Conflicts compound these inequities. Fragile and conflict-afflicted countries account for just a quarter of the world’s infants, yet they harbour half of all zero-dose children, whose numbers have increased from 3.6 million in 2019 to 5.4 million in 2024. In Sudan, vaccination coverage collapsed — from 85% pre-war to as low as 8% in conflict zones — while Yemen’s zero-dose figures climbed significantly, driven by instability, health service disruptions, and misinformation.

Conversely, Gavi-supported, low-income countries saw marked improvements, reducing un- and under-vaccinated cohorts by around 650,000 in 2024. Yet even high- and upper-middle-income economies are experiencing slippage, with measles coverage hovering at 84% (first dose) and 76% (second), below the 95% threshold needed for herd immunity. Consequently, measles outbreaks surged, with 60 countries reporting significant incidents in 2024, doubling since 2022.

Country case snapshots powerfully illustrate these trends. In Bosnia and Herzegovina, measles vaccination rates are at just 55%, compared to Croatia’s 90%, contributing to over 7,000 cases and two adolescent deaths, prompting WHO and UNICEF to urge intensified immunisation campaigns. In Pakistan, polio resurgence has occurred amid militant threats and disrupted campaigns, with over one million children missing doses in 2024. The government’s response includes large-scale vaccination drives and policy enforcement, such as arrest warrants, signalling both the challenge and political recognition of routine immunisation’s fragility. Meanwhile, Bangladesh has steadily expanded its vaccine schedule — adding Hib, rubella, PCV, IPV and MR2 — achieving DTP3 coverage around 93% and fully vaccinated rates near 84% by 2019.

These illustrations reveal both progress and vulnerability. Countries with strong political will, robust systems, and community trust — like Bangladesh — are managing gains. Others, like Pakistan and Bosnia, highlight how instability, mistrust, and misinformation can swiftly unravel public health gains.

The 2024 immunisation data reiterates an urgent message. Global coverage has stabilised and broadened, but millions of children remain vulnerable in conflict zones and complacent high-income settings. Measles outbreaks, polio flare-ups, diphtheria spikes, and new threats like RSV underscore that the progress we’ve made is neither permanent nor evenly shared. Unless we decisively fill funding gaps, fortify health delivery in emergencies, ensure vaccine equity, and strengthen trust, these vulnerabilities will deepen — and outbreaks will follow.

The post Global childhood vaccination remains resilient, but equity cracks are widening appeared first on Medika Life.

Conflicts compound these inequities. Fragile and conflict-afflicted countries account for just a quarter of the world’s infants, yet they harbour half of all zero-dose children, whose numbers have increased from 3.6 million in 2019 to 5.4 million in 2024. In Sudan, vaccination coverage collapsed — from 85% pre-war to as low as 8% in conflict zones — while Yemen’s zero-dose figures climbed significantly, driven by instability, health service disruptions, and misinformation.

Conversely, Gavi-supported, low-income countries saw marked improvements, reducing un- and under-vaccinated cohorts by around 650,000 in 2024. Yet even high- and upper-middle-income economies are experiencing slippage, with measles coverage hovering at 84% (first dose) and 76% (second), below the 95% threshold needed for herd immunity. Consequently, measles outbreaks surged, with 60 countries reporting significant incidents in 2024, doubling since 2022.

Country case snapshots powerfully illustrate these trends. In Bosnia and Herzegovina, measles vaccination rates are at just 55%, compared to Croatia’s 90%, contributing to over 7,000 cases and two adolescent deaths, prompting WHO and UNICEF to urge intensified immunisation campaigns. In Pakistan, polio resurgence has occurred amid militant threats and disrupted campaigns, with over one million children missing doses in 2024. The government’s response includes large-scale vaccination drives and policy enforcement, such as arrest warrants, signalling both the challenge and political recognition of routine immunisation’s fragility. Meanwhile, Bangladesh has steadily expanded its vaccine schedule — adding Hib, rubella, PCV, IPV and MR2 — achieving DTP3 coverage around 93% and fully vaccinated rates near 84% by 2019.

These illustrations reveal both progress and vulnerability. Countries with strong political will, robust systems, and community trust — like Bangladesh — are managing gains. Others, like Pakistan and Bosnia, highlight how instability, mistrust, and misinformation can swiftly unravel public health gains.

The 2024 immunisation data reiterates an urgent message. Global coverage has stabilised and broadened, but millions of children remain vulnerable in conflict zones and complacent high-income settings. Measles outbreaks, polio flare-ups, diphtheria spikes, and new threats like RSV underscore that the progress we’ve made is neither permanent nor evenly shared. Unless we decisively fill funding gaps, fortify health delivery in emergencies, ensure vaccine equity, and strengthen trust, these vulnerabilities will deepen — and outbreaks will follow.

The post Global childhood vaccination remains resilient, but equity cracks are widening appeared first on Medika Life.

Pharmaceuticals have been spared so far from the growing trade war between the United States and many other nations. But that run of fortune may soon be coming to an end as President Trump said recently that the United States will announce a “major” tariff on pharmaceutical imports “very shortly.” While we do not know what the delay in implementing other tariffs means for the threatened tariffs on pharmaceuticals — those on automobiles, for example, are going ahead as planned — the implications of tariffs on pharmaceuticals could have a dramatic impact on multiple areas throughout the US and global healthcare ecosystem.

Tariffs on medicines will, of course, increase prices for US patients. But, as with many other aspects of the fast-moving trade war, this one is likely to have unintended consequences as well. We think that companies should prepare now with an eye to mitigating problems and be prepared to communicate the ramifications of tariffs on health-related areas to diverse audiences, from regulators and policymakers to health providers and patients.

The most likely knock-on effect is on patents and other intellectual property (IP). The US has traditionally protected IP belonging to American companies and the global IP system by threatening trade retaliation against countries that do not respect IP. Those threats may now ring a bit hollow, especially among the countries most well-positioned to capitalize on erratic US policies on biopharma IP.

China

The semi-official Global Times reported on April 9 that China might consider “investigating the intellectual property benefits of US companies operating in China.” China has responded robustly to tariffs of 145% on most of its exports to the US. Vice-President J.D Vance’s characterisation of Chinese as “peasants” may complicate trade negotiations, making it very difficult for the Chinese government to seek conciliation instead of escalation.

As our colleagues have already pointed out, China sees a vast opportunity in the US’s exit from global health. China’s thriving biotech and life sciences sector wants to do more to supply South Asia, Africa, and Latin America. Its COVID vaccines were deployed across the world, but China is positioning its vaccines industry to meet routine and pandemic needs.

The 14th Five-Year Plan (2021–2025) explicitly prioritised biotechnology as a strategic sector for national development, aiming to position the country as a global leader in the bioeconomy by 2035. The Healthy China 2030 and Made in China 2025 initiatives have prioritised development of medical R&D and manufacturing, both in small molecules and biologicals. The government uses subsidies, financial incentives, public-private partnerships, and talent recruitment programmes to foster biotech innovation. High-tech science parks and innovation hubs have been established in regions such as Shanghai and Shenzhen to strengthen industrial capabilities. China is particularly focusing on synthetic biology, gene editing, stem cell research, brain science, and regenerative medicine.

There is an obvious synergy here. China may well relax IP protections for US-based companies, while maintaining its strengthened domestic IP regimen. At its most basic, this would allow Chinese producers to export biosimilars and generic copies of small molecules still protected by patents in the US and EU. Probably more significant would be the shortcuts it might allow Chinese developers in producing new therapeutics and vaccines that build on established American discoveries.

India

In 2022, almost half of US generic medicines came from India. New tariffs could dramatically affect the affordability of medicines within the USA.

India is, for now, not responding to tariffs of 26% on most of its other exports and is putting its hopes on a bilateral trade agreement (BTA) to be concluded by the third quarter of 2025. It may happen, but because presidential authority to conclude trade agreements has expired, the agreement would require Congressional approval and that is usually a fraught process. Absent a BTA, India will look for leverage and, to encourage a BTA’s progress, it may seek to apply pressure in the meantime. In this, India’s government has an advantage: it can leave action to India’s sophisticated civil society sector and the country’s activist courts.

India has long been on the US Priority Watch List for intellectual property (IP) protection and enforcement because of rumbling disputes over administrative and legislative issues. However, India’s generics industry has largely been forced to respect IP on medicines since the early years of this century. That could change without any provocative action by India’s government.

India has recently taken steps to expedite the approval of new treatments based on registration by stringent regulatory authorities such as the EMA and the FDA. Based on these approvals, ordinary Indians can import medicines for personal use. This probably has an untested implication for patents.

India’s Supreme Court has long held that a patent can only be valid in India if the patent holder is “working the patent” in the country; practically this means that a medicine discoverer has to have taken some reasonable steps to make its treatments accessible to Indian patients. The slow pace of approvals in India — and the option of submitting for approval later than in other countries — has meant that developers could control application of this doctrine in the past. Courts might now say that there are few good reasons for a delay in availability in the country and that failure to provide access in these circumstances could invalidate a patent.

India’s government can honestly say that it is powerless to control the courts and fairly helpless to resist activism around patents — look, for example, at the scholarship and training on India’s ever-excellent SpicyIP website. A new trade agreement with the US, when applied fully, could reinforce IP protection but, in its absence, the government can say with some justification that it would have trouble getting any new legislation on pharma IP through the two chambers of Parliament.

As with China, a more subtle threat may come from India’s emerging R&D-based vaccines and medicines industry. The job of developers is much easier if they can use the trade secrets of established rivals.

Ireland

The pharmaceutical industry may have some relief because it holds so much of its intellectual property in Ireland. This is a very sore point for the Trump Administration, but could mitigate the danger from any future moves by China, India and other countries to “investigate US intellectual property benefits”: no-one wants a trade war with the EU as well as the US.

Ireland has, however, been a laggardly partner to the pharma industry. It has been slow to adopt the EU’s United Patent Court (because doing so requires a referendum in Ireland). More seriously, it is one of the slowest countries in Europe to grant access to new medicines. This does not create a legal hazard for patent holders but it does weaken the country’s moral and public relations case, especially because Ireland’s delays are partly the result of policies that favour inefficient national generic producers.

Impact of IP threats

Weakening intellectual property may offer short-term improvements in access, but has many long-term risks.

Generics from India, in particular, are associated with much higher risks to patients than medicines produced in Europe, Israel, Jordan or North America. We don’t yet know enough about generics from China.

It is intellectual property that powers innovation. Developing new drugs is a high-risk, costly endeavour, often requiring billions of dollars and over a decade of research. Strong IP protections, such as patents, allow companies to recoup these investments by granting them exclusive rights to market their products for a defined period. This exclusivity ensures that innovators can profit from their discoveries without immediate competition from generics or imitators. Strong IP frameworks also encourage partnerships between pharmaceutical companies, universities, and research institutions and enable the sharing of expertise and resources, accelerating the development of new treatments while safeguarding proprietary knowledge.

What can companies do?

The evolving global trade outlook is changing by the day, and sometimes by the hour, so it is important to have one or more internal task forces with public affairs experts and consultants in China, India and Latin American markets with some similar dynamics — Brazil, Colombia and Mexico, in particular. Having an internal and an external perspective with clear lines of communication with expert advisors is very important in our current trade climate because different people know different things in fast-changing scenarios. There needs to be a different task force in Ireland, a country that will likely come under unaccustomed scrutiny.

Access planning may be the best mitigation for many of the risks. It is important in India for obvious reasons. It may be important in other countries as part of a response for moves by generic producers elsewhere.

Communication with policymakers and influencers matters more than ever. Policy responses will happen in a far more condensed time frame than they usually do. Having open channels may make all the difference, as well as having a tested protocol in place that allows companies to rapidly distinguish and mitigate misinformation before it influences policy direction. There are many consultancies and advisers with expertise, but it is important to include ones who have worked on intellectual property as well as trade.

The post How the growing trade war could affect biopharma intellectual property appeared first on Medika Life.

Security, Migration, and Budget Pressures

A confluence of political and fiscal forces is accelerating this shift. Europe’s strategic priorities have evolved, driven by concerns ranging from war and migration to domestic economic strains. Many governments feel pressure to divert funds toward defence and security amid Russia’s war in Ukraine and other threats. In Britain, for example, leaders explicitly tied an aid rollback to military needs: Prime Minister Keir Starmer vowed to boost defence spending to 2.5% of GDP and fund it by cutting the aid budget from 0.5% to 0.3% of national income. “National security must always come first,” Starmer said, framing the cut as a painful necessity in a “dangerous new era”.

Curbing immigration is another powerful motivator. Italy’s Prime Minister Giorgia Meloni, elected on a hard-right platform, has bluntly rejected the notion of altruistic aid in favour of deals that keep migrants from leaving Africa. “What needs to be done in Africa is not charity,” she declares. “What needs to be done in Africa is to build cooperation and serious strategic relationships as equals, not predators”. For Rome, that means investing in African infrastructure and economies (dubbed the “Mattei Plan”) to create jobs in migrants’ home countries — and securing Italian energy and business interests — rather than simply writing checks. Other governments in Europe’s north echo this tougher line: the Netherlands’ new ruling coalition plans to trim aid by 2029 while “prioritising the interests of the Netherlands,” shifting funds toward domestic migration control and trade promotion.

At the same time, budget constraints and surging nationalist politics have made foreign aid a prime target for cuts. The populist refrain of “charity begins at home” has grown louder amid economic uncertainty, pandemic debts, and inflation. Even in France — historically a champion of development aid — the government quietly backtracked on a legally enshrined promise to reach the U.N.’s 0.7% aid spending target by 2025. Facing pressure to reduce deficits, President Emmanuel Macron’s administration postponed the 0.7% goal to 2030 and slashed next year’s aid budget by over one-third. A €742 million reduction in 2024 was followed by plans for a further 37% cut (more than €2 billion) in 2025. Such steep cuts, unprecedented in modern French policy, were justified as tough choices in a tight fiscal environment — though critics called it a betrayal of France’s global commitments. Likewise, aid has been swept up in a broader fiscal odyssey in Germany. After a constitutional court ruling forced Berlin to reallocate spending, the development ministry’s 2024 budget was pared down by about 8% (roughly €940 million) compared to the previous year. Germany’s humanitarian relief budget also dropped about 10%. These reductions make it unlikely Germany will maintain its recent 0.7% GNI aid level.

European Aid Budgets in Retreat

The result of these pressures is a marked pullback in many European aid budgets — a trend that spans both EU member states and neighbours like the UK and Switzerland. Recent moves include:

• United Kingdom — Once a leader in aid, the UK has reversed course. It first lowered its long-held 0.7% of GNI aid commitment to 0.5% in 2021 and now plans to sink to just 0.3% by 2027 to free up billions for defence. Aid groups warn this will drag UK assistance to its lowest share of national income in generations, a “short-sighted and appalling move” that will “undoubtedly risk lives,” according to UNICEF.
• France — After years of incremental increases, France is making an abrupt U-turn. The 2025 budget envisions a 35% cut in official development assistance, delaying ambitions to scale up programmes. Lawmakers in Paris concede domestic needs and security priorities are eclipsing foreign aid — a stark change for the world’s fourth-largest donor, which in 2023 still spent €13.9 billion (0.48% of GNI) on development.
• Germany — The eurozone’s largest economy is trimming aid amid belt-tightening. Germany’s 2024 federal budget reduced core development spending to €11.2 billion, about 7–8% lower than in 2023. Humanitarian and crisis aid saw even sharper declines. Further cuts are on the table for 2025 as Berlin prioritises energy price relief and defence.
• Belgium — A new coalition government in Brussels has agreed to cut development cooperation funding by 25% over five years. Belgium’s aid agency has sounded the alarm, with Enabel CEO Jean Van Wetter warning that “disinvestment in international cooperation is a poor decision in our interconnected world” and will undermine Belgium’s global influence.
• Switzerland — Historically, Switzerland has been a steady donor, but the Swiss government is also scaling back. It approved a CHF 110 million reduction in its aid budget and plans to shut down or hand off development programmes in at least three countries (Albania, Bangladesh, and Zambia) by 2028. Swiss officials argue that resources must be focused on fewer priorities as part of a wider cost-cutting drive.
• Italy — Italy’s aid budget has not seen dramatic cuts, but its focus has pivoted under Meloni’s leadership. Rome is redirecting funds toward projects that dovetail with Italy’s geopolitical agenda — chiefly stemming migration. Italian ministers talk of “investment, not charity” and have struck deals, for instance, to finance development projects in Tunisia in exchange for cooperation on keeping migrants from crossing the Mediterranean.

Notably, this contraction is Europe-wide. A recent review tallied seven European donor governments announcing major aid reductions or reallocations in the past year. The collective EU aid effort is sliding: EU institutions and member states gave 0.51% of GNI as aid in 2023, down from 0.56% the year before. In a mid-2024 budget review, the EU reallocated €2 billion of its external aid fund into migration and refugee support — effectively a 7.5% pro-rata cut to other development programmes. As one analyst bluntly summed up, “The door is just closing on aid everywhere we look.”

From Grants to “Blended” Finance

Beyond budget cuts, Europe is fundamentally changing how it delivers whatever aid remains. Rather than simply funding government budgets or health clinics in poor countries, European donors are channelling money into financial instruments — loans, equity stakes, guarantees — that attract co-investors and, ideally, pay for themselves. The buzzword is “blended finance,” which means using a small amount of public or aid money to unlock a larger pool of private capital for development projects. In theory, everyone wins: poor countries get more investment than aid alone could provide, while investors (including European development banks) get risk cushioned by public funds.

All across Europe, aid agencies have been refashioned as mini-development banks. The UK’s famous aid department has been folded into the Foreign Office, and its once grant-focused bilateral programmes are diminished. Instead, Britain is leaning on British International Investment — a government-owned DFI (development finance institution) — to finance projects from renewable energy in India to tech start-ups in Africa, expecting modest returns. France’s Agence Française de Développement (AFD) has likewise expanded its lending, often via its private-sector arm Proparco, under what President Macron calls a “policy of results” approach. “The ambition of this strategic plan is [for AFD] to become a platform for development policy,” Rémy Rioux has said, describing AFD’s evolution beyond traditional aid. AFD now provides billions in low-interest loans for infrastructure and climate programmes, blending French funds with multilateral and private money.

Germany’s KfW Development Bank and its investment subsidiary DEG follow a similar model, financing everything from solar parks to microfinance institutions in developing markets. Even smaller donors have set up investment vehicles — Switzerland’s SIFEM fund, for instance, takes equity stakes in emerging market SMEs. Increasingly, European aid is less about writing checks than structuring deals. As Rioux explains, “Development financing is undergoing a major transformation… Investment has another advantage: it’s built for the long term. It creates lasting partnerships, allows us to track tangible impacts, and demonstrates returns… far more effective and convincing than traditional public aid”. In his view, and that of many peers, mobilising “sustainable resources” through investment is the only way to meet 21st-century challenges as government grants stagnate.

Critically, Europe’s new approach isn’t just about altruism — it’s about mutual gain. Donor governments are so unabashed that they expect strategic payoffs. “International cooperation is not just an act of global solidarity,” says Enabel chief Jean Van Wetter, whose Belgian agency increasingly ties aid to domestic interests. “It is a strategic investment that will bring numerous benefits to Belgium, its businesses and its citizens… By encouraging stability, growth and sustainability in partner countries, Belgium strengthens its own security, economy and international reputation”. This “good for them, good for us” philosophy now permeates European development strategy. Nowhere is it clearer than the European Union’s flagship Global Gateway initiative — a €300 billion plan unveiled in 2021 to fund infrastructure in Africa, Asia, and Latin America. Billed as Europe’s answer to China’s Belt and Road, Global Gateway explicitly seeks “mutually beneficial partnerships” that serve development needs and boost the EU’s strategic autonomy. Projects range from African internet connectivity (benefiting EU telecom firms) to renewable energy grids that could one day supply Europe. “We are moving away from traditional development to mutually beneficial partnerships,” the EU’s development commissioner’s office said, underscoring that the old donor-recipient dynamic is being replaced with joint ventures.

Ripple Effects on Poor Countries

Europe’s pivot has profound implications for countries on the receiving end. In the short term, budget cuts are already being felt in vulnerable communities. Programmes that tackle poverty and disease — but yield no financial return — face an uncertain future. Global health initiatives, in particular, are reeling. Several of Europe’s biggest aid donors have been mainstays of funding for vaccines, HIV treatment, and health systems in Africa. Now, those budgets are shrinking just as need remains high. “Some of Europe’s biggest global health funders are slashing their aid budgets, which health groups fear could spell catastrophe for countries reliant on foreign cash to combat malaria, HIV, tuberculosis,” reports Euronews. Because Europeans are turning inward, health programmes that saved millions of lives may lose support. In 2023, about 10% of European ODA went to global health. Still, going forward, that share must compete with climate projects and private-sector loans for a “shrinking pot of money”. “Many lives are at stake,” warns Dr Michael Charles, head of a major anti-malaria partnership, describing the situation as “quite dire” in countries where donor-backed health services are now at risk.

Lower-income countries could also struggle to attract the kind of private investment Europe is now favouring. The pivot to loans and equity tends to favour middle-income states or commercially viable ventures — where investors see a reasonable chance of returns. Poorer nations, or social sectors like basic education, may be left behind because they offer little profit. Aid advocates note that European funds are flowing increasingly to regions of strategic interest (for example, North Africa for migration control or Ukraine, which alone absorbed nearly €19 billion of EU institutions’ aid in 2023 (Donor Profile: EUI)). Meanwhile, the share going to the least-developed countries has been “trending downward since 2017”. If this continues, the world’s poorest countries may face a double blow: less grant money and limited access to investment capital. Those who do take on more loans could risk new debt burdens down the line. “We have to ensure no one is left behind as we shift to finance and investment,” cautions one development official, noting that purely market-driven aid could bypass fragile states that need help most.

On the other hand, some developing nation leaders welcome the rhetoric of partnership over patronage. African governments have long bristled at the demeaning connotations of “aid” and have called for “trade, not aid” for decades. They see opportunity in Europe’s investment pivot — if it delivers real infrastructure and business growth. In their view, being treated as an investment destination, not a charity case, is a step toward equality. However, they also emphasise that partnerships must be genuine. At a recent EU-Africa forum, several African presidents pointedly rejected mere “EU charity”, saying Europe should address structural imbalances in trade and invest in African value chains rather than offer handouts as a way to buy political favours. In practice, the jury is still out on whether Europe’s new model will benefit developing nations or mainly serve Europe’s interests.

A New Hybrid Model — End of Aid as We Know It?

Is this the end of traditional aid? In many respects, yes. Europe’s development assistance is becoming inseparable from its economic and geopolitical strategy. Whereas 20th-century aid often aimed to foster development for its own sake — rooted in post-colonial moral duty or Cold War diplomacy — 21st-century aid from Europe is increasingly transactional. Grants with no strings attached give way to loans, equity investments, and deals tied to policy conditions (migration management, economic reforms, climate goals). The old model of wealthy nations simply donating money is fading. “The old model of public development aid is disappearing and must be replaced by sustainable and inclusive investment,” says AFD’s Rémy Rioux, who argues that virtually all stakeholders now “agree that we need to rethink the model”. European officials often bristle at the word “aid” altogether. They prefer terms like “cooperation,” “partnership,” and “investment.”

Yet this is not so much an end as an evolution into a hybrid model. Europe isn’t abandoning poorer countries; it is just engaging on different terms. In place of one-way charity, it envisions joint ventures — what one Belgian policy paper calls “reciprocity-based development”. Even as budgets tighten, Europe is leveraging other tools to stay involved abroad: development banks, venture funds, risk guarantees, and diplomatic agreements linking aid to trade. In effect, official development assistance is blended with foreign and commercial policies. It’s no coincidence that the UK merged its aid agency into its diplomatic service or that the EU’s development projects now fall under a strategy explicitly tied to European industrial and security interests. As the European Council concluded its next budget, the goal is to “ensure the [aid] budget advances the EU’s strategic priorities, which are increasingly shaped by domestic interests such as competitiveness, access to raw materials, migration, and security.” This signals a permanent change in mindset.

Whether this new approach can deliver positive results for developing nations remains an open question. Optimists argue that by making development cooperation more about business and mutual gain, Europe will sustain political support and unlock larger pools of money than stagnant aid budgets could. They point to initiatives like Global Gateway and say that if Europe invests smartly in emerging economies, it can help build sustainable industries (from African solar farms to Southeast Asian supply chains) that benefit everyone. Sceptics, however, worry that something fundamental is lost when self-interest justifies aid. There are fears that vital but unprofitable work — fighting extreme poverty, tackling malnutrition, bolstering primary healthcare — will fall by the wayside. They note that global pandemics or climate change require outright grants and global solidarity, not investments that expect a financial return.

European officials insist they are not retreating from global development, just modernising their approach. “France is not stepping back from its international role,” Rioux insists, citing Europe’s $150 billion collective development contribution — roughly three times the U.S. level. But he and others acknowledge the need to “build a more resilient and efficient model” that can withstand domestic political winds. That model increasingly blurs the line between aid and business. It treats poorer countries less as beneficiaries and more as partners — or, in some cases, markets. The Wall Street Journal once dubbed this trend “aid as investment”, and today it’s an apt description of Europe’s new paradigm. Traditional aid may not be entirely dead, but it has undeniably been subsumed into a broader strategy of strategic partnerships.

As Europe resets its development playbook, the world is watching to see if this grand experiment produces genuine development — or if “mutual benefit” mostly benefits the donor. For millions in Africa, Asia, and beyond who have depended on European aid, the hope is that this new era will bring a different rhetoric and tangible progress. If Europe’s investments can drive growth and stability in poorer nations while satisfying European taxpayers, it could herald a new global development model for the 21st century. If not, retreating from traditional aid could leave a void that other powers — or crises — will fill. The only certainty is that Europe’s role in international development is changing profoundly, in real-time, trading in the old charity mindset for something more hard-nosed and, it believes, sustainable for the long haul.

The post Europe Reimagines Foreign Aid as Investment appeared first on Medika Life.

Questionable parenting practices? Yeah. But our dinner conversations are amazing and spark the level of curiosity and appreciation in public health that I wish more people had, especially right now.

About three weeks ago, my kids saw that I was a little worried about something. Instead of telling them outright, I turned to our old game and asked them to tell me what they thought was the scariest disease.

Most people would go for Ebola because of its Hollywood-level freak out potential. Cholera is very scary as well, and an awful way to die. But my kids know by now that there’s one blue ribbon winner in my book when it comes to very scary diseases: Influenza.

Not garden-variety seasonal influenza. No, I’m talking about pandemic level influenza, like the 1918 pandemic flu that killed an estimated 50 million people and sickened a fifth of the world’s population.

This strain of influenza is the stuff of nightmares. A disease that spreads so rapidly that 2-3 healthy people could get infected by one sick person. A disease so deadly that it turns our own immune system against us, tricking it into a massive overreaction called a cytokine storm that either kills us or lays waste to our natural defenses so that that infections like bacterial pneumonia just waltz right into our bodies.

It’s why in 1918 the healthiest people often died the fastest: as in showing up for work in the morning and dead by night kind of fast. In places like Baltimore, Philadelphia, Seattle and countless corners of the world, the Great Influenza killed so quickly and debilitated people so widely that basic services broke down. In scenes reminiscent of Medieval times during the Bubonic Plague, when families were asked to bring out their dead, there were instances of bodies being stacked in the streets of America’s major cities.

And just like Bubonic Plague, where victims near death displayed the tell-tale, malodourous rash of “Ring around the Rosie” children’s song fame, care providers in 1918-19 watched as patients who were near death turned blue from oxygen failing to get through disease-ravaged lungs.

Here’s another little-known twist: Most people refer to the 1918-19 pandemic as the Spanish Influenza, assuming that was where it originated. But that’s not the case. Because of World War I, most of northern Europe was in a news blackout and didn’t report that thousands of soldiers engaged in fighting there were falling sick. Spain was the first European country to report on the emergence of the new disease, earning the unfortunate label as the epicenter for the pandemic.

There is general consensus among global health experts and historians that the true origin of the Spanish Influenza was likely thousands of miles away from Spain. It’s one of the many inconvenient truths that was glossed over in the midst of all the finger pointing and xenophobia directed to China during Covid-19: The deadliest plague in modern human history started just over a century ago not in a lab or a crowded urban tenement, but on a pig farm in the middle of Kansas, USA.

Which is why I’m watching the pigs now.

On October 29, the U.S. Department of Agriculture detected the first known transmission of H5N1 avian influenza to pigs on a small backyard farm in Oregon where poultry had been infected and euthanized recently. While certainly not a reason to panic, this milestone was alarming enough that I couldn’t disguise my concern during family dinner three weeks ago.

There are several reasons why we should all be keeping an eye on where H5N1 goes next.

First, think of pigs like a Vitamix for whirling around zoononic (animal) and human strains of influenza and spilling out the perfect pandemic-level smoothie. Because we share so much in common with pigs, genetically speaking, and because pork is such an integral part of the global diet, the potential for this animal species to serve as an efficient transmitter of deadly influenza strains is particularly high. This is worrisome, because H5N1 is very deadly to humans, carrying with it a 50+ percent fatality rate (compared to a roughly 1 percent case fatality ratio for Covid-19 among U.S. patients).

Second, if Americans are angry now about the price of eggs – which strangely no presidential candidate connected to mass chicken culls from H5N1 – just wait for the economic and food supply impact of broader infections among pig herds.

But most importantly, America’s public health system has been slow to track H5N1, ignoring important lessons from Covid-19 and downplaying the potential threat that could be on the horizon. There are broad concerns that surveillance has lagged and impacted flocks and herds are being undercounted. U.S. media attention has focused on the safety of the nation’s milk supply, which is interesting since pasteurization kills all viruses and bacteria (something to note for all of you raw milk drinkers out there). And there seems to be inexplicable foot dragging with our efforts to conduct and broadly share regular genetic sequencing of different H5N1 samples to understand how the virus may be mutating into a more virulent pathogen.

Instead of focusing on the infrastructure we have in place to detect a potential spillover of H5N1 to humans, we are poised to cut funding and resources needed to effectively track and contain outbreaks before they spread.

While pandemic fatigue is real and we can’t dismiss its influence on U.S. politics, economics or popular culture right now, we also cannot afford to leave our front door open when a virus with pandemic intentions is creeping around our yard.

Now is the time to review and publicly discuss the lessons learned from Covid-19 on surveillance, health system strengthening, rapid reporting and effective intra—government and public communications. We have more advanced technologies and biosecurity measures that we can leverage, as well as incentives to ensure livestock operators are not collateral damage in our war against disease. Lastly, we can’t afford to weaken routine immunization policies when they may be our first line of defense against a novel pathogen that overwhelms our health systems again.

By combining proactive policies with strong communication strategies, including more effective ways to engage and educate the media, we can effectively prevent and manage the threat posed by H5N1 and other pandemic influenza viruses, safeguarding public health and minimizing economic disruptions.

The question is whether there is enough political will remaining after Covid to keep our guard up against pandemic threats, either homegrown in the U.S. or originating in a far-off hot zone. The answer is what keeps me up at night.

The post Watching the Pigs appeared first on Medika Life.

Decolonising global health aims to dismantle the colonial legacies that continue to shape health research, policy and practice worldwide. As Kwete et al. argue, “the current status quo of global health is still replete with various forms of colonial vestiges–ideologies and practices”. These vestiges manifest at multiple levels, from individual interactions to institutional structures to overarching paradigms.

One of the most visible symptoms is the persistent marginalisation of voices from the Global South in leadership, decision-making and knowledge production. Despite rhetoric about equity and partnership, global health remains dominated by institutions and individuals from high-income countries. As one analysis found, over 80% of global health research on Africa has no African authors.

This imbalance reflects deeper issues of power and positionality. As Badham notes, “Voices from the ‘Global South’ are often marginalised because their abilities” are undervalued or overlooked. Addressing this requires more than simply increasing diversity — it demands a fundamental shift in how we conceptualise expertise and authority in global health.

The legacy of colonialism is deeply embedded in the structures and practices of global health. As Peace Direct’s recent report on decolonising aid argues, “Many current practices and attitudes in the aid system mirror and are derived from the colonial-era, which most organisations and donors in the Global North are still reluctant to acknowledge.”

This reluctance to engage with the colonial roots of global health work undermines efforts to address ongoing inequities. Certain modern-day practices reinforce colonial dynamics, from the ‘White saviour’ ideology visible in fundraising imagery to the organisational structures of INGOs in the Global South.

Language and framing also play a crucial role in perpetuating colonial mindsets. Terms like “Global South” and “developing countries” reinforce notions of Western superiority and a linear path of “progress” defined by the West. Even well-intentioned efforts at “capacity building” can imply deficiency. As global health practitioners and researchers, we must critically examine our words and their implicit assumptions.

At an institutional level, the flow of funding, priorities and accountability in global health often mirror colonial relationships. Major funders and international organisations remain concentrated in high-income countries, with limited representation from the communities they purport to serve. This setup can lead to misaligned priorities and interventions that fail to address local needs and realities.

Peace Direct’s consultation found that only 12% of international grant dollars from US foundations go directly to organisations based in the country where programmes are implemented. This means that everything from who controls the disbursement of funds to who defines a project’s success is rooted in the values and beliefs of the Global North.

Transforming these entrenched systems requires more than superficial changes. As Kwete et al. argue, “to fully decolonise global health, systemic reforms must be taken that target the fundamental assumptions of global health”. This includes questioning core premises about the relationship between health and development.

A crucial first step is to acknowledge that structural racism exists within global health institutions and practices. Many organisations still need to engage with this uncomfortable reality. Yet, as Peace Direct’s report argues, “If policymakers, donors, practitioners, academics and activists do not begin to address structural racism and what it means to decolonise aid, the system may never be able to transform itself in ways that truly shift power and resources to local actors.”

This shift requires ceding control and embracing uncertainty. For donors and international NGOs, funding “courageously” means creating more accessible and flexible funding pathways and prioritising local leadership. It means relinquishing the insistence on rigid metrics and acknowledging that transformative change is inherently messy.

For global health education, decolonisation demands expanding curricula beyond Western perspectives to centre diverse scholars, epistemologies and historical analyses. It requires opportunities for students and practitioners from the global North to critically examine their power and positionality.

Decolonising global health does not mean rejecting all Western contributions to the field. Instead, it calls for a more inclusive, equitable approach that values diverse forms of knowledge and experience. As Garba and colleagues argue, the goal is to “create a more just and equitable global health landscape”.

Yet we must also grapple with more radical critiques that question whether global health — given its colonial origins — can ever be decolonised. Some scholars argue for new paradigms centring on solidarity and cognitive justice principles.

Decolonising global health is not a finite destination but an ongoing critical reflection and action process. It demands that we continually examine our assumptions, practices and impacts. As global health practitioners, researchers and advocates, we must ask ourselves: Whose voices are we centring? Whose knowledge are we valuing? And whose interests are indeed being served by our work?

By honestly confronting these questions, we can build a more equitable and genuinely global approach to health. This transformation will take work. Entrenched power structures and vested interests will inevitably resist change.

Yet the stakes could not be higher. As converging crises of pandemic disease, climate change, and widespread inequity threaten health worldwide, we desperately need new approaches that centre the knowledge and leadership of communities on the frontlines.

Decolonising global health ultimately means “moving the centre”, as Ngũgĩ wa Thiong’o reminds us. It requires shifting power, resources and decision-making to those most impacted by health inequities. Only then can we hope to realise the field’s lofty health aspirations.

References:

Kwete, X. et al. (2022). Decolonizing global health: what should be the target of this movement, and where does it lead us? BMC Global Health Research and Policy, 7(1), 1–6.

Peace Direct. (2021). Time to Decolonise Aid: Insights and lessons from a global consultation. London: Peace Direct.

Garba, D. L., Stankey, M. C., Jayaram, A., & Hedt-Gauthier, B. L. (2021). How do we decolonize global health in medical education? Annals of Global Health, 87(1).

The post The Urgent Call to Decolonise Global Health appeared first on Medika Life.

As the world gradually recovers from the shockwaves of the COVID-19 pandemic, the spectre of another potential public health crisis looms ominously on the horizon. A recent report in The Lancet on the risks of avian influenza H5N1 at mass gatherings is a critical reminder that our vigilance against infectious diseases must remain steadfast, especially as we approach a summer filled with major religious, cultural, and sporting events.

Mass gatherings have always been fertile ground for spreading infectious diseases, serving as hubs for international transmission. From the annual Hajj pilgrimage to the bustling celebrations of Kumbh Mela, these events draw millions of people from around the globe, creating perfect storm conditions for pathogen spread. The resurgence of avian influenza, particularly the H5N1 strain, poses a renewed threat that demands immediate and focused attention.

The Silent Spread of H5N1

H5N1, also known as Highly Pathogenic Avian Influenza, has been on the radar of global health authorities since its emergence in 2004. Despite not currently transmitting easily from person to person, recent reports of mild or asymptomatic human cases in the USA, China, Vietnam, and Europe are alarming. The first human case in the USA was reported in 2022 in Colorado, linked to direct poultry exposure. Similarly, England has documented 298 cases since October 2021. This underscores the virus’s persistence and the potential for rapid, widespread outbreaks if left unchecked.

Lessons from History: Preparedness Pays Off

Historical precedents demonstrate the critical importance of proactive public health measures. The past decade has seen mass gatherings successfully navigate Zika, Ebola, and COVID-19 threats through meticulous planning and surveillance. For instance, the 2015 Africa Cup of Nations in Equatorial Guinea proceeded safely amidst the Ebola outbreak, thanks to stringent health protocols and international cooperation.

The ongoing efforts to prevent outbreaks at events like the Tokyo 2020 Olympics and various religious gatherings highlight the effectiveness of preparedness. Yet, these successes should not breed complacency. The ever-evolving nature of viral pathogens necessitates continuous vigilance and adaptation of our health strategies.

The One Health Approach: A Unified Front Against Zoonotic Diseases

The interconnectedness of human, animal, and environmental health underscores the need for a comprehensive One Health approach. Mass gatherings often involve the consumption of animal products and, in some cases, live animal sacrifice. This creates multiple avenues for zoonotic transmission, particularly with avian influenza viruses.

Countries hosting mass gatherings must implement rigorous screening and testing protocols for poultry and other animals to mitigate these risks. This includes mandatory surveillance of imported animals and those used in religious rituals. Wastewater surveillance can also provide early detection of viral presence, allowing for swift intervention.

Bridging Knowledge Gaps: Research and Surveillance

Mass gatherings present unique opportunities for real-time research and data collection. Understanding the transmission dynamics of H5N1 and other zoonotic pathogens is crucial for developing targeted interventions. Enhanced surveillance, using advanced diagnostic platforms, can identify and monitor emerging threats, filling critical knowledge gaps.

The Path Forward: International Cooperation and Vaccine Development

Ultimately, the global community must unite in the face of these emerging threats. Developing and distributing effective vaccines for H5N1 and its variants will be pivotal in safeguarding public health. Collaborative efforts involving organisations like the WHO, FAO, and OIE are essential for a coordinated response.

A Two-Year Effort to produce a global pandemic treaty misses its deadline. On Friday, May 24, Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, announced that the negotiators from the group’s 194 member nations couldn’t reach a consensus in time for the World Health Assembly, which started this week.

The goal had been to draft a document that could be adopted at the meeting and then sent to countries for ratification. However, the sticking points—including the willingness of richer countries to share vaccines and treatments with less well-off countries in the Global South—could not be resolved in time.

What Next?

Scientists predict the next pandemic could occur soon, perhaps in two years or twenty. Still, the message is clear: proactive surveillance and preparedness are not optional. They are imperative. By learning from past experiences and embracing a unified approach, we can protect millions of lives and ensure that mass gatherings are celebrated safely worldwide.

Christopher Nial is a senior partner at FINN Partners. He specialises in global public health and the intersection between climate change and public health. With over 30 years of experience, he is passionate about leveraging public health strategies to save lives.

The post The Urgent Need for Proactive Surveillance of Infectious Disease at Mass Gatherings appeared first on Medika Life.