Hello, and welcome back to The Kable. What a week it has been, huh? Opposition leaders are being manhandled in India, student protesters are being violently repressed in France, the US is trying to rig elections in Brazil, there may be a plague brewing in Russia. Meanwhile, Ebola continues climbing up the charts in the Democratic Republic of Congo (DRC).
Official numbers in Congo now stand at 8,728 cases and 4,205 deaths, and it might seem like case growth is finally slowing down. But the Africa CDC says it is more likely because the security situation is preventing a proper tallying of cases. Earlier in the week, Kenya reported its first case of Bundibugyo Ebola, a citizen who contracted the illness in the DRC before travelling by road to Uganda and then flying in to Nairobi, where he also became Kenya’s first casualty in the outbreak. The Africa CDC media briefing referenced above has a detailed itinerary for this person, which included extensive travel in the DRC, and Uganda. Kenya’s contact tracing is in full swing, with 57 contacts already identified. Considering that in the early days of this outbreak, Kenyan officials were the best with on-point messaging about the disease and means to control it, we would be very surprised if they didn’t get a handle on things fast. Another person with the exact same travel history was also initially believed to have contracted Ebola but later tests have ruled that out thankfully.
So, the plague in Russia... well, first up, Western media have fed us so much disinformation about Russia through the ages, it is difficult to believe anything they publish. What we do know is that a researcher at an institute working on plague research in Irkutsk, Siberia, has died of pneumonia, according to official sources, as reported by the WHO. Russia has told the WHO the death was not due to plague and they’ve not detected any plague pathogens, contrary to media reports blaming pneumonic plague. “Media” reports also said there was another death due to plague and the WHO has sought more information on that as well. In the meantime, if you read things like the researcher dropped a glass vial and her PPE failed and biocontainment procedures failed and she was an unsupervised student and that this was a genetically altered plague version, remember to take all of this with a hearty pinch of salt. And don’t forget, there may be up to 40 bioweapons labs in that general region. In Ukraine. Run by the US government.
Back to Africa, where Zambia and the US have finally signed their bilateral health deal, with the clause for sharing pathogen data removed.
In Sudan, UAE-sponsored conflict has already taken a heavy toll on people and places, with hunger and malnutrition rampant everywhere. A new assessment says, with El Niño truly bedding in, Sudan’s harvest is likely to fail, sending millions more into the grip of famine.
Last week, Botswana opened voluntary notification for Class A and specified medical devices, with fees reduced by up to 50% for fully-local manufacture. The voluntary window closes on 31 March 2027, so if you’re a medical devices manufacturer looking to enter a new market with strong regulatory support, here is your opportunity.
The Africa CDC released a roadmap to improve Reproductive, Maternal, Newborn, Child and Adolescent Health across the continent over the next five years. Now, for budgets and will to match.
The WHO released its Q3 health intelligence report for the Africa region. Mostly good news: decentralised mpox testing, genomic sequencing capacity in 46 of 47 member states, and an 89.4% detection success rate in laboratory external quality assessment.
The WHO too is making maternal and reproductive health a priority this week, with the launch of a global roadmap to tackle hypertension in pregnancy.
And in the US, New York has declared a state of emergency because of measles. The state says it plans to seek federal help. Pity the federal head honcho is someone who’s majorly responsible for the resurgence of measles in the US. Who, as of this week, is still casting doubt on vaccines.
And finally, and maybe unsurprisingly, the US is in the middle of a rash of sexually transmitted diarrhoea. And it is becoming drug-resistant. ‘MURICA!!!
Stories Of The Week
Covid is well and truly over. So, the WHO has released its latest Global Health Estimates and Covid has dropped out of the top 10 causes of death for the first time since 2021. Our theory says this is because we no longer track Covid and all the deaths caused by Covid are not actually attributed to Covid. But anyhoo. Noncommunicable diseases accounted for 74% of global deaths in 2023, up from 58% in 2000. Eight of the ten leading causes of death were noncommunicable diseases, led by ischaemic heart disease, stroke and chronic obstructive pulmonary disease, which killed 9.5 million, 6.8 million and 3.6 million people respectively. Covid fell to fourteenth place, causing an estimated 900,000 deaths. Global life expectancy recovered to 73.3 years, close to its 2019 level, but healthy life expectancy remained 0.4 years below its pre-pandemic level, at 62.8 years.
The shift is uneven across regions and income groups. Individual risk from ischaemic heart disease increased in WHO’s South-East Asia and Western Pacific regions, while the risk of dying from diabetes rose particularly sharply in South-East Asia. In lower-middle-income countries, deaths from heart disease, stroke and chronic obstructive pulmonary disease roughly doubled between 2000 and 2023, while diabetes deaths more than tripled. Yet low-income countries continue to face a substantial infectious disease burden: malaria, tuberculosis and HIV remained among their ten leading causes of death, and lower respiratory infections killed more than 350,000 people annually throughout the period, with little progress in reducing that toll.
Dementia and mental health conditions are also reshaping health needs. Deaths from Alzheimer’s disease and other dementias tripled between 2000 and 2023, making them the fifth leading cause of death globally. Between 2019 and 2023, age-standardised rates of healthy life lost to depression and anxiety increased by approximately 20% and 45% respectively. Drug use disorders showed contrasting regional trends, with the Americas recording the largest increases in mortality and disability risk since 2000, while the Western Pacific saw substantial declines.
(WHO)
From the world to Africa. Noncommunicable diseases caused an estimated 4.70 million deaths across Africa in 2023, according to a Lancet Global Health study highlighted by the Africa CDC. The analysis, published using Global Burden of Disease 2023 data, estimated that these conditions cost the continent 263 million years of healthy life. Although deaths increased between 1990 and 2023, the age-standardised mortality rate fell by 9%, indicating that population growth and demographic changes outweighed improvements in underlying mortality risk. The findings describe a long-term rise in the burden using modelled historical estimates.
Ischaemic heart disease and stroke were the leading causes of NCD deaths, killing an estimated 801,000 and 700,000 people respectively. Chronic kidney disease accounted for 293,000 deaths, hypertensive heart disease for 246,000 and diabetes for 245,000. High systolic blood pressure was the largest attributable risk factor, linked to 26.2% of NCD deaths, followed by dietary risks at 14.7% and air pollution at 14.2%. Across all 88 risk factors assessed, 57.4% of NCD deaths were attributable to potentially modifiable exposures.
The findings strengthen the case for planning around sustained demand for chronic disease medicines and diagnostics, alongside prevention. A key question is whether countries translate that burden into reliable access to long-term care, and whether stronger national surveillance helps direct resources towards the populations and conditions with the greatest unmet needs.
(Africa CDC)
When your day is done. Authorities seized 251 tonnes of medical products across Cameroon, the Republic of Congo, Gabon, the Central African Republic and Chad between 2020 and 2025, according to a new UNODC report. Seizures included antibiotics, antimalarials, painkillers, tramadol and pregabalin, including falsified medicines, diverted genuine products and unapproved drugs. Recorded seizures climbed from about five tonnes in 2020 to nearly 116 tonnes in 2024; Cameroon alone accounted for 96 tonnes in 2025. These figures reflect enforcement activity as well as trafficking. Networks use ports including Douala and Nigeria’s Apapa, alongside river, air and road routes; armed groups profit through looting medicines and taxing convoys.
The market feeds on treatment and access gaps. In Chad, a prefilled insulin syringe cost nearly 16 days’ wages for the lowest-paid government employee, while informal sellers in the Central African Republic made medicines affordable by selling individual tablets. In the same countries, more than half the population lived at least two hours from a public hospital providing emergency care. And yes, the safety risks extend into authorised outlets too: a third of incidents reported to WHO’s surveillance system in the Central African economic bloc were detected in regulated supply chains. Falsified amoxicillin identified in Cameroon and the Central African Republic in 2025 contained no stated active ingredient. So there is an access problem because patients are struggling to afford treatment. But thankfully, there is also a trust problem because people are unsure about whether the medicines they buy will work.
(UNODC)
Play ball. Were you considering bariatric surgery for your under-10s? Or weight-loss devices? Or obesity medicines? First, what in tarnation is wrong with you? And second, the WHO has released its first global guidelines on childhood and adolescent obesity. And it says structured nutrition, physical activity and behavioural support are more important than medicines and surgery. The guidance explicitly advises against obesity medicines, bariatric surgery and weight-loss devices for children under ten. It also says that for adolescents aged 10–19, approved medicines may be considered but only when a supervised programme combining lifestyle interventions has not achieved the desired results. As for surgery, that is an absolute last option for severe obesity.
Childhood and adolescent obesity is a real enough problem. The prevalence among 5–19-year-olds has quadrupled since 1990, reaching 8%, with 170 million affected in 2024. Childhood obesity is accelerating across parts of sub-Saharan Africa, South and Southeast Asia, Latin America and the Pacific, bringing greater risks of type 2 diabetes and cardiovascular disease. And while we don’t always agree with the WHO, we do agree that comprehensive childhood obesity care based on lifestyle might be a better foundation for later years.
(WHO)
Bottom line
The guest who isn’t. Do you think El Niño has gone on far too long already? No? Excellent because the UN says it will pick up some more and will go on till at least February next year. The WMO update puts the likelihood of El Niño persisting through February 2027 at nearly 100%, with a December peak potentially making it one of the strongest events since at least 1950. Temperatures in the key central-eastern Pacific monitoring region are forecast to average 3.7°C above normal during October–December, surpassing the previous seasonal record of 2.6°C.
The regional forecast is equally committed to being a pain in the nether regions: wetter-than-normal conditions are more likely across the Greater Horn of Africa and southeastern South America, while the Indian subcontinent, southern Central America, parts of the Caribbean and northwestern South America face a drier outlook. Much of the globe is also likely to experience above-average temperatures, raising the risk of heat extremes.
(WMO)
Growing up hungry. While El Niño happily extends its stay, UNICEF is counting the children living in its path: more than 347 million across nearly 100 countries and territories could experience unusually wet or dry conditions between October and December. The largest exposed population - at 190 million children - lives in Asia and the Pacific, followed by East and Southern Africa and Latin America and the Caribbean, at 41 million each. These are estimates of exposure to forecast rainfall anomalies, rather than counts of children who will suffer disasters. Even with that distinction, El Niño’s itinerary is looking alarmingly ambitious.
Drier conditions in Colombia, Fiji, Papua New Guinea and the Philippines could intensify water shortages, agricultural drought and acute malnutrition. In the Greater Horn of Africa, particularly Somalia, unusually heavy rainfall could bring flooding, water-borne disease and school closures. For children in conflict-affected countries such as Afghanistan and Chad, those shocks would compound existing hunger, displacement and limited access to care. The forecast arrives months ahead of the worst expected conditions. Whether that warning translates into preparation will help determine how many children experience El Niño as disrupted weather, and how many experience it as a disrupted childhood. We know the answer but one lives in hope.
(UNICEF)
The tiger is back, baby. Maybe. Some wildlife is staging a comeback. WWF’s Living Planet Report 2026 has the receipts. Global wild tiger numbers rose from about 3,200 in 2010 to 5,700 in 2025; Atlantic and Pacific bluefin tuna have recovered following tighter fishing controls; and some southern African elephant populations are increasing, despite declines elsewhere. Green sea turtles moved from Endangered to Least Concern on the IUCN Red List in 2025, following decades of protection across roughly 80 nesting countries. Half the wildlife populations tracked by the Living Planet Index are stable or increasing. So sustained conservation can work, and not just produce excellent photographs of increasingly rare animals.
But the bad news, and there always is bad news, is that the losses still overwhelm those gains. Across 35,803 monitored populations of 5,790 vertebrate species, the index recorded a 73% average decline in population size between 1970 and 2022. Regional declines were steepest in Latin America and the Caribbean, at 95%, followed by Africa at 80% and Asia–Pacific at 49%; North America recorded 28% and Europe and Central Asia 23%, though substantial losses there predated the 1970 baseline. Freshwater populations suffered the greatest decline, at 85%, with habitat destruction and degradation the most frequently reported threats.
Dunno. Maybe we should have led with the bad news. Because the recoveries show that decline can be reversed. But when you look at the broader picture, the successes are so obviously so distant from adding up to a global recovery. 🥲
(Living Planet Report 2026)
Long reads
Cry me a river. Just one long read again. And it is a study that will gladden the hearts of all the MRAs out there. Or maybe not. Because the study says women face higher pain levels than men, across multiple parts of the body. And it doesn’t even account for the fact that women have to deal with men every day.
(Nature Medicine)