Hello from Nairobi.

This week we start with a reminder that the world’s conflicts rarely stay confined to the map. The Iran war is already scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals. 

That said … we’re feeling the energy squeeze, too! Rumors of fuel rationing started circulating in Nairobi early this week, which was enough to send me out late at night to fill up my tank just in case.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The Iran war is a drug shipping fiasco

The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world. 

To be clear, it’s not that the Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not. It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States. 

For reference, this is a region whose “pharmaceutical industry is worth $23.7 billion,” but where roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through. 

And right now both ways these medicines largely transit, the sea shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.” 

Where will the shocks be felt first? 

I reached out to one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains to ask.

Right now the biggest risk is cold-chain medicines, which he writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range, largely “between 2°C and 8°C,” 35-46°F. 

Most cold-chain medicines move by air cargo, Yadav told me, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said. 

When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”

Also at risk is helium supplies, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar. 

Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).

Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area's high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.  

The good news is that, for now, "short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system. 

I also asked Yadav whether the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think. “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” he said. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.) 

But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.

But other cost implications are coming fast. A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.” 

Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit. 

Vaccine side effects (... good ones!)

A senior infectious disease reporter I follow, Helen Branswell, just published an interesting article in STAT News that sits somewhere between op-ed and straight news. She walks readers through vaccine by vaccine to explain a simple but often overlooked point: Immunization programs rarely benefit just one person against one pathogen. 

Pure speculation on my part, but I’m imagining this story originated as a sort of professional self-care for a veteran health reporter. After watching the maddening vaccine debate circle the bowl of conspiracy-land too many times, maybe you just need to reset the conversation. Anyhow, I’m here for it! 

I won’t walk through the whole list here, but three examples really jumped out to me:

Rubella vaccination in kids has essentially eliminated a once-devastating birth defect in mothers that left many babies “deaf, blind, or with developmental delays.” 

The meningitis vaccine has helped decimate gonorrhea infections, with surprising studies suggesting the shot offers about a “30% to 40%” spillover protection against the sexually transmitted infection.

And Human Papillomavirus vaccination has turned into what one expert called “one of the most elegant herd immunity stories that we have” in public health, reducing several cancer rates broadly … even in men who were never the original targets of the vaccine program.

Argentina, out of the WHO

Argentina has finally made good on its year-old promise to withdraw from the World Health Organization, Al Jazeera reports. It is the second country  to ever do so, after the United States. 

It may sound symbolic, but the move cuts off Argentina  from the United Nations agency which (as we’ve covered extensively) “monitors health trends, tracks disease, promotes health care access, and trains medical providers.”

So why’d they do it? 

Argentina’s President Javier Milei has framed the move as a matter of national “sovereignty,” criticizing the WHO’s “health advice during the Covid-19 pandemic,” and saying Argentina will pursue “international cooperation in health through bilateral agreements” instead.

Do those arguments sound familiar? They should, as both the criticisms and the shift toward bilateral deals echo the exact complaints and policies we’ve heard from the Trump administration. So, it’s clearly Argentina’s model.  

Not to quibble, but it’s worth noting one key point: The WHO does not control countries’ health policies, and its Covid-19 recommendations were never strong-armed on Argentina. It is an advisory body. (Just ask Sweden, or Argentina’s neighbor Uruguay.) 

My takeaway? Ultimately, unless this move somehow triggers further exits, I’m not seeing it as a dramatic new fracture in global health cooperation. It’s another aftershock of far-right domestic politics that have been spilling into health policy since 2025. 

Secret jungle medical school

Let’s finish this week with a remarkable story from The Guardian, which followed a group of nursing students in Myanmar who just graduated from a “secret jungle school” of medicine built during the country’s civil war.

The background: After the military coup in 2021 destroyed large parts of the public health system, an underground network of clinics emerged. This “parallel secret health system” surfaced to treat injured pro-democracy fighters and “those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.”

Eventually, the effort expanded beyond treating patients to training the next generation of nurses. One nursing teacher "contacted colleagues in the U.K., and together nurses in Myanmar and Britain arranged video masterclasses,” for a full curriculum. 

All told, “dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum, and “the Phoenix Bachelor of Nursing Science” degree was born. 

The article describes how lectures were “smuggled on memory sticks across the country,” and how the students completed their training under extraordinary conditions: like studying in remote classrooms while dodging drone surveillance and airstrikes. As one organizer put it, “safety is never guaranteed.” Another described bombs landing “right next to the classroom.” 

It’s a powerful read, and the new graduates say the program represents something larger than medical training. “The name Phoenix itself is powerful for us. It symbolizes rising from the ashes of the destruction the coup has caused … We are the living proof that education and hope cannot be extinguished by violence.”

I’ll see you next week!

Thumbnail image by Hussein Faleh / Getty Images