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Later today, U.S. President Donald Trump will commandeer the headlines (I know – he almost never does, right?) with his speech at the 80th U.N. General Assembly. But prior to that, issues that tend to fly below the radar but touch billions of lives around the world were spotlighted — and we have the inside take.
Also in today’s edition: A top U.N. official insists reform efforts are genuine — and strategic.
How do you even begin to describe the U.S. aid purge of this past year? Those who are pessimistic might call it ruination — but Martin Edlund, CEO of Malaria No More, gave us a slightly more nuanced set of words starting with R: reckoning, realignment, renewal.
“I think we’ve just experienced a reckoning in global health,” he said, referring to the Trump administration’s dismantling of U.S. foreign assistance at the start of the year.
Now, with the recent release of Trump’s “America First” health strategy, “I think we’re announcing … a realignment, and my hope is that that leads to renewal and a new way of doing this work going forward.”
Edlund spoke to me at Devex Impact House, our three-day event alongside UNGA80, where health — and the Trump administration’s priorities for it — were a major topic of the day. The United Nations was also holding a high-level meeting on noncommunicable diseases, or NCDs, which account for over 70% of global deaths.
Despite that staggering figure, NCDs — along with so many health crises — are experiencing budget cuts, not funding increases.
But Dr. Elias Zerhouni, former director of the National Institutes of Health, took a more nuanced view. At Devex Impact House, he said he was “optimistic” that the dire situation currently engulfing global health funding can be reversed.
“The most powerful force is actually patients,” he told Devex President and Editor-in-Chief Raj Kumar. “Human beings talking and saying, ‘This is what’s happening at the human level, not at the institutional level.’ It’s not the NIH that’s suffering. It’s millions of people suffering. You have to make that a reality.”
Read: Former NIH chief spotlights ‘most powerful force’ for health funding
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That inescapable reality was the focus of another UNGA-related discussion — hosted by Global Health Corps and others — which featured a strong commitment to turn crisis into opportunity by investing in young African health leaders, my colleague Michael Igoe, who was at the discussion, wrote.
The optimism bubble, however, was pierced by a blunt question about Trump’s new strategy, which aims to replace NGO-led health delivery funds with a scaled-back, private sector-focused assortment of bilateral agreements.
For African countries facing a steep health financing shortfall, is there anything good at all in Trump’s new plan? The audience member directed the question to the two panelists: Pathfinder International’s Tabinda Sarosh and PATH’s Nanthalile Mugala.
Michael writes that Femi Oke proved once and for all why she is the global health and development community’s preeminent moderator by swooping in and intercepting the question. Oke called the Trump administration’s foreign aid cuts and strategy the “elephant in the room of every conversation this week” — an elephant she’s tired of hearing about — and said it wouldn’t be “fair” to require the panelists to answer.
Mugala from PATH took a stab anyway: “Necessity is the mother of invention.”
Read: UNGA80 reporters’ notebook — Day 1
+ Watch out for Day 2 of our reporters’ notebook for updates, interviews, and behind-the-scenes commentary at UNGA80.
Does that adage apply to the UN80 reform agenda as well? That’s been a raging debate at this year’s assembly, where U.N. Secretary-General António Guterres has introduced a sweeping plan of cutbacks and consolidations in response to fiscal constraints.
Skeptics see the agenda as an indiscriminate response to Trump’s aid cuts — and not a genuine attempt at reform. Guy Ryder, U.N. undersecretary-general for policy, sees it quite differently.
“We are taking a strategic approach,” Ryder told Devex President and Editor-in-Chief Raj Kumar during a briefing shortly before UNGA began this week. “The secretary-general is very deliberately investing in some areas and necessarily deprioritizing in others. But it’s a thought-through, reflective approach to the way we have to invest our time, effort, and resources in the future,” Ryder said.
Still, he was realistic that not everyone would view the downsizing as strategic.
“I don’t expect any workforce to welcome a process which is going to lead to … a significant cut in the workforce. I mean, who wants to do that?” he said. “None of us. Absolutely none of us. We are in circumstances where — and this is a judgment of the secretary-general, but it’s also the realities of our member state behavior — where we’re going to have to face up to some very difficult conditions and take difficult decisions.”
Ultimately, the “acid test” of those decisions, as Ryder said, is the member states themselves, which must approve Guterres’ plans.
Watch the full conversation: Top UN official defends reform agenda as genuine, despite skepticism (Pro)
Watch an explainer: UN80 — a reform to maximize impact or just to cut costs?
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Three women who got shut out of the U.N.'s top job in 2016 aren’t going quietly — they’re making a fresh push for female leadership, even as questions linger over whether multiple women candidates could splinter support.
The trio — Susana Malcorra, Helen Clark, and Irina Bokova — talked to Raj about how they became unlikely allies after their unsuccessful 2016 campaigns. With resumes spanning Argentina's foreign ministry, New Zealand’s top government job, and UNESCO’s director-general role, they watched a man claim victory despite facing a majority-female field.
Their argument for 2026? “Why not a woman?” Malcorra said.
The 2016 numbers tell a story. Seven qualified women ran — including a former prime minister, foreign ministers, and U.N. veterans — yet none made the final rounds. “We have to admit things have changed a lot in these 10 years,” Bokova said of the more complex geopolitical environment.
The selection process adds another hurdle. Five permanent U.N. Security Council members effectively pick the winner behind closed doors in what Clark called a “fundamentally undemocratic” process.
The trio dismissed concerns that multiple women candidates in the race could hurt their collective chances — and Bokova contended that electing a woman could actually “strengthen the legitimacy” of an organization facing credibility.
Their advice to potential 2026 candidates? Stay authentic rather than trying to reshape profiles for political palatability.
“Just be yourself,” Malcorra said. “No matter what you try to change, it doesn’t help.”
Related: Is the world ready for a woman at helm of the United Nations?
Undoubtedly the glitziest events at UNGA began with branded popcorn and reusable cups of wine — and after a grand piano rendition of “What a Wonderful World” by musician Jon Batiste and a performance by Brazilian ballet dancer Ingrid Silva, billionaire philanthropist Bill Gates walked across the stage.
“Is it too much to ask that these rich countries — that are getting richer — continue to give that 1% [to development assistance]?” Gates said during his opening speech. “This is the moment to renew our commitment and build an even stronger movement.”
Gates’ remarks were followed by inspirational interludes from American actor Olivia Wilde, Spanish Prime Minister Pedro Sánchez, and community health worker Margaret Odera. But the context was set before Gates even began to speak, with a voice from the theater’s speakers telling the audience that despite the last 25 years of progress, the world has reversed course: More children will die in 2025 than one year prior.
Latif Nasser, a science journalist, reporter, and host for the WNYC Studios podcast Radiolab, broke down why that was the case. With the help and levity of a live Sesame Street production, Nasser walked the audience through what raising a child actually takes — with the help of gynecologists, infectious disease experts, and Indonesia’s minister of health.
The baby from the show ultimately survived the many tribulations thanks to an experimental tool that would genetically modify female mosquitoes to keep them from reproducing. And as a result, a chorus of trumpets celebrated the baby’s 5th birthday party.
“Delivery of those innovations will depend on resources,” Gates said. “But this is a tough time for that. Many countries who have been very dependable in terms of generosity, and aid, and global health aid in particular, are cutting back.”
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Gates announced on Monday $912 million of funding to support the Global Fund to Fight AIDS, Tuberculosis and Malaria. [Reuters]
Artificial intelligence carries risks, but could still help tackle the climate crisis provided governments properly regulate it, according to U.N. climate chief Simon Stiell. [The Guardian]
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