producers Poland, Spain, and Germany. It’s the widest early spread of this disease in a decade.

Disease breakdown: Bird flu is a cousin of human influenza, also known as H5N1. (The H and N numbers refer to the shape of two important proteins on the outside of the virus.) Bird flu spreads largely through bird droppings and is usually fatal in poultry. It usually peaks in autumn and winter in the Northern Hemisphere because that’s when migratory birds carrying the virus arrive along ancient flyways from the Arctic to Africa. The virus mostly stays bird-bound, with crowded poultry farms especially vulnerable. (They are proverbially, and sometimes literally, sitting ducks.) The virus will also occasionally jump to mammals, including humans.

Nowhere is the alarm louder than in Germany. Daily Finland reports that bird flu has been confirmed in wild birds across all but one of 16 German states. According to the article, “more than 200,000 chickens, geese, ducks, and turkeys have been culled … in order to contain the spread of the disease.” While this is still just a 10th of the culling that happened during the worst-ever 2020 outbreak, German Agriculture Minister Alois Rainer noted, “This is not unusual for this time of year.”

And the outbreaks are not just in Europe. Healthbeat Atlanta reports the state of Georgia has confirmed its fifth outbreak this year. And the New York Times reports elsewhere across the United States — where “the virus has affected more than 180 million farmed birds” since 2022 — cases are likewise surging. Worse still, so far “three states … have identified outbreaks in dairy cows.”

What’s the takeaway? Bird flu used to largely be a winter problem. Now it’s showing up earlier each year and in more species, slowly blurring the line between outbreaks from wild flocks and commercial farms. And while the virus hasn’t yet evolved to spread between humans, that leap remains one of the biggest worries for the next pandemic.

A 20/20 future for Fiji

The World Health Organization has officially declared Fiji free of trachoma, which is the leading infectious cause of blindness, Fiji’s Islands Business reports. It’s a victory decades in the making that relied on a long chain of partnerships, including between local nongovernmental organizations like Project Heaven and international efforts such as the former U.S. Agency for International Development-funded Global Trachoma Mapping Project.

Disease breakdown: Trachoma is an infection caused by the chlamydia trachomatis bacteria. It spreads through direct contact with eye and nose discharge, and largely in places with poor water and sanitation. It’s found in 31 countries and is responsible for blindness or visual impairment in about 1.9 million people. That’s because repeated infections scar the eyelid until lashes turn inward and scrape the eye.

Why does eliminating one disease on one tiny island country make the cut this week? (... Other than my desperate attempt to sneak in some good news in a field that, let’s face it, can often be a bit of a bummer.)

Fiji’s trachoma victory, like the progress on polio, is a reminder that international funding and global commitments can be rolling back even as dedicated heroes refuse to let that stop them. Both stories are long-tail wins born of decades of patient coordination and community work. They’re also proof that the systems built by the old global health order are still out there, saving lives.

Following Senegal’s Rift Valley Fever fight

We’ve been following Senegal’s worst outbreak in decades of Rift Valley Fever. Since my last update on Oct. 16, reported cases have more than doubled, and the government has rolled out a nationwide campaign, SciDev.net reports. (A reminder: Rift Valley Fever is largely a mosquito-borne livestock disease, which occasionally spills over into humans, as it’s doing now.) This outbreak is slowly building to what we expected it might become, as I wrote, “a test of how well these national and regional health systems can respond during the global health funding crunch.”

Senegal is taking this extremely seriously. The nationwide campaign has brought “together ministries of health, agriculture, environment, and water resources,” to conduct disease surveillance, mosquito control, livestock vaccination, and a public advisory campaign in various local languages. (Senegal is home to more than 30 languages and dialects.)

I have lots of questions: I’m curious about funding, about the efficacy of this coordinated push, and about what happens beyond Senegal’s borders. Remember, the outbreak cuts through a livestock corridor shared with Mauritania and Mali, which are behind Senegal in development and their outbreak response capacity. Will those countries match Senegal’s urgency, and will international organizations step in to help?

We’ll follow up once there’s concrete evidence on how this all plays out.

The high cost of cutting malaria aid

Last week we covered a bit of political drama on fundraising for The Global Fund, which is the massive organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria. Over the weekend, a new analysis put hard numbers on what those shortfalls might actually mean, The Guardian reports.

According to researchers from the inter-governmental body the African Leaders Malaria Alliance and the nonprofit Malaria No More, a 20% funding cut to the Global Fund could lead to 33 million extra malaria cases, 82,000 malaria deaths, and roughly $5 billion in lost GDP across sub-Saharan Africa by 2030. This effect is particularly severe because The Global Fund “provides nearly 60% of all international financing for malaria controls, such as mosquito nets and preventive drugs.”

The researchers also modeled a total funding collapse scenario, and the toll would be staggering:

“The report estimates there would be 525 million more cases, 990,000 more deaths, and $83 billion in lost GDP. About 750,000 of those deaths would be of children under 5, representing ‘the loss of a generation to malaria’, the report’s authors warned.”

To be clear, there is zero reporting that an apocalyptic collapse in malaria funding is coming. Heck, I’m going on record: It’s not coming. But as countries start to turn down their pledges (the UK is rumored to be considering a 20% cut) this report makes clear the stakes. We’ll follow up at the end of November, when The Global Fund’s public pledging conference wraps up to see where we’ve landed.

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.

Deadly cough syrup brings reckoning for India pharma oversight

2025-10-23T11:00:00+00:00

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Hello from Nairobi.

We’re coming off a weekend bookended by public holidays with two very different tones. On Friday, Kenyans marked a day of mourning for the sudden death of Raila Odinga, the opposition candidate in the last election. (Small branches were tucked away in car grills across the city, a mourning ritual I’ve never seen before.) And Monday brought Mashujaa Day, a celebration honoring those who fought heroically for Kenya’s independence.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

India’s drug safety reckoning

A new tragedy is testing global trust in India, the “pharmacy of the world,” where a fifth of all generic drugs and well over half of all vaccines are manufactured.

It’s a complicated story that’s still unfolding, so let me catch you up quickly: At least two dozen children in India have died since early October after taking a locally made cough syrup laced with a toxic industrial solvent. The deaths triggered a World Health Organization alert and renewed scrutiny of India’s pharmaceutical industry, where weak oversight and cheap, poisonous substitutes caused similar cough syrup poisonings in recent years. (Including killing at least 68 children in Uzbekistan and 70 in The Gambia from 2022 to 2023.)

In response, the federal government of India has demanded that all drug manufacturers upgrade their plants to meet WHO standards by the end of the year, rejecting pleas from smaller factories for more time, India’s Business Standard reports.

What’s the context here, and how worried should the rest of the world be?

I reached out to Prashant Yadav, a senior fellow on the Council on Foreign Relations and arguably the world’s foremost expert on health care manufacturing and supply chains, to break it down.

What’s really on trial here isn’t just one company or one product, but India’s entire drug oversight system. “As India’s pharma industry grew substantially in the last three decades, becoming the leading exporter of generic medicines worldwide, the regulatory system struggled to keep pace,” Yadav said. The problem is structural, because India’s drug oversight is divided between the central and state governments. The weaker state regulators license and inspect factories, while the central authority decides which new drugs are safe to approve.

“In a federal democracy, this division of power can create diffuse accountability and regulatory capture by state politics,” he said. (After all, what state official wants to be known for shutting down local factories and eliminating jobs?)

Yadav applauds the government’s new reforms as “a significant step. However, its success will depend on the government’s enforcement capacity, an area that has historically been quite weak.” Some of Yadav’s big remaining questions are: Will regulators receive the resources to actually enforce new standards? Will smaller firms receive government financing to upgrade their equipment and stay in business? Time will tell.

Importantly, the trade group representing the country’s largest drug manufacturers — the Indian Pharmaceutical Alliance — isn’t pushing back on the reforms. “This is an important moment of reflection and renewal for India’s pharmaceutical industry,” Anita Gokral, the group’s senior communications adviser, told me. She called the changes “a regulatory correction and modernization, not a crisis.”

Skepticism about this industry’s motivations is fair, but it’s worth acknowledging that mass, affordable generic drugs from India remain one of the greatest contributions to global public health in the last half-century.

How does this ripple beyond India? While these changes could shake up India’s domestic industry, Yadav said that the impact on global supply chains will likely be limited. The largest exporters already meet international standards. Some smaller manufacturers (where most of the problems lie) may struggle or shut down. But in the long run that could be a good thing. Importers will shift to safer producers, he said, and the result could be a stronger, more trustworthy pharmacy of the world.

The latest report on severe hunger

A new report from the World Food Programme warns that roughly 13.7 million people are at risk of severe hunger across Afghanistan, the Democratic Republic of the Congo, Haiti, Somalia, South Sudan, and Sudan, Reuters reports.

The reason, in short, is that food aid funding is drying up. The UN agency says it’s working with 40% less funding this year (just $6.4 billion, compared to $10 billion last year), forcing ration cuts even in the hungriest corners of the planet. (A U.S. State Department source confirmed to me that in some of these countries, people in the highest category of famine-like conditions are receiving less than a full ration of emergency food.)

It’s a brutal reversal, and I don’t think most taxpayers in the Western countries that are slashing aid realize the scale and scope of the death that we’re courting. (I wrote about this in an Op-Ed for the New York Times a few months ago.)

If you’re asking why this is a global health story, let me relay what countless humanitarian colleagues have told me over the years: Hunger itself actually rarely kills in famine situations, but it opens the door for everything else that does. Malnutrition weakens immune systems, leaving children and adults alike far more vulnerable to diseases like cholera and malaria, or just simple bacterial or viral infections that become deadly.

In humanitarian terms, food is medicine.

Paging Dr. Pangolin

In a fascinating op-ed in STAT News, two global health and conservation researchers argue that climate change isn’t the only planetary crisis threatening human survival. Biodiversity loss is just as bad, and we’re barely talking about it.

The authors, Dr. Neil Vora and Dr. Chris Walzer, make a simple point: You can’t have healthy people on a dying planet. And it’s the very biomes and species that keep our air clean, our crops pollinated, and our pandemics in check that are perishing at record speed.

They bring receipts. “Earth’s biodiversity is vanishing at an astonishing pace. Over the past 50 years, the average size of wildlife populations declined by nearly 75%,” they write. Maybe I’m naive, but I was particularly shocked by their wild stat that 96% of all mammal biomass on Earth is now only us and our livestock (!). Wild mammals make up just the remaining 4%.

The op-ed, which is short and worth the full read, lists a few chain reactions. When bats die, farmers spray more pesticides, which raise infant mortality. When vultures disappear, rabies spreads through unburied carcasses. “For health professionals, this means that safeguarding biodiversity is not simply an environmental concern but a foundational element of preventive and clinical care,” they write.

Their takeaway? The health sector has (finally) woken up to climate change, but not yet to nature loss. Now is the time. “The implications for human health are profound.”

Mind the (funding) gap

There’s some political drama out of London I’d like to dive into … but it only makes sense if you first understand how the world’s biggest charity jar for fighting disease actually works. So, forgive me, but we’re taking a quick detour into the glamorous/riveting/high-octane world of … global health fundraising. (Just try to stay awake.)

Enter “the Global Fund.” It’s a massive, 23-year-old organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria in more than a hundred countries. (It credibly claims to have saved 70 million lives globally, to date.)

Every three years, the Global Fund enters what’s called a “replenishment phase,” when donor countries publicly attend a “replenishment conference” and pledge how much money they’ll chip in for the next funding cycle. Think of it as part telethon, part diplomatic speed-date, where the pledges are public and political. The next conference is in November, and the Global Fund is seeking to raise $18 billion.

Here’s the catch: These pledges are just promises. The ponying up comes later, and whether countries actually pay or quietly walk back their pledge is not guaranteed. (Looking at you, USA.) In theory, this setup is meant to guarantee a steady stream of funding so countries can plan ahead. In practice, at any given moment, it’s hard to tell who’s actually paying what to fight the world’s deadliest diseases.

Ok, still awake?

Here’s the news: The Guardian reports that UK Prime Minister Keir Starmer is under pressure not to cut Britain’s planned £1 billion (about $1.34 billion) contribution to the Global Fund, as rumors swirl that a 20% reduction is on the table. This is even as the UK co-chairs next month’s replenishment conference in South Africa. Germany just pledged €1 billion (about $1.17 billion) at the World Health Summit in Berlin, raising the stakes for Britain to keep pace.

What the UK decides here will offer one of the clearest snapshots of whether wealthy countries are still committed to funding the fight against the world’s deadliest diseases, or if that commitment is starting to fade. I’ll be following up.

Tuberculosis on course for a comeback

Our last story of the week comes straight from a new Harvard University press release, because no major outlet picked it up. That’s an absolute shame because it’s an important study about tuberculosis, the centuries-old disease that most of the Western world has seemingly tired of … but nevertheless remains the world’s deadliest infectious disease. Worse, tuberculosis is making a stark, unwelcome comeback as global funding evaporates.

Disease breakdown: Tuberculosis, or TB (it was also known as “consumption” until the late 1800s,) is a bacterial infection that damages the lungs and spreads through the air when someone coughs or sneezes. It’s slow-moving, stubborn, and extremely hard to treat. It’s able to lie dormant in lymph nodes in the body for years before turning deadly. Despite being curable with months of regular antibiotics, TB still kills over 1.3 million people every year.

A new study published in the scientific journal The Lancet Child & Adolescent Health warns that recent U.S. funding cuts to fighting tuberculosis could cause nearly 9 million new child tuberculosis cases and 1.5 million children’s deaths over the next decade.

The study is built around a mathematical model, which is basically an attempt to use the data we have now to project what the next decade could look like. While forecasting the future with precision is impossible (surprise!) it’s where the findings point that truly matters. To this end, the researcher’s model is largely in line with what two other research teams found earlier in the year.

What’s staggering is that even in the rosiest scenario, many countries across Africa and Southeast Asia will face such a sharp reversal in tuberculosis cases that it could take decades and billions of dollars just to return to where they were last year. “We could soon see more children dying of TB than we have for many decades,” warns Nicolas Menzies, a professor of global health at Harvard.

Two silver linings, if you can call them that: the first, from the press release, is that “the researchers estimated that 90% of the additional projected TB deaths could be avoided if funding was restored after just one year.” The second? Nations funding their own health systems like China, Brazil, and India (instead of relying on outside donors) are projected to stay the course.

I’ll see you all next week.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

A promising moment in Ebola outbreak, early flu surge, and a rise in life expectancy

2025-10-16T11:00:00+00:00

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Hello from Nairobi.

The sun is shining, and the jacarandas are shedding a purple rain of flowers all along my street. This week, I’m thrilled to share the news that the Global Health Checkup will now be available a day early, every Wednesday, to email subscribers.

You can sign up here.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Ebola update: signs of containment

We’ve been following the worrying Ebola outbreak in the Democratic Republic of the Congo. Our focus has been on how the World Health Organization, alongside partners like the Red Cross and Doctors Without Borders, have scrambled to contain the disease amid severe funding shortfalls. I want to know: Does the world still have the muscle to manage major health emergencies now that the U.S. Agency for International Development (defunct) and the U.S. Centers for Disease Control and Prevention (hobbled) are no longer footing most of the bill, as was true for past epidemics?

In my last update on Oct. 2, I noted that the WHO was sounding some fairly dire alarms: International donors had pledged less than a fourth of what was needed, and the outbreak had already “overwhelmed” health facilities at the epicenter of the crisis. Worrying signs, all.

So it’s a welcome bit of whiplash that the WHO now reports a “potential control of transmission,” which means that 10 days have passed without any newly reported Ebola cases, the Associated Press reports.

I’ll admit, after my last update I found this news surprising, and a good reason to check my priors! Could this be a sign that the American pullback is less crippling to global health than many feared? To get perspective, I reached out again to Dr. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health.

To start, Spiegel called the WHO’s report “encouraging,” although “it’s important to interpret it cautiously,” he said. “Ebola’s incubation period can extend up to 21 days, so a 10-day period without new cases suggests progress, but not definitive containment.”

(I also reached out to the Red Cross, and Fatou Mwaluke, a health coordinator in Kinshasa, tempered any rush to celebrate: “Surveillance teams are actively monitoring nearly 2,000 contacts, and several suspected cases remain under laboratory investigation,” she said, reminding me to avoid the temptation of conflating “delays in reporting and testing” with concrete success.)

Still, Spiegel says the progress “likely reflects effective surveillance, isolation, and community engagement,” all of which are vital but expensive to sustain in such a remote region. To me, this sounds like tentative proof that the WHO and partners like the Red Cross managed to rally new resources after sounding the alarm. And more importantly, that there may be still enough committed actors out there willing to step up, at least for this outbreak.

As for the broader takeaway for global health? Spiegel sees this moment as both promising and precarious. It may indicate “growing resilience” and “diversified global health partnerships,” in a post-American largesse world, but he noted “a structural vulnerability” in how the world pays for emergencies like this. After all, how secure can the system be if it depends on reactive, one-off appeals that pull resources from other crises rather than building lasting capacity?

In short: a promising pause, but not yet victory.

The early-bird flu

Time magazine reports that influenza is breaking tradition, spreading earlier than its usual season across Asia. (Worldwide, the flu is largely seasonal because the virus spreads more easily in cool, dry air, and when people spend more time indoors and close together.)

In Japan, officials declared a nationwide flu epidemic after cases skyrocketed five weeks earlier than usual. Schools and child care centers closed, and 60% of Japanese prefectures saw rising flu counts. “But it’s not just Japan. Flu cases have risen in recent weeks in other countries across the continent, including Singapore, Thailand, and India.”

It’s a long article, but the takeaway comes right at the top: The “surge of influenza cases … has led some medical experts to warn that getting sick more easily throughout the year may be the new reality.”

What’s driving the shift? Experts point to two converging pressures, with plenty of nerdy disagreement on which is the main cause. The first pressure is genetic: the slow evolutionary drift in flu viruses that help them adapt and circulate when there’s a new opportunity. Basically, the virus is evolving. The second pressure is climate change, where shifts in rainfall, increased indoor crowding during extreme weather, and changing seasonal habits in tropical regions may all be eroding the old boundaries of “flu season.”

I know what you’re thinking: If only there were a simple, once-a-year shot that could help prevent all this … oh wait.

Rift Valley Fever outbreak in Senegal

Senegal has confirmed over 100 cases and 17 deaths from an outbreak of Rift Valley Fever, in what officials are calling the “country’s worst in decades,” Africa News reports.

Disease breakdown: Rift Valley Fever is a centuries-old virus, best understood as a livestock disease that occasionally spills over into humans. It primarily affects herding animals, including cattle, goats, sheep, and camels. It spreads through mosquitos (or, occasionally, animal slaughter) and is largely isolated to Africa, the Arabian Peninsula, and some islands in the Indian Ocean. While the majority of cases in humans present as symptomless or as a flu-like fever, it can occasionally lead to coma, loss of vision, or fatal hemorrhaging.

What’s behind the outbreak? Officials are blaming “climate change … for creating ideal breeding conditions for mosquitoes,” with unusually heavy downpours in Northern Senegal followed by intense heat.

At first glance, this might sound like a fairly local story. But there’s more at stake here than meets the eye. The disease is a test for regional cooperation, as it threatens a rough triangle between northern Senegal, Mauritania, and Mali. For context, this is a dramatically underdeveloped region where herders, livestock, and trade routes constantly cross borders. (Underdeveloped may even be an understatement … Mauritania has been described to me as Earth’s own Tatooine.)

It’s an epidemic that’s worth watching closely. There’s an effective vaccine for livestock, but paying for it and deploying it across remote, nomadic, and resource-limited regions is another matter entirely. Like the Ebola story, this one could become a test of how well these national and regional health systems can respond during the global health funding crunch.

Thankfully, there is a bit of luck at play here. Over the weekend, Senegalese scientists confirmed that the current virus is nearly genetically identical to previous outbreaks, so the existing vaccines should work.

An uneven rise in life expectancy

It was a big weekend for the spreadsheet crowd. The Global Burden of Disease report came out, which is the most important recurring study in global health. It is basically the master dataset on what’s killing, sickening, and disabling people around the world, and why. (I imagine that epidemiologists view it publishing like the Coachella lineup dropping.)

The study is a mammoth effort, based on a network of over 16,500 scientists and more than 300,000 data sources. And this year’s edition offers the first true snapshot of health in a fully post-pandemic world. Some of the starkest findings come from the Americas.

According to El País, while global life expectancy has rebounded to record highs (76 years for women and 71 for men) across North and South America, deaths among people in their 20s and 30s have risen much more sharply. These deaths are largely driven by suicide, drug use, and alcoholism, which the researchers call “muertes por desesperación,” or “deaths of despair.”

The biggest increases were observed in the United States, Canada, Mexico, and Brazil, where deaths in the 25-to-29 age group have risen almost 32%, and 50% among people in their 30s (!).

What’s the takeaway? A little humility, to start. There are clearly political and social forces behind these numbers, but I’m internalizing this as a reminder: Progress in public health doesn’t move in a straight line. Even in the world’s wealthiest countries, as science pushes life expectancy higher, and infectious diseases retreat, social fractures and mental health crises are cutting lives short.

From health policy to ideology police

For decades, U.S. global health funding has come with political strings attached. The best known is officially called the “Mexico City Policy.” Under Republican presidents, it bars foreign NGOs that receive U.S. funding from offering, promoting, or even mentioning abortion services … even if they use their own money to do so. (Within USAID, we use to call it the “global gag rule.”)

In practice, it has historically forced clinics in dozens of countries to choose between keeping U.S. financial support or providing comprehensive reproductive health care. The rule is a kind of foreign-policy pendulum I watched swing back and forth during my time at USAID, rescinded under Democratic presidents and reinstated under Republicans, disrupting programs every few years.

Now, the Trump administration is reportedly pushing to extend this model beyond abortion, The Guardian reports. According to Politico, countries, UN agencies, and NGOs are being told to drop all diversity, equity, and inclusion programs or risk losing all funding. If implemented, it would mark the first time the United States has used its global health purse not just to restrict services, but to police ideology itself.

The takeaway? The potential consequences are enormous. As one source told The Guardian: “It risks causing real human suffering, undermining global health, and destabilizing decades of partnerships and progress.”

I’ll see you all next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Global Health Checkup: Chikungunya hits home, malaria’s comeback, and a vaccine for elephants

2025-10-09T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Lagos.

I’m in Nigeria this week for a conference with a British development project I’m working with. It’s my first time here, and I can confirm that the food is fiery, the traffic is legendary, and people dress to impress. Even more exciting: Lagos is to Afrobeat music what Nashville is to country music (the warm, pulsating heart), so I’m hoping to hear some live before I fly out.

The traffic in Abuja, Nigeria, was better than in Lagos, but of an entirely different species.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Chikungunya: from the tropics to Times Square

This week a team of epidemiologists mapped the growing reach of chikungunya virus in the science journal BMJ Global Health, which now threatens up to 35 million people worldwide, The Times of India reports.

Disease breakdown: Chikungunya is a virus first identified in Tanzania in the 1950s and is spread by mosquitoes. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

If you’ve never heard of this disease, that’s likely because most cases of chikungunya remain in India, Brazil, and Indonesia. But the virus is increasingly spreading beyond the tropics. China is now seeing its worst outbreak on record, while Italy and France are fighting surges of their own. And last week, a Long Island woman tested positive despite not having traveled abroad. If confirmed, that would be the first local transmission in New York.

What’s going on here? I spoke with Dr. Marietjie Venter, an animal-borne virus researcher at the University of the Witwatersrand, in South Africa. We talked about why chikungunya is spreading, and what this means.

She said the main issue at play is that mosquitoes are moving. The Asian tiger mosquito (Aedes albopictus) and the yellow fever mosquito (Aedes aegypti) are the main carriers of the disease. Both have expanded their range dramatically, surviving in places once thought too cold. This comes as humans unwittingly ferry mosquito species across continents and (uh, wittingly) warm the global climate.

“At this stage, chikungunya is really about long-term management rather than eradication,” Venter said. “Once Aedes aegypti or Aedes albopictus mosquitoes establish themselves in an area warm enough for them to survive the winter, it becomes extremely difficult to eliminate them.”

Venter also says that unless we stop warming the planet, today’s situation shouldn’t be seen as a high-water mark for chikungunya, but the new normal. And just as outbreaks are spreading through southern Italy and France, the same could soon happen across the southern United States, where both invasive mosquito species have taken hold. “It’s not something to panic about, but it is something to be aware of,” she said.

Malaria’s comeback in Cameroon

Reuters has a report this week on the death of a 9-month-old boy in northern Cameroon. He’s one of a growing number of malaria fatalities that local officials and aid workers are directly linking to the U.S. pullback in foreign assistance. The story is heartbreaking but straightforward:

“Before the cuts, Mohamat might have been diagnosed earlier by one of more than 2,000 U.S.-funded community health workers who would travel over rough dirt roads to reach the region’s remotest villages … [but] nearly all of the U.S.-funded community health workers are now out of service.”

The core issue is that the Trump administration has cut funding for America’s malaria-fighting program, the President’s Malaria Initiative, by nearly half from recent levels of about $800 million a year. This program once paid the stipends and supplied the drugs for the community health workers reaching families like Mohamat’s. In the story, officials warn that northern Cameroon’s malaria fatality rate may have already erased a decade of progress. It’s worth noting that although U.S. funding cuts triggered this crisis, Cameroon’s government (which earns billions from oil and other exports, but ranks as one of the most corrupt in the world) has failed to step up and provide these basic medical services.

As I wrote two weeks ago, the U.S. government insists its new “America First” health strategy will still reduce malaria cases and deaths, but it doesn’t say how. Ultimately strategies, goals, and promises mean little if the math doesn’t work. For perspective, from 2010 to 2023, the United States contributed roughly 37% of all global malaria funding, according to the World Health Organization. Halving that support while promising the same outcome — without explaining how — seems like magical thinking.

Something’s in the air

We tend to think of air pollution risk in terms of lung damage, like asthma or lung cancer. But The Guardian reports that a new global review of studies across 11 countries has found a strong link between long-term exposure to polluted air and an increased risk of “frailty” in middle and older age. The researchers define “frailty” as a clinical state marked by reduced strength, slowness, and a lower ability to recover from illness.

Context: The type of study here matters a lot. Health reporting has long struggled with how to cover single studies, which can sometimes overstate results or show false findings. That’s not necessarily because of fraud or bad science, but simply because when thousands of studies are run, a few will produce statistical outliers that look exciting by chance alone. It’s how you end up with whiplash headlines: “Coffee/chocolate/wine linked to cancer,” and “Coffee/chocolate/wine shown to prevent cancer.” You know the ones I mean.

But this isn’t a single study. This new review is a “meta-analysis,” meaning it’s a synthesis of data from dozens of studies. That gives it more statistical weight and helps pin down patterns that would be impossible to prove on a case-by-case basis, but hold up across different populations.

What’s the takeaway? The correlation was relevant for developing and richer countries alike, even wealthy countries like the UK. “Since frailty can be reversible,” one independent researcher notes, reducing pollution now isn’t just about preventing disease, it’s about preserving quality of life, “extend[ing] years of independence, and eas[ing] the strain on health and social services,” for millions globally.

Growing drug-resistant infections in newborns

Australian researchers are sounding the alarm on a disturbing rise in drug-resistant infections in newborns across South and Southeast Asia, Newsweek reports. In many cases, standard antibiotics fail, leaving doctors scrambling to treat babies with dwindling options. The story highlights hospitals in India, Bangladesh, and Nepal where “neonatal sepsis” (essentially blood poisoning) is caused by resistant bacteria.

The report links several drivers: overuse of broad-spectrum antibiotics (some given even in advance of any illness), weak infection control in hospitals, and a lack of diagnostic labs to guide medication decisions. In one hospital, a newborn unit saw a strain of bacteria (Klebsiella pneumoniae) resistant to a class of last-resort antibiotics. These infections quickly escalate in fragile newborns whose immune systems barely exist.

What’s the takeaway? “Antibiotic resistance spreads across borders,” one researcher warned. While chikungunya or malaria might never touch most readers directly, drug-resistant infections are increasingly likely to. Once resistance takes hold, there’s no rewinding it, and slowing it down will require serious global cooperation and accountability. Moving forward also means another kind of investment, the researchers say. “With so few new drug candidates in the pipeline, we need a significant investment in antibiotic development.”

Finally, some good elephant news

It’s welcome (if not a bit Dr. Seussian) news this week: Scientists in the UK have trailed the first vaccine in elephants, the BBC reports. The vaccine protects the animals from a deadly virus, called elephant endotheliotropic herpesvirus. The illness is reportedly the largest disease risk for Asian elephants, enough so that “seven baby elephants have died of it over the last decade,” at the Chester Zoo in the UK, where the drug trials took place on six individuals.

Last year, a Houston Zoo elephant received an experimental version of a similar vaccine, which is based on the mRNA vaccine advancements that led to the Covid vaccines. But this marks the first proper trial. (Now, you can almost hear the voiceover: “Ask your zookeeper if Tuskaris is right for you.”)

In all seriousness, this is a rare piece of hopeful science, and not just for a species under siege. Just as mRNA vaccines this decade pushed the boundaries of how quickly we can design and test human vaccines, this work shows how far those advances are spreading — to new tools and new species. It’s also a small but meaningful step toward using modern medicine to help endangered animals fight their own battles to survive.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Deal to lower price for new HIV prevention shot is ‘huge moment of hope’ in global health

2025-10-02T11:00:00+00:00

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Hello from Nairobi.

The short seasonal rains have returned, bringing a very welcome, cooling afternoon drizzle. Before we jump in, please enjoy this bizarre and wonderfully thematic painting my spouse just snagged at an U.S. Embassy warehouse auction. (It was sold with a pile of old medical devices, including defibrillators.) We understand it once hung in the embassy medical unit … though I don’t remember seeing it, and we’re puzzling over the Tanzanian flags.

My spouse snagged this painting at a U.S. Embassy warehouse auction.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A shot at ending HIV?

Earlier this year, a new injectable drug to prevent HIV infection called Lenacapavir was approved by both the World Health Organization and the U.S. Food and Drug Administration. It was hailed as a breakthrough in HIV prevention due to its near-perfect trial results and the fact that it offers protection for six months at a time. The catch? Its maker, Gilead Sciences, set the U.S. price at $28,000 per person per year. That’s 700 times more expensive than PrEP, the widely available, daily oral pill, which costs about $40 annually.

But a newly announced landmark deal all but eliminates the price barrier, the BBC reports. By 2027, Lenacapavir will be manufactured as a generic drug in India, and sold for about $40 per person per year across 120 low- and middle-income countries.

Is the news as good as it seems? I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition. We dove into what Lenacapavir means for the global fight against HIV, and where the gap still lies between having a better drug and actually injecting it into the abdomens of the people who need it.

For the most part, Warren says the celebration is warranted. Taking a pill every day still carries stigma in many communities and relies on daily adherence. A twice-yearly injection clears both barriers, making Lenacapavir a clear winner on the efficacy front. “I hope people come away understanding that this is a huge moment of hope and aspiration,” he says.

Still, the current architecture of the global HIV response depends heavily on the United States, which purchases more than 90% of preventative oral pills through its flagship HIV program, PEPFAR, the President’s Emergency Plan for AIDS Relief. Under the Trump administration, PEPFAR has signaled plans to reduce its footprint, narrowing its role to training health workers and procuring drugs and other medical commodities. While this still preserves a potential revenue stream to buy cheaper Lenacapavir, Warren cautions that “procurement is critical, health workers are critical — but they are not sufficient.”

“We have to be very clear that it’s not a miracle drug, and it doesn’t deliver itself,” Warren says. Key to the success of PrEP (which still only reaches 18% of at-risk people) is “demand amongst people who are potentially at risk of HIV, but are not thinking about HIV.”

There are big questions yet to be answered. “We’re talking about delivering an injectable product to people that are otherwise healthy in health systems that are already overburdened. These are not patients, they’re not sick. They don’t want to go to an HIV clinic, so what’s [the approach]? Will pharmacies be able to deliver this? Will community health workers be able to deliver this?” Warren asks.

Still, Warren returns to focus on optimism. “In the midst of lots of hand-wringing and disbelief about what’s happening in the dismantling of the global health architecture, this is an opportunity to lean in and actually do the right thing. It’s a huge opportunity, it’s a huge responsibility, and it’s something that we mustn’t squander.”

Free? Yes. Nutritious? Maybe

Indonesia’s nationwide school lunch program has been rocked by repeated outbreaks of food poisoning, Tempo, one of Indonesia’s leading independent news outlets, reports.

Part of what’s astonishing here is the sheer scale. The country’s “Free Nutritious Meal program” was launched just this year and is a $28 billion initiative that’s planned to feed more than 80 million schoolchildren daily. (That’s roughly equal to the entire population of Germany.)

In the mad rush to scale the program as quickly as possible, the free school lunches have sickened 6,400 children — including 1,000 just last week, the BBC reports. The suspected cause: negligent food preparation, with “cooks to packers to delivery workers” now under investigation.

The context: Yes, this is in many ways a story about Indonesia. But zooming out, malnutrition remains the leading cause of health problems worldwide, and the world is badly off-track on most 2025 United Nations nutrition targets. School meal programs are one of the few solutions with proven, daily impact that can be funded domestically (not just by donors) and reach millions of kids at once. That is … if they don’t get you sick.

More on Ebola’s return to Central Africa

Preface: Last week I shared an Al Jazeera story on how the Democratic Republic of the Congo is facing the first outbreak of Ebola in three years. Dr. Paul Spiegel, director of Johns Hopkins’ Center for Humanitarian Health, told me he isn’t only watching the case and death numbers to see if the containment efforts are a success. He’s also watching whether the response can secure the funding it needs, given the global retreat in emergency health dollars.

How’s the response progressing? Troublingly, according to the Associated Press. It’s still too early to judge how effective the containment effort has been. But the WHO says the outbreak has already “overwhelmed” health facilities in the province at the epicenter of the crisis, with the only treatment center “already at 119% capacity.”

This is partly due to underwhelming fundraising (exactly what Spiegel told us to watch.) Of the “WHO’s projected cost of around $20 million to respond to the outbreak over the next three months,” the international community has pledged less than a fourth — only $4.3 million. It’s worth repeating that previous Ebola outbreaks in Congo benefited from the one-two punch of well-funded responses from the U.S. Agency for International Development and the U.S. Centers for Disease Control and Prevention. This time, local officials say the U.S. presence has dwindled to “some small support,” leaving containment efforts at risk unless new donors step in.

And the clock is ticking. Ebola demands enormous resources right at the outset of the outbreak (protective gear, vaccines, basic ambulances, and the footwork of paying thousands to trace contacts in some of the least developed parts of the world). Every delay gives the virus room to spread further out of control.

We’ll keep following this story.

The most ‘least important’ sandfly parasite

The arid northwest corner of Kenya, called Turkana County, has just declared a public health emergency after a surge in the world’s third-most-deadly parasitic disease, The Kenya Times reports.

Disease breakdown: Kala-azar, also known as visceral leishmaniasis (or, as a bit of a misnomer, as “black fever,”) is a parasite that’s passed by sandfly bites. It causes skin ulcers, fever, and liver damage, and is usually fatal if not treated within two years. It falls into the sad bucket of “neglected tropical diseases,” with no vaccine and very little new medical research devoted to treatments or prevention.

Kala-azar is an illness you’ve probably never heard about. It infects only around 1 million people a year, and unlike malaria, it has no billion-dollar advocacy machine or donor lobby behind it.

Why is this a top-five global health story? (No, it wasn’t just a slow week.) It’s the very smallness that makes it so big. A neglected disease with little outside funding is now testing whether a country like Kenya, which has one of the stronger health systems and economies in sub-Saharan Africa, can mobilize on its own when emergency strikes.

Officials are rushing to respond by detecting cases early, spraying insecticides against sandflies, and outreach with communities. But the backdrop is stark: While working at USAID, I flew into Lomekwi, a small town in Turkana County a year ago (our frightening “runway” was nothing more than a crumbling strip of gravel.) By the end of 2024, USAID was spending more on development programs in Turkana county than the county government itself. Most of that’s gone, which leaves me asking whether a system built on such lopsided outside support was ever sustainable. Or if that largess of development money sowed more harm than good, even before the pullout.

The takeaway: This outbreak is admittedly small, but worth watching. A year ago, foreign donors would likely have stepped in to tamp down the surge in this disease. Now, it’s Kenya’s move, and whether the country can mobilize its own resources for a neglected disease may set an important precedent. I’ll be keeping tabs.

Another pandemic is inevitable

In an Op-Ed in Time magazine, Dr. Seth Berkley warns that the world faces about “a 50% chance [that] another Covid-like magnitude of a pandemic … [hits] in the next 20 to 25 years,” with no guarantee the next one will be any less deadly. (Berkley is a former medical epidemiologist and served for 12 years as CEO of Gavi, the Vaccine Alliance.)

This is an essay worth reading in its entirety, so let me pull only a few quotes. Berkley makes the simple economic argument for the United States continuing to invest in global pandemic preparedness.

“The billions of dollars the U.S. annually spends on preventing a pandemic is a bargain compared to the tens of trillions it will cost in economic losses and expenses to extinguish a full-blown crisis.”

While he lays out how the current slashing in U.S. global health spending threatens this bargain, he points to a new, dramatic potential cut that I have to admit I wasn’t tracking. “The White House, in its funding request to Congress for Fiscal Year 2026, has called for the elimination of the Global Health Center,” an office in the CDC, Berkley writes.

What does this office do?

“For years, the GHC has had a presence in more than 60 countries (many of them low- and middle-income countries), leading efforts to combat diseases like polio, measles, HIV, tuberculosis, and neglected tropical diseases. It has helped those countries build stronger health systems and train experts to monitor, identify, and respond to disease outbreaks. And it coordinates with many other countries to respond to potential crises before they sweep across the globe.”

Any reason to be hopeful?

“There’s a small bit of good news: Congress is currently showing reluctance to dismantle global health programs. The Senate has already rejected proposed budget cuts, in some cases even increasing funding. The House of Representatives’ stance is mixed, but they are hesitant to approve deep cuts to State Department initiatives like Gavi.”

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.

Welcome to the Global Checkup: 5 health stories from around the world

2025-09-25T20:01:21+00:00

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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.