Hello from Nairobi.

Last weekend I went to an ugly-sweater holiday party at the start of the dry season and learned something important about hubris. There is hot, there is very hot, and then there is “woolen knitwear in equatorial sun.” I will choose differently next time.

What’s new this week? Some big moves on American foreign aid, plus we've hit the point in the year when the consequences of the past 12 months are starting to show up in the data. Some of what follows is tough reading, but I promise we will end on something light.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five 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.

Kenya signs first ‘America First’ health deal

Allow me start this week’s opening story with a short rewind on what happened this year to America’s aid bureaucracy. (Bear with me, the background really does matter.)

Earlier this year the Trump administration shut down America’s foreign aid agency, the United States Agency for International Development. While most American aid programs ended with it, about 17% of USAID’s former contracts survived. These included some (though not all) lifesaving global health programs. By July, those programs were all transferred to the State Department, which has been quietly rehiring former USAID staff as temporary contractors to keep them running. Still, for months the ultimate fate of that remaining health aid was anybody’s guess.

Finally, in September, the State Department announced a new plan for American health aid moving forward, which was presented under the banner of “America First.” The heart of the new approach would be country-by-country deals. But the announcement left huge questions about actual funding and long-term commitments unanswered.

Still with me? This brings us to today’s news.

Last week the United States finally signed the first of those global deals here in Kenya, Health Policy Watch reports. The agreement promises “$1.6 billion over the next five years,” for priorities like malaria control and disease surveillance, and hinges on Kenya committing to raise its own health spending by $850 million. Moving forward, American officials say as many as 49 more agreements could follow in Africa alone. 

There has been some hubbub in Kenya about one clause in the deal, which requires the Kenyan government to share health surveillance data with the United States for 25 years, including providing U.S. businesses with genetic data. (I initially didn’t read this as a nefarious data grab, but instead as Washington trying to patch the disease reporting gap it opened when it pulled out of the World Health Organization.)

Meanwhile, Secretary of State Marco Rubio praised the agreement’s new approach by saying, “We are not going to spend billions of dollars funding the NGO industrial complex while close and important partners like Kenya either have no role to play or have very little influence over how health care money is being spent.” It’s worth noting: That framing is flat-out inaccurate, since USAID historically co-designed Kenya’s health programs with the Kenyan government, and routed much of its funding through local Kenyan organizations.

This all gets to my bigger question: How much is actually different in practice once you sift past the rhetoric? I reached out to John Kuehnle, my old colleague who actually ran America’s health programs for USAID in Kenya from 2020 to 2024, to ask. (Today Kuehnle is the CEO of the American NGO Partners for World Health).

Kuehnle welcomes the effort to persuade Kenya to invest more of its own money, which he says mirrors what USAID and the Centers for Disease Control and Prevention had pushed for years. But he warns that “the challenge that we always had was that we knew that even if we got the Kenyan government to agree to increase spending over time, fiscally that would be very difficult for them to actually do. I don't think that has changed,” he said. (It’s worth noting that the agreement is, uh, non-binding.)

“I think that the Kenyan government signed this agreement out of desperation to guarantee funding for the next five years, and buy time in the hopes that their financial situation improves, or that there is a regime change in the U.S. that is open to renegotiating [the agreement] when it ends,” Kuehnle said.

As the agreement rolls out, Kuehnle points to a few key signals to watch. 

For one, “the U.S. government currently does not have enough staff in Kenya to manage an [agreement] like this. Keep an eye on ... the amount of funding that actually moves.” And perhaps most importantly, Kuehnle raised the specter of the c-word that had constrained many of USAID’s earlier attempts to route money more directly through governments like Kenya’s: corruption. “I think many Kenyans outside of the Kenyan government do not believe that their government can be trusted to manage funds directly,” he said.

Preventable childhood deaths are increasing

For the first time in 25 years, childhood deaths from preventable diseases are rising globally, TIME magazine reports. (This is according to University of Washington researchers in the Gates Foundation’s annual report of global health.) All told, an additional 200,000 children under 5 are expected to die in 2025, bringing the total to about 4.8 million. (Disclosure: The Gates Foundation is a funder of Healthbeat).

To be clear, these are deaths that could have been entirely avoided “with vaccines or other [existing] treatments.” In the report (which can be downloaded here) Bill Gates himself puts this compound tragedy fairly succinctly: “There’s something especially devastating about a child dying of a disease we know how to prevent.”

Regular readers of the Global Health Checkup probably won’t be surprised by what is being fingered as the primary driver of this reversal: “significant cuts to spending in global health from the world’s largest donors.”

What’s the takeaway? 

For one, it’s worth noting that the report largely presents this year’s rise in deaths as a short-term bump rather than a lasting reversal. Even without reversing the global cuts, the projections show child deaths falling again in most future scenarios, even as soon as next year. At the same time, the report warns that child survival is now more fragile than before, and that progress against preventable diseases can be increasingly pushed off course by shocks like conflict, climate disruption … or a further drop in funding. 

Malaria is on an ominous path

The World Health Organization just published its yearly report on the global state of malaria, Euronews reports. (One note up front: Like the tuberculosis data we covered three weeks ago, WHO’s reporting speed is glacial, so the “2025” report only describes 2024.)

How was last year? Ominous.

• Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

Even before this year’s aid cuts, malaria cases ticked up in 2024 over 3%, reaching an estimated 282 million total cases. Deaths also rose upward to 610,000 in 2024, with the majority being young children in “11 African countries.”

Malaria is one of the rare tropical diseases with a well-funded advocacy community and decades of scientific focus, so it’s worth asking, why we were losing ground last year? 

There are really two answers, according to the WHO. One is rising resistance to malaria drugs and insecticides, and the other is a familiar foe, climate change, which is giving various mosquito species more places to survive and more months each year to spread the parasite.

My takeaway: Looking “forward” to this past year, malaria is the disease I’m most worried about on the continent I call home. That’s because malaria moves fast (the incubation period is tiny), and once you let off the brakes, or conditions shift, cases can explode. As we covered in early October, in places like Cameroon, aid agencies are already saying the clock has rolled back 20 years due to the aid pullback. If we were already losing ground, the worst may still be ahead.

Exit ebola, enter cholera

It’s been a week of whiplash in the Democratic Republic of the Congo. As we reported last week, the country announced the end of the Ebola outbreak on Dec. 1. But UNICEF, the U.N. Children's agency, just confirmed that DRC is now contending with its worst cholera outbreak in 25 years, Reuters reports. 

Just by the numbers, there’s been more than 64,000 cases and roughly 1,888 deaths since the start of the year. But one, smaller line hit me particularly hard: “In one case, a quarter of the children in a Kinshasa orphanage … died days after the disease swept through.”

• Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The conditions driving this disaster are painfully familiar: “Only 43% of people in Congo have access to at least basic water services [like basic plumbing or just treated water], the lowest rate in Africa, and just 15% use basic sanitation,” like toilets or sanitized latrines. Combine that with ongoing conflict, displacement, overcrowding and crumbling infrastructure, and cholera is spreading through many communities with ease. Unsurprisingly, UNICEF is calling for “more funding” to help contain the crisis, which is unlikely to come unless it is diverted from elsewhere. 

The takeaway: It is encouraging to see what the world can do when it focuses on a threat like Ebola. But if that focus is built on rerouting and draining support from other crises, and if the plan for this cholera outbreak also just moves money from one emergency to the next … it’s hard to celebrate a system that’s only moving the danger around.

Expert advice from Scandinavians on winter darkness 

Admittedly some tough news in today’s report, so let’s end with something light. With the solstice around the corner, the Associated Press just published a story that sums up advice from Nordic health professionals on coping with winter darkness. 

As far as I could tell, the advice seemed sound: You should get morning light, keep your routines, stay social, and lean into winter. That said, there’s a famous adage in journalism on the importance of verifying whatever anyone tells you, even from trusted sources: “If your mother says she loves you, check it out.”

So I passed on the article to three close Scandinavian friends of mine for, uh, let’s call it fact checking. I asked them to be unvarnished, and boy were they!

Generally, my Nords concurred with the AP. One Norwegian stressed just how central the cultural value of coziness (“Hygge”) really is for managing the enduring dark, along with a steady drumbeat of holiday festivals and “small cozy moments and traditions,” he said. That said … he noted that a certain triumvirate of important and traditional Scandinavian winter staples was entirely missing in the AP story. That’s alcohol, caffeine, and salty Christmas food. But “I’m not sure if these are the best tips to put into a global health newsletter,” he acknowledged.

One Swede challenged the central premise of the article. “I’m not sure we, as a population, know how to deal with the winter darkness,” she said. “Yeah, we do a lot of things, but also a lot of people just go depressed.”

But my favorite takeaways came from a Swedish friend, who wrote to me from Kuala Lumpur, Malaysia. “My best remedy for managing Nordic winters is not living there,” he said. 

He also took umbrage with one particular line in the AP story. “The saying ‘there’s no such thing as bad weather — only bad clothing’ is a scam invented to force preschool kids to play outside even in the rain and freezing cold,” he said, channeling what sounded like a long-held grievance. “Ice on the sidewalk and horizontal rain mixed with snow 100% qualifies as bad weather.”

I’ll see you next week!

William

Thumbnail image by Allison Robbert / AFP via Getty Images