Four Ways Asia Can Strengthen Regional Health Security Before the Next Pandemic

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Opinion

Regional cooperation can help countries respond more effectively to future pandemics. Credit: Asian Development Bank (ADB)

MANILA, Philippines, Aug 13 2025 (IPS) – In an interconnected world when infections can circle the globe in hours, cooperation in preparing for pandemics is essential. The COVID-19 pandemic highlighted just how vulnerable countries are when surveillance is fragmented, laboratory networks are underfunded and underequipped, and vaccines are not dispersed equitably.

To safeguard regional health security, several health interventions must be treated as regional public goods.

Regional public goods are services or assets that benefit multiple countries but cannot be provided by a single nation alone. They allow developing economies to cooperate on costs, expertise, and technology for greater development impact than they could achieve individually.

For example, efficient regional infrastructure and trade facilitation brings down transportation and trade costs and promotes freer movement of people and goods; delivering energy across borders improves access to sustainable energy; and financial agreements, such as the Chiang Mai Initiative Multilateralization, boost regional financial stability during crises.

Regional public goods fall into three broad categories: economic initiatives such as transport infrastructure, energy networks, and trade agreements like the Regional Comprehensive Economic Partnership; environmental efforts including river basin management, pollution control, and cross-border conservation programs; and social investments such as public health systems, regional education platforms, and collaborative research networks.

Countries in Asia and the Pacific already work together on trade, infrastructure, and climate action. Broadening areas of cooperation, however, can help countries meet their development goals and address increasingly complex health challenges, including emergencies.

This partnership is particularly important in the area of health emergency response.

A succession of human and animal infections including SARS, avian influenza, African swine fever and COVID-19 have shown just how quickly pathogens can go from a local problem to one that threatens regional and even global security. Countries can protect themselves through early alerts and early action via coordinated surveillance, data-sharing, and equitable vaccine access.

Responses to many recent outbreaks, including the COVID-19 pandemic, have been slow, fragmented, and unfair. Greater regional cooperation can mitigate the impacts of epidemics, especially for the most vulnerable, by pooling expertise, resources, and response capacities.

Health intersects with transport, trade, gender equality, education, and livelihoods. A healthy population underpins a resilient economy and supports social stability. Supporting each other to build systems that can prevent and respond to outbreaks makes sense for countries and the region.

To respond faster and smarter to the next pandemic, countries in Asia and the Pacific should focus on four high-impact areas regional integration and collective action:

Contact Tracing Networks

Early detection saves lives but only if data move faster than the disease. A regional contact tracing network, using interoperable digital tools and shared protocols, can help track outbreaks across borders.

By linking national systems through common standards and real-time data-sharing agreements, countries can monitor risks in high-risk areas, such as along borders and major transit corridors, and prevent spread.

Health Communications Coordination

Misinformation was a major problem during the COVID-19 pandemic, eroding public trust and weakening response efforts. A regional health communications framework, backed by multilingual messaging templates, rumor tracking systems, and coordinated press briefings, can ensure consistent, culturally relevant, and science-based public information across countries. Successes in reaching vulnerable populations and mobile communities can also be quickly shared.

Telemedicine for Cross-Border Care

Regional telemedicine platforms can connect healthcare providers across borders, especially in remote or small island states, ensuring continued access to care even when in-person services are disrupted. Joint investments in infrastructure, digital health standards, and clinician training can allow countries to offer virtual consultations, diagnostics, and even specialist referrals across the region.

Region-wide Public Health Funds

Collaborative procurement of vaccines, therapeutics and diagnostics have helped countries respond to disease outbreaks, and eradicate public health threats. Region-wide public health funds maintained by cooperating counties offer a means of improving timely access to life saving countermeasures.

Effectively preventing and preparing for pandemics requires countries to work in concert. These approaches can strengthen all types of health services and build resilience to all kinds of health threats. Now is the time to act decisively and secure a healthier, more prosperous future for all.

This article was originally published on the Asian Development Blog, and is based, in part, on research related to ADB’s 1st INSPIRE Health Forum: Inclusive, Sustainable, Prosperous and Resilient Health Systems in Asia and the Pacific. Ben Coghlan contributed to this blog post.

Dr. Eduardo P. Banzon is ADB Director, Health Practice Team, Human and Social Development Sectors Office, Sectors Group, who champions Universal Health Coverage and has long provided technical support to countries in Asia and the Pacific in their pursuit of this goal.

Dr. Michelle Apostol is a Health Officer for the Health Practice Team of ADB supporting the bank’s initiatives in strengthening health systems of member countries and advocating for the advancement of Universal Health Coverage (UHC).

Anne Cortez is a communications and knowledge management consultant with ADB. She brings over a decade of experience working with governments, think tanks, nonprofits, and international organizations on initiatives advancing health equity, climate action, and digital inclusion across Asia and the Pacific.

IPS UN Bureau

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Women in Sudan are Starving Faster than Men; Female-Headed Households Suffer

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In Sudan, women-led households are three times more likely to deal with serious food insecurity compared to male-led households. Credit: UN Women Sudan

UNITED NATIONS, Aug 12 2025 (IPS) – The food crisis in Sudan is starving more day by day, yet it is affecting women and girls at double the rate compared to men in the same areas. New findings from UN-Women reveal that female-headed households (FHHs) are three times more likely to be food insecure than ones led by men.

Women and girls make up half of the starving in Sudan, at 15.3 million of the 30.4 million people currently in need. In the midst of the current humanitarian crisis brought on by the Sudanese civil war, women are increasingly seen to be leading households in the absence of men due to death, disappearances or displacement amidst the civil war, making simply living in a FHH a statistical predictor of hunger.

“With conditions now at near famine thresholds in several regions in the country, it is not just a food crisis, but a gender emergency caused by a failure of gender-responsive action,” said Salvator Nkuruniza, the UN-Women representative for Sudan.

Famine Risks for Sudan’s Women

This famine has left only 1.9 percent of FFHs food secure, compared to 5.9 percent of male-headed households (MHHs) reporting food security. 45 percent of the FHHs reported poor food consumption which was nearly double the rate as compared to MHHs at 25.7 percent. Considering this, only one third of FHHs have an acceptable diet in comparison to half of MHHs. In these worsening conditions 73.7 percent of women nationally are not meeting the minimum dietary diversity, which is limiting nutrient intake and thus endangering maternal and child health.

Rates of poor food consumption have doubled in one year across FHHs, meaning a longer drawn conflict will see even worse numbers leading to the ultimate starvation of many. Nearly 15 percent of FHHs are living in conditions that meet or are near famine thresholds compared to only 7 percent of MHHs meeting the same threshold.

With all available funding, the World Food Programme (WFP) has scaled assistance to support nearly 4 million people per month, leaving an additional 26 million people still in need of support. As one representative from the UN Office of the Coordination of Humanitarian Affairs (OCHA) told IPS, under these circumstances WFP has had to make tough calls, either shrinking assistance packages or reducing the amount of people who receive assistance. There have been cases where they have been forced to cut off all assistance in general.

Within Sudan’s civil society, women-led organizations (WLO) are playing a central role in delivering vital meals to affected groups across Sudan. Nkurunziza told IPS that “WLOS are the backbone of response in many areas,” who can access areas which the international system cannot reach. WLOs in West Kordofan are solarizing clinics, running nutrition outreach, managing mobile maternal health care, and operating informal shelters. In North Kordofan, WLOs. are running protection hotlines, distributing food, and helping displaced families find safety. Many times they are providing these services without institutional funding.

UN Women has been supporting 45 WLOs with institutional support, funding and technical assistance, which has allowed these organizations to operate across sixteen states. However, underfunding still remains a critical issue for WLOs. Nkurunziza explained how due to funding deficits, one WLO that operates across eight states was forced to shut down thirty-five of its sixty food kitchens. WLOs must also deal with serious logistical and digital constrains, making it nearly impossible to have any form of coordination meetings. Sudan is also facing the world’s largest displacement crisis, making a shrinking of operations among deteriorating consumption rates detrimental to attempts to elevate food security.

Aid Delivery Challenges

Amidst funding shortfalls, supply chains have struggled reaching critical locations due to Sudan’s size, lack of infrastructure, and weather difficulties. WFP shared that Sudan is “roughly the size of western Europe”, and as such they and other humanitarian actors are having to transport humanitarian items over 2500 kilometers across deserts and challenging terrain. They added that road infrastructure in remote areas such as Darfur and Kordofan has further increased the difficulty. The rainy season between April and October has also added further complications, which has made many roads completely flooded or impassable.

WFP said that the conflict has not only affected supply chains, but trade routes themselves. Among the besieged cities of El Fasher and Kadulgi, supplies remain limited and far and few. WFP is “extremely concerned about the catastrophic situation, especially in El Fasher and Kadulgi and urgently [needed] guarantees of safe passage to get supplies in – while we continue supporting with digital cash transfer”. This comes amidst not being able to deliver food and aid supplies by road.

Gender Disparities and Solutions

Nkurunziza told IPS that even before the conflict, women and girls “faced challenges in accessing their rights due to cultural norms and traditional practices”, adding that this conflict has only widened these gaps.

Food access is only one example of how gender inequality manifests during this crisis. Nkurunziza noted that food queues are often dominated by men compared to women from FHHs. He added that women have been “largely left out” of decision-making spaces, therefore their specific needs are “frequently overlooked”.

The search for food has caused an increase in harmful coping mechanisms like child marriage, sexual exploitation, female genital mutilation, and child labor. The nature of these harmful instances come from unchecked sexual exploitation and abuse due to the lack of law enforcement and government in many areas. Since April 2023, 1,138 cases of rape have been recorded, including 193 children. This number is expected to be even higher, as social and security fears may be preventing accurate reporting of gender-based violence crimes.

“The conflict has magnified every existing inequality,” Nkurunziza said, adding that this created the need for responsive action, moving beyond simple rhetoric.

In their report, UN Women outlined several measures that needed to be adopted in order to diminish famine conditions among women, including prioritizing food distribution and assistance planning to FHHs and establishing localized distribution sites, thus reducing movement-related risks for women. They also recommended increased representation in local aid committees and decision-making spaces by at least 40 percent. They called for increasing investment and funding to WLO’s, which are currently receiving less than 2 percent of humanitarian aid funds.

Despite these challenges, Nkurunziza said that WLOs are still working to feed families. “They are not waiting for permission — they are responding. The question is whether the system will finally recognize them as equal partners or continue to leave them behind.”

IPS UN Bureau Report



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‘After Decades of Making Huge Profits, Companies Shouldn’t Be Allowed to Leave Behind a Toxic Legacy’

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Jul 29 2025 (IPS) –  
CIVICUS speaks with Matthew Renshaw, a partner at a UK law firm that represents Nigerian communities taking legal action against Shell over environmental damage caused by its operations in the Niger Delta.

Matthew Renshaw

Two Nigerian communities, Bille and Ogale, are suing Shell in the UK over decades of oil spills in the Niger Delta that have devastated their land, water and way of life. The High Court has ruled that Shell and its former Nigerian subsidiary can be held liable for ongoing environmental damage, even if caused by oil theft or sabotage, and regardless of how long ago the spills occurred. The decision builds on a 2021 Supreme Court ruling that allowed UK-based parent companies to be sued for harm abroad. A full trial is set for March 2027.

How has oil pollution affected these communities?

Each of the three communities we represent in the Niger Delta have been affected by Shell’s operations in different ways.

The Bodo community endured two major oil spills from Shell pipelines in 2008 that released over half a million barrels of oil, causing the largest devastation of mangrove habitat in history. Families who once depended on fishing can no longer provide for themselves. Even swimming in the waterways is dangerous due to oil contamination. Despite bringing the case before UK courts in 2011, the community is still demanding a proper cleanup that they say has never materialised.

As for the Bille and Ogale communities, they brought their cases against Shell in the UK in 2015. The Ogale community depends primarily on farming and fishing, but since the 1980s, Shell has recorded around 100 spills in and around the area that have resulted in serious contamination of the drinking water. The United Nations conducted tests in 2011 and declared a public health emergency, but very little was done in response. Shell briefly provided safe water to residents, but that ended years ago. With no alternative sources available, many people have been forced to use visibly polluted water to drink and bathe their children.

The Bille community lives on islands in a riverine area where residents depend heavily on fishing and harvesting shellfish. A major pipeline runs directly through the community, very close to where people live. Between 2011 and 2013, multiple oil spills from Shell destroyed mangrove habitats. As with the Bodo community, fishing has become impossible for many people, forcing some to abandon their homes and communities entirely.

Why sue in the UK rather than Nigeria?

The decision to sue Shell in the UK came from our clients. While Shell operates in Nigeria through a local subsidiary, the parent company is based in the UK and has profited immensely from its Niger Delta operations, so our clients view it as equally responsible for the pollution in their communities.

They also believe they can’t get justice in Nigeria. The Nigerian legal system is notoriously slow: cases can take decades to reach judgement due to automatic rights of appeal. Many people won’t live to see justice. Bringing this type of case before Nigerian courts is also prohibitively expensive, because it requires extensive expert evidence that’s inaccessible to most affected communities.

In contrast, UK funding mechanisms make it far more feasible for our clients to pursue justice. They also trust they’ll receive a fairer hearing in London. This approach has already shown results: in the Bodo case, Shell finally brought in international experts to attempt cleanup. International litigation generates meaningful outcomes that wouldn’t happen otherwise.

Even when Shell argued that the case should be heard in Nigeria, in 2021 the UK Supreme Court ruled that because Shell PLC may share responsibility with its subsidiary, the case could proceed in London.

How is Shell defending itself?

Shell claims that most Niger Delta pollution stems from oil theft by local criminals, commonly known as ‘bunkering’. According to Shell, these criminals steal oil from pipelines to sell directly or refine into fuel. The company insists its operations are clean and criminals are to blame, arguing it’s doing its best to stop theft and therefore shouldn’t be held responsible.

This defence is fundamentally flawed. While oil theft is certainly a significant problem in Nigeria, Shell’s claims are overstated. Numerous spills have nothing to do with theft. They’re caused simply by poorly maintained infrastructure and decades-old pipelines that are not fit for purpose. This stands in stark contrast to other countries where maintenance is taken far more seriously.

Even accepting Shell’s argument, our clients contend that Shell should have taken reasonable precautions to prevent foreseeable theft. In other countries, pipelines are buried, fitted with detection systems and monitored closely to detect intrusion attempts or spills. Our clients contend that Shell has failed to implement these basic measures in the Niger Delta.

What did the recent court ruling say, and what do you hope to achieve?

The High Court sided with our position, ruling that if Shell failed to take reasonable steps to prevent foreseeable harm, it can be liable for pollution caused by bunkering. Significantly, the court also rejected Shell’s claims that it couldn’t be held liable for spills older than five years, ruling that if a spill has still not been cleaned up – even if it happened decades ago – the company can still be held accountable.

This ruling has far-reaching implications. It’s particularly significant for the Ogale case where pollution dates back to the 1980s, and it opens the door for many other Niger Delta communities affected by legacy spills dating to the 1970s or earlier. Beyond Nigeria, the ruling sends a warning to multinational companies attempting to divest from polluting operations without accepting responsibility for the damage left behind.

Our clients seek three main outcomes from the 2027 trial: proper cleanup and environmental remediation of their polluted lands, emergency provisions such as access to clean drinking water and compensation for lost livelihoods and damaged property.

A pressing concern is Shell’s recent divestment from its onshore operations in Nigeria. The company has sold its assets to a consortium and is attempting to walk away from decades of pollution. While the communities we represent have at least secured court proceedings, many others have been left behind with no cleanup and no accountability.

We’re determined to prevent Shell and other multinational companies from abandoning polluted sites without taking responsibility. Success in holding Shell accountable, including for decades-old spills, could establish crucial legal precedents. Legally, it would confirm that companies remain responsible for long-term environmental damage. Morally, it’s about basic fairness: after decades of extracting resources and making huge profits, companies shouldn’t be allowed to leave behind a toxic legacy.

While our case won’t create internationally binding precedents, it could significantly influence how similar claims are litigated in other countries, particularly in common law jurisdictions.

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SEE ALSO
Business and Human Rights Treaty: a decade of struggle for corporate accountability CIVICUS Lens 08.Mar.2025
Chiquita verdict offers hope for corporate accountability CIVICUS Lens 29.Jul.2024
Peru’s oil spill raises corporate accountability questions CIVICUS Lens 01.Apr.2022

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Sweet Hope to End Bitter Pills for Multidrug-Resistant Tuberculosis

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Health

Rallying call to end TB by 2030. Credit: Busani Bafana/IPS

BULAWAYO, Jul 15 2025 (IPS) – Every day, Yondela Kolweni has to hold down her son, who screams and fights when it is time for his daily life-saving TB tablets—a painful reminder of her battle with the world’s top infectious killer disease.

“It is a fight I win feeling awful about what I have to do,” says Kolweni (30), a Cape Town resident and a TB survivor. “The tablets are bitter, and he spits them out most of the time, and that reminds me of the time I had to take the same pills.”

Kolweni’s five-year-old son is battling Multidrug Resistant TB (MDR TB), a vicious form of TB that is rising among children globally.

The global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower social and economic development levels, according to a recent study. In addition, the top three highest incidence rates of MDR TB in 2019 were recorded in Southern sub-Saharan Africa, Eastern Europe, and South Asia, while the top three highest rates of deaths in the same period were recorded in Southern, Central, and Eastern sub-Saharan Africa.

South Africa is one of 30 countries that account for 80 percent of all TB cases in the world and has the most cases of drug-resistant TB.

A Bitter Pill to Swallow

Kolweni’s son was diagnosed with MDR-TB five years ago, having tested positive for TB which has affected his grandmother and his mother. He was immediately on treatment, a drug cocktail that included moxifloxacin—a pill not for the yellow-livered.

“There were two medications he had to take, and there was one specifically, the yellow one, that he did not like, and with the color he knew what it was,” Kolweni told IPS in an interview, explaining a daily battle to get her son to take his meds.

It was down to a fight. She crushed the tablets, mixed them with a bit of water, and fed them through a syringe.

“We would sometimes hold him or wrap a towel around him so that we could feed him the medication, but he would still spit it out, which meant he was not taking the dosage he was meant to take,” said Kolweni. “We then came up with the idea to put his tablets in his yogurt, but that technique did not work because, being a smart kid, he took the bait but would soon spit out the medication.”

Moxifloxacin, an exceptionally bitter medicine, is one of the key drugs in the new all-oral treatment for multidrug-resistant tuberculosis (MDR TB). The treatment is a combination of the drugs Bedaquiline, Pretomanid, Linezolid and Moxifloxacin, known as BPaLM. The BPaLM regimen is specially formulated for children but is a bitter pill to swallow.

Sweet Medicine

But there is sweet hope. A new study, by Stellenbosch University and the TB Alliance, found that sweet, bitter-masked versions of Moxifloxacin significantly improve kids’ willingness to take the drug—easing the burden on parents and boosting treatment adherence.

Two formulations of moxifloxacin have been identified by children as tasting better than new generic versions of products currently on the market.

The results from the ChilPref ML study—a Unitaid-funded effort sponsored and led by Stellenbosch University in collaboration with TB Alliance—will help improve MDR TB treatment and adherence in children.

Dr. Graeme Hoddinott, of Stellenbosch University and the principal investigator of the study, notes that children cannot be treated in a humane manner for drug-resistant TB if the medicines taste so terrible that children refuse them or must be forced to take them.

Children diagnosed with drug-sensitive TB have good outcomes even within the four months because there is usually one tablet given, and there is a child-friendly formulation that dissolves easily to be given on a spoon or in a syringe, Hoddinott said. However, for drug-resistant TB, the situation is complicated. Most drugs for MDR TB are no longer used because of their toxicity and have been replaced by new drugs.

MDR-TB drugs are not child-friendly, Hoddinott admits. The active ingredient that kills TB in Moxifloxacin makes the pills incredibly bad tasting for children who have to take the medication daily for between six and nine months in cases of MDR TB.

“These drugs are incredibly bad tasting; they are genuinely awful to a point where adults who have been on extended TB treatment have been unable to administer the same drugs to their children because the smell evokes the time when they were sick,” Hoddinott told IPS. “It is a trauma to administer such bad-tasting drugs to a child, both for the parent and the child, particularly for the young children.”

The ChilPref study recruited just under 100 healthy children, ages 5–17, from two diverse settings in South Africa. The children evaluated flavor blends using a ‘swish and spit’ taste panel—tasting the medicine, which was dissolved in water, and then spitting it out without ingesting any of it.

Each child participant ranked the flavor blends among the three from each manufacturer and also rated the taste, smell and other characteristics of each. For moxifloxacin, there was a clear, strong preference for the new flavor blends (“bitter masker” and orange for Macleods, and strawberry and raspberry and tutti frutti for Micro Labs) over the existing commercially available flavors for both manufacturers. For Linezolid, there was no preference between the flavor blends.

“Ensuring children have access to effective and palatable TB treatments is a crucial step in improving adherence and treatment outcomes,” said Koteswara Rao Inabathina, one of the study’s authors and CMC Project Manager at TB Alliance.

“Through close collaboration with manufacturers, we have addressed critical unmet needs by developing practical solutions that make available and effective drug-resistant TB treatments not only accessible but also palatable and acceptable for children.”

The results of the ChilPref study showed that children preferred two new flavor blends of moxifloxacin, produced by Macleods Pharmaceuticals, India, and Micro Labs Pharmaceuticals, India. The results were communicated to the manufacturers, who are already updating their products.

“We are not surprised that a lot of kids did not like any of the tastings because we knew that they were horrible taste-wise, but we got a very clear signal for both manufacturers that the flavor blends we recommended were more preferred,” Hoddinott said. “We changed which flavor was going to market with relatively simple research.”

Dr. Cherise Scott, Senior Technical Manager at Unitaid, said the easier it was for children to take their medicines regularly, the more likely they were to complete their treatment successfully.

“We will not allow children to be neglected in global health responses simply because their needs are more complex.”

A Promising Treatment for MDR TB

As multi-drug-resistant TB transmission increases among children and adolescents, the development of new treatments is imperative, Hoddinott explained.

Moxifloxacin may also be increasingly used in the future for the treatment of drug-susceptible TB, which affects an estimated 1.2 million children globally each year.

Drug-resistant TB, has previously been one of the most difficult diseases to manage because of limited child-friendly treatment options, but scientists have made strides in developing new treatments for children, explains Dr. Anthony Garcia-Prats, one of the study authors and an associate professor at the University of Wisconsin-Madison.

“Now we are making sure that these medicines are appropriate for children, starting with an aspect that children and parents say is critical: taste,” Garcia-Prats said in a statement.

The new treatment is given when TB is either resistant to rifampicin, a critical first-line drug, or rifampicin and isoniazid, another first-line drug combination. These resistant strains are collectively referred to as RR/MDR-TB.

Annually there are an estimated 32,000 new cases of RR/MDR-TB among children 14 years and under—a population that is extremely sensitive to the taste of medicine, according to researchers.

This discovery could help improve adherence to TB medication and move a step closer towards the United Nations Sustainable Development Goal 3 to end TB by 2030.

“It is not a silver bullet,” Hoddinott cautions. “It does not solve everything, as people affected by TB still face many other challenges, and even the preferred flavor blends still do not taste nice. But, as part of the overall fight against TB in children, it’s an important step.”

Kolweni welcomes the development of masked TB medication.

“My experience with TB medication was not nice, and for children it is worse, and I think flavored tablets would make it easy for children to take, like  Gummies,” she said. “Every child loves flavors; even a suspension would be nice. My son would love it, and I will have no trouble getting him to take his medicine.”

Note: This article is brought to you by IPS Noram, in collaboration with INPS Japan and Soka Gakkai International, in consultative status with the UN’s Economic and Social Council (ECOSOC).

IPS UN Bureau Report

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UN Funding Crisis Threatens Work of Human Rights Council

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Opinion

The Human Rights Council is an intergovernmental body within the UN system responsible for strengthening the promotion and protection of human rights around the globe, and for addressing situations of human rights violations, and making recommendations on them, according to the UN. It has the ability to discuss all thematic human rights issues and situations that require its attention throughout the year. It meets at the United Nations Office at Geneva (UNOG).

NEW YORK / GENEVA, Jul 11 2025 (IPS) – The United Nations Human Rights Council (HRC) has expressed concern at the UN High Commissioner for Human Rights’ announcement that certain activities mandated by the council cannot be delivered due to a lack of funding. The council has sought clarity on why certain activities had been singled out.

Among the activities the commissioner says can’t be delivered is the commission of inquiry on grave abuses in Eastern Congo, an important initiative created—at least on paper—at an emergency session of the HRC in February in response to an appeal by Congolese, regional, and international rights groups.

The establishment of the commission offered a glimmer of hope in the face of grave and ongoing atrocities in the region, and it was hoped it might be an important step toward ending the cycle of abuse and impunity and delivering justice and reparations for victims and survivors.

It is not only the activities highlighted by the commissioner that are impacted by the funding crisis, however. Virtually all the HRC’s work has been affected, with investigations into rights abuses—for example in Sudan, Palestine, and Ukraine—reportedly operating at approximately 30-60 percent of capacity.

In discussions about the proposed cuts, several states—notably those credibly accused of rights abuses—have sought to use the financial crisis as cover to attack the council’s country-focused investigative mandates or undermine the Office of the High Commissioner’s broader work and independence. For example, Eritrea invoked the crisis in its ultimately unsuccessful effort to end council scrutiny of its own dismal rights record.

Amid discussions on the current crisis, there has been little reflection among states on how the UN got into this mess. States failing to pay their membership contributions, or failing to pay on time, has compounded the chronic underfunding of the UN’s human rights pillar over decades.

The United States’ failure to pay virtually anything at the moment, followed by China’s late payments, bear the greatest responsibility for the current financial shortfall given their contributions account for nearly half of the UN’s budget.

But they are not alone: 79 countries reportedly still haven’t paid their fees for 2025 (expected in February). Among those that haven’t yet paid this year are Eritrea, Iran, Cuba, Russia, and others that have used the crisis to take aim at the council’s country mandates or to undermine the work or independence of the high commissioner’s office.

Rather than seeking to meddle in the office’s work or reduce the HRC’s scrutiny of crises, states should work with the UN to ensure funds are available for at least partial delivery of all activities they mandate through the council, particularly in emergencies.

Urgent investigations into situations of mass atrocities are key tools for prevention, protection, and supporting access to justice. They cannot wait until the financial crisis blows over.

Lucy McKernan is United Nations Deputy Director, Advocacy, Human Rights Watch (HRW), and Hilary Power is UN Geneva Director, HRW

IPS UN Bureau

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HIV/AIDS Funding Crisis Risks Reversing Decades of Global Progress

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About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

UNITED NATIONS, Jul 10 2025 (IPS) – UNAIDS called the funding crisis a ticking time bomb, saying the impact of the US cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) could result in 4 million unnecessary AIDS-related deaths by 2029.

A historic withdrawal of global HIV/AIDS funding threatens to derail decades of hard-won progress in the fight against AIDS, according to UNAIDS’ annual report, entitled Aids, Crisis and the Power to Transform. This funding shortage – caused by sudden and massive cuts from international donors – is already dismantling frontline services, disrupting lifesaving treatments for millions and endangering countless lives in the world’s most vulnerable communities.

“This is not just a funding gap—it’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima.

Despite major strides in 2024, including a decrease in new HIV infections by 40 percent and a decrease in AIDS-related deaths by 56% since 2010, the onset of restricted international assistance, which makes up 80 percent of prevention in low- and middle-income countries, could have disastrous effects. The report, mostly researched at the end of 2024, concluded that the end of AIDS as a public health threat by 2030 was in sight.

However, in early 2025 the United States government announced “shifting foreign assistance strategies,” causing them to withdraw aid from organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR), which had earlier promised 4.3 billion USD in 2025. PEPFAR is one of the primary HIV testing and treatment services in countries most affected. Such a drastic decision could have ripple effects, including pushing other major donor countries to revoke their aid. The report projected that if international funding permanently disappears, they expect an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029.

At a Press Briefing, Assistant Secretary-General for UNAIDS Angeli Achrekar noted the importance of PEPFAR since its inception in 2003, calling it one of the most successful public health endeavors. She expressed hope that as the US lessens its support, other organizations and countries are able to take up the global promise of ending AIDS without eroding the gains already made.

Achrekar noted “acute shifts” in a weakening of commitment from countries less directly affected by HIV/AIDS since the US has pulled funding.

UNAIDS also reports a rising number of countries criminalizing populations most at risk of HIV – raising stigma and worsening gender-based violence and non-consensual sex, two of the highest HIV risk-enhancing behaviors. The report showed the primary groups who lacked care were child HIV infections and young women, which is likely related to government campaigns  “attacking HIV-related human rights, including for public health, with girls, women and people from key populations.”

These punitive laws include criminalization or prosecution based on general criminal laws of HIV exposure, criminalization of sex work, transgender people and same-sex sexual activity and possession of small amounts of drugs. These laws have been on the rise for the past few years, and in conjunction with limited funding, the results for HIV/AIDS-positive patients could be fatal.

Recently, scientific breakthroughs have been made regarding long-acting medicine to prevent HIV infection. Health workers have seen tremendous success, both with new technologies like annual injections and the potential for more growth in the form of monthly preventative tablets and in old prevention techniques like condom procurement and distribution and access to clean, safe needles for drug users. However, due to various global conflicts and wars, supply chains have been disrupted, often harming countries not in the thick of the altercation but reliant on products like PrEP, an HIV prevention medication.

Although many countries most afflicted with the AIDS crisis have stepped up, promising more national funding for the issue, and many community networks have doubled down on their efforts, the disruption of supply chains and the lack of international frontline health workers cannot be solved overnight. To entirely restructure how healthcare is provided takes time – something those with HIV do not always have.

Areas like sub-Saharan Africa, which in 2024 housed half of the 9.2 million people not receiving HIV treatment, have been particularly affected by the recent changes. The majority of child infections still occur there, and combinations of “debt distress, slow economic growth and underperforming tax systems” provide countries in sub-Saharan Africa with limited fiscal room to increase domestic funding for HIV.

Despite the loss of funding, significant progress has been made to protect essential HIV treatment gains. South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 3.3% annual increase for HIV and tuberculosis programs over the next three years. As of December 2024, seven countries in sub-Saharan Africa have achieved the 95-95-95 targets established by UNAIDS: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed. UNAIDS emphasized the importance of this being scaled up to a global level.

Achrekar observed, referring to countries whose domestic funds towards AIDS have increased, that “prevention is the last thing that is prioritized, but we will never be able to turn off the tap of the new infections without focusing on prevention as well.”

She reiterated the importance of countries most affected by the HIV/AIDS crisis establishing self-sustaining health practices to ensure longevity in both prevention and treatment.

Achrekar praised the global South for their work in taking ownership of treatment while still calling upon the rest of the world to join.

She said, “The HIV response was forged in crisis, and it was built to be resilient. We need, and are calling for, global solidarity once again, to rebuild a nationally owned and led, sustainable and inclusive multi-sectoral HIV response.”

IPS UN Bureau Report

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