World Health Organization

Italy is welcoming 19 children who were evacuated from Gaza by the World Health Organization. They’ll receive advanced medical treatment in several hospitals across the country.

A surge in chikungunya cases has hit southern China, fuelled by climate change, urbanisation and global travel. Experts warn the next pandemic is inevitable – but have we learned enough from COVID-19 to be prepared?

Presenter: Stefanie Dekker

Guests:
Carmen Perez Casas – Head of pandemic prevention, Unitaid
Albert Fox Cahn – Founder, Surveillance Technology Oversight Project (STOP)

US states have relied on vaccine mandates since the 1800s, when a smallpox vaccine offered the first successful protection against a disease that had killed millions.

More than a century later, Florida’s top public health official said vaccine requirements are unethical and unnecessary for high vaccination rates.

“You can still have high vaccination numbers, just like the other countries who don’t do any mandates like Sweden, Norway, Denmark, the [United Kingdom], most of Canada,” Florida Surgeon General Dr Joseph Ladapo said on October 16. “No mandates, really comparable vaccine uptake.”

It’s true that some countries without vaccine requirements have high vaccination rates, on a par with the United States. But experts say that fact alone does not make it a given that the US would follow the same pattern if it eliminates school vaccination requirements.

Florida state law currently requires students in public and private schools from daycare through 12th grade to have specific immunisations. Families can opt out for religious or medical reasons. About 11 percent of Florida kindergarteners are not immunised, recent data shows. With Florida Governor Ron DeSantis’s backing, Ladapo is pushing to end the state’s school vaccine requirements.

The countries Ladapo cited – Sweden, Norway, Denmark, the UK and parts of Canada – don’t have broad vaccine requirements, research shows. Their governments recommend such protections, though, and their healthcare systems offer conveniently accessible vaccines, for example.

UNICEF, a United Nations agency which calls itself the “global go-to for data on children”, measures how well countries provide routine childhood immunisations by looking at infant access to the third dose in a DTaP vaccine series that protects against diphtheria, tetanus and pertussis (whooping cough).

In 2024, UNICEF and the World Health Organization (WHO) reported that 94 percent of one-year-olds in the United States had received three doses of the DTaP vaccine. That’s compared with Canada at 92 percent, Denmark at 96 percent, Norway at 97 percent, Sweden at 96 percent and the UK at 92 percent.

Universal, government-provided healthcare and high trust in government likely influence those countries’ vaccine uptake, experts have said. In the US, many people can’t afford time off work or the cost of a doctor’s visit. There’s also less trust in the government. These factors could prevent the US from having similar participation rates should the government eliminate school vaccine mandates.

Universal healthcare, stronger government trust increase vaccination

Multiple studies have linked vaccine mandates and increased vaccination rates. Although these studies found associations between the two, the research does not prove that mandates alone cause increased vaccination rates. Association is not the same as causation.

Other factors that can affect vaccination rates often accompany mandates, including local efforts to improve vaccination access, increase documentation and combat vaccine hesitancy and refusal.

The countries Ladapo highlighted are high-income countries with policies that encourage vaccination and make vaccines accessible.

In Sweden, for example, where all vaccinations are voluntary, the vaccines included in national programmes are offered for free, according to the Public Health Agency of Sweden.

Preventive care is more accessible and routine for everyone in countries such as Canada, Denmark, Norway, Sweden and the UK with universal healthcare systems, said Dr Megan Berman of the University of Texas Medical Branch’s Sealy Institute for Vaccine Sciences.

“In the US, our healthcare system is more fragmented, and access to care can depend on insurance or cost,” she said.

More limited healthcare access, decreased institutional trust and anti-vaccine activists’ influence set the US apart from those other countries, experts said.

Some of these other countries’ cultural norms favour the collective welfare of others, which means people are more likely to get vaccinated to support the community, Berman said.

Anders Hviid, an epidemiologist at Statens Serum Institut in Copenhagen, told The Atlantic that it’s misguided to compare Denmark’s health situation with the US – in part because Danish citizens strongly trust the government to enact policies in the public interest.

By contrast, as of 2024, fewer than one in three people in the US over age 15 reported having confidence in the national government, according to data from the Organisation for Economic Co-operation and Development, a group of advanced, industrialised nations. That’s the lowest percentage of any of the countries Ladapo mentioned.

“The effectiveness of recommendations depends on faith in the government and scientific body that is making the recommendations,” said Dr Richard Rupp, of the University of Texas Medical Branch’s Sealy Institute for Vaccine Sciences.

Without mandates, vaccine education would be even more important, experts say

Experts said they believe US vaccination rates would fall if states ended school vaccine mandates.

Maintaining high vaccination rates without mandates would require health officials to focus on other policies, interventions and messaging, said Samantha Vanderslott, the leader of the Oxford Vaccine Group’s Vaccines and Society Unit, which researches attitudes and behaviour towards vaccines.

That could be especially difficult given that the United States’s top health official, Health and Human Services Secretary Robert F Kennedy Jr, has a long history of anti-vaccine activism and scepticism about vaccines.

That makes the US an outlier, Vanderslott said.

“Governments tend to promote/support vaccination as a public health good,” she said. It is unusual for someone with Kennedy’s background to hold a position where he has the power to spread misinformation, encourage vaccine hesitancy and reduce mainstream vaccine research funding and access, Vanderslott said.

Most people decide to follow recommendations based on their beliefs about a vaccine’s benefits and their child’s vulnerability to disease, Rupp said. That means countries that educate the public about vaccines and illnesses will have better success with recommendations, he said.

Ultimately, experts said that just because something worked elsewhere doesn’t mean it will work in the United States.

Matt Hitchings, a biostatistics professor at the University of Florida’s College of Public Health and Health Professions, said a vaccine policy’s viability could differ from country to country. Vaccination rates are influenced by a host of factors.

“If I said that people in the UK drink more tea than in the US and have lower rates of certain cancers, would that be convincing evidence that drinking tea reduces cancer risk?” Hitchings said.

Google Translate was used throughout the research of this story to translate websites and statements into English.

The campaign aims to protect the children from the drug-resistant disease spreading across South Asia.

Bangladesh has begun a nationwide vaccination campaign to protect millions of children from typhoid, a life-threatening disease that is becoming increasingly resistant to antibiotics.

The monthlong drive, launched on Sunday, aims to immunise about 50 million children aged between nine months and 15 years with a single dose of the typhoid conjugate vaccine (TCV).

The vaccine, approved by the World Health Organization (WHO), offers protection for up to five years and is being distributed free under the government’s Expanded Programme on Immunisation (EPI).

The campaign follows mounting concerns over drug-resistant typhoid strains spreading across South Asia. Pakistan has been battling a strain since 2016 that is resistant to nearly all antibiotics except one.

Health workers in Bangladesh are administering the vaccine through schools, clinics, and door-to-door visits, prioritising urban slums and remote villages. The campaign will run until November 13, after which TCV will be included in the country’s regular immunisation schedule.

Typhoid, caused by Salmonella Typhi bacteria, spreads through contaminated food and water. It triggers fever, abdominal pain, and nausea, and can cause fatal complications if untreated.

Researchers in Bangladesh have recently identified ceftriaxone-resistant strains – a worrying development, as ceftriaxone remains one of the last effective treatments.

Experts warn that without preventive action, resistant strains could make typhoid far harder to manage. Supported by Gavi, the Vaccine Alliance, the campaign aims to lower infection rates and limit the spread of resistance.

Inaugurating the drive, the government’s health adviser, Nurjahan Begum, said it was “shameful” that children still die from typhoid in Bangladesh. She expressed hope that the country would defeat the disease as it did diarrhoea and night blindness.

Officials highlighted the vaccine’s strong safety record in neighbouring countries such as Pakistan, Nepal, and in India’s Mumbai, where no major side effects were reported.

Abuja and Nasarawa, Nigeria – In the neighbourhood of Kado Lifecamp on the outskirts of Nigeria’s capital, 29-year-old Eucharia Joseph grips a cooler box and sets out for her day. Inside are oral polio vaccines packed in ice.

Joseph’s route takes her through dusty lanes, past tin-roofed homes, mosques and churches. By nightfall, she and her team of six women will have vaccinated hundreds of children. Their mission: To ensure no child is left unprotected from the disease that once crippled thousands across the country.

In 2020, Nigeria was declared free of wild poliovirus by the World Health Organization (WHO) – a landmark achievement for a country once at the centre of global transmission. But the virus hasn’t vanished entirely.

A related strain, known as circulating vaccine-derived poliovirus (cVDPV), still threatens under-immunised communities. Unlike the wild virus, cVDPV emerges when the weakened virus from oral vaccines mutates and spreads via contaminated food or water, for instance, in areas where too few children are vaccinated.

That threat remains. Despite steady progress, Nigeria still reports sporadic outbreaks of cVDPV. As of March this year, the country had reported 10 cases of the mutated strain. Last year, 98 cVDPV2 cases were reported.

With ongoing insecurity in northern Nigeria and pockets of resistance elsewhere, the job of eradicating polio now rests heavily on the shoulders of women like Joseph, who are often the only ones granted access to households due to a confluence of cultural, religious and safety reasons.

“It’s my gift,” Joseph said of her work, as she adjusted her headscarf under the sun. “I go to different localities. I talk to mothers. I sit with them. I know how to convince them. That’s what makes this work possible.”

Women on the front lines

Female health workers like Joseph are the backbone of Nigeria’s polio response.

In rural or conservative communities, male health workers are often not allowed to interact with women and children. While in conflict-affected areas, strange men moving between households may be viewed with suspicion, as many of these areas are battling rebels.

In Borno State – the epicentre of Nigeria’s long-running Boko Haram rebellion and one of the regions hardest hit by polio outbreaks – the stakes are especially high. Male health workers have sometimes been suspected by the community of working with government forces or intelligence services.

In some neighbourhoods, the mistrust and resistance extend to female vaccinators as well.

“Most people in Maiduguri [the state capital] don’t always like the vaccine. They think it prevents them from giving birth,” said Aishatu, who chose not to reveal her last name. The community health worker leads immunisation rounds across several wards in the area.

Such rumours about the effects of vaccines have circulated for years, often fanned by misinformation circulating among community networks, some religious leaders, and occasionally by armed groups such as Boko Haram, which has attacked vaccinators and portrayed immunisation as part of a foreign agenda.

In some cases, religious teachings have been misrepresented, for example, claims that vaccines are forbidden during certain religious festivals or that immunisation interferes with divine will. There have also been conspiracy theories saying vaccines are a Western plot to sterilise children.

Combined with longstanding mistrust of government programmes in some areas, belief in these rumours has made vaccine acceptance a persistent challenge in parts of northern Nigeria, health workers say.

For front-liners like Aishatu, confronting the beliefs has become part of the job. Her strategy is persistence and patience.

“We handle it by trying to increase sensitisation,” she said, referring to the repeated community visits, one-on-one conversations, and informal group talks that female health workers use to counter vaccine myths and build trust among hesitant parents. “We keep talking to the mothers, telling them the truth. Some accept it slowly, some after seeing others take it.”

Aishatu has to balance this work with managing her household responsibilities. But she sees the job as something beyond a paycheck. “The work is a professional one,” she said. “But it also adds so much to life. I know I am helping people and I love it.”

But she also believes more needs to be done to expand the programme’s reach. “More female vaccinators are needed,” she said. “That’s the best approach for the government to use for creating more awareness about [the need and effectiveness of] polio vaccines.”

In areas or situations where male vaccinators face access constraints and restrictions, women doing the work have been more effective. And for some, their demeanour and approach to patients is what also makes a difference.

“Women are very social,” said Esu Danlami Audu, village head of Kado who has seen his village stamp out new polio cases because of efforts by women vaccinators.

“They are able to talk to parents, gain trust, and explain the importance of vaccines in ways men cannot. That is why they have played such an important role in our progress against eradication of poliovirus.”

This access has proven more critical in regions like Borno. According to the WHO, female vaccinators and community health promoters have been instrumental in reaching children in hard-to-access areas, sometimes even risking their lives to do so.

“All over Africa, despite facing life threats at many places, their [women vaccinators’] presence and persistence have helped overcome barriers of trust, cultural norms, and insecurity. This is especially true for conflict-affected areas of northern Nigeria where women are often the only ones allowed into households – especially those with young children – making their role irreplaceable,” said Dr Ndoutabe Modjirom, coordinator of WHO-led polio outbreaks rapid response team for the African region.

Innovation, persistence and economic ripple effect

To further counter these challenges, health workers have also adopted a mix of innovation and local knowledge.

Geographic Information System (GIS) mapping now helps identify missed settlements. Community mobilisers, often local women, monitor newborns and report missed vaccinations. Mobile health units and door-to-door outreach campaigns are routine.

“We go to schools, churches, mosques and markets,” said Aminat Oketi, a vaccinator in Nasarawa State and a mother of six. “Sometimes we vaccinate 150, even 300 children a day. The work is tough. But when I see a child protected, it is worth it.”

Although Oketi earns some money from her work, the job is not well paid. Most vaccinators receive just 12,000 naira (about $8) from the government for a five-day campaign. Transport often eats into their earnings, forcing them to supplement this income with petty trade or hawking goods.

Aishatu supplements her income by running a small beans trading business in Maiduguri to earn an income. “I buy and sell beans,” she said. “I manage it by separating my time to work [as a health worker] and do business.”

While the campaigns has improved public health outcomes, it has also unintentionally created a foundation for economic empowerment among women, many say. Empowered by training and purpose, many of these women have become micro-entrepreneurs and informal community leaders.

Vaccinators like Oketi, who joined the programme four years ago, are not only safeguarding children but also building personal livelihoods.

She runs a small poultry business alongside her health work. “I have a shop where I sell chicken feed and I rear birds too,” she said. Her modest vaccine stipend barely covers transport, but the exposure to community networks and the sense of mission have translated into entrepreneurial confidence.

“When people trust you with their children, they also trust you to provide them with other services,” she said. “My customers come because they know me from the vaccination rounds. It is all connected.”

This is a common trajectory. While some female vaccinators have leveraged their community credibility to start small businesses, others, like Joseph, have set up informal health outreach networks, advising new mothers and coordinating care for sick children.

According to Cristian Munduate, UNICEF’s country representative, this dual role of healthcare provider and entrepreneur reflects a deeper shift. “They are not just women with jobs; they are agents of change,” she said. “Vaccination campaigns have opened a pathway for leadership, agency, and financial independence.”

Helen Bulus, a government health officer in charge of vaccinations in Mararaba town in Nasarawa, reflects on the sense of commitment female health workers share.

“We are mothers too. Women take care of children, not just their own. That’s why they don’t give up [even when there is hardship],” she said.

And as they persevere, their work creates other positive ripples, like contributing to higher school enrolment among girls in some regions, she added. “As mothers become more economically stable, they invest more in their daughters’ futures.”

A global model  – with challenges

While wild polio now remains endemic only in Pakistan and Afghanistan, Nigeria’s experience offers vital lessons. Its fight against polio, led by women, supported by community trust, and bolstered by innovative strategies, has reshaped how public health can be delivered in fragile settings.

The next step, experts say, is sustaining this momentum.

“Routine immunisation must be strengthened,” said Munduate. “And communities must be supported, not just during outbreaks but all year round.”

The polio infrastructure has also transformed Nigeria’s broader healthcare system. Cold chains, data systems, and human networks developed for polio now support routine immunisations, maternal health, and even responses to outbreaks like cholera and COVID-19.

“We have built a legacy platform. Female vaccinators trained for polio are now part of nutrition drives, health education, and emergency response. They have become health champions,” WHO’s Modjirom explained.

Still, hurdles persist. Insecurity continues to hinder access in parts of northern Nigeria. In conservative areas, misinformation remains rife, fed by rumours that vaccines cause infertility or are part of foreign agendas.

Despite gains, health workers say there is little scope for complacency. Experts warn that until every child is reached, the virus remains a threat not just to Nigeria, but to global eradication efforts.

“For each paralytic case, thousands more may be infected,” said Munduate. “That’s why we can’t stop and efforts have to continue.”

The reporting for this story was supported by UN Foundation Polio Press Fellowship

United States health officials are urging travellers to remain vigilant as a mosquito-borne virus continues to circulate across parts of Asia, Africa, Europe, Latin America and the Indian Ocean.

Since the beginning of 2025, there have been approximately 240,000 chikungunya virus infections and 90 deaths in 16 countries, according to the European Centre for Disease Prevention and Control (ECDC).

In China, an outbreak has infected roughly 7,000 people since late June, with most cases concentrated in the city of Foshan, in Guangdong province, just north of Hong Kong. This marks the country’s largest chikungunya outbreak since the virus was first identified there in 2008.

Here is what we know about the disease and how it is spreading.

What is the chikungunya virus?

Chikungunya is a viral disease that is spread through the bite of infected Aedes aegypti mosquitoes. These mosquitoes also carry and spread dengue, yellow fever and the Zika virus.

The name, chikungunya, derives from a word in the Kimakonde language, spoken in Tanzania and Mozambique, meaning “to become contorted”.

In most cases, patients will feel better within a week. In many cases, however, the joint pain can last for months or even years.

There is no cure for the chikungunya virus, but deaths are rare. If an infected mosquito bites a healthy human, it injects the virus into the bloodstream.

People most at risk of serious illness from chikungunya include newborns, older adults and those with existing health problems such as heart disease or diabetes.

There is no cure for the chikungunya virus, but the death rate is low, except in high-risk populations.

If an infected mosquito bites a healthy human, it injects the virus into the bloodstream. If a non-infected mosquito bites a person who is already infected, it sucks the virus from that person’s blood and becomes a carrier capable of transmitting the virus to others through bites.

How bad is the current spread of the virus?

According to the World Health Organization (WHO), the current surge in cases began in early 2025, with major outbreaks in Indian Ocean Islands, including La Reunion, Mayotte and Mauritius.

In La Reunion, more than 47,500 cases of chikungunya and 12 associated deaths were reported up to May 2025, with sustained high transmission across the island, according to the WHO. The ECDC also reports that as of July 18, there were more than 54,000 cases reported from La Reunion.

This is now the most serious chikungunya outbreak in La Reunion since the 2005–2006 epidemic, which saw an estimated 244,000 to more than 300,000 cases, and prompted large-scale public health efforts to control mosquito breeding and limit transmission.

The virus has also spread to other countries, including Madagascar, Somalia and Kenya, and has shown signs of epidemic-level transmission in parts of Southeast Asia, as well as India, where financial capital Mumbai has seen a surge in cases since July.

The WHO has also raised concerns about the rising number of imported chikungunya cases in Europe. Since May 1, about 800 imported cases have been reported in mainland France.

According to the ECDC, the Americas as a region have reported the highest number of chikungunya cases globally. As of mid-July 2025, the countries with the most cases in the region include Brazil (185,553), Bolivia (4,721), Argentina (2,836) and Peru (55).

In China, infections have been reported in at least 12 cities across southern Guangdong province, in addition to Foshan.

Chinese authorities said that an “imported case triggered local transmission” in July, but did not specify where the infection originated. According to experts, rising global temperatures have led to warmer and wetter weather, allowing mosquitoes to thrive.

Separately, on Saturday, Hong Kong confirmed its first case of chikungunya: a 12-year-old boy who developed a fever, rash and joint pain since July 31, after visiting Foshan. This was the territory’s first case of the virus in six years.

How are China and other countries fighting the spread?

According to a Bloomberg news report, China has promised to take swift and decisive action to contain the spread of the chikungunya virus.

Drones are being used to find places where mosquitoes are breeding. At the same time, scientists are releasing large “elephant mosquitoes” – about 2cm (0.8 inches) long – whose larvae eat the smaller mosquitoes that spread the virus. Health experts hope these mosquito helpers will play an important role in stopping the outbreak.

According to a report by the BBC, residents of affected areas in China have been ordered to eliminate standing water in and around their homes – including in flowerpots, coffee machines and empty bottles. Noncompliance may result in fines of up to 10,000 yuan (approximately $1,400), and in more serious cases, people could face criminal charges for “obstructing the prevention of infectious diseases”.

Citing local sources, The New York Times said that in some instances, infected residents in Foshan are being moved to “quarantine wards”, where they are kept behind mosquito nets and screens. Some patients also say they were given no choice but to seek treatment at their own expense.

In other places, such as La Reunion and Mayotte, authorities have also launched enhanced surveillance, mosquito control initiatives and targeted vaccination efforts.

The Basque Country in Spain activated preventive protocols after a case was detected in Hendaye, just across the border in France. The protocols include increased surveillance in border towns and encouraging people to make reports through apps such as Mosquito Alert.

How can chikungunya be prevented and treated?

Health authorities advise protecting oneself against mosquito bites as the most effective strategy against the spread of chikungunya.

This may involve wearing long sleeves and trousers, applying mosquito repellents, removing bodies of standing water where mosquitoes can breed, and staying in closed, air-conditioned spaces indoors or behind mosquito netting when outdoors.

While there are no specific medicines to treat the virus, rest, fluids and pain relievers may help alleviate symptoms, according to the US Centers for Disease Control and Prevention (CDC).

However, some pain relievers may be unsafe during a suspected infection. The CDC recommends avoiding non-steroidal anti-inflammatory drugs (NSAIDs) until dengue is ruled out, as they can raise the risk of bleeding.

Houayxay, Laos – Fishing went well today for Khon, a Laotian fisherman, who lives in a floating house built from plastic drums, scrap metal and wood on the Mekong River.

“I caught two catfish,” the 52-year-old tells Al Jazeera proudly, lifting his catch for inspection.

Khon’s simple houseboat contains all he needs to live on this mighty river: A few metal pots, a fire to cook food on and to keep warm by at night, as well as some nets and a few clothes.

What Khon does not always have is fish.

“There are days when I catch nothing. It’s frustrating,” he said.

“The water levels change all the time because of the dams. And now they say the river is polluted, too. Up there in Myanmar, they dig in the mountains. Mines, or something like that. And all that toxic stuff ends up here,” he adds.

Khon lives in Laos’s northwestern Bokeo province on one of the most scenic stretches of the Mekong River as it meanders through the heart of the Golden Triangle – the borderland shared by Laos, Thailand and Myanmar.

This remote region has long been infamous for drug production and trafficking.

Now it is caught up in the global scramble for gold and rare earth minerals, crucial for the production of new technologies and used in everything from smartphones to electric cars.

Over the past year, rivers in this region, such as the Ruak, Sai and Kok – all tributaries of the Mekong – have shown abnormal levels of arsenic, lead, nickel and manganese, according to Thailand’s Pollution Control Department.

Arsenic, in particular, has exceeded World Health Organization safety limits, prompting health warnings for riverside communities.

These tributaries feed directly into the Mekong and contamination has spread to parts of the river’s mainstream. The effects have been observed in Laos, prompting the Mekong River Commission to declare the situation “moderately serious”.

“Recent official water quality testing clearly indicates that the Mekong River on the Thai-Lao border is contaminated with arsenic,” Pianporn Deetes, Southeast Asia campaigns director for the advocacy group International Rivers, told Al Jazeera.

“This is alarming and just the first chapter of the crisis, if the mining continues,” Pianporn said.

“Fishermen have recently caught diseased, young catfish. This is a matter of regional public health, and it needs urgent action from governments,” she added.

The source of the heavy metals contamination is believed to be upriver in Myanmar’s Shan State, where dozens of unregulated mines have sprung up as the search for rare earth minerals intensifies globally.

Zachary Abuza, a professor at the National War College in Washington and an expert on Southeast Asia, said at least a dozen, and possibly as many as 20, mines focused on gold and rare earth extraction have been established in southern Shan State over the past year alone.

Myanmar is now four years into a civil war and lawlessness reigns in the border area, which is held by two powerful ethnic armed groups: the Restoration Council of Shan State (RCSS) and the United Wa State Army (UWSA).

Myanmar’s military government has “no real control”, Abuza said, apart from holding Tachileik town, the region’s main border crossing between Thailand and Myanmar.

Neither the RCSS nor the UWSA are “fighting the junta”, he said, explaining how both are busy enriching themselves from the chaos in the region and the rush to open mines.

“In this vacuum, mining has exploded – likely with Chinese traders involved. The military in Naypyidaw can’t issue permits or enforce environmental rules, but they still take their share of the profits,” Abuza said.

‘Alarming decline’

Pollution from mining is not the Mekong River’s only ailment.

For years, the health of the river has been degraded by a growing chain of hydropower dams that have drastically altered its natural rhythm and ecology.

In the Mekong’s upper reaches, inside China, almost a dozen huge hydropower dams have been built, including the Xiaowan and Nuozhadu dams, which are said to be capable of holding back a huge amount of the river’s flow.

Further downstream, Laos has staked its economic future on hydropower.

According to the Mekong Dam Monitor, which is hosted by the Stimson Centre think tank in Washington, DC, at least 75 dams are now operational on the Mekong’s tributaries, and two in Laos – Xayaburi and Don Sahong – are directly on the mainstream river.

As a rule, hydropower is a cleaner alternative to coal.

But the rush to dam the Mekong is driving another type of environmental crisis.

According to WWF and the Mekong River Commission, the Mekong River basin once supported about 60 million people and provided up to 25 percent of the world’s freshwater fish catch.

Today, one in five fish species in the Mekong is at risk of extinction, and the river’s sediment and nutrient flows have been severely reduced, as documented in a 2023–2024 Mekong Dam Monitor report and research by International Rivers.

“The alarming decline in fish populations in the Mekong is an urgent wake-up call for action to save these extraordinary – and extraordinarily important – species, which underpin not only the region’s societies and economies but also the health of the Mekong’s freshwater ecosystems,” the WWF’s Asia Pacific Regional Director Lan Mercado said at the launch of a 2024 report titled The Mekong’s Forgotten Fishes.

In Houayxay, the capital of Bokeo province, the markets appeared mostly absent of fish during a recent visit.

At Kad Wang View, the town’s main market, the fish stalls were nearly deserted.

“Maybe this afternoon, or maybe tomorrow,” said Mali, a vendor in her 60s. In front of her, Mali had arranged her small stock of fish in a circle, perhaps hoping to make the display look fuller for potential customers.

At another market, Sydonemy, just outside Houayxay town, the story was the same. The fish stalls were bare.

“Sometimes the fish come, sometimes they don’t. We just wait,” another vendor said.

“There used to be giant fish here,” recalled Vilasai, 53, who comes from a fishing family but now works as a taxi driver.

“Now the river gives us little. Even the water for irrigation – people are scared to use it. No one knows if it’s still clean,” he told Al Jazeera, referring to the pollution from Myanmar’s mines.

‘The river used to be predictable’

Ian G Baird, professor of geography and Southeast Asian studies at the University of Wisconsin–Madison, said upstream dams – especially those in China – have had serious downstream effects in northern Thailand and Laos.

“The ecosystem and the lives that depend on the river evolved to adapt to specific hydrological conditions,” Baird told Al Jazeera.

“But since the dams were built, those conditions have changed dramatically. There are now rapid water level fluctuations in the dry season, which used to be rare, and this has negative impacts on both the river and the people,” he said.

Another major effect is the reversal of the river’s natural cycle.

“Now there is more water in the dry season and less during the rainy season. That reduces flooding and the beneficial ecological effects of the annual flood pulse,” Baird explained.

“The dams hold water during the rainy season and release it in the dry season to maximise energy output and profits. But that also kills seasonally flooded forests and disrupts the river’s ecological function,” he said.

Bun Chan, 45, lives with his wife Nanna Kuhd, 40, on a floating house near Houayxay. He fishes while his wife sells whatever he catches at the local market.

On a recent morning, he cast his net again and again – but for nothing.

“Looks like I won’t catch anything today,” Bun Chan told Al Jazeera as he pulled up his empty net.

“The other day I caught a few, but we didn’t sell them. We’re keeping them in cages in the water, so at least we have something to eat if I don’t catch more,” he said.

Hom Phan has been a fisherman on the Mekong his entire life.

He steers his wooden boat across the river, following a route he knows by instinct. In some parts of the river, the current is strong enough now to drag everything under, the 67-year-old says.

All around him, the silence is broken only by the chug of his small outboard engine and the calls of distant birds.

“The river used to be predictable. Now we don’t know when it will rise or fall,” Hom Phan said.

“Fish can’t find their spawning grounds. They’re disappearing. And we might too, if nothing changes,” he told Al Jazeera.

Evening approaches in Houayxay, and Khon, the fisherman, rolls up his nets and prepares dinner in his floating home.

As he waits for the fire to catch to cook a meal, he quietly contemplates the great river he lives on.

Despite the dams in China, the pollution from mines in neighbouring Myanmar, and the increasing difficulty in landing the catch he relies on to survive, Khon was outwardly serene as he considered his next day of fishing.

With his eyes fixed on the waters that flowed deeply beneath his home, he said with a smile: “We try again tomorrow.”

The hunger that has been building among Gaza’s more than two million Palestinians has passed a tipping point and is accelerating deaths, aid workers and health staff say.

Not only Palestinian children – usually the most vulnerable – are falling victim to Israel’s blockade since March, but also adults.

The United Nations’ World Food Programme says nearly 100,000 women and children urgently need treatment for malnutrition, and almost a third of people in Gaza are “not eating for days”. Medical workers say they have run out of many key treatments and medicines.

The World Health Organization reports a sharp rise in malnutrition and disease, with a large proportion of Gaza’s residents now starving.

Doctors Without Borders, known by its French initials MSF, says a quarter of all young children and pregnant or breastfeeding women screened at its clinics in Gaza last week were malnourished, blaming Israel’s “deliberate use of starvation as a weapon”.

The Director-General of the World Health Organisation has warned more than two million people in Gaza are facing starvation, as deaths from malnutrition surge. His comments come as Israel continues to prevent aid supplies, including baby formula, from reaching the enclave.

Nearly half the global population has also been exposed to dust levels exceeding WHO safety thresholds.

A new report by the United Nations’ World Meteorological Organization (WMO) has found that sand and dust storms are leading to “premature deaths” due to climate change, with more than 330 million people in 150 countries affected.

On Saturday, the UN General Assembly (UNGA) marked the International Day of Combating Sand and Dust Storms and its designation of 2025 – 2034 as the UN Decade on Combating Sand and Dust Storms.

The storms “are fast becoming one of the most overlooked yet far-reaching global challenges of our time”, said Assembly President Philemon Yang. “They are driven by climate change, land degradation and unsustainable practices.”

The secretary-general of WMO, Celeste Saulo, said on Thursday that sand and dust storms do not just mean “dirty windows and hazy skies. They harm the health and quality of life of millions of people and cost many millions of dollars through disruption to air and ground transport, on agriculture and on solar energy production.”

Airborne particles from these storms contribute to 7 million premature deaths annually, said Yang, adding that they trigger respiratory and cardiovascular disease, and reduce crop yields by up to 25%, causing hunger and migration.

“About 2 billion tonnes of dust are emitted yearly, equivalent to 300 Great Pyramids of Giza” in Egypt, Laura Paterson, the WMO’s UN representative, told the UNGA.

More than 80% of the world’s dust comes from the deserts in North Africa and the Middle East, added Paterson, but it has a global effect because the particles can travel hundreds and even thousands of kilometres across continents and oceans.

Undersecretary-General Rola Dashti, head of the UN Economic and Social Commission for Western Asia, told the assembly the storms’ economic costs are “staggering”.

In the Middle East and North Africa, it costs $150bn, roughly 2.5% of gross domestic product (GDP), annually to deal with dust and sand storms, she said.

“This spring alone, the Arab region experienced acute disruption,” Dashti said, citing severe storms in Iraq that overwhelmed hospitals with respiratory cases and storms in Kuwait and Iran that forced school and office closures.

Dust from the Sahara Desert in Africa has travelled as far as the Caribbean and Florida, she said. For the United States, dust and wind erosion caused $154bn in damage in 2017, a quadrupling of the amount since 1995, according to a study in the scientific journal Nature.

The WMO and World Health Organization also warned that the health burden is rising sharply, with 3.8 billion people – nearly half the global population – exposed to dust levels exceeding WHO safety thresholds between 2018 and 2022, up from 2.9 billion people affected between 2003 and 2007.

Spain has seen the most recent cases of the disease as experts say one activity ‘drastically increases’ the risk of catching it

New cases of a killer virus have been detected in holiday hotspots loved by British tourists – and experts have warned it could reach the UK. It’s been described as the current biggest threat to public health, after breaking out in Iraq and Namibia.

Crimean-Congo hemorrhagic fever (CCHF), has also caused two reported deaths in Pakistan – with several cases reported in Spain. Last week, insiders speaking to Parliament’s Science, Innovation and Technology Committee revealed it was “highly likely” there could soon be cases in the UK.

In its most recent report the European Centre for Disease Prevention and Control said a case of Crimean-Congo haemorrhagic fever was recetnyl reported in Spain with the illness ‘known to be circulating among animals in this region and human CCHF cases have been previously reported in the area.”

In the eight years to 2024 a total of 16 autochthonous CCHF cases have been reported in Spain with dates of disease onset between April and August. The province of Salamanca is a hotspot for CCHF, with 50% of the cases being exposed to ticks.

It adds that in certain conditions in Spain people are much more likely to catch Crimean-Congo hemorrhagic fever: “This risk drastically increases for people performing activities that expose them to tick bites (e.g. hunting, forestry work, hiking, animal surveillance).

The UK Heath Security Agency has said it is estimated that globally between 10,000 and 15,000 human infections, including approximately 500 fatalities, occur annually, although this is likely to be an underestimate as many cases.

Confirmed CCHF cases have been imported into the UK, including one fatal case in 2012 and one in 2014. In March 2022, a CCHF case was reported in the UK following an initial positive test result.

To prevent CCHF:

• Use DEET-containing insect repellent to prevent tick bites.
• Wear gloves, long sleeves, and pants when handling animals where CCHF is found.
• Avoid contact with body fluids of potentially infected animals or people.

“As a general precaution against CCHF, but also against other tick-borne diseases, people who may potentially be exposed to ticks should apply personal protective measures against tick bites. In 2023 experts speaking to Parliament’s Science, Innovation and Technology Committee revealed it was “highly likely” there could soon be cases in the UK.

During the hearing, James Wood, head of veterinary medicine at Cambridge University, said CCHF could find its way to the UK “through our ticks, at some point”. The disease is caused by Nairovirus, a condition that is spread by ticks and according to the World Health Organization (WHO) and has a fatality rate of between 10 and 40 percent. Typically, the condition is found at small stages in Africa, the Balkans, the Middle East and in Asia, reports the Express. However, the disease could be expanding out of its usual territories and moving towards the likes of Britain and France due to climate change.

WHO noted CCHF was among its nine “priority diseases”, a system that lays bare the biggest public health risks. CCHF was first described in the Crimea in 1944, among soldiers and agricultural workers, and in 1969 it was recognised that the virus causing the disease was identical to a virus isolated from a child in the Congo in 1956. Humans (and possibly non-human primates) are the only animal species known to manifest severe clinical CCHF disease.

Symptoms of CCHF

Among the virus’ symptoms include headaches, high fever, back and joint pain, stomach ache, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are also common.

In severe cases, WHO warns, jaundice, mood swings and sensory perception are encountered. As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.

In documented outbreaks of CCHF, fatality rates in hospitalised patients ranged from nine percent to as high as 50 percent. The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow.

Globally, there have been case reports, virological or serological evidence of human infection in at least 55 countries. In the European Region and its neighbouring countries, locally acquired human cases and/or outbreaks have been reported from Albania, Bulgaria, Georgia, Greece, Kosovo, Russia, Spain, Turkey and Ukraine. Spain officially reported its first autochthonous case in August 2016, the first in Western Europe, following their first detection of CCHFV infected ticks in 2010. At the end of October 2023, French officials reported the detection of CCHFV in H. marginatum ticks collected from cattle in the eastern Pyrénées, which was the first time the presence of the virus in tick populations had been confirmed in the country.

Health and Human Services Secretary Robert F Kennedy Jr has announced that the United States will no longer contribute to Gavi, a global health programme that has vaccinated more than one billion of the world’s poorest children.

In a video that aired at a Gavi fundraising event in Brussels on Wednesday, Kennedy said the group had made questionable recommendations around COVID-19 vaccines. He also raised concerns about the diphtheria-tetanus-whole cell pertussis vaccine, known by the acronym DTPw, though he provided no evidence to support those fears.

“I call on Gavi today to re-earn the public trust and to justify the $8bn that America has provided in funding since 2001,” Kennedy said in the video.

Kennedy added that Gavi should consider all available science before investing in vaccines. “Until that happens, the United States won’t contribute more,” he said.

The details of the video were first reported by the publication Politico and later by the news outlet Reuters.

Gavi said in a detailed statement that safety was one of its top priorities and that it acts in line with World Health Organization recommendations.

The statement also indicated that Gavi has full confidence in the DTPw vaccine, which it credits with having helped to cut child mortality in half in the countries it supports since 2000.

“The DTPw vaccine has been administered to millions of children around the world for decades, and is estimated to have saved more than 40 million lives over the past 50 years,” the statement notes.

The administration of US President Donald Trump has previously indicated that it planned to cut US funding for Gavi, representing around $300m annually, as part of a wider pullback from international aid.

Advocacy groups called on the US to reverse its decision.

“Kennedy claims that Gavi ignored science are entirely false,” nonprofit consumer advocacy organisation Public Citizen wrote in a statement.

“Gavi’s recommendations are grounded in global evidence and reviewed by independent experts. His suggestion otherwise fuels the same disinformation that has already led to deadly measles outbreaks and the resurgence of vaccine-preventable diseases, including polio.”

A longtime vaccine sceptic, Kennedy has upended the US medical establishment since taking office in February. He has raised questions about possible ties between autism and vaccines, though numerous studies have shown there is no link.

Earlier this month, Kennedy fired all 17 members of the expert panel on vaccines at the Centers for Disease Control and Prevention (CDC), known as the Advisory Committee on Immunization Practices (ACIP).

Created 60 years ago, the committee serves as an independent government body to review data and make recommendations about who should get vaccines. Those recommendations, in turn, can affect which vaccines health insurance plans may cover.

Of Kennedy’s initial eight replacement members, about half have advocated against vaccines.

Kennedy’s new vaccine advisers hold inaugural meeting

The newly revamped committee met for the first time on Wednesday, under intense scrutiny from medical experts worried about Americans’ access to lifesaving shots.

But already, conflicts are starting to simmer in and around the panel.

Ahead of the two-day gathering, government scientists prepared meeting materials calling vaccination “the best protection” during pregnancy — and said most children hospitalised for COVID-19 over the past year were unvaccinated.

That advice, however, conflicts with Kennedy’s. The health secretary already announced COVID-19 vaccines will no longer be recommended for healthy children or pregnant women, and his new advisers are not scheduled to vote this week on whether they agree.

COVID-19 remains a public health threat, resulting in 32,000 to 51,000 US deaths and more than 250,000 hospitalizations since last fall, according to the CDC.

Kennedy’s newly reconstituted panel also lost one of its eight members shortly before Wednesday’s meeting.

Michael Ross, a Virginia-based obstetrician and gynecologist, stepped down from the committee, bringing the panel’s number to just seven. The Trump administration said Ross withdrew during a customary review of members’ financial holdings.

The meeting opened as the American Academy of Pediatrics announced that it will continue publishing its own vaccine schedule for children, but now will do so independently of the ACIP, calling it “no longer a credible process”.

ACIP’s recommendations traditionally go to the director of the CDC. Historically, nearly all are accepted and then used by insurance companies in deciding what vaccines to cover.

But the CDC currently has no director, so the committee’s recommendations have been going to Kennedy, and he has yet to act on a couple of recommendations ACIP made in April.

Separately, on Wednesday, Senate hearings began for Trump’s nominee for CDC director, Susan Monarez.

During the hearings, she said she has not seen evidence linking vaccines and autism and said she would look into the decision to cut Gavi funding.

“I believe the global health security preparedness is a critical and vital activity for the United States,” she said.

“I think that we need to continue to support promotion of utilisation of vaccines.”

India has reported a sudden rise in COVID cases, starting from late May. Authorities said the number of active cases of the disease has surpassed 5,000.

India is the latest of a number of countries to report an uptick in COVID cases this year as, more than five years after the virus was declared a global pandemic, waves of new strains continue to emerge.

Here is what we know about the new variant of COVID and where it has spread:

How many COVID cases are there in India?

As of Thursday this week, there are 5,364 active cases in India, according to India’s Ministry of Health and Family Welfare. Since January 1, more than 4,700 people have recovered from COVID in India, while 55 people have died from the virus.

Which variants are causing new cases and where?

The main coronavirus variant causing a new spread of the disease is known as NB.1.8.1. Cases caused by this variant have been reported in the United Kingdom, the United States, Australia, Thailand, China and Hong Kong, among other countries. It is now the dominant variant in China and Hong Kong.

A second variant, LF.7, is also responsible for some of the cases in India.

The UK Health Security Agency (UKHSA) said it had recorded 13 cases of the NB.1.8.1 variant in England, with “small numbers” detected across the UK.

By late April, NB.1.8.1 comprised about 10.7 percent of submitted sequences globally, according to the World Health Organization (WHO). This rose from just 2.5 percent one month before.

What do we know about the NB.1.8.1 variant?

The Omicron variant NB.1.8.1 was first detected in January this year.

It is a “recombinant” variant, which means it has arisen from the genetic mixing of two or more existing variants.

On May 23, 2025, the WHO declared the NB.1.8.1 strain a “variant under monitoring” (VUM).

According to a 2023 definition by the WHO, a VUM is a variant which has undergone genetic changes that scientists believe could potentially affect the behaviour of the virus; early data suggests that this variant can grow faster or spread more easily than others, but this has not yet been confirmed.

The evidence of the variant’s impact on health, immunity or transmission is still unclear.

Why are there so many new cases?

While the NB.1.8.1 strain is still being researched, the evidence so far suggests that the strain may spread more easily, virologist Lara Herrero wrote for The Conversation on May 28.

Researchers using lab-based models have found that of several variants tested, the new strain had the strongest ability to bind to human cell receptors. This suggests that the strain may “infect cells more efficiently than earlier strains”, Herrero wrote.

“It is more transmissible,” Subhash Verma, a professor of microbiology and immunology at the University of Nevada, Reno School of Medicine, told CBS News.

What are the symptoms?

Common symptoms of the NB.1.8.1 strain include a sore throat, cough, muscle aches, fever and nasal congestion.

It can also cause gastrointestinal symptoms such as nausea and diarrhoea.

Are COVID vaccines effective against the new strain?

Vaccines remain a powerful defence against COVID infections, severe sickness, hospitalisation and death, clinicians say.

However, virologist Herrero wrote that besides spreading more easily, NB.1.8.1 may “partially sidestep” immunity gained from the vaccines or prior infection.

For now, health authorities say current COVID jabs are expected to be effective against this coronavirus variant and protect people from severe illness.

Should we be concerned?

Health experts worldwide say there is no evidence that the new strain of the coronavirus is more severe or deadly than any previous strain. However, it does appear to spread more easily.

Since COVID spreads through airborne particles and droplets, the spread of the virus can be prevented by getting tested if symptoms show, wearing a mask and social distancing, clinicians have advised.

Numbers of children requiring hospitalisation for complications due to severe malnutrition rising as WHO warns ‘health system is collapsing’.

More than 2,700 children below the age of five in Gaza have been diagnosed with acute malnutrition, marking a steep increase in the number of children suffering from the serious medical condition since screening in February, the United Nations reports.

Of almost 47,000 under-fives screened for malnutrition in the second half of May, 5.8 percent (or 2,733 children) were found to be suffering from acute malnutrition, “almost triple the proportion of children diagnosed with malnutrition” three months earlier, the UN said on Thursday.

The number of children with severe acute malnutrition requiring admission to hospital also increased by around double in May compared with earlier months, according to the report by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

According to data from the Nutrition Cluster cited by OCHA, more than 16,500 children below the age of five have been detected and treated for severe acute malnutrition in Gaza since January, including 141 children with complications requiring hospitalisation.

Despite the increase in children suffering serious malnutrition and requiring hospitalisation, “there are currently only four stabilisation centres for the treatment of [severe acute malnutrition] with medical complications in the Gaza Strip,” the OCHA report states.

“Stabilisation centres in North Gaza and Rafah have been forced to suspend operations, leaving children in these areas without access to lifesaving treatment,” it adds.

The UN’s latest warning on the health of young children in Gaza comes as the Palestinian territory’s entire population deals with starvation, and the World Health Organization (WHO) warned that the enclave’s “health system is collapsing”.

Issuing an appeal for the “urgent protection” of two of Gaza’s last remaining hospitals, the WHO said the “Nasser Medical Complex, the most important referral hospital left in Gaza, and Al-Amal Hospital are at risk of becoming non-functional”.

“The relentless and systematic decimation of hospitals in Gaza has been going on for too long. It must end immediately,” the WHO said in a statement.

“WHO calls for urgent protection of Nasser Medical Complex and Al-Amal Hospital to ensure they remain accessible, functional and safe from attacks and hostilities,” it said.

“Patients seeking refuge and care to save their lives must not risk losing them trying to reach hospitals.”

UN experts, medical officials in Gaza, as well as medical charities, have long accused Israeli forces of deliberately targeting health workers and medical facilities in Gaza in what has been described as a deliberate attempt to make conditions of life unliveable for the Palestinian population in the Strip.

WHO calls for urgent protection of Nasser Medical Complex and Al-Amal Hospital in the Gaza Strip

WHO warns that the #Gaza Strip’s health system is collapsing, with Nasser Medical Complex, the most important referral hospital left in Gaza, and Al-Amal Hospital at risk of becoming… pic.twitter.com/Rd3ZjASuBp

— World Health Organization (WHO) (@WHO) June 5, 2025

The virus has been detected at a number of holiday destinations and one government has issued an alert

The government in a UK holkiday hotspot has urged people to wear masks, wash their hands, get vaccinated and avoid activity that could spread Covid as a new variant sends cases rocketing, The World Health Organisation has issued a warning over the new variant, NB.1.8.1, which has seen cases soar in countries including Egypt, the Maldives and Thailand.

The new strain, which is said to be more infectious than previous variants, has also been found in the US and the UK. Now the government in Thailand has issued a warning after 257,280 cases of Covid and 52 deaths.

The latest outbreak has been worst in the capital Bangkok and in Chonburi Province. Deputy government spokesperson Anukool Pruksanusak said international travel and the oncoming rainy season, could accelerate the outbreaks and the Ministry of Public Health will monitor the situation closely.

Anukool said people should ‘limit activities that increase the risk of infection, wash their hands regularly, wear masks in crowded places, get booster vaccinations when due, and seek medical attention promptly if experiencing symptoms’

Cases of the virus have been surging since mid-February and are now at their highest rate since last June. The WHO says there are higher levels of Covid in 73 countries – including the Caribbean.

The WHO has designated the new strain NB.1.8.1 as a ‘variant under monitoring’ amid concern about the sharp rise in cases. By late April 2025, NB.1.8.1 comprised roughly 10.7% of all submitted sequences – up from just 2.5% four weeks before. It is already the dominant strain in Hong Kong and China. Lara Herrero Associate Professor and Research Leader in Virology and Infectious Disease, at Griffith University said thanks to multiple mutations the new strain ‘ may infect cells more efficiently than earlier strains’.

“But importantly, the WHO has not yet observed any evidence it causes more severe disease compared to other variants. Reports suggest symptoms of NB.1.8.1 should align closely with other Omicron subvariants.

“Common symptoms include sore throat, fatigue, fever, mild cough, muscle aches and nasal congestion. Gastrointestinal symptoms may also occur in some cases.”

The new strain is being found in large numbers in the Eastern Mediterranean, an area including the tourist destination of Egypt. It is also being found in South East Asia – including in Thailand and the Maldives.

The WHO said recent increases have also been observed in Cambodia, China, Hong Kong and Singapore.

The report reads: “WHO recommends that countries remain vigilant, adapt to evolving epidemiological trends, and leverage COVID-19 management strategies to strengthen systems for all respiratory disease threats. Member States should continue offering COVID-19 vaccines in line with WHO recommendations.

“Based on the current risk assessment of this event, WHO advises against imposing travel or trade restrictions.”

Accord aims to prevent repeat of disjointed response and international disarray that surrounded COVID-19 pandemic.

Members of the World Health Organization (WHO) have adopted an agreement intended to improve preparedness for future pandemics, but the absence of the United States casts doubt on the treaty’s effectiveness.

After three years of negotiations, the legally binding pact was adopted by the World Health Assembly in Geneva on Tuesday. WHO member countries welcomed its passing with applause.

The accord aims to prevent a repeat of the disjointed response and international disarray that surrounded the COVID-19 pandemic by improving coordination, surveillance and access to medicines during any future pandemics.

“It’s an historic day,” WHO chief Tedros Adhanom Ghebreyesus said after the vote.

The agreement’s text was finalised last month after multiple rounds of tense negotiations.

“The world is safer today thanks to the leadership, collaboration and commitment of our member states to adopt the historic WHO Pandemic Agreement,” Tedros said in a statement.

“The agreement is a victory for public health, science and multilateral action. It will ensure we, collectively, can better protect the world from future pandemic threats. It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during COVID-19,” he added.

The agreement aims to better detect and combat pandemics by focusing on greater international coordination and surveillance and more equitable access to vaccines and treatments.

The negotiations grew tense amid disagreements between wealthy and developing countries with the latter feeling cut off from access to vaccines during the COVID-19 pandemic.

Dr Esperance Luvindao, Namibia’s health minister and chairwoman of a committee that paved the way for the agreement’s adoption, said COVID-19 inflicted huge costs “on lives, livelihoods and economies”.

“We, as sovereign states, have resolved to join hands as one world together, so we can protect our children, elders, front-line health workers and all others from the next pandemic,” Luvindao added. “It is our duty and responsibility to humanity.”

Effective without US support?

The US, traditionally the WHO’s top donor, was not part of the final stages of the agreement process after the Trump administration announced the US pullout from the WHO and funding for the agency in January.

US Health and Human Services Secretary Robert F Kennedy Jr slammed the WHO as “moribund” during the annual assembly.

“I urge the world’s health ministers and the WHO to take our withdrawal from the organisation as a wake-up call,” he said in a video shown at the meeting in Geneva. “We’ve already been in contact with like-minded countries, and we encourage others to consider joining us.”

Kennedy accused the WHO of failing to learn from the lessons of the pandemic.

“It has doubled down with the pandemic agreement, which will lock in all of the dysfunction of the WHO pandemic response. … We’re not going to participate in that,” he said.

The treaty’s effectiveness will face doubts without the US, which poured billions into ensuring pharmaceutical companies develop COVID-19 vaccines quickly. Countries face no penalties if they ignore it, a common issue in international law.

Countries have until May 2026 to thrash out the details of the agreement’s pathogen access and benefit-sharing (PABS) mechanism.

The PABS mechanism deals with sharing access to pathogens with pandemic potential and then sharing the benefits derived from them, such as vaccines, tests and treatments.

Once the PABS system is finalised, countries can then ratify the agreement. Once 60 do so, the treaty will then enter into force.