Following COVID-19, the African Union elevated the Africa Centres for Disease Control and Prevention (Africa CDC) to autonomous status, empowering it to declare Public Health Emergencies of Continental Concern (PHECs). This mechanism was first operationalised in August 2024 in response to sustained mpox transmission across 13 AU member states — where 17,541 cases and 517 deaths had been recorded, representing a 160% rise in cases compared to the same period in 2023 — despite the WHO's earlier lifting of its own PHEIC. Applying the Critique, Reform, Withdrawal, and Transformation (CRWT) framework, this commentary argues that the PHECs represent both a strategic withdrawal from overreliance on the WHO PHEIC system and a transformative effort to embed African-led governance rooted in Pan-African solidarity. The mechanism mobilised USD 10.4 million in emergency AU funding and a tripartite vaccine distribution agreement, demonstrating its capacity for rapid resource mobilisation. Key recommendations include a tiered activation system for early response, a Pandemic Peer Review Mechanism modelled on the African Peer Review Mechanism, a dedicated AU Health Protocol to formalise Africa CDC's authority, and closer integration with continental financial instruments. The authors argue that PHECs represent a critical reconfiguration of Africa's role in global health — from recipient of external interventions to architect of regional norms and accountability — not by rejecting multilateralism, but by recalibrating it on African terms.
Governance and participation in health
Drawing on two case studies, the authors argue that ethical participatory research on climate change and health requires ongoing negotiation of power, participatory priority-setting, and holistic risk assessment. The first case study, an impact evaluation of climate adaptation actions in rural Zimbabwe (2019–2022), found that researchers needed to revise their initial selection of adaptation interventions after community consultation revealed that psychosocial distress from droughts was a more pressing local concern than the externally identified priorities. The second case study examined informal outdoor workers in Viet Nam facing heatwaves and extreme rainfall, identifying ethical risks including potential reprisals from employers for worker empowerment activities, the overshadowing of immediate socioeconomic concerns, and difficulties translating findings into policy. The authors identify three core ethical dilemmas: i. whose priorities shape the research agenda; ii. how to balance scientific rigour with participatory integrity; and iii. how to manage the tension between urgent climate timelines and the time required for meaningful community engagement. The authors conclude that ethical participatory research in climate and health must go beyond procedural compliance, to recognise communities as knowledge producers, address structural inequities, and ensure that research outcomes deliver tangible benefits to participants.
As world leaders gathered at the World Economic Forum in Davos in January 2026, the author argued that the Forum — despite its rhetoric of dialogue and shared problem-solving — serves the interests of a wealthy elite without delivery for the global majority. The wealthiest 0.001% now control three times more wealth than half of humanity combined, yet WEF's political influence perpetuates corporate tax reductions, regressive consumption taxes, and the thriving of tax havens. The author contrasts this with the 'We the 99 People's Summit' held in Johannesburg in November 2025, where movements from across the world adopted a ten-point, people-centred roadmap calling for taxing the super-rich and big tech, closing tax havens and shell companies, protecting civic and cultural rights, and ending occupation and genocide. At a time when multilateralism is being increasingly undermined, the author rejects substitutes for democratic global governance and argues that legitimacy comes from people, participation, and collective power.
In a rapidly expanding network of bilateral health agreements the United States has been negotiating across Africa under its America First Global Health Strategy, more than 20 memoranda of understanding are already signed with African governments and total commitments approaching $20 billion. The author notes that Zimbabwe withdrew from a proposed $367 million agreement after describing it as an unequal exchange; Kenya's High Court suspended a $2.5 billion agreement on data protection grounds; and Zambia's proposed $1 billion partnership reportedly included a clause linking termination to a separate minerals compact covering copper and cobalt. The author situates these arrangements within a longer history of colonial medical exploitation — from forced drug trials during sleeping sickness campaigns in French Equatorial Africa to Pfizer's controversial 1996 meningitis trial in Nigeria — and warns that bilateral agreements risk undermining the WHO Pandemic Agreement's pathogen access and benefit-sharing framework. The author calls on African governments to negotiate collectively through the African Union and Africa CDC rather than accept fragmented, asymmetric bilateral pacts that risk reproducing colonial extraction in new scientific form.
Artificial intelligence (AI) is transforming traditional, complementary, and integrative medicine by enhancing patient-centred care, diagnostics, personalized treatment, and knowledge digitization across four domains: end users, practitioners, practices, and interventions. AI applications include machine learning for syndrome classification, deep learning for tongue and facial diagnostics, clinical decision support systems for personalized prescriptions, and digitization initiatives like India's Traditional Knowledge Digital Library. However, critical challenges persist: regulatory complexities and legal accountability, ethical concerns regarding intellectual property and cultural sensitivity, data privacy and security risks, scarcity of standardized data, preservation of human-centred care relationships, and need for global collaboration. This paper proposes comprehensive policy strategies including adapted regulatory frameworks, protection of traditional knowledge through mechanisms like the Nagoya Protocol, robust data governance aligned with global standards, standardized data infrastructure, practitioner capacity building, and multistakeholder collaboration through organizations like WHO's Global Centre for Traditional Medicine. Responsible AI integration requires balancing technological innovation with respect for cultural heritage, ecological values, and ethical standards to advance equitable and sustainable global health outcomes.
Artificial intelligence (AI) solutions are being adopted across the globe, including the Global South, to address health needs and strengthen health systems. The rapid adoption of AI solutions provides tremendous potential to redress health inequities and strengthen health systems. It also entails substantial risks of deepening inequities, creating new forms of exclusion and weakening fragile health systems. Drawing on field-based case studies and interdisciplinary consultations, this paper presents an emergent research landscape that prioritizes health equity, gender equality, ethical safeguards, inclusive governance and Global South leadership.
This paper draws on 40 in-depth interviews with current and former medication for opioid use disorder clients and four focus groups with 35 current clients at an opioid treatment clinic in Dar es Salaam, Tanzania. Transcripts were thematically analyzed to explore how stigma influenced medication for opioid use disorder adherence and retention. Five themes emerged: stigma encountered while using public transportation; employment-related stigma; lack of family support due to misinformation; institutional stigma within the treatment setting; and stigma management strategies, including altering appearance and distancing from peers. Gendered expectations intensified stigma for women, while assumptions of untrustworthiness shaped client interactions across settings. These experiences posed significant barriers to consistent treatment engagement. To support medication for opioid use disorder retention, the authors propose integrating stigma reduction through expanded family engagement, more flexible clinic policies, client-informed approaches and public education.
The 80th session of the UN General Assembly (September 2025) convened amid rising geopolitical tensions, authoritarianism, climate crises, and the genocide in Palestine, highlighting urgent calls for UN power redistribution. This critical reflection examines the UN's historical evolution from its 1945 founding after the League of Nations' failure, through early peacekeeping successes like the 1956 Suez crisis, to current structural limitations exposed by its inadequate response to Palestinian genocide. Global South leaders condemned the concentration of binding and veto power in the five-member Security Council over the 193-member General Assembly's non-binding recommendations, arguing this structure perpetuates colonial-era power imbalances and prevents timely humanitarian intervention. Leaders called for urgent restructuring to transfer decision-making authority from the Security Council to the General Assembly, arguing that true multilateralism requires equality among nations in both theory and practice to fulfil the UN Charter's foundational commitments to human rights, dignity, and social progress.
This paper assessed nutrition literacy and its association with diet quality among 1206 adolescents and young adults aged 10–24 years in Mayuge district, Eastern Uganda. Using a structured questionnaire, the Global Diet Quality Score was adapted to estimate diet quality, and the Adolescent Nutrition Literacy Scale was used to assess nutrition literacy status. Among 1206 respondents, 85.9% were still in school, over 62% were from low socioeconomic status households, and only 14% used mobile phones. Low nutrition literacy was prevalent, with many unfamiliar with a balanced diet or ignoring dietary advice, although 62% were willing to promote healthy eating. Overall, 12.6% had poor diet quality marked by frequent refined grain consumption and low fruit/vegetable intake. Having low nutrition literacy was associated with a close to five-fold increase in poor diets, while mobile phone use was associated with better diet quality by 56%. The authors propose that targeted interventions to improve nutrition literacy can enhance diet quality among adolescents and young adults. .
Climate change is a major threat to sustainable growth and development in Sub-Saharan Africa (SSA). The efforts of SSA to achieve the Sustainable Development Goals by 2030 may be seen as a mirage if the adverse effects of climate change are not addressed. This review discusses the motivations for and importance of engaging communities in climate change and health research, the extent to which communities have been engaged in this in SSA and the barriers and facilitators faced. The findings highlight the demand to engage communities using strategies and processes that are sensitive to the community context in which it occurs, using participatory rural appraisal and community-based participatory approaches for interventions to address the effects and impacts created by climate change that are effective and responsive to community needs and interests. The authors argue that involvement and support by communities is design is essential for this.