Devex CheckUp: Fighting for health funding in a time of austerity

The International Monetary Fund is backing low-income countries into a corner — compelling them to sacrifice spending on health care in order to service foreign debt, according to a recent ActionAid report.

Consider Nigeria, one of the countries highlighted in the report: The country allocated 4% of its national revenue to health in 2024, while 20.1% went to repaying foreign debt.

The IMF encourages these austerity measures, arguing that they will help countries stabilize their economies, though officials have promised to address the debt burden at some point. But health officials warn reforms are not coming soon enough, leading to worse or more expensive services now, resulting in unnecessary deaths. The impact is disproportionately on women, particularly pregnant or lactating mothers, who are losing access to even basic maternal care.

The IMF does include “social spending floors” in its recommendations. These are minimum government spending targets on social services, such as health care. But experts say those targets need to be turned into binding commitments, not optional goals.

They are also calling for other progressive taxation measures, including taxes on unhealthy foods and beverages. Those funds can then be channeled into the health system.

This dovetails with a new initiative from the World Health Organization called 3 by 35, which proposes a price increase of at least 50% in the next decade for alcoholic beverages, sugary drinks, tobacco, and other unhealthy commodities that are fueling the rise in noncommunicable diseases. In addition to the potential health revenue, the taxes — which could raise an additional $1 trillion over the next 10 years — would make those products expensive, potentially keeping them out of the hands of young people and reducing NCDs.

Some people are looking for even more radical solutions to this problem. African civil society groups organized a tribunal calling for debt cancellation ahead of this week’s Fourth International Conference on Financing for Development, or FfD4. They also called for broader reforms of the IMF and World Bank.

Read: How Africa’s schools and hospitals are paying the price of IMF austerity

Also: WHO pushes for 50% price hike on tobacco, alcohol, and sugary drinks

Not going back

Gavi, the Vaccine Alliance is moving ahead, with or without the United States.

Of course, the organization would prefer it to be with, Gavi CEO Sania Nishtar told Devex Editor-in-Chief Raj Kumar during an event on the sidelines of FfD4. And she is hopeful that the Trump administration will restore the U.S. contribution, which accounted for 13% of the organization’s total funding, or $300 million annually.

The U.S. Congress appropriated that same amount for this fiscal year, and Nishtar said, “We look forward to the administration executing that – implementing that.”

Even without a U.S. commitment, Nishtar said she is still celebrating Gavi’s recent replenishment. In a historically difficult funding environment, Gavi raised $9 billion of the $11.9 billion the organization needs to execute its next five years of programming.

The highlight of the upcoming efforts will be a “wide-ranging” reform journey that is being called the “Gavi leap.” The idea is to give countries more decision-making authority, simplifying how they access Gavi funds, creating “bespoke” solutions for countries, and reducing duplications with other partners.

Read: Gavi’s Sania Nishtar is ‘very hopeful’ US will return as a donor

Into the sunset

One thing Nishtar didn’t talk about was sunsetting Gavi. Nevertheless, Nelson Aghogho Evaborhene, a global health security expert, has written an opinion piece for Devex laying out a strategy for how — if the organization were to close down — it might do so responsibly.

Among the many critical steps, he spells out a need to ensure that countries are actually able to take over vaccine operations that Gavi is doing, which may require bridge funding and other support. That could mean strengthening local and regional institutions, such as the Africa Centres for Disease Control and Prevention, to make sure they are able to provide that backing.

It is also crucial that elements such as a skilled health workforce and strong supply chains are already in place before any transition takes place.

The point, Evaborhene writes, should be “not merely ‘ending aid’ but transforming it. It means redesigning global health cooperation to align with country priorities and autonomy.”

Opinion: If Gavi plans a ‘sunset,’ let it be a thoughtful transition

WHO’s who

In the midst of a dramatic downsizing, WHO has some updates on how it will juggle around its directors. What it adds up to is mostly familiar names taking on bigger roles.

That includes Dr. Meg Doherty, who previously led WHO’s work on HIV, hepatitis, and sexually transmitted infections. She will take on a new position as director of science, research, evidence, and quality for health under the office of the chief scientist.

Many of the other moves involved WHO officials adding to their portfolios:

• Dr. Etienne Krug’s role is expanding from director of the social determinants of health to also include health promotion.

• Kalipso Chalkidou, already the head of health finance, will also lead on governance, economics, primary health care, and universal health coverage.

• Alain Labrique is adding data and analytics and delivery for impact to a portfolio that already included digital health.

• Gaudenz Silberschmidt, who has been the director of health and multilateral partnerships, will also take on resource mobilization.

• Dr. Tereza Kasaeva, who led the WHO’s global program on tuberculosis, will also take over HIV, hepatitis, and STIs from Doherty.

Read: WHO names new directors in ongoing restructure

What’s smoking

One jam-packed session at the recently concluded World Conference on Tobacco Control was on the impact of U.S. funding cuts and policy changes on tobacco control programs worldwide.

The U.S. cuts affected the Demographic and Health Surveys, weakening data collection critical to informing policies on tobacco control. In Pakistan, this hinders civil society’s ability to advocate for higher tobacco taxes and regulation on tobacco use. The gaps in data are also being exploited by the tobacco industry — which is now offering policymakers its own funded research that downplays the risk of new tobacco products and suggests that taxes could lead to illicit trade and economic losses, according to Mumtaz Mughal, program director at the nonprofit Aurat Foundation.

In Kenya and Bangladesh, there is fear that funding cuts would force governments to make a choice between paying for health programs affected by the cuts or strengthening tobacco control – and that the tobacco industry might try to influence the decision.

It wouldn’t be the first time: During the COVID-19 emergency, some governments received monetary and in-kind support from the industry. And in some settings — during a pandemic driven by a respiratory disease — cigarettes were even labeled as essential commodities.

ICYMI: How US Health and Human Services budget cuts could impact global health

From the archives: Tobacco industry 'preyed on' governments during COVID-19 — report

Related: Another victim of Trump’s aid cuts? His own development legacy (Pro)

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What we’re reading

U.S. cuts to foreign aid could lead to 14 million additional deaths by 2030, a third of which would be among children, according to new research. [BBC]

A scientific advisory group convened by WHO said it could not conclusively determine that COVID-19 began as a natural spillover from animals, but noted the lack of new evidence for U.S. President Donald Trump’s pet theory that it was caused by a leak from a Wuhan laboratory. [Science]

Researchers have discovered that mpox can infect and kill human brain cells, though treatment can dramatically reduce the risk. [Nature]

Jenny Lei Ravelo contributed to this edition of Devex CheckUp.