An injection given twice a year now stops HIV, and the town in Uganda that helped prove it has already run out

The stories

41 stories on this beat today.

Every story told the same way: what happened, who is involved, why it matters, how it works, the truth and the good news.

1. 01

   An injection given twice a year now stops HIV, and the town in Uganda that helped prove it has already run out

   6 months

   of protection against HIV from one injection

   it replaces a pill that has to be swallowed every day [1]

   $40 a year

   the price set for copies of the drug in 120 poorer countries from 2027

   about a thousandth of the original cost, and it starts in 2027 [7][8]

   13%

   fewer deaths among children old enough for the malaria vaccine

   measured across more than two million children in Ghana, Kenya and Malawi [23]

   3,471

   measles cases confirmed in the United States so far in 2026

   counted to 17 September; the whole of 2025 held 2,289 [27]

   What happened

   • Lenacapavir is an injection given twice a year that stops people catching HIV, and it replaces a pill that has to be swallowed every day. [1]
   • It is injected into the abdomen and releases slowly, so one jab protects for six months. [1]
   • It attacks the virus at several stages of its life cycle rather than one, which is why the US regulator also allowed it for people whose HIV has survived other drugs. [1]
   • Flavia Matovu Kiweewa, who led the Uganda trial, describes other prevention drugs as a guard on one door and this one as guards posted throughout the building. [1]
   • In the PURPOSE 1 trial, none of the nearly 4,200 women caught HIV in the year after everyone was offered the drug, and more than 96 per cent came back for their injection on time. [1]
   • An independent monitoring committee found it so effective that the randomised part of both trials was stopped early, and the people on dummy injections were offered the real drug. [1]
   • The US drug regulator approved it in June 2025 and the World Health Organization recommended it for HIV prevention the following month. [1][7]
   • Kenya gave the first injection in East Africa, Nigeria added it to its national programme, and South Africa launched at 360 clinics as the ninth African country. [2][3][4]
   • Zambia's medicines regulator approved it in 12 working days and Zimbabwe's in 18, by relying on reviews already done elsewhere under a WHO procedure. [6]
   • Uganda received nearly 20,000 doses in February 2026 and began giving them in April, a month late. [1]
   • Kasensero, a fishing town of about 15,000 people with one of Uganda's highest HIV rates, got enough for 60 people and has run out. [1]
   • Kalangala, a district chosen for the trial because so many people there catch HIV, was left out of the first round; the health ministry's plan adds more sites in November 2026 when new stock arrives. [1]

   The daily pill365 times a year

   The injection2 times a year

   Who is involved

   • Gilead Sciences the US drug company that makes lenacapavir; it licensed six generic manufacturers royalty-free for 120 poorer countries and refused to sell directly to Doctors Without Borders
   • The Global Fund the international fund that buys HIV, tuberculosis and malaria medicines for poorer countries; it agreed with Gilead to reach two million people with the injection
   • The World Health Organization the United Nations' health agency; it recommended the injection in July 2025 and runs the reliance procedure Zambia used to approve it in 12 working days
   • Gavi, the Vaccine Alliance the body that buys vaccines for low-income countries; it has pledges of $9bn against an $11.9bn target and has not received the $300m the US Congress voted

   How it unfolded

   1. Jun 2025 the US drug regulator approves lenacapavir for preventing HIV
   2. Jul 2025 the World Health Organization recommends it
   3. Sep 2025 two funding deals set a $40-a-year generic price for 120 countries from 2027
   4. Nov 2025 Zambia approves it in 12 working days; Eswatini and Zambia get 500 doses each
   5. Feb 2026 Uganda receives nearly 20,000 doses
   6. Jun 2026 South Africa launches at 360 clinics, the ninth African country

   Why it matters

   Watch whether the next batch reaches the districts that were skipped: Uganda's health ministry says more sites join in November 2026 when new stock lands, and Kalangala is not in the first round. [1]

   The truth

   • What is really going on Kasensero in Uganda got enough of the injection for 60 people and ran out. [1]
   • Why it works on people Every one of these rollouts opened with a ceremony and a named first patient, which makes a programme feel finished on the day it starts. [2][4]
   • Who gains Regulators using WHO's reliance procedure — Zambia approved the HIV injection in 12 working days and Zimbabwe in 18 by leaning on assessments already done elsewhere, rather than funding full reviews of their own. [6]
   • Who pays People in Kalangala district, Uganda — The district was picked for the trial because HIV is common there, and it was left out of the first distribution round. [1]
   • Who pays Kasensero, a town of about 15,000 — Sixty people got six months of protection and the town's only clinic has run out; the next batch is due this month. [1]
   • Who pays Health workers on shortening contracts — Amiri Kabuye, who oversees HIV care in Kasensero, has gone from yearly contracts to three-to-five-month ones because of budget uncertainty. [1]
   • Nobody knows yet

     How many doses of the HIV injection will actually reach Africa, and when.

     The first delivery was 500 doses each to Eswatini and Zambia; Uganda's 20,000 ran out in the single district that received any. [5][1]

1. 02

   Gilead refuses to sell to Doctors Without Borders

   What happened

   • Doctors Without Borders, the medical charity that works in war zones and emergencies, asked Gilead Sciences for a limited supply of lenacapavir and was turned down after months of talks. [10]
   • Gilead will not sell the injection directly to humanitarian organisations. [10]
   • The charity gets it instead through the Global Fund, the international fund that buys HIV, tuberculosis and malaria medicines for poorer countries, which agreed with Gilead in late 2024 to distribute the drug to two million people. [10]
   • The charity called the refusal unconscionable. [10]

   Why it matters

   Humanitarian groups reach people no national programme reaches - refugees, people in camps, people in places with no clinic.

   Going through a third party means they get what is left after governments have ordered.

   The truth

   • Who pays Patients of Doctors Without Borders — Gilead refused to sell the injection directly to the charity, so it can only get it through the Global Fund's allocation. [10]
   • Nobody knows yet

     Whether the target is two million doses or two million people.

     NPR reports the Global Fund and Gilead aiming at least two million doses to the highest-burden countries by 2028; STAT reports the same deal as reaching two million people. Two doses a year would make those two very different promises. [5][10]

2. 03

   South Africa asks to make the drug at home

   What happened

   • South Africa's government is negotiating with Gilead Sciences for a voluntary licence that would let the drug be produced inside the country. [11]
   • The talks followed months of argument over access. [11]
   • Before them, campaigners had urged South Africa's government to issue a compulsory licence instead, which would let local manufacturers copy the drug without the patent holder's agreement. [13]
   • Yvette Raphael, co-founder of Advocacy for Prevention of HIV and AIDS, said no access plan can leave South Africa out. [13]

   Why it matters

   South Africa has about eight million people living with HIV, more than any other country, and roughly 160,000 new infections a year. [4]

   Who makes the drug decides how fast it arrives there.

   The truth

   • Nobody knows yet

     Whether South Africa will be allowed to make the drug itself.

     Gilead and the South African government have been negotiating a voluntary licence since at least March 2026, and no terms have been published. [11]

3. 04

   Money to hand out the injection in hair salons

   What happened

   • Unitaid, an international body that pays to get medicines into poorer countries, is funding South Africa and Zambia to widen access to lenacapavir. [12]
   • The plan works through health ministries and community groups to reach sex workers and pregnant and breastfeeding women. [12]
   • Distribution is meant to run through unorthodox channels, including pharmacies and hair salons, rather than only through clinics. [12]

   Why it matters

   The drug only prevents anything in people who come and get it.

   Reaching people through places they already go is the part of prevention that a licence and a price cannot fix.

4. 05

   Two funders pay for cheap copies

   What happened

   • On 24 September 2025 two agreements were announced that set a price of $40 per patient a year for generic lenacapavir in 120 low- and middle-income countries from 2027. [8]
   • Unitaid, the Clinton Health Access Initiative and the Wits Reproductive Health and HIV Institute in Johannesburg are backing Dr Reddy's Laboratories; the Gates Foundation is backing Hetero Labs. [8][9]
   • Gilead had already signed royalty-free licences with six generic makers in October 2024. [8]
   • The generic versions still need regulatory approval. [7]

   Why it matters

   Funders are paying a company's development costs so that a copy exists sooner.

   That is the step that turns a price announcement into a vial in a fridge.

   The truth

   • Who gains Gilead Sciences — It licensed six generic makers royalty-free for 120 poorer countries and kept the upper-middle-income markets, including Brazil, Peru and Mexico, outside that list. [8]
   • Who gains Dr Reddy's Laboratories and Hetero Labs — Unitaid, the Clinton Health Access Initiative and the Gates Foundation are paying their development, regulatory and technical costs to produce the copies. [8][9]
   • Nobody knows yet

     Whether the $40 generic price arrives on time.

     Two agreements set it for 2027 in 120 countries, and the generic versions have not yet been approved by any regulator. [8][7]

5. 06

   New HIV infections are down 42 per cent since 2010

   What happened

   • The World Health Organization reported in July 2026 that 32 million people living with HIV were on treatment by the end of 2025. [14]
   • New infections have fallen by 42 per cent since 2010 and AIDS-related deaths by 57 per cent. [14]
   • Nine million people still have no treatment, and new infections are rising in several regions, particularly among men who have sex with men, sex workers, people who inject drugs, transgender people and people in prison. [14]
   • Hepatitis B infections are down 32 per cent since 2015. [14]

   Why it matters

   This is the base the injection is being added to.

   A 42 per cent fall took fifteen years of daily pills, testing and clinics, and it is that machinery the new drug plugs into.

   The truth

   • Nobody knows yet

     How much of the fall in global HIV funding has already reached patients.

     WHO says donor cuts in 2025 disrupted prevention programmes in several countries and that its own figures are preliminary. [14]

6. 07

   Half of Europe's HIV diagnoses come too late

   What happened

   • The European Centre for Disease Prevention and Control and the WHO's European office reported 105,922 HIV diagnoses across 53 countries in Europe and central Asia in 2024. [15]
   • Fifty-four per cent were made late, meaning the immune system had already been damaged before treatment started. [15]
   • In the 30 countries of the European Union and European Economic Area there were 24,164 diagnoses and 48 per cent were late. [15]
   • Nearly one in three diagnoses was in a person born outside the country where it was made. [15]

   Why it matters

   A late diagnosis means years of untreated illness and years in which the virus can pass on.

   Europe has the drugs; what it is short of is people finding out in time.

7. 08

   Half of US HIV diagnoses are in the South

   What happened

   • The US Centers for Disease Control and Prevention published 2024 figures showing more than 38,000 people aged 13 and over diagnosed with HIV in the United States and seven territories. [16]
   • Men were 80 per cent of diagnoses and sex between men accounted for 65 per cent. [16]
   • Black Americans are 12 per cent of the population and 39 per cent of diagnoses. [16]
   • The southern states account for 51 per cent of all diagnoses. [16]

   Why it matters

   The injection was approved in the United States before anywhere else, and these are the people it would have to reach there.

   Half of them live in the region with the thinnest public health funding.

8. 09

   HIV funding fell and the UN agency may close

   What happened

   • About 6,000 researchers and campaigners met at the International AIDS Conference in Rio de Janeiro in July 2026. [17]
   • Funding from the United States, the single largest funder of global HIV work, fell from $6.7bn to $4.6bn last year. [17]
   • The UN secretary-general has proposed closing UNAIDS, the agency that leads the global effort, by the end of the year as part of shrinking the UN; after objections, no final decision has been made. [17]
   • Winnie Byanyima, who runs UNAIDS, said that when prevention disappears, infections rise. [17]

   Why it matters

   The injection arrives at the same moment as the cuts.

   A drug that works twice a year still needs a clinic, a nurse and a supply chain that somebody pays for.

9. 10

   Money voted for PEPFAR is not being sent

   What happened

   • PEPFAR, the US programme that buys HIV medicines abroad, has been credited with saving 26 million lives since it began in 2003. [18]
   • Congress appropriated close to $6bn for global HIV work in 2026, more than President Trump requested and about the same as the year before. [18]
   • People inside and outside the US government say the US State Department is deliberately withholding some of it. [18]
   • Programmes the Trump administration itself called lifesaving are close to shutting down. [18]

   Why it matters

   This is money that exists, was voted for, and is not moving.

   Caspian Chouraya, who works on HIV in Eswatini, now spends his time reading up on the law around layoffs. [18]

10. 11

    A US HIV prevention fund quietly lapsed

    What happened

    • Community groups that provide HIV testing and prevention in the United States are pushing federal health officials to renew a funding programme that recently lapsed. [19]
    • If it is not renewed, expanded access to preventive care would be at risk and some groups may have to close. [19]
    • Jeremiah Johnson, who runs the advocacy group PrEP4All, said groups have already heard from staff they may not be able to keep. [19]

    Why it matters

    These are the organisations that would hand out the new injection in American cities.

    Some of them may have to close if the grant is not renewed. [19]

11. 12

    Zambia starts vaccinating half a million children against malaria

    What happened

    • Zambia's health ministry launched the R21/Matrix-M malaria vaccine as part of its routine childhood immunisation programme, aiming to vaccinate more than 500,000 children aged six to eight months in the following months. [20]
    • The rollout covers 83 districts first, 79 of them high-burden. [20]
    • Malaria cases among Zambian under-fives reached 523 per 1,000 children in 2023. [20]
    • The vaccine is given in four doses, at six, seven, eight and 18 to 23 months. [20]

    Why it matters

    Four doses spread over eighteen months means four separate journeys to a clinic.

    Kenya gave exactly that reason for girls missing a second HPV dose: distance, cost, or simply forgetting to come back. [37]

12. 13

    Ethiopia becomes the 23rd African country with a malaria vaccine

    What happened

    • Ethiopia launched the same R21/Matrix-M vaccine on 21 October 2025, becoming the 23rd African country to put a malaria vaccine into its routine schedule. [21]
    • It started in 58 districts across nine regions, chosen as the highest-burden areas, with more than 91,000 children in the first phase. [21]
    • Doses are given at six, seven, nine and 15 months. [21]
    • The vaccine is being added alongside bed nets, indoor spraying and treatment rather than replacing them. [21]

    Why it matters

    WHO helped Ethiopia with its Gavi application, the implementation guidelines and the training materials. [21]

    Each country that joins leaves those documents behind for the next one.

13. 14

    The malaria vaccine cut child deaths by 13 per cent

    What happened

    • An independent evaluation followed more than two million children given the first malaria vaccine, RTS,S, in Ghana, Kenya and Malawi between 2019 and 2023. [23]
    • Deaths from all causes among children old enough to be vaccinated fell by 13 per cent, and hospital admissions for severe malaria dropped substantially. [23]
    • More than nine in ten children ended up covered by at least one malaria protection, either the vaccine or a treated bed net. [26]
    • The WHO published further evidence in May 2026 confirming the effect. [25]

    Without the vaccine100 deaths

    With it87 deaths

    Why it matters

    The fall is in deaths from all causes, not only deaths from malaria. [23]

    It is also the hardest kind of result to show anyone, because it is made of funerals that did not happen.

    The truth

    • What is really going on One injection stops HIV for six months, one HPV dose protected as well as two in a Costa Rica trial, and the malaria vaccine cut all-cause child deaths by 13 per cent across Ghana, Kenya and Malawi. [1][35][23]

    Good news

    • More than two million children in Ghana, Kenya and Malawi were given the first malaria vaccine between 2019 and 2023. Deaths from all causes among the children old enough to get it fell by 13 per cent.
14. 15

    Malaria vaccine doses rose 169 per cent in a year

    What happened

    • As of April 2026, 25 African countries were giving a malaria vaccine, including nine of the ten countries with the heaviest malaria burden. [22]
    • In 2025 some 28.3 million doses were distributed, a 169 per cent increase on the year before. [22]
    • Cameroon recorded 17 per cent fewer laboratory-confirmed malaria cases between 2024 and 2025. [22]
    • Burkina Faso, which introduced the vaccine in February 2024, saw total cases fall from 10.8 million to 7.3 million, and 38 per cent fewer among under-fives. [22]

    Why it matters

    Burkina Faso's drop is a third of a national caseload in under two years.

    It is the clearest evidence yet that the vaccine changes what happens in a country and not just in a trial.

1. 16

   Malaria cases went up anyway

   What happened

   • Global malaria cases rose from 238 million in 2018 to 282 million in 2024, and deaths from 575,000 to 610,000. [24]
   • Malaria is still endemic in 80 countries. [24]
   • The WHO African Region carries 94 per cent of cases and 95 per cent of deaths, and about 438,000 African children died of malaria in 2024. [26]
   • In trials both vaccines cut malaria cases by more than half in the first year, and by about 75 per cent when given seasonally alongside preventive medicine. [26]

   2018238 million cases

   2024282 million cases

   Why it matters

   A vaccine that works can sit inside a rising case count.

   Bed nets, spraying, diagnosis and treatment all have to keep working at the same time, and resistance is now eroding all three. [22]

   How it works

   Nobody can see the child who did not get ill

   Almost everything in today's edition works, and what keeps failing is the money behind the ones whose only result is that nothing happened.

   The twist

   A vaccine's bill is a real number. The children it saved are not on any list, because nothing happened to them.

   The picture

   12

   90%95%100%

   1. 1Enough children vaccinated to stop measles spreading95%
   2. 2US kindergarten coverage, 2024-2592.5%

   Step by step

   1. 1 A vaccine or a preventive drug works
   2. 2 The illness stops turning up
   3. 3 Nobody meets anyone who has had it
   4. 4 The cost, the visit and the needle stay visible
   5. 5 The money moves to problems people can see
   6. 6 Coverage falls and the illness comes back

   The same force, elsewhere today

   Where this chain is also running, in today's other stories.

   • The United States has counted 3,471 measles cases this year

     Twenty-five years with almost no measles left parents comparing a real needle with a disease they had never seen, exemptions rose, and school coverage fell to 92.5 per cent

   • The US has not sent the $300m Congress voted for vaccines

     Congress voted the money and it has not moved. What it pays for is children who do not get ill, and nobody can be shown one of them

   • Fifty-eight countries have got rid of a tropical disease

     The reward for finishing is a certificate, and the programmes that earned it are the first ones development aid cuts reach

   • Malaria cases went up anyway

     Vaccines reached 25 countries while cases rose from 238 million to 282 million, because the nets, the spraying and the drugs that were already working still had to be paid for every year

   Where you've seen this

   Flood walls

   a wall that holds means a flood nobody remembers, so the repair budget is the first one cut

   Aircraft inspections

   most inspections find nothing wrong, and that is the outcome the airline is paying for

   Security patches

   the break-in that never happened leaves no report for anyone to point at

   Fire drills

   a building that never burns makes the drills look like an interruption to the working day

   The catch

   The slide is not automatic. US measles coverage stayed above 95 per cent for twenty-five years after the disease vanished, so the fall needed more than forgetting: easier school exemptions, cut public health budgets and loud public argument about the vaccine all arrived together.

   And the whole of it

   You cannot name the measles you never caught. Neither can the official writing next year's health budget, and the nurse, the needle and the cold store still have to be paid for.

   The truth

   • Nobody knows yet

     Whether malaria vaccines can turn the case count around.

     Cases rose from 238 million in 2018 to 282 million in 2024 while 25 countries introduced the vaccine, and resistance to the main drug and to bed-net insecticide is spreading at the same time. [24][22]

1. 17

   The parasite is learning to survive the main drug

   What happened

   • Partial resistance to artemisinin, the backbone of malaria treatment, has now been confirmed or is suspected in multiple African countries, according to the WHO's World Malaria Report 2025. [22]
   • Jane Carlton, who directs the Johns Hopkins Malaria Research Institute, says mosquito resistance to the insecticide used on bed nets is also widespread, and that some rapid tests now miss mutant parasite strains. [22]
   • That puts prevention, diagnosis and treatment under pressure at the same time. [22]

   Why it matters

   The vaccine is the newest tool and the other three are the old ones.

   If the old ones stop working, the vaccine is protecting children inside a system that is failing around it.

2. 18

   The United States has counted 3,471 measles cases this year

   What happened

   • As of 17 September 2026 the CDC had confirmed 3,471 measles cases in the United States for the year, reported by 47 jurisdictions. [27]
   • There have been 39 new outbreaks in 2026, and 95 per cent of confirmed cases were linked to an outbreak rather than isolated. [27]
   • Some 1,376 of them came from outbreaks that began in 2025 and never stopped. [27]
   • The whole of 2025 held 2,289 cases. [27]
   • When the count passed 2,000 in June, experts said the true number was probably about three times higher. [34]

   All of 20252,289 cases

   2026 to 17 Sept3,471 cases

   Why it matters

   Measles was declared eliminated from the United States in 2000. [30]

   That status ends if the virus keeps spreading inside the country for twelve months, and outbreaks that started in 2025 are still producing cases this year. [30][27]

   How it works

   Twenty-five years with almost no measles left parents comparing a real needle with a disease they had never seen, exemptions rose, and school coverage fell to 92.5 per cent

   The idea, in story 16: Nobody can see the child who did not get ill →

   The truth

   • Nobody knows yet

     Whether the United States keeps its measles elimination status.

     The status depends on not having 12 months of uncontrolled domestic spread, and 1,376 of this year's cases came from outbreaks that began in 2025. [30][27]

3. 19

   South Carolina has the biggest outbreak in the country

   What happened

   • South Carolina reported 558 measles cases in January 2026, 124 of them in three days, with the count nearly doubling in a week. [28]
   • The centre is Spartanburg County, where 90 per cent of schoolchildren are vaccinated against a threshold of 95 per cent. [28]
   • Six linked cases appeared in North Carolina and three in Snohomish County, Washington. [28]
   • Helmut Albrecht, an infectious disease doctor at Prisma Health, said the state had lost the ability to contain it with the immunity it has. [28]

   Why it matters

   Spartanburg sits five points under the level that stops measles spreading. [28]

   The outbreak there has already put linked cases in North Carolina and in Washington state. [28]

   The truth

   • Who pays Children in Spartanburg County, South Carolina — School vaccination stands at 90 per cent against the 95 per cent needed, and 558 people in the state caught measles. [28]
4. 20

   Kindergarten vaccination has fallen to 92.5 per cent

   What happened

   • Coverage of the measles vaccine among US children starting school fell from 95.2 per cent in the 2019-20 school year to 92.5 per cent in 2024-25. [29]
   • The target is 95 per cent, the level at which enough people are immune to stop the virus finding a chain of hosts. [29]
   • KFF, a US health policy research group, reports that non-medical exemptions from school vaccine requirements have risen since the pandemic and are still rising. [31]

   Why it matters

   A 2.7 point fall sounds like nothing.

   Measles is one of the most contagious diseases there is, so below 95 per cent one infected child starts a chain instead of being the end of one. [28]

5. 21

   The United States could lose its measles-free status

   What happened

   • A country keeps elimination status as long as it has not had 12 months or more of uncontrolled domestic transmission. [30]
   • The United States has held that status since 2000. [30]
   • From January 2025 to the end of March 2026, states reported more than 3,800 cases. [30]
   • KFF lists the causes as funding and staffing cuts at federal, state and local level, mixed messages from the health secretary, no Senate-confirmed CDC head for almost the whole period, and rising public doubt about the vaccine. [30]

   Why it matters

   Elimination is a statement about a country's surveillance and its clinics rather than its luck.

   The United States has held the status since 2000. [30]

6. 22

   Some US counties are under 60 per cent covered

   What happened

   • Researchers writing in Nature Health used parents' own reports, gathered through an online surveillance platform, to estimate measles-mumps-rubella coverage county by county for children under five. [32]
   • They found areas with coverage below 60 per cent. [32]
   • The clusters of undervaccinated children overlapped closely with the places that had recent outbreaks, particularly in Texas and New Mexico, where the model put coverage well below the official figures. [32]

   Why it matters

   National averages hide the number that decides an outbreak, which is the coverage of the particular town the virus lands in.

   School-entry records and phone surveys systematically miss the most vulnerable families. [32]

7. 23

   England moves the second measles dose earlier

   What happened

   • Britain's vaccine advisory committee recommended giving the second measles-mumps-rubella dose earlier, from 2026, and researchers modelled what that would do in England. [33]
   • Moving it to 24 months, from three years and four months, cut simulated cases by 11.9 per cent. [33]
   • If the second dose reached as many children as the first, cases fell by 22.4 per cent. [33]
   • Allowing for protection fading over time, the gain shrank to 5.3 per cent. [33]

   Why it matters

   The change costs nothing new: the same vaccine, the same child, an earlier appointment.

   What it buys is fourteen fewer months in which a toddler is only partly protected.

8. 24

   Twenty-one million children missed a first measles dose

   What happened

   • About 85 per cent of the world's infants, around 110 million children, received three doses of the diphtheria-tetanus-pertussis vaccine during 2025. [23]
   • Nearly 21 million children missed their routine first measles dose, worse than the 19 million who missed it in 2019. [23]
   • The WHO treats measles as an early warning system, because its contagiousness exposes gaps in immunity faster than any other disease. [23]

   Why it matters

   Twenty-one million is the pool that every future outbreak will be drawn from.

   They are mostly not in countries with a vaccine debate; they are in countries with no nurse within walking distance.

9. 25

   One dose of HPV vaccine protected as well as two

   What happened

   • A US-funded trial in Costa Rica gave girls one dose of an HPV vaccine, then gave half of them a second dose and the other half a tetanus jab as a control. [35]
   • The girls were tested for new infections every six months for five years. [35]
   • One dose was no worse than two, and both were at least 97 per cent effective against lasting infection with the two virus types behind more than 77 per cent of cervical cancers. [35]
   • The results were published on 3 December 2025. [35][36]

   Why it matters

   Cervical cancer kills about 250,000 women a year and fewer than 30 per cent of the world's adolescent girls have been vaccinated. [35]

   Halving the number of visits halves the main reason girls never finish.

   The truth

   • Nobody knows yet

     How long a single HPV dose protects.

     The Costa Rica trial followed girls for five years and cervical cancer appears decades after infection, so the answer cannot exist yet. [35]

10. 26

    Kenya switched to a single HPV dose

    What happened

    • Kenya moved from a two-dose to a one-dose HPV schedule in November 2025, following the WHO's expert immunisation group. [37]
    • The country had vaccinated 10-year-old girls on two doses since 2019. [37]
    • Cervical cancer is the second most common cancer among Kenyan women, with about 5,845 new cases and 3,600 deaths a year. [37]
    • Beatrice Dbwoge, a nurse at Kilifi County Hospital, said girls were missing the second dose because of distance, cost, or simply forgetting to come back. [37]

    Why it matters

    One visit instead of two lets the same budget and the same nurses protect more girls. [37]

    The change is administrative, and what it alters is how many cervical cancers appear decades later.

    The truth

    • Who gains Health ministries that switched to one HPV dose — Kenya now protects more girls from the same budget and the same nurses, because each girl needs one visit rather than two. [37]
11. 27

    Africa went from 12 to 35 countries vaccinating girls

    What happened

    • Since 2019 the number of African countries running HPV vaccination programmes has risen from 12 to 35, and coverage from 5 per cent in 2014 to 47 per cent in 2024, second in the world only to the Americas. [38]
    • Recent national introductions and multi-age campaigns in Nigeria, Ghana, Ethiopia and Angola reached millions of girls within weeks, often through schools. [38]
    • A Gavi and WHO assessment estimates that HPV vaccination has averted close to one million cervical cancer deaths in 29 African countries as of 2024. [38]

    20145%

    202447%

    Why it matters

    Coverage went from 5 girls in every 100 to 47 in ten years. [38]

    The averted deaths are an estimate, because the cancers they refer to would have appeared decades from now.

    Good news

    • Since 2019 the number of African countries vaccinating girls against the virus that causes cervical cancer has risen from 12 to 35, and coverage has gone from 5 per cent in 2014 to 47 per cent in 2024.
12. 28

    Why some countries have not switched to one dose

    What happened

    • Researchers interviewed 66 immunisation officials, technical partners and civil society staff across 19 low- and middle-income countries between September 2023 and February 2024, to find out what drives the decision on the HPV dose schedule. [39]
    • Eleven of the countries had mature programmes and eight had introductions coming; ten were adopting the single dose and nine were undecided. [39]
    • The WHO first recommended a single-dose schedule in December 2022. [39]

    Why it matters

    WHO recommended the single dose in December 2022, and by early 2024 nine of these 19 countries were still undecided. [39]

    Evidence arriving is the fast part of the process.

13. 29

    What a one-dose campaign cost in Ethiopia

    What happened

    • Researchers costed Ethiopia's single-dose HPV campaign for girls aged nine to 14, run in late 2024, using data from 82 health facilities across four regions. [40]
    • Staff at 90 per cent of the facilities ran vaccination sessions in schools and 73 per cent did outreach beyond them. [40]
    • Facilities delivered an average of 910 doses each. [40]
    • The study measured both cash spent and the value of staff time taken from other work. [40]

    Why it matters

    Health ministries argue about what a campaign costs to run, and the single-dose evidence so far has been about protection instead.

    Staff time taken from other clinics never appears on an invoice, and this study counted it.

14. 30

    US states with the most cervical cancer vaccinate the least

    What happened

    • In 2023, 38 per cent of US 13 to 17 year olds in Mississippi were up to date on the HPV vaccine, and 40 per cent in Georgia. [41]
    • At the other end were North Dakota on 78 per cent, Massachusetts on 82 and Rhode Island on 84. [41]
    • Cervical cancer rates vary more than twofold across states, from about six cases per 100,000 women in Massachusetts and New Hampshire to 14 or 15 in Mississippi, Oklahoma, Arkansas and Louisiana. [41]
    • The states with the highest rates have the lowest coverage. [41]

    Why it matters

    The vaccine is the same everywhere in the United States.

    A girl in Rhode Island is more than twice as likely to have had it as a girl in Mississippi. [41]

    The truth

    • Who pays Girls in Mississippi — Thirty-eight per cent are up to date on the HPV vaccine, and the state has one of the highest cervical cancer rates in the country at 14 to 15 cases per 100,000 women. [41]
15. 31

    Gene editing left 27 of 28 people free of sickle cell crises

    What happened

    • In the RUBY trial, 28 people with severe sickle cell disease were given one infusion of their own blood-forming stem cells. [42]
    • The cells were edited to switch fetal haemoglobin back on, which stops red cells bending into a crescent that jams small blood vessels. [42]
    • Twenty-seven of them had no painful crises afterwards, a result the doctors call a functional cure. [42]
    • In the full group of 40, 95 per cent avoided those crises, and most had been in hospital about five times a year before. [43]

    27 of 28

    people in the RUBY trial with no painful crises after treatment

    Why it matters

    About 80 per cent of the world's sickle cell cases are in sub-Saharan Africa. [45]

    Samuel Idahosa grew up with the disease in Nigeria, had the therapy at UCLA Health in 2025, and is considered cured. [45]

    The truth

    • Nobody knows yet

      What gene-edited sickle cell treatment will cost outside rich countries.

      About 80 per cent of the world's cases are in sub-Saharan Africa, and the results reported today come from hospitals in the United States. [45][42]

    Good news

    • Twenty-seven of the 28 people with severe sickle cell disease in the RUBY trial had no pain crises at all after a single infusion of their own gene-edited cells. Before the treatment, most people in that trial were in hospital about five times a year.
16. 32

    A half-matched donor cured 95 per cent

    What happened

    • Johns Hopkins doctors reported that a gentler bone marrow transplant, using donors who are only a half match, gave long-run survival of about 95 per cent in people with sickle cell disease. [44]
    • The regimen also produced low rejection rates and appears to preserve fertility in women, which older, harsher transplants often destroyed. [44]
    • The results were published in Blood Advances on 26 March 2026. [44]

    Why it matters

    A half-matched donor is usually a parent or a child, so far more patients have one available.

    That was the limit on transplant, and this regimen also appears to leave fertility intact. [44]

17. 33

    Chile is the first country in the Americas free of leprosy

    What happened

    • The WHO verified on 4 March 2026 that Chile has eliminated leprosy, the first country in the Americas to reach that standard. [46]
    • Chile has recorded no locally caught case for more than 30 years; the last was in 1993, on Rapa Nui, also called Easter Island. [46]
    • The disease was never dropped from the country's health agenda: it stayed a notifiable condition with mandatory reporting and continuous clinical readiness across the health system. [46]

    Why it matters

    Chile kept leprosy a notifiable disease, and kept its clinics ready to spot it, for thirty-three years after the last local case. [46]

    The verification measures that surveillance rather than luck.

    Good news

    • Chile has not had a locally caught case of leprosy since 1993. In March the World Health Organization verified it as the first country in the Americas to have eliminated the disease.
18. 34

    Libya becomes the 28th country free of trachoma

    What happened

    • Trachoma is a bacterial eye infection that scars the inside of the eyelid until the lashes turn inward and scratch the eye.
    • The WHO validated on 18 February 2026 that Libya has eliminated it as a public health problem, protecting future generations from that blindness. [47]
    • Libya is the 28th country worldwide and the eighth in the WHO's Eastern Mediterranean region to reach the standard. [47]
    • It got there through years of humanitarian and migration upheaval. [47]

    Why it matters

    Twenty-eight countries have now cleared it, and none of them needed a new invention to do it. [47]

    What Libya protected is the eyesight of children who are not born yet.

19. 35

    Two more countries stop passing HIV to babies

    What happened

    • Denmark became the first European Union country certified as having ended mother-to-child transmission of HIV and syphilis, on 27 February 2026. [48]
    • The standard is testing and treating at least 95 of every 100 pregnant women and keeping new infant infections below 50 per 100,000 births, met every year from 2021 to 2024. [48]
    • The Bahamas was certified for HIV on 22 April 2026, after offering antenatal care to every pregnant woman regardless of nationality or legal status, with screening at the first visit and again in the third trimester. [49]

    Why it matters

    Both countries got there through ordinary antenatal appointments rather than anything new.

    The Bahamas offers that care to every pregnant woman whatever her nationality or legal status. [49]

20. 36

    Fifty-eight countries have got rid of a tropical disease

    What happened

    • Neglected tropical diseases, a group that includes trachoma, leprosy, river blindness and worm infections, still affect about a billion people. [50]
    • In 2024 around 1.4 billion people needed treatment against them, 36 per cent fewer than in 2010. [50]
    • As of early 2026, 58 countries had eliminated at least one of these diseases, against a WHO target of 100 countries by 2030. [50]
    • Preventive treatment returns an estimated $25 for every dollar spent, and these programmes remain among the most underfunded in global health. [50]

    Why it matters

    Fifty-eight countries is more than a quarter of the world's countries, against a target of 100 by 2030. [50]

    Deep cuts to development aid for these programmes now threaten to stall it. [50]

    How it works

    The reward for finishing is a certificate, and the programmes that earned it are the first ones development aid cuts reach

    The idea, in story 16: Nobody can see the child who did not get ill →
21. 37

    The US has not sent the $300m Congress voted for vaccines

    What happened

    • Gavi buys vaccines for low-income countries, and the United States has been its third largest funder, providing 13 per cent of its money since it began. [51]
    • Congress appropriated $300m in both 2025 and 2026, and the Trump administration has not passed it on, citing concerns about vaccine safety. [51]
    • Gavi's latest fundraising round raised pledges of more than $9bn against an $11.9bn target for 2026 to 2030. [51]
    • USAID, the US agency that ran much of this work, has been dissolved. [52]

    Pledged$9bn

    Target for 2026-2030$11.90bn

    Why it matters

    A $2.9bn shortfall is roughly the difference between reaching every child in the poorest countries and choosing which ones to reach.

    How it works

    Congress voted the money and it has not moved. What it pays for is children who do not get ill, and nobody can be shown one of them

    The idea, in story 16: Nobody can see the child who did not get ill →

    The truth

    • What is really going on The US Congress voted $300m for the vaccine alliance Gavi, and the Trump administration has not sent it. [51]
22. 38

    The world is short of diphtheria antitoxin

    What happened

    • Diphtheria makes a toxin that kills tissue in the throat and damages the heart, and the only treatment is an antitoxin made from the blood of immunised horses. [53]
    • Given in time it cuts deaths by up to 76 per cent; without vaccination the disease kills about 30 per cent of the people it infects. [53]
    • The WHO received reports of 24,782 cases in 2023, up from 10,027 in 2022. [53]
    • A CDC survey of manufacturers and buyers found prices and availability varying widely and serious doubt about obtaining enough for growing outbreaks. [53]

    Why it matters

    The only treatment is still made from horse blood.

    The teams developing a modern antibody version told the CDC they are struggling to fund the clinical and manufacturing work. [53]

    The truth

    • Who gains Makers of equine diphtheria antitoxin — Reported diphtheria cases more than doubled between 2022 and 2023, and a CDC survey found buyers unable to secure enough of a product with few manufacturers and widely varying prices. [53]
23. 39

    There is not enough cholera vaccine to go round

    What happened

    • Oral cholera vaccines cut illness and death, but the global stockpile is limited and poorer countries face long application processes to get any. [54]
    • The CDC is running in-country training with the Global Task Force on Cholera Control to help countries apply for and use the doses that exist. [54]
    • The agency argues that planning several years ahead, rather than applying during an outbreak, would prevent more deaths. [54]

    Why it matters

    Cholera kills through dehydration within hours, so a vaccine that arrives after an outbreak starts is treating the next one.

    Multi-year planning is the unglamorous fix.

24. 40

    WHO's vaccine advisers plan for less money

    What happened

    • The WHO's Strategic Advisory Group of Experts on Immunization met from 9 to 12 March 2026. [55]
    • Its report describes a sharp reduction in development assistance for health and a shift away from countries depending on aid towards paying for their own programmes. [55]
    • WHO says it is now protecting what it calls the core of the core: guidance, data, coordination and support to national advisory groups. [55]
    • Several big programmes restart in this period, including Gavi's 2026-2030 phase. [55]

    Why it matters

    When a body that sets global vaccine policy starts naming which of its own functions it will protect, that is a budget document rather than a strategy.

25. 41

    Neighbouring countries agree to chase malaria across their borders

    What happened

    • Health officials met in May 2026 and agreed to work across national borders on malaria and neglected tropical diseases, because parasites and the mosquitoes carrying them do not stop at a frontier. [56]
    • The 2030 targets are a 90 per cent cut in malaria cases and deaths, and elimination of malaria in at least 35 countries. [56]
    • Daniel Ngamije Madandi, who directs the WHO's malaria department, warned that weak health systems, drug resistance, climate change and falling funding all threaten the gains. [56]

    Why it matters

    A country that eliminates malaria alone keeps re-importing it from next door.

    The last stretch of elimination is the part that cannot be done by one government.