The Exhibition Floor as a Market Signal

However, after several days walking the exhibition floor and listening to discussions across multiple stages, another story emerged. The most interesting development at HLTH Europe was not the continued rise of AI. It was the growing number of companies applying artificial intelligence to solve very specific challenges faced by researchers, physicians, health systems and patients.

What appears on the stages and exhibition floor at HLTH often reflects where the market sees opportunity. Conferences do not create trends. They reveal them. HLTH Europe brought together more than 400 speakers, some 350 sponsors and approximately 5,000 participants from across the global health ecosystem. Artificial intelligence was not simply one topic among many. The conference featured a dedicated AI @ HLTH Zone, AI-focused exhibitors and numerous sessions exploring implementation, governance, clinical applications and operational adoption.

The prominence of AI across both the agenda and exhibition hall was revealing. Conference organizers dedicate space and programming to topics that matter to attendees, investors and sponsors. The visibility of AI at HLTH Europe suggested that health-specific applications of artificial intelligence have moved beyond emerging interest and are now a significant market focus.

That shift matters because health has always demanded more than technological capability. New tools must operate within environments where privacy, safety, accountability and trust are essential. Researchers are looking for ways to accelerate discovery. Physicians want to reduce administrative burdens that consume valuable time. Health systems seek efficiencies that improve operations without compromising quality. Increasingly, innovators are designing AI solutions around those specific needs.

That reality helps explain why many of the most compelling AI companies at HLTH Europe are building solutions specifically for health rather than adapting tools designed for other industries.

As Sophie Taylor-Roberts, managing partner and FINN Partners UK Health Group Lead, shared: “A mistake in healthcare carries a human cost: it can literally mean life or death. That’s why healthcare needs bespoke AI models, tools and solutions that allow for diverse patient populations, differing clinical guidelines, funding and regulatory structures.”

She added, “As with all aspects of health, one size doesn’t fit all. AI must be treated like a highly specialized medical instrument, built to respect national sovereignty, multilingual patient care, and absolute data privacy.”

Health-Specific AI Moves from Possibility to Practice

The trend was visible throughout the exhibition hall, where companies focused on clinical research, physician workflow, diagnostics, patient engagement, digital safety and operational efficiency demonstrated how specialized AI is rapidly becoming a category of its own.

The trend was visible throughout the exhibition hall, where companies focused on clinical research, physician workflow, diagnostics, patient engagement, digital safety and operational efficiency demonstrated how specialized AI is rapidly becoming a category of its own. Their growth reflects a broader shift occurring across the health sector as organizations seek tools designed for specific scientific, clinical and operational challenges.

Gabriele Ricci, Chief Data & Technology Officer at Takeda, captured that evolution when discussing AI’s growing role across the research and development continuum. “AI is transforming the future of healthcare by accelerating every stage of the R&D value chain through purpose-built capabilities tailored to specific scientific and clinical challenges,” he said.

His emphasis on purpose-built capabilities mirrors what was visible throughout HLTH Europe. The conversation is no longer centered exclusively on artificial intelligence as a technology platform. Increasingly, attention is turning toward how specialized applications can address distinct needs across research, clinical care and health operations.

Among the companies reflecting this shift was Briya, whose AI-powered platform helps researchers interact with complex data through conversational interfaces. Rather than requiring users to navigate multiple databases, coding environments and analytical tools, the platform seeks to simplify the path from question to insight.

David Lazerson, Briya’s co-founder and chief executive officer, believes many organizations misunderstand where the greatest challenge in AI adoption resides.

“Many people assume AI adoption is about choosing the right model,” he said. “In reality, the model is only a small part of the solution. The hard part is everything around it: security, governance, data harmonization, domain expertise, and the methodology required to produce trustworthy outcomes.”

His observation reflects a reality becoming increasingly evident throughout the health sector. Access to powerful AI models is expanding rapidly, shifting competitive advantage toward organizations that can generate reliable outcomes within specific health environments. That reality helps explain the growing number of exhibitors focused on narrowly defined use cases rather than general-purpose AI.

A similar perspective emerged from conversations with Keith Grimes, MD, Chief Innovation Officer at Curistica. A physician who spent 24 years in primary care, Grimes approaches artificial intelligence through the lens of risk management, governance and patient safety.

“Physicians have always governed risk,” he explained. “We do it instinctively for doctors, drugs and devices. Digital is just the fourth D, and the discipline is much the same, but it is the one we were never trained for, so the commitment to ‘do no harm’ runs ahead of the know-how.”

His comments address one of the most significant challenges facing health organizations today. Many leaders recognize the promise of AI, yet remain uncertain about implementation, oversight and accountability, particularly in smaller physician practices and community-based care settings.

Dr. Grimes emphasizes that smaller organizations should not view those limitations as barriers.

“Small practices are the cornerstone of primary care, but they cannot out-resource a hospital trust, and it does not need to,” he said. “Good governance scales down, and the same standards that protect a large organization can be borrowed rather than rebuilt.”

“We give whoever is responsible for AI and digital safety both the platform and the people,” Dr. Grimes said. “Power tools that guide them, whatever their experience, with clinical safety experts behind the software.”

Taken together, the perspectives of Dr. Grimes and Lazerson point to the emergence of a new category of innovation. The most promising health AI companies are not focused exclusively on algorithms. They are creating environments that combine technology, expertise and governance to solve specific high-friction problems.

The Future Belongs to Reliable Outcomes

For smaller organizations, this evolution may prove particularly significant. Historically, adopting advanced technology often required substantial investment, specialized technical talent and complex integration efforts. Many health organizations lacked the resources to pursue those initiatives.

Lazerson believes that model is changing. “That’s why we’re seeing the emergence of a new layer of domain-specific AI,” he said. “Instead of every organization hiring AI engineers and building custom infrastructure, they can access a complete, purpose-built environment as a service.”

The implications extend far beyond research organizations. Physician practices, community health providers, home health agencies and emerging life science companies increasingly have access to capabilities that previously required significant internal resources.

“For smaller organizations in particular, it’s a no-brainer,” Lazerson added. “They can start generating value immediately without complex integrations, dedicated AI teams, or having to solve privacy, security, and compliance challenges on their own.”

Throughout HLTH Europe, companies focused on clinical research, workflow automation, diagnostics, care coordination and patient engagement demonstrated how artificial intelligence is becoming increasingly specialized. Rather than attempting to transform every aspect of health simultaneously, they are concentrating on areas where measurable value can be achieved quickly and responsibly.

That focus on practical outcomes may ultimately become the defining characteristic of the next generation of health innovation.

Dr. Grimes summarized the principle succinctly. “Safety is not a box-ticking exercise; it works when everyone knows the part they play,” he said. “The advantage is not scale, it is fit.”

Walking through HLTH Europe, I was reminded that innovation rarely advances through a single breakthrough. More often, progress emerges through focused efforts to solve meaningful problems. The companies attracting attention were helping researchers move faster, supporting clinicians facing administrative burdens and enabling organizations to adopt new capabilities with greater confidence.

Perhaps among the more important lessons from HLTH Europe. The future of AI in health will not be defined solely by the largest platforms. It will be shaped by innovators who combine technology, expertise, and specificity to deliver reliable outcomes. As Lazerson observed, “The future won’t belong to organizations with the biggest models. It will belong to those who can turn AI into reliable outcomes.”

Judging by what appeared across the stages and exhibition floor in Amsterdam, that future is taking shape.

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Despite living longer than men, women spend approximately 25 percent more of their lives in poor health, according to research from the World Economic Forum and the McKinsey Health Institute. Across reproduction, brain health, autoimmune conditions, cardiovascular disease, and mental health, the gaps in research, funding, and care are persistent.

That reality provided important context for the launch of The Shift, a new mini documentary series from BBC StoryWorks Commercial Productions, unveiled at HLTH Europe. The series explores issues ranging from reproductive health and cardiovascular disease to autoimmune disorders, menopause, mental health and healthy aging. Through storytelling, the documentary project elevates the experiences of women while highlighting the challenges that persist and the opportunities for progress.

The HLTH EU panel discussion was timed for the opening of The Shift and featured Shahnoor Abbas, Senior Series Developer and Research Development Lead for The Shift at BBC StoryWorks Commercial Productions; Elena Bonfiglioli, General Manager, Global Health & Life Sciences at Microsoft, and Priya Agrawal, MD, Vice President, Global Health Equity and Partnerships at MSD. Their conversation, moderated by Jody Tropeano Greene, Head of Content for HLTH, explored why women’s health remains one of the most significant opportunities for innovation, investment and system improvement.

A Conversation Decades in the Making

The panelists approached the topic from different perspectives, yet a common theme emerged. Women’s health has received increasing attention for more than a decade, but many of the barriers women encounter remain rooted in the design of health systems.

For BBC StoryWorks, The Shift represents an effort to sustain attention on issues that too often receive episodic interest. The series combines personal stories with broader insights into the realities women face across different countries, cultures and stages of life.

The BBC initiative and the HLTH EU mainstage conversation arrive at a time when women’s health is attracting growing attention from investors, entrepreneurs, policymakers and health industry leaders. New companies are emerging. New technologies are being developed. More organizations are recognizing both the societal and economic importance of addressing longstanding gaps in care.

The timing of The Shift is notable. Women’s health innovation is receiving growing attention from investors, entrepreneurs, policymakers and health leaders. Industry analysts estimate that approximately $2 billion was invested in venture-backed women’s health companies across the United States and Europe in 2025, reflecting increased interest in addressing challenges that extend beyond reproductive health to include cardiovascular disease, menopause, mental health, oncology and healthy aging.

The trend signals growing recognition that improving women’s health is a societal imperative and a significant economic opportunity. Yet as the discussion at HLTH Europe made clear, investment and innovation alone will not be enough if women continue to face fragmented systems that are difficult to navigate.

When Access Exists but Navigation Fails

Dr. Agrawal, an obstetrician-gynecologist by training, whose work has included clinical practice in the UK NHS, global pharma brand stewardship in emerging middle-income nations, maternal health awareness initiatives, and the creation of sustainable health markets, described a reality familiar to many women. Access to care may exist on paper; however, reaching that care, understanding available options and navigating fragmented systems remains a challenge.

“We’ve built systems like mazes with different entry points, different providers and different messages,” said Dr. Agrawal. “Women are often left navigating all of this themselves at the moments where they are most vulnerable.”

Her observation echoed the comments by fellow panelists, which touched on an issue that extends beyond women’s health. Across many countries, patients frequently encounter disconnected providers, inconsistent communication and care journeys that require them to coordinate appointments, referrals and information on their own. The burden of connecting those pieces often falls on the individual seeking care rather than the system intended to support them.

For women, that complexity can be especially challenging. Responsibilities related to caregiving, work, family and personal health often intersect at the very moment care is needed. Understanding what symptoms are normal, knowing when to seek help, determining where to go and finding trusted sources of information become added obstacles.

That reality led to one of the discussion’s compelling observations. “This is not an access problem. It’s a design problem.”

The distinction matters. Discussions about women’s health often focus on whether services exist. Design asks a different question: can people realistically find, understand and benefit from those services when they need them most?

The Power of Stories to Sustain Change

The panel also explored the role technology may play in addressing those challenges. Rather than adding new layers of complexity, emerging digital tools and artificial intelligence applications are increasingly being developed to simplify navigation, improve continuity and support people between clinical encounters.

“What excites me is that technology is finally starting to reduce friction instead of adding layers of complexity,” Dr. Agrawal observed.

That perspective aligned with comments from Bonfiglioli, whose work at Microsoft focuses on helping health systems leverage data, cloud technologies and artificial intelligence to improve outcomes. Technology, however, was not presented as a solution on its own. The discussion repeatedly returned to the importance of human connection.

Those themes are central to the documentary series itself. BBC StoryWorks has built a reputation for transforming complex issues into compelling narratives that audiences can understand and relate to. Through The Shift, the goal is not merely to document challenges but to foster greater understanding of the experiences women face and the opportunities that exist to improve care.

Abbas emphasized the power of storytelling to connect data and lived experience. Statistics can identify a problem. Research can explain it. Stories help people understand why it matters and why action is necessary.

That may be the enduring value of The Shift. The series does not introduce a new conversation. Instead, it brings fresh perspectives to longstanding challenges. Through stories from around the world, the films remind viewers that behind every statistic is a person navigating the complexities of health and care. By fostering greater understanding and empathy, the series encourages health leaders, innovators and policymakers to view women’s health not as a periodic topic of interest, but as an ongoing priority deserving sustained attention and action.

The women featured throughout the series deserve more. The discussion at HLTH Europe reinforces that improving women’s health is more than developing new technologies and expanding services. It is also about creating systems that are easier to navigate, more responsive to people’s medical priorities and ultimately more human in their design.

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The Centers for Medicare & Medicaid Services released the rules on June 1. That deadline was set last year in the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which established a work requirement for certain people enrolled in Medicaid, the state-federal health insurance program for people with low incomes or disabilities.

Medicaid agencies are scrambling to rework IT systems and make sure they have staff to effectively enforce the rules, while also keeping enrollees from losing coverage for administrative reasons, such as difficulty navigating state eligibility portals.

The newly announced regulations offer a clearer picture of what roughly 18.5 million Medicaid enrollees will have to do to prove they qualify for benefits.

Jim Torres, who helps people enroll in health coverage at the Samuel U. Rodgers Health Center in Kansas City, Missouri, said a “very small percentage” of his clients have heard of the changes coming to Medicaid.

“These folks have very busy lives. They’re doing the best they can to get by,” he said. “It’s just not a top-of-mind thing for most of them.”

Health policy researchers and consumer advocates said enrollees should keep a few things in mind as the Jan. 1, 2027, rollout approaches in most states.

1. The work rules won’t apply to everyone.

The new rules will apply to people covered through what’s known as Medicaid expansion. Since 2014, more than 40 states and the District of Columbia have decided to allow more people into their Medicaid programs, generally low-income adults without dependents. Georgia and Wisconsin offer coverage to some people in this group, so they’ll be subject to the rules.

Children and pregnant people, as well as individuals with disabilities who receive Social Security payments — all groups that already qualify for Medicaid — won’t be subject to the rules. Nor will people determined to be “medically frail,” or too sick to work.

People subject to the work rules are “crowding out” people in the Medicaid program who are “truly in need,” CMS Administrator Mehmet Oz claimed during a June 1 press call. “Work requirements are going to turn this around, we hope.”

The rules are set to take effect in most places in January. Nebraska started enforcing them in May. Montana plans to start in July but won’t kick people off until October. Arkansas will do a “soft” launch in July — it will start enforcing the rules but with no penalties until next year.

2. States will take your word that you’re too sick to work. For now.

Federal officials have stressed that states should make the process of reporting hours and requesting exemptions as simple as possible for Medicaid enrollees by creating automated systems and using existing data sources, such as unemployment and education records.

If states cannot determine you’re performing 80 hours of qualifying activities a month using those data sources, you may be allowed to “self-attest” to that in 2027, health policy researchers said.

People will also be allowed to “self-attest” that they are too sick to work in 2027, and do so one time in 2028. Then states will start asking for proof, if they can’t find it through available data.

But after the initial rollout, the burden of proof is likely to still fall on many enrollees, said researchers and consumer advocates.

People may need to dig up pay stubs, medical records, and doctors’ notes and submit them for state review, said Morgan Henderson, who has studied Medicaid work programs in Georgia and Arkansas at The Hilltop Institute, a research center at the University of Maryland-Baltimore County.

“The higher this manual reporting burden, the less people are going to do it,” he said. “That means that we’re going to see coverage drop-offs.”

3. The rules are tougher than expected for people too sick to work.

One of CMS’ primary goals has been to “protect vulnerable populations” through “strong exemptions to make sure people who can’t reasonably be expected to work are not subject to the requirements,” Dan Brillman, a deputy administrator at the agency, said during the June 1 press call.

Consumer and patient advocates, however, said the final rules’ exemptions are more restrictive than expected. Enrollees will eventually have to provide documentation, such as a statement from a medical professional, to prove that a health condition keeps them from working. And each individual state will have to determine the severity of beneficiaries’ medical conditions.

“Someone could be medically frail in Nebraska but not medically frail in Delaware,” said Carolyn Sheridan, associate director of state policy for the National Organization for Rare Disorders, which lobbies for patients with rare diseases. She said her group had hoped the rules would offer a standardized definition of who counted as medically frail and not leave the decision up to states.

Trump administration officials have publicly crusaded against fraud in government health programs, such as Medicaid, and states could face financial penalties for incorrectly granting people exemptions from the work rules, said Jennifer Tolbert, who researches Medicaid at KFF, a health information nonprofit that includes KFF Health News.

“States may be more cautious,” she said. “That will likely lead to people losing coverage who may still be eligible.”

4. Only certain qualifying activities count.

Enrollees can satisfy the rules by working 80 hours a month. They can also be enrolled in college courses, volunteer through a community organization, or do “in-kind” work that doesn’t result in pay.

The rules set out, in detail, how many academic credit hours translate to 80 hours a month — students need to be enrolled in six credit hours per semester to meet the “half-time” requirement. An unpaid internship can count toward the 80 hours.

People can also prove they’re volunteering with “a document from a community service organization.”

Consumer advocates say it might be hard for people to obtain proof they’re performing these kinds of informal activities. But supporters of the rules say volunteerism can already be tracked.

“If you run into trouble with the law and the judge says, ‘Hey, you need some volunteering and community service to serve your time,’ there are already ways that we verify that,” said Niklas Kleinworth, who works on state health policy for the conservative Paragon Institute.

5. You have time to prepare.

Make sure your state Medicaid agency has your current mailing address and keep your eye on your mailbox, said researchers and consumer advocates. State Medicaid agencies must inform you in two ways if you’ll be subject to the rules — by either regular mail or email, and by one other form of communication, such as a text or phone call or by posting a notice online.

“The important stuff comes by mail,” Henderson said.

And check in with your state Medicaid agency, said researchers and advocates. Some states, including Arkansas, California, and Wisconsin, have already posted information about the work rules on their websites. If you can’t find what you’re looking for there, visit or call a local office. A caseworker should be able to tell you whether you’ll be subject to the rules.

“Get ahead of this,” said Joan Alker, who is executive director of the Georgetown University Center for Children and Families and studies Medicaid. “So that you don’t end up going to the pharmacy one day and they say, ‘Oh, you’re not insured anymore’ when you’re trying to get your prescriptions refilled.”

KFF Health News correspondent Samantha Liss and senior correspondent Rachana Pradhan contributed to this report.

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Loneliness, it turns out, isn’t just an emotion. It’s a biological signal, as powerful and urgent as hunger or thirst. When you’re lonely, your brain doesn’t just feel sad. It sounds an alarm. Your body responds. And if that alarm keeps ringing, day after day, real physical damage begins.

Your Brain Treats Loneliness Like Starvation

Here’s something researchers at MIT discovered when they had people sit alone in a room for ten hours: afterward, when those isolated individuals looked at pictures of people laughing and connecting, the same part of their brain lit up that activates in people who are starving and looking at food. That’s not a metaphor. The craving for company and the craving for food share the same neural real estate.

Kay Tye, a neuroscientist at the Salk Institute for Biological Studies in California, has spent years mapping what she calls “social homeostasis” in the brain. Homeostasis is the fancy word for the way your body stays balanced. Your temperature stays near 98.6 degrees. Your blood sugar stays in a range. Tye’s research suggests that your need for human connection operates in the same way. Your brain has a set point. Stray too far from it, and systems start firing to bring you back.

In 2025, a paper published in Biological Psychiatry by Tye and colleagues formally introduced “social homeostasis” as a new way to think about mental health. The authors argue that chronic loneliness or overcrowding can shift the brain’s set point, leading to the kind of nervous system imbalance seen in many psychiatric conditions.

Deep Inside the Brain, a Social Thermostat

Catherine Dulac, a neuroscientist at Harvard University, wanted to know exactly where in the brain this social regulation lives. She looked to the hypothalamus, the ancient region buried deep in our skulls that controls hunger, thirst, and sleep. It turned out to be the right place to look.

In 2025, her team published findings from experiments on mice that had been separated from their companions for 5 days. They found two distinct clusters of neurons in the hypothalamus. One cluster fired when the animals were alone. The other fired when they were reunited. More telling: the longer the animals had been isolated, the more intensely they sought contact once reunion was possible. Greater deprivation, greater need. Just like thirst.

When researchers artificially activated the “separation” neurons, the mice actively avoided whatever chamber triggered the signal. Being alone felt bad, in a physical, measurable way. When they activated the “reunion” neurons, which connect to the brain’s dopamine reward system, the mice sought out that feeling. Connection felt good. Not just emotionally. Chemically.

These deep brain structures look nearly identical in mice and humans. We share this wiring because it’s ancient. The need to belong is not a modern luxury. It’s a survival code, written into the oldest parts of who we are.

Touch Matters More Than You Think

In Dulac’s experiments, vision didn’t count for much. Neither did sound or smell. Mice separated by a screen that still let them hear and smell each other reacted as if they were fully alone. The only sense that truly registered “I’m not alone” was touch. The physical presence of another body against their own.

Ishmail Abdus-Saboor, a neurobiologist at Columbia University, studies the specific nerve pathways dedicated to social touch in human skin. Our bodies actually have neurons in hairy skin that respond specifically to slow, gentle stroking, the kind a friend or family member might offer. These aren’t generic touch receptors. They’re wired for connection. A hug or a hand on the shoulder isn’t just a nice gesture. It’s information your nervous system uses to update its social score.

This is why phone calls help but don’t completely fill the gap. Why video chats feel better than nothing, but still leave something missing. Your brain needs data that only physical proximity can provide.

When Loneliness Goes Untreated, Your Body Pays

Social disconnection isn’t just hard on the heart emotionally. It’s hard on the actual heart. Research published in Cureus in 2025 reviewed data spanning decades and found that loneliness nearly doubles the risk of stroke and recurrent coronary artery disease, driven largely by increased inflammatory responses in the body.

The American Heart Association has stated that social isolation and loneliness raise the risk of heart attack, stroke, or death from either condition by about 30 percent. And a 2025 narrative review published in the journal Stress mapped the full internal chain of events: loneliness activates the body’s stress response system, raises cortisol levels, increases inflammatory proteins in the blood, changes how the amygdala reacts to social threat, and contributes to cardiometabolic risk markers.

Research published in Frontiers in Human Neuroscience in 2026 linked chronic loneliness to reduced gray matter in brain regions involved in memory and emotional regulation, including the hippocampus. It also found that loneliness is a significant risk factor for accelerated cognitive decline and dementia.

Put simply: isolation doesn’t just make us miserable. It changes our brain structure, disrupts our hormones, inflames our blood vessels, and shortens our lives.

What This Means for How We Live

Knowing that connection is a biological need rather than a preference changes the conversation. You’re not weak if you feel lonely. You’re not clingy if you crave company. You’re responding to an ancient alarm system that has kept our species alive for hundreds of thousands of years.

The research also offers a practical insight. Because touch plays such a central role, the quality of our physical presence with others matters enormously. Abdus-Saboor says he’s intentional about physical contact with his family every single day. Not grand gestures. Just a hug before the kids leave for school. A hand on a shoulder. A back rub. These aren’t small things. They’re medicine.

Tye adds another useful idea: building a variety of social settings into your life. Spending time alone, in small groups, and occasionally in larger groups can help your social thermostat stay flexible and resilient. The goal isn’t constant togetherness. It’s a healthy range.

It’s also worth noting that the damage from loneliness isn’t inevitable. Research on loneliness as a health issue consistently points to the same takeaway: these effects are modifiable. Community programs, social prescribing in healthcare, nature-based group activities, and intentional outreach to isolated neighbors all show measurable results.

The Bottom Line

If you feel lonely, don’t brush it off as a mood that’ll pass. Your brain is signaling something real. Your body is already responding. The good news is that connection, real physical presence with people who matter to you, works as powerfully in the other direction. It turns the alarm off. It restores the balance. It’s not a luxury. It’s what your biology has been asking for all along.

Science is saying what our hearts have always known: we need each other. Now we know exactly why.

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Diabetes

40 million Americans have diabetes mellitus, or 12% of the population. Of these 38 million have type 2 diabetes (previously known as “adult onset”) and 2 million have type 1 (previously known as “juvenile diabetes.) 29 million have been diagnosed, yet 11 million are unaware that they have the disease. Our focus is type 2 diabetes.

Diabetes type 2 incidence increases with age, such that nearly 30% of those over 65 have diabetes, compared to ages of 40 to 59 with a 12% incidence, and 4% for those under 40.

Of great concern is the rising incidence over time. In 2000, a total of 8% of Americans had diabetes. This has risen to about 12% or a 50% increase in just two decades. Some would term this an epidemic. Of further concern, many young people are now developing diabetes.

Diabetes substantially increases the risk of multiple diseases. Among them are blindness, kidney failure (the most common reason for a kidney transplant is diabetes damage), cardiovascular disease, including heart attacks and strokes, loss of sensation in the feet and lower legs (neuropathy and paresthesia), reduced vascular supply to the lower legs and the feet, often resulting in amputation of toes, feet, or legs, and Alzheimer’s disease.

Diabetes and its associated diseases combined cost America $640 billion per year, or 25% of all healthcare spending.

The major risk factors for type two diabetes include being substantially overweight, having a family history, being inactive or sedentary, and being over the age of 45.

You can’t change your family history. But your genes need not be your destiny. The basics of prevention include losing weight, increasing activity, eating healthy foods, and substantially reducing the intake of ultra-processed foods.

Diabetes and Alzheimer’s disease

Type 2 diabetes increases the risk of Alzheimer’s disease by 50 to 65%. It’s a shared risk factor with increased blood pressure and increased cholesterol, all leading to brain cell inflammation.

The increased risk of diabetes correlates with insulin resistance not only throughout the body but also in the brain. Some scientists think that brain insulin resistance is separate from the resistance in other parts of the body, and as a result, use the term “type 3 diabetes” as a synonym for Alzheimer’s disease. The brain cells are in effect “starved” for glucose, which is the neurons’ principal source of energy, despite plenty of glucose circulating in the bloodstream.

Insulin resistance of brain cells is associated with increased oxidative stress and neuroinflammation, which in turn leads to neurodegeneration.

Bottom line — reducing the possibility of developing diabetes markedly reduces your chances of developing Alzheimer’s disease. Diabetes begins with prediabetes, so the place to start your preventive work is there.

Prediabetes

115 million Americans have prediabetes. 81% do not know it. 18% of teens have prediabetes, and this number is on the rise.

The typical person with prediabetes is overweight, has excess belly fat, and is sedentary. They tend to eat a diet high in sugar and foods that are quickly digested into sugar, as well as ultra-processed foods. Many will also have a family history of diabetes.

Those with prediabetes have a 5–10% chance of progressing to diabetes each year, which accumulates so that in 3–5 years, 15–30% will have developed diabetes. And, if followed for enough years, up to 70% will progress.

Prediabetes is diagnosed by measuring your average blood glucose over the course of 2 to 3 months. This is done with a test called A1c, a blood test that can be drawn at any time of day. If the A1c is between 5.7% and 6.4%, that is diagnostic of prediabetes. If it’s 6.5% or higher, that’s diagnostic of diabetes. As noted, most people with prediabetes don’t know it. However, the A1c test is simple and inexpensive. If you have any of the risk factors for prediabetes, it’s well worth your while to have the test. Your doctor may order it at your annual evaluation. Ask to have it done and then ask for the result.

Knowing you have prediabetes is essential because the progression to diabetes can be reversed with lifestyle changes. Yes, these can be challenging, but they are well worth the time and effort so that you do not progress to diabetes and all of its downstream complications, including dementia.

The other reason to reverse prediabetes is that it is not a benign condition. It is silent but causes trouble over time. Prediabetes leads to slow but long-term damage to blood vessels, the heart, and the kidneys. Prediabetes can be part of the metabolic syndrome — a combination of any three of elevated blood sugar, high blood pressure, high LDL cholesterol and low HDL cholesterol, elevated triglycerides, and excess belly fat. These conditions in combination lead to diabetes, heart disease, stroke, fatty liver disease, and cognitive decline.

Although usually not measured, the underlying problem is the early stages of insulin resistance when the pancreas can still compensate by producing excessive insulin to overcome the resistance. Once it can no longer do that, blood glucose remains high, and you now have diabetes.

Reversing prediabetes

The good news is that you can reverse prediabetes back to normal. The steps are straightforward and usually do not require medication. Since prediabetes develops because of being overweight, being sedentary, and eating too much sugar and foods that readily convert to sugar, the steps are straightforward.

Check your waist-to-height ratio. Your waist should be less than 50% of your height. Details here.

Losing just 5 to 7% of body weight will reduce the risk of progressing to diabetes by 50%. For a 200-pound person, this is only 10–14 pounds. The second step is to get about 150 minutes of aerobic exercise each week. A brisk 30-minute walk five days a week will suffice. Add resistance exercises 2 to 3 times per week.

The third step is to eat a low-glycemic (meaning food that does not digest to sugar rapidly and thereby leads to rapid increases in blood sugar — think candy, ice cream, cakes), micronutrient-dense diet that includes increased fiber intake, non-starchy vegetables (for example, dark green veggies), whole grains (whole wheat, brown rice), legumes (beans and lentils), lean meats, fish, eggs, nuts, and avocados.

It is very important to reduce sugary drinks and high-sugar foods, such as pastries, pies, and ice cream. Eating only whole grains means no products made from white flour, such as white bread, most prepared cereals, pastries, and donuts.

Avoid ultra-processed foods, as they contain high levels of sugar, salt, and white flour. Ultra-processed foods themselves are linked to dementia. It is also important to get adequate sleep and to reduce chronic stress.

It’s a good idea to monitor your progress with continuous glucose monitoring. It will show you whether certain foods cause spikes in blood sugar and how exercise affects it. These monitors are now available at most pharmacies.

These lifestyle changes can reverse prediabetes within a few months.

You want to get your A1c level down, not just to the upper limit of normal at 5.6, but lower still, because the cutoff from normal to prediabetes, although highly useful, is still a static number. You want to be well under the top limit of “normal.”

Some people have tried but cannot lose weight or can’t keep it down after losing. They often benefit from using a GLP1 drug such as Wegovy (semaglutide) and Zepbound (tirzepatide). For many people, these have proven highly valuable. A word of caution. Weight loss usually includes both fat and muscle, so you need to do resistance exercises to counteract muscle loss. Once started, many people need to continue indefinitely, otherwise they regain weight, fat, but not muscle.

It is to your definite advantage to learn if you have prediabetes and then to do what is needed to reverse it. Habits can be difficult to modify, but the benefits are so great that the time and effort are well worth it, including a major risk reduction in dementia. And remember, it is never too late to get started.

With thanks to retired long-time expert diabetes educator Charlene Freeman, RN CDE CPT

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A bill passed by the state legislature in March then signed into law by Democratic Gov. Jared Polis allows Colorado to further uncouple itself from federal guidance.

The law allows health officials to follow the recommendations of national medical groups when making decisions such as purchasing bulk vaccines for the Medicaid program.

“We are insulating our state from the dysfunction coming out of Washington,” said Democratic state Sen. Kyle Mullica, a co-sponsor of the bill and a registered nurse. “We’re going to rely on science.”

“From fighting during the pandemic for Coloradans to get vaccines as quickly as possible to combating the Trump Administration’s barriers to getting vaccinated, we have expanded access to vaccines for Coloradans who want them,” Polis said in a statement when he signed the law.

Colorado is one of at least 29 states that, along with Washington, D.C., have taken steps to bypass the new federal recommendations amid worries that the changes could chip away at public trust in vaccines and erode broad vaccine coverage.

Previously, Colorado, like most states, had followed federal guidance set by the Centers for Disease Control and Prevention. In January, CDC advisory panelists, selected by Health and Human Services Secretary Robert F. Kennedy Jr., removed six pediatric immunizations from the agency’s universal recommendation list.

Last year, doctors, scientists, local leaders, and other supporters came together to form an outreach and advocacy coalition called Colorado Chooses Vaccines.

The group aims to offer a clear, unified voice on the proven benefits of vaccines and reassure residents confused by the many federal changes.

Carol Boigon, a former Denver City Council member, joined the group because she wants more people to hear her own chilling story about vaccine-preventable illness.

“Every summer everybody got sick,” Boigon said, recounting her childhood in 1950s Detroit.

The illness was polio, a highly contagious viral disease that attacks the nervous system, sometimes causing partial or full paralysis.

During the summer of 1953, “the whole block was sick and some of us got crippled, and that was just the way it was,” she said.

New Group Steps Up

Boigon’s personal history will be part of the coalition’s work to educate new generations about the dangers of infectious diseases that were once common in the U.S. but are now relatively rare.

The group, which formed last September, will also compile vaccine information from medical groups and the state health department and advocate for policy proposals with the state government.

“It was in direct response to the federal threats,” said another coalition member, former state lawmaker Susan Lontine. She leads the nonprofit Immunize Colorado.

Another member, public relations specialist Elizabet Garcia, wants more outreach to Hispanics, whose vaccination rates lag behind other groups’.

“A lot of time it’s this fear that they’re going to have to pay out-of-pocket, that their insurance doesn’t cover it, that they might not even have insurance in general,” Garcia said.

Boigon was 5 when she got sick and was hospitalized for six weeks with a fever. The virus attacked her spine.

“None of my limbs worked immediately afterwards,” Boigon said.

Although she regained function in her other limbs, her right arm never fully recovered. She had to adapt, relearning everyday tasks such as reaching out to shake hands with people with her left hand.

In 1955, not long after she got sick, the new polio vaccine became more widely available to the public. As vaccinations took off, U.S. cases of polio, once one of the nation’s most feared diseases, dropped by an estimated 85%-90%.

Increasing Public Trust

State leaders have taken other steps to promote public health. After the Trump administration pulled the U.S. out of the World Health Organization, several states, including Colorado, decided to join the WHO’s Global Outbreak Alert and Response Network on their own.

Colorado also joined a multistate lawsuit challenging the Trump administration’s changes to the childhood vaccine schedule.

And the new state law has provisions besides allowing the state to diverge from federal recommendations. It codifies pharmacists’ ability to prescribe and give vaccines themselves. It also increases legal protections for healthcare workers who give vaccines.

“This law will provide more clarity to guide all Coloradans, including providers who administer vaccines,” Lontine said.

But the legislation has opponents who say it would interfere with parental choice and claim vaccines might be unsafe or ineffective.

“I just want to make sure we’re not just getting into a big political dispute between the federal recommendations — the CDC and so forth — and different political views in Colorado here,” said Republican state Sen. John Carson, who voted against the vaccine bill.

NPR contacted the U.S. Department of Health and Human Services about Colorado’s new law. Spokesperson Emily Hilliard answered in an email: “The updated CDC childhood schedule continues to protect children against serious diseases.”

Preventable Illnesses Surge

The flurry of statewide activity comes as Colorado and the nation have seen surges in illnesses such as flu and measles.

As of mid-May, Colorado had recorded 22 measles cases this year. In 2025, it registered 36 cases, according to the state health department, far surpassing totals from previous years.

Across Colorado, kindergarten vaccination rates for measles were 88% last school year — with only a few counties achieving rates of 95%, the level needed for herd immunity, according to data published by The Washington Post in December.

This has also been Colorado’s worst flu season in recent years.

Vaccination rates for both flu and covid-19 have dropped slightly in Colorado, according to the state health department.

Eight children in Colorado have died this season from flu; one from covid; and one from RSV, or respiratory syncytial virus. Vaccines for all three are available for children and recommended by the state’s health department.

Kennedy, a longtime anti-vaccine activist, has defended his decisions to overhaul the recommended schedule for childhood vaccinations.

In March, a federal judge put on hold many of the changes.

“We’re not taking vaccines away from anybody. If you want to get the vaccine, you could get it. It’s going to be fully covered by insurance just like it was before,” Kennedy told CBS News in January.

When a reporter suggested the new changes could result in fewer people getting a flu vaccine, Kennedy said: “Well, that may be, and maybe that’s a better thing.”

Boigon is sometimes incredulous at everything that has happened.

“It’s like we’re going backwards,” she said. “It’s like we have decided we don’t want a modern life; we want to be back in the 1950s, where children are sick and dying.”

This article is from a partnership with Colorado Public Radio and NPR.

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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
6. Romero M, Góngora D, Caicedo M. Cost-Minimization and Budget Impact Analysis of a Hexavalent Vaccine (Hexaxim®) in the Colombian Expanded Program on Immunization

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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/           
12. Practical Implementation Guide for the 2016 National Immunization Schedule in Algeria. Available at: https://cnpm.org.dz/wp-content/uploads/2024/01/Guide_Pratique_de_Mise_en_Oeuvre_du_Nouveau_Calendrier_Natio-1.pdf
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

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His fears did not dissipate after the birth of the baby. Instead, they worsened. One night when the baby began to cry, and his wife failed to get up immediately to soothe him, Jake yelled out, “Shut the F… up!” Horrified by his actions, his wife turned on him. “What is wrong with you?!” she asked.

Jake eventually discovered what was wrong, but not before his job and his marriage suffered the effects of his changed behavior. Jake had developed what one in ten new fathers (13 percent according to some estimates) suffer from. Until recently, it was believed that only women suffered from Postpartum Depression (PPD.) While there is still no diagnostic category for PPD in the DSM, it is subsumed under the general category of Major Depressive Disorder.

SYMPTOMS OF MALE POSTPARTUM DEPRESSION

Symptoms of male PPD share many similarities to those in women. A partial list, includes:

• Irritability, anger, or aggressive behavior.
• Easily stressed.
• Withdrawal from family and relationships.
• Poor concentration and difficulty focusing.
• Changes in appetite or sleep patterns (insomnia or oversleeping).
• Feeling overwhelmed, anxious, or hopeless.
• Suicidal thoughts.
• Risk-taking behaviors including substance and alcohol use.
• Physical symptoms including headaches and stomach aches.
• Indecisiveness.
• Restricted range of emotion

CAUSES OF MALE PPD

Several factors put men at risk for PPD, including sleep deprivation, a prior personal or family history of depression, or a feeling of being shut out from mother and child. Up to half of all men with a depressed partner also show signs of depression according to one study, but surprisingly, fathers also experience hormonal shifts that alter mood, especially a decline in testosterone.

A 2024 article on Understanding Paternal Postpartum Depression notes that while more women than men suffer PPD (one in 7 versus one in 10), men also experience hormonal changes.

Jonathan R. Scarff, in his article Innovations in Clinical Neuroscience; Postpartum Depression in Men, explains that low testosterone in general is linked to symptoms of depression in men, while low levels of estrogen, prolactin, vasopressin, and/or cortisol in new fathers negatively affect father-infant bonding/attachment.

PUSHED OUT BUT RESPONSIBLE

Jenna Berendzen, ARNP at UnityPoint Health, suffered severe postpartum depression and anxiety after the birth of her son. While Berendzen was admitted to the county perinatal psych unit, her husband was left to worry about her and to figure out how to single handedly care for their new baby. Two years later they discovered that he, too, had suffered PPD, yet he couldn’t say anything at the time because, in his mind, he hadn’t given birth, especially a C-section. Instead he felt pushed aside while trying to carry the load of the entire family,”

An Allied Health article notes, “Many dads want to be active participants in the care of their new baby, but sometimes end up feeling like they’re on the outside. As the bond between mother and child begins to strengthen, fathers may feel sidelined. “Many men have a breadwinner mentality that compels them to bottle up the pressure and downplay symptoms of PPD both as they are preparing for fatherhood and afterward.”

In an article I wrote for L.A. Baby when my own son was a baby, I noted how women tended to believe they knew what was best for their baby, and as a result, often pushed their husbands out of the nursery, which only added to the father’s feelings of ineptitude, rejection and even abandonment. The result was that dads didn’t really bond with their babies until the child was older.

BECOMING A FATHER

Despite the dearth of research on new fathers, some experts claim that the journey to fatherhood represents a unique and transformative time in a man’s life. According to one study, “A man does not become a father only at the moment when the child is born…it is a long-lasting dynamic process where the father’s identity is formed and sustained through various experiences.”

Once the baby is born, everything suddenly becomes real. Even the diminutive size and fragility of a newborn can feel overwhelming. Dads need support, reassurance and education about how to hold and care for an infant. This is where some men back off, preferring to abdicate the “tender tasks” to mom, rather than learn from her.

In my own book Midlife Parenting, A Guide to Having and Raising Kids in Your 30s, 40s and Beyond, I found that men who start parenting later in life are more mature and settled. However, many of them are also accustomed to more freedom and independence, which presents its own challenges.

CHANGING ROLES AND EXPECTATIONS FOR FATHERS

Researchers point out that the psychological process of becoming a father has changed in the last couple decades. As one study notes: “We can observe a shift in the perception of the father’s role in Western societies, and in younger generations there is a growing incidence of the so-called “new fatherhood” associated with emotional intimacy and availability of the father as well as increased involvement of the father in childcare and household care.” The authors point out that today men are not only welcomed, but are expected to attend parenting preparation courses and to be present during childbirth as well as postnatal care.

SO WHAT’S A DAD TO DO?

The good news is that there is treatment for male PPD. It begins the moment the couple learns they are having a baby. That’s when the conversations should start, says one researcher who offers the following advice:

• Invite Active Participation: Active participation in the pregnancy, supporting one’s partner, and learning what to expect during and after delivery will help fathers feel involved and prepared.
• Talk to a Financial Planner: Money is a top challenge. With proactive conversation and some professional guidance, new fathers will know what to expect and how to best navigate the expenses of having a child.
• Lean into Support: As the baby’s arrival date approaches, soon-to-be fathers should lean into their support system. Reinforcing relationships and being open to advice will help fight the fear of the unknown.
• Seek out Help: As men are preparing for fatherhood, it’s normal to occasionally feel overwhelmed. It’s important to seek out help sooner rather than later and work to solidify a healthy mindset before the baby arrives.

If symptoms do emerge, dads should seek out professional help. Jonathan Scarf suggests that in serious cases, psychotherapy, especially cognitive behavior therapy (CBT) and interpersonal therapy (IPT) have been shown to be effective, as well as daily morning light to correct circadian rhythms, which are related to PPD.

For some men, individual or couples therapy may be preferred over anti-depressants. Other times a combination may be most effective. Treatment can be short-term or long-term, based on whether there are deeper or more serious underlying issues, which are exacerbated by the birth of a child.

Other recommendations include meditation, yoga and other “mindfulness” approaches to stress. And finally, it would be helpful if employers or government programs supported paid paternity leave for men, recognizing the value of fathers in the earliest stages of parenthood.

Christi Taylor-Jones is a Licensed Marriage and Family Therapist, Jungian Analyst and writer. She is author of Midlife Parenting and Touched by Suicide. She is also a mother and soon-to-be grandmother.

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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.

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