Healthbeat

Hantavirus cruise ship quarantine: 5 passengers sent to home quarantine, 13 remain in Nebraska facility

2026-06-01T23:21:17+00:00

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Five passengers from the hantavirus cruise ship have been allowed to leave a secure quarantine facility in Nebraska and continue being monitored at home, but 13 others remain at the secure facility, the U.S. Department of Health and Human Services told Healthbeat on Monday.

At least two of those released to home quarantine on Monday will be under around-the-clock monitoring and have been put under an official quarantine order, New York officials said.

Multiple media outlets have reported that federal officials had wanted to require that state health departments ensure a police officer or public health worker was stationed 24/7 outside each of the individuals’ homes. That is an unusual step that may stigmatize people who have shown no signs of infection.

Officials at HHS and the Centers for Disease Control and Prevention did not answer questions about why some passengers are being allowed to leave the facility after 21 days of a 42-day quarantine or why others are remaining inside a secure, institutionalized setting. Nor have they provided any public health or scientific basis for how potential risks from former passengers of the M/V Hondius are being managed.

The lack of transparency and inconsistency in the federal government’s approach to managing potential public health risks in the wake of a deadly outbreak of Andes hantavirus is drawing concern from legal experts and public health officials.

Testing so far has not found any of the U.S. passengers being held in quarantine to be infected with the virus.

“The administration is being quite secretive and arbitrary in its use of quarantine powers,” said Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University.

“Quarantining a person is a massive infringement of civil liberties and must be done using a clear and science-based process,” Gostin said Monday. “I do not think the administration is acting in a transparent or rational fashion.”

The 18 U.S. passengers from the cruise ship were evacuated last month to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha after three people who had been aboard an international nature cruise died from severe respiratory illness caused by an unusual type of hantavirus that has the potential for “limited” spread between people.

So far, health officials in multiple countries have identified 10 additional cases of Andes hantavirus among people who were among the nearly 150 passengers and crew aboard the ship, according to the World Health Organization’s latest update on May 28.

It’s unclear what the terms and conditions are for the five U.S. passengers who on Monday were allowed to leave the Nebraska facility, and whether federal health officials have issued any new or renewed federal quarantine orders to force any of the other passengers to remain in the facility.

Neither HHS nor the CDC would say. Officials at the University of Nebraska Medical Center also did not answer questions from Healthbeat.

“All five remain symptom-free and have met public health criteria to safely continue monitoring outside the NQU,” HHS said in an email to Healthbeat. The department did not respond to questions about what those criteria were.

Health workers in hazmat suits board the Dutch polar expedition cruise ship MV Hondius at a dock in Rotterdam. So far there have been 10 cases of the Andes hantavirus worldwide among about 150 passengers and crew. (Photo by Nicolas Economou/NurPhoto via Getty Images)

The five people being released to home quarantine will not travel on any commercial flights, HHS said. The department said “appropriate biocontainment measures are in place during transport,” but no details were released.

Once these five people are home, HHS said that state health departments will continue “daily symptom monitoring, maintain 24/7 oversight, and provide guidance throughout the remainder of the 42-day monitoring period.”

HHS officials did not answer questions about how the monitoring and oversight would be carried out.

“CDC encourages the public to support the people and families affected by this situation,” HHS said. “Public health monitoring is a precautionary measure that helps safeguard the health of potentially exposed individuals and protect communities.”

Two of the passengers beginning home quarantine have returned to their private residences in undisclosed locations outside of New York City, Dr. James McDonald, New York state health commissioner, said in a statement Monday afternoon. He said they will remain under “around-the-clock surveillance” and under a quarantine order.

A third New York passenger has chosen to complete the remaining 21 days of their quarantine in Nebraska, McDonald said.

Another Hondius passenger who has chosen to stay at the Nebraska facility is Jake Rosmarin, an Instagram content creator who switched from documenting sightseeing aboard the ship to documenting his time in quarantine.

“This whole experience has totally traumatized me,” Rosmarin said in a video posted Sunday to his Instagram account explaining why he’s choosing to stay at the National Quarantine Unit. “I’m afraid to leave this room until I know that I will not get sick. I do not want to leave here until I know that there is a 0% chance of me getting sick, a 0% chance of me risking my family and friends getting sick, or the general public getting sick.”

He said he also wants to be at a facility that can quickly treat him should he develop any symptoms of Andes virus before the quarantine period ends.

Rosmarin said the process that federal officials have set up to allow some Hondius passengers to leave the facility is complex and involves federal, state, and local authorities.

“The media is making it out to be much simpler than it actually is logistically to get people home to self isolate,” he said. “It is a really complicated process, and there’s a lot of factions that have to agree upon us going home to make that work.”

HHS noted that no cases of Andes virus have been confirmed in the United States. The risk to the public remains low, officials said.

The Andes virus is typically spread by rodents in South America, but has in some cases been able to spread from one infected person to another, according to the CDC. But this person-to-person spread usually requires close contact, such as having direct physical contact with the sick person, spending “prolonged” time in close or enclosed spaces, or being exposed to the infected person’s body fluids.

It can take between four and 42 days from when a person is exposed to the virus to when they start showing symptoms, such as fatigue, fever, achy muscles. People who are infected can become seriously ill with Hantavirus Pulmonary Syndrome. There is no specific treatment or vaccine. For those who are sickened, medical care focuses on managing symptoms.

Last month, the CDC issued federal quarantine orders to two of the 18 people being monitored at the Nebraska facility. Those orders were based on a disease list that does not include hantavirus.

The passengers had initially been “requested” to stay at the facility for testing and monitoring through May 31. When two of them began making arrangements to leave and quarantine at home, the CDC issued two federal quarantine orders against them, requiring that they stay in the facility.

CDC and HHS officials did not answer Healthbeat’s questions about the status of these quarantine orders.

Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health, called the approach to managing the U.S. passengers’ risk unusual and concerning.

“Every American should be concerned about the somewhat quixotic and a bit arbitrary approach that they have taken in dealing with these passengers,” Nuzzo said.

Nuzzo noted that some passengers who disembarked the Hondius cruise ship after the first passengers died but before health officials were aware of an outbreak, have been allowed to quarantine at home since their return to the United States.

“To tell some passengers you can’t leave Nebraska, and to tell other passengers it’s okay to be home, that doesn’t make any sense. There’s no public health rationale for that,” she said.

She also questioned why the federal quarantine orders were issued last month to two of the patients who sought to quarantine at home.

“I have not heard a single assertion that these patients don’t want to quarantine,” Nuzzo said.

“The general public health practice, the ethical practice, the historical practice is we impose measures by the least restrictive means necessary,” Nuzzo said. “Quarantining in facilities is not typical, and only done under extreme cases, usually because someone has refused to comply with other measures.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine orders are based on a disease list that doesn’t include hantavirus

2026-05-22T02:34:45+00:00

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The deadly hantavirus that has killed three passengers from a cruise ship does not appear on a key list that gives the Centers for Disease Control and Prevention its expansive detention powers, a public health law expert told Healthbeat. That means the federal quarantine orders the agency is using to detain two exposed passengers could face legal challenges.

At issue: Federal regulations only allow the CDC to quarantine people for specific “quarantinable communicable diseases” that are on a list created through presidential executive orders. The list includes a wide range of dangerous diseases: viral hemorrhagic fevers, infectious tuberculosis, measles, severe acute respiratory syndromes, and flu that can cause a pandemic.

However, no type of hantavirus is on this list.

The list can only be updated by presidential executive order, and President Donald Trump has not issued an order to add the deadly Andes hantavirus that has prompted worldwide concern.

Until this week, federal officials had requested, but not mandated, that 18 U.S. passengers from the M/V Hondius cruise ship undergo medical screening and observation at a Nebraska quarantine facility through May 31, which would be the 21st day of their monitoring period.

On Tuesday the CDC announced that it had issued federal quarantine orders to two of the passengers at the Nebraska facility, requiring that they stay until the monitoring period is over.

One of the passengers being held in Nebraska, Angela Perryman, has spoken publicly about receiving a quarantine order after making plans to leave the facility to continue voluntarily quarantining on her own. Perryman could not be reached.

James Hodge, Jr., director of the Center for Public Health Law & Policy at Arizona State University, told Healthbeat that he’s seen a copy of the CDC’s quarantine order. Federal health officials are using a broader category of disease placed on the list more than a decade ago to justify detaining the two passengers.

“Here’s what they’ve done: They are classifying hantavirus, the Andes strain, as a severe acute respiratory syndrome condition,” Hodge said. “That is a listed condition for which the CDC can actually quarantine.”

The Andes hantavirus, which is usually spread through contact with urine or droppings from rodents, can cause severe pulmonary symptoms. It is the only hantavirus that can also spread from person to person.

Hodge said he’s spoken to some medical experts who think it’s legitimate to classify the Andes hantavirus as a type of severe acute respiratory syndrome, but he noted that’s not typically how the term is applied.

“That’s going to be a real question,” Hodge said, “and it might be one for which we do see that quarantine order being significantly challenged.”

Officials at the CDC and the U.S. Department of Health and Human Services did not respond to questions from Healthbeat on Thursday.

Hodge said the CDC’s quarantine orders are relying on a July 2014 executive order issued by President Barack Obama that updated the list of quarantinable diseases to include a broadly defined category of “severe acute respiratory syndromes.”

The executive order defines these syndromes as “diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.”

The order specifies that this definition does not apply to influenza.

It’s unclear whether the executive order was intended to apply to diseases such as those caused by the Andes strain of hantavirus, which has shown the ability to spread from person to person for many years.

The Obama executive order was issued amid heightened concerns about outbreaks of MERS – Middle East respiratory syndrome – coronavirus.

Obama’s order amended an April 2003 executive order issued by President George W. Bush that added “Severe Acute Respiratory Syndrome (SARS)” to the quarantinable list. The SARS coronavirus emerged in China in 2002 and spread to 28 countries before the outbreak ended in 2003.

Given the broadly written definition of severe acute respiratory syndromes in the Obama order, Hodge said the CDC is seeking to make the case that the Andes hantavirus qualifies as a quarantinable disease.

But he said the passengers subject to this week’s quarantine orders also have the potential to make several arguments if they choose to challenge the orders in court, including that the virus wasn’t specified as a quarantinable disease. “I would be saying, you’ve never previously called hantavirus Andes strain a severe acute respiratory condition,” he said.

Hodge added that any uncertainty could be ended with an executive order adding the Andes virus to the quarantinable list. “President Trump could issue that order in the next five minutes and we’d be done here,” he said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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

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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

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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

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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.

Doctors warn of a deadly complication from measles outbreaks

2026-03-13T15:57:15+00:00

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The first sign came when Deepanwita Dasgupta was 5 and started stumbling more while playing at her home in Bangalore in southern India. The girl was always up to something, so her parents figured extra bumps and bruises were just symptoms of an active childhood. Maybe, they thought, it was ill-fitting shoes.

Relatives described the unicorn-loving child as smart, affectionate, and occasionally rascally. Before she learned the alphabet, she had figured out how to find her favorite show, “Blippi,” on a phone. She was known to sneak butter from the fridge to enjoy a few finger licks.

But then her limbs started jerking. A spinal tap revealed measles in her cerebrospinal fluid. The virus she probably had as an infant had secretly made its way to her brain. Now 8 years old, Deepanwita is paralyzed, unable to talk.

Measles causes complications — ranging from diarrhea to death — in 3 in 10 infected people, according to the Infectious Diseases Society of America. Some are immediate, while others take weeks or months to appear. The one Deepanwita is experiencing, subacute sclerosing panencephalitis, or SSPE, typically takes years to rear its head.

“People think, ‘Oh, you know, if we get measles, then we’ll be fine, because I know my neighbor had it and they’re fine,’” said Yasmin Khakoo, who leads the national Child Neurology Society but spoke to KFF Health News in her capacity as a New York City doctor with expertise in neurologic conditions.

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

Measles, though, can be dangerous: A 7-year-old in South Carolina will have to relearn how to walk after enduring one of the more immediate complications, brain swelling. And every so often, the virus plants a ticking time bomb in the nervous system. A person can recover from measles and continue life as usual, no longer contagious and without any identifiable symptoms — sometimes for a decade or more — before problems appear. While some patients end up severely disabled for a while, Khakoo said, the condition is almost always fatal.

Before the advent of widespread and effective vaccines, the complication occurred enough in the United States that in the 1960s a doctor created a national registry of SSPE patients. Researchers now estimate about 1 in 10,000 people who get measles will develop SSPE, but the risk is significantly higher for those who contract measles before age 5. Populous nations where the virus is endemic, including India, see cases routinely.

Now, doctors and researchers fear that as vaccination rates drop and measles spreads in the United States, cases of this debilitating complication will also rise here. Since the start of 2025, the Centers for Disease Control and Prevention has recorded over 3,500 measles cases — more than in the entire preceding decade — mostly people who were unvaccinated. Many were children. Last year, Connecticut doctors diagnosed a 6-year-old with SSPE, and in California, a school-age child who’d had measles as an infant died of it.

“We are likely to see SSPE cases going forward, especially if we don’t get this under control,” said Adam Ratner, a member of the American Academy of Pediatrics’ Committee on Infectious Diseases and author of the book "Booster Shots."

Concern about SSPE was great enough that in January, the Child Neurology Society published a video to educate U.S. clinicians about the condition, and doctors who have seen such cases are warning their peers.

“We don’t have a way of knowing who’s going to get it, and we don’t have a way of very effectively treating it,” said Aaron Nelson, a professor of neurology with the New York University Grossman School of Medicine. “The one best thing that we can do, ideally, is to prevent children from having to go through it in the first place.”

The recommended two-dose measles vaccine slashes an exposed person’s risk of getting the contagious virus from 90% to 3% — and thus reduces the chance of SSPE. The vaccines carry small risks of febrile seizure and a bleeding condition, but measles itself has a higher risk of causing both.

Researchers find some missed SSPE cases

A 2017 study of California children who developed SSPE after a measles outbreak there years ago determined that 1 case is diagnosed for about every 1,400 known cases of measles in children under age 5, and 1 for every 600 infected babies.

The researchers also found that, over the years, doctors had missed some cases among patients who had died with undiagnosed neurologic illness.

The possibility that future cases could go undiagnosed spurred Nava Yeganeh and her colleagues to publish a news release in September when a Los Angeles County child died of SSPE.

Deepanwita Dasgupta and her mother, Anindita Dasgupta, celebrate the child’s fifth birthday in 2022.

“We’ve had very few cases of measles in the last 25 years in this country,” said Yeganeh, who is the medical director with the Vaccine Preventable Disease Control Program at the Los Angeles County public health department and has had two patients with SSPE. “Unfortunately, that’s changing, and so we wanted to make sure that everyone was aware of this long-term complication.”

The California child who died had gotten measles as an infant, Yeganeh said, before the child could receive the vaccine. Measles is highly contagious, so at least 95% of the population must be immune to it to protect vulnerable people — including babies too young to vaccinate and people who are immunocompromised — from infection.

“This is an example of someone who did everything right, wanted to protect their child against this infection, and unfortunately ended up losing their child because we didn’t have herd immunity for them,” Yeganeh said.

Shortly after Yeganeh’s group published the news release in California, Nelson was working to get the word out, too.

He had recently seen a 5-year-old whose family had traveled to the United States for medical care after the child started stumbling, jerking, hallucinating about bugs and animals, and having seizures. The child had contracted measles as an infant and had been too young to be vaccinated. Nelson diagnosed the child with SSPE.

“Imagine that: Having a child who is healthy and happy, moving to talking less and less, eventually not able to walk,” Nelson said. “It’s a very sad thing.”

He thought he would encounter the condition only in medical school textbooks, as a relic of the past. Instead, in October he found himself presenting the case at the Child Neurology Society’s national conference and participating in the society’s video about the condition. “I’ve now seen something I shouldn’t have ideally seen ever in my career,” he said.

Warning signs come from India

Globally, the number of measles outbreaks has increased in recent years, and physicians in places including the U.K. and Italy have recently seen clusters of SSPE.

The high human cost of measles’ spread is especially evident in India. While total cases aren’t tracked, about 200 families caring for people with SSPE, including Deepanwita’s, are in a single chat group in the Bangalore area.

In New Delhi, Sheffali Gulati studies SSPE and sees about 10 new patients a year with the condition, what she calls the “delayed echo” of measles outbreaks. The youngest she has seen was 3 years old.

“The ages are coming down, and a death or a vegetative state can develop as soon as in six months to five years of onset,” said Gulati, who leads the pediatric neurology program at the All India Institute of Medical Sciences and until recently led India’s Association of Child Neurology.

Gulati hasn’t found any treatments that reverse SSPE’s course, only some that slow its progress. She’s found herself counseling parents: It’s catastrophic, it’s not their fault, and they can do nothing but accept it.

Deepanwita’s relatives try to find joy where they can. They think they noticed the girl smiling when her favorite cousin called recently. Anindita Dasgupta, her mother, said Deepanwita moves her hands and feet on her own and sometimes turns her head, especially when her father enters the room. The girl communicates with her parents through her eyes and a few sounds.

But it’s far from where she was in 2022: At a cousin’s birthday, a few months before noticeable symptoms started, Deepanwita started the birthday song and sang the loudest.

At her own 8th-birthday gathering last year, Deepanwita, wearing a pink eyelet dress and a nasal tube, could only blink and move her eyes as she sat propped up before two cakes that she would not be able to eat. She can no longer swallow, so her mom dabbed a bit of icing on her tongue.

‘The problem could be solved with vaccination’

Roberto Cattaneo, a molecular biologist at the Mayo Clinic in Rochester, Minnesota, has been studying SSPE for years. He recently used postmortem brain tissue to map how the measles virus can spread from the frontal cortex to colonize the entire brain. Still, he said it’s a “black box” what exactly measles is doing in those dormant years between the initial infection and when the symptoms of neurologic damage crop up.

It’s possible the virus replicates in the brain that whole time, undetected, killing off neurons. But with so many neurons in the human brain — 10 times as many as people living on the planet — the brain may find a way to adjust, Cattaneo said, until finally it can’t anymore.

He’s applying for funding to continue research on the disease and possible treatments, though ultimately, he wishes he didn’t have to. The tools to obliterate the condition already exist.

“The problem could be solved with vaccination,” Cattaneo said. The United States should have no cases of SSPE, he said. “It’s just painful.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

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

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

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

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.

NYC infectious disease experts prep for World Cup as ‘huge global migration event’ with 1.2M visitors

2026-02-13T18:39:37+00:00

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Health care professionals at the nation’s oldest hospital in New York City have been quietly preparing for an influx of soccer fans to come watch the 2026 FIFA World Cup this summer.

Such a large increase in visitors from around the world also raises the risk of imported infectious diseases – including “high-consequence” ones, or special pathogens that have high mortality rates, like Ebola or the Marburg virus.

That’s why doctors, nurses and others at NYC Health + Hospitals/Bellevue Hospital have been practicing elaborate drills that include actor patients and even chartered and commercial airplanes. As part of that broader preparation effort, some 500 health care professionals working at hospitals near the main World Cup venue in New Jersey have received training to ensure they’re ready to treat what comes.

“We’re training a lot,” said Dr. Vikramjit Mukherjee, an intensive care physician who is chief of critical care and the special pathogens program at Bellevue. “Through June, we’re going to the hospitals next to the MetLife stadium, where people will be more prone to present with symptoms, and making sure their front-end capabilities are ready.”

MetLife Stadium in East Rutherford, New Jersey, a venue that holds 82,500 spectators, will host eight World Cup matches starting June 13, including the championship on July 19. Greater New York is expected to see more than 1.2 million visitors this summer for the tournament, as the United States expects up to 10 million. Sixteen major cities, and a few smaller ones, across North America will host matches.

Big crowds will gather. A watch party in Central Park is expected to draw some 250,000 viewers. A separate party is scheduled for Liberty State Park in Jersey City.

Public health leaders see this year’s World Cup, billed as the largest tournament in world history, as the world’s largest temporary migration into the United States’ most densely populated urban corridor. They are planning accordingly.

“We’re looking at it as if it’s a huge global migration event,” Mukherjee said while giving Healthbeat a tour of Bellevue, including its biocontainment lab and tuberculosis ward. “The whole health care system in New York City will be a bit on alert for all of these events.”

Bellevue Hospital leads outbreak preparedness

The New York City health care system has experience with an influx of international visitors and potential pathogens. Greater New York has three international airports that are among the busiest in the world, and the city has been on the front line of recent disease outbreaks as they near or encroach upon the United States. The oldest hospital in the United States and one of the largest, Bellevue has had years to prepare.

In October 2014, the hospital received a bit of fame for treating New York City’s only confirmed Ebola patient. Dr. Craig Spencer had been treating Ebola patients in Guinea when he contracted the fatal disease and later entered Bellevue (his discharge is captured in a photo hanging on a hospital wall).

“Because of what we’ve seen in the last few years — Ebola, Covid, and mpox — we feel that we will be the ones who will be affected first for the next outbreak, and therefore have an additional responsibility of keeping prepared,” Mukherjee said.

Central to preparation has been simulated exercises that bring together different agencies working in different time zones and across international borders. Repeated drills help spot deficiencies.

Last summer, Bellevue health care professionals and others participated in a four-day exercise that required transporting by air a group of pretend patients with a high-consequence infectious disease from Toronto, a World Cup host city, to LaGuardia Airport in New York. The pretend patients were then taken to Bellevue for treatment. The exercise aimed to test workers’ ability to handle a portable biocontainment unit — a device used to isolate and transport patients with highly contagious diseases.

“That was the biggest drill we’ve done, because that involved local, state, federal, and international partners,” said Noel Alicea, a spokesman for Bellevue.

New York City Mayor Zohran Mamdani named a former campaign manager to the new post of “World Cup Czar,” but it is unclear whether the position has public health responsibilities.

“Maya Handa will use this innovative role to oversee the Mamdani administration’s inter-agency work to host the FIFA 2026 World Cup and ensure the historic event benefits the city’s residents and economy,” the city said in announcing the role.

Cities have stronger role in preparedness

The World Cup games are also certain to test local public health workers’ ability to coordinate with the federal government. Because the Trump administration has overhauled the U.S. Centers for Disease Control and Prevention and withdrawn from the World Health Organization, both of which have historically played a major role with disease surveillance, state and local governments have taken on additional responsibilities preparing for the World Cup. They are expected to do the same once the matches begin.

This week, the New York State Department of Health announced that it was joining a WHO global network of public health institutions, governments, academic agencies, and labs that aims to coordinate responses to public health threats. New York City, California, and Illinois have also joined.

For its part, the White House created a FIFA task force, led by Andrew Giuliani, the son of former New York City Mayor Rudy Giuliani. Reporting to the Department of Homeland Security, Andrew Giuliani is “spearheading the federal government’s extensive efforts to ensure that the largest World Cup in history will also be the safest,” according to the task force’s website.

Asked how Bellevue was preparing for the World Cup in light of the significant federal changes, Mukherjee said:

“We are trying to paint the picture that this is essential to U.S. biosecurity, which has great bipartisan support, and we recognize that at the end of the day our biggest asset are our health care workers, and if we cannot keep them safe, the entire health care system infrastructure falls through.

“So our priority — our laser focus — is toward making sure our health care workers are safe as they go into relatively dangerous zones of high-consequence, infectious diseases. And that’s what we advocate for in D.C. That’s what we teach and train every day at the front lines.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

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

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

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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.

Public Health Service workers are quitting over assignments to Guantánamo

2026-02-09T09:00:00+00:00

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Rebekah Stewart, a nurse at the U.S. Public Health Service, got a call last April that brought her to tears. She had been selected for deployment to the Trump administration’s new immigration detention operation at Guantánamo Bay, Cuba.

This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the torture and inhumane treatment of men suspected of terrorism in the wake of 9/11.

“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.

Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom KFF Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.

Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.

The Trump administration’s mass arrests to curb immigration have created a new type of health emergency as the number of people detained reaches record highs. About 71,000 immigrants are currently imprisoned, according to Immigration and Customs Enforcement data, which shows that most have no criminal record.

Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, several news organizations have reported that many of the men shipped to the base had no criminal convictions. As many as 90% of them were described as “low-risk” in a May progress report from ICE.

In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, according to The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the United States or deported.

While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the United States. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.

“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.

Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.

“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”

One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.

“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”

Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told KFF Health News.

“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.

“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”

The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.

“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, said in an emailed statement to KFF Health News.

Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: Say “Yes Sir!,’ salute smartly, and execute the mission: Show up, provide humane care, and protect health.” Christine is a recent appointee who, until recently, was a urologist specializing in testosterone and male fertility issues.

“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”

Into the unknown: PHS officers’ questions unanswered

In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.

“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”

Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.

Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?

U.S. service members stand by during an April 2025 simulated medical evacuation of immigrants detained at Guantánamo.

Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.

But PHS officers who were deployed to the base told KFF Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.

Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.

The consequences of insufficient preparation can be severe. In 2014, the Navy threatened to court-martial one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol was brutal: A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.

“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”

The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was guided by professional ethics. After a year, the military dropped the charges.

A uniformed doctor or nurse’s power tends to depend on their rank, their supervisor, and chains of command, Xenakis said. He helped put an end to some inhumane practices at Guantánamo more than a decade ago, when he and other retired generals and admirals publicly objected to certain interrogation techniques, such as one called “walling,” in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to torture.

Torture hasn’t been reported from Guantánamo’s immigration operation, but ICE shift reports obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.

“Welfare checks with potential hunger strike IA’s,” short for illegal aliens, says an April 30 note from a contractor working with ICE. “In case of a hunger strike or other emergencies,” the report adds, the PHS and ICE are “coordinating policies and procedures.”

“De-escalation of potential pod wide hunger strike/potential riot,” says an entry from July 8. “Speak with alien on suicide watch regarding well-being.”

Inmates and investigations have reported delayed medical care at immigration detention facilities and dangerous conditions, including overcrowding and a lack of sanitation. Thirty-two people died in ICE custody in 2025, making it the deadliest year in two decades.

“They are arresting and detaining more people than their facilities can support,” one PHS officer told KFF Health News. The most prevalent problem the officer saw among imprisoned immigrants was psychological. They worried about never seeing their families again or being sent back to a country where they feared they’d be killed. “People are scared out of their minds,” the officer said.

No sunlight in high-security Camp 6

The PHS officers who were at Guantánamo told KFF Health News that the men they saw were detained in either low-security barracks, with a handful of people per room, or in Camp 6, a dark, high-security facility without natural light. The ICE shift reports describe the two stations by their position on the island, Leeward for the barracks and Windward for Camp 6. About 50 Cuban men sent to Guantánamo in December and January have languished at Camp 6.

A Navy hospital on the base mainly serves the military and other residents who aren’t locked up — and in any case, its capabilities are limited, the officers said. To reduce the chance of expensive medical evacuations back to the United States to see specialists quickly, they said, the immigrants were screened before being shipped to Guantánamo. People over age 60 or who needed daily drugs to manage diabetes and high blood pressure, for example, were generally excluded. Still, the officers said, some detainees have had to be evacuated back to Florida.

PHS nurses and doctors said they screened immigrants again when they arrived and provided ongoing care, fielding complaints including about gastrointestinal distress and depression. One ICE monthly progress report says, “The USPHS psychologist started an exercise group” for detainees.

Doctors’ requests for lab work were often turned down because of logistical hurdles, partly due to the number of agencies working together on the base, the officers said. Even a routine test, a complete blood count, took weeks to process, versus hours in the United States.

DHS and the Department of Defense, which have coordinated on the Guantánamo immigration operation, did not respond to requests for comment about their work there.

One PHS officer who helped medically screen new detainees said they were often surprised to learn they were at Guantánamo.

“I’d tell them, ‘I’m sorry you are here,’” the officer said. “No one freaked out. It was like the ten-millionth time they had been transferred.” Some of the men had been detained in various facilities for five or six months and said they wanted to return to their home countries, according to the officer. Health workers had neither an answer nor a fix.

Unlike ICE detention facilities in the United States, Guantánamo hasn’t been overcrowded. “I have never been so not busy at work,” one officer said. A military base on a tropical island, Guantánamo offers activities such as snorkeling, paddleboard yoga, and kickboxing to those who aren’t imprisoned. Even so, the officer said they would rather be home than on this assignment on the taxpayer’s dime.

Transporting staff and supplies to the island and maintaining them on-base is enormously expensive. The government paid an estimated $16,500 per day, per detainee at Guantánamo, to hold those accused of terrorism, according to a 2025 Washington Post analysis of DOD data. (The average cost to detain immigrants in ICE facilities in the United States is $157 a day.)

Even so, the funding has skyrocketed: Congress granted ICE a record $78 billion for fiscal year 2026, a staggering increase from $9.9 billion in 2024 and $6.5 billion nearly a decade ago.

Last year, the Trump administration also diverted more than $2 billion from the national defense budget to immigration operations, according to a report from congressional Democrats. About $60 million of it went to Guantánamo.

“Detaining noncitizens at Guantanamo is far more costly and logistically burdensome than holding them in ICE detention facilities within the United States,” wrote Deborah Fleischaker, a former assistant director at ICE, in a declaration submitted as part of a lawsuit brought by the American Civil Liberties Union early last year. In December, a federal judge rejected the Trump administration’s request to dismiss a separate ACLU case questioning the legality of detaining immigrants outside the United States.

Anne Schuchat, who served with the PHS for 30 years before retiring in 2018, said PHS deployments to detention centers may cost the nation in terms of security, too. “A key concern has always been to have enough of these officers available for public health emergencies,” she said.

Andrew Nixon, an HHS spokesperson, said the immigration deployments don’t affect the public health service’s potential response to other emergencies.

In the past, PHS officers have stood up medical shelters during hurricanes in Louisiana and Texas, rolled out Covid testing in the earliest months of the pandemic, and provided crisis support after the deadly shooting at Sandy Hook Elementary School and the Boston Marathon bombing.

“It’s important for the public to be aware of how many government resources are being used so that the current administration can carry out this one agenda,” said Stewart, one of the nurses who resigned. “This one thing that’s probably turning us into the types of countries we have fought wars against.”

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

NYC health department joins global network after U.S. pulls out of WHO

2026-02-05T20:15:29+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York City Department of Health and Mental Hygiene announced Thursday it has joined a World Health Organization network that works on disease outbreaks and other public health emergencies around the world. The city said it was the first U.S. municipality to do so.

The decision to join WHO’s Global Outbreak Alert and Response Network is the latest example of a government agency in the United States seeking to work with the WHO following the Trump administration’s withdrawal from the organization in January, coupled with deep cuts to the U.S. Centers for Disease Control and Prevention. California Gov. Gavin Newsom announced last month that his state was joining the network; on Tuesday, Illinois Gov. JB Pritzker announced his state would join.

The WHO group is an international public health network that brings together more than 300 public health institutions, governments, academic centers, laboratories, and response organizations. Their aim is to rapidly detect and respond to public health threats and emergencies. To this end, the different entities receive direct access to early-warning alerts and outbreak intelligence, along with training and exercises.

New NYC health commissioner is ER doctor with policy degree: ‘Not a traditional pick’

The membership will likely prove essential this summer when the United States, along with Mexico and Canada, hosts the 2026 FIFA World Cup. Matches will take place in major cities throughout North America, culminating with a final in July at MetLife Stadium in East Rutherford, New Jersey. Greater New York alone is expecting more than a million visitors. For its part, the White House has created a World Cup task force, led by Andrew Giuliani, son of former New York City Mayor Rudy Giuliani, that is housed at the U.S. Department of Homeland Security.

Public health experts say the Trump administration’s retreat from the WHO will make the world – and the United States – more vulnerable to disease outbreaks and other public health threats. The United States has long been a key player in containing outbreaks in other parts of the world that might otherwise show up at the U.S. borders. The United States was the WHO’s single largest donor, with contributions fluctuating, donating $1.2 billion during the 2022-23 biennium.

In an interview with Healthbeat last week, New York State Health Commissioner James McDonald said the state was also looking into joining the WHO network.

McDonald said the U.S. withdrawal from the WHO would undermine global immunization efforts, which would bring illness as a result. A healthier world means a healthier New York state and United States.

“One of my big concerns is by pulling out of the World Health Organization and by underfunding CDC, what risk are we inviting in the United States?” McDonald said. “Because people get in planes and travel, and you are literally 12 hours away from the biggest surprise ever. I don’t understand why we’re willing to live in this period of ignorance."

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

When conspiracy theories dictate global vaccine policy

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

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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

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

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 working in a clinic in rural India taught me about health care

2026-01-26T16:13:01+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

In 2016 and 2017, I worked at a hospital and community health program in rural eastern India. That revolutionized my view of what health care could be like.

Everything in the system was geared to serve the patient: Signs over offices and paperwork included pictograms for the mostly illiterate people we served. This proved so effective that many of our village health workers successfully completed their work without ever learning to read.

We economized on everything, using mosquito nets for hernia repairs and washing gloves with bleach so they could be reused.

We didn’t have much – and it was by no means perfect – but what we did have was care; respect; compassion – all built into a community health system that actually served its community.

When I came back to Atlanta, I worked in hospital emergency rooms. Here, we had state-of-the-art equipment, highly trained staff, air-conditioning, and gloves galore. But something felt different to me. Patients and doctors spoke English, but talked right past one another. Doctors were scolded for taking too long with patients. Psychiatric patients and others lingered for days because we could find no place to send them.

And worst of all, we were all rowing in different directions. The doctors answered to one authority; the nurses to another; social workers and chaplains appeared and then disappeared; and no one seemed to care about the environmental services team, who worked so hard to keep the hospital clean.

Spending time at clinics like this one in rural Chhattisgarh in eastern India helped me rethink how health care is delivered.

I was disheartened that my hometown, a public health capital, couldn’t provide the kind of compassionate care I saw being provided in rural India. Yes, our patients were sick, but so was our system. For more than a year, I took all this in and bottled up my emotions, mostly, my anger and sadness.

Finally, I had an aha moment: I put down those bitter emotions and picked up my pen, pledging to write about what I knew. That was more than five years ago, and while I can’t claim to have fixed our broken system, I am proud to to be here, still writing about health in my hometown, learning from all of you, and carrying with me the compassion and can-do spirit that I learned thousands of miles away in rural India.

Born and raised in Atlanta, Rebecca Grapevine is back home as a Healthbeat local reporter. She has a Ph.D. in history from the University of Michigan and in her travels learned to speak Hindi (nearly) fluently. Read her Healthbeat work here. Contact Rebecca at rgrapevine@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

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

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.

‘I never thought I deserved something so valuable’: How health kits are empowering birth care in New York and abroad

2026-01-21T14:58:37+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 18 at Powerhouse Arena bookstore in Brooklyn. Watch the full show here. Sign up to receive Healthbeat’s free New York newsletter here.

I’m going to share with you two “aha” moments – both revolving around the lifesaving toolkits that we at Saving Mothers distribute to pregnant women. It’s a story that highlights both the shared experiences of giving birth, no matter where on Earth you live, but also the wide discrepancies in available birth care.

I’ll start here at home in New York City, where Saving Mothers has been giving out “mPOWHER” kits.

These are maternal health kits that contain resources that women need to take charge of their maternal health care and understand their health risks in pregnancy. They also contain cards that are meant to help them talk to their doctors and nurses in the hospitals and clinics so they can make sure that they are seen and heard.

We know that racial disparity in maternal health is very high here in New York City. So these kits are specifically aimed toward addressing racism and disparity, making sure women can advocate for themselves, get their needs met, and frame their questions in a way that they can get quick answers and thorough answers.

The kits have these resources, including a blood-pressure cuff, a Fitbit, some venodyne stockings to address blood clots. They target the top causes of maternal death here in New York City, that’s where we focused the kit.

These kits cost about $125 because they include a lot of nice resources, like the Fitbit, the blood-pressure cuff, a beautiful diaper bag for the mother, and some other giveaways. They are nice kits that we put together, that we do by hand, that we have our teams pack.

The goal of the kit was to improve maternal health and improve their odds in pregnancy. We give it out to the women, and we asked for feedback. And one mom I remember, and this was an “aha” moment for me: She opened the kit, she looked at all the resources, and we asked her about her feedback, like, how did she think that the kit was helpful? And she said, “When I opened this kit, I just started crying, because no one has ever given me anything so beautiful and so valuable. And I never thought that I deserve something so valuable.”

That was her feedback. It was an “aha” moment for me as a doctor, as an OB-GYN, because I’m thinking she’s going to give me feedback about how she used the blood-pressure cuff, or how she used the resources. But she was so touched by the fact that someone packed this kit for her and that it had valuable contents – it had a Fitbit, it had things that she knew had some value – and she just loved it so much.

From Kenya to New York: How a global nonprofit is addressing local maternal health needs

She said, “I brought my mPOWHER kit everywhere. I brought it to every appointment. I did everything that was in it. I felt so lucky to have such a valuable kit.” I thought that was really, really interesting and really telling about how mothers, especially underserved mothers, those who live in shelters, or in areas of the city where they don’t have a lot of access, how much they truly do value this. She could see that we put a lot of thought and effort into it, too. We put little handwritten notes in it, like “You can do this.” We have a lot of inspirational messaging that we include.

Through the feedback that the mothers in New York have given us, we’ve also added a mental health component to the kit. Now the kit has a journal, and that journal has inspirational words and stories for mothers along the lines of “You are valuable. You are important. You are amazing. You can complete this pregnancy, have a baby.” We have inspirational words to get them through pregnancy and postpartum, as well.

That one helped us understand the mental health piece, which I think is something that needs more attention. Now our $125 kit includes that. It includes a mental health card and a wellness card and a journal, and it actually incorporates a lot of the feedback that we got from our mothers and the focus groups.

I’ve learned other things from those focus groups, too, like that blood-pressure cuff that we give women – the woman doesn’t just use it for herself in pregnancy. It’s actually become a family unifying thing. They do everyone’s blood pressure, the in-laws come over, the parents come over. Everyone’s getting their blood pressure checked now, and a lot of these families are larger. That’s also a really great downstream effect of habit, giving people resources and making sure they know how to use them.

These are low-cost, high-impact kits, the “mPOWHER” kits that we’ve used in New York. But we have another kit, probably our longest-standing kit that we created when we started Saving Mothers in 2009 – the clean, safe birth kit.

In Africa, women must bring own birthing supplies to hospital

What I have learned about birth in many of our countries that we’ve served in many parts of Africa, specifically many of the hospitals there, is that mothers, when they want to deliver, they cannot come into the hospital, even a major hospital in a big city, like in rural West Pokot, Kenya, without bringing their own birth supplies.

A laboring woman will come to the hospital, and she will be turned away for delivery because she doesn’t have her clean birth supplies, like cord clamps, scissors to cut the umbilical cord, gloves for the doctor or nurse, a clean surface, soap – some of these basic tools that women and their families in very poor, very underserved regions of the world, have to go and find and purchase and come back with.

I didn’t realize when we first created the clean birth kit that the hospitals also needed the resources, that women were actually being asked to bring their own clean birth kit. That was an “aha” moment.

The clean birth kit was meant for the over 80% of women that deliver babies at home in most regions of the world. In most of the world, there aren’t a lot of trained OB-GYNs. There are whole countries that have a handful of trained OB-GYNs. Back when we were working in Liberia years ago, 2009, 2010, there were like three. The vast majority of women around the world are being delivered by birth attendants or midwives with varying levels of training. Some places they have some training; other places, not as much.

They’re called anything from traditional birth attendants to midwives. But they lack training, and obviously they’re not surgically trained – any of them – to be able to deal with urgent, emergent and C-section type delivery. So these clean birth kits were meant to be a resource for women at home, so that we could promote sanitary birth, so we could lower the risk of infection to the newborn. So that the mother had a provider that was using gloves. So that there was a clean surface. So that the attendant washes their hands, at least with Purell, even if there was no running water.

Our safe birth kit cost $15, and we’ve sent tens of thousands of these kits around the world since we started. They go everywhere, from clinics, directly to community health workers and birth attendants, especially in the areas where we train them, like Guatemala and Kenya. Then we empower them with the kits, as well. It’s been really amazing to see how much these kits are needed everywhere.

The $15 includes shipping. We bundle that into the cost because we want them to be accessible and low cost. Our big goal is always to make all of our things low cost. It’s about creating things and streamlining programming so that the highest number of women have access, so the cost is always important.

People need our kits everywhere. They need them, based on the culture, the circumstance, the issues that bring the highest risk of maternal death. Those causes are different in different communities. But the need is the same: for all women, everywhere, to have a safe, clean birth.

Dr. Taraneh Shirazian is the founder and president of Saving Mothers, a 501(c)3 non-profit organization founded in 2009. Saving Mothers is dedicated to eradicating preventable maternal deaths and birth-related complications in the developing world. She is also a practicing gynecologic surgeon and associate professor at NYU Langone Medical Center and director of NYU Langone’s Center for Fibroid Care.

Her story was told at Healthbeat’s event by Re Perry, program coordinator for Saving Mothers who earned her MPH at NYU.

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.

HIV work in Kenya showed me the powerful impact of treating a whole population

2026-01-12T15:03:39+00:00

I embodied the cliché that drives many people to become doctors: I wanted a career that was both deeply impactful and also really interesting. And I made it. I graduated from the medical school at Temple University and then completed my residency in, um, “war-torn” Portland, Oregon.

Although as a teenager, I’d been aware of the Centers for Disease Control and Prevention’s investigative work during the 1976 Legionnaires’ disease outbreak in Philadelphia, it was during residency that I truly began to understand public health. The general concept was familiar — impacting health — but instead of working with one patient at a time, public health offered the chance to impact entire populations simultaneously.

After residency, I joined the CDC’s Epidemic Intelligence Service. I found myself in Pakistan, evaluating the validity of survey questions on immunization rates, and later on rooftops in Los Angeles, sampling water from cooling towers for the now-infamous Legionella bacteria. After EIS, I returned to clinical medicine to complete my infectious diseases specialty training and was immersed in the rapidly evolving world of HIV treatment.

A decade later, I landed my best job ever — working for the CDC to help establish HIV treatment clinics in Kenya. In Kisumu, in western Kenya, where I lived with my family, 1 in 4 adults had HIV infection. Almost all hospitalized adults were HIV positive. When we arrived in 2001, coffin makers were thriving. Our research programs had to hire 125% of needed field staff because so many people were dying on the job.

The world had finally begun to realize that HIV treatment needed to be offered in the hardest hit parts of the world. With initial seed funding from the CDC, followed by a major grant from Columbia University’s School of Public Health, then the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief – PEPFAR – my job was to visit clinic after clinic with my Ministry of Health colleagues, asking whether they wanted to establish HIV treatment services. When they voiced concerns about lacking resources or expertise, I could say, “I can offer both.”

As PEPFAR started, we had to secure the drugs. The contracting office put us in a bind — they’d finalize the contract to secure essential drugs and supplies from the mission — but only if we could secure signatures from six board members scattered all over Kenya over a weekend. My colleague, John, took eastern Kenya, I took the west. With a CDC driver, off I went. I had the easier job. All of the board members were bishops, but two of mine were Anglican, meaning they had wives — who were easier to find, and who led us to their husband board members.

Cellphone coverage was limited, and the roads were rough, but by the end of the weekend, John and I had both secured our share of the needed signatures. To the people who’d been asking “when are the drugs coming,” I could soon say “they are here.”

Before HIV treatment was made available in western Kenya, many furniture manufacturers turned to making coffins.

I had lived through the transformation of HIV in the United States — from a death sentence to a manageable chronic illness. Now, I had the privilege of witnessing that transformation again, on a massive scale. By the time my family returned to the United States in 2005, 65,000 people in Kenya were on treatment. That’s a small fraction of the number who have since initiated care.

But that early period was transformative. Coffin makers returned to building furniture. Ambulances stopped serving as full-time hearses. Weekends, once dominated by funerals, reclaimed their hold on dance parties and weddings.

Taxi drivers in Kenya are a great source of wisdom. During my frequent trips to Nairobi, I often asked for their perspectives. Every one of them had been touched by HIV — through a sibling, a spouse, or their own diagnosis. Many had faced initial reluctance to get tested or seek treatment. But in overcoming stigma and barriers, they found a return to normalcy — and a deep gratitude to the World Health Organization and the United States.

The effects of establishing HIV programs began to ripple outward, strengthening the health system. That trust meant we were often the first called when new threats emerged — whether aflotoxicosis from poorly stored corn, or a hemorrhagic fever.

So maybe not so much an “aha” moment, but a quiet recognition: Focused programs can build immense goodwill. And I had the great privilege of being one small part of that.

Dr. Barbara Marston is an infectious diseases physician who retired from the CDC in 2022 after a 28-year federal career primarily focused on international health. She had leadership roles in emergency responses (Ebola in West Africa and the international component of the Covid response). Since retiring, she’s traveling and supporting protection of endangered amphibians and native plants. She is the co-founder and the coordinator of a CDC advocacy group, CDC Alumni and Friends.

ByHeart baby formula outbreak prompts global safety study as U.S. struggles to find botulism source

2026-01-08T16:06:51+00:00

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An international food standards committee of the United Nations and World Health Organization has called for a scientific risk assessment of botulism spores in powdered infant formulas as a result of the U.S. outbreak linked to ByHeart products.

The action by the Codex Committee on Food Hygiene, supported by attendees from 50 member countries, noted the “global implications” of contaminated baby formula. It was taken as U.S. health agencies have struggled since early November to determine how ByHeart’s formula became contaminated.

Investigations have been ongoing since early November.

At least 51 U.S. babies have been sickened with infant botulism in the outbreak, with no new cases identified in recent weeks; all required hospitalization. The U.S. Food and Drug Administration has said it was first alerted on Nov. 6 to an initial cluster of illnesses linked to ByHeart formula and that its investigation has been underway since then.

ByHeart has recalled all of its formula products. Federal officials have said they cannot rule out the possibility the company’s formula – which was marketed as a premium, organic formula “closest to breast milk” – has been contaminated with botulism bacteria since it was first put on the market in March 2022.

Food safety advocates said they supported the international risk assessment, but noted it will likely take years to result in any reforms to protect against future outbreaks.

A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe.”
Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest

“It’s a really bad sign for Americans when a slow-moving international scientific agency has now initiated public plans, and yet our own regulators responsible for preventing this outbreak haven’t taken any public action,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest, a consumer advocacy group in Washington, D.C., that focuses on food issues.

“A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe,” Sorscher told Healthbeat. “Instead, we have utter silence. It’s a complete failure of leadership.”

Officials with the FDA, Centers for Disease Control and Prevention, and U.S. Department of Health and Human Services said their investigations are ongoing but they did not answer Healthbeat’s questions this week about what challenges may be contributing to delays in finding the cause.

They also didn’t respond to questions about whether it’s surprising that a source of ByHeart’s botulism bacteria contamination hasn’t yet been identified.

Federal regulators haven’t decided whether a U.S. risk assessment is needed

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can take 30 days to start growing in their immature guts and produce a toxin that can cause symptoms ranging from constipation, loss of head control, difficulty swallowing and breathing, and respiratory arrest.

Recent tests by government investigators and ByHeart have detected botulism bacteria in some containers of the company’s formula. The company received a formal warning letter from the FDA in August 2023 about contamination issues with a different type of bacteria and its plants have been cited by FDA inspectors for manufacturing and sanitation issues.

A HHS spokesperson, in an email to Healthbeat, said the FDA advocated for the Codex committee’s request for the international risk assessment. Staff from the FDA and U.S. Department of Agriculture participated in the Codex meeting, the meeting’s report shows.

ByHeart baby formula recall exposes dangerous gaps in food safety

“We welcome any and all scientific evidence that can inform recommendations on this important public health matter,” HHS said.

When asked whether the FDA or CDC would be doing their own U.S. assessment of risks for infant formula contamination with Clostridium botulinum bacteria, which cause infant botulism, HHS said that has not yet been determined. The FDA will decide the need for any additional risk assessment after more information is gathered about the current outbreak, HHS said.

“Additional testing by ByHeart, FDA, CDC, and state partners is currently underway, and more results are expected in the coming weeks,” HHS said. No details were provided about the types of testing being done.

ByHeart said the ongoing investigation “includes a rigorous audit of every step of our supply chain” and that the company is working closely with regulators to identify the source of the contamination.

HHS Secretary Robert F. Kennedy Jr., in launching Operation Stork Speed last spring, said that “safe, reliable, and nutritious” infant formula is a priority of the administration.

During the Codex Committee on Food Hygiene, which held its multi-national meeting Dec. 15-19 in Nashville, Tenn., members discussed the need for scientific input to inform a potential revision in the international code of hygienic practice for powdered infant formula. The code has sections that need updating, including sections on cleaning and environmental monitoring when producing formula, participants said.

Global review seeks to identify safety gaps in powdered formula manufacturing

“While Members acknowledged that historical data had not always categorized Clostridium botulinum as a major risk in these products, the importance of investigating whether current gaps in [the powdered infant formula code] contributed to the risk was underlined,” according to the report of the meeting.

The committee’s request seeks a risk assessment of spore-forming pathogens in powdered infant formula, and specifically cites Clostridium botulinum, which causes infant botulism, and Bacillus cereus, which can produce a toxin that causes nausea, vomiting and diarrhea.

Nestle is undertaking a global recall of certain infant formulas because of possible contamination with the toxin produced by Bacillus cereus. The company said a potentially contaminated ingredient is the culprit. While the recall involves formula sold in dozens of countries, the company’s recall advisory as of Thursday morning did not list the United States.

The Codex committee also has asked for an update to the existing risk assessment and scientific advice on environmental pathogens, such as Cronobacter and Salmonella, and to provide additional scientific advice to inform recommendations for strengthened pathogen control measures in all stages of the formula manufacturing process.

During last month’s meeting, a representative of the Food and Agriculture Organization of the United Nations, also referred to as the FAO, said that the scientific advice requested by the committee would be provided by an international scientific expert group called JEMRA – the Joint FAO/WHO Expert Meetings on Microbial Risk Assessment. The FAO did not respond to questions from Healthbeat about how long the risk assessment process will take or what it will involve.

Elisabeth Sterken, a nutritionist with the International Baby Food Action Network Global Council, said actions to address infant botulism and other microbial risks in powdered infant formula need to be taken sooner than will occur through this process. IBFAN is an international coalition that advocates for public policies that favor breastfeeding and investigates the marketing of infant formula.

“From JEMRA, which will likely take years, its recommendation will then go back to the Codex Committee on Food Hygiene, and any changes in the Code of Hygienic Practice will take at least another two years,” Sterken told Healthbeat.

Moms say ByHeart recall has shaken their trust in baby formula safety

“From there the final recommendations go to national regulatory bodies,” she said. “In the meantime, infants will continue to be at risk from the serious health consequences of potentially contaminated powdered infant formula.”

HHS, the FDA, and CDC have not responded to a Dec. 8 letter from the Safe Food Coalition, a group of major food safety organizations, that has called for actions to address “dangerous deficiencies” in the nation’s food inspection and regulatory systems that they say have been highlighted by the ByHeart recall and infant botulism outbreak.

Sorscher, whose organization – the Center for Science in the Public Interest – is a member of the coalition, called the lack of any response to the five-page letter “unacceptable.”

“These agencies owe answers to the public, and the silence at this point speaks volumes about their current ability to protect our food,” she said.

The letter, among many recommendations, has called for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

Other coalition members that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

The HHS last month told Healthbeat it has received the letter and will be responding to it.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Screwworm threat returns to U.S.: Why it matters

2026-01-05T14:29:14+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2025, the United States faced a series of reminders that the security of our food supply depends on public health systems that are largely invisible to the general population. Poultry and dairy production were disrupted by H5N1 avian influenza and infant formula by botulism contamination. Less visible was a parasite that once terrified American ranchers: the New World screwworm.

The resurgence of screwworm highlights the fragility of infectious disease control and the importance of sustained government cooperation across different sectors and across international borders.

What screwworm is and why it matters

The New World screwworm is caused by the larvae of a blowfly called Cochliomyia hominivorax. The adult fly targets warm-blooded animals, most often cattle, and lays its eggs in open wounds. These wounds can be large, such as those caused by branding or dehorning, or barely visible, such as a tick bite or an abrasion.

Within hours, the eggs hatch, and the larvae burrow into the flesh and feed aggressively on living tissue. (This is what distinguishes screwworm from other maggots, which eat decaying or dead tissue.) As the larvae grow, the wound expands, attracting more flies, which deposit even more eggs. The larvae cause severe pain, tissue destruction, secondary infections, and often death of the animal.

After several days, mature larvae drop to the ground, pupate in the soil, and emerge as adult flies ready to repeat the cycle on another cow. Under warm conditions, the entire process can take only a few weeks. In a herd setting, infestations can spread rapidly, devastating entire herds of cattle.

Before eradication, screwworm caused hundreds of millions of dollars in financial losses each year in the United States. Ranchers spent enormous time and money on treatment and prevention. The parasite also occasionally infected wildlife, pets, and some humans.

How screwworm was controlled in the 20th century

Beginning in the mid 20th century, U.S. scientists developed a special technique to stop screwworm reproduction. The “sterile insect technique” involved breeding millions of male screwworm flies in specialized facilities, sterilizing them with radiation, and releasing them into the wild. Because female screwworm flies mate only once, they produce no offspring after they mate with a sterile male fly. Over time, the screwworm population dies off.

Using this approach, screwworm was eliminated from the United States by the mid 1960s. The program then moved south, in collaboration with Mexico and Central American countries. By the early 2000s, screwworm had been pushed as far south of the United States as Panama. Every week, sterile flies were released to prevent northward spread from endemic regions in South America, creating a biological barrier to screwworm making its way into the United States.

This screwworm control program remains one of the most successful examples of international disease control in the Americas. To maintain it, however, requires constant effort to produce sterile flies and conduct surveillance for breakthrough infections.

Why the screwworm threat has returned

For decades, screwworm was largely absent from the United States and Mexico. That changed in 2023, when outbreaks began spreading northward through Central America and into southern Mexico. The reasons are still being investigated, but likely include interruptions in sterile fly production during the Covid pandemic, increased movement of cattle and people, and the sheer difficulty of maintaining surveillance across remote terrain.

In August, the United States confirmed its first human screwworm case in decades. The patient, a Maryland resident, had recently traveled to El Salvador and returned with larvae embedded in living tissue. The infection was treated successfully, and there was no evidence that infection was either acquired locally or transmitted onward.

While the risk to Americans of this case was low, it was considered an important warning sign. Because they are so rare, even one human screwworm infection suggests widespread prevalence in animals.

The economic stakes are particularly worrisome. Cattle herd sizes in the United States are near historic lows due to drought and rising costs. In response to the screwworm threat, the United States halted cattle imports from Mexico in 2025. Prolonged disruption could drive prices higher, an important problem because the average American consumes 60 pounds of beef each year.

What is being done to stop the New World Screwworm outbreak?

The United States and Mexico have begun to rebuild the capacity that previously stopped screwworm transmission in both countries. Sterile insect production in Panama has been expanded to release roughly 100 million flies per week. Facilities in southern Mexico are being renovated to produce tens of millions more, and the U.S. Department of Agriculture is working on additional dispersal capacity in Texas.

These efforts are expensive and slow. Experts estimate that several hundred million sterile flies per week may be needed to re-establish the barrier that once existed. At the same time, workforce reductions and loss of institutional memory are making it harder for the U.S. government to respond quickly.

New tools are also emerging. Last month, the Food and Drug Administration conditionally approved a topical antiparasitic drug for cattle that can help prevent or treat screwworm infestations. While this drug gives cattle farmers another option, there are challenges with using it; it is prescription only, has withdrawal periods, and cannot be used in all cattle.

Why this matters beyond screwworm

The return of screwworm illustrates broader lessons about public health and food security. When they work, public health protections are invisible, and, when they fail, the consequences are difficult and expensive.

Particularly with food security, these protections must embrace a One Health model, in which human, animal, and environmental sectors work in partnership. And, finally, at a time when the United States has dramatically cut its global health workforce, screwworm offers an important example about why such work remains essential.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

Homeward bound: How MedShare is bringing global mission back to Atlanta

2025-12-19T21:30:01+00:00

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MedShare is a global health nonprofit founded in Atlanta in 1998. It sends medical supplies that are frequently discarded in the United States to clinics around the world for free. More recently, it has added domestic work to its portfolio, providing unique insights into the needs of American safety-net clinics that serve the most vulnerable.

Since its founding, the nonprofit has grown to work in 120 countries, including disaster zones, like Jamaica after Hurricane Melissa, and war-torn Ukraine. It ships items as small as sutures and syringes, to those as large as X-ray machines, transformers, and even, once, a morgue, around the world.

Now the organization is looking homeward, bringing its “circular approach” to medical supplies to American clinics that serve people in need, including in its home state of Georgia.

While the organization had periodically helped out in domestic crises like wildfires in California, CEO and Executive Director Stacey Koehnke told Healthbeat, Covid brought home the similarities between MedShare’s work abroad and domestic needs, since it had personal protective equipment to supply during the pandemic.

Since Covid, MedShare has adopted an intentional approach to working with clinics domestically. There are many similarities, she said.

Like the clinics it supports internationally, safety-net clinics in the United States serve vulnerable populations.

That domestic work has become a priority for MedShare over the past 18 months, Koehnke said, with 10% of its resources distributed domestically, with an eye toward further growth.

“Where our biggest impact is in access domestically for those communities who may be under- or uninsured,” she said, pointing to the examples of rural areas that lack hospitals, Native American reservations, and neighborhoods with many immigrants as other sites of health care need. MedShare has provided supplies to clinics in about 35 states, including at least 27 clinics in Georgia, in urban and rural areas.

Creative partnerships with medical supply companies help MedShare meet clinics’ needs at home or abroad. The goal is to provide needed supplies while preventing waste.

Take, for example, a recent effort to send ultrasound machines to low-cost clinics across the country. MedShare obtained machines from medtech firm BD. The equipment was new, but BD had taken the machines off the market in favor of updated models. MedShare sent the outdated but functional ultrasound machines to 30 states, Koehnke said. MedShare also provided training to technicians at those clinics in troubleshooting and using the equipment.

Patients can save money and time if they can get ultrasounds in clinics, rather than an outside provider, Koehnke said. That could help with maternal health and other issues, she said. MedShare also provides clinics with blood pressure monitors, both for patients with hypertension and for pregnant women who need to keep an eye out for pre-eclampsia.

Three of the clinics that got the ultrasound machines are in Georgia. Bethesda Community Clinic, based in Ball Ground in Cherokee County, will use one on a women’s health van to be deployed in the spring. The ultrasound machine will be used for basic prenatal care like confirming pregnancies and identifying complications early.

“Having this capability on our mobile unit allows us to bring essential diagnostic services directly to underserved patients who otherwise lack access to these resources,” said executive director Melissa Belfield. The free machine is helping the clinic expand its services without incurring costs that would take away from direct patient services.

The Macon Volunteer Clinic also got an ultrasound machine through the program, and the clinic’s nurse practitioner has attended a virtual training. The clinic plans to use it for placing IUDs and determining blood flow in cases of deep vein thrombosis, spokesperson Julia Norman said.

MedShare has in recent years focused on ensuring that the medical equipment it sends to clinics at home or abroad gets used over the long term by including training.

The domestic ultrasound donation program led MedShare to develop a remote training program since it couldn’t send team members to each of the American clinics that got the devices. It also sends its workers abroad to help clinic workers learn to use and maintain equipment.

“If there’s no one there who knows how to do basic troubleshooting and basic repairs, it becomes a wasteland of beautiful equipment that’s unusable,” Koehnke said.

Maternal care is a top concern, but it looks different in different places

Domestic work gives MedShare employees a close-up view of the challenges American safety-net clinics face.

One clinic that was using disposable tools was able to save money after MedShare provided it with an autoclave. The goal is to increase the resources that go to direct patient care instead of supplies, Koehnke said.

Decreasing federal and state funding is one concern, Koehnke said. The reduction of services or closure of community hospitals also puts added pressure on the clinics. She said many hospitals first eliminate maternity care due to liability risk, pushing the clinics to pick up the slack.

“We are seeing added requests, added needs for equipment that we originally didn’t know that we would need to provide,” she said. “We get requests for ultrasound all the time now. We don’t have as many ultrasounds to give as we’d love to.”

Maternal care is a concern domestically and globally, Koehnke said, but it looks different depending on the setting.

“We’re still working kind of within that (U.S.) system, so people are used to certain levels of care. There’s certain expectations from the different clinics and hospitals, and even the patients that we’re working with, which may have a different sensibility internationally,” she said.

For example, clinics abroad often want clean birthing kits, which help people deliver babies at home in sterile conditions. But that’s not the case in the United States. “That is not something we’d be able to provide domestically, even for mothers who may not have a hospital nearby.”

Koehnke said the needs are similar – pregnant women need to be prepared for safe births – but in the United States, the focus is more on preventing complications, such as through providing blood pressure monitors and pulse oximeters, the clip-on fingertip devices that measure heart rates and how well oxygen is moving through the body.

“It’s a different way to provide care, but the fact is that there are still underserved communities with families and children who need access to health care, and our role is to help ensure that those who can provide that direct care are given the tools and support to do that,” Koehnke said.

How MedShare works: It’s like Amazon – but free

Equipment comes to MedShare in a variety of ways, Koehnke said. Along with donations of equipment that is no longer for sale or has been refurbished, hospitals often have a large amount of everyday supplies like syringes that would otherwise go to waste.

She gave the example of a case of individually packaged syringes that a hospital or home health care facility would otherwise dispose of once it was opened, even though the remaining syringes were safe to use.

“We’re able to repackage those and get them actually out to someone who can still use them. So there is also a very much an underlying environmental element to the work that we do,” Koehnke said.

Nurses are often key catalysts for the donations, she said: “They’re thinking, ‘Wow, I really don’t want to throw this out. How can I get this to someone?’” Supply chain administrators at hospitals are also key conduits.

Once the supplies reach MedShare, it operates like most online shopping. Clinics register with MedShare and, once approved, they use an online portal to look for supplies. All supplies are free, and clinics outside Georgia pay only shipping costs, while Georgia clinics do not pay for shipping.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

There’s more to the measles comeback than misinformation

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

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

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.

Meet Trenton Daniel, Healthbeat’s new senior reporter in New York

2025-12-12T20:28:07+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

When we heard the initial reports of a cholera outbreak in the heart of Haiti, I dropped an assignment about a school opening and raced to a busy port city near the country’s longest river.

Saint-Marc was said to be the area hardest hit by the waterborne disease and that proved to be true. The main hospital, Saint Nicolas, was overrun with IV-tethered patients, from the corridors to the courtyard, as men showed up with sick family members on large beds that they had somehow liberated from their modest homes. The car radio crackled with stories of people collapsing in the street.

I had written about public health issues before, like child malnutrition in the Guatemalan countryside and illness linked to an incinerator ash in a historic Fort Lauderdale, Florida, neighborhood. But the cholera outbreak in Haiti was profoundly different: Imagine if a stranger came to town, ostensibly with good intentions, dumped his contaminated waste in a central waterway, and then thousands died and more fell sick. It would seem almost inevitable that the authorities would want to hold that individual liable for wrongdoing, but that really wasn’t the case in Haiti.

By all accounts, a United Nations peacekeeping mission from Nepal was found to have introduced cholera to Haiti in October 2010 by dumping its untreated fecal waste into the country’s main river. This was several months after the massive earthquake pummeled the Port-au-Prince capital, and humanitarian workers had already hailed the absence of disease.

The largest cholera epidemic in modern times followed. Officials say more than 10,000 people died, but the death toll is likely higher because of limited record keeping. Lawyers for the victims and family members unsuccessfully sued the U.N. in the U.S. court system. Due to mounting public pressure, in 2016, then-Secretary-General Ban Ki-moon issued a public apology. In a memoir, he later described the lawsuit as a “fraudulent” extortion attempt. It could have undercut U.N. work everywhere had it prevailed, he wrote.

The Haiti cholera story made stark the political nature of health: Some lives are deemed worthy of being healthy, others less so. At every turn, I had tried to hold officials accountable, from the U.N. to Haiti’s health ministry, and it is this kind of accountability reporting that has informed my work over the years, from my early days as a beat reporter at The Miami Herald to, more recently, as a member of the AP global investigations team using public records to break news and bolster the news cooperative’s coverage. I want to bring this same commitment to holding officials accountable to my new role at Healthbeat.

The job comes at a time like no other for New York. Voters last month overwhelmingly rejected the political status quo as they elected Zohran Mamdani, a candidate from outside the Democratic establishment who aims to make one of the most expensive cities in the world more affordable for its residents. It’s a goal that sounds as pedestrian as it does profound. It will be interesting to see how the 34-year-old political newcomer delivers on his campaign promises following his Jan. 1 inauguration. He might be mayor of the largest (and arguably most dynamic!) city in the United States but he is unlikely to escape scrutiny as the country follows him, with a mix of cheer, curiosity and, for some, contempt.

With the support of his yet-to-be named commissioner, Mamdani will oversee the largest and oldest health department in the United States. His work will be cut out for him. His health care plan as presented during the campaign was noticeably thin, leaving some to wonder what he might have in store for a critical expense that is making life for many of us a little more unaffordable.

Because he has said so little, a preview of his health vision might be found in the composition of his transition committee, which is staffed with a mix of hospital executives, public and private university academics, union leaders, former health commissioners, and LGTBQ+ advocates. To be certain, parts of his campaign agenda overlapped with public health issues. A community safety initiative, for example, seeks to help New Yorkers experiencing mental health episodes by sending medical professionals, rather than just police officers with scant training, to the scene.

New York City’s health sector is poised to experience significant changes, ones that are bound to reshape the health and wellbeing of residents in all five boroughs. President Donald Trump’s “One Big Beautiful Bill Act” includes major revisions to Medicaid financing and the Affordable Care Act. The New York state Department of Health estimates these changes could cause 1.5 million people to lose Medicaid coverage, and ACA recipients could see a spike next year in their deductibles and premiums. As such, New York hospitals and other health care providers will experience an increase in uncompensated costs, and a borough like the Bronx, whose economy is heavily reliant on hospitals, will bear further brunt.

I look forward to writing about a broad range of public health issues, from, of course, the Mamdani administration’s policies to the federal government’s Make America Healthy Again mandate. Other areas of keen interest include Greater New York’s efforts to keep pathogens at bay next summer when more than a million visitors are expected to show up to watch the 2026 World Cup, as well as plans to make the city’s aging infrastructure more climate resilient. We all know that, when a storm parks itself above New York, even for a few hours, we see flooding that looks like the end times on IG reels and brings the city to its knees.

That said, I’m seeking public health stories that are unique to New York; I’m also seeking unique public health stories that happen to be set in New York. These could be about, say, scientists in Queens doing ground-breaking work and/or research that raises broader questions about health, science, and climate. Above all, I want my reporting to do two things: Hold health officials accountable, be they from the White House or City Hall, and be interesting and illuminating.

I’d love to know more about the issues that concern Healthbeat readers and warrant deeper coverage during this pivotal time. What would you like to know more about? How are these new policies playing out in your communities and affecting you, your family, and friends? What’s working? What needs improvement?

If you happen to have any documents or emails you think I should see, please send them.

You can reach me at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

I hope to hear from you soon.

Trenton

Kenya signs first U.S. aid deal – but can it afford to pay its share?

2025-12-11T12:00:00+00:00

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

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 adding doors to toilets became a lifeline for women’s health in the Balkans

2025-12-08T16:03:15+00:00

My story is about health care deserts in the heart of the Balkans. It involves periods, toilets, and a mobile clinic.

Health care desert number one: menstruation.

It was 2019, and I was serving as the British Ambassador to North Macedonia. The country’s Institute of Public Health had released a survey that showed over 90% of girls in rural areas in North Macedonia miss school during their period due to poor menstrual hygiene facilities at schools.

Girls were missing school not just because they couldn’t afford sanitary products, but also because the school toilets didn’t have doors. Doors! It was frankly eye opening to see that in a European country.

After this survey was released, we, the United Kingdom, partnered with a regional government to fix a small number of toilets and fund free menstrual products in school bathrooms. We talked to some journalists about the project, and that helped get information out about the problem and the impact on education.

It was a small campaign. It was not expensive to the UK. But the ripple effect was amazing. Here’s what happened next:

The World Bank supported a project to refurbish toilets across primary schools.
The central government offered free menstrual products for high school girls.
The government dropped the value-added tax from period products nationwide.

Rachel Galloway is the British Consul General to the Southeast United States.

Because of all of these steps, girls in rural areas were able to go to school when they had their periods. That moment — watching a policy shift born from a box of pads and a few well-placed headlines — it was stunning. And it made me think, what else can the UK do here?

Which brings me to health care desert number two: mammograms and pap smears.

The UK funded a mobile gynecology unit — an ambulance retrofitted to deliver exams in rural villages. It was a lifeline, especially during 2020 pandemic lockdowns, when women were trapped at home, often in unsafe situations.

The unit reached Roma communities and others who had never seen a doctor. It was a fantastic program. I was really proud of it. But something gnawed at me.

There were no records. No continuity. The nurses remembered faces, the doctors remembered stories, but the system remembered nothing. It was health care by memory, not by data. And in a pandemic, memory isn’t enough.

Local health care workers spoke about the challenge of serving a community without having background knowledge of who people were, what they needed, and even what they understood.

Both of these examples highlight the problem of health care deserts, which are a global problem. And as our mobile clinic demonstrates, it’s not just about providing direct access, but also about the need for better tools. Maybe this is where artificial intelligence could be useful.

An AI future does seem a little scary at times. But when it comes to health care, AI could change lives for the better. It is an area that the UK and the United States are collaborating on through our new technology partnership.

Imagine mobile units equipped not just with medical tools, but with smart systems that build records, track needs, and flag risks. Imagine AI helping us understand those farflung communities in rural locations. It could go a long way in predicting future outbreaks, tailoring care, and building trust.

It won’t replace the nurse who remembers every patient’s story. But it could mean that the next time we roll into a village, we’re not starting from scratch. We’re building on knowledge, not just goodwill.

And maybe we’ll remember that sometimes diplomacy starts with a door on a toilet — and ends with a country changing its laws.

Rachel Galloway is the British Consul General to the Southeast United States. She arrived in July 2022 having previously served as the UK’s Ambassador to the Republic of North Macedonia where she played a pivotal role in strengthening diplomatic relations in the region, including the country’s accession to NATO. Her career spans various positions, from working in Brussels at the EU, to leading a team working on Darfur policy, to a posting in Helmand Province in Afghanistan to a stint at the British Embassy in Washington.

Emory researcher explains how ‘frugal’ AI could reshape global public health

2025-12-04T21:20:09+00:00

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As the U.S. public health system weighs how to integrate artificial intelligence, an Emory University lab is patenting new ideas for precision medicine that its leader says could bring AI research into practical use – quickly and with nuance.

Professor Anant Madabhushi’s work covers AI options for detecting and treating a dizzying range of diseases, from cancer to HIV to cardiovascular disease, in countries from China to Tanzania to Brazil.

The bioengineer’s upbringing in Mumbai, India, and work with researchers around the world has driven his focus on finding uses for AI to save money, time, and resources in public health and health care.

Madabhushi holds more than 225 issued or pending patents and has headed the Empathetic AI for Health Institute at Emory since 2023. He’s also co-founded several companies focused on AI in health.

The U.S. Department of Health and Human Services announced Thursday an intention to incorporate AI into public health.

Artificial intelligence could have major public health benefits across the world, including the rural United States, Madabhushi said. But he’s concerned the United States is falling behind in the large-cohort studies needed to fuel AI’s promise.

“The necessity of these technologies, frugal and opportunistic, have implications not just in the Global South, but also in rural America,” he said. “We really owe it to Americans to be able to do whatever we can, particularly in this time of health care costs and some of the challenges with access.”

Here are seven takeaways from a recent conversation with Madabhushi.

Artificial intelligence will not replace clinicians.

“In reality, the real value lies in augmenting clinical decision-making, reducing variability, and expanding access — especially where clinical expertise is limited,” Madabhushi said. That includes parts of the world with limited resources, whether that’s his native India or rural Georgia.

Artificial intelligence has the power to transform lives and health systems, but the breakthroughs aren’t “plug-and-play.”

“In truth, they require careful validation, bias mitigation, regulatory oversight, and thoughtful deployment to ensure they actually help patients rather than introduce new inequities,” Madabhushi said.

He pointed to the example of a cancer center in India that sees about 1 million patients a year.

“Whatever technology you bring into play not only has to be able to deliver accurate insights, it also has to be done in a way that doesn’t add time to the system” Madabhushi said. “You can’t add more complexity. You can’t add more seconds to the diagnosis, to the clinical workflow.”

With 1 million patients a year, just one second added to the workflow means “suddenly you’re talking about some serious amount of time.”

Eyes are diagnostic windows to health, Madabhushi said.

Using AI, eyes can predict heart failure among patients with chronic kidney disease, as well as early forms of blood cancers.

“It turns out that even the simple fundus image [of the eye] has so much information, which, with the opportunistic use of AI, could start to tell us about a whole bunch of systemic conditions and systemic diseases,” Madabhushi said. That, in turn, could catch diseases very early and allow people to make lifestyle changes to mitigate their risks.

A “frugality constraint” could be “a game changer.”

Madabhushi and his team studied 10 diseases commonly seen in emergency rooms and found that AI could help reduce the costs of diagnosis while preserving accuracy. The point is to reduce the number of tests – and costs – required to get to a correct diagnosis.

“When you have this frugality constraint encoded into the AI algorithm, then we only require something like 10% or 11% of the total tests that were ordered for that particular patient to get to that diagnosis right,” Madabhushi said. That could dramatically reduce system and individual costs in a variety of settings.

Madabhushi’s longtime obsession with imaging has driven his commitment to saving money on the front end of diagnosis. AI can save “some very, very serious money” on pathology slides. Pathologists often need multiple stains of slides to diagnose disease. Those costs can add up quickly, with the burden falling on patients in countries like India. AI could obviate that by producing the multiple stains all at once.

In places like India, “You don’t have the luxury of these additional [pathology] stains, and if we could learn all of these various stains and parameters from a single HD [high definition] image with the power of AI, now that becomes a game changer,” Madabhushi said.

AI can reduce human suffering.

A paper Madabhushi published this week highlights this. The paper reports that AI could distinguish which types of prostate cancer would benefit from a particular type of chemotherapy drug (docetaxel) without the need for additional biopsies. The ability to distinguish which types of prostate cancer would benefit from the strong drug could prevent people from needlessly suffering serious side effects, which can include neurotoxicity and, very rarely, death.

AI research should reflect diverse populations.

“We want to make sure that we have diversity in these data sets for training the models. We want to make sure these tools that we’re developing truly are going to work across a plurality of populations,” Madabhushi said.

He pointed to a paper published this summer that found differences in endometrial cancer in Black and white patients.

“When we explicitly incorporated those differences in creating more population-tailored models for Black women, those AI models work much, much better compared to a what is called a population-agnostic one,” Madabhushi said.

The United States is losing its edge in AI health research.

“Maybe there was a time where we had a bit of an edge, but I think we’ve really given up that edge,” Madabhushi said, noting China is “quite significantly ahead” in the health care and AI space. Chinese researchers are more easily able to access and share large datasets about patients, which are key to validating AI algorithms.

“The Chinese have been able to figure this out at speed compared to us,” Madabhushi said, in part through robust data-sharing arrangements.

He also pointed to India, saying the country’s entrepreneurial spirit of doing more with less has driven innovative technologies that are now being deployed in the United States.

Madabhushi gave the example of Mumbai-founded Qure.AI, a company with AI products that can help detect lung cancer and tuberculosis. The company’s technology has been deployed in over 100 countries, according to its website, including the United States and across Europe.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@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

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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.

‘Ikigai to Ubuntu’: How a chance encounter in Haiti gave me a new ‘reason for being’

2025-11-10T18:15:33+00:00

In the tapestry of life, there are moments that stand out like vibrant threads, weaving together experiences that shape our understanding of purpose and community.

One such moment for me was the day I discovered the profound connection between the Japanese concept of ikigai — a reason for being — and the African philosophy of Ubuntu, which emphasizes our shared humanity.

This realization came to me in a small, unassuming community health center, where a simple act of kindness resulted in a chance encounter that transformed my perspective on the impact of my work.

It was a warm muggy afternoon in the outskirts of Port au Prince, Haiti. I was at a local community health center, a place that served as a refuge of hope for many in the surrounding neighborhood. As I entered the compound, I was greeted by the warm smiles of children playing and the gentle hum of conversations among countless adults.

I had been involved in various community service projects around the world, but that day felt different. It had been a few years after the 7.0 magnitude earthquake that left tens of thousands dead and millions homeless. I was there to help organize a health fair, but little did I know that I was about to experience a pivotal moment in my life.

As I sorted through boxes of medical supplies that we had acquired from MedShare International in Georgia, I noticed an elderly woman sitting alone at a table, her hands trembling slightly as she sorted through a box of food items. Her name was Mama Guerline, a widow who had lived in the community for decades. I approached her, offering a smile and a helping hand. We began to chat, and she shared stories of her late husband, and her late children, all lost in the 2010 earthquake.

She talked about the challenges she faced living on rations on a day-to-day basis. Despite having extraordinarily little left to her name, she was determined to do her part to help rebuild her torn nation. She believed her life had been spared during the earthquake so she could be a messenger of hope and change. She did not have any sources of funding, but she had a heart of gold and the determination of steel.

As she spoke, I felt a deep sense of empathy wash over me.

Here was a woman whose life was filled with love and loss, yet she radiated resilience and hope. I asked her what we could do differently for her, and she stated: Do not worry about me. Instead, focus on the youth, as they represent tomorrow. She stated that the children represent the heartbeat of the broken community. If the heart failed, the community would cease to flourish.

In that moment, I realized that my work was not just about organizing health fairs, or collecting and distributing medical donations and countless resources. It was about connecting with people, understanding their stories, and recognizing the impact of our collective efforts in the bid to transform the community.

Ubuntu: ‘I am because we are’

Mama Guerline’s gratitude for the small act of kindness we offered was palpable. She expressed how the community health center had become a lifeline for her and many others, a place where she felt valued and cared for. It struck me that this was the essence of ikigai — finding purpose in serving others and contributing to the greater good. As our conversation deepened, Mama Guerline introduced me to what I then realized was the concept of Ubuntu. She explained that in her culture, the phrase “I am because we are” encapsulates the idea that our identities are intertwined with those of others.

This philosophy resonated with me, illuminating a path forward that I had not previously considered. I began to see how my work could extend beyond individual acts of service to fostering a sense of community and belonging. That day, I left the community health center with a renewed sense of purpose. What we were doing was simply not enough. The children in the community needed to go to school in order to champion the cause for tomorrow. To do that, they needed to have food and nourishment, and they also needed to have a safe environment to live and play in.

Our group of students and volunteers adopted a Creole term on that day: “Nou kapab,” simply meaning “We can.”

I understood that my role was not merely to aid but to cultivate relationships and create an environment where everyone felt seen, heard, and respected. The ripple effect of a small act of care and simply listening could transform lives, just as it had for Mama Guerline. I realized that when we invest in one another, we build a stronger, more resilient community.

How deep listening can be a catalyst for change

In the weeks, months and years that followed, I took this newfound understanding to heart. I began to engage more deeply with the people we served, listening to their stories and learning about their needs. We organized a student movement that not only provided outreach and resources but also fostered connections among community members by engaging the community and performing extensive community needs assessments.

I witnessed firsthand how these small initiatives created a sense of belonging and empowerment. People began to share their knowledge, skills, and talents, forming a network of support that transcended individual struggles. The breakthrough I experienced that day was not just a personal revelation; it was a call to action. I understood that my work could be a catalyst for change, a means to uplift others and create a healthier and more compassionate society.

The principles of ikigai and Ubuntu became guiding lights in my journey, reminding me that true fulfillment comes from serving others and recognizing our shared humanity.

Reflecting on that pivotal moment, I am grateful for the opportunity to connect with Mama Guerline and the many others who have enriched my life. Their stories have taught me that every small act of kindness has the potential to create ripples of change and transformation. I have come to appreciate the beauty of community, where we can support one another and thrive collectively.

In conclusion, my journey from ikigai to Ubuntu has been transformative. It has illuminated a path forward, one that emphasizes the importance of connection, empathy, and shared purpose. As I continue to navigate my work and life, I carry with me the lessons learned from that day – a reminder that we are all interconnected, and that our actions, no matter how small, can have a lasting impact on the world around us.

Dr. Alawode Oladele is the supervising physician and laboratory director for infectious diseases and refugee health at DeKalb Public Health, following decades in global public health. He has degrees from the Morehouse School of Medicine and the Rollins School of Public Health at Emory University.

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.

Refugees will be among the first to lose food stamps under federal changes

2025-10-30T15:06:54+00:00

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CLARKSTON, Ga. — After fleeing the war-torn Democratic Republic of Congo, Antoinette landed in the Atlanta area last November and began to find her footing with federal help.

Separated from her adult children and grieving her husband’s death in the war, she started a job packing boxes in a warehouse, making just enough to cover rent for her own apartment and bills.

Antoinette has been relying on the Supplemental Nutrition Assistance Program, formerly known as food stamps, for her weekly grocery trips.

But now, just as life is starting to stabilize, she will have to deal with a new setback.

President Donald Trump’s massive budget law, which Republicans call the One Big Beautiful Bill Act, slashes $187 billion — or nearly 20% — from the federal budget for SNAP through 2034. And separate from any temporary SNAP stoppages due to the federal shutdown, the law cuts off access completely for refugees and other immigrant groups in the country lawfully. The change was slated to take effect immediately when the law was signed in July, but states are still awaiting federal guidance on when to stop or phase it out.

For Antoinette, 51, who did not want her last name used for fear of deportation and likely persecution in her native country, the loss of food aid is dire.

“I would not have the means to buy food,” she said in French through a translator. “How am I going to manage?”

Throughout its history, the United States has admitted into the country refugees like Antoinette, people who have been persecuted, or fear persecution, in their homelands due to race, religion, nationality, political opinions, or membership in a particular social group. These legal immigrants typically face an in-depth vetting process that can start years before they set foot on U.S. soil.

Once they arrive — often with little or no means — the federal government provides resources such as financial assistance, Medicaid, and SNAP, outreach that has typically garnered bipartisan support. Now the Trump administration has pulled back the country’s decades-long support for refugee communities.

The budget law, which funds several of the president’s priorities, including tax cuts to wealthy Americans and border security, revokes refugees’ access to Medicaid, the state-federal health insurance program for people with low incomes or disabilities, starting in October 2026.

From Khartoum to Clarkston: How a Sudanese nurse is filling a gap in health care

But one of the first provisions to take effect under the law removes SNAP eligibility for most refugees, asylum seekers, trafficking and domestic violence victims, and other legal immigrants. About 90,000 people will lose SNAP in an average month as a result of the new restrictions narrowing which noncitizens can access the program, according to the Congressional Budget Office.

“It doesn’t get much more basic than food,” said Matthew Soerens, vice president of advocacy and policy at World Relief, a Christian humanitarian organization that supports U.S. refugees.

“Our government invited these people to rebuild their lives in this country with minimum support,” Soerens said. “Taking food away from them is wrong.”

Refugees pay more in taxes than they receive in benefits

The White House and officials at the United States Department of Agriculture did not respond to emails about support for the provision that ends SNAP for refugees in the One Big Beautiful Bill Act.

But Steven Camarota, director of research for the Center for Immigration Studies, which advocates for reduced levels of immigration to the United States, said cuts to SNAP eligibility are reasonable because foreign-born people and their young children disproportionately use public benefits.

Still, Camarota said, the refugee population is different from other immigrant groups. “I don’t know that this would be the population I would start with,” Camarota said. “It’s a relatively small population of people that we generally accept have a lot of need.”

Federal, state, and local spending on refugees and asylum seekers, including food, health care, education, and other expenses, totaled $457.2 billion from 2005 to 2019, according to a February 2024 report from the Department of Health and Human Services. During that time, 21% of refugees and asylum seekers received SNAP benefits, compared with 15% of all U.S. residents.

In addition to the budget law’s SNAP changes, financial assistance given to people entering the United States by the Office of Refugee Resettlement, a part of HHS, has been cut from one year to four months.

The HHS report also found that despite the initial costs of caring for refugees and asylees, this community contributed $123.8 billion more to federal, state, and local governments through taxes than they received in public benefits over the 15 years.

It’s in the country’s best interest to continue to support them, said Krish O’Mara Vignarajah, president and CEO of Global Refuge, a nonprofit refugee resettlement agency.

“This is not what we should think about as a handout,” she said. “We know that when we support them initially, they go on to not just survive but thrive.”

Since arriving in the United States last year from Ethiopia, Lukas has been visiting the Mosaic Health Center in Clarkston, Georgia, to address diabetes-related complications. Food stamps allow him and his family to afford fresh vegetables like spinach and broccoli.

Food is medicine

Food insecurity can have lifelong physical and mental health consequences for people who have already faced years of instability before coming to the United States, said Andrew Kim, co-founder of Ethnē Health, a community health clinic in Clarkston, an Atlanta suburb that is home to thousands of refugees.

Noncitizens affected by the new law would have received, on average, $210 a month within the next decade, according to the CBO. Without SNAP funds, many refugees and their families might skip meals and switch to lower-quality, inexpensive options, leading to chronic health concerns such as obesity and insulin resistance, and potentially worsening already serious mental health conditions, he said.

Polio can still be eliminated – it just may take longer with $1.7B shortfall

After her husband was killed in the Democratic Republic of Congo, Antoinette said, she became separated from all seven of her children. The youngest is 19. She still isn’t sure where they are. She misses them but is determined to build a new life for herself. For her, resources like SNAP are critical.

From the conference room of New American Pathways, the nonprofit that helped her enroll in benefits, Antoinette stared straight ahead, stone-faced, when asked about how the cuts would affect her.

Will she shop less? Will she eat fewer fruits and vegetables, and less meat? Will she skip meals?

“Oui,” she replied to each question, using the French for “yes.”

Since arriving in the United States last year from Ethiopia with his wife and two teen daughters, Lukas, 61, has been addressing diabetes-related complications, such as blurry vision, headaches, and trouble sleeping. SNAP benefits allow him and his family to afford fresh vegetables like spinach and broccoli, according to Lilly Tenaw, the nurse practitioner who treats Lukas and helped translate his interview.

His blood sugar is now at a safer level, he said proudly after a class at Mosaic Health Center, a community clinic in Clarkston, where he learned to make lentil soup and balance his diet.

“The assistance gives us hope and encourages us to see life in a positive way,” he said in Amharic through a translator. Lukas wanted to use only his family name because he had been jailed and faced persecution in Ethiopia, and now worries about jeopardizing his ability to get permanent residency in the United States.

Hunger and poor nutrition can lower productivity and make it hard for people to find and keep jobs, said Valerie Lacarte, a senior policy analyst at the Migration Policy Institute.

“It could affect the labor market,” she said. “It’s bleak.”

More SNAP cuts are coming

While the Trump administration ended SNAP for refugees effective immediately, the change has created uncertainty for those who provide assistance.

State officials in Texas and California, which receive the most refugees among states, and in Georgia told KFF Health News that the USDA, which runs the program, has yet to issue guidance on whether they should stop providing SNAP on a specific date or phase it out.

And it’s not just refugees who are affected.

Nearly 42 million people receive SNAP benefits, according to the USDA. The nonpartisan Congressional Budget Office estimates that, within the next decade, more than 3 million people will lose monthly food dollars because of planned changes — such as an extension of work requirements to more people and a shift in costs from the federal government to the states.

In September, the administration ended a key report that regularly measured food insecurity among all U.S. households, making it harder to assess the toll of the SNAP cuts.

The USDA also posted on its website that no benefits would be issued for anyone starting Nov. 1 because of the federal shutdown, blaming Senate Democrats. The Trump administration has refused to release emergency funding — as past administrations have done during shutdowns — so that states can continue issuing benefits while congressional leaders work out a budget deal. A coalition of attorneys general and governors from 25 states and the District of Columbia filed a lawsuit on Tuesday contesting the administration’s decision.

Cuts to SNAP will ripple through local grocery stores and farms, stretching the resources of charity organizations and local governments, said Ted Terry, a DeKalb County commissioner and former mayor of Clarkston.

“It’s just the whole ecosystem that has been in place for 40 years completely being disrupted,” he said.

Muzhda Oriakhil, senior community engagement manager at Friends of Refugees, an Atlanta-area nonprofit that helps refugees resettle, said her group and others are scrambling to provide temporary food assistance for refugee families. But charity organizations, food banks, and other nonprofit groups cannot make up for the loss of billions of federal dollars that help families pay for food.

“A lot of families, they may starve,” she said.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Polio can still be eliminated – it just may take longer with $1.7B shortfall

2025-10-30T11:00:00+00:00

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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.

Watch Healthbeat’s Alison Young on media’s role in investigating origin of Covid-19 pandemic

2025-10-29T20:54:55+00:00

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Healthbeat Senior National Reporter Alison Young moderated a discussion this week on the media’s role in investigating the origin of the Covid-19 pandemic: Was it caused by an accident at a lab in Wuhan, China? Or an infected animal at a Wuhan market or in the wild?

The discussion, hosted by the Brookings Institution in Washington, D.C., focused on the media’s role in exploring those two theories – and why they appeared to receive unequal coverage.

The question of the pandemic’s origin has been the subject of controversy and debate.

Government authorities in China have refused to provide international investigators from the World Health Organization with key data that would help solve the origin question. Information being withheld includes hundreds of viral sequences from people sickened earliest in the pandemic, details about animals sold in Wuhan markets, and details about research and biosafety conditions in Wuhan.

“As things stand, all hypotheses must remain on the table, including zoonotic spillover and lab leak,” the WHO’s director general, Tedros Adhanom Ghebreyesus, said in June, when the organization released its latest report on the pandemic’s origin.

Over the years prominent scientists have published research that they have said provides an “extraordinarily clear picture that the pandemic started at the Huanan market” in Wuhan, and that their work “lays to rest the idea that the virus escaped from a laboratory.”

Meanwhile, intelligence agencies remain divided in their assessments of how the pandemic began. The Central Intelligence Agency, the U.S. Department of Energy, and the Federal Bureau of Investigation lean toward a lab-related event being the most likely cause. Other intelligence agencies lean toward a natural origin. All had “low confidence” in their assessments except for the FBI, which had “medium confidence.”

Young is a longtime public health reporter and is author of the 2023 book “Pandora’s Gamble: Lab Leaks, Pandemics, and a World at Risk.”

As part of Brookings’ work on biosafety and pandemic prevention, Young moderated a “fireside chat” with Vanity Fair journalist Katherine Eban, who broke stories on the pandemic’s origin.

Watch the video here.

Health alert shows growing concerns about type of mpox spreading in Europe and California

2025-10-28T15:55:59+00:00

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European health officials are warning that they have identified a concerning type of mpox virus spreading locally in four countries. The announcement follows the discovery of similar mpox cases spreading locally in California.

The European Centre for Disease Prevention and Control (ECDC), in a public alert issued Friday, said that locally acquired cases of a type of clade I mpox virus have been identified in Spain, Italy, Portugal, and the Netherlands.

It is the first time this type of mpox has been detected spreading within the European Union and European Economic area, the health agency said. Previously, cases of this form of the virus were associated with international travel outside the region.

Will new type of mpox virus spread beyond California? Many at-risk people aren’t vaccinated.

Outbreaks of clade I mpox have been ongoing in parts of Central and Eastern Africa.

There are two types of mpox, clade I and clade II, and both are spread through close, intimate and sexual contact and cause potentially painful rashes. During 2022-23, outbreaks across the United States involved the milder clade II type of the virus, which continues to circulate here at low levels.

The clade I type of the virus has the potential to cause more severe disease, health officials have said.

While an mpox vaccine provides protection against both the clade I and clade II virus, Healthbeat reported last week that federal data show in most U.S. states, more than half of people at highest risk of mpox infections were not vaccinated in the wake of the 2022-23 outbreaks.

Here are four takeaways from the ECDC’s new alert.

Clade I mpox has been detected spreading locally in Europe

The ECDC says cases of mpox clade I have been spreading locally in European countries, rather than just being brought in by travelers.

Spain reported its first locally acquired clade I case on Oct. 10. The Netherlands reported a case on Oct. 17. Since then, two cases were reported in Italy and one in Portugal. The patients started showing symptoms between Sept. 16 and Oct. 7.

Among these five patients, all men, none had any history of travel to countries with known transmission of clade I mpox. Of the four patients whose vaccination status was known, only one was vaccinated against mpox.

“These new cases have been reported among men, some of whom identify themselves as men who have sex with men, with no recent travel history to mpox-endemic areas,” the ECDC said. “This indicates that transmission may be ongoing in sexual networks among men who have sex with men in European countries.”

In its alert, the ECDC noted that local transmission of clade Ib cases has also been detected in California among gay, bisexual, and other men who have sex with men and their social networks.

European risk assessment says more cases are likely to be identified

An mpox threat assessment, also released Friday by the ECDC, said the overall risk of mpox clade I infection in Europe is “moderate for men who have sex with men and low for the general population.”

But the agency noted there is “substantial uncertainty” about the extent of transmission within sexual networks. “In general, the likelihood of exposure is higher with a higher number of casual sexual partners, which is supported by historical data from the mpox outbreak in 2022/23,” the assessment said.

The assessment said it is likely there are additional mpox clade I cases that have not yet been detected.

The severity of locally spread clade I mpox is unclear

While the three recent clade I cases identified in California all required hospitalization, the ECDC said the five European cases all had mild symptoms.

Clade I mpox is divided into two subtypes: clade Ia and clade Ib. The recently identified European and California cases are all clade Ib mpox, the ECDC said.

According to the U.S. Centers for Disease Control and Prevention, infections with clade 1a mpox, especially among children younger than 15, have occurred in Central Africa through contact with infected dead or live animals and through household transmission or patient care.

Clade Ib was more recently identified as spreading through intimate and adult sexual contact.

The ECDC, in its health alert Friday, said: “Some uncertainties remain regarding the transmissibility and clinical severity of clade Ib” compared to the clade II virus that has circulated since the 2022-23 outbreaks.

Before the recent locally transmitted clade I cases were identified, there had been 29 travel-related clade I cases reported to the ECDC, with seven of them needing hospitalization. But the agency said it is difficult to estimate the severity of disease based on such small numbers.

The ECDC said the severity of clade I infections may be worse among those living with HIV, especially if they are receiving inadequate treatment. People with other underlying health conditions, including suppressed immune systems, and people over the age of 65, may also be at increased risk for severe disease.

Awareness, vaccination can protect against mpox

Both the clade I and clade II types of mpox cause a rash that may look like pimples or blisters. The rash, which may involve a few lesions or many, can appear on any part of the body, including the hands, face, mouth, chest, or near genitals.

Mpox may also cause flu-like symptoms. The virus is usually spread through close contact, such as skin-to-skin contact and during sex, health officials say.

“If an unusual rash develops, they should seek medical help by contacting a health care professional for testing and advice. It is also important to avoid close physical or sexual contact with others until they are symptom-free,” the ECDC said.

Vaccination is the best protection against both clade I and clade II, health officials in Europe and the United States said.

The mpox vaccine in the United States, called JYNNEOS, is available through retail pharmacies, usually with advance appointments, as well as through clinics, health care providers, and public health departments. Locations that may offer the vaccine can be found at: www.EmpoweredAgainstMpox.com.

The ECDC has called for European countries to ensure lab testing is easily accessible, especially in locations that serve men who have sex with men, and that those at higher risk are advised to get vaccinated.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Disease sleuths piece together clues in unusual malaria case in Washington state

2025-10-27T11:00:00+00:00

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When public health investigators received a report this summer about a woman hospitalized with malaria who lived east of Tacoma, Wash., the case didn’t seem unusual.

Even though malaria was officially eliminated from the United States decades ago, every year about 2,000 people travel to places where the disease is common and bring it back with them.

All it takes is a bite from an infected mosquito to inject the malaria parasites into the skin.

So when the Tacoma-Pierce County Health Department received an official notifiable disease report on Aug. 4 about the woman’s malaria diagnosis, it triggered a routine investigation.

In the beginning it was just another of the 20-70 malaria cases reported in Washington state each year, and among the thousands of reports for a wide array of other diseases and conditions that health departments across the state track and investigate.

“The vast majority of people who are diagnosed with malaria in the United States have traveled to a malaria endemic setting,” Dr. James Miller, the department’s health officer, told Healthbeat. “By the time they’re diagnosed, they’re back in the U.S.”

It usually takes seven to 30 days from the time the person is infected until they start getting sick with fever, chills, sweating and other flu-like symptoms. Without quick treatment, the infection can become life-threatening.

Dr. James Miller, health officer for the Tacoma-Pierce County Health department, says he was initially skeptical a local mosquito bite could have caused a woman's malaria infection.

Each person whose malaria case is reported to the department gets interviewed by public health staff.

The department’s health investigators expected to learn that the woman had traveled to one of more than 80 countries where malaria infections routinely occur. Worldwide, there were about 263 million new malaria cases in 2013, according to the World Health Organization, and about two-thirds of them occurred in about a dozen African countries.

Yet the woman in Washington state hadn’t traveled anywhere she could have become infected.

“That’s what made this case unusual,” Miller said.

Reports of locally acquired malaria are rare in the U.S.

It raised the question: Could the Pierce County woman have somehow become infected with malaria in the local community?

That seemed implausible. There had never been a case of locally acquired malaria documented in Washington state, he said.

While rare, there had been sporadic reports of local infections in other parts of the United States over the years.

In 2023, health departments in Florida, Maryland, Texas, and Arkansas identified 10 people whose malaria infections were attributed to mosquito bites in those four states. Before this unusual series of small malaria outbreaks, it had been 20 years since a locally acquired malaria case had been identified in the United States.

So Miller was skeptical that a local mosquito bite was how the woman in Pierce County, Wash., had been infected.

“Initially I thought we’ll probably find some other explanation here,” he said.

New research raises concerns about local malaria infections in U.S.

Before joining the local health department, Miller had been a regional medical officer for the state’s health department, and he had also served as an epidemic intelligence officer – a disease detective – for the Centers for Disease Control and Prevention.

Often in public health investigations, he said, additional interviews and other probing will result in an explanation that makes sense. “So I think that was my first thought, that we would find another explanation,” he said.

After consulting with zoonotic disease specialists at the Washington State Department of Health and additional experts in the CDC’s malaria branch, Miller and his team started digging deeper.

“The first step was to do a more detailed Interview with the patient and their family,” he said. “Not just recent international travel, but exploring their lifetime international travel history, also looking at recent domestic travel, looking at things like outdoor activities, as well as any other potential sources of infection.”

There can be rare scenarios where people can become infected with malaria without a mosquito being involved, Miller said.

Could the woman have been infected with malaria through a transfusion, despite precautions blood banks take to prevent that from happening? Or could she have been exposed to malaria-contaminated blood through unsterilized medical equipment or perhaps by getting a tattoo in unsterile conditions?

“Again, very rare, but obviously local transmission of malaria is also rare. So we explore all the possibilities,” Miller said.

“There are rare cases where someone can have traveled to a malaria-endemic setting years prior and then not develop malaria until later,” he said. “But in this case, we didn’t identify any relevant travel for the patient, even in the more distant past.”

Investigators also didn’t identify any medical procedures or other potential blood exposures that could explain her infection.

Miller said his skepticism about a local mosquito causing the infection faded after the team’s in-depth interview with the patient and her family.

“Even though it seems very unlikely, we have to really be thinking that this could be transmission within Washington,” Miller said.

Investigators went from skeptical to warning the public

On Aug. 6, the department put out a press release alerting the public that they were investigating a possible locally acquired case of malaria.

The most likely cause of the woman’s infection, the release said, was a local mosquito biting someone who was infected with a travel-associated case of malaria, then spreading the infection to the Pierce County woman.

Malaria is caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people.

The department emphasized that the risk to the public was “very low,” that malaria does not spread directly from person to person, and that the best way to protect against malaria was to prevent mosquito bites and to talk with a health care provider about taking anti-malaria medications if traveling to countries where the disease is more common.

An alert also was sent to the area’s health care providers to be on the lookout for malaria infections, even in people who had not traveled abroad. “Without a relevant travel history, people wouldn’t be suspecting malaria in a place like Washington,” Miller said.

Meanwhile, the Tacoma-Pierce County public health team worked with the state health department and CDC to examine recent emergency department data. The records were analyzed looking for people with possible malaria symptoms who may not have been diagnosed with the disease in the recent past and going forward. No additional malaria cases were identified, Miller said.

Mosquitoes were trapped at the patient’s house and at other nearby locations.

Investigators wanted to determine whether the specific type of mosquito that’s capable of spreading malaria – the Anopheles mosquito – was present in the area. Some Anopheles mosquitoes were captured, but testing showed none of these individual mosquitoes was infected with the malaria parasite, Miller said.

The local health investigators went back and reviewed the cases of other people in the county who had been diagnosed recently with travel-related malaria infections, just to see if there was anything that was overlooked in those earlier investigations, Miller said.

They also went back to the Pierce County woman’s family and took a closer look at their travel and illness histories, in case one of them had been an initial malaria case.

But neither of these efforts produced additional clues, Miller said.

In labs at the CDC, scientists did molecular testing on samples of the malaria parasites that infected the Pierce County woman, then compared the findings with the genetic makeup of the parasites involved in the county’s other recent travel-related malaria cases.

These lab results indicated parasites in the county’s recent malaria cases weren’t similar enough to suggest any connection, Miller said.

“So where that leaves us is that in the absence of any other explanation, we think the most likely scenario is that this person did acquire a mosquito bite either here in Pierce County or potentially in a neighboring county,” Miller said.

The investigation’s findings suggest that this Pierce County woman is the state’s first known locally acquired malaria infection.

But there is no way to know exactly how her infection occurred.

One possibility, Miller said, is that a mosquito with malaria could have somehow been brought into the United States, perhaps on a plane.

The CDC’s testing of the malaria parasites that infected the woman indicate that they are most likely from sub-Saharan Africa, Miller said.

Another possibility, he said, is that there may have been a person in the area who had malaria, but their infection didn’t receive medical attention, and therefore wasn’t reported to public health officials. Miller noted that people who have lived in areas where malaria infections are common can have some level of immunity and may have a less severe case of the disease.

“And then a mosquito would have had to bite that person and then bite the person with locally acquired malaria,” Miller said.

But there is no way to know for sure. “We don’t have any confirmation or ability to say for sure about any of those scenarios,” he said.

Miller said the rapid investigation of this malaria case highlights the way the nation’s public health system should work, with local, state and federal agencies, sharing resources and expertise.

“In this situation, fortunately, the patient recovered. We didn’t identify any other cases. But of course, you don’t know that at the beginning of an investigation,” Miller said. “So it’s important to have a public health system that’s ready to ramp up quickly and to work together effectively to do an investigation.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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.

‘Going down the drain’: Atlanta global health work imperiled by U.S. aid cuts

2025-10-20T19:09:56+00:00

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Sudden cuts to U.S. global health aid this year have hit Atlanta-based international nonprofits hard, spurring layoffs of close to 1,000 workers, and imperiling their mission to help millions of people access food and life-saving health services.

A program that trained thousands of health and nutrition workers in Bangladesh is “going down the drain,” said Joyce Sepenoo, senior director of global health programs at CARE. Programs that are helping countries like Uganda nearly eliminate river blindness have lost funding, said Dr. Kashef Ijaz of The Carter Center.

They are among leaders of four Atlanta global health organizations affected by cuts implemented by the Trump administration since taking office in January.

The suddenness of cuts to the U.S. Agency for International Development caused far more disruption than was necessary, said Dr. Patrick O’Carroll, president and CEO of The Task Force for Global Health.

“Many countries said, ‘If you told us this was going to happen, and you gave us five years to do that, we could have done a pretty good job, and it’s really in our interest to do so’,” O’Carroll said. “But this happened so suddenly.”

In March, U.S. Secretary of State Marco Rubio said the government was canceling 83% of the programs at USAID. “The 5,200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” Rubio said in a March post on X.

Atlanta’s global health leaders disagree.

Tropical diseases like trachoma, a bacterial eye infection, or even malaria could come back here if they are not well-controlled overseas, Ijaz said.

Reducing diseases globally is good for America’s security, too, Ijaz said, because it helps improve economies and political stability in other countries.

Here’s a rundown of where things stand at five large global health organizations based in Atlanta.

CARE: Aid to 18.4M people terminated

Cooperative for Assistance and Relief Everywhere was founded in 1945 in the wake of World War II to put together food and life-saving items for people in war-torn Europe: care packages. Since then, it has dramatically expanded its scope to a range of humanitarian projects around the world and moved its headquarters to Atlanta in 1993.

CARE lost $165 million in direct federal funding – mostly from USAID, since the start of the year, said spokesperson Michael de Vulpillieres. The organization received a total of just over $903 million in revenue for the year ending June 30, 2024, according to its financial statements.

Global Health Checkup: A promising moment in Ebola outbreak, early flu surge, and a rise in life expectancy

The loss of funds resulted in layoffs: 850 full-time workers cut from a total workforce of about 7,400. Most of those positions were in other countries, but 110 U.S.-based workers also lost their jobs. Contract positions have also been cut, de Vulpillieres said.

All told, 46 programs in 30 countries that reached an estimated 18.4 million people have been terminated, he said.

Those include:

health programs and food distribution programs in Sudan, where “a protracted famine is taking hold,” according to the World Food Programme
health and nutrition services to mothers and children in Bangladesh
health programs in the eastern part of the Democratic Republic of Congo
Programs to provide services to survivors of violence in Honduras and Guatemala

“Our program in Bangladesh trained and invested in over 50,000 workers, and it’s all going down the drain,” Sepenoo said during an Oct. 4 panel discussion at the Decatur Book Festival. “The world is coming to a place where we all need to shout on top of our voices and say we are so connected that the impact of these things in one country affect all of us.”

Carter Center helps fill gaps in U.S. aid

The Carter Center receives only about 9% of its funding from the federal government, so it hasn’t been hit as hard as others, Ijaz said. There have been no layoffs in its health programs.

Still, Ijaz is worried about how countries like Uganda, which is very close to eliminating river blindness, and Ethiopia, which has the highest burden of trachoma in the world, will continue to make progress because other nonprofits working there have lost significant funding.

“If you miss one mass drug administration for prevention of trachoma in a population at risk, you basically put the program back two years,” Ijaz said. As in many countries, the effort in Ethiopia relies on drugs donated from pharmaceutical company Pfizer. Those could expire if they are not administered on schedule.

“All those gains which were made, they can be reversed,” Ijaz said. The Carter Center is trying to help “meet the moment” by drawing on its own resources to fill the gap left by U.S. aid cuts, including providing $5 million to partner organizations for trachoma elimination in Mozambique, which is close to eliminating the disease, and continuing its own work in Ethiopia.

“We want to reach the finish line and finish the job, and this is our contribution, in this larger ecosystem of partnerships, collaboration and relationship, to fill in those gaps,” Ijaz said.

The Task Force for Global Health finds workarounds for some programs

The Task Force for Global Health is the “world’s longest-running pharmaco-philanthropy,” O’Carroll said during the book festival panel. Much of the organization’s work focuses on managing drug donations from pharmaceutical companies for diseases like river blindness and trachoma to countries around the world.

The Task Force, founded in 1984 and headquartered in Decatur, has had to lay off staff, spokesperson Jessica Wurst said, though she declined to say how many people. It also lost funding for a USAID-funded neglected tropical disease program in early 2025 aimed to improve how sub-Saharan governments and organizations prevent and treat diseases like river blindness.

The $45 million award involved a partnership with the Kwame Nkrumah University of Science and Technology in Ghana and an African research network, according to a 2024 news release.

The Task Force’s partners have found workarounds in the short-term, Wurst said. Pfizer donates the medication for trachoma, and nongovernmental organization partners stepped in to ensure that drugs were distributed before they expired.

Still, Wurst said, that’s only a short-term solution, and the organization is concerned about next year because about 40% of the areas that need the trachoma drugs were funded by the U.S. government.

Other funding streams have remained intact, Wurst said. Those include efforts to support national programs to dramatically reduce intestinal worm infections in several countries, including Bangladesh and Malawi, work on polio eradication in the remaining countries where outbreaks persist, and providing support for viral hepatitis elimination.

Merck and GSK donate drugs for lymphatic filariasis and river blindness, and so far none of those drugs have expired, Wurst said. Countries that lost USAID funding are “pursuing alternative solutions to sustain progress toward elimination.”

In the United States, The Task Force is watching what Congress will do to the U.S. foreign aid budget. “Some cuts that have been proposed would diminish our country’s ability to prevent future pandemics, manage outbreaks, and maintain the infrastructure of health systems across the globe,” Wurst said. “These losses weaken global capacity to fight diseases that continue to threaten lives worldwide and jeopardize American safety.”

Atlanta’s public health ‘anchor’: the CDC

O’Carroll likened the Centers for Disease Control and Prevention to the “anchor store” in a mall because it is the cornerstone of Atlanta’s global health work.

The agency has been rocked by multiple rounds of layoffs this year, most recently on Oct. 10. The CDC formerly had offices in more than 60 countries, according to its website.

Funding for malaria prevention was canceled, and 27 workers in sub-Saharan Africa were recalled to the United States earlier this year, Politico reported. Staffers who focused on global HIV and TB in the Global Health Center were terminated in April.

After the United States withdrew from the World Health Organization in January under an executive order from President Donald Trump, CDC staffers were instructed to stop communicating with the organization.

Trump’s proposed fiscal year 2026 budget would, if approved, cut funding for the CDC’s Global Health Center by more than half, from $693 million to $293 million, according to the CDC Data Project.

“CDC is funded by U.S. tax dollars to protect the health of Americans, but there is no way to protect the health of Americans and turn a blind eye to global health,” O’Carroll said.

The CDC Foundation is an independent nonprofit created in 1995 to fill “gaps in what CDC could do,” Brandon Talley, chief program and foundation officer, said at the book festival. The foundation has domestic and international programs and has worked in more than 100 countries.

Federal funding cuts have primarily impacted the foundation’s domestic work, said Amy Tolchinsky, associate vice president for communications.

The organization received Covid-19 supplemental funding from the federal government that was not renewed. It was using that money to support state and local public health agencies in hiring CDC Foundation staff members to work on local health needs, so when the funding ended, 90 staffers were laid off.

The foundation also laid off 32 additional people who work in the United States due to a decrease in other federal funds, Tolchinsky said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

New research raises concerns about local malaria infections in U.S.

2025-10-17T15:52:26+00:00

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An unusual series of small U.S. malaria outbreaks – attributed to mosquito bites occurring in Florida, Maryland, Texas, and Arkansas in 2023 – illustrates what may be an increasing risk of the disease transmitting locally in the future, according to new research from local and federal public health investigators.

Their paper, published this month in the journal JAMA Network Open, comes as health officials in New Jersey and Washington state are investigating the potential that two people may have been infected with malaria this summer in those states. Neither had traveled to international destinations recently.

Malaria was largely eliminated in the United States more than 70 years ago and health officials say the risk of contracting the disease in this country remains low.

The greatest risk involves international travel to countries where the disease is widespread. Such travel is the source of most of the 2,000 malaria cases in the United States each year, according to the Centers for Disease Control and Prevention.

Yet the local U.S. malaria outbreaks in 2023 and sporadic locally transmitted cases over the decades illustrate the potential for malaria infections to occur from mosquito exposures across the United States.

That’s because when malaria-infected travelers return to or arrive in the United States and are bitten by local mosquitoes, the disease can spread in U.S. communities. More than a dozen states – including Georgia and New York – are where most of these imported malaria cases have been identified.

Here’s what you need to know.

What is malaria?

Malaria is a serious, but treatable, disease caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people. The disease does not spread from person to person like the cold or flu.

Initial symptoms – which typically occur seven to 30 days after infection – can include fever, chills, headache, muscle aches, and fatigue. If not quickly treated, the disease can become fatal, causing kidney failure, seizures, and coma, according to the CDC.

How often do malaria cases occur in the U.S.?

Local transmission of malaria in the United States was largely eliminated by 1951 because of intensive public health efforts dating back to 1914 that included drainage projects and the spraying of mosquito-killing pesticides.

The Centers for Disease Control and Prevention, which began in 1946 as the Communicable Disease Center, traces its history to an earlier World War II malaria-control agency that worked to protect troops at military training bases in Southern states as well as U.S. territories. The historic challenges eliminating malaria in the Southeast is a big part of why the CDC is based in Atlanta.

Captured in 1954, this historic image depicts a view of what was the Centers for Disease Control and Prevention, formerly known as the Communicable Disease Center, Newton Field Station, located on the Ichauway Plantation in Newton, Georgia. This wooden structure was known as the Mossy Pond tower, used to trap insects.

Malaria was considered eliminated from the United States by the early 1950s and the World Health Organization certified the United States as malaria-free in 1970.

These days, malaria cases in the United States are usually the result of infections that occurred during international travel. Each year there are about 2,000 travel-related malaria cases reported to the CDC, and on average during 2007-22 there were nearly seven deaths per year.

On occasion, however, the public health teams that investigate each U.S. malaria case cannot find any connection to international travel, raising the possibility that the infection occurred here in the United States.

For example, in August 2002, when two teenagers in northern Virginia became infected locally, public health investigators concluded the source of their infections was “probably the bite of an infective mosquito that had acquired the parasite by biting a malaria-infected person in the general vicinity.” The teens lived about a half mile apart from each other, but the 19-year-old who became infected had made numerous visits to friends who lived across the street from the 15-year-old who became infected.

How unusual were the domestic outbreaks of malaria in 2023?

Over the past 50 years, the CDC says that malaria that has been transmitted locally in the United States has resulted in more than 150 cases and more than 60 limited outbreaks.

Yet after 2003, no U.S.-acquired malaria infections from local mosquito bites were detected for 20 years. That ended in 2023, according to an examination of the 2023 cases by local, state and federal health officials published this month in JAMA Network Open.

From May through September 2023, 10 people across four states were sickened with fevers and other malaria symptoms, nine of them seeking treatment from emergency departments, and one from primary care.

After a 20-year absence of documented local malaria infections, it was “unexpected” to have so many cases spread across multiple states in one summer, the researchers wrote.

Seven of the people lived in Sarasota County, Florida, and the other three lived in Cameron County, Texas; Saline County, Ark; and the National Capital Region of Maryland. All were treated with antimalarial medications and recovered.

None had recent international travel that could explain their malaria exposures, the team found, and none had risk factors for blood-borne transmission, such as transfusions, tattoos, or needle-sharing practices.

The public health investigators found that in the weeks before these people became ill, all had a history of spending time outdoors at night – the time when Anopheles mosquitoes pose the greatest risk. Two of the infected people had worked outdoors overnight, three reported being homeless, and the rest said they had been involved in other types of outdoor nighttime activities.

Genetic and other testing determined that the cases in Florida, Arkansas, and Texas involved malaria strains associated with Central or South American parasites, the paper says. The Florida cases appeared to share a common source, the testing indicated.

But the Arkansas and Texas cases were not genetically related to each other nor were they related to the Florida cases. The infection in the Maryland case had a genetic signature consistent with African malaria parasites.

Hundreds of mosquitoes were collected and tested in the four states in the areas near where the infected patients lived. Three Anopheles mosquitoes captured over three nights in May 2023 from the same swamp in Sarasota County, Florida indicated a recent blood meal from a person infected with malaria. Evidence of malaria was not detected in any of the other mosquitoes collected as part of the investigation.

A spokesperson for the Florida Department of Health in Sarasota County said no one was available to discuss the 2023 cases.

What caused these outbreaks?

The research team noted that there were likely many factors that contributed to the U.S. malaria outbreaks in 2023. It’s suspected that the risk of local transmission of malaria has increased along with the increase in the number of malaria cases being imported to the United States through international travel.

After the Covid-19 pandemic, as “as international travel rebounded, preliminary 2023 data suggested a record high of 2,205 imported malaria cases,” the researchers said.

While most U.S. states report at least one travel-related case of malaria each year, 75% of these infected travelers in 2022 were located in 13 states. Three of the four states involved in the 2023 outbreaks were among the top states with imported cases of malaria.

Other top states for imported malaria cases in 2022 included Georgia, New York, Pennsylvania, Ohio, Virginia, Minnesota, and Virginia.

Prior to the 2023 locally acquired malaria cases, the new paper notes that the last outbreak of locally transmitted malaria occurred in 2003 in Palm Beach County, Florida, that involved eight cases.

What lessons can we take from the 2023 malaria outbreaks?

While the research team said sustained malaria transmission within the United States is unlikely, they warned that a variety of factors may increase the risk of future cases that are locally acquired in U.S. communities.

Those factors include continued increases in international travel and migration, and that rising temperatures increase the potential for mosquito exposures.

The researchers noted that there were several challenges to identifying these locally transmitted malaria outbreaks because doctors may not consider malaria as a possible diagnosis when people haven’t had recent international travel.

“Although all patients were eventually diagnosed and treated appropriately, several experienced delayed diagnosis and health care access barriers,” the paper notes.

In addition, they said, more research is needed about the prevalence and patterns of Anopheles mosquitoes in the United States. Other species are prioritized because they more commonly spread disease in this country.

“There is no national surveillance system for Anopheles species,” they wrote. And they noted that local capabilities to perform resource-intensive mosquito control efforts vary by jurisdiction.

“This case underscores common challenges in malaria diagnosis, including differentiation from babesiosis and other diseases, and potential for sporadic locally acquired malaria cases in the United States,” said Amanda Hils, a spokesperson for the Maryland Department of Health, whose investigators were co-authors of the paper. “It also highlights the need for coordinated efforts among public health officials, clinicians, laboratories, and the public to prevent, detect, investigate, and respond to such cases.”

What’s known so far about this summer’s New Jersey and Washington malaria cases?

In New Jersey, state health officials announced in August that they were working with the CDC to investigate a possible locally acquired malaria infection in a resident of Morris County, which is about 30 miles northwest of New York City.

The infected resident had no history of international travel, state health officials said. They noted the possibility the person became infected in New Jersey and said they were working to reduce potential public risks through local mosquito control activities.

If the New Jersey case is confirmed as being a locally acquired infection, it would be the first in the state since 1998, officials there said.

“The investigation to determine a potential source of the case is ongoing and is awaiting investigational testing at CDC,” Dalya Ewais, communications director for the New Jersey Department of Health, told Healthbeat on Thursday. “This testing takes time and may or may not provide definitive information.”

Ewais said the department’s trapping and testing of mosquitoes did not identify any that carried malaria parasites. The department also is not aware of any additional cases of suspected locally acquired malaria in the state, beyond the one in Morris County, she said.

“Risk of non-travel-related malaria to the general public in New Jersey remains low,” she said.

In Washington, the Tacoma-Pierce County Health Department announced earlier this summer that a woman in East Pierce County, who had not traveled recently, was diagnosed with malaria on Aug. 2.

The county health department, which has been working with the Washington State Department of Health and the CDC to investigate how the woman became infected, said it did not have an update to provide about the investigation at this time. The department as previously noted it’s “possible she was recently infected with malaria in Washington.”

If confirmed, the department said it would be the first known locally acquired case of malaria in Washington.

The CDC, which is part of the ongoing federal government shutdown, did not respond to a request for information about the New Jersey and Washington malaria cases.

What can U.S. residents do to reduce their risk of malaria?

Because mosquitoes can spread a variety of diseases besides malaria – including the viruses that cause West Nile virus, dengue and Zika – the CDC recommends protecting against mosquito bites. Some tips for doing this include using proven insect repellants that are registered with the U.S. Environmental Protection Agency, wearing loose-fitting clothing with long sleeves and pants, using screens on windows and doors, and eliminating or treating standing water outdoors where mosquitoes breed.

The biggest risk of being infected with malaria comes with international travel. Most of the approximately 2,000 cases of malaria diagnosed in the United States each year involve people returning home after trips to countries where malaria is common.

For U.S. cases where the country of infection was known in 2019, the CDC says 93% acquired malaria in Africa; 4% in Asia; 2% in the Caribbean, South America and Central America; and less than 1% in Oceania and the Middle East. When these infections occurred among U.S. civilians, 76% were traveling to visit friends or relatives.

Before going to countries where malaria is endemic, the CDC advises travelers to consult with health care providers about their risk factors and whether they should be taking an anti-malaria medication to prevent infection during their trip. The CDC maintains a list of health risks by international destination and guidance for health care providers who advise and treat travelers.

CDC officials note that even people who may have once had some immunity to malaria because they previously lived in a country where the disease is widespread can quickly lose that immunity. They are also urged to take preventative actions to avoid infection.

Preventing malaria infections during international travel reduces the risk of bringing the parasites back to the United States, where mosquito bites on returning home have the potential to spread the disease in this country.

Where in the world does malaria pose the greatest risk?

Worldwide there were an estimated 263 million malaria cases and 597,000 deaths in 83 countries during 2023, according to the WHO.

About two-thirds of these malaria cases and deaths occurred in 11 African countries: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, United Republic of Tanzania and Uganda. And the African region as a whole accounted for an estimated 94% of malaria cases, according to the WHO.

But malaria endemic countries are found around the world. Outside of Africa they include Bolivia, Brazil, Colombia, Haiti, Indonesia, Iran, Myanmar, Pakistan, Panama, Papua New Guinea, and Peru.

The United States is among 44 countries and one territory that have been certified as malaria-free by the WHO.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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

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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.

Jimmy Carter’s last crusade: New film shows near eradication of Guinea worm disease

2025-10-01T11:00:00+00:00

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A new documentary about former President Jimmy Carter takes place in Sudan, but the lessons from his work to eradicate Guinea worm disease may resonate throughout the world and back to his home in Georgia.

Carter made it his life’s goal to see the disease eliminated in his lifetime, and he came very close before his death in December. The Atlanta-based Carter Center used its influence to encourage local governments around the world to address the problem. The number of Guinea worm disease cases in humans was reduced from the millions in 1986 to just four reported so far this year.

The story of the effort to wipe out the disease in Sudan is told in the documentary “The President and the Dragon,” released Wednesday to mark what would have been Carter’s 101st birthday on Amazon, Hoopla, and Verizon Fios streaming.

“One of the biggest lessons learned is meeting people where they are, which means you have to listen to them,” Adam Weiss, director of the center’s Guinea worm disease eradication program, told Healthbeat. “You have to understand their context. You have to understand their beliefs, which may be different than your beliefs.”

The “dragon” in the title refers to Guinea worm, or Dracunculus medinensis, a parasite contracted from drinking infected water. The larvae are born in human and some animal bodies, and over a period of 10 to 14 months, the female worm can grow to around three feet in length before exiting the body through a lesion, Weiss said.

The documentary shows a young girl screaming in pain as a worm is extracted from her ankle and depicts the long-term damage the disease can do by harming joints and rendering people permanently disabled.

The Carter Center’s approach has always been to work with local leaders and communities, Weiss said, which was crucial to its success.

“It’s not about parachuting into a location and saying, ‘We’re going to fix your problem.’ Not only is that naive and incorrectly ethnocentric, but it also is not going to be sustainable and durable,” Weiss said.

Weiss, a former Peace Corps volunteer, gave the example of working in Muslim communities in northern Ghana, where people are religiously required to use natural water for ablution rituals. He said conversations about the meaning of “natural water” and using filters to show people that there were parasites in pond water were far more effective tactics in changing behavior than simply having an outsider tell them not to use pond water.

Weiss drew a parallel with Covid-19 pandemic in the United States.

“Who was talking to community members, who was talking to mothers and fathers, who was talking to schools or others to understand, ‘Hey, how can we do these things that we need to do to protect you, but how can we do it in a way that meets you where you are?’” Weiss said.

The documentary describes how difficult it was to get funding and support to work on eliminating the disease in the late 1970s and 1980s. A United Nations Water Conference did not even mention Guinea worm disease, though it is a debilitating water-borne illness.

Carter and his wife, Rosalynn Carter, brought their influence, and the resources of The Carter Center to the effort beginning in 1986. In the documentary, Carter describes how urban leaders often did not know about Guinea worm disease, despite the damage it wrought in villages.

Regina Natube, social mobilizer for the Guinea worm eradication program, is shown at Akoruni village in South Sudan on Nov. 12, 2019.

A robust surveillance system in endemic countries, as well as simple water filtration systems, formed the mainstay of the effort to eradicate the disease.

Carter’s work drove a six-month “Guinea worm ceasefire” in southern Sudan in 1995 to allow health workers to enter. They tackled Guinea worm disease and provided other services like immunizations. South Sudan became independent in 2011.

Weiss recounted seeing Jimmy Carter consoling a young girl in northern Ghana who was infected with Guinea worm. That human suffering is what motivated the Carters to direct their resources and political influence to eradicating the disease.

“He really was so empathetic that he felt that pain,” Weiss said. “You could see it in his eyes.”

The film was directed by Waleed Eltayeb, who is Sudanese, and Ian Murphy, who is Irish. Proceeds from the film rentals will be donated to The Carter Center.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Welcome to the Global Checkup: 5 health stories from around the world

2025-09-25T20:01:21+00:00

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

Hello and welcome to the Global Health Checkup, Healthbeat’s new weekly report highlighting five of the week’s most important stories in public health from around the world. My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya.

We’re launching this report at Healthbeat.org – and soon as a newsletter; sign up here – with a few goals.

First, to cut through the dense world of disease outbreaks and global health policy to pull out what truly matters and why. Unless you’re steeped in the field, it’s easy to find this space repetitive or incomprehensible. To help, I’ll be bringing in experts to help us digest the news.

We want to help people understand how global health connects us all. When you strip away the jargon, you’re left with a story that everyone can care about. It’s about how humanity wrestles with our oldest agonies: sickness, survival, death, and care. As we saw in the last global pandemic, what happens in one place doesn’t always stay there. Outbreaks, shortages, and breakthroughs tend to ripple outward.

Second, to put it all in context. I’m a science and health journalist by training, but I spent the last 8 1/2 years as the head of communications for the U.S. Agency for International Development in Rwanda, Ethiopia, and Kenya. With the dissolution of America’s foreign aid agency and the broader retreat of global health funding from the world’s wealthier nations, I want to understand what the pullback really means. But I also want to resist catastrophizing, check my priors, and highlight the brilliant people across the developing world who are working to make their societies healthier, with or without outsiders’ help.

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

Ebola returns to Central Africa

The Democratic Republic of the Congo is facing the first outbreak of Ebola in three years, Al Jazeera reports. The United Nations confirmed 48 cases and 31 fatalities on Sept. 18.

Disease breakdown: Ebola is a virus in the family of the deadly “hemorrhagic fevers.” It’s a disease that first occurred in 1976 and is contracted through infected animals, blood, or other bodily fluid. Because symptoms often end in organ failure and internal/external bleeding, the average fatality rate is around 50%. Ebola is a nightmare disease in all but one very important way: It moves slowly, because it requires direct contact with infected people or contaminated objects to spread.

The World Health Organization and other international partners have rushed in “more than 14 tons of essential medical equipment and supplies and [deployed] 48 experts.” Importantly, these supplies include a relatively new vaccine — approved in 2019 — and an antibody therapy — approved in 2020.

Will this be enough? I spoke with Dr. Paul Spiegel, the director of Johns Hopkins’ Center for Humanitarian Health, for his takeaway on this story and others.

Spiegel said the WHO has “done a good job so far, but the key is to watch how the outbreak response expands,” especially when it comes to the expensive, time-consuming task of contact tracing. “My biggest concern is that the WHO’s capacity has been decimated because of funding shortfalls, particularly the U.S. reduction in funding,” as has the U.S. Centers for Disease Control and Prevention, “which has historically been a major player in past [Ebola] outbreaks.”

We’ll be watching not just how this outbreak unfolds, but what it reveals about the world’s capacity to control epidemics.

Malnutrition deaths rising in South Sudan

In South Sudan hunger is worsening at an alarming rate. As is universally true, when hunger or famine hits, it is children who disproportionately suffer. The Associated Press reports that “about 2.3 million children under 5 in South Sudan now require treatment for acute malnutrition.” One source in the AP story reports that nearly a quarter of “children admitted for malnutrition [in the capital city’s] largest children’s hospital have died of hunger.”

What’s to blame? Conflict, corruption and climate change are factors, but the country has been especially vulnerable to the global retreat of foreign aid. Here’s an excerpt:

“Critics say years of aid dependence have exposed South Sudan. The government allocates just 1.3% of its budget to health — far below the 15% target set by the World Health Organization, according to a recent UNICEF report. Meanwhile, 80% of the health care system is funded by foreign donors.”

The AP cites closed malnutrition centers, layoffs for nutrition-focused medical workers, and dangerously low stocks of the therapeutic food (called RUTF) that are given to children on the brink of death. The crisis comes from two directions: Trump administration cuts to global malnutrition programs, and NATO allies shifting aid funds toward military budgets.

Spiegel said that unlike the acute crisis of Ebola, “what we are seeing is an exacerbation of some very long-term trends in South Sudan.” He concurs that partly at issue is the government of South Sudan’s failure to allocate funds to their health sector (despite their oil revenue.) But he notes that even a more willing and able government wouldn’t be able to match the “magnitude of the reduction in nutrition funding so quickly,” he says.

Coupled with severe flooding and a political crisis (particularly the ongoing trial of the vice president) that threatens to send the country into a severe phase of conflict and civil war, “this is an extremely serious situation that threatens to become much worse. Although it may not be hugely surprising, the scope of what is happening is horrifying.”

UNAIDS proposal: closure by 2026

Reuters reports that the United Nations may shutter its HIV/AIDS agency as it faces funding shortfalls. A draft plan from the U.N. Secretary-General calls for UNAIDS to “sunset” by the end of 2026, with its work folded into the wider UN system. The agency had already mapped out a transition with a 55% staff cut and possible closure after 2027. This new plan would accelerate that timeline.

What does this mean? Let’s turn to Eswatini in southern Africa, which has the highest rate of HIV among adults in the world.

The Times of Eswatini — the small landlocked country’s main daily — reported a stark reaction from the head of the Eswatini government body that coordinates non-governmental organizations: “I am beyond shocked myself at the fact,” Thembinkosi Dlamini said. In Eswatini, UNAIDS isn’t just a provider of technical support, he said. It underpins community testing campaigns and helps people stick to life-saving HIV treatment. Without it, he warned, new infections in Eswatini could climb again.

His appeal was for the government to begin budgeting to absorb some of UNAIDS’ functions. “We cannot rely on donors, especially at a time like this,” he said.

America first. Global health … after?

The U.S. State Department has unveiled a 36-page strategy that reframes U.S. engagement on global health under President Donald Trump’s “America First” agenda. This comes after the Trump administration has made a U.S. withdrawal from the WHO, a roughly 70% cut to U.S. global health spending (more than $9 billion), and the shuttering of USAID. An analysis by Think Global Health breaks down the document.

Let’s start with the good news: The strategy “emphasizes a continued commitment to the ambitious goals that have been set over the past decades for HIV/AIDS, malaria, polio, and TB,” Think Global Health reports.

How will the U.S. accomplish these ambitious goals after a 70% funding cut? The new plan offers no clear explanation of how (or if) those goals could be met beyond vows of “efficiency,” cuts to non-frontline work, foreign country “co-investment” to fill the gap, and some ominous silence on other longstanding U.S. commitments.

Which leads us to the bad news:

“The plan is silent on whether the United States will continue to support historically bipartisan investments in routine childhood immunization, nutrition, maternal and child health, family planning (aside from abortion), and pandemic preparedness (beyond surveillance and outbreak response)... [and] is also silent on [helping] low- and middle-income countries to manufacture vaccines, diagnostic tests, and countermeasures locally.”

The takeaway: Without a credible plan to backfill cuts, the strategy is less a roadmap to hit global targets for diseases like malaria or HIV, and more of a pivot that risks hollowing out other commitments.

More mosquitos, less problems?

The Independent reports that Brazil has just opened the largest biofactory in the world for producing mosquitoes purposely infected with a bacteria called Wolbachia. This human-friendly bacteria blocks the transmission of a suite of diseases from mosquitoes, including dengue, Zika, and chikungunya. Dengue is the main target of this effort.

Disease breakdown: Dengue is a millennia-old mosquito-borne virus that’s sometimes called “break-bone fever” for the intense joint and muscle pain it causes. Although it has a very low fatality rate (less than 1%), it spreads quickly through mosquitoes that thrive in cities. That makes it extremely difficult to wall off and allows outbreaks to balloon to millions of cases — hence the need for inventive solutions.

Each week, the factory can churn out over 100 million mosquito eggs carrying the bacteria. After the mosquitoes are grown, “public health officials release laboratory-bred mosquitoes infected with Wolbachia to breed with local mosquito populations,” to pass on the virus-blocking ability.

The way this is actually rolled out sounds like it was designed by a cartoon supervillain:

“Cars laden with infected mosquitoes will pass through dengue hotspots and release the insects with the push of a button.”

In all seriousness, Brazil’s health ministry estimates the program could protect up to 140 million people over the next few years, and could provide a model for other countries facing current surges in dengue, like Bangladesh.

Thank you for reading. I’ll see you next week!

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

New from Healthbeat: Global Health Checkup will bring context to news from around the world

2025-09-25T20:00:43+00:00

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

Hello, Healthbeat readers.

Today, we are expanding our reporting, zooming out a bit more intentionally to provide more context to the story of global public health at this time of great upheaval.

William Herkewitz, a journalist and former communications director at USAID, is Healthbeat's global health writer.

The Trump administration’s decimation of American aid to foreign countries is a developing story that will have vast consequences. Our new Global Health Checkup will keep tabs on what’s happening on the ground abroad, informed by reporting from other local outlets, a perspective that is often missing from the conversation.

The weekly report will also bring context to a broader scope of news around global public health, to show how it’s all connected - and what it means for Americans.

Healthbeat’s 1st year: Explaining public health in chaotic times

We’re thrilled to have William Herkewitz to anchor this reporting. William has over 10 years of experience in science, health, and policy journalism. From 2016 to 2025, he also served as the head of communications at the U.S. Agency for International Development’s country offices in Rwanda, Ethiopia, and Kenya. He is based in Nairobi.

William’s experience gives him a keen grasp of the global public health landscape and how to tell that story in a way that Americans will hear it. That’s what Healthbeat is all about, and we’re excited to add this layer of context for our readers.

We’re launching the Global Health Checkup this week here at Healthbeat.org. It will soon become a newsletter, too. If you’d like to get it in your inbox a day early, sign up here.

Thanks for reading.

Charlene Pacenti

Editor in Chief

CDC decapitated: What comes next for public health in the United States?

2025-09-03T11:00:00+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The resignations and public statements of multiple senior leaders from the Centers for Disease Control and Prevention last week signaled what I feared was inevitable under the new presidential administration: The nation’s premier public health agency is now guided by ideology, rather than science.

The recently confirmed director and three top officials are leaving, saying the Trump administration directed them to approve vaccine policy changes that defy scientific evidence and threaten the health of all Americans. Forced to choose between professional integrity and political obedience, they walked away.

These dramatic events raise two questions: Why do we need a CDC? What happens if we do not have one we can trust?

Why national public health agencies matter

Since the 1950s, governments around the world have learned that strong national (and multi-national) public health agencies are critical to population health. They serve five roles that no local system can perform on its own:

Monitor health conditions and potential threats to health that involve more than one state.
Provide a repository of expertise about these conditions, including highly specialized reference laboratory services.
Synthesize the best available evidence about these conditions and threats, then translate them into norms and standards for improving the health of communities.
Coordinate responses to all hazards, both acute and chronic, providing staff, supplies, and funding from the federal government to promote health and prevent disease.
Train the next generation of public health professionals, including epidemiologists, microbiologists, disease intervention specialists, and informaticians.

Over the past several decades, governments and multi-national organizations around the world have looked to the CDC as the premier model of a public health agency, choosing to create agencies that mirror the CDC for their populations. I had the privilege of helping in these efforts in Asia and Africa.

‘I hope this is a tipping point’: 3 CDC leaders walk out over RFK Jr. policies

Amid the 2002-03 SARS epidemic, the Chinese government identified critical weaknesses in its ability to detect and respond to outbreaks. In response, it combined formerly disparate programs into a new public health agency called “China CDC,” named its subsidiary units after the U.S. CDC’s, and asked the U.S. CDC to help strengthen its programs. In 2008, I was invited to help China CDC improve detection and response to emerging infectious diseases. The Chinese government wanted to establish disease surveillance, laboratory systems, and applied epidemiology training programs similar to the United States. One of the programs I helped them build — surveillance for “severe acute respiratory infections” — led to the detection of Covid in late 2019.

I had a similar experience in Africa. The West Africa Ebola epidemic from 2014 to 2016 revealed that no single country in Africa could respond effectively to cross-border threats. In the midst of that outbreak, U.S. President Barack Obama negotiated an agreement with the African Union, the inter-governmental organization that oversees the 55 countries on the African continent, to establish a continent-wide public health agency.

As part of that agreement, I was seconded from the CDC to the African Union to help establish the Africa CDC. Africa CDC’s mission was to “safeguard Africa’s health” by providing technical expertise, cross-jurisdictional coordination, and human resources training. Soon after its establishment, Africa CDC built systems that detected and stopped outbreaks in fragile states, such as Ebola in the Democratic Republic of Congo. During Covid, Africa CDC developed a continent-wide response plan that was endorsed by 55 member states Feb. 22, 2020 – before the United States declared a national emergency on March 13. (The United States had declared a “public health emergency” on Jan. 31, 2020.)

My experiences working in Africa and Asia taught me how important these centralized public health agencies are. Without them, local and state health officials are often left to improvise, resulting in policies that conflict and substantial gaps in data, expertise, and resources.

How the U.S. CDC became compromised

According to public statements of departing officials, the crisis at CDC today arises from a deliberate campaign to subvert these functions. The agency is being directed to endorse policies that have already been decided for political reasons. It is expected to find data that support fringe beliefs, reject input from established professional societies and experts, and enlist advisers who have financial conflicts and limited expertise. Its leaders are constrained in what they can say publicly and what actions they can endorse.

The new acting director for CDC has no training in science, medicine, or public health. He is an expert in politics, and, instead of relying on CDC experts to develop guidance based on scientific consensus, he’s being appointed with a clear directive to implement policies based on ideology. The disclosures by the departing CDC director suggest the CDC is now expected to create policy-based evidence, rather than evidence-based policy.

Run. Hide. Fight. What the CDC shooting means for public health

For much of my career, I have focused on detecting and responding to new external threats, such as pathogens arising from nature, laboratory accidents, or deliberate release. The assumption was that institutions like the CDC would always retain the capacity to respond, even under strain. That assumption no longer holds. The greater danger now is vulnerability created by weakened institutions. Instead of stopping the bullets that are flying through the air, we’re now taking off our bulletproof vests.

Can public health survive without a strong CDC?

If the U.S. CDC is compromised, can public health improve without a national public health agency? I do not know of any models in which an economically advanced country with a well-established public health system suddenly dismantled it. The nearest example might be the newly independent states after the collapse of the U.S.S.R. Those states dealt with highly lethal outbreaks of infectious diseases for more than a decade before they were able to rebuild their systems.

One colleague of mine put it bluntly: “No one is coming to save us.” In his view, throughout recorded history, communities have organized their own systems of care when the government could not meet their needs. The future of public health may need to look like the past with community-owned and operated systems, such as worker-run clinics, community health councils, and locally controlled infrastructure. While these systems would look modest compared to the professionalized infrastructure that we are used to, they could be more resilient. They are rooted in communities and cannot be dismantled by the results of a single election or the preferences of specialized interests.

When I was based in Thailand, I saw how programs initiated by concerned citizens and run by community leaders were uniquely effective at saving lives and reducing suffering during the 2004 tsunami. In the United States, Covid offered a glimpse of this possibility. Mutual aid networks arose across the country, delivering food, masks, and reliable information when official channels faltered.

Building the future of public health in the U.S.

While the lesson of the CDC for over 75 years is that strong central public health agencies matter profoundly, the lesson for the future may be that systems must be built and strengthened at the local level first.

In the United States, public health will succeed only if communities, professionals, and civic leaders across all 50 states organize now to preserve evidence, protect science, and create systems that endure beyond political cycles. The challenge now is whether they can be made durable, with the essential physical infrastructure, legal frameworks, and financing needed to endure.

International doctors keep this Brooklyn hospital running. Visa whiplash has jeopardized that.

2025-08-15T13:43:18+00:00

This story was originally published by THE CITY. Sign up to get the latest New York City news delivered to you each morning. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

When Russia invaded Ukraine in 2022, Anastasiia Tsyunchyk was just finishing medical school. After her studies, she held off from starting a residency in favor of sorting medications and acting as a translator — work, she said, that was more valuable at the time, because as a resident in Ukraine she would not have been able to work directly with patients.

Then, she met Conrad Fischer, a physician at Brookdale Hospital and the residency program director there. Fischer was in Ukraine at the time on a medical mission.

Tsyunchyk applied to the medical residency program at Brookdale, part of the One Brooklyn Health hospital network, and moved here in 2024. At first, she had to make some cultural adjustments. Ukraine, she said, has less of a culture around small talk. But American patients, she found, “want more of an interaction with you.”

“They want to know a little bit more about you, which is a nice thing,” she said.

In Ukraine, patients can much more easily afford essential medicines, Tsyunchyk said. But here, “I’ve had so many people who needed some sort of medications for their heart condition or their kidney condition and it’s going to provide [a] mortality benefit, but they simply cannot afford it.”

At Brookdale, many of her coworkers come from other countries. “A lot [of doctors] are coming from war zones, too, which helped me feel that I belong here,” she said. “Here, I open new horizons for myself.”

But now, her ability to stay and work in the United States may be under threat.

States facing doctor shortages ease licensing rules for foreign-trained physicians

For months, the international medical residents who make up a significant number of the Brookdale physician staff, have been caught up in a whirlwind of restrictions and regulations regarding their visa and travel status.

In May, the Trump administration paused interviews for J-1 and J-2 student visas, which many international medical residents work under in the United States. Less than a month later, they resumed. On top of that, travel bans affecting at least 19 countries mean the many international residents of Brookdale find themselves in a kind of limbo.

“We are feeling that we are not valued,” said Tsyunchyk. “We are feeling partially in fear, too, for ourselves.”

“They’re terrified,” Fischer said. “All those people on visas are daily scared that there could be a change in legality.”

NYC hospitals depend on international doctors

The doctors-in-training rely on the hospital for their legal status to be here, and the hospital very much depends on those health workers to operate.

Fischer’s internal medicine department employs 135 international medical graduates, or IMGs, who account for almost all of his doctors. About half of the IMGs are in the United States on visas.

“If we didn’t have international graduates, we would close,” Fischer said. “We could not stay open — because what do you do if you miss 80 to 90% of your doctors? You’re done. We couldn’t go a year.”

Dr. Conrad Fischer has helped staff the Brookdale Hospital trauma center in New York with physicians from all over the world.

According to the National Resident Matching Program, 6,653 positions across the country for first-year residents were “matched” to non-U.S. IMGs this year, out of a total of 37,667 matches. Almost 20% of them — 1,259 — landed in New York state.

New York City’s hospitals have especially high rates of international residents, and most are here on J-1 visas. Those hospitals depend heavily on international residents to staff their departments: surgical wards, emergency rooms, internal medicine, and more.

At Brookdale, the rate of visa-holding residents is even higher, in part because the hospital has challenges attracting American medical graduates.

“Brookdale is a very troubled hospital,” said Bill Hammond, senior fellow for health policy at the Albany-based think tank the Empire Center. The hospital network, and Brookdale in particular, has faced significant concerns around patient safety and finances. Incorporating it into the larger One Brooklyn Health network was “kind of a pet project” of former Gov. Andrew Cuomo, Hammond said.

“He was going to turn it around. They were going to become efficient, and it just hasn’t worked out that way,” he said.

Brookdale’s residency program has grown as New York City’s hospitals have been hit by a series of consolidations and closures over the years, and other residency programs have shrunk or closed as a result.

Fischer says he receives 6,000 total applicants for 55 internships, the first year of a three-year residency. Most of those applicants are IMGs, he said.

For Sebastian Arruarana, a residency in the United States offered opportunities to improve healthcare in his native Argentina and globally that he would not have been able to find at home. Arruarana, a third-year internal medicine resident at Brookdale and founder of a network for IMGs, emphasized that international IMGs often fill lower-paying residency positions at hospitals that American doctors are not interested in.

Argentinian Dr. Sebastian Arruarana has been working as a resident at the Brookdale Hospital trauma center in New York.

“Not many people wanna work in these underserved communities,” he said. “Sometimes, you end up doing the work of the phlebotomist, the transporter, you’re dealing with a shortage of different things. But it’s part of our practice and training.”

Even local medical students in the city don’t often want to stay in the neighborhoods or boroughs where they study, Fischer said. Medical graduates of the only medical school across Brooklyn, Queens, and Staten Island, he said, often prefer to work in Manhattan, or other more highly-ranked hospitals around the country.

“Most of those students don’t want to stay in Brooklyn, so you can’t force them to stay in Brooklyn,” Fischer said.

Patients, too, choose to cross boroughs for care, which compounds financial issues for places like Brookdale. Hammond attributed some of its problems to patients electing to go to better-regarded hospitals in Manhattan when they have the choice.

“You go to your local hospital when it’s an emergency, but if it’s not an emergency, and you’re having a baby, or you’re having a hip replacement, or something like that, you go to the hospital with the best reputation, even if that means traveling,” he said. “Brooklyn hospitals in general, and One Brooklyn in particular, is suffering from living in the shadow of all these well-regarded hospitals in Manhattan.”

Visa limbo, travel fears impact doctors and hospitals

When J-1 visa interviews were paused by the Trump administration earlier this year, two incoming residents, from Greece and Pakistan, to Fischer’s internal medicine department were unable to enter the country — one for a few days, the other for a couple of weeks. While they are now settled in Brooklyn, Fischer emphasized that their slots might not have been saved for them at other hospitals.

“They made it, but I want to be clear that other programs, they wouldn’t have waited,” Fisher said. “Most of the program directors would not wait that long, and they would have lost their spots.”

Georgia has a doctor shortage. Barriers to training keep immigrant physicians from filling the gap.

For the international doctors who have made it to the United States, Fischer said many have missed crucial family events — postponing weddings and family visits — for fear of not being able to re-enter the country.

“The J-1 visa program isn’t just so we could do a bunch of nice things for international doctors,” said Fischer. “We drive an 80-hour work week for not even $90,000 for a doctor. And they should not be subject to this treatment where they cannot see their families. Ultimately, that’s not good for patients.”

Arruarana said interviews have resumed for doctors from countries that currently fall under the travel ban. Argentina is not on the list; countries like Haiti, Sudan, and Afghanistan are. To Arruarana’s knowledge, no doctors in banned countries have received visas, despite having waivers that should, in theory, allow them.

“They’re completely left behind, these guys,” said Arruarana. “Those are the ones that are very stressed, the ones that are coming from banned countries — desperate, trying to email congressmen and senators and everyone.”

The impacts of visa and travel restrictions on under-resourced, short-staffed hospitals is just one secondary impact of the Trump administration’s sweeping immigration policies.

“It’s an example of the Trump administration not thinking through all of the ins and outs, not thinking through all the ripple effects of what they’re doing on immigration,” said Hammond. “It doesn’t just affect people who find work in Home Depot parking lots, it doesn’t just affect daycare and home care. It also affects people going to the emergency room at their local hospital.”

Anna Oakes is a summer 2025 reporting fellow with THE CITY and recent graduate of Columbia Journalism School.

‘They’ve gone off the map’: Fear drives immigrants away from NYC clinics

2025-08-14T19:23:17+00:00

In a quiet exam room at a clinic in Harlem, the absence of some patients speaks louder than any diagnosis.

For months now, Dr. Chanelle Diaz, a primary care physician with roots in immigrant health, has noticed a troubling pattern: Her undocumented patients — some of whom once relied on safety-net programs like NYC Care and hospital charity care — have stopped showing up.

“I haven’t seen any of my patients on charity care come into the clinic in recent months,” she told THE CITY. “They’ve just gone off the map.”

While it has always been hard to track how undocumented people receive medical care, some new figures and reports from frontline providers show a potentially concerning trend.

This year, for the first time since its creation in 2019, enrollment in NYC Care — a program designed to provide health access to New Yorkers ineligible for insurance, including undocumented residents — has declined.

And while the NYC Health and Hospitals officials who run NYC Care say the dip is due to aging participants transitioning to Medicaid, public health experts warn it may signal something far more troubling: fear of being caught in the Trump administration’s widening deportation dragnet.

Since its launch, the program grew rapidly — from 24,500 enrollees in Fiscal Year 2020 to over 143,000 by 2024, buoyed by community outreach and rising demand.

But according to data obtained from NYCHH, enrollment dropped in the third quarter of FY 2025 to 141,129 members, down from 143,503 at the end of FY 2024.

Though the decline is relatively small, it marks the first downward shift in a program that had been steadily expanding, even amid a historic influx of asylum seekers.

A Health and Hospitals statement said the drop was “largely due to undocumented residents aged 65 and over becoming eligible for Medicaid and thus ending enrollment in NYC Care.”

But former city Health Commissioner Dr. Oxiris Barbot isn’t convinced that’s the full story and noted that President Donald Trump’s targeting of immigrants and their rights is also likely to blame.

“I think it’s important to talk about all of the ways the current Trump administration is affecting the health of New Yorkers,” Barbot told THE CITY. “We’ve been concerned about the chilling effect on help-seeking behavior that anti-immigrant rhetoric is having. People are scared.”

Dr. Carolina Miranda, a family physician who has worked in the South Bronx for eight years, said the Trump administration’s ramped up hunt for undocumented people has deepened anxiety among her patients — many of whom are immigrants, asylum seekers, or experiencing homelessness.

“We’ve seen a very significant drop,” said Miranda, who works at a federally qualified health center that partners with homeless shelters and offers mobile medical units to reach vulnerable populations. “In one shelter, which was designated a sanctuary shelter for migrants, the patient volume declined so sharply that we stopped going there because almost no one was showing up for care.”

The doctor explained that many patients have stopped seeking care out of fear of Immigration and Customs Enforcement raids or arrests.

“People are afraid to leave their homes. Some tell me they canceled appointments because an app alerted them that ICE was in their neighborhood,” Miranda said. “Others are hesitant to engage with formal medical systems that keep records, worrying it could jeopardize their immigration status.”

Former Mayor Bill de Blasio launched NYC Care as he was ramping up a failed campaign for president. The program guarantees access to care for uninsured New Yorkers — particularly undocumented immigrants who are excluded from Medicaid and other public programs.

City officials stress that the initiative is not insurance: It’s a membership in a network of services provided by NYC Health + Hospitals. Cost is calculated on a sliding scale, with many participants paying little or nothing out-of-pocket.

“Having membership in NYC Care is about connecting people to high-quality primary care,” said Barbot, who currently heads the nonprofit United Hospital Fund. “It’s not sporadic sick care. It’s about prevention, coordinated services, and referrals to specialists when needed. That’s both humane and cost-effective.”

New policies raise privacy concerns

Barbot noted that recent federal policies — such as revelations earlier this year that the Centers for Medicare and Medicaid Services shared personal data with Immigration and Customs Enforcement — could make people wary.

The Associated Press reported in July that CMS agreed to give 79 million enrollees’ information to the Department of Homeland Security, “including home addresses and ethnicities.”

Under the de Blasio administration, City Hall was explicit in its refusal to share immigrant data with federal authorities. The Adams administration says it also does not share information with immigration officials unless the person has been accused of committing a crime.

“We’re not allowed to collaborate for civil enforcement, period,” the mayor said in May.

But Barbot said the mayor needs to do more to make that clear.

“It would be very helpful if the city publicly reinforced that it won’t share data,” Barbot said. “That was certainly the position when the program launched. But now more than ever, people need reassurance.”

The stakes, she added, go beyond individual patients.

“If the funding goes away for how institutions care for undocumented immigrants, it’s only a matter of time before services for other New Yorkers start taking a hit,” Barbot said. “These institutions don’t just serve immigrants — they serve all of us.”

“For those who end up uninsured because of policy changes, NYC Care is one of the only lifelines they have left,” she said.

Hospital officials insist they do not share info with ICE.

“NYC Health + Hospitals does not maintain records or track the immigration status of patients seeking care,” said agency spokesperson Alex Hunter. “We only release patient information with your consent or if authorized or required to do so by law.”

And yet, confusion still abounds, according to Barbot and other medical professionals.

Barbot pointed to broader cuts enacted at the state federal levels — including restrictions to New York’s Essential Plan and looming Medicaid work requirements — as compounding factors. These changes could cause many low-income residents, including immigrants, to lose coverage entirely.

Many people mistake NYC Care for traditional health insurance, they said. Others don’t know it exists. And for some, fear of government surveillance or deportation prevents them from signing up altogether.

“This program needs to be advertised again — aggressively,” Barbot urged. “The city needs to make it crystal clear that NYC Care is safe, private, and here to help.”

Some of that fear has long existed in immigrant communities and predates the Trump election, but Barbot said the current climate has pushed it to a “fever pitch.”

Masked agents wait to detain people leaving immigration court on Aug. 7.

Diaz, the doctor who practices at Columbia University Irving Medical Center and has served nearly a decade as a medical evaluator for people seeking asylum, said the recent federal cuts, combined with escalating fear, are driving this silent exodus.

And for many undocumented New Yorkers, the stakes are life and death.

During Trump’s first term in office, one of her former patients in a former practice, an undocumented man with long-untreated diabetes, ended up in the hospital with a severe foot infection that had spread to the bone while he avoided going to the doctor due to fear of immigration problems.

“He needed an amputation,” Diaz said. “And he was terrified. He’d been in this country working for 40 years. He said, ‘I’ve been paying taxes for 40 years — are you telling me I can’t get any help?’ It was heartbreaking.”

It’s not just new asylum seekers who are avoiding leaving their homes to seek medical care, she added.

“Legal permanent residents, people with visas — they’re all worried,” she said.

The chilling effect of these moves is already being felt, according to Diaz and other doctors focusing on the immigrant community.

“In the past, we could say confidently that your information is confidential, that it wouldn’t be used against you,” Diaz said. “I can’t say that anymore.”

‘Almost no one was showing up for care’

The consequences go beyond a few missed appointments.

“We’re seeing the consequences in real time,” Diaz said. “People end up in the ER with strokes, with complications from diabetes — things that could have been managed with routine care, if they had known where to go, or had felt safe enough to go.”

In the Bronx, Miranda emphasized that the decline predates but worsened significantly after the Trump election.

“This fear is more explicit and severe than before,” she said. “Even when people remain in shelters, they avoid coming downstairs to the clinic because they’re nervous about being documented or stopped.”

Many patients delay specialist appointments they’ve waited months for, and some send their American citizen children to pick up medications to avoid exposure themselves, she added.

The doctor noted that her federally qualified health center does not accept NYC Care insurance, which is mainly used at public city hospitals like Bellevue and Harlem Hospital.

Still, she sees many of the same immigrant populations and noted the overall drop in engagement with city-supported health care programs.

To adapt, Miranda has turned to virtual appointments to reach patients reluctant to leave home, though the shift is limited by patients’ access to technology and comfort with remote care.

She also collaborates with medical-legal partnerships to help patients prepare for contingencies such as possible deportations — including sessions on legal guardianship for children.

“It’s heartbreaking when patients tell me, ‘I skipped my specialist appointment because I was scared ICE was nearby,’” she said. “I try to reassure them, but the anxiety and mental health burden are overwhelming.”

A colleague who specializes in pediatric care has repeatedly been asked if they’d be willing to adopt the patient’s children if they get detained by ICE, according to Miranda.

Some patients are also worried about starting new treatments, she added.

“I have a patient who is a transgender man who is afraid to pursue gender affirming care because he worries about being deported — despite his legal status given his pending asylum case,” she said. “He’s afraid that if he is forced to return to his birth country and has noticeable changes like facial hair and a deeper voice, he will no longer be able to pass as the gender he was assigned at birth, and this would be dangerous for him.”

And the nature of her job has shifted since the Trump election.

“Before, I didn’t have to talk about ‘know your rights’ or deportation fears at every visit. Now, it’s a constant part of the conversation.”

Reuven Blau is a senior reporter for THE CITY.

How AI can help public health agencies improve screening, prevention, and treatment of diseases

2025-08-05T13:33:05+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

While public health agencies focus primarily on assessment, policy development, and assurance of services, they are also frequently tasked with the primary prevention and control of high-priority infectious and chronic diseases and with supporting maternal-child health.

Artificial intelligence can improve disease control by improving patient communication, supporting clinical decision-making, and managing resources and data more effectively.

AI can improve immunization logistics and uptake

Public health agencies often manage the ordering, distribution, and monitoring of recommended childhood vaccines and some adult vaccines, such as influenza. The Covid-19 pandemic exposed important weaknesses in these systems, including patient registration and eligibility assessments, recall reminders, and inventory management.

Many immunization information systems also have gaps in their ability to integrate with electronic health records, and, in some states, legal barriers restrict the completeness of recording and reporting. AI can help clean and standardize these records, filling in missing data and identifying children who have missed routine vaccines.

Several examples of using AI for immunization systems have been documented outside the United States. In DataKind’s collaboration with Gavi, an AI-supported system used natural language processing to scan paper-based health records and extract vaccine histories, helping outreach workers locate unvaccinated children. It also used machine learning to predict where vaccine stocks would run low and which areas were likely to have higher dropout rates.

These insights help immunization programs pre-position supplies, organize mobile clinics, and target community education campaigns. They also help prevent waste and shortages of vaccines.

AI can strengthen HIV, STI, and TB prevention and treatment

Public health departments operate some of the longest-running, most comprehensive programs to screen and treat tuberculosis, sexually transmitted infections, and HIV. Despite tremendous advances in biomedicine — from rapid testing systems to improved prevention and treatment regimens for all three conditions — many health departments still rely on antiquated systems for other aspects of disease control. Registering, tracing, and tracking patients and exposed persons often requires the use of paper forms, faxed results, and manual data entry.

How AI can help strengthen emergency response to public health threats

Digital chatbots, already tested in HIV and STI programs in South Africa, can improve outreach by answering common questions, booking appointments, and conducting eligibility screening. AI can also analyze surveillance data to identify geographic clusters of new cases or detect unusual patterns that might indicate a gap in prevention services.

For TB, computer vision algorithms can now interpret chest X-rays more accurately than non-specialist clinicians. While these tools do not replace clinicians or case managers, they could be used to triage patients faster, support decision-making, and flag anomalies in real time.

That, in turn, allows skilled public health workers to focus on activities that require human interaction, empathy, and judgment, such as interviewing patients about highly sensitive topics, counseling them on treatment options and social services, and supporting them emotionally.

AI can strengthen services to pregnant patients and infants

Public health systems have long prioritized linking people to care as soon as they become pregnant and supporting them through pregnancy and the first weeks of a baby’s life. Delays in accessing care, poor follow-up, and low-quality care can lead to complications, disability, or death, as demonstrated by persistently high infant mortality rates and a growing epidemic of congenital syphilis.

Digital assistants powered by AI can help frontline health workers deliver timely information to pregnant people and new parents, including personalized messages about antenatal visits, warning signs, and infant feeding. When integrated with electronic health records, these systems can alert providers when patients miss appointments or when risk factors suggest the need for more frequent monitoring.

New York City leaders tout doula initiative progress, though gaps remain

In Rwanda, an AI algorithm used data from routine prenatal visits to predict which pregnancies were most likely to result in adverse outcomes. When applied, this could help nurses and midwives prioritize specific patients for follow-up care, reducing their workload and improving outcomes. Similarly, AI-supported triage tools can help differentiate normal from high-risk deliveries, ensuring that women are routed to the most appropriate facility for their pregnancy.

Postnatal care may offer the most immediate opportunity to improve outcomes. Many deaths among mothers and newborns occur in the weeks immediately after birth. AI-powered mobile apps or voice-based tools can help monitor symptoms, guide self-care, and prompt clinic visits when needed.

AI can help expand reach and reduce inequity in chronic disease care

While screening for hypertension, diabetes, and cancer is primarily carried out by clinics and hospitals, public health agencies often organize mass screening events, promulgate guidelines, and work to connect underserved populations to care. AI can help improve the efficiency and equity of these efforts.

Algorithms can analyze electronic health records and insurance claims to identify people who are overdue for screening. AI tools can also support mobile screening units by rapidly interpreting test results and flagging high-risk individuals for follow-up. In India, researchers developed a smartphone-based retinal scanner paired with an AI system that screens for diabetic retinopathy, allowing trained technicians, not ophthalmologists, to provide service in rural areas.

For cancer screening, AI can support interpretation of mammograms, Pap smears, or stool-based tests. Chatbots, phone-based reminders, and predictive risk models can help ensure that people complete initial testing and follow through with diagnostic evaluation and treatment.

AI implementation requires funding, leadership, and oversight

One of the most critical unanswered questions is whether AI applications will improve services and disease control in populations who distrust health institutions or face barriers to care. AI evangelists argue that AI can help health care workers personalize their outreach messages, identify the highest priority persons or populations for intervention, and offload some routine tasks to increase the amount of direct human contact with persons in need of services.

The risks, however, remain substantial. AI in public health raises concerns about data privacy, surveillance, bias, and accountability. Systems trained on incomplete or biased data can reinforce inequities. Tools designed without community input may be rejected by those they aim to serve. And commercial AI systems may be unaffordable for public agencies unless open-source models or shared infrastructure are developed.

Realizing the benefits of AI, while limiting the harms, will require public health agencies to have a combination of funding to modernize data systems, leadership willing to take chances, and ongoing technical, ethical, legal review about patient rights and equitable application.

‘Global work on a local level’: DeKalb gets new tuberculosis clinic

2025-07-17T22:52:30+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

DeKalb County has the highest rate of tuberculosis cases in Georgia. Next week, it’s opening a new clinic to help test for the disease and treat it.

The clinic at the county’s Richardson Health Center on Winn Way is in a renovated space on the ground floor. It features eight treatment rooms, along with a separate entrance and negative pressure technology to prevent the spread of the contagious bacterial infection. A new radiology suite has a digital imaging system for X-rays.

Last year, DeKalb reported 52 cases of TB (a rate of 6.8 per 100,000 in 2023) while neighboring Gwinnett and Fulton reported 35 and 26 respectively, according to a surveillance report from the state Department of Public Health.

Part of the reason for DeKalb’s high rate of TB is the demographic make-up of the county, said Dr. Alawode Oladele, the supervising physician and laboratory director for infectious diseases and refugee health at DeKalb Public Health.

“It has to do with the diversity of the county and the fact that a lot of folks who are here, who are not U.S. born, come from what we call high TB-burden countries,” Oladele said, referring to nations with high TB rates.

People who were born abroad make up about 73% of the county’s TB cases, he said. Most came from Mexico, India, Guatemala, or Vietnam, according to the state DPH’s 2023 surveillance report.

DeKalb Public Health's new tuberculosis clinic features a separate entrance to prevent the spread of the bacterial infection.

Refugees and immigrants are typically screened for TB before they enter the United States. Oladele said most of DeKalb’s cases are in undocumented migrants or immigrants who have been here for awhile from high-burden countries.

The other 27% of DeKalb’s cases come from people born in the United States, Oladele said, affecting people from all walks of life.

17 tuberculosis workers laid off in DeKalb

Oladele has spent the past 28 years working on TB in DeKalb. He was born in Nigeria and came to Atlanta to study medicine at Morehouse School of Medicine and Emory University.

“I would watch people die from TB [in Nigeria], and it’s sad, because we have the capacity to prevent those deaths, right? But we didn’t have access,” Oladele said.

He sees his work in DeKalb as “an opportunity to do global work on a local level,” noting that the World Health Organization last year deemed TB the top infectious cause of death in the world, with about 1.25 million deaths in 2023.

Oladele said treating TB and stopping its spread is very resource intensive. In some cases, staff members must supervise patients taking their drugs daily, typically for four to six months. Contact tracing can be complicated, especially among undocumented communities and those who lack trust in the government and medical workers.

DeKalb County funded the new clinic, but recent cuts to public health funding have introduced new constraints. Oladele said 17 of the more than 20 people who worked on TB contact tracing and ensuring people took their medications in DeKalb were recently let go by the state after the federal government “clawed back” Covid relief funding to state health departments.

“Without the funding, without the resources, we’re handcuffed, and it limits our ability to do the work,” Oladele said.

Global funding for tuberculosis prevention and treatment decreased in 2023 and “remains far below target,” according to the WHO.

The U.S. Agency for International Development, the country’s main foreign aid agency, until this year led global TB eradication efforts. But the Trump administration has dissolved USAID.

President Donald Trump’s proposed budget for next year would, if approved, decrease support for global TB work from this year’s $406 million to $228 million.

“It’s been amply demonstrated that investments by the U.S. government in strengthening global TB prevention and control have direct benefit to our country,” said Carmen Marsit, a professor at Emory University’s School of Public Health. “It is really crucial that, just as diseases know no borders, our efforts don’t stop at our border.”

While tuberculosis numbers were on the way down prior to Covid, cases have since ticked back up, globally, nationally, and in DeKalb, Oladele said.

The Centers for Disease Control and Prevention reported that national tuberculosis rates increased three years in a row, from 2020 to 2023.

What is tuberculosis?

TB is an infectious bacterial disease that primarily affects the lungs but can infect other parts of the body. The bacteria can stay in a person’s body for years or even decades without making them sick or being transmissible to other people, in what is called latent TB.

But if a person’s immune system can no longer control the infection, latent TB can develop into active TB, which can lead to sickness or even death, especially if left untreated. TB germs can spread through the air when a person with active TB coughs, speaks, or sings. In comparison to highly transmissible diseases like measles, TB typically requires prolonged, close contact to spread.

DeKalb Public Health's new tuberculosis clinic includes negative air pressure technology to prevent the spread of the bacterial disease.

In the United States, those at higher risk of disease exposure include people who live in certain congregate settings like homeless shelters or prisons, as well as people traveling from countries where TB is common, according to the CDC. People at risk of developing the disease, if infected, include those with immune systems that are weakened due to medications, or conditions like cancer or HIV/AIDS.

In its primary stage, TB manifests with flu-like symptoms, like a low fever, tiredness and cough. Active TB disease can result in coughing up blood or mucus, chest pain, fever, and chills, among other symptoms.

The disease is treated through the use of antibiotics, and a patient is typically required to take daily medications over many months.

Globally, rising numbers of drug-resistant TB complicate the work of controlling this disease. Drug-resistant TB doesn’t respond to common medications and requires more complex treatment. The WHO describes multidrug-resistant TB as a public health crisis, noting that worldwide, only about 2 in 5 people with drug-resistant TB accessed the treatment in 2023.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

NYC’s India Home loses federal funding over its culturally sensitive senior care. It’s not giving in.

2025-07-02T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Vasundhara Kalasapudi, known as Dr. K, a psychiatrist specializing in geriatrics, lost her father to vascular dementia. When she found out about his diagnosis, she wanted to bring him to New York City from India. She called the city’s department of health, then state and federal agencies, looking for resources, but she kept hearing the same response.

“They said, ‘Dr. K, we know what you are looking for, but, you know, we don’t have any curry-serving facilities,’” she recalled.

Years later, she would create some: India Home, a nonprofit senior care provider serving South Asian and Indo-Caribbean immigrants. Kalasapudi serves as executive director. Now the centers’ cultural sensitivity has made it a target. India Home has lost $1 million in federal funding to support a new affordable housing project it is building in Jamaica, Queens.

The January decision was tied to an executive order signed by President Donald Trump, which aimed to eliminate all programs and policies based on race or sex, including those promoting racial equity and attempts to address disparities and cultural differences.

“We cannot say we are not culturally sensitive. We will continue to serve halal and vegetarian meals, and run our regular activities because we are committed to our core mission,” Kalasapudi said. “We’re hopeful that our city and state officials understand the challenges happening at the federal level and continue to support our services.”

New York City food pantries work to give immigrants a taste of home. Trump’s aid cuts are making it harder.

India Home operates five senior care centers with over 1,000 members and two co-living homes across Queens. It provides services that respect the 25 different languages their clients speak, their dietary habits, and cultural norms, while helping seniors access public health benefits such as transportation and housing. With both co-living homes at full capacity and waiting lists to get in, the new project would add 94 units.

The organization was awarded $2.5 million in federal funding for the 2024 and 2025 fiscal years to support the $70 million development, along with the state, investors and philanthropists. India Home purchased the properties, and has identified a developer, architect, and a legal firm.

But in late January, India Home received a call from New York Democrat Sen. Chuck Schumer’s office informing them that the second year of federal funding would be cut.

Kalasapudi describes the 2007 founding of India Home as a story of three daughters. She was looking for a place where her father would feel at home. Then she noticed one of her colleagues would drop her mother, who has dementia, at a nursing home while attending medical conferences. When her colleague returned, her mother would ask, “Why did you leave me?”

Another friend, who trained in geriatric psychiatry with her, had to quit her job for two years to care for her father with Parkinson’s disease. “That’s when I realized that even as doctors, we struggled to find the right support,” she says. “So what about regular people, especially those who don’t speak English? Where do they turn for help?”

Mohammad Razvi, CEO of the nonprofit Council of Peoples Organization, which has helped over 40,000 South Asians across New York City through food pantries and older adult services, emphasizes the importance of culturally sensitive programming to ensure clear communication.

“Even when a translator is available, things can get lost in translation due to a lack of cultural competency, and that’s what we’re facing,” Razvi said.

Homelessness remains one of the most pressing issues in New York City, especially for its growing aging population. The city saw a 250% increase in homeless people ages 55 and older, and a 300% increase of those 65 and older, between 2004 and 2017, according to a study by the New York State Health Foundation. The same study projected that by 2030, the homeless population over 55 and 65 could triple again.

“The housing projects are helping the community with long-term solutions,” Kalasapudi said. “A lack of housing or food leads to more hospitalizations. So this initiative isn’t just about getting seniors into housing, it’s about giving them stability, improving their health, and keeping them out of shelters. That has a ripple effect, not just on the budget, but on the entire community.”

With NYC’s aging population growing, The Bay Ridge Center shows what older adult care can be in Brooklyn — and the nation

At the Jamaica Muslim Center-India Home on a recent morning, about 50 seniors gathered in the room above the prayer room for an exercise class. Some standing and others seated, they engaged in light movements, rotating their arms in wide circles and moving their hips from side to side while mingling. The class has become a part of their daily routine.

Kavita Sivaramakrishnan, an associate professor of sociomedical sciences at Columbia University’s Mailman School of Public Health, criticized the administration’s attack on DEI efforts as anti-immigrant.

“Once migrants have settled and are tax-paying citizens, or dependents of tax-paying citizens, then even immigrants need to be integrated in their old age. I think it’s a social responsibility,” she said. “It’s very selfish to think that you could take their cheap labor when they were young and that you don’t owe them anything in their old age.”

Kalasapudi said that when they apply for grants for India Home, they extol the cultural sensitivity they bring to senior care services – and will keep doing so.

“Honestly, we’re not making any changes to the services we provide or how we hire staff,” she says. “We’re not changing anything, because it’s important that our team can speak the different South Asian languages our seniors speak. It is important for them to connect with the seniors.”

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

New York City food pantries work to give immigrants a taste of home. Trump’s aid cuts are making it harder.

2025-06-18T14:30:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

For Alfred Atherley-Ward, food means family.

The 42-year-old former chef fondly recalls memories of home-cooked meals with their daughter back in their native Guyana.

“My daughter would always look forward to when I was going to be in the kitchen cooking up food, especially dal, that we would sit together and enjoy,” Atherley-Ward said. “The look on her face, and she with her little hands in the bowl – those moments are so precious to me.”

Atherley-Ward views cooking meals rooted in their Indo- and Afro-Caribbean background as a way to feel closer to the now 19-year-old daughter they left behind while seeking asylum in the United States in 2021. The move followed years of persecution for Atherley-Ward, who identifies as queer and uses they/them pronouns. In Guyana, homosexuality is considered a crime.

The experience of fleeing violence back home coupled with struggles to access food and housing upon relocating to New York City made them all the more grateful for the culturally inclusive food items available at the Food Justice Program, an initiative of the Queens-based Caribbean Equality Project, which provides legal and social services to Indo- and Afro-Caribbean LGBTQ+ immigrants and asylum seekers.

“We go through so much mental health trauma,” said Atherley-Ward, who experienced an 18-month period of homelessness shortly after moving. “All we’re looking for is a place of acceptance on this journey.”

The Food Justice Program is one of a growing number of food pantries in New York City working to provide culturally responsive help for the city’s immigrant communities. A lifeline amid the Covid-19 pandemic, these programs now find their sustainability threatened by the Trump administration’s cuts to federal food aid.

“The pandemic was a spark for an increase in food needs, and that need never dissipated,” said Caitlin Caspi, director of food security initiatives at the Rudd Center for Food Policy and Health at the University of Connecticut. “In the last few years, we’ve seen high levels of federal food assistance, but all of that now is being stripped away.”

NYC food insecurity nearly doubled at start of pandemic

Research shows that New York City’s incidence of food insecurity, which is defined as uncertain access to adequate food at the household level, nearly doubled during the first six months of the pandemic. A 2020 report found that the number of food-insecure individuals increased from 1.2 million in March 2020 to 2 million in August 2020, an incidence rate of nearly 14.6%.

The pandemic’s impact on communities of color, including immigrant populations, was particularly pronounced, with more than half of Black, Latino, and Asian New Yorkers reporting an inability to buy groceries during the period, compared to 42% of white New Yorkers. Issues of limited food access, which can lead to increased risks of obesity, diabetes, and cardiovascular disease as a result of a nutrition-poor diet, continue to persist among those groups.

“They say Covid is over, but the folks we’re providing service to, it’s never over for them. Their rent has increased, their daily expenses have increased, but their wages haven’t.”
Mohammad Razvi, CEO of the Council of Peoples Organization

More recent data, including 2024, shows that while the citywide food insecurity rate remains elevated at pandemic levels, the rates of food insecurity for communities of color are two to three times higher in every borough compared to their white counterparts.

Jennifer Cadenhead, executive director of the Laurie M. Tisch Center for Food, Education and Policy at Teachers College, Columbia University, said people of color’s heightened food vulnerability is due to low wages and a lack of worker protections in service-based industries, such as restaurants, which employ many immigrants and were disproportionately impacted by the pandemic.

“In terms of food security, people of color tended to do worse both during Covid and in their ability to get back to baseline,” Cadenhead said.

The economic downturn of the pandemic contributed to increased use of food pantry services. One in three New Yorkers reported using a food pantry at least once post-pandemic compared to 1 in 5 New Yorkers pre-pandemic, according to a 2024 report issued by the Robin Hood Foundation.

Why access to cultural food options matters

Immigrant recipients of food pantry services state being unsure of how to cook American foods, research shows. A lack of access to culturally inclusive foods is also associated with poorer mental health outcomes, such as increased feelings of shame and stigma, in immigrant communities.

Culturally inclusive food pantries are essential to creating a more dignified experience for clients by allowing them to choose their own food, Caspi said.

“Food pantries have been trying to move toward more choice-based programs that allow people to feel like they’re shopping in a grocery store,” she said.

Caribbean Equality Project staff, volunteers and community partners gather for a Food Justice Program pantry distribution.

The Caribbean Equality Project’s Food Justice Program, which launched in Flatbush in 2020 following the pandemic, caters to the city’s Caribbean diaspora and has served more than 55,000 people. Among its offerings are ingredients for balanjay, a Guyanese dish made with eggplant, potatoes, cumin, and other traditional spices; as well as lentils and flour.

Atherley-Ward, who now works as a community adviser at the Caribbean Equality Project, said the organization’s commitment to distributing fresh produce, such as cabbage and tomatoes, which serve as ingredients for traditional curries, supports the nutritional needs of the Caribbean diaspora.

“I’m not just getting food, but rather food that I’m accustomed to, that I can create healthy meals with,” they said. “It helps with the daily stress of wondering ‘what can I make with this?’”

Trump cuts to food aid threaten local programs

The Trump administration’s cuts to federal funding for food banks and other emergency assistance food programs threaten projects like the Food Justice Program. In March, the administration announced that $500 million in support of the Local Food Purchase Assistance Cooperative Agreement Program, a federal initiative that enables food banks to purchase goods from local farms, would be cancelled.

Later that month, the administration pulled another $500 million dedicated to The Emergency Food Assistance Program, which distributes emergency food assistance to states, from the federal budget.

The Caribbean Equality Project’s executive director, Mohamed Amin, worries about the impact. He points to a recent letter from the organization’s food assistance partner, the Campaign Against Hunger, that warns of reduced food aid deliveries in the coming months.

At present, the Campaign Against Hunger provides the Food Justice Program with monthly food aid for 250 families. A decrease in resources would put additional financial strain on the organization, he said, which already spends $5,000 a month to support additional pantry clients.

“These cuts not only have a direct impact on the community members that we serve, but also on programs like ours that fill the gap,” Amin said. “And now we’re seeing this gap become wider and more disproportionate.”

Fresh produce is available at a Food Justice Program pantry distribution.

The structure of the emergency food system also places extra financial burden on organizations like the Caribbean Equality Project, which strives to meet the needs of communities of color. TEFAP food aid, which flows down to local pantries like the Food Justice Program, is made up of staple items like apples and beans, meaning it doesn’t always meet the cultural needs of communities, Caspi said.

Amin and his colleagues remain committed to utilizing existing pantry funding to purchase culturally inclusive products.

“We are not willing to negotiate the needs of our communities,” he said.

Food prices up 20% over five years ago

The funding cuts come at a time of greater need for food aid, much of it driven by increases in the cost of living. According to Federal Reserve Economic Data, prices on goods, including food, are up 20% over five years ago.

“They say Covid is over, but the folks we’re providing service to, it’s never over for them. Their rent has increased, their daily expenses have increased, but their wages haven’t,” said Mohammad Razvi, CEO of the Council of Peoples Organization, a Brooklyn-based group that provides social services to low-income immigrant families, a majority of whom are South Asian and Muslim.

The council, which operates a weekly halal food pantry started shortly before the pandemic, has become increasingly reliant on food donations from local businesses. The donations, which help make up for reduced goods from local food banks, are critical to serving the pantry’s more than 2,000 weekly clients.

In recent months, though, Razvi has observed shorter pantry lines, which he attributes to the Trump administration’s immigration policies and threats of mass deportation.

“People are saying, ‘Can I take this for my friend? He’s afraid to come’,” he said.

Fearful clients are requesting home delivery, but Amin said it’s hard to establish new services in a time of limited resources.

“We don’t have the infrastructure to deliver to families who are undocumented, who are afraid to come because of fears of ICE,” he said of Immigration and Customs Enforcement.

Support for such food pantry operational costs are the focus of efforts by local advocacy organizations. Grace Bonilla, president and CEO of United Way of New York City, said the organization is working to double the city’s funding to $100 million in the upcoming fiscal year for Community Food Connection, a program supporting more than 700 community kitchens and food pantries.

“When the dust settles, and people begin to emerge, we could see spikes in food need,” she said of the political climate against immigrants. “We have to be prepared for that.”

Amin, though, remains hopeful.

“I think about abundance, and I dream about abundance, and I manifest abundance because that is what the immigrant community needs right now,” he said. “We need an abundance of resources to make sure that we are not just surviving, but thriving.”

This story has been updated to correct that the Caribbean Equality Project is based in Queens, not Brooklyn.

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

From Kenya to New York: How a global nonprofit is addressing local maternal health needs

2025-06-16T13:48:41+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

A nonprofit that works to help women survive childbirth in Guatemala, Kenya, and the Dominican Republic is expanding work in its only location in a developed country: New York City.

Saving Mothers, founded by New York University gynecologist and professor Taraneh Shirazian, is among several initiatives working to ease a maternal mortality crisis in the city, where deaths per 100,000 live births reached 19 last year.

Women in underserved areas of New York City are dying under many of the same conditions seen in less-developed countries - high blood pressure, infection and severe bleeding due to limited access to health care, poverty, social inequities, fear of medical devices, and mistrust of hospital staff, said Reham Perry, the programs coordinator at Saving Mothers. (Many others are also dying of drug overdose).

Saving Mothers aims to ease the crisis by equipping pregnant patients in underserved communities to advocate for themselves in the health care system and track their own vital signs for early indications of dangerous conditions like preeclampsia.

Globally, more than 343,000 women die in pregnancy or childbirth yearly, the majority in Sub-Saharan Africa and southern Asia. In the United States, 80% of pregnancy-related deaths are preventable, and of those deaths, Black women are three times more likely to die than white women, according to the Centers for Disease Control and Prevention.

How New York is addressing health disparities in pregnancy-associated deaths

While global maternal mortality rates have seen a reduction of 40% between 2000 and 2023, some areas, like New York City, have maintained steady or slight increases.

Part of the reason is that the city is home to so many people from various backgrounds, creating more factors that contribute to deaths associated with pregnancy and childbirth, Perry said.

“Even when we have statistics about Black women, and we say that they are more likely to die than white women that are laboring in the same hospitals, Black women aren’t a monolith,” she said.

They may encounter language barriers, doctors who don’t take their pain seriously, or assume they are using drugs, she said.

Saving Mothers steps in with its mPOWHER kit, designed to help pregnant New Yorkers help themselves.

Kits help patients track vital signs, monitor for dangerous symptoms

Preeclampsia, a high blood pressure disorder that occurs during and after pregnancy, is 60% more likely to occur in Black women than white women, according to the Preeclampsia Foundation. It can be caused by a pre-existing condition such as high blood pressure, which Black people are predisposed to.

Preeclampsia patients are at risk of seizures, kidney/liver failure, and cardiovascular events, such as stroke. Their babies are at risk of preterm birth, low birth weight, or stillbirth, as well as neurological and psychological defects.

Women being trained as birth attendants attend graduation at New York-based Saving Mothers' school in Guatemala. The birth attendants are known as "comadronas," trained to deliver babies and assess and recognize high-risk situations.

Saving Mothers’ medical team – a health literacy expert, health care providers, and a doula – help curate the mPOWHER kit with items aimed at preventing three conditions: cardiovascular disease, embolism and hemorrhage, the three leading causes of death among expecting mothers. The kit includes a Fitbit or other tracker, a blood pressure cuff, and compression socks to reduce swelling.

The Fitbit tracks heart rate and exercise, as well as helps prevent embolisms by encouraging movement. The blood pressure cuff helps patients monitor for random spikes they can report to their medical providers to help to catch conditions like preeclampsia, Perry said.

Patients get guidance on how to advocate for themselves

The kit also includes guides with information to help patients advocate for their health, like suggestions for different ways to communicate with their doctor. The tips aim to empower them to speak up in their appointments so they don’t feel overpowered or dismissed.

Teneisha “Adwoa” Olivierre recalls the difficulties of her first pregnancy in 2005, exacerbated by a lack of support from her obstetrician.

“He didn’t answer my questions, he brushed me off, gave me the wrong due date, he sent me for all my tests and things very late in the pregnancy,” she said. “The most he would do is put the stethoscope to my stomach, listen for the heartbeat, weigh me, and send me home. There was no measuring of the stomach, there was nothing.”

A midwife paid more attention: “She actually took her time and asked questions.”

Perry said the ability to self-advocate is important in a vulnerable condition like pregnancy and helps patients make the most of their doctor visits.

‘This Side Up’ onesies and crib distribution: Infant sleep safety efforts central in Queens

“They really empower the mom to take up space in those appointments and not feel like, okay the doctor is rushing, so I can’t ask these questions,” she said.

Saving Mothers also trains doulas to address health issues like preeclampsia and gestational diabetes.

The group plans to update the kits this summer with guidance on how to talk to doctors about postpartum mental health needs.

The organization distributes the kits at baby showers hosted by organizations including the New York Public Library, the New York City Housing Authority, and Healthy Start Brooklyn.

A second version, a safe birth kit, is designed for expectant mothers abroad who may need to give birth at home. It includes an umbilical clamp and razor blade to remove the cord after birth, a sterile sheet for delivering the baby, a glove, a bar of soap, illustrated directions for delivering the baby, and a hat and blanket for the baby.

How stress and access to health care can affect maternal health

Stress can play just as big a role in Black maternal mortality as any medical condition, Perry said, pointing to microaggressions and bias that affect Black women.

Rewa Thompson, a nurse educator of 20 years and a clinical associate professor at Stony Brook University’s School of Nursing, said social determinants of health – income, education and access to health care – factor in, as well.

For example, many low-income pregnant patients rely on Medicaid, which offers limited resources.

A team from New York nonprofit Saving Mothers works with pregnant patients at Kapenguria Regional Hospital in Kenya.

“There are more Black women who use these public hospitals,” Thompson said. “The hospitals are short staffed.” Bias and fatigue can lead staff to dismiss concerns of Black mothers. “So they become desensitized to the complaints, and then they’re like, she’s fine, and next thing you know, she has a massive blood clot in her lungs, and she’s dead.”

Thompson recommends that Black mothers have a trusted representative with them for the birth experience, to speak up for them in the event that they cannot advocate for themselves.

How federal funding cuts affect maternal health

Perry says recent cutbacks from a restructuring and reorganization of federal health agencies ordered by the new Trump administration have put maternal resources in jeopardy.

In January, data collection for the Pregnancy Risk Assessment Monitoring System was cut, and the 17 employees who worked in the CDC program were laid off on April 1.

New York state has taken steps to expand affordable health care for pregnant patients and offer free doula services under Medicaid.

Olivierre, who now works as a doula, said she was much more prepared for her second pregnancy, in 2023. She used a kit provided by Saving Mothers and took care in choosing her providers.

A week after giving birth, Olivierre noticed a spike in her blood pressure. After an emergency room checkup, it was confirmed that she had developed preeclampsia.

“If I didn’t have the blood pressure cuff, I wouldn’t have known that I needed to go to the emergency room,” she said.

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

Reports of ‘Disease X’? Here’s how to think clearly when you hear about an outbreak

2025-04-09T15:24:46+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Social media feeds filled up in recent days with reports of an outbreak in Russia of people with severe respiratory symptoms, including coughing up blood. According to these reports, tests for common viruses were negative, and there was fear this was caused by a new virus. As one journalist aptly observed, “The speed with which viral rumors can trigger public concern is a growing challenge for health officials in Russia and globally.”

Indeed, in the past year, I have become concerned about an epidemic of epidemic reports, a tendency for social and mainstream media to write about illnesses or deaths in other countries and speculate that a “mystery” infectious disease has emerged. Notable examples include “disease X” in Congo from October to December 2024, human metapneumovirus in China in December 2024, a cluster of unexplained deaths in Congo in February 2025.

How can you interpret these reports better? When is concern justified, and when is it not?

When a new disease outbreak makes headlines, most people fixate on the wrong details. They often focus on gruesome symptoms, reported deaths, and stories involving particularly sympathetic groups, such as young children.

The past two decades of pandemics – from SARS to Ebola to Covid-19 – have taught epidemiologists that it is more important to think about a potential outbreak across three dimensions. Was there laboratory confirmation? How easily does it spread? How severe is it? What tools do we have to prevent or treat it?

Was there laboratory confirmation?

When I trained in the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, the first lesson we learned about outbreak response is: Confirm it’s an outbreak. Part of that involves comparing the number of cases against what is expected, but the other important part is testing specimens from ill persons.

Early reports may simply reflect clinical symptoms — cough, diarrhea, fever — not the actual cause. These reports often lack important details about what tests, if any, have been performed.

If the report describes people with respiratory symptoms, how many people had specimens collected? Were they from the nose, throat, or lungs? What about specimens from the blood (which can be important for some viral infections and invasive bacterial infections) or even from the urine (for Legionella)?

Was testing done using polymerase chain reaction, a highly sensitive method of identifying genetic fragments of pathogens, or were they done using other techniques? Were those tests done in high-quality (also known as “reference”) laboratories?

In many low-income countries, clinics may lack the supplies to collect certain specimens, hospital laboratories lack the ability to perform many advanced tests, and, even if those labs have the appropriate equipment, the quality of testing may be inferior. Much of my work in Southeast Asia on tuberculosis and in China on foodborne and respiratory infections involved trying to address these weaknesses.

To determine whether a disease is caused by a known pathogen or something truly new, investigators must perform extensive testing. Without it, a cluster of reports about people with vomiting and diarrhea could just as easily be due to norovirus or Salmonella as it could be a new pathogens.

Consider, for example, the Disease X “outbreak” from Congo in late 2024 involving (as of Dec. 16) 891 ill people and 48 deaths. For weeks, news outlets speculated that a new disease had emerged and could spread to other countries. After a large international response, testing of 420 samples identified “malaria, [as well as] common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus).”

The presence — or absence — of laboratory confirmation helps separate signal from noise.

How easily does it spread?

The transmission patterns of a new disease provide crucial initial insights into its potential impact. The five most common routes of transmission are respiratory, vector-borne (e.g., mosquitos, ticks), direct contact, gastrointestinal, and body fluid (e.g., sexual, blood).

Of these, transmission by the respiratory tract is most worrisome. A person who expels a pathogen into the air by coughing or simply breathing (as happens with measles) can rapidly spread the infection to many people. When they do so in a public setting, they immediately extend the geographic spread of that pathogen beyond that person’s close contacts.

Think about how quickly the 2009 H1N1 influenza strain and Covid-19 spread around the world. This certainly explains why there was so much reporting about the increase in HMPV cases in China. But it’s important to put these infections in context. Unlike Covid-19, HMPV is a well-documented seasonal virus that has coexisted with human populations for decades. Understanding transmission requires looking beyond the simple fact of spread to examine whether a pathogen is following known patterns or exhibiting new behaviors.

Consider also the 2022 mpox outbreak. When it originally arose, there was concern that it might spread by the respiratory route similar to its sister virus, smallpox. But, to date, transmission appears limited to direct physical contact and the sexual route, which is why infections in the United States have largely been restricted to gay men and people in their sexual networks.

How severe is it?

Disease severity matters, but often not in the way that people think. Infections that kill a high percentage of people and that do so quickly can often be contained more easily than other infectious diseases. It is easy to identify and isolate the ill, and the ill have fewer opportunities to spread infections to other people.

Consider why Ebola never caused widespread outbreaks in the United States. People with Ebola are at highest risk of spreading infection when they are most severely ill – that is, they are not walking around, but rather confined to their bed or a hospital room.

Infections spread rapidly in settings in Africa, where infection control in health care facilities is inadequate, and where it is a common cultural practice for multiple people to bathe and touch a person after they have died – that is, at the moment of peak infectivity. Therefore, even though Ebola is a severe disease, those who are most severely ill in the United States are likely to be in a setting where they cannot readily spread the infection to others.

Consider also why SARS was contained, but Covid-19 has not been. With SARS, people did not readily spread the infection until they had symptoms. Even though those symptoms were severe (the “S” stands for severe), people could not readily spread it to other people because they were so ill.

Covid-19, in contrast, could infect people and not cause any symptoms. Many people cited this as a reason for why we should not be particularly worried about the virus. But, for infectious disease epidemiologists, this was one of its most worrisome features: People with minimal symptoms would walk around and spread it to lots of people without knowing it.

What tools exist?

Our capacity to respond to a disease threat represents the third crucial element in risk assessment. Do we have drugs that can reduce symptoms, reduce infectiousness, and/or cure disease? Do we have vaccines that can prevent severe illness and reduce infectiousness?

This is one reason Covid-19 was so problematic. When this pathogen emerged, we had no drugs or vaccines available and had to rely on masks and social distancing to reduce transmission. H5N1, bird flu, is particularly worrisome because existing influenza vaccines do not reliably prevent infection or reduce the severity of disease.

Thinking critically about outbreak news

In a world where information travels far faster than infections, it is more important than ever to think critically about reports of new diseases or outbreaks. While dramatic stories about individual cases may capture headlines, pay attention to both what these reports include and omit, particularly as it relates to laboratory testing, routes of transmission, disease severity, and existing treatments and vaccines. Evaluating the data behind the story is key to separating fear from fact.

Why cuts to global AIDS relief threaten U.S. health, economic growth, and physical security

2025-02-28T12:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Journalists and foreign policy experts have written extensively about the suffering caused by the Trump administration’s decision to halt food, health care, and other forms of assistance to some of the poorest people in the world. Given income inequality and the fragility of the social safety net in the United States, I am not surprised that some Americans approve, thinking, “Why are we spending money on people in other countries when it could be spent here, like to pay my health care bills?”

Defenders of foreign assistance rightly point out that it accounts for only a tiny fraction of the U.S. budget (about 1%) and that there has long been a bipartisan consensus that the wealthiest nation in the world has an ethical obligation to help people in other countries. One reason that popular support for foreign assistance has eroded is that many Americans are unaware that it directly benefits our own health, economic growth, and physical security. The most obvious example is U.S. foreign health assistance, such as through the President’s Emergency Plan for AIDS Relief.

What is PEPFAR, and how does it work?

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) under President George W. Bush started as a $15 billion commitment spread over five years to support 15 countries around the world, then eventually expanded to support more than 50 countries.

PEPFAR operates by directly funding health programs in recipient countries, working with governments, non-governmental organizations, and local health providers. The program provides antiretroviral therapy (ART), supports prevention (including stopping HIV transmission from mothers to their newborn babies), and strengthens overall health care infrastructure, including clinics, labs, and supply chains.

Through PEPFAR, U.S. government agencies, such as USAID and the Centers for Disease Control and Prevention, assign physicians, epidemiologists, lab scientists, and experts in related fields to live and work in these countries. The job was to work with the foreign government agencies and NGOs funded by PEPFAR and ensure that U.S. taxpayer money was spent wisely on saving lives and preventing infections.

Since its inception, PEPFAR has, in fact, saved over 25 million lives through ART, prevented HIV infections in 5.5 million babies, and increased life expectancy in PEPFAR-supported countries, an accomplishment that has been celebrated by people from different political backgrounds.

My experience with infectious disease control abroad

In 2003, I moved with my family from the CDC’s headquarters in Atlanta to Bangkok, Thailand to serve as the first CDC regional adviser to Southeast Asia for tuberculosis control. My job was to support the Ministries of Health in Thailand, Cambodia, and Vietnam with improving diagnosis, treatment, and prevention of TB.

At that time, HIV was spreading rapidly throughout Southeast Asia, because treatment was still not widely available. When HIV infection suppresses the immune system, it makes people exquisitely susceptible to developing severe illness and death from TB. Despite highly effective drugs against both TB and HIV, TB remains one of the world’s leading killers of people and the number one killer in people with HIV infection.

The U.S. government has a direct interest in supporting global TB control, because most TB cases in the United States arise in people who acquired their infection overseas (76% in 2023). As we have learned from Covid-19, Ebola, and mpox in the past 10 years, any disease around the world can readily spill over into the United States. (While I was based in Thailand, for example, I helped lead the response to an outbreak of multidrug-resistant TB among refugees being resettled to the United States.)

My assignment in Thailand was initially funded by money that had been appropriated by Congress in 1999 for the “Leadership in Fighting an Epidemic” initiative. Through that funding, the CDC assigned experts like me to countries with a severe HIV burden to help them prevent, care, and treat people with HIV and control associated diseases, like TB. Soon after I moved to Bangkok in 2003, Bush made the decision to super-charge the LIFE initiative and turn it into PEPFAR.

U.S. President George W. Bush takes part in a roundtable discussion on the PEPFAR AIDS program in 2008 at the Amana district hospital in Dar es Salaam.

Cutting PEPFAR threatens U.S. health

Twenty-two years later, cutting PEPFAR funding has immediate harmful consequences. Some of the world’s leading mathematical modelers in infectious disease previously collaborated to estimate what would happen to HIV infections and deaths if services were interrupted due to COVID-19 control measures. Adapting that model to the current situation, they estimate that thousands of adults and babies may have died already from the decision to halt PEPFAR services.

Why should Americans worry about this?

When millions of people reliant on ART have their treatment interrupted or receive drugs only intermittently, we create the ideal environment for the emergence of drug-resistant HIV strains — infections that will eventually spread to the United States and directly imperil the health of Americans. There is a similar risk of drug resistance emerging and spreading for TB, because the U.S. government is the largest donor of TB drugs and care through PEPFAR and other U.S. assistance programs. Without treatment, other infectious diseases may emerge too; patients with HIV develop severely impaired immune systems and then become a population in which new pathogens evolve or cause outbreaks, such as new variants of Covid-19 and mpox.

One important way that the U.S. government learns about outbreaks of emerging diseases is because we have CDC and USAID personnel in these countries working with ministries of health, the World Health Organization, and other health groups. Every time a new disease threat has emerged, these personnel have been instrumental in verifying what is happening, continuously monitoring the threat so that the United States can prepare adequately for it, and helping to slow or stop it from spreading to the United States.

The most dramatic example is how CDC personnel assigned to Thailand were critical in identifying the cause of the SARS outbreak in 2003. When I served overseas, I frequently reported back to Atlanta about what we were seeing about the emergence of new diseases. While at the African Union during the initial emergence of Covid-19, I participated in multiple calls, for example, with the National Security Council to help them understand the security implications for the United States.

One of the main reasons the United States stations intelligence and military personnel around the world is so that the government has eyes, ears, and boots on the ground to protect Americans from threats overseas before they come to the United States. For more than 20 years, Congress has funded overseas CDC personnel because it believes this type of work is as important for health security as it is for physical security.

A huge bolus of additional funding for CDC and USAID global health work came after the 2014-16 West Africa Ebola outbreak in which personnel from these agencies who were already assigned in Africa for PEPFAR-related work played a critical role in detecting, monitoring, containing, and treating Ebola. I was in Sierra Leone for two months in 2015 helping lead the CDC response, and many of my colleagues there with me were people whose salaries were paid by PEPFAR. Eliminating these programs makes us more vulnerable to disease threats.

Cutting PEPFAR threatens U.S. economic growth

By enhancing public health, PEPFAR has contributed to increased workforce productivity and economic growth in countries and regions, particularly in Africa. PEPFAR funding has been linked to a 2.1 percentage point increase in GDP per capita growth rates in recipient countries, partially through a significant increase in male employment rates.

Stopping PEPFAR funding could reverse these economic gains, leading to decreased productivity, higher health care costs, and economic instability in affected regions. This, in turn, could diminish markets for U.S. exports and disrupt global supply chains, adversely impacting the U.S. economy.

Many people do not realize that a large percentage of “foreign” assistance is actually “domestic” assistance. USAID, the CDC, and other agencies spend foreign assistance funding on contracts with U.S. companies; those companies create jobs for Americans and buy American-made medications, medical supplies, and technology that are sent overseas.

Cutting PEPFAR threatens U.S. physical security

PEPFAR is a critical tool of health diplomacy, strengthening U.S. alliances and fostering goodwill in regions of strategic importance. When the United States provides life-saving assistance, it builds partnerships that are crucial for intelligence-sharing, counterterrorism efforts, and military cooperation.

When I served the U.S. government overseas, I worked across the Asian and African regions with U.S. diplomats and military advisers. At the weekly “country team” meetings with U.S. ambassadors, I and my colleagues highlighted the assistance we were providing to the country we were in and our collaborations with the United Kingdom, Canada, the European Union, and other important U.S. allies — information that U.S. diplomats and military advisers would then use in their conversations with the local government and other ambassadors to highlight how our interests there were not simply about ourselves.

In a recent speech, the president of Ghana used polite diplomatic language to remind the United States what it was losing by its actions — and that U.S. competitors would now be gaining.

“One thing the U.S. will lose is that soft power it has wielded in the world — I mean, these are people that are grateful for the assistance they get,” President John Dramani Mahama said. “There are many other partners. The U.S. are not our only partner. We will continue to cooperate with other countries and that’s why we have a multipolar world.”

(When diplomats in Africa use the term “multi-polar” to U.S. and EU diplomats, they mean China.)

Beyond diplomacy, the United States needs to worry about the impact that the funding cuts will have on stability of different regions. A nation suffering from a collapsing health system is far more likely to experience political instability, mass migration, and conflict—all of which can have direct security consequences for the United States. By withdrawing health support, the United States risks losing influence in key regions, making it harder to negotiate treaties, access strategic information, or deploy military resources effectively when needed.

What it all means

While American generosity is important, building broad-based support in the United States to restart foreign assistance requires us to talk more openly about benevolent self-interest. Yes, we are doing good for the world, but even more importantly, we are doing good for ourselves. The consequences of cutting PEPFAR are clear: increased global instability, economic losses, and heightened threats to U.S. health and security.

Uncertainty over USAID’s global health aid impacts Atlanta-based nonprofits

2025-02-19T18:38:48+00:00

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The Trump administration’s threat to cut funding for global health initiatives is being felt in Atlanta, where nonprofits administer millions in USAID awards.

The nation’s main foreign aid agency funds Atlanta-based organizations like CARE, The Task Force for Global Health, and The Carter Center’s work on global health projects.

USAID’s work is important to Atlanta on “many levels,” said Mark Rosenberg, former president and CEO of the task force, which is headquartered in Decatur, from supporting nonprofits to preventing disease.

“If we do work overseas in global health to prevent the spread of Ebola, it protects us. If we do work around the world and prevent multiply drug resistant TB, it helps us,” Rosenberg said. “The other reason why we should be supporting global health and a lot of the work that USAID does is because we are compassionate people.”

A statement from CARE provided to Healthbeat said “there will undoubtedly be reductions” at the organization.

A five-year USAID-funded project administered by the task force has been paused, spokesperson Jessica Wurst said. The project aimed to improve how sub-Saharan governments and organizations prevent and treat neglected tropical diseases, including river blindness.

The $45 million award involved a partnership with the Kwame Nkrumah University of Science and Technology in Ghana and an African research network, according to a 2024 news release.

“That USAID-funded program has been paused, in compliance with federal directives,” Wurst said.

The task force received just over $95 million in revenue in 2023, according to its annual report. Typically more than half of its program funds come from government sources. The organization also helps manage $961 million in medicines donated by pharmaceutical companies.

Founded in 1961, USAID distributed more than $43 billion in global aid in fiscal 2023, according to a recent Pew Research Center report.

“The abrupt suspension of USAID funding had jeopardized Georgia’s robust global health sector,” said Maria Thacker Goethe, president of Georgia Life Sciences, a non-profit group that promotes the life sciences industry.

A 2020 study of global health found the field contributes more than $3 billion annually to Georgia’s GDP and supports more than 33,000 jobs, Thacker Goethe said.

USAID status is uncertain

The status of USAID workers and projects is unclear. Some employees were told they would be put on leave — and others were — in early February. Work was halted following a Jan. 20 executive order from President Donald Trump calling for “reviewing and realigning” U.S. foreign aid. The order included a 90-day pause on foreign aid spending.

Earlier this month, a federal judge issued a temporary order stopping USAID from placing people on administrative leave. That has been extended to Friday.

“It’s a very fluid and evolving situation,” said Sarah McCool, a professor at Georgia State University who has worked with USAID.

She’s worried about the agency’s humanitarian work.

“Consider … a child that is suffering from severe, acute malnutrition and the program that’s helping feed the child has immediately been halted,” McCool said. “People will die.”

USAID is also key to U.S. “soft power” abroad, she said. “USAID having the global stop-work order is indicative of … a retreat from the broader global stage in terms of humanitarian and global health work."

CARE was working in dozens of countries

Nonprofit CARE, Cooperative for Relief and Assistance Everywhere, headquartered in Atlanta, had about 8,000 employees globally with more than 500 on its American payroll, according to a 2023 tax document.

The organization supports a variety of health and education projects in 121 countries, according to its website.

CARE’s total support was around $900 million, with about a third of that coming from the federal government, mostly from USAID, for the year ending June 30, 2024, according to an audit report.

The report lists at least $278 million in USAID grants for CARE’s work in countries including the Philippines, Bangladesh, Egypt, Ghana, Nigeria, and many others with more than 100 USAID awards.

“CARE is currently reviewing the impacts of these recent developments on our staff and work,” the organization said in a statement. “It is an extremely challenging time, and there will undoubtedly be reductions, though it remains too early to tell how wide-ranging.”

CARE Action, the group’s advocacy wing, earlier this month posted an image stating “Foreign aid is worth it” on its X (formerly Twitter) feed, calling on supporters to call elected representatives and oppose the federal funding pause on foreign assistance.

Carter Center, UGA programs funded by USAID

The Carter Center also lists partnerships with or support from USAID, including a project aimed at eliminating river blindness and an initiative announced last year to improve women’s access to information in Bangladesh.

Carter Center CEO Paige Alexander spent more than a decade at USAID in senior roles, according to her official biography.

The organization would not comment on USAID’s status, spokesperson Rennie Sloan told Healthbeat.

A peanut innovation lab at University of Georgia is also funded by USAID. The agency in 2023 renewed funding for the lab for five years, with a reported $15 million award.

The lab supports a wide range of projects focused on improving peanut farming in five African countries: Ghana, Madagascar, Malawi, Senegal, and Uganda, according to its annual report.

Representatives from the university did not respond to requests for information about the status of the lab.

Tuberculosis programs could be at risk

Emory University professor Dr. Kenneth Castro said he’s worried about the fate of tuberculosis programs abroad given the threat of the dismantling of USAID.

Castro, who served as the director of the Center for Disease Control and Prevention’s Division of Tuberculosis Elimination for two decades, is a senior adviser to USAID’s TB Division.

He said his assignment to USAID was suspended in late January.

USAID leads America’s global tuberculosis program, with a focus on 24 countries with high rates of the disease, Castro said.

He’s worried about people losing access to TB treatment and of the development of highly drug-resistant tuberculosis.

“If you cease programs that have been implemented for the last several years, you run the risk of worsening of disease,” Castro said. He’s also worried about his colleagues abroad.

“As of now, the future and details surrounding USAID and its work remain uncertain,” Castro wrote Friday.

Do you work with an agency in Atlanta that is impacted by federal funding uncertainty? Tell us about it. Email reporter Rebecca Grapevine at rgrapevine@healthbeat.org.

What a U.S. exit from the World Health Organization means for global health

2025-01-27T19:51:45+00:00

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For decades, the United States has held considerable power in determining the direction of global health policies and programs. President Donald Trump issued three executive orders on his first day in office that may signal the end of that era, health policy experts said.

Trump’s order to withdraw from the World Health Organization means the United States will probably not be at the table in February when the WHO executive board next convenes. The WHO is shaped by its members: 194 countries that set health priorities and make agreements about how to share critical data, treatments, and vaccines during international emergencies. With the United States missing, it would cede power to others.

“It’s just stupid,” said Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in America’s best interests.”

Executive orders to withdraw from the WHO and to reassess America’s approach to international assistance cite the WHO’s “mishandling of the Covid-19 pandemic” and say that U.S. aid serves “to destabilize world peace.” In action, they echo priorities established in Project 2025’s “Mandate for Leadership,” a conservative policy blueprint from the Heritage Foundation.

The 922-page report says the United States “must be prepared” to withdraw from the WHO, citing its “manifest failure,” and advises an overhaul to international aid at the State Department. “The Biden Administration has deformed the agency by treating it as a global platform to pursue overseas a divisive political and cultural agenda that promotes abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism,” it says.

As one of the world’s largest funders of global health — through both international and national agencies, such as the WHO and the U.S. Agency for International Development — America’s step back may curtail efforts to provide lifesaving health care and combat deadly outbreaks, especially in lower-income countries without the means to do so alone.

“This not only makes Americans less safe, it makes the citizens of other nations less safe,” said Tom Bollyky, director of global health at the Council on Foreign Relations.

“The U.S. cannot wall itself off from transnational health threats,” he added, referring to policies that block travelers from countries with disease outbreaks. “Most of the evidence around travel bans indicates that they provide a false sense of security and distract nations from taking the actions they need to take domestically to ensure their safety.”

U.S. payment less than 1% of federal spending

Technically, countries cannot withdraw from the WHO until a year after official notice. But Trump’s executive order cites his termination notice from 2020. If Congress or the public pushes back, the administration can argue that more than a year has elapsed.

Trump suspended funds to the WHO in 2020, a measure that doesn’t require congressional approval. U.S. contributions to the agency hit a low of $163 million during that first year of Covid, falling behind Germany and the Gates Foundation. (Disclosure: The Gates Foundation is a supporter of Healthbeat.) Former President Joe Biden restored U.S. membership and payments. In 2023, the country gave the WHO $481 million.

As for 2024, Suerie Moon, a co-director of the global health center at the Geneva Graduate Institute, said the Biden administration paid biennium dues for 2024-25 early, which will cover some of this year’s payments.

“Unfairly onerous payments” are cited in the executive order as a reason for WHO withdrawal. Countries’ dues are a percentage of their gross domestic product, meaning that as the world’s richest nation, the United States has generally paid more than other countries.

Funds for the WHO represent about 4% of America’s budget for global health, which in turn is less than 0.1% of U.S. federal expenditures each year. At about $3.4 billion, the WHO’s entire budget is roughly a third of the budget for the Centers for Disease Control and Prevention, which got $9.3 billion in core funding in 2023.

The WHO’s funds support programs to prevent and treat polio, tuberculosis, HIV, malaria, measles, and other diseases, especially in countries that struggle to provide health care domestically. The organization also responds to health emergencies in conflict zones, including places where the U.S. government doesn’t operate — in parts of Gaza, Sudan, and the Democratic Republic of the Congo, among others.

In January 2020, the WHO alerted the world to the danger of the Covid outbreak by sounding its highest alarm: a public health emergency of international concern. Over the next two years, it vetted diagnostic tests and potential drugs for Covid, regularly updated the public, and advised countries on steps to keep citizens safe.

Experts have cited missteps at the agency, but numerous analyses show that internal problems account for the United States’ having one of the world’s highest rates of death due to Covid. “All nations received the WHO’s alert of a public health emergency of international concern on Jan. 30,” Bollyky said. “South Korea, Taiwan, and others responded aggressively to that — the U.S. did not.”

U.S. withdrawal is a moment of ‘geopolitical shift’

Nonetheless, Trump’s executive order accuses the WHO of “mishandling” the pandemic and failing “to adopt urgently needed reforms.” In fact, the WHO has made some changes through bureaucratic processes that involve input from the countries belonging to it. Last year, for example, the organization passed several amendments to its regulations on health emergencies. These include provisions on transparent reporting and coordinated financing.

“If the Trump administration tried to push for particular reforms for a year and then they were frustrated, I might find the reform line credible,” Moon said. “But to me, it’s a red herring.”

“I don’t buy the explanations,” Bernard said. “This is not an issue of money,” he added. “There is no rationale to withdraw from the WHO that makes sense, including our problems with China.”

Trump has accused the WHO of being complicit in China’s failure to openly investigate Covid’s origin, which he alludes to in the executive order as “inappropriate political influence.”

“The World Health Organization disgracefully covered the tracks of the Chinese Communist Party every single step of the way,” Trump said in a video posted to social media in 2023.

On multiple occasions, the WHO has called for transparency from China. The agency doesn’t have the legal authority to force China, or any other country, to do what it says. This fact also repudiates Trump’s warnings that a pandemic treaty under negotiation at the WHO impinges on American sovereignty. Rather, the accord aims to lay out how countries can better cooperate in the next pandemic.

Trump’s executive order calls for the United States to “cease negotiations” on the pandemic agreement. This means the pharmaceutical industry may lose one of its staunchest defenders as discussions move forward.

In the negotiations so far, the United States and the European Union have sided with lobbying from the pharmaceutical industry to uphold strict patent rights on drugs and vaccines. They have opposed efforts from middle-income countries in Asia, Africa, and Latin America to include licensing agreements that would allow more companies to produce drugs and vaccines when supplies are short in a crisis. A study published in Nature Medicine estimated that more than a million lives would have been saved had Covid vaccines been available around the world in 2021.

“Once the U.S. is absent — for better and for worse — there will be less pressure on certain positions,” Moon said. “In the pandemic agreement negotiations, we may see weakening opposition towards more public-health-oriented approaches to intellectual property.”

“This is a moment of geopolitical shift because the U.S. is making itself less relevant,” said Ayoade Alakija, chair of the Africa Union’s Vaccine Delivery Alliance. Alakija said countries in Asia and Africa with emerging economies might now put more money into the WHO, change policies, and set agendas that were previously opposed by the United States and European countries that are grappling with the war in Ukraine. “Power is shifting hands,” Alakija said. “Maybe that will give us a more equitable and fairer world in the long term.”

WHO withdrawal has echoes of Project 2025

In the near term, however, the WHO is unlikely to recoup its losses entirely, Moon said. Funds from the United States typically account for about 15% of its budget. Together with Trump’s executive order that pauses international aid for 90 days, a lack of money may keep many people from getting lifesaving treatments for HIV, malaria, and other diseases.

Another loss is the scientific collaboration that occurs via the WHO and at about 70 centers it hosts at U.S. institutions such as Columbia University and Johns Hopkins University. Through these networks, scientists share findings despite political feuds between countries.

A third executive order commands the secretary of state to ensure the department’s programs are “in line with an America First foreign policy.” It follows on the order to pause international aid while reviewing it for “consistency with United States foreign policy.” That order says that U.S. aid has served “to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations.”

These and executive orders on climate policies track with policy agendas expressed by Project 2025. Although Trump and his new administration have distanced themselves from the Heritage Foundation playbook, CBS News reviewed the work histories of the 38 named primary authors of Project 2025 and found that at least 28 of them worked in Trump’s first administration. One of Project 2025’s chief architects was Russell Vought, who served as director of the Office of Management and Budget during Trump’s first term and has been nominated for it again. Multiple contributors to Project 2025 are from the America First Legal Foundation, a group headed by Trump adviser Stephen Miller that’s filed complaints against “woke corporations.”

Project 2025 recommends cutting international aid for programs and organizations focused on climate change and reproductive health care, and steering resources toward “strengthening the fundamentals of free markets,” lowering taxes, and deregulating businesses as a path to economic stability.

Several experts said the executive orders appear to be about ideological rather than strategic positioning.

The White House did not respond to questions about its executive orders on global health. Regarding the executive order saying U.S. aid serves “to destabilize world peace,” a spokesperson at USAID wrote in an email: “We refer you to the White House.”

Amy Maxmen is Healthbeat’s national reporter through is partnership with KFF Health News.

NYC Health Department urges mpox vaccination amid global emergency

2024-08-15T22:17:58+00:00

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On the heels of the World Health Organization’s declaration of a global emergency for mpox, the New York City Department of Health and Mental Hygiene on Thursday urged anyone at risk to get vaccinated against the virus.

“We have learned many lessons from the 2022 outbreak, and we are prepared,” Health Commissioner Dr. Ashwin Vasan said in a statement. “While the current risk to New Yorkers and Americans is low, we must not only plan ahead but act now.”

Vasan urged anyone at risk for mpox who has not been vaccinated to do so immediately, noting that two doses are needed for maximum protection. New Yorkers can search for a vaccination appointment on the Health Department’s website.

In 2022, New York City was at the epicenter of the country’s outbreak of mpox, formerly known as monkeypox, which is a close relative of smallpox. The outbreak peaked that summer with nearly 100 cases of the virus each day.

By early 2023, following the vaccination of more than 100,000 New Yorkers — and with the city touting one of the highest vaccination rates in the country among those at risk for the disease — the Health Department declared the outbreak over.

Still, the virus has continued to circulate in small numbers in New York City. Since Jan. 1, 307 people in the city have tested positive for mpox, with 26 cases from July 7 to Aug. 3, according to the Health Department.

Mpox is spread almost exclusively through oral, anal and vaginal sex and other intimate contact, typically through direct contact with the rash or sores of someone who has the virus, according to the Health Department. Other symptoms can include a sore throat, fever and swollen lymph nodes. Symptoms tend to emerge three to 17 days after exposure and last for two to four weeks.

The Health Department recommends vaccination if you have sex with men and identify as male, transgender, nonbinary, genderqueer or gender-nonconforming, or if you consider yourself to be at risk in the future.

Other prevention measures include not having sex or intimate contact if you or your sexual partners have unexplained rashes or sores, reducing your number of sexual partners, and asking partners if they feel sick, the Health Department advises.

Stephen S. Morse, a professor of epidemiology at the Columbia University Mailman School of Public Health, said that since mpox generally spreads through direct contact, it is far less transmissible than a virus like Covid-19. Even so, a few travel-related cases can launch a broader outbreak.

“The concern is that it’s still moving,” he said. “It needs to be controlled.”

The mpox virus has two types, Clade 1 and Clade 2. Clade 1 is dominant in current mpox outbreaks in the Democratic Republic of Congo, which have spread to a dozen other African countries. Clade 2 drove the global mpox outbreak in 2022, including New York City’s crisis.

Clade 1 tends to cause a higher number of severe infections and have a higher mortality rate than Clade 2, according to the Department of Health and Human Services. There are currently no known cases of Clade 1 mpox in the United States.

“For New York City, we’ve been there before, and hopefully we can get it right this time,” Morse said.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

WHO overturns dogma on airborne disease spread. The CDC might not act on it.

2024-07-30T16:36:41+00:00

The World Health Organization has issued a report that transforms how the world understands respiratory infections like Covid-19, influenza, and measles.

Motivated by grave missteps in the pandemic, the WHO convened about 50 experts in virology, epidemiology, aerosol science, and bioengineering, among other specialties, who spent two years poring through the evidence on how airborne viruses and bacteria spread.

However, the WHO report stops short of prescribing actions that governments, hospitals, and the public should take in response. It remains to be seen how the Centers for Disease Control and Prevention will act on this information in its own guidance for infection control in health care settings.

The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others.

While it may seem obvious, and some researchers have pushed for this acknowledgment for more than a decade, an alternative dogma persisted — which kept health authorities from saying that Covid was airborne for many months into the pandemic.

Specifically, they relied on a traditional notion that respiratory viruses spread mainly through droplets spewed out of an infected person’s nose or mouth. These droplets infect others by landing directly in their mouth, nose, or eyes — or they get carried into these orifices on droplet-contaminated fingers. Although these routes of transmission still happen, particularly among young children, experts have concluded that many respiratory infections spread as people simply breathe in virus-laden air.

“This is a complete U-turn,” said Julian Tang, a clinical virologist at the University of Leicester in the United Kingdom, who advised the WHO on the report. He also helped the agency create an online tool to assess the risk of airborne transmission indoors.

Emphasis on improving ventilation

Peg Seminario, an occupational health and safety specialist in Bethesda, Maryland, welcomed the shift after years of resistance from health authorities. “The dogma that droplets are a major mode of transmission is the ‘flat Earth’ position now,” she said. “Hurray! We are finally recognizing that the world is round.”

The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals, it could evolve to more easily infect people and spread among them through the air.

Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. Such advice overwhelmed recommendations for N95 masks that filter out most virus-laden particles suspended in the air. Employers denied many health care workers access to N95s, insisting that only those routinely working within feet of Covid patients needed them. More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.

However, a committee advising the CDC appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities.

Lisa Brosseau, an aerosol expert and a consultant at the Center for Infectious Disease Research and Policy in Minnesota, warns of a repeat of 2020 if that happens.

“The rubber hits the road when you make decisions on how to protect people,” Brosseau said. “Aerosol scientists may see this report as a big win because they think everything will now follow from the science. But that’s not how this works and there are still major barriers.”

Money is one. If a respiratory disease spreads through inhalation, it means that people can lower their risk of infection indoors through sometimes costly methods to clean the air, such as mechanical ventilation and using air purifiers, and wearing an N95 mask. The CDC has so far been reluctant to press for such measures, as it updates foundational guidelines on curbing airborne infections in hospitals, nursing homes, prisons, and other facilities that provide health care. This year, a committee advising the CDC released a draft guidance that differs significantly from the WHO report.

Whereas the WHO report doesn’t characterize airborne viruses and bacteria as traveling short distances or long, the CDC draft maintains those traditional categories. It prescribes looser-fitting surgical masks rather than N95s for pathogens that “spread predominantly over short distances.” Surgical masks block far fewer airborne virus particles than N95s, which cost roughly 10 times as much.

Viruses travel like smoke

Researchers and health care workers have been outraged about the committee’s draft, filing letters and petitions to the CDC. They say it gets the science wrong and endangers health. “A separation between short- and long-range distance is totally artificial,” Tang said.

Airborne viruses travel much like cigarette smoke, he explained. The scent will be strongest beside a smoker, but those farther away will inhale more and more smoke if they remain in the room, especially when there’s no ventilation.

Likewise, people open windows when they burn toast so that smoke dissipates before filling the kitchen and setting off an alarm. “You think viruses stop after 3 feet and drop to the ground?” Tang said of the classical notion of distance. “That is absurd.”

The CDC’s advisory committee is comprised primarily of infection control researchers at large hospital systems, while the WHO consulted a diverse group of scientists looking at many different types of studies. For example, one analysis examined the puff clouds expelled by singers, and musicians playing clarinets, French horns, saxophones, and trumpets. Another reviewed 16 investigations into covid outbreaks at restaurants, a gym, a food processing factory, and other venues, finding that insufficient ventilation probably made them worse than they would otherwise be.

In response to the outcry, the CDC returned the draft to its committee for review, asking it to reconsider its advice. Meetings from an expanded working group have since been held privately. But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion. Another warned that “supply and compliance would be difficult.”

The nurses’ union, far from echoing such concerns, wrote on its website, “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.” Jane Thomason, the union’s lead industrial hygienist, said the meeting records suggest the CDC group is working backward, molding its definitions of airborne transmission to fit the outcome it prefers.

Tang expects resistance to the WHO report. “Infection control people who have built their careers on this will object,” he said. “It takes a long time to change people’s way of thinking.”

The CDC declined to comment on how the WHO’s shift might influence its final policies on infection control in health facilities, which might not be completed this year. Creating policies to protect people from inhaling airborne viruses is complicated by the number of factors that influence how they spread indoors, such as ventilation, temperature, and the size of the space.

Adding to the complexity, policymakers must weigh the toll of various ailments, ranging from Covid to colds to tuberculosis, against the burden of protection. And tolls often depend on context, such as whether an outbreak happens in a school or a cancer ward.

“What is the level of mortality that people will accept without precautions?” Tang said. “That’s another question.”

This story originally published on May 1, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Finland is offering farmworkers bird flu shots. Some experts say the U.S. should too.

2024-07-30T15:03:40+00:00

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As bird flu spreads among dairy cattle in the U.S., veterinarians and researchers have taken note of Finland’s move to vaccinate farmworkers at risk of infection. They wonder why their government doesn’t do the same.

“Farmworkers, veterinarians, and producers are handling large volumes of milk that can contain high levels of bird flu virus,” said Kay Russo, a livestock and poultry veterinarian in Fort Collins, Colorado. “If a vaccine seems to provide some immunity, I think it should be offered to them.”

Among a dozen virology and outbreak experts interviewed by KFF Health News, most agree with Russo. They said people who work with dairy cows should be offered vaccination for a disease that has killed roughly half of the people known to have gotten it globally over the past two decades, has killed cats in the U.S. this year, and has pandemic potential.

However, some researchers sided with the Centers for Disease Control and Prevention in recommending against vaccination for now. There’s no evidence that this year’s bird flu virus spreads between people or causes serious disease in humans. And it’s unclear how well the available vaccine would prevent either scenario.

But the wait-and-see approach “is a gamble,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University. “By the time we see severe outcomes, it means a lot of people have been infected.”

“Now is the time to offer the vaccines to farmworkers in the United States,” said Nahid Bhadelia, director of the Boston University Center on Emerging Infectious Diseases. Even more urgent measures are lagging in the U.S., she added. Testing of farmworkers and cows is sorely needed to detect the H5N1 bird flu virus, study it, and extinguish it before it becomes a fixture on farms — posing an ever-present pandemic threat.

U.S. stockpiling vaccines

Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, said the agency takes bird flu seriously, and the U.S. is stockpiling 4.8 million doses of the vaccine. But, he said, “there’s no recommendation to launch a vaccine campaign.”

“It’s all about risk-benefit ratios,” Daskalakis said. The benefits are blurry because there hasn’t been enough testing to understand how easily the virus jumps from cows into people, and how sick they become. Just four people in the United States have tested positive this year, with mild cases — too few to draw conclusions.

Other farmworkers and veterinarians working on dairy farms with outbreaks have reported being sick, Russo said, but they haven’t been tested. Public health labs have tested only about 50 people for the bird flu since the outbreak was detected in March.

Still, Daskalakis said the CDC is not concerned that the agency is missing worrisome bird flu infections because of its influenza surveillance system. Hospitals report patients with severe cases of flu, and numbers are normal this year.

Another signal that puts the agency at ease is that the virus doesn’t yet have mutations that allow it to spread rapidly between people as they sneeze and breathe. “If we start to see changes in the virus, that’s another factor that would be part of the decision to move from a planning phase into an operational one,” Daskalakis said.

On July 8, researchers reported that the virus may be closer to spreading between people than previously thought. It still doesn’t appear to do so, but experiments suggest it has the ability to infect human airways. It also spread between two laboratory ferrets through the air.

In considering vaccines, the agency takes a cue from a 1976 outbreak of the swine flu. Officials initially feared a repeat of the 1918 swine flu pandemic that killed roughly half a million people in the United States. So they rapidly vaccinated nearly 43 million people in the country within a year.

But swine flu cases turned out to be mild that year. This made the vaccine seem unnecessarily risky as several reports of a potentially deadly disorder, Guillain-Barré Syndrome, emerged. Roughly one of every million people who get influenza vaccines may acquire the disorder, according to the CDC. That risk is outweighed by the benefits of prevention. Since Oct. 1, as many as 830,000 people have been hospitalized for the seasonal flu and 25,000 to 75,000 people have died.

An after-action report on the 1976 swine flu situation called it a “sobering, cautionary tale” about responding prematurely to an uncertain public health threat. “It’s a story about what happens when you launch a vaccine program where you are accepting risk without any benefit,” Daskalakis said.

Paul Offit, a virologist at the Children’s Hospital of Philadelphia, sides with the CDC. “I’d wait for more data,” he said.

However, other researchers say this isn’t comparable to 1976 because they aren’t suggesting that the U.S. vaccinate tens of millions of people. Rather they’re talking about a voluntary vaccine for thousands of people in close contact with livestock. This lessens the chance of rare adverse effects.

FDA hasn’t approved new version

The bird flu vaccine on hand, made by the flu vaccine company CSL Seqirus, was authorized last year by the European equivalent of the FDA. An older variety has FDA approval, but the newer variety hasn’t gotten the green light yet.

Although the vaccine targets a different bird flu strain than the H5N1 virus now circulating in cows, studies show it triggers an immune response against both varieties. It’s considered safe because it uses the same egg-based vaccine technology deployed every year in seasonal flu vaccines.

For these reasons, the United States, the United Kingdom, the Netherlands, and about a dozen other countries are stockpiling millions of doses. Finland expects to offer them to people who work on fur farms this month as a precaution because its mink and fox farms were hit by the bird flu last year.

In contrast, mRNA vaccines being developed against the bird flu would be a first for influenza. On July 2, the U.S. government announced that it would pay Moderna $176 million for their development, and that the vaccines may enter clinical trials next year. Used widely against COVID-19, this newer technology uses mRNA to teach the immune system how to recognize particular viruses.

In the meantime, Florian Krammer, a flu virologist at Mount Sinai’s Icahn School of Medicine, said people who work on dairy farms should have the option to get the egg-based vaccine. It elicits an immune response against a primary component of the H5N1 bird flu virus that should confer a degree of protection against infection and serious sickness, he said.

Still, its protection wouldn’t be 100%. And no one knows how many cases and hospitalizations it would prevent since it hasn’t been used to combat this year’s virus. Such data should be collected in studies that track the outcomes of people who opt to get one, he said.

Krammer isn’t assuaged by the lack of severe bird flu cases spotted in clinics. “If you see a signal in hospitals, the cat is out of the bag. Game over, we have a pandemic,” he said. “That’s what we want to avoid.”

Action urged before flu season

He and others stressed that the United States should be doing everything it can to curb infections before flu season starts in October. The vaccine could provide an additional layer of protection on top of testing, wearing gloves, and goggles, and disinfecting milking equipment. Scientists worry that if people get the bird flu and the seasonal flu simultaneously, bird flu viruses could snag adaptations from seasonal viruses that allow them to spread swiftly among humans.

They also note it could take months to distribute the vaccines after they’re recommended since it requires outreach. People who work beside dairy cows still lack information on the virus, four months into this outbreak, said Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health.

Health officials have talked with dairy farm owners, but Boggess’ interviews with farmworkers suggest those conversations haven’t trickled down to their staff. One farmworker in the Texas Panhandle told her he was directed to disinfect his hands and boots to protect cows from diseases that workers may carry. “They never told us if the cow could infect us with some illness,” the farmworker said in Spanish.

The slow pace of educational outreach is a reminder that everything takes time, including vaccine decisions. When deciding whether to recommend vaccines, the CDC typically seeks guidance from its Advisory Committee on Immunization Practices, or the ACIP. A consultant to the group, infectious disease researcher William Schaffner, has repeatedly asked the agency to present its thinking on Seqirus’ bird flu vaccine.

Rather than fret about the 1976 swine flu situation, Schaffner suggested the CDC consider the 2009-10 swine flu pandemic. It caused more than 274,000 hospitalizations and 12,000 deaths in the U.S. within a year. By the time vaccines were rolled out, he said, much of the damage had been done.

“The time to discuss this with ACIP is now,” said Schaffner, before the bird flu becomes a public health emergency. “We don’t want to discuss this until the cows come home in the middle of a crisis.”

This story originally published July 11, 2024 at KFF Health News, Healthbeat’s national reporting partner.