Devex CheckUp: WHO’s bold bid to stay afloat

A massive budget shortfall has forced the World Health Organization to dramatically reduce its scope, with the agency cutting more than half of its departments and dropping five of 12 senior managers.

Director-General Tedros Adhanom Ghebreyesus made the announcement that WHO departments would shrink from 76 to 34 during a briefing with member states this week. The new structure will involve four divisions, with three focused on core areas of work:

• Health promotion, disease prevention, and control.

• Health systems.

• Health emergency preparedness and response.

The office of the chief scientist will support all of them. And then a fourth division will handle business operations. The office of the director-general will also remain in place.

It’s still not clear who will stay and who will go in this new structure. Tedros told members that WHO is facing a salary gap of as much as $650 million for 2026-2027, which is about 25% of staff costs in the current biennium. But while people are almost certainly going to lose their jobs, Tedros said it doesn’t necessarily mean the agency will cut 25% of its staff.

The next step, though, is likely to be an announcement of who will remain as assistant directors-general and department heads.

Read: WHO to slash senior leadership and departments by nearly half

ICYMI: As WHO lays off staff, why is transparency more crucial than ever? (Pro)

Unhealthy alliances

How do you hold powerful private actors accountable for any harm that they are doing to people’s health? Well, it would help to first figure out exactly what a PPA is.

They include the range of private foundations, financial institutions, and corporations that increasingly shape health outcomes for people around the world.

Some PPAs are more obvious, such as the companies that block efforts to regulate tobacco use or to curb the consumption of unhealthy foods, thereby contributing to increased disease and death. Then there are the private equity firms that are buying up hospitals and pharmaceutical companies and prioritizing profits over people’s health. But PPAs also extend to the private foundations that are increasingly setting global health priorities.

What connects them is not just that they are powerful, but that it is difficult for people harmed by their actions to actually hold them accountable. And it’s not clear that governments will. Indeed, it is often officials who are making it easier for their health systems to be privatized, or who welcome support from the Gates Foundation or other funders.

But there is a movement underway, highlighted this week by a symposium I attended in Malaysia, to begin naming these PPAs, tracing their influence, and demanding that they face greater accountability for any harm that they do.

Read:  The rise of private global health actors sparks calls for accountability

Counting the dead

Since the Trump administration initiated a foreign aid freeze in January, 40,000 people living with HIV are estimated to have died after losing access to U.S.-funded treatment. That includes almost 4,000 children.

Those deaths have been largely invisible … until last week. AIDS activists deposited more than 200 cardboard coffins outside the U.S. Department of State, each representing more than 100,000 people once supported by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.

According to activists, almost none of the money appropriated for PEPFAR this fiscal year has actually been spent. The total allocation is about $4.85 billion. Meanwhile, questions continue to swirl around the future of the program.

There is even more bad news for PEPFAR. The Centers for Disease Control and Prevention’s Global Health Center is on the chopping block in a budget proposal for the U.S. Department of Health and Human Services, which oversees CDC. The center plays a critical role in administering PEPFAR, including implementing much of the HHS’ $1 billion budget for the program.

The cuts to HHS in the budget proposal would also eliminate the National Institutes of Health’s Fogarty International Center, which provides crucial training to both U.S. and foreign scientists. And they would end funding for the Office of Global Affairs, which leads on global health diplomacy and policy.

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

Plus: AIDS activists pile coffins outside State Dept. to protest PEPFAR cuts

Never-ending story

Speaking of that foreign aid freeze, it was meant to only last for 90 days until the Trump administration could complete a review of foreign aid. That review should have been completed on April 20. It’s now totally unclear whether it’s still ongoing or if it has been finished.

The Trump administration told the U.S. Congress that the review was over at the end of March. That was after the gutting of the U.S. Agency for International Development and Secretary of State Marco Rubio's announcement that 83% of its programs have been terminated..

But then Jeremy Lewin, the new director of foreign assistance, sent out a memo that actually seemed to extend the review by another 30 days. So, which is it? The Trump administration isn’t saying.

Read: Trump administration extends foreign aid review another 30 days

Number crunching

In the wake of those USAID cuts, my colleague Miguel Antonio Tamonan did some analysis on just who is still drawing money from the agency after the Trump administration slashed 5,200 contracts.

At the top of the list is Chemonics, despite losing half of its awards. The organization will remain engaged in procuring and supplying drugs and commodities and in helping to combat malaria.

FHI 360 was second, based on an eight-year program to pursue epidemic control for diseases such as HIV, COVID-19, and mpox.

Interested in the full list? Check out Miguel’s analysis.

Read: Who’s still standing? USAID’s new top 15 implementers (Pro)

+ Not yet a Devex Pro member? Start your 15-day free trial today to access all our expert analyses, insider insights, funding data, events, and more. Check out all the exclusive content available to you.

In the shadows

When we talk about sexual violence, the focus tends to be on women and girls — and for good reason. But there's a critical gap in the conversation that’s often overlooked: boys. In an opinion piece for Devex, child protection experts Rita Panicker and Zeny Rosales highlight how boys who experience sexual violence are routinely left out of data collection, policy frameworks, and support services.

This exclusion has serious consequences. Boys are less likely to report abuse, more likely to suffer in isolation, and rarely receive the care and protection they need. Panicker and Rosales argue that it’s time to “break the societal and cultural barriers that prevent boys from seeking help and receiving the support they need” — and to ensure that systems are built to recognize and support all survivors.

As part of their advocacy, the authors are urging the United Nations to declare April 16 as the official International Day for the Prevention of Sexual Violence Against Boys.

Opinion: We are still failing boys on sexual violence

What we’re reading

The Trump administration may demand that pharmaceutical companies slash U.S. drug prices to match the level in other global north countries. [Reuters]

Overall cancer death rates in the U.S. declined steadily between 2001 and 2022, but for women, new cancer diagnoses increased. [CNN]

One in every 9 residents of Réunion Island is suspected of being infected with chikungunya, a painful virus spread by mosquitoes that has no treatment. [France 24]