global health – UAB Institute for Human Rights Blog

Silent Spread: Rising Drug Resistant Gonorrhea

Gonorrhea is no longer just a common sexually transmitted infection (STI) – it has become one of the world’s most dangerous drug-resistant infections. Gonorrhea is a preventable and curable STI that infected over 82 million adults in 2020. The consequences of infection include infertility and the increased risk of HIV. The impact of gonorrhea is dangerous enough to raise international caution, but the development of drug-resistant gonorrhea has resulted in this not just being a sexual health issue, but a public health emergency. The issue of antimicrobial resistance is coupled by delayed diagnosis, stigma, and gaps in global health, leaving millions of lives vulnerable and jeopardizing their human right to health.

What is Gonorrhea?

Gonorrhea is caused by Neisseria gonorrhoeae which is a bacteria that is transmitted sexually. The infection primarily impacts younger populations from 15 to 49 years old and largely women. Generally, in international populations, LGBTQ+, racial minorities, indigenous populations, and sex workers bear a disproportionate burden of gonorrhea.

This burden is both physical and emotional. When working through the development of the infection, it may bring up concerns for distrust; a patient in Georgia bravely accounts for her story with gonorrhea with a date. From unprotected intercourse to getting tested early, she shares the dangers in onset and the importance of urgency with the infection.

If the infection is not treated in a timely manner, there could be significant reproductive health complications such as pelvic inflammatory disease, which is an infection of the female reproductive organs, and chorioamnionitis, a serious pregnancy complication, both of which contribute to the onset risk of infertility. This is coupled by the heightened risk of HIV acquisition.

The danger of gonorrhea is that asymptomatic infections, making up around 90% of infections in women and 56% to 87% of infections in men, can silently spread in communities. This increases the risk of transmission and complications due to the infection. This amplifies the public health crisis of sexually transmitted infections throughout the world, placing an increased burden on communities with already limited resources.

What is Antimicrobial Resistance?

Antimicrobial resistance is a critical global health development, claiming the title of the “Silent Pandemic.” Its danger is developed through the misuse of antimicrobials in humans, animals, and plants; this results in the development of bacteria and pathogens that are resistant to drugs. Although new drugs are developed to support intervention against a variety of infections across the world, there is always the risk of antimicrobial resistance, regardless of how complex the drug is. The issue of antimicrobial resistance spans beyond low and middle income countries; rather, it affects countries from all income levels. However, its drivers are exacerbated by poverty and inequality.

In 2021, antimicrobial resistance caused around 1.1 million deaths, with a forecast of 1.9 million deaths by 2050. This is coupled by financial losses, resulting in an economic impact of trillions of dollars across the world. Along with these losses, there is the problem of drug-resistant HIV, tuberculosis, and malaria. The onset of drug-resistant forms of these diseases results in a lack of access to critical medication that can promise maintenance or help address the disease at hand. This challenge has been approached by a variety of factors. From the expected means, like education and public awareness, to the integration of artificial intelligence, there are a variety of tools to help combat and address antimicrobial resistance.

Antimicrobial Resistance of Gonorrhea

What is unique about the relationship between antimicrobial resistance and gonorrhea is that gonorrhea has grown resistant to nearly every drug that is used to treat it. This has resulted in there being only one class of antibiotics available for gonorrhea control. When reflecting on its accessibility, it is easily covered by insurance throughout the United States and other Global North countries, but treatment is not as accessible in the Global South, requiring collaborations and private-public partnerships.

Global conversations suggest that resistance to ceftriaxone and cefixime, common antibiotics used for treatment of gonorrhea, have risen to 5% and 11% respectively, whereas resistance to ciprofloxacin, another formerly effective drug against gonorrhea, has reached 95%. Data for the United States, specifically through the Gonococcal Isolate Surveillance Project, has suggested that gonorrhea has decreased susceptibility to an antibiotic, and laboratory results demonstrate that increased antibiotics are critical to halt all growth. Internationally, resistance to key treatments further supports the need for surveillance of gonorrhea, but this may not be feasible.

Factors Contributing to the Rise of Antimicrobial Resistance

Antimicrobial resistance has been on the rise across the globe for a variety of reasons. The largest reason, as mentioned, is antibiotic misuse. This is driven by the administration of antibiotic prescriptions without a policy or treatment regimen, which is especially common in developing countries, as many prescription medicines are available over the counter in these countries. In developed countries, lack of health literacy or forewarning by healthcare providers also fuels misuse. The nature of antibiotic prescriptions also contributes to the global burden of antimicrobial resistance; its being overprescribed by healthcare providers contributes to the development of resistance long term, especially when these medicines are prescribed over lengthy courses.

Another factor that contributes to antimicrobial resistance is the general delay of care for sexually transmitted diseases and infections. Generally, barriers to care-seeking can be attitudes, social stigma or mental conditions, which can be exacerbated by health system factors like lack of access to a clinic or lack of insurance. This delays timely treatment and access to a treatment regimen that would work best for the patient.

The Need for Gonorrhea Resistance Surveillance

In spite of certain medical interventions’ not working, there is one action that can promise a healthier future and that is expanding surveillance. Genomic surveillance, the process of monitoring and analyzing the genetic makeup of a pathogen, can help guide gonorrhea control. There have been a variety of programs that have supported understanding gonorrhea. From the CDC’s Gonococcal Isolate Surveillance Project to the WHO’s Gonococcal Antimicrobial Surveillance Program, data about gonococcal antimicrobial susceptibility has been collected. With this data, information is mobilized to key regions, which then informs the gonorrhea strategy in each country. Surveillance is challenged by access to funding and laboratory resources, but this approach still demonstrates that collecting key data can help support global treatment guidelines and policies.

What Is Next?

As the global fight against antimicrobial resistance occurs, it is critical for us all to do our part. Within the conversation of prevention, it is critical that safe sex practices, like condom use and STI testing, are leveraged. If symptoms appear, it is critical to seek our care and not start any medication regime without medical guidance. Within all conversations, it is critical to normalize conversations about sexual health and seeking out medical help when needed. As the danger of drug-resistant gonorrhea is growing, it is critical for everyone to take a part in the journey, helping us prevent a future where gonorrhea is untreatable. Drug-resistant gonorrhea is not inevitable; it’s a preventable crisis. The choices we make today will determine whether future generations inherit an infection we can still control and are able to fully enjoy their human right to health.

High-Income Countries Retreat from a Healthy Environment

Secretary-General António Guterres (right) meets with King Carl XVI Gustaf and Queen Silvia of Sweden. UN Photo/Eskinder Debebe.

Introduction

Global efforts aim to achieve net-zero CO₂ and limit warming to 1.5 degrees Celsius above pre-industrial levels by 2050 (Intergovernmental Panel on Climate Change, 2018). However, current national policies remain misaligned with this goal, with trends in several high-income countries falling short of necessary reductions (Climate Action Tracker, 2023). For example, Sweden, once a leader in climate control and environmental justice, is now retreating from its commitments. The 2024 report by the Swedish Climate Policy Council shows that recent decisions reflect a de-prioritization of national climate goals (Swedish Climate Policy Council, 2024). Meanwhile, mounting pressures to accelerate the fossil fuel phase-out at the 29^th United Nations Climate Change Conference (COP29) were met with diplomatic compromises that failed to commit to a full phase-out, disappointing many climate advocates (Carlin, 2024). These are not isolated developments. They signal an increasing pattern of high-income countries placing domestic economic and geopolitical priorities over environmental rights. As climate risks escalate, these decisions reflect a strategic withdrawal from global responsibility.

Legal Foundations of Environmental Justice

The right to a healthy environment is more than an aspirational claim; it is deeply rooted in international human rights law. In 1948, Article 25 of the Universal Declaration of Human Rights (UDHR) affirmed the right to a standard of living adequate for health and wellbeing (United Nations, 1948). Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) further codified this right in 1966, obligating states actors to seek improvement in “all aspects of environmental and industrial hygiene” (United Nations, 1966). The Office of the United Nations High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) jointly issued General Comment No. 14 in 2008, clarifying that the right to health is directly undermined by environmental degradation and must be addressed through preventative action (OHCHR & WHO, 2008).

These legal foundations, as mirrored in the Sustainable Development Goals (SDGs), conclusively link environmental protection to human dignity and global equity. The SDGs – specifically (3) good health and well-being, (6) clean water and sanitation, (13) climate action, and (16) peace, justice, and strong institutions – reinforce the technical and practical dimensions of environmental rights (United Nations, 2015; OHCHR, n.d.). The United Nations General Assembly added to this evolving legal architecture through Resolution 76/300, which formally recognizes the right to a clean, healthy, and sustainable environment as “crucial to the enjoyment of all human rights” (United Nations General Assembly, 2022). In combination, these mechanisms establish environmental rights as enforceable obligations, central to global equity and intergenerational justice.

Policy Shifts

Faltering climate ambition echoes across the G20, the forum of world economies that coordinate global economic policy. Their 2025 declaration failed to reaffirm the 1.5°C target, reflecting a collective failure to meet Paris Agreement goals (Joint Research Centre, 2025). Just weeks after 2024 was declared the hottest year on record, the United States formally withdrew from the Paris Agreement for a second time (Human Rights Watch, 2025). Shortly after, Argentina announced plans to exit the agreement and withdrew from COP29 negotiations (Climate Cosmos, 2025). While Argentina is not classified as a high-income country, this action still denotes a further weakening of global consensus. Several other G20 countries (Australia, Japan, Canada, Italy, and South Korea) have backed out of previous net-zero pledges and multilateral obligations through delayed climate targets, reclassified fossil fuels, and suspended mitigation policies (Climate Cosmos, 2025). The United States has also seen significant cuts to climate research and clean energy programs, discontinuing more than 100 federally funded studies (Temple, 2025).

The United Kingdom, another former leader in this field, has directed funds away from climate action and toward defense and trade priorities (United Kingdom Foreign, Commonwealth & Development Office [UK FCDO], 2025). In April of 2025, a group of civil society organizations filed a case against the French government for failing to protect citizens from foreseeable climate harms, claiming that current adaptation plans are insufficient (Jones Day, 2025). Germany’s government, while continuing to support renewable energy, has deprioritized emissions reductions in favor of industrial competitiveness (Clean Energy Wire, 2025).

These shifts in government focus are not limited to the public sector. Many of the corporations that made net-zero pledges within the past five years have begun scaling back efforts due to political and financial pressure. Major financial institutions have classified ESG backlash as a material risk, leading companies to scale back climate commitments (Conference Board, 2025). ESG (Environmental, Social, and Governance) is a set of criteria historically used to evaluate corporate sustainability and ethics; however, it is now criticized by conservative lawmakers and skeptical investors as politically charged or financially burdensome (Conference Board, 2025). Ioannou (2025) notes that this new backlash reflects deeper tensions surrounding corporations in the advancement of social and environmental goals. A deeper ideological repositioning can be seen through these developments. While climate justice was once a collective imperative, it is now being treated as a negotiable interest, shaped by national politics and short-term economic goals.

Secretary-General António Guterres at the Climate Summit 2025, a high-Level special event on Climate Action. “The science demands action. The law commands it. The economics compel it. And people are calling for it.” UN Photo/Manuel Elías.

Implications and Consequences

These policy shifts have tangible and far-reaching human consequences. As inaction continues, the risk of compounding impacts onto other human rights increases. The right to housing and security is threatened by rising climate-related displacement (Amnesty International, 2025). The right to food is at risk due to extreme weather events disrupting agricultural systems (Food and Agriculture Organization, 2025). Overall, health and well-being continue to be threatened by rising air pollution, heat stress, and vector-borne diseases (Romanello et al., 2025).

Low- to middle-income countries and Indigenous communities are disproportionately impacted, despite contributing less to climate change overall. For instance, aid cuts by Australia and the UK fail to support vulnerable nations and regional populations, limiting their ability to protect lives, livelihoods, and ecosystems (Lowy Institute, 2024; UK FCDO, 2025). This undermines the moral and legal obligations enshrined in UNGA Resolution 76/300 and the ICESCR, which have been ratified by both countries (United Nations, 1966; United Nations General Assembly, 2022).

With climate disasters escalating in frequency and severity, high-income countries are not immune to the consequences of their retreat. From wildfires in Australia and floods in Germany to storms and heatwaves in the United States, public infrastructure and economies have been strained, revealing critical gaps in disaster preparedness (Pengilley, 2025; Clean Energy Wire, 2025; Climate Central, 2025).

Aside from immediate and prolonged dangers, these events erode public trust in environmental governance. As citizens see governments scale back their climate commitments, they turn to litigation and civil disobedience to demand accountability. Globally, youth-led lawsuits have surged in 2025, seeing plaintiffs invoke their constitutional and human rights to challenge state action/inaction (Merner, 2025; Environmental Health News, 2025). Not only does this challenge the moral authority of high-income countries, but it undermines their credibility and weakens their capacity to lead on broader global challenges. Such a withdrawal is not only unjust from a human rights standpoint, but strategically shortsighted.

A view of pamphlets during the event “International Day of Sport for Development and Peace 2023: Scoring for People and the Planet”. UN Photo/Mark Garten.

Closing Reflection

More than symbolic pledges, environmental justice requires enforceable obligations, consistent funding for climate action, and consideration for the most impacted communities. High-income countries must stop viewing climate action as a zero-sum trade-off and reframe it through a shared, rights-based infrastructure of resilience. The consequences from previous retreats, from displacement to institutional erosion, must be urgently addressed. Rebuilding public trust must begin with global recommitments, inclusive governance, and transparent financing. Meeting today’s demands will require high-income countries to abandon performative pragmatism for principled action. Climate justice is not a luxury, but a prerequisite for global survival.

High-Income Countries Retreat from Global Health

President Donald Trump holds a cabinet meeting, Wednesday, February 26, 2025, in the Cabinet Room. (Official White House Photo by Molly Riley)

Introduction

In favor of focusing on domestic economic recovery, migration control, and new geopolitical strategy, high-income countries are overlooking global health in their reprioritized foreign aid plans (Nain, 2025). This retreat from investing in global health displays a departure from historically fundamental moral and legal obligations to global health and human rights. From the Universal Declaration of Human Rights (UDHR) to the International Covenant on Economic, Social and Cultural Rights (ICESCR), the right to health has been codified as a shared responsibility. However, recent policy changes suggest a breakdown in multilateral obligations. The blog seeks to explore the ideological and structural consequences of this retreat, asking what does it mean when global health is no longer treated as a collective imperative, but as a negotiable interest?

Historical Context

More than mere technical interventions, global health has a history of moral and legal obligations rooted in human rights. The right to health, as enshrined in Article 25 of the UDHR, affirms that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family” (United Nations, 1948). This was further codified in Article 12 of the ICESCR through the obligation of state actors to act toward “the prevention, treatment and control of epidemic, endemic, occupational and other diseases,” as well as the “creation of conditions which would assure to all medical service and medical attention in the event of sickness” (United Nations, 1966; Office of the United Nations High Commissioner for Human Rights & World Health Organization, 2008). Scholars and practitioners over the past two decades have asserted global health to be rights-based and participatory (Meier & Gostin, 2018; Gostin & Meier, 2020). Additionally, Mulumba et al. (2025) argue that enforceable commitments from high-income countries are essential to the global realization of the right to health. Despite these observations, recent trends suggest a troubling retreat from these shared responsibilities.

Delegates from Netherlands looking at documents at AMR conference — Rene Verleg Fotografie
10 February 2016, 09:02 AMR conference – Ministers Schippers & van Dam EU2016 NL from The Netherlands

Policy Shifts

A series of global health funding cuts, including a 67% reduction from the United States in 2025, has disrupted various health programs including those surrounding HIV, tuberculosis, and maternal health across dozens of countries (Krugman, 2025). Similarly, the United Kingdom instituted an aid reduction of 0.5% to 0.3% of gross national income by 2027, most severely impacting sexual and reproductive health rights (SRHR) (Parker & Garcia, 2021). Through the Mattei Plan, Italy restructured its aid to prioritize migration control and energy diplomacy, which reduced bilateral health programming by 26% (Donor Tracker, 2025). Canada, despite earlier commitments to scale SRHR investments, paused new global health funding in 2024, claiming to instead be prioritizing domestic equity (Global Affairs Canada, 2024). Australia deprioritized health programs through a $500 million cut from its Indo-Pacific aid portfolio in favor of strategic infrastructure and defense partnerships (Stanhope, 2024).

Citing “shifting national priorities,” the Netherlands withdrew support from SRHR, LGBTQIA+, and harm reduction programs (Meier & Gostin, 2018). Norway reduced its aid by 5% in 2024, drastically impacting emergency relief and support for low- to middle-income countries (Norad, 2025). Revising its Development Cooperation Charter to align foreign aid with national security, Japan launched Official Security Assistance (OSA) and shifted focus from multilateral health to defense and tech diplomacy (International Institute for Strategic Studies, 2024).

Germany and France have reallocated development funds toward trade competitiveness, migration control, and domestic security (Parker & Garcia, 2021). Germany, despite remaining a top donor to the World Health Organization (WHO), has adopted a transactional posture that has subordinated health to economic and geopolitical interests (Bayerlein, 2025; Bundesministerium für Gesundheit, 2025). Similarly, France launched a new Global Health Strategy and co-hosted the WHO’s Investment Round but cut global health aid by 33% amid domestic budget strain (Organisation for Economic Co-operation and Development, 2024; World Health Organization, 2025a; Krugman, 2025).

Spain and South Korea complicate this trend through selective engagement rather than full high-income country retreat. South Korea reaffirmed its leadership through strategic dialogue with the WHO, and Spain launched a new Global Health Strategy in 2025 (World Health Organization, 2024a; World Health Organization, 2024b; Donor Tracker, 2024). Despite these efforts, both countries have simultaneously recalibrated foreign policy toward economic security and technology diplomacy (Lee, 2024; Ministry of Foreign Affairs of Spain, 2025).

These are more than fiscal shifts in a world of economies. They reflect a deeper ideological repositioning. Many governments increasingly justify aid reductions through a “domestic-first” standpoint that frames global health as competing priority with national economic recovery, rather than as a complementary one (Center for Development, 2025). Others prioritize defense, trade, and migration over health equity as a geopolitical strategy. This logic is echoed across the philanthropic sector, where the Gates Foundation’s 25-year sunset plan embodies a transition from broad global health engagement to a finite, legacy-oriented agenda (Gates Foundation, 2025; Shefcik, 2025). This recalibration, framed as a pivot toward “achievable” goals, reflects the broader trend of donor fatigue and feasibility framing. This trend suggest that global health priorities are now shaped by power asymmetries, short-term metrics, and political expediency rather than solidarity across shared interests (Abimbola, 2021).

Human Rights Implications

We have already begun to feel the consequences of these shifts. UNAIDS (2025) warns of the impact felt in countries like Tanzania and Uganda, which have seen closures and disruption in HIV clinics and other essential services. These disruptions, as documented by Physicians for Human Rights (2025), threaten to reverse decades of progress in HIV prevention and treatment. UN agencies are also warning that gains in preventable death reduction from maternal health programs could be lost (World Health Organization, 2025b). These disruptions disproportionately affect marginalized populations and violate core human rights obligations (Meier & Gostin, 2018; Gostin & Meier, 2020; UNRIC, 2025). The WHO has reported that over 70% of surveyed countries are experiencing similar health system breakdowns due to aid withdrawals (World Health Organization, 2025c). These outcomes show the severe impacts of eroded accountability measures within global health governance (Parker & Garcia, 2021).

One of the signs at the main entrance to the US Agency for International Development (USAID) offices being taped over on February 7, 2025. This is on the west side of the Ronald Reagan Building. 1300 Pennsylvania Avenue NW, Washington, DC 20004.
7 February 2025, 12:54:26 http://edwardjohnson.com/ G. Edward Johnson

Domestic Consequences

High-income countries are not exempt from the consequences of the retreat from global health. Parker and Garcia (2021) argue that isolationist health policies create blind spots that leave even wealthy nations vulnerable to transnational threats. Weakened pandemic preparedness, undermined surveillance systems, and limited coordinated response capacity are all side effects of reduced engagement (Bond, 2025). Perhaps more significantly, the public is experiencing a breakdown of trust in health institutions. Amid a growing crisis of confidence in public health leadership, calls for renewed efforts to restore institutional legitimacy are on the rise (Leslie, 2023; Cooper, 2025). Withdrawing from global health commitments not only abandons vulnerable populations globally but also compromises the moral leadership and resilience of high-income countries.

Closing Reflection

Beyond restored funding, a reorientation of values is necessary for a rights-based recommitment to global health. This requires the abandonment of performative pragmatism for enforceable obligations to solidarity and justice. It demands the centering of marginalized voices, the rebuilding of institutional trust, and the recognition of global health as a shared infrastructure of resilience, rather than a zero-sum game of political maneuvering. The consequences of this retreat – from disrupted HIV clinics to weakened pandemic preparedness – must be confronted as we forge a new path rooted in justice. Furthermore, for a more equitable and secure world, it is a strategic imperative that we reclaim global health as a human right.

Impacts of Terminating USAID (United States Agency for International Developement)

Since early February, the United States Agency for International Development (USAID) has been essentially disbanded, experiencing mass layoffs and the forced closure of its headquarters in Washington, D.C.. This follows President Donald Trump’s executive order, which halted all foreign assistance payments for 90 days, along with his administration’s narrative that the agency is plagued with fraud and programs that undermine national interests. Although this idea has continued to spread, the reality is that USAID is an important agency, both domestically and internationally. As United States foreign assistance funding constitutes a significant percentage of worldwide foreign aid, shutting down these programs jeopardizes the health and safety of various countries and communities but also poses issues for American citizens who work alongside these assistance efforts.

Image 1: USAID’s official logo. Source: Yahoo Images.

What is USAID?

USAID, the United States Agency for International Development, is a governmental agency that aims to assist countries undergoing humanitarian crises, support marginalized groups, and monitor democratic consolidation in recently formed democracies. These goals are achieved through agency-created programs and funding non-governmental organizations (NGOs) worldwide. Created in 1961, USAID was designed to fulfill the country’s moral obligation to use its wealth to assist other, less affluent nations while also countering the perceived influence of the Soviet Union during the height of the Cold War. While it may work alongside these organizations, the agency functions independently from the Department of Defense and the Department of State. Having this separation grants USAID the flexibility to work more closely with civil society groups and local communities as opposed to communicating through upper-level government officials. Similarly, projects run by and funded through USAID are generally focused on achieving a long-term goal. This focus on connecting at the local level and supporting sustained health, growth, and democracy fosters long-lasting relations with partner countries– and this type of relationship varies significantly from more transactional, political relations seen in other diplomatic channels.

Impacts of USAID

With a budget of $71.9 billion in 2023 or 1.2 percent of that year’s federal budget, USAID is the largest donor of foreign assistance, contributing to over 40% of all foreign aid. This money is used to fund international organizations such as the World Food Program, the United Nations Children Fund, and countless other partners with similar missions, along with sponsoring numerous projects in over 120 countries. These projects include the President’s Emergency Plan for AIDS Relief (PEPFAR), a program designed to control the circulation of HIV/AIDS throughout heavily impacted countries. It is credited with “saving over 25 million lives, preventing millions of HIV infections, and supporting several countries to achieve HIV epidemic control,” working closely with more than 50 countries– many of those in South Africa. PEPFAR is managed, led, and largely funded by USAID, with the agency contributing to 20% of the program’s total budget. Overall, PEPFAR is viewed as a successful program, with a general increase in health outcomes in funded countries. USAID also seeks to eradicate the spread of other infectious diseases, such as tuberculosis (TB), where the agency is estimated to have saved the lives of more than 58 million patients.

USAID also directs funding to smaller, more localized NGOs. In several Eastern European countries, for instance, money is sent to support independent media outlets and democratic organizations that consolidate democracy in post-communist states. These NGOs ensure that private media companies can compete against historically inaccurate state media sources. The agency also partnered with women’s rights groups to fight for better treatment in societies where women often face discrimination.

A USAID worker helps two young boys. — Image 2: A USAID worker assists two young boys at a camp for internally displaced people. Source: Yahoo Images

Ramifications of USAID Termination

Global Impacts

The termination of USAID and the halt on foreign assistance have already begun to have negative global outcomes. In regards to medical care, the lack of funding for the PEPFAR program has triggered a suspension of medicine distribution and the closure of clinics throughout Africa, with the United Nations Program on HIV and AIDS estimating that almost 3,000 preventable HIV infections have since occurred. Similarly, the lack of adequate funding has left many clinics defunct, with officials in the Democratic Republic of Congo unable to afford air conditioning to keep necessary medicines cold. Furthermore, Syria has seen the firing of over 150 medical officials along with the cessation of 10 crucial clinics in one of the country’s most dire regions. Similar risks are faced with numerous diseases, such as tuberculosis. Without adequate funding, clinics and NGOs can no longer afford to test for or treat TB patients, nor can they maintain the staff necessary to carry out these actions. Since TB is an airborne illness, its spread is not confined to one particular area, meaning it can quickly become a much larger issue, thus making its impact even greater.

This halt in assistance will also likely contribute to greater global inequality, where organizations that promote education, women’s and LGBTQ+ rights, and refugee assistance will likely face large funding gaps and be unable to achieve their goals.

Geopolitical Impacts

Though many argue that USAID projects are often antithetical to the country’s national interests, the reality is that the agency allows the United States to create long-lasting, positive relations with partnering countries while preventing the extension of influence from its adversaries. Ceasing funds abruptly means that affected communities and US relations are both at risk. By turning away from foreign aid, other countries will step in to fill these funding gaps. However, by doing so, these countries can exert soft power, challenging the US hegemony. Efforts are already being made by China, which has begun to fund projects in former USAID recipient regions. Funding issues aside, this rapid change to foreign aid distribution may also reduce global trust in the US as countries question the nation’s ability to follow through on projects. This distrust could further weaken America’s diplomatic relations with both former USAID recipient countries and with new countries in the future. In short, by cutting funding, diplomatic relations are strained, and a space for competing hegemonic powers is opened.

Domestic Impact

While cutting USAID primarily impacts countries abroad, this termination of funding also carries domestic ramifications. As the agency is the leading provider of global humanitarian food aid, cutting USAID has also meant ending government contracts with farmers. In 2020, the federal government bought $2 billion worth of food aid from American farmers, and while this number is a small portion of the entire agriculture market, it does provide stability for those contract employees and fills a demand gap for specific grains. Even food aid received prior to the funding freeze has yet to be delivered and it is not being sent to its planned destination.

The abrupt termination of USAID also raises questions regarding democracy and legality in the United States, as the actions taken by the current administration undermine Congress’s authority over agency creation and budgetary power. Agency creation and elimination requires Congressional approval; however, nothing has been brought to the legislative branch that requests to dissolve USAID. Similarly, these decisions are guided by the Department of Government Efficiency, a temporary contract organization. The dismantling of the agency has triggered a flurry of lawsuits, with one of them expecting a final hearing on February 21st. Since terminating USAID in this fashion is illegal, the result of the lawsuit and subsequent actions demand close attention.

Conclusion

Cutting USAID leaves the US and the world worse off. As the nation contributes a significant portion of aid funding, countries will struggle to fill the gap, leaving poorer nations to struggle. This termination also creates issues for the US. In a time when nations continue to compete for power, the US’s seclusion from foreign aid could allow other countries to expand their influence. Similarly, diplomatic relations could be weakened as aid relations are severed with little warning. American citizens also reap the consequences, seeing large layoffs and the cancelation of government-farmer contracts. This global situation is in desperate need of monitoring as it is still unclear to what extent aid-receiving countries will struggle.

Japan’s Public Health Diplomacy: A Pillar for Advancing Global Human Rights

When thinking about Japan, remembrance of its rich history and culture may come to mind. However, unknown to most is Japan’s role on the global stage for public health diplomacy. Ranging from international development to research investments, Japan has contributed to the expansion of health as a fundamental right, as stated by Article 25 of the Universal Declaration of Human Rights. Japan’s commitment to human rights is prominent through expanding global health equity, prioritizing universal access, improving technological innovation, and assisting with disaster relief.

Background of Japan’s Public Health Diplomacy

Public health diplomacy is the use of diplomatic channels and strategies to help address global health challenges. This ranges from the development of multilateral partnerships, domestic offices, funding opportunities, and more; with the main focus on addressing health issues, any avenue can be explored to address the nuances. The cultural foundation of Japan emphasizes its role as an international power; Japan’s ethos of wa, meaning harmony, and omotenashi, meaning hospitality, has further accelerated its role in space.

Japan’s emergence as a global health power began after World War II when it was developing its own healthcare infrastructure. In 1922, the Health Insurance Act was developed; this was in parallel to the German social insurance model that was managed jointly between employers and employees. In 1961, under this act, Japan finally achieved a universal healthcare system. This was done by developing the same fee schedules for all plans and requiring providers to maintain equity through contained costs. To further support underrepresented communities, subsidies were available for elderly people and children.

The strong domestic foundation developed by Japan opened up an opportunity for it to serve as a global leader as well. Since joining the WHO (World Health Organization) in 1956, it has contributed millions of dollars, giving over US$ 218 million in the 2020-2021 year to the WHO and US$ 50 million to the Contingency Fund for Emergencies; it has mobilized a lot of financial support, which has then supported humanitarian crisis in countries across the world.

Photo 1: Photo of Japan Medical Assistance Team jacket.Source: Flickr — Photo 1: Photo of Japan Medical Assistance Team jacket.
Source: Flickr

Japan’s Current Initiatives

With the successful implementation of universal health coverage, Japan has been a leader in mobilizing it in other countries. One way it has done so was through the 2017 UHC (Universal Healthcare) Forum in Tokyo. This forum, organized in collaboration with JICA (Japanese International Cooperation Agency), UNICEF (United Nations Children’s Fund), and the World Bank Group, discussed the urgency of making progress towards universal health coverage by engaging over 40 countries to motivate action towards equity for all communities. Beyond that of programmatic support, the World Bank-Japan Joint UHC Initiative has developed the analytics needed to contribute to the progress towards international UHC. This support has also been tried through bilateral collaborations; for example, Myanmar received around US$ 19 million in universal health coverage support from Japan, helping build its international health portfolio. With universal health coverage, health equities can be reduced across the globe.

Beyond that of universal health coverage, Japan has contributed to the development of valuable maternal and child health initiatives across the globe. Through programs and partnerships with entities like JICA, people can receive the training they need to support women and children who are systematically vulnerable communities. An example of their specific support is noted in Cambodia; by providing financial support and programmatic avenues, maternal mortality rates decreased significantly from the increased training for midwives and the improved clinics.

Even beyond that of the Asian continent, Japan has worked to develop programs in Africa to improve maternal health outcomes. An example of this is the Safe Motherhood program in Kenya. The program, developed in 1987, helped reduce maternal mortality by 50% in the country. Analyzing maternal and child healthcare is foundational to achieving gender equality and prioritizing sustainable development.

Japan is also strong in mobilizing support for disease relief and recovery assistance. The Japan Disaster Medical Assistance Teams have been trained to address domestic and international issues; rooted in Japan’s own history in disaster relief, their role on the global stage is prominent. For example, after the 2010 earthquake in Haiti, Japan provided over US$ 320 million in support that was mobilized as emergency assistance after the earthquake or in development assistance; this ranged from providing emergency relief goods, like jerry cans, to assisting with rehabilitating the water supply system. Another example is the US$ 500 million pledge to assist with the 2004 Indian Ocean tsunami; the multilateral support to all impacted countries was integral to their redevelopment and solidified Japan’s role as a key actor in global health diplomacy, helping restore health services to ensure affected populations are able to come back to their normal health levels.

Japan’s Model for Success

Japan is a leader in global health diplomacy and can share many insights with other nations and entities to improve their presence on the global stage as well. Despite domestic challenges of aging populations and criticisms for low refugee intake, their holistic approach is a strong suit. By combining technological innovations, hospitality, and multilateralism, they have been able to provide culturally sensitive care to countries around the world. As they contribute to work in health diplomacy, it is valuable to underline all efforts with the continued advocacy for health as a fundamental human right, addressing challenges that might exist proactively. By working to play their role, Japan has improved not only the health but the lives of millions of people across the world.

The Eradication of Malaria in Egypt: A Triumph for Public Health and Human Rights

When thinking about malaria, we tend to forget its impact across the world. Especially living in the global north, my experience with malaria has been restricted to my coursework; however, the reality of the disease is that it exists and poses a prominent issue in many countries across the world. The illness, spread by a mosquito vector, had over 247 million cases in 2021; this spanned across many regions worldwide, primarily impacting Africa.

In recent years, the WHO (World Health Organization) has worked in many different countries to eradicate malaria and has successfully done so with their WHO Guidelines for Malaria. An example of these guidelines being successful is Algeria, which reported its last case in 2013. However, a recent accomplishment in the world of malaria has been noted, which is the eradication of the disease in Egypt. For decades, Egypt had struggled with the disease and the associated outcomes.

Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region.Source: WHO — Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region. Source: WHO

Malaria’s History in Egypt

The nature of Egypt had made it susceptible to the fruition of the illness. Historically, the disease was tested around the Nile Delta and Upper Egypt, tracing back to 4000 B.C.E. As most of the population was concentrated in these areas, it led to the development of disease impacting millions of individuals. In recent history, the illness has contributed to the fragility of the country, ranging from increased economic losses, inflated healthcare costs, and decreased labor productivity.

The first ever effort to control malaria can be dated to 1950, with the introduction of dichloro-diphenyl-trichloroethane (DDT). This initial intervention was an insecticide that was used to help not only reduce the mosquito population but also address the development of typhus and other insect-borne diseases. However, this intervention resulted in some resistance amongst the community and additional environmental concerns; as of 2001, the intervention was observed as a possible human carcinogen and has since been banned in Egyptian agriculture.

In 1969, the creation of the Aswan Dam posed a new risk for the development of disease, all of which resulted in the need for new interventions. With additional adjustments to the approach against malaria, in the 1980s, the WHO helped push towards the eradication of malaria in Egypt with their eradication program. This program included regions like Africa, the Americas, Asia-Pacific, and the Middle East and Eurasia. This resulted in outcomes such as reducing the number of cases by 300,000 between 1980 and 2010. Though these outcomes are significant, those with limited access to healthcare were still disadvantaged in the global conversation.

Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt.Source: WHO — Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt. Source: WHO

The New Approach to Malaria

Building upon previous interventions, additional interventions have been explored in the past few decades; these have contributed meaningfully to the eradication of malaria in the country. Before mobilizing interventions, it is important to educate communities about what malaria is and develop trust in proposed interventions. The Egyptian government, in collaboration with different NGOs (Non-Governmental Organizations), launched different campaigns that reached communities all across the country; these talked about prevention, symptoms, and where people can find diagnostic centers. These were taught in schools, local community centers, and other locations to ensure that populations were able to access the information needed to become a part of the solution. This resulted in an 80% increase in malaria case reporting in disproportionately impacted areas by 2020.

These education opportunities are coupled with healthcare access and monitoring. By improving the healthcare infrastructure, treatment facilities were able to strengthen their interventions for those impacted by malaria. However, with recent inflation and economic instability in the country, with the support of international supporters, these interventions became even more accessible by being low-cost or even free. With the additional investment into data collection and monitoring systems, the Egyptian Ministry of Health was able to monitor trends in malaria incidence and collaborate with healthcare providers to mobilize and target interventions for those who need them most. With the compounded efforts of treating and monitoring malaria, strides were made to help understand the spread of malaria in the country.

Beyond education and monitoring, it is valuable to identify interventions that would be accessible to the population. These interventions must be easily understood to ensure they are efficacious. Vector control is noted to be central to Egypt’s strategy. Leveraging the use of insecticide-treated bed nets was the most prominent intervention; by 2019, 3 million of these nets had been distributed to reduce the incidence of malaria, especially in high-risk areas. This, coupled with indoor spraying, helped reduce malaria cases by 90% in over 2 decades.

Malaria Eradication is a Victory for Human Rights

As outlined in the International Covenant on Economic, Social, and Cultural Rights, the right to health is fundamental to human existence. By working to eradicate malaria in the country, Egypt has made strides to fulfill this right for its citizens of all socioeconomic classes.

Egypt’s victory brings hope to the fight against malaria; not only can public health interventions align with human rights, but they can create a sustainable model for health equity. Many countries in the global south are in a place that Egypt was in not too long ago; as global communities begin to face the amplification of health issues, Egypt’s framework and history of eradication can be seen as a success and applied to other countries.

Now that malaria is off the docket of issues Egypt faces, it is not time to focus on addressing other inequities the country is facing. As health equity is improved in the country, issues such as mental health, maternal and child health, and non-communicable diseases can be addressed with the utmost efficiency, helping improve outcomes in the country.

Understanding Vaccine Diplomacy in the Case of COVID-19: A Global Approach to Health EquityUnderstanding Vaccine Diplomacy: A Global Approach to Health Equity

In the landscape of global health, vaccine diplomacy has emerged as a compelling strategy, melding healthcare initiatives with international relations. This approach is pivotal in the ongoing battle against infectious diseases, most recently the COVID-19 pandemic. Vaccine diplomacy involves countries utilizing their surplus vaccine supplies to forge diplomatic ties, enhance global influence, and foster goodwill. This is often done in partnership with private pharmaceutical entities and public health organizations. However, while aiming to address the urgent need for equitable vaccine access worldwide, vaccine diplomacy raises critical questions concerning human rights and health equity on a global scale.

Evolution of Vaccine Diplomacy

The vaccine diplomacy has existed long before the COVID-19 pandemic, but we noted its increased influence during this unique time. Nations like the United States, Canada, and the United Kingdom, possessing robust vaccine manufacturing capabilities, sought to leverage their surplus doses as a means of geopolitical influence. For example, the United States promised to donate over 1.1 billion vaccines by 2023. This approach gained momentum as vaccine shortages persisted across continents, exacerbating health inequities, especially among women and children, and prompting a response beyond national borders.

Photo of vaccine vile.Source: Flickr — Photo of vaccine vile. Source: Flickr

Examples of Vaccine Diplomacy

Vaccine diplomacy has manifested in diverse forms. China and Russia have actively supplied their respective COVID-19 vaccines, including Sinovac, Sinopharm, and Sputnik V, to various nations as part of aid packages or through bilateral agreements. India, known for its significant vaccine production capacity, contributed doses through the COVAX initiative and direct donations to neighboring countries and beyond. These mobilization efforts are valuable to the development and growth of vaccine diplomacy through the lens of aid. This improves the well-being of marginalized groups and pushes national interests abroad.

Photo of kids lining up to get vaccinated.Source: Flickr — Photo of kids lining up to get vaccinated. Source: Flickr

Human Rights and Vaccine Diplomacy

At its core, vaccine diplomacy intersects with human rights, particularly the right to health. Access to vaccines is considered a fundamental human right, and ensuring equitable distribution is paramount to providing equal protection against COVID-19. Yet, the disparities in vaccine access have sparked concerns about the violation of this right for marginalized and vulnerable populations globally. Several countries have taken commendable steps to uplift vaccine diplomacy and do their part to make interventions more accessible. The United States pledged substantial donations of vaccine doses through COVAX and direct allocations to nations facing acute shortages, aiming to bolster global vaccine access. Countries like Sweden and Norway have also committed funds to support COVAX’s efforts in distributing vaccines to low-income nations.

To enhance the accessibility and efficacy of vaccine diplomacy, countries must prioritize transparent vaccine-sharing mechanisms, equitable distribution plans, and fair allocation strategies. Greater collaboration among nations, regulatory transparency, and a resolute commitment to multilateralism are essential elements for ensuring broader vaccine access. This can be done through working alongside pharmaceutical companies, local organizations, and many other avenues.

How to Get Involved

Individual engagement plays a pivotal role in advancing the cause of equitable vaccine distribution. Advocating for fair vaccine distribution, supporting initiatives that promote vaccine access in underserved communities, and raising awareness about the critical importance of global health equity are impactful ways for individuals to contribute. Engaging with policymakers, supporting organizations dedicated to vaccine distribution, and staying informed about global health issues are pivotal steps toward effecting change.

Vaccine diplomacy stands at the nexus of opportunity and challenge in addressing the global vaccine disparity. While it serves as a conduit for international cooperation, its success hinges upon ensuring vaccines reach those most in need, aligning with the fundamental principles of human rights and health equity.