politics

'Unprecedented crisis' in Africa healthcare: report

  • "Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face two to four million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within," it said.
  • Africa's Centre for Disease Control and Prevention (CDC) said Thursday that the continent faces "an unprecedented financing crisis" that could lead to between two to four million additional deaths annually.
  • "Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face two to four million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within," it said.
Africa's Centre for Disease Control and Prevention (CDC) said Thursday that the continent faces "an unprecedented financing crisis" that could lead to between two to four million additional deaths annually.
Members of the African Union pledged in 2001 to allocate at least 15 percent of national budgets to health, but only three countries -- Rwanda, Botswana and Cabo Verde -- have consistently met or exceeded the target, the CDC said in a new report.
The continent faces a multi-pronged crisis, with many countries struggling under massive amounts of debt and now facing huge cuts to aid from the United States and other Western countries.
It also comes as public health emergencies are surging -- rising from 152 in 2022 to 213 in 2024, according to the CDC -- as outbreaks of Mpox, Ebola, cholera and other diseases are reported.
"Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face two to four million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within," it said.
"Furthermore, 39 million more Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks."
The report highlighted Africa's heavy dependency on foreign assistance, with over 90 percent of vaccines, medicines and diagnostics being externally sourced, leaving countries vulnerable to global supply chain shocks.
"This is not just a sectoral crisis -- it is an existential threat to Africa's political, social and economic resilience, and global stability," said the CDC report, titled "Africa's Health Financing in a New Era".
It called for a "three-pillar strategy" comprising more domestic financing, "innovative financing" to raise additional cash such as new taxes on airline travel and alcohol, and infrastructure projects funded through a mix of public and private capital. 
"Ultimately, success depends on political will, regional solidarity, and strong accountability mechanisms," the report said.
er/rbu/kjm

conflict

Shiny and deadly, unexploded munitions a threat to Gaza children

BY LOUIS BAUDOIN-LAARMAN

  • - 'Attractive to kids' - Demining expert Orr, who was in Gaza for charity Handicap International, said that while no one is safe from the threat posed by unexploded munitions, children are especially vulnerable.
  • War has left Gaza littered with unexploded bombs that will take years to clear, with children drawn to metal casings maimed or even killed when they try to pick them up, a demining expert said.
  • - 'Attractive to kids' - Demining expert Orr, who was in Gaza for charity Handicap International, said that while no one is safe from the threat posed by unexploded munitions, children are especially vulnerable.
War has left Gaza littered with unexploded bombs that will take years to clear, with children drawn to metal casings maimed or even killed when they try to pick them up, a demining expert said.
Nicholas Orr, a former UK military deminer, told AFP after a mission to the war-battered Palestinian territory that "we're losing two people a day to UXO (unexploded ordnance) at the moment."
According to Orr, most of the casualties are children out of school desperate for something to do, searching through the rubble of bombed-out buildings sometimes for lack of better playthings.
"They're bored, they're running around, they find something curious, they play with it, and that's the end," he said.
Among the victims was 15-year-old Ahmed Azzam, who lost his leg to an explosive left in the rubble as he returned to his home in the southern city of Rafah after months of displacement.
"We were inspecting the remains of our home and there was a suspicious object in the rubble," Azzam told AFP.
"I didn't know it was explosive, but suddenly it detonated," he said, causing "severe wounds to both my legs, which led to the amputation of one of them."
He was one of hundreds of thousands of Palestinians returning home during a truce that brought short-lived calm to Gaza after more than 15 months of war, before Israel resumed its bombardment and military operations last month.
For Azzam and other children, the return was marred by the dangers of leftover explosives.

'Attractive to kids'

Demining expert Orr, who was in Gaza for charity Handicap International, said that while no one is safe from the threat posed by unexploded munitions, children are especially vulnerable.
Some ordnance is like "gold to look at, so they're quite attractive to kids", he said.
"You pick that up and that detonates. That's you and your family gone, and the rest of your building."
Another common scenario involved people back from displacement, said Orr, giving an example of "a father of a family who's moved back to his home to reclaim his life, and finds that there's UXO in his garden".
"So he tries to help himself and help his family by moving the UXO, and there's an accident."
With fighting ongoing and humanitarian access limited, little data is available, but in January the UN Mine Action Service said that "between five and 10 percent" of weapons fired into Gaza failed to detonate.
It could take 14 years to make the coastal territory safe from unexploded bombs, the UN agency said.
Alexandra Saieh, head of advocacy for Save The Children, said unexploded ordnance is a common sight in the Gaza Strip, where her charity operates.
"When our teams go on field they see UXOs all the time. Gaza is littered with them," she said.

'Numbers game'

For children who lose limbs from blasts, "the situation is catastrophic", said Saieh, because "child amputees require specialised long-term care... that's just not available in Gaza".
In early March, just before the ceasefire collapsed, Israel blocked all aid from entering Gaza. That included prosthetics that could have helped avoid long-term mobility loss, Saieh said.
Unexploded ordnance comes in various forms, Orr said. In Gaza's north, where ground battles raged for months, there are things like "mortars, grenades, and a lot of bullets".
In Rafah, where air strikes were more intense than ground combat, "it's artillery projectiles, it's airdrop projectiles", which can often weigh dozens of kilograms, he added.
Orr said he was unable to obtain permission to conduct bomb disposal in Gaza, as Israeli aerial surveillance could have mistaken him for a militant attempting to repurpose unexploded ordnance into weapons.
He also said that while awareness-raising could help Gazans manage the threat, the message doesn't always travel fast enough.
"People see each other moving it and think, 'Oh, they've done it, I can get away with it,'" Orr said, warning that it was difficult for a layperson to know which bombs might still explode, insisting it was not worth the risk.
"You're just playing against the odds, it's a numbers game."
lba/acc/jd/ami/ser/jfx

environment-pollution

Health concerns swirl as Bolivian city drowns in rubbish

  • "We are demanding our right to health; the municipality does not listen to us," Alcira Estrada, a 38-year-old merchant who lives near the landfill, some 10 kilometers (6.2 miles) from the city center, told AFP.  The protest has now seen the problem spread wider, with about 7,000 tons of waste accumulated on Cochabamba's streets, according to municipal estimates.
  • Health officials in Bolivia's fourth-biggest city raised disease concerns Wednesday as tons of rubbish have accumulated on the streets due to a 12-day-old protest by residents blocking access to its main landfill.
  • "We are demanding our right to health; the municipality does not listen to us," Alcira Estrada, a 38-year-old merchant who lives near the landfill, some 10 kilometers (6.2 miles) from the city center, told AFP.  The protest has now seen the problem spread wider, with about 7,000 tons of waste accumulated on Cochabamba's streets, according to municipal estimates.
Health officials in Bolivia's fourth-biggest city raised disease concerns Wednesday as tons of rubbish have accumulated on the streets due to a 12-day-old protest by residents blocking access to its main landfill.
Officials warned of a severe public health issue in Cochabamba, a city of 600,000 whose residents have closed off the landfill to demand its permanent closure.
The city's health department said cases of diarrhea soared by seven percent in the last week, and those of Hepatitis A -- a viral disease spread through contaminated food or water -- rose by 55 percent.
"This could be the beginning" of a health crisis, the department's epidemiology head Ruben Castillo told AFP.
Residents living near the K'ara K'ara landfill are demanding it be shuttered permanently, claiming contamination due to improper waste management.
"We are demanding our right to health; the municipality does not listen to us," Alcira Estrada, a 38-year-old merchant who lives near the landfill, some 10 kilometers (6.2 miles) from the city center, told AFP. 
The protest has now seen the problem spread wider, with about 7,000 tons of waste accumulated on Cochabamba's streets, according to municipal estimates.
The municipality had agreed last September to close the landfill within six months, but the deadline has now passed.
Cochabamba produces between 600 and 800 tons of garbage daily, according to municipal spokesperson Juan Jose Ayaviri. 
gta/vel/db/mlr/jgc

budget

WHO facing $2.5-bn gap even after slashing budget: report

  • But even after that dramatic scaling back, it remains $1.9 billion short towards the budget, Health Policy Watch reported Wednesday.
  • The World Health Organization is facing a gaping deficit this year and through 2027 following the US decision to withdraw, even after dramatically slashing its budget, a media report indicated on Wednesday.
  • But even after that dramatic scaling back, it remains $1.9 billion short towards the budget, Health Policy Watch reported Wednesday.
The World Health Organization is facing a gaping deficit this year and through 2027 following the US decision to withdraw, even after dramatically slashing its budget, a media report indicated on Wednesday.
As the United Nations health agency has been bracing for the planned full US withdrawal next January, it has gradually shrunk its two-year budget for 2026-2027 from $5.3 billion to $4.2 billion.
But even after that dramatic scaling back, it remains $1.9 billion short towards the budget, Health Policy Watch reported Wednesday.
That figure, which the publication said had been provided to staff during a town hall meeting on Tuesday, comes on top of the nearly $600 million the agency had already warned was missing towards this year's budget, it said.
WHO did not immediately respond to AFP's request for comment on the report, which comes as the organisation is grappling with the looming departure of its historically biggest donor.
Besides announcing the US pullout from the WHO after returning to the White House in January, President Donald Trump decided to freeze virtually all US foreign aid, including vast assistance to health projects worldwide.
The United States gave WHO $1.3 billion during its 2022-2023 budget period, mainly through voluntary contributions for specific, earmarked projects rather than fixed membership fees.
But Washington never paid its 2024 dues, and is not expected to respect its membership obligations for 2025, the agency acknowledged.
Altogether, the United States owes $260 million in membership fees alone for 2024-2025, according to a WHO overview.
In an effort to bridge the funding gap, outgoing German Health Minister Karl Lauterbach announced on Wednesday his government would allocate an additional two million euros ($2.2 million) to the agency, bringing its total contribution to just over $317 million. 
"The United States' withdrawal from the WHO not only threatens financial stability but also multilateral cooperation in the global health architecture," Lauterbach said in a statement, calling the agency "indispensable". 
Only last Friday, WHO chief Tedros Adhanom Ghebreyesus had informed staff of the $600-million hole in this year's budget, warning in a message seen by AFP that the agency had "no choice" but to start making cutbacks.
"Dramatic cuts to official development assistance by the United States of America and others are causing massive disruption to countries, NGOs and United Nations agencies, including WHO," Tedros said in his email.
He said that even before Trump triggered the one-year process of withdrawing from the WHO, the organisation was already facing financial constraints.
"Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce," said Tedros.
"This reduction will begin at headquarters, starting with senior leadership, but will affect all levels and regions," he told staff.
Last month, Tedros asked Washington to reconsider its sharp cuts to global health funding, warning that the sudden halt threatened millions of lives.
He said disruptions to global HIV programmes alone could lead to "more than 10 million additional cases of HIV and three million HIV-related deaths".
nl/vog/jhb/giv/rmb

pacemaker

World's tiniest pacemaker is smaller than grain of rice

BY DANIEL LAWLER

  • When the patch detects irregular heartbeats, it automatically flashes light that tells the pacemaker what heartbeat it should stimulate.
  • Scientists said Wednesday they have developed the world's tiniest pacemaker, a temporary heartbeat regulator smaller than a grain of rice that can be injected and controlled by light before dissolving.
  • When the patch detects irregular heartbeats, it automatically flashes light that tells the pacemaker what heartbeat it should stimulate.
Scientists said Wednesday they have developed the world's tiniest pacemaker, a temporary heartbeat regulator smaller than a grain of rice that can be injected and controlled by light before dissolving.
While still years away from being tested in humans, the wireless pacemaker was hailed as a "transformative breakthrough" that could spur advances in other areas of medicine.
Millions of people across the world have permanent pacemakers, which stimulate hearts with electrical pulses to ensure they beat normally.
The US-led team of researchers behind the new device said they were motivated to help the one percent of children born with congenital heart defects who need a temporary pacemaker in the week after surgery.
The pacemaker could also help adults restore a normal heartbeat as they recover from heart surgery.
Currently, temporary pacemakers require surgery to sew electrodes onto heart muscles, with wires connecting to a powered device on the patient's chest. 
When the pacemaker is no longer needed, doctors or nurses pull out the wires, which can sometimes cause damage. 
Neil Armstrong, the first person to walk on the Moon, died from internal bleeding after his temporary pacemaker was removed in 2012.
But the newly developed pacemaker is wireless. And at just one millimetre thick and 3.5 millimetres long, it can fit into the tip of a syringe. 
It has also been designed to dissolve into the body when no longer needed, sparing patients invasive surgery.

'Significant leap forward'

 
The pacemaker is paired to a soft patch worn on the patient's chest, according to a study describing the device in the journal Nature. 
When the patch detects irregular heartbeats, it automatically flashes light that tells the pacemaker what heartbeat it should stimulate.
The pacemaker is powered by what is called a galvanic cell, which uses the body's fluids to convert chemical energy into electrical pulses that stimulate the heart. 
So far, the pacemaker has worked effectively in tests on mice, rats, pigs, dogs and human heart tissue in the lab, according to the study.
Senior study author John Rogers of Northwestern University in the United States told AFP he estimated the pacemaker could be tested in humans in two to three years. 
His lab has launched a start-up to pursue this goal, he added.
In the future, the underlying technology could also "create unique and powerful strategies to address societal challenges in human health," Rogers said.
Bozhi Tian, whose lab at the University of Chicago has also developed light-activated pacemakers but was not involved in the latest research, called it a "significant leap forward".
"This new pacemaker is a transformative breakthrough in medical technology," he told AFP.
"It's a paradigm shift in temporary pacing and bioelectronic medicine, opening up possibilities far beyond cardiology -- including nerve regeneration, wound healing and integrated smart implants."
Heart disease is the world's leading cause of death, according to the World Health Organization.
dl/phz

TB

UK drawing up new action plan to tackle rising TB

  • It called for academic, health and social care professionals, public health experts, data scientists and those with lived experience of tuberculosis to share their insights.
  • Britain on Wednesday urged health experts and sufferers of tuberculosis (TB) to come forward to help draw up a new five-year action plan as it deals with record rises in the disease.
  • It called for academic, health and social care professionals, public health experts, data scientists and those with lived experience of tuberculosis to share their insights.
Britain on Wednesday urged health experts and sufferers of tuberculosis (TB) to come forward to help draw up a new five-year action plan as it deals with record rises in the disease.
In 2023, England recorded its largest annual increase (11 percent) in cases since enhanced surveillance began in 2000.
Provisional figures for 2024 indicate a further 13-percent annual rise to 5,480 cases, reflecting a similar global trend.
The government is in the preliminary stages of preparing its new National Action Plan (2026–2031), which aims to improve the prevention, detection and control of TB in England.
It called for academic, health and social care professionals, public health experts, data scientists and those with lived experience of tuberculosis to share their insights.
"TB is curable and preventable, but the disease remains a serious public health issue in England," said Esther Robinson, head of the TB unit at the Health Security Agency (UKHSA).
While England is still considered a low-incidence country for TB, the rise in cases over recent years means that "we are now just below" the World Health Organization-defined low-incidence threshold of 10 cases per 100,000 population, Robinson said.
The government has said the highest incidence of the disease in the UK, 81.5 percent, is among people born outside the country.
Research in the UK has shown a clear link between TB and deprivation, including among the homeless, those addicted to drugs and alcohol, and people who have had contact with the criminal justice system.
"This call for evidence will help us develop an action plan that prioritises the most effective interventions to reverse this trend, focusing particularly on the needs of those most affected," Robinson added.
jwp/jkb/jhb

politics

Mass layoffs targeting 10,000 jobs hit US health agencies

  • The restructuring plan would consolidate the current 28 divisions of the Department of Health and Human Services into 15, including a new entity called the Administration for a Healthy America, or AHA. While addressing issues such as America's obesity epidemic and industry-favored food regulations aligns with concerns shared by many in the scientific and medical communities, Kennedy's long history of promoting misinformation about vaccines and questioning basic scientific principles has caused deep concern.
  • Mass layoffs began at the major US health agencies on Tuesday as the Trump administration embarks on a sweeping and scientifically contested restructuring that will cut 10,000 jobs.
  • The restructuring plan would consolidate the current 28 divisions of the Department of Health and Human Services into 15, including a new entity called the Administration for a Healthy America, or AHA. While addressing issues such as America's obesity epidemic and industry-favored food regulations aligns with concerns shared by many in the scientific and medical communities, Kennedy's long history of promoting misinformation about vaccines and questioning basic scientific principles has caused deep concern.
Mass layoffs began at the major US health agencies on Tuesday as the Trump administration embarks on a sweeping and scientifically contested restructuring that will cut 10,000 jobs.
US Health Secretary Robert F. Kennedy Jr. said the layoffs were part of a major reform of his department, aiming to refocus efforts on chronic disease prevention.
Calling it a "difficult moment for all of us," Kennedy said "our hearts go out to those who have lost their jobs." 
"But the reality is clear: what we've been doing isn't working," he added, complaining that "Americans are getting sicker every year" despite increasing spending at the federal agencies guiding US health policy.
According to photos and testimonials posted on social media, employees learned of their dismissal early on Tuesday morning by email or by having their access badges not working when they showed up to work in the morning.
The layoffs affect the Department of Health and Human Services and the federal agencies it oversees, such as those in charge of approving new drugs (FDA), responding to epidemics (CDC) or medical research (NIH).
According to US media reports, several senior officials from these agencies, including Jeanne Marrazzo, who had replaced Anthony Fauci as head of one of the NIH's branches, have been offered reassignment to isolated locations in Alaska or Oklahoma.
"The FDA as we've known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed," said Robert Califf, a former FDA commissioner during the Obama and Biden administrations.
The move comes despite the country facing its worst measles outbreak in years and mounting fears that bird flu could spark the next human pandemic.
Kennedy has alarmed health experts with his rhetoric downplaying the importance of vaccines and even suggesting that avian influenza should be allowed to spread freely among America's poultry.
Including early retirements and so-called "deferred resignations," the total downsizing will reduce the department's workforce from 82,000 to 62,000 employees, according to an official statement last week, saving an estimated $1.8 billion annually -- a tiny fraction of the HHS annual budget of $1.8 trillion.
The restructuring plan would consolidate the current 28 divisions of the Department of Health and Human Services into 15, including a new entity called the Administration for a Healthy America, or AHA.
While addressing issues such as America's obesity epidemic and industry-favored food regulations aligns with concerns shared by many in the scientific and medical communities, Kennedy's long history of promoting misinformation about vaccines and questioning basic scientific principles has caused deep concern.
The current measles outbreak has affected hundreds of people -- the overwhelming majority of them unvaccinated -- and resulted in two deaths.
arp-cha/md

environment

Battery boom drives Bangladesh lead poisoning epidemic

BY PHILIPPE ALFROY

  • Akter is one of 35 million children -- around 60 percent of all children in the South Asian nation -- who have dangerously high levels of lead exposure. 
  • Bangladeshi Junayed Akter is 12 years old but the toxic lead coursing through his veins has left him with the diminutive stature of someone several years younger.
  • Akter is one of 35 million children -- around 60 percent of all children in the South Asian nation -- who have dangerously high levels of lead exposure. 
Bangladeshi Junayed Akter is 12 years old but the toxic lead coursing through his veins has left him with the diminutive stature of someone several years younger.
Akter is one of 35 million children -- around 60 percent of all children in the South Asian nation -- who have dangerously high levels of lead exposure. 
The causes are varied, but his mother blames his maladies on a since-shuttered factory that hastily scrapped and recycled old vehicle batteries for profit, in the process poisoning the air and the earth of his small village. 
"It would start at night, and the whole area would be filled with smoke. You could smell this particular odour when you breathed," Bithi Akter told AFP. 
"The fruit no longer grew during the season. One day, we even found two dead cows at my aunt's house."
Medical tests showed Junayed's blood had twice the level of lead deemed by the World Health Organization to cause serious, and likely irreversible, mental impairment in young children.
"From the second grade onward, he didn't want to listen to us anymore, he didn't want to go to school," Bithi said, as her son sat next to her while gazing blankly out at the courtyard of their home. 
"He cried all the time too."
Lead poisoning is not a new phenomenon in Bangladesh, and the causes are manifold. 
They include the heavy metal's widespread and continued use in paint, in defiance of a government ban, and its use as an adulterant in turmeric spice powder to improve its colour and perceived quality. 
A great many cases are blamed on informal battery recycling factories that have proliferated around the country in response to rising demand. 
Children exposed to dangerous levels of lead risk decreased intelligence and cognitive performance, anaemia, stunted growth and lifelong neurological disorders. 
The factory in the Akter family's village closed after sustained complaints from the community. 
But environmental watchdog Pure Earth believes there could be 265 such sites elsewhere in the country. 
"They break down old batteries, remove the lead and melt it down to make new ones," Pure Earth's Mitali Das told AFP.
"They do all this in the open air," she added. "The toxic fumes and acidic water produced during the operation pollute the air, soil and water."

'They've killed our village'

In Fulbaria, a village that sits a few hours' drive north of the capital Dhaka, operations at another battery recycling factory owned by a Chinese company are in full swing.
On one side are verdant paddy fields. On the other, a pipe spews murky water into a brackish pool bordered by dead lands, caked with thick orange mud.
"As a child, I used to bring food to my father when he was in the fields. The landscape was magnificent, green, the water was clear," engineer and local resident Rakib Hasan, 34, told AFP.
"You see what it looks like now. It's dead, forever," he added. "They've killed our village."
Hasan complained about the factory's pollution, prompting a judge to declare it illegal and order the power be shut off -- a decision later reversed by the country's supreme court. 
"The factory bought off the local authorities," Hasan said. "Our country is poor, many people are corrupt."
Neither the company nor the Chinese embassy in Dhaka responded to AFP's requests for comment on the factory's operations.
Syeda Rizwana Hasan, who helms Bangladesh's environment ministry, declined to comment on the case because it was still before the courts. 
"We regularly conduct operations against the illegal production and recycling of electric batteries," she said. 
"But these efforts are often insufficient given the scale of the phenomenon."

'Unaware of the dangers'

Informal battery recycling is a booming business in Bangladesh.
It is driven largely by the mass electrification of rickshaws -- a formerly pedal-powered means of conveyance popular in both big cities and rural towns.
More than four million rickshaws are found on Bangladeshi roads and authorities estimate the market for fitting them all with electric motors and batteries at around $870 million.
"It's the downside of going all-electric," said Maya Vandenant of the UN children's agency, which is pushing a strategy to clean up the industry with tighter regulations and tax incentives.
"Most people are unaware of the dangers," she said, adding that the public health impacts are forecast to be a 6.9 percent dent to the national economy.
Muhammad Anwar Sadat of Bangladesh's health ministry warned that the country could not afford to ignore the scale of the problem.
"If we do nothing," he told AFP, "the number of people affected will multiply three or fourfold in the next two years."
pa/gle/cms/jfx

health

Slashed US funding threatens millions of children: charity chief

BY NINA LARSON

  • - 'More exposed' - During her Washington visit, the Gavi chief said she aimed to show how effective funding has been so far for her organisation.
  • A halt to US funding for Gavi, an organisation that vaccinates children in the world's poorest countries, will leave a dangerous gap threatening the lives of millions, its chief warned on Monday.
  • - 'More exposed' - During her Washington visit, the Gavi chief said she aimed to show how effective funding has been so far for her organisation.
A halt to US funding for Gavi, an organisation that vaccinates children in the world's poorest countries, will leave a dangerous gap threatening the lives of millions, its chief warned on Monday.
"The first impact would be for the most vulnerable children of the world," Gavi chief executive Sania Nishtar told AFP.
She spoke via video link from Washington, during a visit to try to convince US authorities that their 25-year collaboration with the Geneva-based organisation must continue.
The New York Times broke the news last week that President Donald Trump's administration, which has been aggressively slashing foreign aid, aims to cut all funding to Gavi.
That step featured in a 281-page spreadsheet related to cuts to USAID that was sent to the US Congress.
The decision would impact about 14 percent of Gavi's core budget -- and came just days after the Congress had approved $300 million in funding for the organisation.
"I was very, very surprised," Nishtar said, adding that her organisation still had received no official termination notice from the US government.
The medical doctor and former minister and senator in Pakistan said: "Gavi was supported by the previous Trump administration. We had a very good relationship."
If the cuts go ahead, Nishtar warned it would have devastating effects.

'Children will die'

"Frankly, this is too big a hole to be filled," Nishtar warned, even as Gavi scrambled to find donors to offset the missing US funding.
"Something will have to be cut."
Gavi says it helps vaccinate more than half the world's children against infectious diseases including Covid-19, Ebola, malaria, rabies, polio, cholera, tuberculosis (TB), typhoid and yellow fever.
Since its inception in 2000, Gavi has provided vaccines to more than 1.1 billion children in 78 lower-income countries, "preventing more than 18.8 million future deaths," it says.
Before the US decision, the organisation has a goal of vaccinating 500 million more children between 2026 to 2030.
The US contribution is directly responsible for funding 75 million of those vaccinations, Nishtar said.
Without them, "around 1.3 million children will die from vaccine-preventable diseases".
Beyond Gavi's core immunisation programmes, the funding cut would jeopardise the stockpiling and roll-out of vaccines against outbreaks and in health emergencies, including for Ebola, cholera and mpox. 
"The world's ability to protect itself against outbreaks and health emergencies will be compromised," Nishtar said.

'More exposed'

During her Washington visit, the Gavi chief said she aimed to show how effective funding has been so far for her organisation.
For every $1 spent on vaccinations in developing countries where Gavi operates, $21 will be saved this decade in "health care costs, lost wages and lost productivity from illness and death," the vaccine group estimates.
Unlike other organisations facing cuts, Gavi has not received an outsized contribution from Washington towards its budget, Nishtar noted, insisting that the US contribution was proportionate to its share of the global economy.
Other donors were paying their "fair share", while recipient countries also pitch in and are provided with a path to transition away from receiving aid, she said.
Some former recipients, like Indonesia, had even become donors to the programme, she pointed out, voicing hope that such arguments would help sway Washington to decide to stay the course.
Without the US backing, "we will have to make difficult trade-offs", Nishtar warned.
That "will leave us all more exposed".
nl/vog/rmb

quake

Fear of aftershocks in Myanmar forces patients into hospital car park

  • Fear of aftershocks is widespread across the city, with many people sleeping out in the streets since the quake, either unable to return home or too nervous to do so.
  • Hundreds of patients, including babies, the elderly and Buddhist monks, lie on gurneys in a hospital car park in the sweltering heat of Mandalay, a city still living in fear of aftershocks three days after a deadly quake struck Myanmar.
  • Fear of aftershocks is widespread across the city, with many people sleeping out in the streets since the quake, either unable to return home or too nervous to do so.
Hundreds of patients, including babies, the elderly and Buddhist monks, lie on gurneys in a hospital car park in the sweltering heat of Mandalay, a city still living in fear of aftershocks three days after a deadly quake struck Myanmar.
Mandalay General Hospital -- the city's main medical facility -- has around 1,000 beds but despite high heat and humidity, most patients are being treated outside in the wake of the massive earthquake that killed more than 2,000 people in Myanmar and neighbouring Thailand.
Friday's 7.7-magnitude quake was followed by repeated aftershocks that rattled Mandalay, Myanmar's second-largest city, over the weekend, and patients are being kept outside in case more tremors cause damage inside.
"This is a very, very imperfect condition for everyone," one medic, who asked to remain anonymous, told AFP. 
"We're trying to do what we can here," he added. "We are trying our best."
As temperatures soared to 39 degrees Celsius (102 degrees Fahrenheit), patients sheltered under a thin tarpaulin rigged up to protect them from the fierce tropical sun.
Relatives took the hands of their loved ones, trying to comfort them, or wafted them with bamboo fans.
Small children with scrapes cried amid the miserable conditions, while an injured monk lay on a gurney, hooked up to a drip.
It is not only the patients that are suffering. Medics sat cross-legged on the ground, trying to recuperate during breaks in their exhausting shifts. 
Although the hospital building itself has not been visibly affected, only a handful of patients who need intensive care, and the doctors who look after them, remain inside. 
The rest crammed themselves under the tarpaulin, or a shelter close by with a corrugated iron roof surrounded by motorbikes.
Fear of aftershocks is widespread across the city, with many people sleeping out in the streets since the quake, either unable to return home or too nervous to do so.
Some have tents but many, including young children, have simply bedded down on blankets in the middle of the roads, trying to keep as far from buildings as possible for fear of falling masonry.
The tempo and urgency of rescue efforts wound down Monday in Mandalay, one of the cities worst hit by the quake, as hopes faded of finding more survivors in the rubble of ruined buildings. 
Nearly 300 people remained missing across the country.
bur-aph/pdw/sco

crime

Australian black market tobacco sparks firebombings, budget hole

BY DAVID WILLIAMS

  • In March, the government cut its budget forecast for tobacco tax revenue in the period to 2029 by Aus$6.9 billion.
  • Sky-high tobacco prices in Australia have created a lucrative black market, analysts say, sparking a violent "tobacco war" and syphoning away billions in potential tax revenue.
  • In March, the government cut its budget forecast for tobacco tax revenue in the period to 2029 by Aus$6.9 billion.
Sky-high tobacco prices in Australia have created a lucrative black market, analysts say, sparking a violent "tobacco war" and syphoning away billions in potential tax revenue.
Faced with a pack of 25 cigarettes costing up to Aus$50 (US$32) or more -- including Aus$1.40 in tax on each stick -- many smokers have instead turned to readily available illicit tobacco.
At the same time, authorities have cracked down on vapes, restricting legal sales to pharmacies and opening up another illegal market for people in search of affordable nicotine.
In March, the government cut its budget forecast for tobacco tax revenue in the period to 2029 by Aus$6.9 billion.
"We've got a challenge here and too many people are avoiding the excise," Treasurer Jim Chalmers conceded after revealing the figures.
He announced an extra Aus$157 million for a multi-agency force battling organised crime groups involved in the market and a string of "tobacco war" fire-bombings.
The situation was a "total disaster", said James Martin, criminology course director at Deakin University in Melbourne.
"We have taken a public health issue, smoking, and our tobacco control policies have transformed it into a multi-fronted crisis," he told AFP.
"It is a fiscal crisis, so we are losing billions and billions of dollars in tobacco tax excise but also, more concerning for me as a criminologist, it has turned into a major crime problem."
Since the start of 2023, there had been more than 220 arson attacks targeting either black-market retailers or store owners who refuse to stock illicit tobacco products, Martin said.

Extortion and intimidation

"This is really serious organised crime, extortion and intimidation of otherwise law-abiding citizens."
Alleged crime figures named in local media as big players include convicted heroin trafficker Kazem Hamad, who was deported to Iraq in 2023, and an infamous Melbourne crime family. 
Australian Criminal Intelligence Commission chief Heather Cook said criminals fighting over the "lucrative" illegal market were associated with "violence and dangerous behaviour".
"This is impacting communities," she told Melbourne's Herald Sun in February.
Law enforcement alone could not solve the problem, Martin said. 
"If we just keep making nicotine harder to get to, people are going to turn to the black market."
Australia had made two mistakes, he said: pricing legal cigarettes so high that a pack-a-day habit cost about Aus$15,000 a year and at the same time heavily restricting sales of vapes, which were predominantly sold on the black market.
"The government needs to lower the tobacco tax excise to stop the bleed to the black market, and they need to legalise consumer vaping products."
New Zealand was the only country that had successfully introduced a similar tobacco taxation policy to Australia's, Martin said.
"But they did it by legalising vaping back in 2020," he added.
"So, New Zealand used to have a higher smoking rate than we did back just four years ago. It's now substantially lower than Australia's."
Illicit cigarettes are flowing into Australia from China and the Middle East, with vapes predominantly being sourced from Shenzhen in China, the criminologist said.

'War on nicotine'

And the black market still thrives despite the Australian Border Force saying it detected huge volumes of illicit tobacco in the year to June 30, 2024 -- 1.8 billion cigarettes and more than 436 tonnes of loose leaf tobacco.
Daily tobacco smoking in Australia has fallen sharply over the past decades: from 24 percent of those aged over 14 in 1991 to 8.3 percent by 2023, according to a national household survey.
But monitoring of nicotine in Australian wastewater -- whether from cigarettes, vapes, or nicotine replacement products -- showed consumption per person had remained "relatively stable" since 2016, according to the government's health and welfare institute.
Edward Jegasothy, senior lecturer in public health at the University of Sydney, said smoking rates in Australia fell just as fast during periods of sharp price increases as they did when prices were stable.
The black market had undermined government policy by providing a cheaper alternative, he told AFP.
To address the problem, authorities would probably need to lower taxes on tobacco and strengthen law enforcement, he said.
Broader nicotine restrictions in Australia had left people with fewer less harmful alternatives to tobacco, Jegasothy said.
People switching to vapes were going to the unregulated market where concentrations of nicotine and other adulterants were unknown, he said. 
"So that's another risk that's unnecessarily there because of the black market."
The high tobacco tax policy also hit people in the lowest socioeconomic groups the hardest, Jegasothy said, both because they were spending a higher proportion of their incomes on it, and because they had higher rates of smoking.
Australia's "disproportionate" focus on cutting nicotine supply rather than reducing demand and harm echoed the "War on Drugs", Jegasothy argued in a joint paper with Deakin University's Martin.
"As with Australia's broader War on Drugs, there is little evidence to suggest that our de facto War on Nicotine is an optimal strategy for reducing nicotine-related harms," it warns.
djw/sft/dan/fox

WAL

Burton in 'dream' England women's rugby debut three years after 25-day coma

  • "I'm so excited," Burton, 25, told the BBC. "I've tried not to let the emotion get the better of me this week but, honestly, this group is unbelievable and I'm so grateful to be a part of it, so yeah it was a dream debut.
  • England's Abi Burton capped a "dream" Test debut by coming off the bench to score two tries as England hammered Wales in the Women's Six Nations on Saturday, three years after spending 25 days in a coma while battling encephalitis.
  • "I'm so excited," Burton, 25, told the BBC. "I've tried not to let the emotion get the better of me this week but, honestly, this group is unbelievable and I'm so grateful to be a part of it, so yeah it was a dream debut.
England's Abi Burton capped a "dream" Test debut by coming off the bench to score two tries as England hammered Wales in the Women's Six Nations on Saturday, three years after spending 25 days in a coma while battling encephalitis.
The two-time Olympic Sevens competitor has made a remarkable comeback to elite rugby union after a 76-day stay in hospital in 2022 after dealing with the auto-immune condition which attacks the brain.
Burton lost three stone in weight and was wrongly detained under mental health regulations after an initial misdiagnosis.
The back-row forward came on with just 13 minutes of normal time left at Cardiff's Principality Stadium yet still managed to score two of England's 11 tries in the 67-12 rout.
"I'm so excited," Burton, 25, told the BBC. "I've tried not to let the emotion get the better of me this week but, honestly, this group is unbelievable and I'm so grateful to be a part of it, so yeah it was a dream debut.
"Earlier on this week when we came for the team run I just stood here (on the pitch) and I just absolutely relished it. It's unbelievable and to make my debut here also is like a really big dream come true. Twickenham would be amazing, but this is also pretty cool as well."
Burton, speaking in midweek about the health problems she had overcome, said: "It's super freeing." 
"I now play without the thought that I'm going to disappoint somebody or disappoint whoever's around me, because ultimately every time I step on to the pitch now, I think this could be the last time because there was a point where I didn't even ever think like that."
She added: "I probably took some of those moments, those five, six years that I had playing in international rugby in the Sevens, going to all these extraordinary places, probably took those for granted quite a bit. 
"So now when I step on the pitch, good game, bad game, I'm just happy to be running around with my mates, smashing people up, doing what I love."
jdg/dj

budgets

WHO must cut budget by fifth after US pullout: email

BY ROBIN MILLARD

  • "We have, therefore, proposed to member states a further reduced budget of $4.2 billion -- a 21 percent reduction from the original proposed budget."
  • The World Health Organization has proposed slashing a fifth of its budget following the US decision to withdraw, and must now reduce its reach and workforce, its chief said in an internal email seen by AFP on Saturday.
  • "We have, therefore, proposed to member states a further reduced budget of $4.2 billion -- a 21 percent reduction from the original proposed budget."
The World Health Organization has proposed slashing a fifth of its budget following the US decision to withdraw, and must now reduce its reach and workforce, its chief said in an internal email seen by AFP on Saturday.
The WHO is facing an income gap of nearly $600 million in 2025 and has "no choice" but to start making cutbacks, WHO Director-General Tedros Adhanom Ghebreyesus said in the message sent Friday to the UN health agency's staff.
Besides announcing the US pullout from the WHO after returning to the White House in January, President Donald Trump decided to freeze virtually all US foreign aid, including vast assistance to health projects worldwide.
The United States was by far the WHO's biggest donor.
"Dramatic cuts to official development assistance by the United States of America and others are causing massive disruption to countries, NGOs and United Nations agencies, including WHO," Tedros said in his email.
He said that even before Trump triggered the one-year process of withdrawing from the WHO, the organisation was already facing financial constraints.
"The United States' announcement, combined with recent reductions in official development assistance by some countries to fund increased defence spending, has made our situation much more acute," said Tedros.
"While we have achieved substantial cost savings, the prevailing economic and geopolitical conditions have made resource mobilisation particularly difficult.

WHO budget cut

Last month, the WHO's executive board reduced the proposed budget for 2026-2027 from $5.3 billion to $4.9 billion.
"Since then, the outlook for development assistance has deteriorated, not only for WHO, but for the whole international health ecosystem," said Tedros.
"We have, therefore, proposed to member states a further reduced budget of $4.2 billion -- a 21 percent reduction from the original proposed budget."
In the body's last two-year budget cycle, for 2022-23, the United States pitched in $1.3 billion, representing 16.3 percent of the WHO's then $7.89 billion budget.
Most of the US funding was through voluntary contributions for specific earmarked projects, rather than fixed membership fees.
"Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce," said Tedros.
"This reduction will begin at headquarters, starting with senior leadership, but will affect all levels and regions," he told staff.

Impact on lives

Earlier this month, Tedros asked Washington to reconsider its sharp cuts to global health funding, warning that the sudden halt threatened millions of lives.
He said disruptions to global HIV programmes alone could lead to "more than 10 million additional cases of HIV and three million HIV-related deaths".
The WHO is conducting a prioritisation exercise, to be completed by the end of April, to focus its efforts on core functions.
Since taking office in 2017, Tedros has made it his mission to reform the organisation's finances and put them on a more secure and predictable footing.
To overcome the risk of relying on a handful of traditional major nation-state donors, the WHO now also seeks philanthropy and public donations.
rjm/gv

fluoride

Utah becomes first US state to ban fluoride in drinking water

BY ISSAM AHMED

  • Ending fluoridation is generally opposed by the dental and public health communities.
  • The western US state of Utah has become the first to prohibit fluoridation of its public drinking water, part of a growing movement reexamining the decades-old public health practice.
  • Ending fluoridation is generally opposed by the dental and public health communities.
The western US state of Utah has become the first to prohibit fluoridation of its public drinking water, part of a growing movement reexamining the decades-old public health practice.
New US Health Secretary Robert F. Kennedy Jr. has long been a vocal critic of fluoridated water, which currently reaches an estimated 200 million Americans -- about two-thirds of the population.
Utah's ban, signed into law by Governor Spencer Cox on Thursday, is set to take effect on May 7. Legislatures in other Republican-led states including North Dakota, Tennessee, and Montana, are considering similar measures.
Opposition is not limited to red states. Liberal-leaning cities such as Portland, Oregon, and the City and County of Honolulu, Hawaii, have also banned fluoridation.
Fluoride was first introduced to US water systems in 1945, dramatically reducing childhood cavities and adult tooth loss. The Centers for Disease Control and Prevention hails it as one of the top public health achievements of the 20th century.
But controversy has grown around its potential neurotoxic effects. Last year, the Department of Health and Human Services under former president Joe Biden concluded with "moderate confidence" that higher levels of fluoride are linked to lower IQ scores.
This January, a paper in the prestigious journal JAMA Pediatrics, authored by the same government scientists, found a "statistically significant association" between fluoride exposure and reduced IQ. However, it left open key questions about what dosage levels may be harmful.
The World Health Organization's safety threshold stands at 1.5 milligrams per liter -- about double the US guideline of 0.7 mg/L -- and the study said there was insufficient data to determine whether that limit should be revised.
Ending fluoridation is generally opposed by the dental and public health communities. Critics of the recent study argue it failed to adequately control for confounding variables and environmental factors.
Fluoride occurs naturally in varying concentrations and strengthens teeth in several ways: by restoring minerals lost to acid, reducing acid production by cavity-causing bacteria, and making it harder for those bacteria to adhere to enamel.
Proponents argue fluoridation reduces socioeconomic disparities in dental care.
But with fluoride toothpastes widely available since the 1960s, some research suggests diminishing returns. 
A recent Canadian study found that ending fluoridation increased dental caries, while an Irish study reported a decline in severe caries in both fluoridated and non-fluoridated areas.
Fluoridation policies also vary widely by country, with many, including Germany and France eschewing the practice altogether.
ia/bjt

US

Gavi: vaccine alliance facing US funding cuts

BY ROBIN MILLARD

  • Here is an overview of what it does, and how US funding cuts could impact its operations and child health worldwide: - Gavi's mission and set-up - Founded in 2000 as the Global Alliance for Vaccines and Immunisation, Gavi was created to provide vaccines to developing countries.
  • The Gavi vaccine alliance, which proudly claims it vaccinates more than half the world's children against deadly and debilitating diseases, is now seemingly next in line for US funding cuts.
  • Here is an overview of what it does, and how US funding cuts could impact its operations and child health worldwide: - Gavi's mission and set-up - Founded in 2000 as the Global Alliance for Vaccines and Immunisation, Gavi was created to provide vaccines to developing countries.
The Gavi vaccine alliance, which proudly claims it vaccinates more than half the world's children against deadly and debilitating diseases, is now seemingly next in line for US funding cuts.
The United States is reportedly set to axe its funding as President Donald Trump slashes foreign aid spending -- a move Gavi says could cost more than a million lives.
Despite its important role, Gavi is little known among the general public. Here is an overview of what it does, and how US funding cuts could impact its operations and child health worldwide:

Gavi's mission and set-up

Founded in 2000 as the Global Alliance for Vaccines and Immunisation, Gavi was created to provide vaccines to developing countries.
The United States has been on board from the start, as one of the six original donor countries. It now contributes around 15 percent of the regular budget.
A public-private partnership, Gavi is a non-profit organisation based in Geneva.
It works tightly with the UN health and children's agencies -- the World Health Organization (WHO) and UNICEF -- the World Bank and the Gates Foundation, as well as vaccine manufacturers, research agencies and vaccine-administering countries.
Its chief executive Sania Nishtar is a medical doctor and former minister and senator in Pakistan. Former EU chief Jose Manuel Barroso chairs the board.

Impact of US pullout

Nishtar said the US cutting its funding would have a "disastrous impact" on global health security and potentially result in more than a million deaths from preventable diseases.
Some 97 percent of Gavi's funding goes directly to vaccination programmes, meaning that if 15 percent of the budget goes, vaccination campaigns will suffer.
Over 2026-2030, Gavi aims to protect 500 million children against 20 or so diseases -- so by its calculations, 75 million fewer children would be vaccinated.
And if around nine million lives would be saved, that number could drop by 1.3 million.
Gavi is also worried about its ability to maintain its stockpiles of vaccines against diseases like Ebola, cholera and meningitis.
The WHO said Friday that an estimated 154 million lives have been saved over the past 50 years due to global vaccination drives.
"Our best defence against infectious diseases is continued investment in life-saving immunisations for all," it said.
"Nobody should be mistaken that reversing the gains of the past 25 years of immunisation is anything other than a grave threat to us all."

Budget and US funding

Its budget for the 2021-2025 cycle is over $21 billion -- swelled by more than $12 billion for the Covax scheme, which Gavi co-led in response to the Covid pandemic.
Washington contributed $4 billion to Covax, and was its biggest funder.
With Covax, US regular contributions and pledges for 2021-2025 amount to $1.19 billion.
The United States has steadily increased its regular contributions to Gavi, from $48 million in 2001 to $300 million in 2024.
"US global health assistance has emphasised ending preventable child deaths through high-impact, low-cost interventions," the alliance says.
US contributions accounted for 10 percent of Gavi's funding in 2011-2015; 15 percent for 2016-2020; and 24 percent in 2021-2025, including Covax.
But excluding Covax, the United States is the third-biggest contributor to Gavi, behind the Gates Foundation and Britain, covering about 15 percent of the budget.
For the years 2026-2030, Washington made a five-year pledge of at least $1.58 billion.

Gavi's vaccines

Gavi supports vaccines against 20 infectious diseases, including Covid-19, Ebola, malaria, rabies, polio, cholera, typhoid and yellow fever.
Gavi says that since its inception, it has helped immunise more than 1.1 billion children in 78 lower-income countries, "preventing more than 18.8 million future deaths".
By June 2023 it had crossed the landmark of having helped provide roughly six billion vaccinations globally.
According to its latest figures, more than 69 million children were vaccinated in 2023.
The alliance says that for every dollar spent on vaccines between 2021 and 2030, $21 would be saved in healthcare costs, lost wages and lost productivity due to illness and death.

Covid jabs role

Gavi co-led Covax, the globally pooled Covid vaccine procurement and equitable distribution effort.
The scheme to ensure Covid vaccines reached people in poorer countries wound up in December 2023.
It delivered nearly two billion doses to 146 territories.
Gavi estimates more than 2.7 million deaths were averted by Covax in low- and middle-income countries.
rjm/apo/jhb