This commentary analyses the America First Global Health Strategy (AFGHS), launched by U.S. Secretary of State Marco Rubio in September 2025, and the bilateral health agreements subsequently signed with 14 African countries — including Kenya, Nigeria, Uganda, Rwanda, and Ethiopia — worth a combined $16 billion. Drawing on a detailed reading of the publicly available U.S.-Kenya agreement, the author identifies deeply asymmetric terms that amount to a surrender of health sovereignty. Key concerns include: the granting of U.S. FDA emergency use authorisation to mandate medical products in signatory countries during outbreaks; requirements for African countries to share pathogen specimens and genetic sequencing data with the U.S. within five days of a request for a period of 25 years with no reciprocal obligation; U.S. access to participating countries' digital health infrastructure and data systems; and a legal clause explicitly stating the agreement confers no rights or obligations under international or domestic law. The author situates these arrangements within a longer history of the exploitation of African bodies for medical research, and argues that health data has become Africa's new gold — extracted, commercially exploited, and sold back to the continent at a premium. The author calls on the African Union to convene an emergency summit on the bilateral agreements, to negotiate collectively as a bloc on their status, ensure full transparency and legislative scrutiny, and insist on reciprocity and legal enforceability in any future agreements.
Health equity in economic and trade policies
The Big Three asset managers — BlackRock, Vanguard, and State Street — collectively managing close to US$25 trillion in assets, are among the most prominent shareholders across forty leading corporations in ten key health-harming commodity industries, including tobacco, fossil fuels, ultra-processed food, weapons, and gambling. Analysis of their 2024 shareholder meeting voting behaviour found that all three voted in favour of all identified management proposals to boost shareholder payouts and authorise political lobbying, while overwhelmingly opposing shareholder proposals calling for social and environmental objectives to be incorporated into corporate policies. Seven such proposals may have succeeded had they received Big Three support. The findings suggest the Big Three are reinforcing shareholder primacy in health-harming industries, risking perpetuation of health inequities. The authors recommend that states take greater action to regulate private finance — including through mandatory exclusion of unsustainable assets and credit guidance policies — to prioritise health equity over narrow financial interests.
Drawing on a desk review of over 219 public domain documents across five sectors — food, essential medicines, extractive industries, information, and finance — this viewpoint maps the pathways through which powerful private actors (PPAs), including transnational corporations, private financial institutions, philanthropic foundations, and ultra-wealthy individuals, influence health and health policy in sub-Saharan Africa (SSA). Private equity and venture investment in SSA grew 66% between 2017 and 2022, with TNCs controlling the bulk of the region's US$12.7 billion pharmaceutical market. The authors identify five interlocking drivers of PPA influence: a neoliberal policy context that has shrunk the state and weakened market regulation; narrative and agential power used to promote pro-market framings and suppress alternatives such as IP waivers; tax concessions and corporate tax abuse that limit public revenues and weaken health systems; SSA representation deficits in key global forums including OECD and UN platforms; and the marginalisation of civil society, which undermines public interest accountability. In response, the authors outline four areas for engagement: institutionalising evidence generation and challenging harmful narratives; shifting from voluntary to legal regulatory measures; widening debate on economic policy alternatives; and strengthening unified continental platforms for global negotiations on IP, tax, and UN reform. The authors conclude that addressing PPA influence requires confronting the neoliberal rule systems that underpin it, building political economy alternatives that more sustainably and equitably promote health and well-being in SSA.
This paper explores sub-Saharan African tobacco control stakeholders' perspectives on tobacco endgame strategies suitable for the region. Twenty-nine stakeholders from academia, civil society, and government across 12 sub-Saharan African countries were interviewed online using a semi-structured schedule, with interviews analysed thematically using NVivo 12. Stakeholders broadly supported tobacco endgame adoption, citing tobacco's negative impacts on health, the environment, and the economy. Proposed strategies were grouped into five themes: product-focused, user-focused, market- and supply-focused, institutional structure-focused, and legislation implementation-focused. Stakeholders emphasised that endgame approaches should be Afrocentric and sensitive to regional dynamics, and that success depends on political will, multisectoral collaboration, adequate resources, public buy-in, and monitoring of the tobacco industry.
Economic sanctions imposed by the USA or EU were reported in this paper to be associated with an estimated 564,258 deaths annually from 1971 to 2021 — exceeding annual battle-related casualties — while their success rate in achieving stated policy aims was around 30%. All economic sanctions are ultimately noted to function as sanctions on health, undermining access to medical products, healthcare services, and determinants of health such as food security, with disproportionate effects on children, women, and marginalised populations. The editor suggests that countries wielding economic sanctions must monitor their health consequences, establish explicit exit mechanisms, and weigh whether the health toll constitutes a justifiable trade-off.
Intensified marketing and expanding consumption of ultra-processed foods (UPFs) that contain high sugar, salt, trans-fats and other additives and sugar sweetened beverages in Sub-Saharan Africa (SSA) are associated with rising obesogenic environments and non-communicable diseases, termed by some an ‘industrial pandemic’ due to its commercial drivers and cross border nature. This review paper addresses the question of how far SSA, positioned at an early point of a rising wave, is controlling this growing health challenge. It presents information on responses underway in SSA on (i) generating and sharing evidence and information as a form of discursive power; and on engaging (ii) on policy, regulation and other institutional measures; and (iii) at structural level, on taxes on UPFs and sugar sweetened beverages (SSBs) and investment measures, including to promote healthy food system alternatives, particularly in urban areas. While there is clear policy recognition of the need to respond effectively, the findings suggest that the response is not yet matching the scale or pace of the challenge. The paper examines the challenges in and options for implementing regulatory, policy, tax, and institutional interventions to prevent the health harms of UPFs and SSBs.
Corporate fast-food retailers (FFRs) represent a key retail channel through which both ultra-processed foods and intensively produced animal source foods are consumed and normalised within corporate-industrial food systems. These dietary patterns are strongly associated with increased risks of diet-related diseases and contribute significantly to environmental degradation, including greenhouse gas emissions, land use change, and biodiversity loss. Despite the growing significance of FFRs, there has been limited analysis of their financial strategies and implications for global food system transformation. The authors conducted a global analysis of market data from 54 countries and financial data of publicly listed FFRs, examining trends in FFR sales (2009–2023), market dominance, and the financial performance of leading publicly listed firms (1980–2023). While sales in high-income countries were stagnating, leading firms maintained stable net profit margins and delivered relatively high shareholder returns, facilitated by financial strategies such as franchising and private equity ownership. U.S.-based corporations dominated the global market, with substantial expansion into countries outside the global North. These trends reflect the consolidation of power within the corporate food regime. The global expansion of corporate FFRs underscore their growing influence over diets and food systems, with critical implications for public health, ecological sustainability, and social justice. Policies targeting structural leverage points, for example, democratising corporate governance, reducing the influence of private equity, and re-orienting agri-food subsidies, are essential to countering the entrenchment of this model and supporting more democratic and sustainable food systems.
There are three innovations with Global Health Watch 7 (GHW7). First, almost all of the chapters involved writing groups and contributions representing the geographic breadth of People’s Health Movement (PHM). As an exercise in ‘movement building,’ writing groups were encouraged to use their chapters as opportunities to discuss and engage across these geographies, allowing activists to learn with each other. PHM published with a solidarity publisher (Daraja Press) where each chapter could be posted for free download and distribution as soon as it was completed, and is now downloadable as a single book PDF or as an on-demand print version in English and Spanish. GHW7 comes to life with contributions from over one hundred activists around the world, sharing experiences and analysis on issues affecting people’s health in the contexts they live in and efforts to progress towards greater health justice.
This commentary addresses the global health security threats posed by increased critical minerals mining in Africa driven by the clean energy transition and 2050 net-zero emissions targets. The Democratic Republic of Congo houses over 55% of global cobalt reserves and produces 75% of global cobalt, while Guinea contains the world's largest bauxite reserves, South Africa holds over 70% of platinum, and Zimbabwe has the largest untapped lithium deposits. The author argues that without appropriate safeguards, expansion of mining operations increases risks of mining-associated infectious disease outbreaks with epidemic and pandemic potential. Several studies report linkages between habitat encroachment from mining activities and outbreaks of emerging/re-emerging infectious diseases, with examples from DRC and Uganda. The recent emergence of a more severe strain of the 2023 Mpox outbreak in DRC has for example been traced to the Kamituga mining area. The author recommends expanding Environmental, Social, and Governance standards to include biosecurity risk analysis under Environmental Impact Assessments; increased stakeholder representation in the Mineral Security Partnership; integration of spill-over/emergence/spread (SES) risk analysis into the draft Pandemic Accord, and leveraging earth observation technologies and pathogen surveillance for early detection and prevention of mining-associated health security threats.
This blog post discusses how conflicts in Gaza, Sudan, and Ukraine, affecting 2.4 billion people worldwide, create conditions where bacteria develop immunity to existing drugs through the destruction of infrastructure, forced population movements, and environmental contamination. Heavy metals used in weapons (zinc, lead, mercury, chromium, antimony, and barium) released during bombings are easy inducers of antimicrobial resistance. Examples from Iraq, Afghanistan, Libya, Syria, and Gaza show recurrent outbreaks of multi-resistant bacteria among military personnel and civilians. AMR is said to have already resulted in 5 million deaths in 2019, with projections suggesting humanity could return to a "pre-penicillin era" if current trends continue. The author argues that the systemic scope of AMR is underestimated, with hyper-reductionist interpretations dominated by financial interests in food, pharmaceutical, and bio-surveillance industries reluctant to change course. Microorganisms are observed to know no geopolitical borders and to strengthen their ability to spread silently during uncontrolled chaos of war, with spill-over effects in neighbouring countries and regions affected by ongoing conflicts.