That is what makes the Digital Health & AI Innovation Summit (DHAI), taking place June 8-9 in Boston, distinctive within an increasingly competitive field of AI and innovation conferences. The Summit certainly offers a high-caliber program and noted speakers. However, its real value proposition beyond the agenda lies in the conversations and takeaways.

The carefully curated forum, organized by Amir Lahav, PhD, and World BI, is intentionally designed for a smaller community of roughly 500 attendees and more than 150 speakers and innovators. The result is that the connections become as valuable as the presentations.

That distinction matters more than many realize.

Artificial intelligence and digital health are moving at extraordinary speed. Health systems, pharmaceutical companies, regulators, investors and technology innovators are all trying to answer the same questions: How do we apply innovation responsibly while improving outcomes for patients and clinicians? How do we integrate AI into the R&D process? How can we leverage information technologies to accelerate the recruitment of the right people for clinical trials? The challenge is no longer simply technological capability. The challenge is implementation, governance and integration into the realities of care delivery.

Those questions are difficult to answer from the back row of a ballroom.

They are more likely to be explored over coffee between sessions, during a shared meal, or in quieter moments when people can challenge assumptions, exchange experiences and discuss what is actually working in health systems, research environments, and patient care settings.

That is where DHAI distinguishes itself.

The Power of Curated Expertise

What gives a conference enduring value is not only the quality of its speakers, but whether those speakers remain accessible enough to challenge assumptions, answer difficult questions and engage in unscripted dialogue. That is increasingly uncommon in modern health conferences, where influence often feels managed from a distance.

At DHAI, the proximity to the experience of 150 presenters is intentional.

The next era of health won’t be built in silos and it certainly won’t be forged by focusing on the hype. It requires leaders willing to share their failures alongside their successes, and their fears alongside their visions,” shares Amir Lahav, PhD, curator and DHAI organizer. “The DHAI Summit provides an exclusive, trusted space for these unfiltered conversations that rarely happen on public stages. This is an exclusive invitation to join the health AI  pioneers who are moving the needle and step into the room where the real trajectory of medicine is being shaped,” he adds.

For attendees seeking to understand how artificial intelligence is moving from experimentation to clinical reality, few conversations may prove more valuable than those surrounding the work of Dr. Dennis Wall at Stanford University. His groundbreaking efforts to apply AI to accelerate diagnostics, particularly in neurological and developmental conditions, reflect the growing intersection of machine learning and patient-centered medicine. In most settings, hearing someone like Wall speak might last 20 minutes. Here, the opportunity to continue the discussion between sessions may be equally important as the presentation itself.

The same can be said for leaders shaping the future of pharmaceutical innovation through AI. Thomas Fuchs, Chief AI Officer at Eli Lilly and Company, operates at the center of one of the most significant transformations underway in life sciences. His work integrating AI, pathology and drug discovery reflects how computational science is redefining therapeutic development. With pharmaceutical companies investing billions into AI-enabled research ecosystems, the ability to exchange perspectives directly with someone navigating those realities daily carries extraordinary value.

Precision medicine also takes on a more practical dimension through leaders such as John Axerio-Cilies, Chief Data and Technology Officer at Tempus AI. Tempus has become emblematic of how data science, oncology and artificial intelligence are beginning to reshape personalized medicine and diagnostics. Yet the real insight often comes not from keynote slides but from candid reflections on implementation challenges, physician adoption, workflow integration, and trust in AI-driven systems.

What also distinguishes the program is its recognition that health innovation no longer lives within traditional boundaries. Biology, computational science, organizational leadership and entrepreneurship are rapidly converging, creating entirely new expectations for how innovation enters the health ecosystem.

That reality becomes especially clear when considering trusted voices such as Tom Lawry, author of Hacking Healthcare and one of the most respected global advisors on AI strategy in health. For years, Lawry has argued that artificial intelligence alone cannot transform the delivery of care. Institutions themselves must evolve alongside technology. Leadership structures, workflow, culture and decision-making all become part of the innovation equation. His perspective reinforces an increasingly important truth: AI implementation is not fundamentally a technology challenge. It is a human challenge.

That same intersection between innovation and execution is reflected in the participation of Sally Ann Frank, Global Lead for Health & Life Sciences at Microsoft for Startups. Her work focuses on helping emerging companies move beyond promising ideas toward scalable and commercially viable solutions. Through strategy development, technical enablement and go-to-market support, she works directly with startups navigating the increasingly complex realities of AI, digital health and life sciences innovation. At a time when thousands of companies are entering the AI marketplace, Frank brings an unusually practical understanding of what separates experimentation from sustainable impact across the global health ecosystem.

The scientific and technical dimensions of the Summit are equally compelling. Arturo Loaiza-Bonilla, MD, MSEd, Co-Founder and Chief Medical AI Officer of Massive Bio, Network Chief of Hematology and Oncology at St. Luke’s University Health Network, whom I met recently during HITLAB Health Innovation Week in New York, champions an important evolution in medicine, where clinical leadership, oncology, data science and AI innovation are interconnected. His work sits at the intersection of precision medicine, clinical trials and responsible AI application, demonstrating how technology can expand access and support informed care decisions while keeping physicians and patients at the center of the experience.

The program also grounds innovation in the realities of patient care and health system operations. Through her leadership at NYC Health + Hospitals, Dr. Komal Bajaj has focused extensively on quality, equity and implementation within one of the nation’s largest public health systems. Her perspective introduces an important layer of realism into discussions that can sometimes become overly theoretical. AI may promise efficiency, but health systems must still ensure that innovation improves care delivery rather than complicates it.

That balance between aspiration and practicality is also reflected in leaders such as Lauren Li of Novartis, whose work in AI and innovation strategy demonstrates how global life sciences companies are integrating AI responsibly across research, development, and commercialization. The questions facing companies like Novartis are no longer whether AI will shape health innovation, but how to apply it responsibly while preserving scientific rigor and public trust.

Equally important to the DHAI agenda is the presence of Jeremy Walsh, Chief AI Officer at the Food and Drug Administration. At a moment when AI is moving rapidly into research, clinical decision support, diagnostics and operational health systems, regulatory leadership must provide oversight. FDA voice addresses a growing concern that innovation and governance cannot operate on separate tracks. The future of AI in health will depend not only on technological capability, but on transparency, accountability and safety. His perspective brings a policy and regulatory dimension to a conversation too often dominated by technology.

Taken together, these leaders represent more than expertise. They reflect the convergence of medicine, data science, biotechnology, health systems, patient engagement and policy. The global health ecosystem is entering a period in which barriers between disciplines are dissolving. Clinicians must understand data science. Technologists must better appreciate patient experience and the realities of workflow. Pharmaceutical leaders must think beyond molecules toward digital ecosystems and longitudinal patient engagement.

Why Human Connection Still Matters in the AI Era

That convergence changes the value of gatherings like this one. Large conferences often showcase these worlds side by side. Smaller curated forums create the possibility for those worlds to interact.

That dynamic is particularly important in digital health, where enthusiasm can sometimes outpace evidence. AI is neither a miracle nor a menace. It is a tool shaped by human intention, data quality and leadership. The most important conversations in AI and health today are not only about capability. They are about judgment.

How do we reduce physician burnout without depersonalizing medicine? How do we use predictive analytics responsibly? How do we ensure that innovation improves access rather than deepens disparities? How do we maintain trust while integrating increasingly autonomous technologies into patient care?

Those are conversations that require candor and mutual learning.

As someone attending and stepping to the stage during DHAI, I believe that may ultimately become its greatest differentiator. In health, relationships still matter. Communication still matters. Shared perspective still matters. Technology may accelerate insight, but human interaction remains essential to wisdom.

Health innovation does not advance through presentations alone. It advances through collaboration, challenge and conversation. Those exchanges between sessions often become the catalyst for strategies and unexpected ideas that continue long after this event comes to a close.

In a global health environment often defined by complexity, there is growing value in spaces where innovation feels ambitious and human. The DHAI appears designed to deliver that ROI.

The post The Value of Health AI Conferences Is No Longer the Stage. It’s the Hallway Conversation appeared first on Medika Life.

An operational model developed in Algeria may show a way that countries can make childhood vaccines more effective, more acceptable and more economical. It is a model that may provide a framework for middle-income countries across the globe, including many across the rest of Africa.

Six-in-one (or hexavalent) vaccines are cutting the number of clinic visits needed to prevent multiple life‑threatening infections and easing pressure on already stretched health systems. Growing economic evidence from Algeria and several Latin American countries suggests that while these vaccines may cost more upfront, the investment may be largely or entirely recovered through fewer appointments, streamlined logistics, and a reduction in cases of vaccine-preventable diseases and potential adverse events from vaccination. Yet the children who could benefit most – those living in low‑ and middle‑income countries are still the least likely to receive them, widening an avoidable gap between what modern vaccines can do and the protection children actually receive.

Most hexavalent vaccines save money in another way: they reduce the number of adverse events – side effects – that require treatment in a hospital or clinic. Acellular hexavalent vaccines include a type of protection against pertussis, or whooping cough, which is the gold standard for immunization in higher-income countries but has not yet been widely adopted beyond them.

With more than a decade of historical data supporting safety and efficacy, these acellular pertussis vaccines have a notable track record of improving vaccination coverage rates (VCR) and parents’ willingness to have their children protected, as they cause fewer painful adverse events [1].

Acellular pertussis (aP) vaccines are formulated using isolated antigens, which are purified and detoxified, thereby removing most of the components of the bacterium that cause undesirable reactions [2].

Most low- to middle-income countries still use whole-cell pertussis vaccines, which include a suspension of the entire inactivated Bordetella pertussis organism – some 3,000 antigens. Although the inclusion of far more antigens can result in a marginally higher immune response, the complexity of the vaccine leads to varying amounts of reaction-causing components between batches of vaccine and varying levels of protection [2].

The combination of more adverse events and variable efficacy means that developing countries bear a disproportionate share of the burden incurred through side effects. The side effects in children lead to an increased reluctance among parents to agree to future vaccines for their children and higher costs for the healthcare system. These problems often arise in healthcare systems that are inadequately equipped to deal with them.

Expert opinion from Algeria indicates that acellular hexavalent vaccination has improved vaccination coverage levels and simplified the vaccination schedule by reducing the number of appointments. It reduces the required number of immunization visits from ten to six. This eases pressure on overstretched health services, simplifies logistics and cold-chain management, and reduces indirect societal costs, including the time parents spend away from work.

Algeria is the third WHO African region country to adopt the acellular hexavalent vaccine into its national immunization schedule. Economic data from those countries and several in Latin America demonstrate that a rollout of the vaccine across African countries is not only possible but also economically advantageous [3,4,5,6].

Algeria’s vaccination metrics: an operational model for success

Vaccines have transformed child health in Algeria, as they have across the world. Since the initial introduction of vaccination in Algeria, followed by sustained efforts to expand the vaccination schedule, infant mortality rates have dropped dramatically from 163 per 1,000 live births in 1966 to 20 per 1,000 in 2023, a reduction of around 87% [7].

The percentage of children protected in Algeria has exceeded the targets set by the World Health Organization (WHO) for decades, with diphtheria, tetanus toxoid and pertussis (DTP) coverage consistently above 90% [8]. As in many countries, the COVID-19 pandemic disrupted healthcare systems, leading to a decline in vaccination rates, with DTP-3 coverage, a key measure of childhood vaccination, reduced to 77% in 2022 [9]. This situation was quickly improved, with coverage increasing to 92% by 2024 [9].

In 2022, three cases of polio caused by circulating vaccine-derived poliovirus type 2 were reported [10]. Rarely, the circulating vaccine-derived virus causes polio, highlighting the necessity of timely vaccination with IPV, with which these vaccine-derived cases do not occur [11].

The shift to hexavalent vaccination

Algeria’s shift from its former schedule to hexavalent vaccination was not a straightforward process. Initially, the five-in-one (or pentavalent) vaccine was replaced by a combination of the tetravalent vaccine (DTP-Hib) and the monovalent Hepatitis B vaccine (HBV), administered across 10 separate healthcare visits, necessitating additional appointments [12].

The change in the vaccination schedule resulted in delays in dose administration and a decrease in vaccination coverage. This issue was resolved with the introduction of the new schedule, which integrated an acellular hexavalent vaccine in 2023, reducing the number of required healthcare visits to six [13].

While polio vaccination was present in the previous schedule (with one IPV dose at 3 months and 3 OPV doses at 2, 4, and 12 months), inclusion as part of a hexavalent vaccine simplified the schedule (giving three doses of IPV at 2, 4, and 12 months associated with three OPV doses), helping to maintain the global strategy for polio eradication. The WHO recommends that all countries using OPV adopt a vaccination schedule with at least two doses of inactivated vaccine, which gives individual protection without the risk of vaccine-related polio [14].

The financial metrics of the switch

A recent whitepaper conducted a pharmacoeconomic analysis of the budgetary impact of transitioning from a whole-cell tetravalent vaccination schedule to an acellular hexavalent schedule. While the switch was associated with an increase in annual program expenditure of approximately 26 million Euros (around a 58% rise in upfront costs), this was substantially offset by nearly 19 million Euros in annual savings generated through the management of adverse events, improved logistics and transportation, and increased parental productivity [13]. Overall, roughly 73% of the upfront cost was offset by these savings.

Algeria is the latest in a series of examples where this is the case. The nominal, upfront cost of acellular hexavalent vaccines is typically higher than that of whole-cell vaccines; this has, in many cases, deterred countries from adopting them. However, there are many benefits at both the economic and systemic levels that recoup much of the costs of acellular hexavalent vaccines. In many instances, these costs are hidden and not factored into initial value calculations.

Similar experiences have been seen in other countries. In Argentina, Peru, and South Africa, the switch to hexavalent vaccines led to higher initial costs, but these were substantially offset by savings from fewer adverse events, lower programmatic expenses, and improved logistics. For example, in data from Argentina, roughly 90% of the initial investment into acellular hexavalent vaccines was recovered through fewer adverse event-associated costs and lower programmatic costs [15]. Peru reported a reduction in logistical costs by nearly 60%, with roughly 44% of the initial increase in costs recovered [16]. South Africa achieved overall savings of about 10 USD per child [3].

These calculations overlook benefits that are more difficult to quantify. For example, what costs are generated because of vaccines missed and infections caused by increased vaccine hesitancy on the part of parents. Across these settings, the higher upfront investment in hexavalent vaccines has proven to be economically viable, with much of the cost recouped through broader system efficiencies.

Programmatic benefits of hexavalent vaccination

Hexavalent vaccination offers the potential for simpler systems and higher levels of acceptance among patients. For the child, integrating six antigens into a single injection drastically reduces the number of needle sticks, alleviating injection-related anxiety and the prevalence of local reactions. This increases parental acceptance and helps to improve vaccination coverage.

Parents are relieved of the burden of coordinating multiple medical appointments, covering travel costs, and dealing with lost workdays. By reducing parental anxiety and the strain of repeated visits, combined vaccines help mitigate vaccine hesitancy within communities. This has been demonstrated in multiple studies across Africa, with investigations in Gambia and South Africa documenting concerns among parents about a child receiving more than two injections in a single visit [17,18]. Limiting the number of healthcare visits is also a crucial factor in increasing vaccine coverage in areas with limited healthcare infrastructure, such as those in rural southern Algeria.

For healthcare professionals, particularly in resource-limited settings such as rural areas in Africa, the adoption of combined vaccines helps to ease the administrative burden of multiple appointments. These formulations optimize consultation efficiency by drastically reducing the required administration time and simplifying inventory management [19].

The use of ready-to-use liquid vaccines, such as the hexavalents, has been shown to simplify and enhance the safety of the vaccination procedure when compared to vaccines that come as a powder that has to be reconstituted [20]. The preference for this approach among frontline workers is overwhelming: one study indicated that 97.6% of healthcare providers favored these liquid, combined formulations in their daily work [21]. Evidence supports this preference, demonstrating that the switch led to a dramatic reduction in administration errors (from 42.8% to 4%) and needlestick injuries (from 42.3% to 9.5%), while also yielding an average time savings of 1.1 minutes per dose [22].

The case for Hexavalent vaccination across Africa

Across the WHO Africa region, VCR has improved significantly over the last few decades; however, unfortunately, this improvement has stalled. The level of coverage for the third dose of DTP-containing vaccines, a standard benchmark for immunization system performance, has sat in the mid-70s for over a decade, with a current coverage of 76% [23].

This stagnation of the VCR is reflective of the ongoing issue of inequality. The gap in vaccine access runs not only between Africa and higher‑income regions, but also within the continent itself, where some countries consistently outperform others. Diseases, however, do not recognize borders; any outbreak that affects one country is likely to increase the risk to surrounding countries. Air travel enables a disease case to be spread to virtually any country in the world within just two days [24].

The COVID-19 pandemic was a clear example of the rapid spread in today’s world. Within a period of weeks, the virus spread from its origin in China to the entire globe, despite public health measures and lockdowns. With this in mind, any country that is falling behind on vaccination coverage becomes a weak link in a global chain where diseases can flourish and form reservoirs of cases that can allow diseases such as polio to spread unchecked.

Bringing vaccine equity to lower- and middle-income countries is therefore vital to addressing global health concerns. Hexavalent vaccination has demonstrated its ability to increase vaccine coverage in these countries. Among the WHO Africa region, Mauritius, which adopted hexavalent vaccination in 2017 [4] currently stands notably above the average for the region, with 96% coverage for the first dose of inactivated polio vaccine, and 93% for the benchmark based on DTP-containing vaccines [25].

Vaccine coverage translates into increased prosperity. Vaccination cannot be viewed as an inconvenient expense but as an investment. The WHO estimates that for every dollar spent, vaccination can yield a return on investment of around 54 USD – provided, of course, that the vaccines actually find their way into the arms of children [26].

As the Algerian case study demonstrates, higher upfront costs for acellular hexavalent      vaccines are often paid back by improvements in logistical efficiency, reduced healthcare burdens, and improved parental compliance. By bridging the gap between high- and low-income immunization standards through this investment, the life-saving benefits of gold standard vaccinations can become more than a privilege of geography, but a universal foundation for human health.

[This consensus paper is based on the findings of a white paper discussing the findings of a group of vaccination experts focusing on paediatric immunisation, supported by Sanofi. Intended for professional use.]

Reference list

1. Boisnard, F., Manson, C., Serradell, L., & Macina, D. (2023). DTaP-IPV-HB-Hib vaccine (Hexaxim): an update 10 years after first licensure. Expert Review of Vaccines, 22(1), 1196–1213. https://doi.org/10.1080/14760584.2023.2280236
2. World Health Organization (2017) The immunological basis for immunization series: module 4: pertussis, update 2017. Available at: https://www.who.int/publications/i/item/the-immunological-basis-for-immunization-series-module-4-pertussis-update-2017
3. Batson A, Glassman A, Federgruen A, et al. The world needs to prepare now to prevent polio resurgence post eradication. BMJ Global Health. 2022;7(12):e011485. doi: https://doi.org/10.1136/bmjgh-2022-011485
4. ReliefWeb. Hexavalent vaccine: less injections and more protection babies. Available at: https://reliefweb.int/report/mauritius/hexavalent-vaccine-less-injections-and-more-protection-babies
5. Olivera, I., Grau, C., Dibarboure, H. et al. Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine. BMC Health Serv Res 20, 295 (2020). https://doi.org/10.1186/s12913-020-05115-7
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7. World Bank Data. Available at: https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=DZ
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9. World Health Organization.  DTP vaccination coverage. Available at: https://immunizationdata.who.int/global/wiise-detail-page/diphtheria-tetanus-toxoid-and-pertussis-(dtp)-vaccination-coverage?CODE=DZA&ANTIGEN=DTPCV3&YEAR=
10. GPEI – Algeria. Available at https://www.archive.polioeradication.org/where-we-work/algeria/
11. Global Polio Eradication Initiative. GPEI-OPV. polio global eradication initiative . Published 2016. Available at: https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/           
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13. Laichour A, Kihel M, Aissaoui A, Olivera G. Pharmacoeconomic evaluation of national immunization program realisation in Algeria: cost-minimization analysis of switch from DTwP-Hib + HBV + IPV to an acellular hexavalent (DTaP-HBV-Hib-IPV) vaccine. Poster presented at: ISPOR Europe 2023; November 2023; Copenhagen, Denmark. Value in Health. 2023;26(Suppl 2):S2-EE134.
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15. Olivera, I., Pérez, C.G., Lazarov, L. et al. Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Serv Res 23, 1067 (2023). https://doi.org/10.1186/s12913-023-10038-0
16. Seinfeld J, Rosales ML, Sobrevilla A, López Yescas JG. Economic assessment of incorporating the hexavalent vaccine as part of the National Immunization Program of Peru. BMC Health Serv Res. 2022 May 16;22(1):651. doi: 10.1186/s12913-022-08006-1. PMID: 35570278; PMCID: PMC9109284.
17. Idoko OT, Hampton LM, Mboizi RB, et al. Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine. Vaccine. 2016;34(41):5034-5039. doi: https://doi.org/10.1016/j.vaccine.2016.07.021
18. Hanani Tabana, Dudley L, Knight S, et al. The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa. BMC Public Health. 2016;16(1). doi: https://doi.org/10.1186/s12889-016-3324-2
19. Pelissier JM, Coplan PM, Jackson LA, May JE. The effect of additional shots on the vaccine administration process: results of a time-motion study in 2 settings. Am J Manag Care. 2000 Sep;6(9):1038-44.
20. Al-Bashir L, Ismail A, Aljunid SM. Parents‘ and healthcare professionals’ perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application. Front Immunol. 2023;14:1052450.
21. De Coster I, Fournie X, Faure C, Ziani E, Nicolas L, Soubeyrand B, Van Damme P. Assessment of preparation time with fully-liquid versus non-fully liquid paediatric hexavalent vaccines. A time and motion study. Vaccine. 2015;33(32):3976–82.
22. Esteve IC, Fernández PF, Palacios SL, Rodrı́guez MJ, Vino HP, Ortega BR, Nieto Nevot ML, Manch´on GD, L´opez-Belmonte J-L. Health care professionals’ preference for a fully liquid, ready-to-use hexavalent vaccine in Spain. Prev Med Rep. 2021;22:101376.
23. World Health Organization. Immunization data: African region. Available at: https://immunizationdata.who.int/dashboard/regions/african-region
24. Findlater A, Bogoch II. Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel. Trends Parasitol. 2018 Sep;34(9):772-783. doi: 10.1016/j.pt.2018.07.004. Epub 2018 Jul 23. PMID: 30049602; PMCID: PMC7106444.
25. World Health Organization. Immunization data: Mauritius. Available at: https://immunizationdata.who.int/dashboard/regions/african-region/MUS
26. World Health Organization (2025) Fully funded Gavi, the Vaccine Alliance, is a lifeline for child survival, says WHO. Available at: https://www.who.int/news/item/28-03-2025-fully-funded-gavi–the-vaccine-alliance–is-a-lifeline-for-child-survival–says-who

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Behind every budget shift lies a ripple effect, and today, global healthcare is at the receiving end. The result is shrinking access, rising costs, and widening inequities. The impact of geopolitical decisions is rarely confined to borders, it now extends into clinics, hospitals, and communities. What we are witnessing is not just a funding gap, but a structural shift in how the world values health.

The silent reallocation

Over the past years, global defense spending has surged to record levels. According to the Stockholm International Peace Research Institute (SIPRI), global military expenditure rose by 9.4% in real terms to $2718 billion in 2024, the highest global total ever recorded by SIPRI and the 10th year of consecutive increases. The total military expenditure accounted for 2.5% of the global gross domestic product (GDP) in 2024. These figures are expected to climb further following the June 2025 commitment by North Atlantic Treaty Organization (NATO) members to increase defence and security spending to 5% of GDP by 2035, more than twice the earlier 2% benchmark.

Meanwhile, public health budgets are being trimmed or stagnating. The World Health Organization (WHO) has raised serious concerns about the strain on global health systems, pointing to shrinking international aid and ongoing funding shortfalls. In February, Director-General Tedros Adhanom Ghebreyesus highlighted that abrupt and significant reductions in bilateral assistance have severely disrupted healthcare services across multiple countries, describing 2025 as “one of the most challenging years” in the organization’s history.

As per the WHO, an estimated 4.6 billion people worldwide still do not have access to essential health services, while around 2.1 billion experience financial strain due to healthcare expenses. Compounding this challenge, the global health workforce is projected to face a shortfall of 11 million professionals by 2030, with nurses accounting for more than half of this gap. When 4.6 billion people lack access to essential services, this is not only a development failure, but also a global stability risk – translating into fewer vaccinations, delayed disease surveillance, and weakened emergency response systems.

The global policy conversation increasingly treats defence spending as essential security investment. Health spending, however, is still framed as social expenditure rather than strategic infrastructure. This shift is particularly devastating for LMICs, where international aid often fills critical gaps.

Conflict and the collapse of care

Conflict has long been a stress test for health systems, but the consequences today are deeper and more far-reaching. As the Russia–Ukraine war entered its fifth year in 2026, Ukraine’s health system faced unprecedented strain, with attacks on healthcare rising nearly 20% in 2025 alone. Since the full-scale invasion began, the WHO has documented at least 2,881 attacks targeting hospitals, health workers, ambulances, and medical infrastructure, severely disrupting care delivery. Health outcomes have deteriorated sharply, with 59% of people in frontline areas reporting poor health, alongside surging mental health issues, cardiovascular conditions, and widespread lack of access to essential medicines. Intensified attacks in 2025, including a spike in strikes on medical warehouses, have further crippled supply chains.

In the aftermath of the war in Gaza, the region’s health system remains on the brink of collapse despite months of humanitarian efforts and intermittent pauses in fighting. Widespread damage to hospitals, severe shortages of medicines, and a surge in patients continue to overwhelm already fragile services. Many facilities operate at drastically reduced capacity, with critical treatments, including cancer care, meeting only a fraction of demand, while rising cases of skin and respiratory illnesses place further strain on the system. Healthcare workers, operating under extraordinary pressure and with limited resources, are struggling to manage overwhelming caseloads each day amid ongoing supply constraints and infrastructure damage. The crisis extends well beyond acute injuries, as patients with chronic illnesses face dangerous interruptions in care and deteriorating living conditions, turning access to healthcare into a daily struggle for survival.

Meanwhile, after three years of conflict, the Sudan war has evolved into the world’s largest humanitarian and health crisis, with 34 million people in need of aid and 21 million lacking access to basic healthcare. The system is collapsing under the combined weight of widespread disease outbreaks, acute malnutrition affecting over 4 million people, and relentless attacks on healthcare infrastructure—37% of facilities are now non-functional. As infectious diseases surge and funding falls short, Sudan’s health crisis continues to deepen, turning basic healthcare access into a matter of survival for millions.

What distinguishes the current moment is the scale of global interdependence. Earlier crises were largely contained within regions. Today, disruptions are transmitted across borders through tightly integrated supply chains, financing systems, and health workforces. The Ukraine conflict, for instance, has affected global pharmaceutical logistics and energy prices, indirectly increasing healthcare costs across Europe, Asia, and beyond. The result is not just localized breakdowns, but a systemic fragility in global health security.

Conflict as a cost multiplier in health delivery

Healthcare systems are tightly linked to global supply chains, making them highly vulnerable to geopolitical disruptions. When conflicts interrupt trade routes, restrict exports, or trigger sanctions, costs rise almost immediately, across pharmaceuticals, medical devices, and even basic supplies.

Energy shocks add further pressure. Hospitals, being energy-intensive, face higher operating costs as fuel and electricity prices climb. In conflict zones, even critical functions like vaccine cold chains and intensive care become difficult to sustain. The result is a steady increase in healthcare costs, one that is unevenly felt. While high-income countries may cushion the impact through insurance and subsidies, LMICs face a harsher reality, where rising out-of-pocket expenses can push millions into poverty.

At the same time, conflicts are driving up demand for care. Displacement, malnutrition, and infectious disease outbreaks are becoming more frequent, often compounded by climate-related crises. This creates a vicious cycle. Underfunded systems struggle to respond, outcomes worsen, and long-term costs escalate as preventable issues turn into full-blown crises.

Health communicators bridging gaps in a fragmented world

In times of systemic stress, communication becomes a strategic imperative. Health communicators are no longer just interpreters of science. They are interpreters of risk, resilience, and national preparedness. Their role is to translate complex realities into actionable understanding, to advocate for evidence-based decision-making, and to maintain trust in institutions. In today’s environment, narrative gaps are becoming policy gaps. When health is absent from security conversations, it is often absent from security budgets.

In the current context, communicators must:

• Elevate the narrative around health as a security priority, not a secondary concern.
• Highlight the human impact of budget cuts, moving beyond statistics to real stories.
• Counter misinformation proactively, especially in conflict-affected and resource-constrained settings.
• Support policy advocacy, ensuring that health remains central in national and global agendas.

Equally important is the need for communicators to adopt a more systems-oriented approach. This means connecting the dots between geopolitical decisions and health outcomes, helping stakeholders understand that these are deeply interconnected challenges. Investing in health is not just a moral imperative; it is an economic and strategic one. Strong health systems contribute to productivity, stability, and resilience. They are foundational to national security in the broadest sense.

Governments, multilateral organizations, private sector players, and civil society must come together to reassert the importance of health in the global agenda. Innovative financing mechanisms, public-private partnerships, and more efficient use of resources can help bridge funding gaps. But without political will, these solutions will remain insufficient.

If current trajectories persist, the consequences will extend far beyond strained health systems, they will reshape how societies absorb risk, respond to crises, and sustain economic stability. Healthcare cannot remain the residual line item in a world that is becoming more volatile, more interconnected, and more vulnerable. Narratives shape priorities, and priorities shape funding. If health continues to be framed as a cost rather than a cornerstone of resilience, it will keep losing ground to more immediate, visible threats. That framing must change urgently and decisively. Over the next decade, the countries that succeed in protecting population health will not necessarily be those spending the most on healthcare, but those most effectively integrating health into national security thinking. The real question before policymakers and global leaders is whether nations can remain economically stable, politically resilient, or socially secure while treating health as a

The post The Hidden Cost of Global Conflict: Why Health Security Is the First Casualty appeared first on Medika Life.

The Strait also ships vaccines.

Save the Children has a consignment of urgently needed medicines stuck at a supplier’s warehouse in India. The road route is closed due to conflict. The usual fallback — air freight — has just doubled in price due to jet fuel prices. The charity’s chief executive, Janti Soeripto, put the situation to NPR earlier this month: “The transport for the drugs is more expensive than the drugs themselves.” That sentence is the story this piece is about. Not the Strait, not the oil, not even the war. The slow, awkward arithmetic by which a maritime closure thousands of miles away ends up determining whether a child in Kandahar gets a vial of antibiotics.

What the Strait actually carries

Commercial activity through Hormuz remains around 90 per cent below pre-war levels, according to analysis from the Council on Foreign Relations. Pre-conflict, around 3,000 vessels transited the strait each month; the latest House of Commons Library figures put current traffic at roughly five per cent of that. The strait is partially open, partially closed, and oscillating depending on the state of the Lebanon ceasefire and which side has most recently accused the other of violating it.

The pharmaceutical reading of those numbers takes a different shape. The Gulf Cooperation Council region serves as a transit hub linking Africa, Asia, Europe, India and the United States, and its pharmaceutical industry, valued at $23.7 billion, relies on imports through Gulf airspace and the strait for around 80 per cent of its product. Most of what matters most moves by air, not by container ship. Wouter Dewulf, professor at the University of Antwerp and a specialist in pharmaceutical logistics, told Al Jazeera last week that 35 per cent of pharmaceuticals move by air, and around 90 per cent of life-saving pharmaceuticals and vaccines do. He estimates that 22 per cent of global air cargo flows are exposed to disruptions in the Middle East.

Why a closed sea lane raises the cost of a mosquito net

The mechanism is rarely intuitive. India, which produces almost half of US generic prescriptions, depends on the strait for around 40 per cent of its crude oil imports — and that crude is the upstream feedstock for the petrochemicals used in active pharmaceutical ingredient manufacturing. With oil trading above $100 a barrel, the cost of producing the ingredient rises before a single tablet has been pressed. Indian air cargo rates have climbed 200 to 350 per cent on some routes, according to industry analysis, and war-risk insurance premiums for vessels transiting Hormuz have, by some measures, surged more than 1,000 per cent since late February.

The exposure is not abstract. The US Pharmacopeia has flagged that 48 per cent of US amoxicillin oral suspension is produced in Jordan, alongside a quarter of doxycycline hyclate capsules — common antibiotics, sourced from inside the conflict’s regional footprint.

It travels further than that. Jean Kaseya, director-general of Africa CDC, told reporters earlier this month that fuel shortages are pushing up the cost of producing mosquito nets, which are made from polyester, which is made from petrochemicals, which depend on a sea lane currently being charged at over a million dollars a transit when it is open at all. Malaria control is now, by an unobvious chain of reasoning, also a Hormuz story.

And the medicines that can’t wait

Of all the downstream consequences, the cold chain is the most exposed. Vaccines, insulin, biologics, and cancer therapies must be maintained within a narrow temperature range, typically between 2 and 8 degrees Celsius. Most of those products move by air, not sea, and most of the world’s high-volume air corridors run through Gulf hubs that have been variously closed, struck or rerouted around. Prashant Yadav, senior fellow for global health at the Council on Foreign Relations and one of the leading specialists in the field, has pointed to the timing problem with characteristic clarity: cargo carriers need roughly a week and a half to recover for every week of suspended shipments.

The arithmetic compounds.

It is partly a structural constraint. Yadav has also noted that European airlines and the two African carriers that have stepped in are unlikely to add new cargo capacity, as the disruption might continue for a few more months. Capacity is not bought overnight, and the current ceiling is, more or less, the medium-term one.

The countries most exposed are those already short of a buffer. The European Union has a stockpiling mechanism. The UK has flagged the risk of medicine shortages within weeks, but holds some reserve. The United States ordered a six-month stockpile of essential medicines last year. Sub-Saharan Africa, by contrast, imports around 70 per cent of its pharmaceuticals and runs far closer to the wire — arriving at this moment as aid budgets across major European donors are repackaged as investment rather than grants. Routine immunisation in much of the region relies on Gavi-procured stock that travels through the same air corridors, and the cold chain in those settings was already fragile before any of this began. How long current buffers hold is a function of variables nobody is in a position to forecast confidently. Bob Kitchen, vice-president of emergencies and humanitarian action at the International Rescue Committee, who is based in Nairobi, told NPR that he had not seen a comparable convergence in his career — pandemic, Ukraine and the current crisis included. A UN-managed depot in East Africa is currently holding stocks bound for Sudan, Ethiopia and other acute crises that cannot be released.

Save the Children’s drugs are still in India. As of late April, the strait remains effectively closed despite a conditional ceasefire, with Iran and the United States locked in a dual blockade as Pakistan-mediated talks continue. France and the UK have signalled that they will lead an international defensive mission once a sustainable ceasefire holds. None of that gets a vial to Kandahar this week.

What is the longer-term lesson? Supply chain analysts have been writing it for years, and now have a vivid case in front of them. A global medicine system optimised for cost works only as long as nothing goes wrong in three or four key chokepoints. Hormuz is one. The Suez and the Bab al-Mandeb are others. The Panama Canal is a fourth. The system functions until it doesn’t, and the people who feel the failure first are rarely the people the system was designed for.

Soeripto’s sentence is worth reading again. The transport for the drugs is more expensive than the drugs themselves. It is not, on its face, a sentence about war or oil or even shipping. It is a sentence about who, in a system held together by chokepoints, ultimately pays the bill. The strait will reopen. The arithmetic — and the question of who absorbs it — will not.

The post The Strait That Ships the World’s Vaccines appeared first on Medika Life.

From court decisions, recent analysis challenging vaccine skepticism polling results, and congressional testimony, the past month reflects a vindication of the value of immunization, scientific advancement and plain old common sense over ideology-based medical beliefs untethered from clinical evidence.

It would be nice to think that cooler heads have prevailed and we are seeing a return to science-backed decisions guiding American vaccine policy. But the reality is that a resurgent defense of immunization practices may be driven by two bigger forces: measles and midterms.

As I wrote five years ago, disease can be a powerful change agent. Thanks to the ultra-high effectiveness of the measles vaccine to prevent measles outbreaks, an entire generation of kids, parents and healthcare providers had never seen the disease or knew what kind of devastation it could bring. With measles out of sight and out of mind, it was easy for a small band of vocal critics to cast doubt on the value of the measles vaccine. Instead of building on a culture of collective action against disease, we allowed that small band of critics to grow into a chorus of public health freeloaders.

Measles had other ideas. With our weakening herd immunity – a result of declining vaccination rates – it didn’t take much for the virus to quickly reintroduce itself. Since the start of the year, there have been more than 1,700 cases of infection across 19 outbreaks throughout the country. We haven’t seen case numbers this high in 35 years. And if the deaths of American children from measles aren’t tragic enough, we are now on the verge of losing our status of officially eliminating measles. As a preeminent leader in immunology science, it is a startling embarrassment for the U.S. to accept this public health defeat.

Americans of all political stripes now seem to be paying attention. Following a decade of significant decline in vaccination, particularly among Republicans, there now is a push to back away from hardline anti-vaccine rhetoric ahead of the midterm elections. It’s easy to see why: at a time when measles outbreaks are a highly visible example of failed policy by the incumbent ruling party, politicians are not willing to risk being associated with practices that are out of step with the direction in which most U.S. voters want to go.

It’s telling that 66% of MAGA voters support vaccination as a requirement for kids to attend school. The measles outbreak has done a lot to educate people on the value of vaccines, which may be one reason why last week’s congressional testimony by RFK Jr., in which he was forced to admit that the measles vaccine is both safe and effective, and the timely appointment of Dr. Erica Schwartz, a physician and vaccine supporter, to lead the CDC may reflect the political liability posed by alternative vaccine doctrine in the months leading up to the midterm elections.

With growing distrust in federal vaccine messaging, there is a vacuum of credible sources for Americans to turn to for vaccine guidance. That void may actually be an opportunity in disguise for vaccine communicators.

Health care providers, including pharmacists, are still the most trusted source for reliable vaccine information: 4 out of 5 Americans look to these professionals to provide the right mix of personalized, empathetic communication with credible safety and efficacy information. Their stories can carry the power of connection, compassion and candor that we need right now.

Vaccination may seem like a black and white decision for a lot of us, but health care providers know that many parents need help navigating the gray areas. How we tell those stories – and who tells them – is essential to strengthening the national conversation around immunization.

Working more closely together, vaccine makers, innovators in antibody science, medical institutions and non-profit advocacy groups can create more compelling, unified communications that reach people when they are closest to making immunization decisions. This can be done by leveraging the voices of medical professionals to convey the emotional value of protecting our children against preventable disease instead of defaulting to statistics-heavy, complex messaging; pulling those stories through in coordinated media and policymaker engagement; and linking back to credible research sources that feature more prominently in online searches.

If the current measles epidemic in the U.S. is a crisis of our own making, it’s our responsibility to leverage the harsh health and economic lessons from this experience. We must act, not for the political convenience of the midterm elections, but to create better, more durable immunization policies and communications that again can unite Americans against our common disease enemies.

The post Of Measles and Midterms appeared first on Medika Life.

Suicide remains one of the leading causes of death in the United States, with young people particularly affected. These are not abstract figures. Each life lost represents a story interrupted, a family altered, and a community left to navigate grief and unanswered questions. Public health requires that we confront this reality not only with data, but with a commitment to building systems that respond to human experience in real time.

From Fragmentation to Continuity Across the Lifespan

For many years, suicide prevention in the United States has been shaped by dedicated organizations working across research, advocacy, education, and crisis response. The American Foundation for Suicide Prevention has played a central role in advancing scientific understanding, funding critical research, and advocating for national policy changes that recognize suicide as a preventable public health issue. Its work has helped elevate awareness, influence legislation, and bring suicide prevention into mainstream health conversations.

The Jed Foundation has taken a complementary path, focusing on upstream prevention by strengthening emotional health among adolescents and young adults. Through partnerships with high schools, colleges, and universities, JED has worked to embed mental health support within the environments where young people live and learn. Its programs have helped institutions move beyond reactive approaches toward more proactive models that build resilience, identify risk earlier, and foster a sense of belonging.

Each organization has demonstrated meaningful impact over time. Each has contributed to saving lives and shaping how mental health is understood. Their efforts, however, have largely operated within distinct domains. One has advanced national research and advocacy. The other has transformed youth and campus mental health systems. Both have addressed critical points along the continuum of care, yet the broader system has remained fragmented.

The decision to merge as equals reflects a recognition that suicide prevention cannot be addressed in silos. Public health challenges of this magnitude require continuity across the lifespan. Early emotional support, community-based intervention, crisis response, and long-term recovery must function as part of an integrated system rather than a series of disconnected efforts.

Connection, Not Scale Alone, Defines Public Health Impact

Public health is often described through infrastructure and policy. Those elements are essential, yet they are insufficient on their own. Public health is ultimately about connection. It connects evidence to action, systems to individuals, and care to lived experience.

Suicide prevention sits at the intersection of these connections. Risk is influenced by social conditions, access to care, stigma, and the environments in which people interact. Protective factors such as trusted relationships, purpose, and community support can alter outcomes when they are present and accessible. The challenge has not been a lack of understanding. The challenge has been delivering that understanding in ways that are coordinated, equitable, and sustained.

A unified organization has the potential to bridge long-standing gaps. It can align research with real-world application, ensuring that scientific insights inform programs that reach people earlier. It can connect youth-focused interventions with broader public awareness efforts, creating continuity rather than gaps as individuals move through different life stages. It can also strengthen advocacy by bringing together complementary perspectives into a more cohesive national voice.

Scale introduces both opportunity and responsibility. A larger organization can mobilize resources, influence policy, and expand reach. Public trust, however, is built in local and personal interactions. The effectiveness of this merger will depend on its ability to maintain proximity to individuals and communities while expanding its national impact. Size alone does not create connection. Intentional design does.

The combined organization is expected to operate with substantial resources, which creates an opportunity to accelerate progress. Resources must translate into accessible programs, stronger partnerships with schools and health systems, and tools that enable families, educators, and clinicians to act with confidence. Public health systems succeed when they reduce friction for those seeking help and make support visible before a crisis emerges.

This moment also offers a broader lesson for the health sector. Fragmentation is not unique to suicide prevention. Across chronic disease, health equity, and digital health, organizations often operate with shared purpose but limited alignment. The willingness of these two organizations to merge reflects an understanding that structural change may be necessary to achieve meaningful outcomes.

The integration process will require thoughtful leadership and a clear sense of purpose. Combining cultures, programs, and strategies requires discipline and humility. Success will not be measured by organizational scale or visibility. It will be measured by whether fewer individuals reach a point of crisis without support and whether more people experience a system that feels connected, responsive, and human.

Suicide is often described as preventable, which places responsibility on the systems designed to address it. Prevention requires more than awareness. It requires intentional coordination, early recognition, and sustained engagement across the continuum of care.

This merger does not resolve the complexity of suicide prevention. No single organization can. It does represent a meaningful step toward greater alignment in how society responds to one of its most pressing public health challenges. Connection is not an abstract ideal in public health. It is the foundation upon which progress depends.

For more information about both organizations, visit these organizations’ websites at afsp.org and jedfoundation.org. 

The post Suicide Prevention Is a Public Health Imperative, Not a Patchwork Effort appeared first on Medika Life.

Early in the book, Nosta writes, “The solved can never touch the whole.”  That line lingers. It captures the essence of his argument. AI can solve, generate, synthesize, and accelerate. Yet something about the human experience of thinking, the struggle, the friction, the meaning-making, exists beyond resolution.

This tension defines the book. It is not anti-technology. Nosta is deeply engaged with AI and candid about its value. He describes large language models as tools that “move faster and connect more disparate concepts than our minds could ever manage on their own.”  He is equally clear that this capability introduces a subtle risk. We may begin to outsource not just tasks, but thought itself.

That distinction matters more than many may be willing to admit.

From Tools to Thought

One of the most compelling contributions of The Borrowed Mind is its framing of AI not as the next step in computing, but as a turning point in cognition. Nosta traces a clear arc. Gutenberg unlocked words. Google unlocked facts. AI, he argues, is unlocking thought. 

That progression is elegant, yet also unsettling. Words and facts could be externalized without fundamentally altering the structure of human reasoning. Thought is different. It is intimate. It is identity. It is how we become.

Nosta reminds us that thinking once required effort, a type of natural friction that created sparks of innovation. “The distance between question and answer created space for our discernment.”  Within that space, judgment formed, curiosity deepened, and understanding took root.

AI compresses that distance. It removes friction. It delivers coherence with remarkable speed.  One of the book’s most important insights emerges here. Coherence is not the same as understanding.

Nosta introduces the concept of “anti-intelligence,” describing it as “fluency without understanding. Coherence without experience.”  AI does not think. It mirrors the structure of thinking. It produces language that resembles reasoning without sharing its origin.

In health, where evidence, interpretation, and judgment must coexist, this distinction is not academic. It is operational. It shapes how clinicians trust tools, how leaders deploy them, and how patients ultimately experience care.

The Seduction of the Socratic Mirror

One of the most original sections of the book is Nosta’s description of the “Socratic Mirror.” He draws a parallel between classical dialogue and modern AI interaction. Socrates asked questions to surface the truth. AI, in a different way, reflects our thinking back to us, reframed, extended and sometimes clarified.

Nosta writes that the model “…does not tell me what to think but creates the conditions under which my own thinking could deepen.” This is where the book moves beyond critique and into possibility.

Used well, AI becomes a cognitive partner. It expands perspective, accelerates exploration, and invites iteration. In clinical research, patient engagement, and system design, this capacity holds enormous promise.

Nosta does not romanticize the relationship. He recognizes its asymmetry. The model has no interior life. It does not ponder. It does not carry consequence. It does not bear responsibility. That responsibility remains human.

Rethinking the Fear of Displacement

A persistent anxiety runs beneath every conversation about AI. Many fear it will become a job slayer, a force that displaces rather than elevates human contribution. That concern is understandable, yet not new.

Every meaningful advance in technology has reshaped how people work. The wheel did not eliminate labor. It redefined movement. The stethoscope did not replace physicians. It extended their ability to listen and interpret. The tollbooth transponder did not end transportation roles. It changed the flow and focus of human involvement. Each innovation shifted roles, demanded new skills, and expanded what people could do.  AI belongs in that lineage.

What distinguishes this moment is not the elimination of work, but the redistribution of cognitive effort. The real risk is not that machines will think for us, but that people may become less inclined to think for themselves. Nosta’s warning is subtle yet profound. Surrendering curiosity, judgment, and reflection to systems that generate answers with ease risks dulling the very faculties that define human intelligence.

This is why The Borrowed Mind is such an important read at this moment. It does not dismiss concerns around job displacement. It reframes it. The central challenge is not protecting roles as they exist today, but strengthening the uniquely human capacities no system can replicate. Creativity, discernment, ethical reasoning, and the ability to navigate ambiguity are not diminished by AI. They become more essential.

The book offers reassurance without complacency. The future of work will favor those who sharpen their thinking, engage deeply with ideas, and remain active participants in their own intellectual development. The machine is not the adversary. Neglecting the development of one’s own mind is a danger.

Composite Intelligence and the Limits of the Machine

Nosta introduces “composite intelligence” to describe the interaction between human and machine cognition. Composite does not mean blended into sameness. It means distinct contributions working in concert. The model brings speed and breadth. The human brings depth.

This triad becomes one of the most useful frameworks in this book. AI excels in velocity and scale. Depth, the slow transformation of understanding, remains human. As Nosta writes, “Models do not ponder.” 

In health, this distinction is profound. Data can inform. Algorithms can suggest. The act of deciding, especially in moments of uncertainty, requires something more. It requires what Nosta elevates as the defining human contribution. Virtue.

Drawing on Aristotle’s concept of practical wisdom, Nosta reminds us that judgment is forged through experience, consequence, and accountability. A model can generate options. It cannot live with outcomes.

This is where the book resonates most deeply for those working in health. Intelligence is becoming abundant. Discernment is becoming scarce and, therefore, more valuable.

The Risk of the Borrowed Mind

The book’s title is not metaphorical. It is a warning. Nosta argues that as engagement with AI deepens, internal dialogue begins to change. The model becomes a cognitive tuning fork, subtly shaping how questions are framed, how ideas are explored, and how answers are anticipated. This dynamic is not inherently negative. It can elevate thinking, accelerate learning, and make complex domains more accessible. Dependency remains the concern.

Reliance on generated thought risks weakening the muscle of original thinking. Access can be mistaken for understanding. Individuals may become, in Nosta’s words, “cognitive clones.” 

This concern is particularly relevant in health ecosystems already strained by time, complexity, and administrative burden. The temptation to offload cognitive work will be strong. The discipline to remain intellectually engaged will be essential.

A Book About AI That Is Not About AI

What makes The Borrowed Mind stand apart is that it is not ultimately about technology. It is about humanity. Nosta writes, “This book is not really about technology. It is about you.”  That idea anchors this work.

Readers are challenged to consider what it means to remain “the authors of our own minds.”  Not passive recipients of generated insight, but active participants in meaning-making.

This question sits at the center of the health ecosystem’s future. As AI becomes embedded in clinical workflows, research, and patient engagement, the issue is not whether it will improve efficiency. It will.

The deeper question is whether it will deepen humanity or dilute it. Will it create space for clinicians to think more deeply, connect more meaningfully, and act more wisely? Or will it create a system that values speed over reflection, output over understanding, and coherence over truth?

Nosta offers no simple answers. He offers a framework for asking better questions.

The post “The Borrowed Mind” – Reclaiming Thought in an Age That Wants to Do It For Us appeared first on Medika Life.

This story also ran on NBC News. See below.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.

“This legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill into law on March 31.

“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he said.

Delegate Laura Kimble, the Republican from Harrison County who introduced the legislation, told KFF Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

From Arizona to Rhode Island, at least half of all state legislatures have taken up bills this year related to prior authorization, a process that requires patients or their medical team to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country await relief from prior authorization hurdles, as promised by dozens of major health insurers in a pledge announced by the Trump administration last year.

The West Virginia law was inspired by Eric Tennant, a coal-mining safety instructor from Bridgeport who died on Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly denied him coverage of a $50,000 noninvasive cancer treatment, called histotripsy, that would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. His family didn’t expect the procedure to eradicate the cancer, but they hoped it would buy him more time and improve his quality of life. The insurer said the procedure wasn’t medically necessary and that it was considered “experimental and investigational.”

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After Series of Denials, His Insurer Approved Doctor-Recommended Cancer Care. It Was Too Late.

Eric Tennant’s doctors recommended histotripsy, which would target, and potentially destroy, a cancerous tumor in his liver. But by the time his insurer approved the treatment, Tennant was no longer considered a good candidate. He died in September. Read More

Becky Tennant, Eric’s widow, told members of a West Virginia House committee in late February that she submitted medical records, expert opinions, and data as part of several attempts to appeal the denial. She also reached out to “almost every one of our state representatives,” asking for help.

Nothing worked, she told lawmakers, until KFF Health News and NBC News got involved and posed questions to the Public Employees Insurance Agency about Eric’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

“But by then, the delay had already done its damage,” she said.

Within one week of the reversal in late May, Eric Tennant was hospitalized. His health continued to decline, and by midsummer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision did not simply delay care. It closed doors,” his wife said.

Had the new law been in effect, Kimble said, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill was passed unanimously by the state legislature in March.

U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, the health insurance industry trade group, says prior authorization acts as an important guardrail in preventing potential harm to patients and reducing unnecessary health care costs. But denials and delays tend to affect patients who need expensive, time-sensitive care, studies have shown.

The practice has come under intense scrutiny in recent years, particularly after the fatal shooting of a health insurance executive in New York City in late 2024. Americans rank prior authorization as their biggest burden when it comes to getting health care, according to a poll published in February by KFF, a health information nonprofit that includes KFF Health News.

Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law’s financial impact on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp said.

In a fiscal note attached to the bill, Jason Haught, the Public Employees Insurance Agency’s chief financial officer, said the law would cost the agency an estimated $13 million annually and “cause member disruption.”

West Virginia isn’t an outlier in targeting prior authorization. By late 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had some form of a prior authorization law — or laws — on the books, according to a report published in December by the National Association of Insurance Commissioners.

Many states have set up “gold carding” programs, which allow physicians with a track record of approvals to bypass prior authorization requirements. Some states establish a maximum number of days insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retrospective denials after a service has already been preauthorized. There are also a crop of new state laws seeking to regulate the use of artificial intelligence in prior authorization decision-making.

Meanwhile, prior authorization bills introduced this year across the country, including in Kentucky, Missouri, and New Jersey, have been supported by politicians from both parties.

“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. “They realize that they’re not really going to get much action at the federal level given the degree of gridlock we’ve already seen.”

Last summer, the Trump administration announced a pledge signed by dozens of health insurers vowing to reform prior authorization. The insurers promised to reduce the scope of claims that require preapproval, decrease wait times, and communicate with patients in clear language when denying a request.

Consumers, patient advocates, and medical providers have expressed skepticism that companies will follow through on their promises.

Becky Tennant is skeptical, too. That’s why she advocated for the West Virginia bill.

“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she told lawmakers. Tennant, who sees the bill’s passage as bittersweet, said she thought her husband would have been proud.

During Eric’s final hospital stay, Tennant recalled, right before he was discharged to home hospice care, she asked him whether he wanted her to keep fighting to change the state agency’s prior authorization process.

“‘Well, you need to at least try to change it,’” she recalled her husband saying. “‘Because it’s not fair.’”

“I told him I would keep trying,” she said, “at least for a while. And so I am keeping that promise to him.”

—–

NBC News health and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

The post After Man’s Death Following Insurance Denials, West Virginia Tackles Prior Authorization appeared first on Medika Life.

In fact, there is a lot. Some of it requires help from your physician, but most depends on your lifestyle, preferably begun in midlife or even sooner. But it is never too late to start. Even with early evidence of developing dementia, making changes can be of tremendous help.

Details below, but the most important steps are regular exercise — resistance and aerobic, a high protein, high fruit, and vegetable, but low sugar diet, good sleep, reduced stress, no tobacco, limited alcohol, intellectual challenges, and social engagement, along with attention to high blood pressure, high cholesterol, and high blood sugar or diabetes.

The causes of dementia

It is best to think in terms of risk factors rather than direct causes. There are multiple types of dementia, but the most common is Alzheimer’s disease. It has many possible risk factors, often in combination, in any individual. Among the most important are high blood pressure, type 2 diabetes, elevated LDL cholesterol, obesity, high intake of ultraprocessed foods, being sedentary, not dealing with chronic stress, inadequate deep sleep, smoking, an unchallenged brain, and lack of social engagement.

Untreated high blood pressure damages the blood vessels supplying the brain, as does poorly controlled type 2 diabetes. Diabetes correlates with a 10 to 15 times greater risk of Alzheimer’s. Like the rest of the body, brain cells can become insulin-resistant, depriving them of their primary fuel—glucose —hence the term “type 3 diabetes.” Add to this elevated LDL cholesterol, which leads to plaque deposition in the large blood vessels, analogous to that seen in the heart’s coronary arteries.

Obesity is a definite risk factor, especially as it predisposes to diabetes, but also produces chemicals that cross the blood-brain barrier and cause inflammation. The combination of blood vessel damage and inflammation is clearly associated with the development of Alzheimer’s disease.

Being sedentary, along with eating excess ultraprocessed, sugary, fatty, and salty foods and smoking, are known to correlate with dementia, as does persistent lack of restorative sleep and continuing low-level chronic stress. Maintaining good muscle mass through appropriate exercise not only supports muscle and bone density but also releases chemicals that positively impact brain function. Substantial exercise literally enlarges the brain’s hippocampus and prefrontal cortex, both critical to cognition.

Among the presumably less important risk factors for dementia are some chronic infections, often undetected, such as chronic Lyme disease, which can cause persistent low-level brain inflammation. So too can a variety of neurotropic viruses, such as the varicella-zoster virus that causes chickenpox and shingles. The varicella-zoster virus (VZV) remains dormant in the nervous system after chickenpox infection but is reactivated in older age as herpes zoster (shingles). It is believed that this virus causes long-term chronic inflammation in the brain while dormant, and then amplifies inflammation when reactivated as shingles.

There are other causes of inflammation. An unbalanced colonic microbiome is common. There is a gut-brain axis, meaning the two systems send messages back and forth, which can be altered by the microbiome. This axis can help or hinder normal inflammation maintenance in the brain.

The gut bacteria convert high-fiber diets into short-chain fatty acids (SCFAs), which, in mice, lead to reduced microglial (the brain’s immune cells) activity and a lower degree of brain inflammation. Aging mice normally have reduced SCFAs, but a high-fiber diet increases SCFAs and reduces inflammation in their brains. The key message is that a healthy colonic microbiome can help to prevent the development of Alzheimer’s disease.

The mouth has its own microbiome. Chronic oral gum infections, known as periodontal disease, often go unrecognized, disrupting the oral microbiome and inducing a chronic state of inflammation that produces a steady flow of damaging chemicals that affect the brain. The bacterium Porphyromonas gingivalis is a frequent cause of periodontal infection, but it can also directly affect the brain. It produces a toxic enzyme called gingipain, which crosses the blood–brain barrier and directly damages neurons. P gingivalis has also been found in the brains of deceased Alzheimer’s patients.

Even the eye microbiome has been shown in a January 2026 article in Nature Communications to have an adverse impact on the brain if it includes Chlamydia pneumoniae, a common cause of pneumonia and sinus infections that, in some people, infects the retina and, from there, travels to the brain, amplifying inflammation.

Several environmental toxins have been implicated in Alzheimer’s development. Lead is a known neurotoxin. Once in the body, it can persist in bones. We tend to think of it in old lead paint, but it is common in many city water supplies (remember Flint, Michigan) and was common in leaded gasoline until about 1980. Leaded gasoline suggests that many older people may have elevated bone lead levels.

Lead is also occasionally found in food and air. In a prospective study reported in February 2026, bone lead levels correlated with the onset of Alzheimer’s disease and all-cause dementia in a representative sample of Americans followed for 30 years in the National Health and Nutrition Examination Survey (NHANES _III). The authors speculate that up to 18% of dementia cases could be avoided with reduced lead exposure.

Various other metals (e.g., arsenic, zinc, mercury, and cadmium) and biotoxins (produced by molds, especially Aspergillus, bacteria, and viruses) are believed to be correlated with the onset and progression of dementia through the production of cytokines (compounds produced and released from cells) that cause neuroinflammation and neurodegeneration.

Microplastics (particles less than 5 mm in diameter) have been implicated as a potential cause or predisposing factor to Alzheimer’s disease, although the data are limited. It is known that they can cross the blood-brain barrier and, in animal models, elicit neuroinflammation and neurodegeneration. Microplastics can be found in the brains of many people at autopsy. Still, the quantity in the brains of those with dementia tends to be many times higher, suggesting both a cause and a dose-response relationship. Microplastics are found in air, food, and water. It is not known which microplastics are potentially important, nor which route might be most important — inhalation, skin absorption, or ingestion. Finally, be aware that these are correlation studies, not causal studies.

Hearing loss not only causes social isolation but also directly leads to brain atrophy and “cognitive overload,” meaning the brain cannot process inputs as effectively and has fewer resources left for memory and thinking. The combination leads to an increased risk of dementia. Visual loss, common with age-related cataracts, as well as macular degeneration, glaucoma, and diabetic retinopathy, has the same impact as hearing loss.

Bear in mind that all of these are correlation studies. Correlation does not equal causation, but when they are found in study after study, they are likely actual risk factors.

Note also that many of these risk factors create or amplify chronic low-level inflammation. It is the inflammation that is doing much of the damage. Inflammation means that your immune system, the system that normally protects you from disease-causing agents like bacteria, is constantly turned on at a low level, damaging your brain without you knowing it until years later, cognitive decline becomes obvious.

What you can do to avoid dementia

It is not unlike what I described for slowing normal cognitive aging, but with more intensity and a broader range of inputs.

Let’s start with the medical side of it

Most physicians do not look or know to look for many of these predisposing conditions, but since you do, ask to have them checked for you. They will most likely check your blood pressure, cholesterol, and blood sugar, for different reasons.

High blood pressure is a clear predisposing factor. Unfortunately, nearly 50% of Americans have hypertension >130/80), with the prevalence increasing to about 70% of adults over age 60, but many are unaware, and even less, perhaps 20–25%, are adequately treated. Be sure you are being treated appropriately.

Type 2 Diabetes is a profound predisposing factor to Alzheimer’s disease. What both high blood pressure and diabetes have in common is that they cause inflammation in the brain, blood vessels, and neurons. Over time, they also lead to reduced blood flow to the brain. Over ten percent of Americans have diabetes, with the prevalence rising with age. Only about 50% are adequately treated and controlled. Here, again, be sure you know if you have diabetes and follow your doctor’s advice on management.

High LDL cholesterol (the “bad” type), especially when combined with hypertension and diabetes, can lead to plaques in the blood vessels supplying the brain, similar to those in the coronary arteries. Just one more adverse cause of reduced blood flow to the brain. Only slightly more than 20% have adequate management of all three key factors. So be sure to have your physician review your blood pressure, blood sugar, and cholesterol status, and follow their advice, remembering that lifestyle changes might be adequate (see below), but, if not, there are effective medications.

Obesity is a significant predisposing factor. If you are obese and have had difficulty with weight reduction, you and your physician might want to consider GLPs like Wegovy or Zepbound.

Ask to be checked for lingering chronic infections, such as Lyme disease. Visit your dentist and dental hygienist every six months for a prophylaxis. You will not only be preserving your oral health but also reducing your risk of dementia. You should be tested for lead and other heavy metals.

Consider the shingles vaccine if you are 50 or older. Multiple studies have shown that it reduces dementia by about 20% for at least seven years after vaccination. Less clear is how long the effect lasts after that or whether a booster is necessary. Certainly, it is an easy way to get a dual benefit — less likelihood of dementia while also reducing the occurrence of shingles and possibly even heart disease.

If you are over 65, you have likely gotten regular influenza vaccines. Recent data published in April 2026 show that the standard vaccine has some protective effect, and the higher-dose vaccine has an even greater effect, at least for the 2–3 years of follow-up in the studies.

If you have significant hearing loss, work with an audiologist to determine the best approach for you. Fortunately, there are now devices that can assist at a reasonable price. If you have significant vision loss due to cataracts, the evidence is strong that correction will significantly reduce your risk.

Early life

Those who start adulthood with the “strongest” brains have “more room” for loss, suggesting that it is advisable to encourage your children and grandchildren to be as well educated as possible.

Lifestyle modifications

Your doctor can be a major source of assistance in limiting your chance of dementia, but of even greater importance is what you can do for yourself with lifestyle modifications, especially exercise and diet.

Maintaining your physical health is one of the most important things you can do to avoid dementia. If you smoke, get help to stop; it’s critical. Then, start with exercise. The science is clear: those who move are at much reduced risk of dementia. Aerobic exercise, like walking, cycling, or swimming, helps your heart and lungs deliver more blood to the brain. When doing aerobic exercises, push to the point where you are breathing somewhat heavier than normal and, although you can respond to a question, you are too busy breathing to engage in a conversation.

When a group of 120 young adults aged 28 -56 was randomized to a steady moderate to vigorous exercise regimen for 12 months or not, those who exercised had brains that appeared “younger” after one year. In contrast, the control group showed no significant change between MRIs taken at the beginning and end of the year. VO2 max increased substantially over the 12 months in the exercise group but not in the control group.

And those who regularly engage in resistance exercises are at an even lower risk. In fact, resistance exercises may be the single most important thing you can do to prevent dementia. Choose a variety of exercises that maintain and strengthen your upper, core, and lower body muscles. Plan to use a resistance weight you can fully move, like a biceps curl, for only 8–12 repetitions. Remember that these exercises release chemicals called myokines or exerkines that stimulate the brain, heart, and blood vessels. They can stimulate growth of the hippocampus and other parts of the brain, perhaps by releasing brain-derived neurotrophic factor (BDNF). Exercise also stimulates the liver to release exerkines. One of these, called GPLD1, reverses memory loss in aging mice.

Various studies have shown that regular resistance exercise is critical to maintaining brain function and brain volume. Leg power is especially effective in reducing cognitive aging.

In addition to regular aerobic activity and at least twice-weekly resistance training, consider high-intensity interval training (HIIT). Dr. Harry Oken and I discuss this in detail in our book BOOM — Boost Our Own Metabolism. In brief, ride an exercise bike at a comfortable resistance and pace for a few minutes to warm up, then increase the resistance and pedal as fast as you can for 30 seconds. Your legs should ache, and you may be sweating. Drop back to a comfortable pace for 90 seconds. Repeat eight times. Studies indicate that this can enlarge your hippocampus, the brain’s processing center, by as much as 50% or more over six months. More neurons are produced, connectivity is enhanced, and cognitive abilities are maintained or improved. HIIT is also the most efficient way to improve your VO2 max.

What you eat, or do not eat, and what you drink are of critical importance. Avoid ultraprocessed foods, excess fast foods, sugar (such as candy, sodas, and ice cream), and foods that are digested directly into sugar (such as white bread and other white-flour products—pastries and donuts). A good “diet” to follow is the Mediterranean diet or its cousin, the MIND diet. The former emphasizes healthy grains, seeds and nuts, legumes like beans, good oils such as olive oil and avocado oil, and cold-water fish (salmon, mackerel, sardines). Eat somewhat less dairy and poultry and relatively little red meat.

As for red meat, processed meats like bacon, jerky, and many deli meats are unhealthy, whereas meat from 100% pasture-raised animals is probably healthy. The MIND diet is based on the Mediterranean diet but emphasizes green leafy vegetables like spinach, kale, and collards, as well as berries over other fruits. When participants in a long-term study at Rush University Medical Center followed these diets, their brains at autopsy showed less evidence of Alzheimer’s compared to those who ate a “less healthy” diet.

If you like coffee or tea, you will be pleased to know that in a long-term study of 131,000 individuals followed for up to forty years, those that drank two to three cups of coffee (but not more) had an 18% reduction in dementia onset compared to those in the lowest intake group. The findings were similar for tea, with a 14% reduction. Presumably, coffee and tea with their many chemicals reduce inflammation, reduce oxidative damage, improve the lining of blood vessels, reduce blood-brain barrier leakage, and enhance neurons’ ability to communicate. Notably, decaf coffee did not have the same effect.

Also consider fasting. Just avoiding eating after dinner and before breakfast is a good start, or pushing breakfast off for a few hours.

Restorative sleep is very important to avoid dementia. Deep sleep is the time when the brain cleanses itself of toxins and other waste materials. It is also when memories are formed and the hippocampus, the brain’s processing center, is “emptied” so it can begin again tomorrow. Don’t listen to people who say they can get by with less than about seven hours of sleep.

Most Americans are living with low-level chronic stress. Stress releases a series of compounds that stoke chronic inflammation in the brain and elsewhere. Ways to reduce stress include exercise, a healthy diet, meditation, Tai Chi, yoga, and avoiding, when possible, those things, people, and situations that lead to your stress.

Your brain needs to be used and challenged. Do creative activities like chess, art, writing, learning a musical instrument, dancing, or learning a foreign language.

Computer-assisted cognitive training. All studies have not been effective, except for a 20-year follow-up clinical trial published in February 2026 by Johns Hopkins involving 2021 adults over age 65. This study evaluated a cognitive training program initiated in 1999 and followed through to dementia onset in 2019. Alzheimer’s was reduced by 25% among those who did computer-based cognitive speed training, with a 6- to 12-month booster. Speed training asked the person to identify a center object (like a car) on the computer screen while locating a peripheral target (like a road sign) on a screen, with the speed increasing as the user improved. The other arms of the trial, looking at memory and reasoning, did not lead to reduced dementia.

“This study shows that simple brain training, done for just weeks, may help people stay mentally healthy for years longer,” said NIH Director Jay Bhattacharya, M.D., Ph.D. “That’s a powerful idea — that practical, affordable tools could help delay dementia and help older adults keep their independence and quality of life.”

Humans need social engagement. Call it “cognitive engagement.” Make and keep friends, meet regularly with others, and get involved in group activities. It’s enjoyable, and it’s critical. The Rush Memory and Aging Project followed about 2000 individuals with an average entry age of 79 for nearly 8 years. In their February 2026 article in Neurology, the authors looked at lifetime cognitive enrichment activities and found those in the highest cohort had a 38% lower risk of developing Alzheimer’s disease. Those with the highest level of lifetime enrichment who did develop AD did so 5 years later than those with the lowest levels. Similarly, their rate of cognitive decline over the course of the study was slower.

Where possible, merge your creative, active, and social activities, such as group Tai Chi, dancing, or walking together. Consider dancing. If you are learning a new step, your brain must follow the music and move your body to the new step; a dual cognitive function and social engagement, with some aerobic exercise.

Remember that there is no one risk factor for dementia, so “bundling” lifestyle changes makes the most sense, a logical concept that is supported by a research study in Finland that showed multiple steps taken together slowed cognitive decline in high-risk seniors. It helps to have help with structured support so that lifestyle changes become consistent rather than relying on willpower alone.

Putting it all together

This may at first glance seem overwhelming. But you can address your risk step by step and have fun doing so. Remember that the 7 Keys to Healthy Aging not only reduce your risk for Alzheimer’s disease but are also very effective in preventing the development of many chronic diseases, such as cardiovascular disease, diabetes, and obesity, so start with these and pick one or two to address first. I would suggest diet and exercise, as they are likely the most important. But before you start anything discussed here, talk with your doctor to see if these suggestions are appropriate for your personal situation. And while there, discuss the items you need their help with — especially elevated blood pressure, blood sugar, LDL cholesterol, and excess weight. No matter your age, it is never too late to start.

Can this really prevent Alzheimer’s?

There are no guarantees. But following these suggestions will have a major impact on your risk of developing Alzheimer’s disease. It will also go a long way to preventing other chronic diseases like heart, lung, kidney disease, or cancer. That’s a very good return on your investment of time and energy.

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I’m always surprised that the LSHTM gives me the privilege of returning to talk about the shifting landscape of funding and how to help assure that it is spent well and to benefit Africa’s future. As I met the Zoom room full of bright, engaged students (many of whom are living the challenges of adequate funding daily in countries such as Uganda, Nigeria, Kenya, and Cameroon) I was struck by how fast the familiar old world of advocacy died, and how urgent it is that we build a new one.

My perspective is shaped by 35 years as a policy and communications consultant working across the continent. I have seen the era of the “Great Man” advocacy, where we simply tried to bend the ear of a US President or a billionaire philanthropist. We look back at those days with rose-tinted glasses: the billionaires and rich-country leaders were fickle and their focus was often on getting recognition or a seat at the top table, not on the real need. Even when they did try to assess the real needs, it was usually through the uninformed eyes of over-priced management consultants whose only knowledge of Africa came from airport VIP lounges. The billionaires were also shockingly bad at effective advocacy for something as obviously cost effective as health spending.

In any case, those days are over. If we want to secure the future of health in Africa, our work to influence policy must evolve to meet a much harsher, more complex fiscal reality.

The Shifting Foundation of Global Health Funding

We have seen a fundamental failure in advocacy around health funding. The data released by the OECD reveals a stark trend: the era of expanding bilateral aid is ending. Total Official Development Assistance (ODA) is contracting, and 96% of that decline is driven by just five donors: Germany, the UK, Japan, France, and most significantly, the USA.

The US alone is responsible for three-quarters of the global decline in health funding. While Germany has technically become the largest provider of ODA for the first time in history, even it is cutting budgets, albeit in an attempt to become more efficient. Meanwhile, traditional multilateral ODA, money flowing to the WHO or the World Food Programme for example, is shrinking less than bilateral grants, but the overall pie is getting smaller.

The good news is that the World Bank and regional development banks such as the African Development Bank (AfDB) are stepping in to fund some health projects. There are questions over “additionality”: are these institutions really funding things that private equity or other lenders to states would not? And there are frequent criticisms that the banks have failed to create funding buckets for innovative models such as low-cost private-sector primary care. However, there are real successes. The AfDB in particular has said loudly and clearly that economic growth depends in large measure on better health and has encouraged governments and funding agencies to invest accordingly.

The Rise of the America First Bilateral Accords

US funding has not disappeared: it has shrunk and mutated into the America First health policy. This administration is moving away from broad global initiatives toward strict bilateral health accords between the US and individual African countries. These are not just funding agreements; they are ideological and strategic contracts that come with significant strings attached.

Under these accords, the US makes a five-year commitment with a clear “exit strategy”: funding is front-loaded but tapers off to zero, forcing national governments to take on “ownership.” While national ownership sounds positive, the requirements are often demanding.

The focus is what you would expect from an administration with an ideological focus derived from Project 2030. It is on maternal and child health (and, yes. The State Department often says that it is the health of children “born and unborn”) and infectious disease.

These accords also require African countries to share pathogen data and specimens with the US within five days of an outbreak. This creates a parallel data mechanism to the WHO and, more importantly, seeks to capture what one of the post-graduate students called, “the new oil.” Africa holds 80% of humanity’s genetic diversity. In an era of genetic medicine, this data is a massive national asset. Several students at LSHTM rightly pointed out that countries like South Africa and Kenya see this as a key resource to be traded for R&D investment, not just given away for a few years of HIV funding. Africa is also developing national health databases that can be used to assess and model the impact of interventions and, as when the continent pioneered payments from mobile phones, it is less encumbered with antiquated existing systems and threatened vested interests.

Most alarmingly to me, these accords are sometimes tied to non-health issues. We’ve seen Zambia refuse to sign because the US tied HIV funding to access to critical minerals and mining data.

One Path Forward: the Accra Reset

The Accra Reset sets out to be a roadmap for this new era. It aims for 55% of health spending to be domestic by 2030, funded in part through “sin taxes” on sugar-sweetened beverages and tobacco. Other means of national funding include surcharges on profitable data transactions and health solidarity funds. Its organisers say that these taxes will raise £750 million in 2026 in six countries alone. I think that’s a high estimate, but there is real money there.

The Accra framework is, though, delusional in thinking that out-of-pocket health can be reduced over the next five years. The AfDB projection is that the private health market in Africa will explode. This is not necessarily bad news for health equity: much of the growth will come in highly efficient fixed-cost private primary care models targeted to working people (although, admittedly, rarely to the bottom of the pyramid or the working poor). These models can be valuable ways to give fast access to innovation and convenient, timely provision of sexual and reproductive health services.

Recommendations for the New Advocate

Given this backdrop, I suggested that these elite advocates do the following.

1. Make Health Explicitly Political

We often hear that health should be non-political. This is a mistake. Non-political subjects are boring and ignored. We need health to be the subject of election campaigns, impassioned debates and social media memes. When health becomes a political must-have, politicians make promises they can be held to. We want people shouting about health in the streets of Accra, Nairobi, and Lagos.

2. Frame Health as a Capital Asset, Not a Cost Centre

We must stop arguing for funding based solely on morality. We need to speak the language of Finance Ministers. According to the World Bank and the AfDB, health is a growth engine.

• ROI Data: For every $1 spent on malaria treatment, the economy gets $35 back. For paediatric immunisation, it’s $20. For SRHR, the returns are less often quantified rigorously but similarly massive because they enable women to enter the workforce and stay productive.
• Preventative Care as Infrastructure: Just as investing in robotics improves productivity, investing in the health of a citizen from birth to age 65 creates a stock of human capital that belongs on a national balance sheet, as the World Bank has now recognised.

3. Build Alliances with FBOs

Faith-Based Organisations (FBOs) provide roughly 30% of healthcare in Africa. The America First plan prioritises them, in part because it plays well to US domestic audiences and, in part, because they are efficient and embedded in communities. While we may disagree with some FBOs on abortion or family planning for unmarried youth, they have incredible national reach. As one student noted, a Pentecostal church in Nigeria aiming for a branch every 15 minutes of walking distance is a more powerful delivery network than any government programme. We must engage them to improve quality and advocate for rights within their frameworks.

4. Harness the Power of Media and Social Media

We can’t forget about media, especially in Africa where so many people are still dependent entirely on TV and local radio and where online and offline newspapers are declining less slowly.

Increasingly, though, we must go where the people are — which is social media. During the lecture, students raised concerns about medical influencers spreading misinformation or misogyny. My response: then we must flood the zone. We need to train responsible influencers. When Joe Fazer, a bodybuilding influencer with about 30 million followers produces content about health equity, he can mobilise a generation we will never reach through traditional policy papers.

Overall, we are in a time of great opportunity and serious danger. The transition from aid to co-investment is the only way to escape the whims of Washington or Berlin. We must be like the “trained revolutionaries” Lenin spoke of — professionals who know how to stir up movements and demand that our governments prioritise health not because a donor asked them to, but because their own citizens demand it.

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