Gavi, the Vaccine Alliance, has its billion dollar grant cut by Trump administration

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Gavi, the Vaccine Alliance is a global health group that thinks in the billions.

Since its founding in 2000 the organization says it has played a role in vaccinating 1.1 billion children against a raft of potentially devastating diseases from polio to malaria to mpox.

When kids in lower-resource countries get their vaccines, Gavi is a critical part of the chain. With its massive budget — donated by both countries and philanthropies — the alliance contributes cash to countries to help them buy vaccines from manufacturers and also is a supporter of programs that take the vaccines from their arrival in-country to the many places where they’re administered.

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Gavi also wants to encourage countries to take responsibility for their own vaccine programs. When a country’s economy improves, they’re asked to pay a larger share of the vaccine costs. And some countries graduate. Indonesia, for example, once a beneficiary, is now a Gavi donor.

The United States has provided 13% of Gavi’s funding since its inception — and had pledged under the Biden Administration a grant of $2.53 billion starting in September 2022 through the year 2030. Of that amount $880 million has so far been dispersed.

On the list of canceled programs

But this week, according to a 281-page document detailing foreign aid cuts and compiled by the United States State Department, that billion-dollar grant was canceled. It was one of thousands of contracts totaling billions of dollars in allocations eliminated as part of a review to eliminate expenditures “that did not serve, (and in some cases even harmed), the core national interests of the United States” according to a statement posted on X by Secretary of State Marco Rubio.

The U.S. is the third biggest donor among countries and philanthropic groups that support the organization, behind the United Kingdom and the Gates Foundation.

This cut won’t put Gavi out of business. But the news comes as Gavi has already been facing a tough road in fund-raising to meet its goals — there’s more competition in the global arena from a variety of groups and continuing [demands including humanitarian, health care and defense from Ukraine and the Middle East, among other issues.

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So the loss of the U.S. funds is a blow.

“A cut in Gavi’s funding from the U.S. would have a disastrous impact on global health security, potentially resulting in the deaths of over a million children over five years and endangering lives everywhere from dangerous disease outbreaks,” Sania Nishtar, CEO of Gavi, told NPR.

Nishtar holds out hope that, as with some other USAID cuts there could be a change of heart. “We have not received a termination notice from the U.S. government and are engaging with the White House and Congress with a view to securing the $300 million approved by Congress for our 2025 activities and longer-term funding for Gavi,” she said.

The potential impact

If the funding cuts stand, “we don’t know the timeline for the ramifications,” says Dr. William Moss, who leads the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. But he has no doubt there will be an impact: “What is almost certain is that we will see more frequent and larger measles outbreaks globally but also a resurgence of many other vaccine-preventable diseases, such as whooping cough and rotavirus diarrhea — both of which can be fatal. We would also see delays or disruptions to the introduction of new, life-saving vaccines in the communities most in need.” That would include new, promising malaria vaccines just being introduced.

And outbreaks of infectious disease in other countries can travel to the U.S.

“Some of the infectious diseases that Gavi combats includes those that have implications for U.S. health security such as mpox and measles,” says Dr. Amesh Adalja, a senior scholar at Center for Health Security at Johns Hopkins. “With measles, for example, as U.S. vaccine hesitancy increases, the chance of outbreaks linked to international travel increases and will increase more if areas in which Gavi operates in have a higher measles burden due to lower vaccination rates.”

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Thomas Bollyky, director of the global health program at the Council on Foreign Relations, a nonpartisan think tank in Washington, D.C., tells NPR that it will be difficult, if not impossible, to make up the shortfall that Gavi would face from a cut in U.S. funding — as well as funds lost from other donors. The United Kingdom, the largest donor to Gavi, which pledged the equivalent of 1.9 billion dollars for GAVI’s 2021 to 2025 funding cycle, has announced a decision to slash development assistance from 0.5% of GDP to 0.3% by 2027 — a move aimed at increasing defense spending in response to the wavering U.S. commitment to Ukraine, says Bollyky.

The Gates Foundation, which had pledged $1.8 billion from 2021 to 2025, would likely seek to make up some of the gap, “but that will be difficult to sustain on its own, indefinitely,” says Bollyky.

In a statement released this week, Mark Suzman, CEO of the Gates Foundation (which is a funder of NPR and this blog) said: “We are going to do everything possible to convince the Administration and the Congress to reverse these actions if true.”

Bollyky says that what worries him most is that when Gavi was created in 2000, there were 43 countries, including most of sub-Saharan Africa, where at least 1 out of 10 children died before age 5 from infectious diseases. Today there are only five such countries — Chad, Niger, Nigeria, Sierra Leone and Somalia “[and] GAVI is a big part of the reason why.”

Janeen Madan Keller, deputy director of the Global Health Policy Program at the Center for Global Development in Washington, D.C., said in a statement that the timing of the U.S. funding cuts could also thwart Gavi’s efforts to roll out new malaria vaccines that could play a transformational role in the fight against one of the world’s deadliest diseases.

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Said Keller, “there’s a very real, urgent, need to ensure sufficient funding which will be essential to protect lives and limit the spread of infectious diseases. But in the longer-term, we need to continue working toward finding ways to ensure countries are less reliant on increasingly volatile donor funding.”

Asked to comment on the Gavi funding termination and concerns about the impact on infectious disease outbreaks, a State Department spokesperson confirmed that the termination of the grant is “accurate” and reiterated the reasoning behind all the 5,300-plus cancellations — they were “inconsistent with the national interest or Agency policy priorities.”

The State Department response stressed that “critical USAID program awards remain active,” noting: “USAID continues to support the U.S. coordinated, interagency response to the Ebola outbreak in Uganda; to provide lifesaving HIV care and treatment services; to provide emergency assistance in conflict zones; and to support key American strategic partners.”

Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health.

What does it take for a famine to be declared in Gaza?

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Gaza’s hunger crisis worsens by the day, but it’s still not been declared a famine.

The war-torn Palestinian enclave faces catastrophic shortages of food, water and medicine, according to the British Red Cross and the World Health Organization. The World Food Programme, an arm of the United Nations, said Monday that hunger in Gaza has reached “astonishing levels,” with a third of the population of just over 2 million people currently going multiple days without eating.

On Tuesday, U.N. Secretary-General António Guterres called Gaza a “horror show” of devastation and starvation, marked by “a level of death and destruction without parallel in recent times.”

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So why the hesitation in labeling it a famine? And who are the authorities with the power to make that call?

Here are five takeaways from NPR interviews with specialists and analysts who monitor hunger crises around world.

There’s a very specific, internationally-agreed upon system for gauging hunger crises

The system the world relies on to track food emergencies began in the 1980s, said Tim Hoffine, now deputy chief of party-innovation at the Famine Early Warning Systems Network (FEWS NET). In response to famines in East and West Africa, U.S. aid officials realized the need for a way to monitor global hunger. The goal, Hoffine said, was to provide “independent, timely and evidence-based analysis” to help decision-makers prevent future famines.

That led to the founding in 1985 of FEWS NET by the U.S. Agency for International Development (USAID) to contract with experts to collect and analyze data on at-risk areas monthly.

Still, there was no universal standard to define the severity of hunger crises — making coordination among donors and aid groups difficult.

As former World Food Programme spokesperson Steve Taravella put it, “There is a serious need for the aid community to understand the levels of hunger in a scientific, authoritative way … We needed something reliable and authoritative that everybody working on these issues could use as a baseline.”

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So in 2004, during a food emergency in Somalia, FEWS NET and international partners developed the “Integrated Food Security Phase Classification” initiative -– or IPC.

“It’s a mouthful of humanitarian jargon,” Taravella said, “but it’s basically the authoritative, respected, scientific mechanism for measuring levels of hunger in different areas.”

The IPC is coordinated by the U.N. Food and Agriculture Organization in Rome but brings together working groups of experts to analyze each crisis individually.

“Donors wanted a single estimate of need,” Hoffine said. “And the IPC responded to that desire for consensus.”

Multiple conditions need to be met before a location is technically considered in “famine”

The IPC categorizes hunger on a five-phase scale. FEWS NET, which monitors hunger hot spots monthly, also uses this system.

Phase one means conditions are normal. In phase two, communities are “stressed” — still eating enough but many households struggle to afford other essentials.

At phase three — “crisis” -– “that’s where we start getting nervous,” Taravella said. People begin to have trouble getting enough food. “They might not have meals as often.” Many turn to short-term coping strategies that undermine long-term survival, like selling off livestock.

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In phase four — “emergency” — hardships deepen. Food gaps widen, and people resort to “really extreme forms of coping,” Hoffine said. That might mean liquidating nearly all assets or eating seeds needed for future planting. Rates of acute malnutrition and excess deaths rise.

Only in phase five is a location considered in “famine.” Three criteria must be met: at least 20% of households face “catastrophe,” meaning, Hoffine explained, “an extreme lack of food that … leads to acute malnutrition and mortality.”

Second, at least 30% of children under five suffer from acute malnutrition, or wasting.

Third, at least two of every 10,000 adults die each day from non-trauma causes. As Hoffine noted, hunger often kills not just through starvation but by weakening immune systems to the point where people can’t fight off disease.

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FEWS NET places Gaza in phase four; as of May 2025, the IPC estimates that 925,000 Gazans (44%) are already experiencing “emergency” acute food insecurity — close to the starvation threshold. A further 244,000 (12%) are in “catastrophe” or experiencing famine.

FEWS NET lacks an operational presence in Gaza, posing potential challenges to monitoring acute food insecurity, but says its analysis methods remain consistent with its standard project-wide practices.

“In conflict zones, collecting reliable data, especially on non-trauma mortality, often proves difficult,” Jean-Martin Bauer, the World Food Programme’s director for food security and nutrition analysis service, told NPR. “This means lack of data can hinder an official classification of famine. By the time famine is declared, people are already dying.”

Some areas in Sudan have been declared to be facing famine conditions since 2024. Parts of South Sudan were declared in famine in 2020 and 2017.

There’s an even higher bar for actually declaring a famine

Even if FEWS NET or the IPC determine that a location meets all three famine criteria, they can’t declare it on their own. Their findings must be reviewed and approved by a committee of independent experts convened by the IPC. In Gaza’s case, the committee reviewed and signed off on similar reports from both organizations.

Still, neither FEWS NET nor the IPC makes the official declaration. “It’s up to government institutions, United Nations upper leadership, and other high-level representatives to actually make a famine declaration,” Hoffine said.

Starvation can occur long before famine is declared

Because all three thresholds must be met to trigger a famine designation, many people may be starving well before phase five is reached.

“Until famine thresholds are breached, you would still have people dying from hunger or hunger-related mortality,” Hoffine explained. “So in Gaza you would still expect there to be mortality. And the longer this goes without a solution, the more that we can expect that sort of mortality to occur.”

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It’s not too late – but time is running short

Hoffine and Taravella emphasized the caveats in their organizations’ reports are critical. Both FEWS NET and IPC say famine in Gaza can be alleviated if hostilities cease and aid workers are granted full access.

That’s the goal of the famine classification system: to alert the world before it’s too late. While higher-phase designations don’t mandate action, they are powerful tools for mobilizing a response, Taravella said. “It puts the world on notice.”

He cited World Food Programme chief economist Arif Husain: “Several years ago, when [famines] happened in certain places, you could say, ‘I’m sorry. I did not know.’ Today we see crises in real time. So we cannot say we did not know.”

Today, while Gaza’s starvation crisis is well-covered in the media, the political implications of a formal famine declaration are less often discussed. Such a designation carries weight, increasing pressure on governments and agencies to ramp up aid and on Israel to allow full humanitarian access. It could also lead to diplomatic fallout.

Farewell to USAID: Reflections on the agency that President Trump dismantled

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A storied US agency, one that began under President Kennedy in 1961 with the aim of providing global stability through a wide array of humanitarian aid and development programs, has now formally closed.

Since January, the Trump administration has systematically dismantled the US Agency for International Development (USAID), canceling thousands of contracts and firing or placing on leave thousands of employees within the U.S. and overseas.

In a public statement issued in early February, the U.S. State Department wrote that USAID “has long strayed from its original mission of responsibly advancing American interests abroad, and it is now abundantly clear that significant portions of USAID funding are not aligned with the core national interests of the United States.”

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To course correct, Secretary of State Marco Rubio was appointed as Acting Administrator of USAID. And as of July 1, the remainder of the aid agency will be absorbed into the State Department.

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NPR interviewed four former high level officials within USAID, including previous heads of the agency during both Democratic and Republican administrations, to reflect on this milestone event: Atul Gawande, Dean Karlan, Andrew Natsios and Susan Reichle.

Reichle says that the reorganization amounts to “an absolute train wreck” and Natsios calls it “an abomination.”

In addition, they all expressed concern that the State Department is not equipped to manage what’s left of the agency’s programming and staff. NPR reached out to the State Department for comment on the July 1 transition and this critique but did not receive a reply.

Andrew Natsios , the USAID administrator from 2001 to 2006 under George W Bush, thinks it will take at least five to seven years to tee up the infrastructure needed to run the complex global aid programs once managed by the agency.

“I think the State Department’s the finest diplomatic institution in the world,” he says. “However, it’s not an aid institution. That’s completely different.” And with 94% of the some 13,000 USAID staff now laid off, Natsios questions how everything will be managed.

“Who is going to run this system?” he asks. “Santa Claus?”

The potential growth of famine

One of Natsios’ areas of expertise is famine. Part of that interest is personal. His great uncle died during the famine in Greece that was brought on by the Nazi occupation and that wiped out at least 300,000 people.

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Natsios explains that deaths due to famine have dropped over the last 40 years “and that’s because of the evolution of [the] humanitarian response system in the world, which is dominated by [USAID].” Since the late 1980s, the agency has used its Famine Early Warning Systems Network to predict food emergencies and deployed its Disaster Assistance Response Team to manage the crises. Natsios says that at least a quarter of the $35 billion USAID budget has historically been allocated for disaster response, most of which was for food emergencies.

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With the effective dissolution of the aid agency, he worries that hunger and famine — already on the rise for six consecutive years — may continue to grow with devastating consequences.

“During any famine, people start moving when they’re dying. And where do they go? They go to countries that are rich where there’s food,” he says. “The way to stop migration, which President Trump ran for election on, is you stop the reason why people are moving.” He argues that can be achieved by improving life in those places facing food insecurity, a task that he believes that USAID was designed to accomplish.

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More broadly, instability forces people from their homes in search of something better despite the severe risk that migration involves. ” I think we don’t have the tools anymore to deal with these crises because we just eliminated them all,” says Natsios, referring to the USAID shutdown.

“So by letting the international system collapse, we’re going to increase the pressure on our borders,” he says. “It’s not what the President wanted, but that’s what’s going to happen. It’s madness.”

The slow death of USAID

Dean Karlan, who served as USAID’s Chief Economist from late 2022 until February of this year , says that since President Trump’s inauguration, the agency has been dying a slow death. The July 1 date simply confirms what many have known: “USAID stopped being what it was several months ago,” he says. Currently, 83% of the agency’s programs have been terminated .

During his time at USAID, Karlan and his team were tasked with designing more cost-effective programs. He believes the State Department may be able to save lives in a manner similar to USAID. “We’re still waiting to see what they put in place,” he says.

However, he says he has reason to be skeptical. “The political appointees leading State have done nothing to figure out what’s working and what’s not in order to fund the things that are more effective,” he says. “Every indication and everybody I’ve been talking to is telling me that they are not putting those processes in place.”

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Take child mortality. For decades, there’s been a steady year over year decline globally in the number of deaths of children under the age of five due to improvements in public health and reductions in poverty. The UN Interagency Group for Child Mortality Estimation calculates that since 1990, the under-five mortality rate has fallen by more than half . But 2025 may be a turning point.

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“This is probably going to be the first year in decades that more children under five globally died than in the prior year,” says Karlan, who’s not confident that the absorption of what remains of USAID into the State Department will alter that projection. That’s because programs focused on food insecurity have been canceled , including all of the $114.5 million of awards to the UN Food and Agriculture Organization and $108 million for the agency’s Bureau for Resilience, Environment, and Food Security, along with “food sitting in warehouses literally going bad,” he says. “That happened from the moment those stop work orders were put in place. So there’s death that has happened that cannot obviously be reversed.”

In addition, USAID staffing has been decimated since January. Susan Reichle , who worked as a Senior Foreign Service Officer with USAID in Colombia, Haiti, Nicaragua and Russia, says that fewer than 6% of the agency’s original employees — 718 people — will be transferring into the State Department.

These individuals will help run the remaining programs, which represent a small fraction of the thousands that USAID was once responsible for. But many of those programs may well sunset in September, says Reichle, because the State Department does not currently have the authority or capacity needed to extend those contracts.

So in her new role running the Aid Transition Alliance , an initiative to support the USAID community of current and former employees through mental health, communication and career transition services, she has been focused on celebrating the many aid workers who’ve worked at USAID over the decades. “They have served heroically for this country,” Reichle says. She points to their containment of the Ebola epidemic of West Africa that began in 2013. “They prevented migrants from migrating across the Western hemisphere by giving them opportunities for education. And they have saved 25 million lives just with PEPFAR,” a program credited with helping to prevent HIV-related deaths that was started by George W. Bush and co-administered by USAID.

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Fighting fights

Natsios points to one potential upside of the reorganization — navigating interagency politics.

“State knows how to fight fights with the Treasury Department, the CIA, the Defense Department,” he says. “Usually, we’re allied with them, but [State] wouldn’t take our policies up as their first priority. They might do that now.”

Still, Natsios doesn’t think this merits the evisceration of USAID.

“Privately, if you talk to the State people, they want to control what [USAID] did,” he says. “But they don’t want to run it because they don’t know how to do it.”

Karlan and Reichle have both welcomed critical reviews of foreign assistance in the past to improve the effectiveness of programs and personnel. This merger, says Karlan, “is not inherently a bad thing,” but the hasty manner in which it’s happening isn’t consistent with the spirit of those reviews.

Natsios says it would be as improbable as fusing two disparate corporations like Exxon and Microsoft. “I’m not comparing State and [USAID] to either of those companies, but the cultures are completely different,” he says. That mismatch has led him to predict a failure at such a scale that within five years, there will be a call for a new independent aid agency.

A possible rebirth out of heartbreak

Atul Gawande , who led global health at USAID during the Biden administration, finds the demise of the foreign aid agency “heartbreaking.”

“It’s enabled us to have enormous impact and influence around the world,” he says. “It’s arguably saved more lives per dollar than any other agency” through disease prevention and eradication, stabilizing conflict, disaster response and international development.

He allows that the State Department will be able to carry on some of USAID’s work, but it will be “a fraction of the impact and leadership that we have been able to provide around the world.” And he worries that the aid efforts will become more politically oriented or inspired once they’re no longer housed within an independent agency. (Though Karlan admits that politics has long been a force that seeps into foreign aid to some extent.)

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Reichle calls 1 July a pivotal day. That’s because it’s also the date that the severance payments for many who have been laid off will stop, marking an official end to their tenure in government. “We are losing people that have developed decades of experience in how to not just manage these really important life saving programs but also how to build trust with with our partners on the ground,” she says.

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“It will be too late to save USAID, but I do pray that we can save development,” she adds. “We’re a very resilient community and development is not going away. It’s not over.”

Gawande agrees. He has spoken with foreign aid professionals who have told him, “Who knows, I might well have an opportunity to return to government. And even after all this, I would return again in a heartbeat — to be able to have this kind of impact in the world.”

He argues that the chaos and destruction emerging from the changes to USAID are not necessarily permanent. That’s why he says, “I have faith that this work will come back. I don’t know if it’ll take six months, two years, ten years. But this is work that humanity has been pursuing for decades, if not centuries, so we will come back to it.”

Still, Gawande acknowledges that USAID as the world knew it will never return. “You can’t rebuild that network built up over 60 years and destroyed in a matter of weeks,” he says.

He pauses to reflect on what an appropriate epitaph for the foreign aid agency might be — to be chiseled on its tombstone on July 1.

“It lifted us up,” Gawande says at last, “our country and the world.”

This may be the most lead polluted place on Earth. Is there any hope?

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In a soft, faltering voice, her large brown eyes staring absently ahead, Winfrida Besa repeats “A-B-C-D” over and over as she tries to sing the ABCs. With her thin, hollow face and slight frame, 7-year-old Winfrida looks much younger than she really is.

“Winfrida doesn’t go to school. She would just leave the classroom and wander off, and we worry she would get lost,” sighs her grandfather, Bobby Besa, 60. The little girl was born “normal,” he says, but soon she was exhibiting a constellation of disturbing symptoms that are familiar to residents of Kabwe, Zambia. The diagnosis came after blood testing at the local clinic: Lead poisoning.

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This city of almost 300,000 people, 80 miles north of Zambia’s capital of Lusaka, was identified by a 2022 U.N. report as a “sacrifice zone” — one of the most polluted places on the planet. Between 1906 and 1994, Kabwe was home to Broken Hill, one of the world’s largest lead and zinc mines. For decades, highly toxic lead particles were blown across town, carried by the wind and the waterways, contaminating the soil in courtyards, playgrounds and on dirt roads where speeding trucks raise plumes of dust.

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Who is to blame? That’s the subject of a class action lawsuit filed in 2020 on behalf of 100,000 Kabwe residents against a subsidiary of the mining company Anglo American, seeking compensation for lead poisoning.

In response to questions from NPR, Anglo American pointed to a statement that said its subsidiary, Anglo American South Africa, was only indirectly involved in the mine between 1925 and 1974 to provide “technical services,” and never “owned or operated it.” The mine was nationalized in 1971 and operated under a Zambian state-owned company, ZCCM, until its closure in 1994.

Anglo American said while it had “sympathy” for the residents of Kabwe and “contamination was not acceptable anywhere,” it wasn’t “responsible for the current situation.”

A South African court threw out the lawsuit in December 2023, saying it would set a “grave precedent” that “a business could be held liable half a century after its activities have ceased, to generations not yet born, as a result of being tested against future knowledge and standards unknown at the time.”

But the claimants’ lawyers, who won permission to appeal nearly a year ago, argue that the dangers have been apparent for a very long time. As yet there is no date set for the appeal.

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Sitting in his garden in Chowa township, one of the most polluted areas in Kabwe, former miner Andrew Siyanga, 77, remembers his colleagues being “leaded out” as early as 1969, when he joined Broken Hill as a young workshop employee. He says the long-time owner of the mine — Zambia Broken Hill Development Company Limited used that phrase when transferring employees to safer areas, outside of Kabwe, if their levels of lead were deemed too high in weekly testing. Some were only “leaded out” for a few days, but others required months to return, or never came back. (The owner became ZCCM after nationalization.)

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Dr. Ian Lawrence, who was employed as a doctor at the mine in 1969 and 1970, says he became alarmed at the high death rates among young children in the residential township where mine employees lived, according to a 2020 affidavit filed in connection with the class action lawsuit. He took blood samples from about 500 children under the age of 5 and found that nearly all exceeded safe blood lead levels. In the affidavit, Dr. Lawrence stated that he believed dust from the mine was poisoning the children,

Despite these red flags, production continued at the mine until its closure in 1994. Even now, 30 years later, the former grounds of the Broken Hill mine swarm with independent miners digging in the toxic slag left behind in search of zinc, lead, and stones they sell back to mining companies.

“We are scared of lead, but we don’t have any other way to put food on the table,” one miner explains. “We get sick,” says another, as he sifts black soil to separate out the heavier lead slag. “Short memory,” adds a third, darkly joking about a symptom of chronic lead poisoning, before jumping into the artificial lake to rinse himself off.

This continued activity at the mine, by constantly disturbing the toxic dust, compounds the problems that have plagued the surrounding community for more than a century.

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“Kabwe is the most contaminated site that I know of on the planet,” says Jack Caravanos, clinical professor of environmental public health sciences at NYU’s School of Global Public Health.

He was part of an international team of scientists behind a 2018 report published in the journal Environmental Research, which analyzed the health impact of lead exposure on children in Kabwe. Data showed that more than 95% of children in the most affected townships had elevated blood lead levels, and half had levels requiring medical intervention. In another large-scale study by Japanese and Zambian researchers, published in the journal Nature in 2020, nearly 75% of residents tested across the entire Kabwe district had elevated blood lead levels.

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“You are living with the thought that anytime, this might kill you,” says Mable Besa, Winfrida’s grandmother. In the township of Makandanyama, near the old mining grounds, she explains, it is impossible to escape the pollution. That 2018 report noted that soil samples taken from near her home were “highly contaminated with the metal.” She worries about that every time she wipes dust off her couch.

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Winfrida’s exposure may have started in utero: Her late father, who died in a car accident, scavenged on the site of the former mine. Her mother died a few years ago from an unknown sickness — the symptoms of which, including weakness and abdominal pain, are consistent with lead poisoning. Lead in a mother can affect a developing fetus, and studies suggest that paternal lead exposure can lead to low birth weight or prematurity.

Testing has revealed that Winfrida’s 5-year-old cousin also has high blood lead levels, so both girls are on what’s known as chelation therapy: introducing elements into the body that bind with the lead to facilitate its excretion from the body .

But there are limits to how helpful that can be. Caravanos asks, “What’s the point of giving people a pill, if they’re going to be exposed the next day?” In this environment, limiting daily exposure is almost impossible. Young children are particularly at risk, as they tend to play in the dirt and frequently put their hands in their mouths.

Winfrida and her cousin have dusty hands and faces, having just come in from the courtyard where a crowd of children is watching a traditional dancer perform, his feet kicking up clouds of ochre dust as he jumps to the rhythm of drums. “Every child that is born needs to step on the ground, but the soil is contaminated,” laments Mable Besa. “It’s not manageable to just stop the children from playing outside. If you wash their clothes, they gather dust when you hang them up. Even inside the house, if you leave food in the pots, you will find dust there,” she says.

toggle caption Tommy Trenchard for NPR

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A few houses away, Rose Asabi, 58, digs through boxes to find the scattered pages on which she has listed the names of all 515 neighborhood children affected by lead poisoning. She has worked as a community health mobilizer since 2006, informing families about the risks, recording lead poisoning cases and referring them to the local clinic.

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“The majority of children in this community have blood lead levels above 45 [micrograms per deciliter of blood], and in some cases, it even goes up to 110,” she explains. According to the World Health Organization (WHO), there is no known safe level of lead in blood — although the safety threshold is generally set a 5 micrograms per deciliter (about half a cup of blood) and urgent medical treatment is required starting at 45 micrograms.

“Many have memory loss, stunted growth … they get involved in fights or they don’t grasp the concepts they are taught at school,” Asabi says. “Sometimes, a child will wake up in pain all over their body, or become weak in the joints.” These are all known signs of lead poisoning, which attacks the central nervous system and most organs including the heart, kidney and liver, causing irreversible damage, according to WHO .

toggle caption Tommy Trenchard for NPR

toggle caption Tommy Trenchard for NPR

Sitting on the ground in the yard, her four grandchildren play with spinning tops made out of bottle caps. Their blood lead levels range between 45 and 89 micrograms per deciliter, she says. After testing finally became available to adults last year, Asabi’s blood tests also came back positive for high blood lead levels. She is currently on chelation medication, which only became widely available in Kabwe in recent years, after decades of pressure from civil society organizations, including Human Rights Watch.

In 2016, Zambia received a $65.6 million World Bank loan to support cleanup efforts. The vision is to end contamination from the mine site, bury lead-contaminated surfaces with pavement or cement, and roll out testing and treatment at a much larger scale, particularly for children. A January 2024 World Bank status report rated the project outcomes as “moderately satisfactory,” but according to a report by Human Rights Watch published two months later, little had been achieved apart from cleaning up “a small number of homes” and a highly polluted canal. With the country currently in the grip of a devastating drought , even basic remediation measures such as planting grass in the courtyards, which was encouraged by authorities in order to reduce the spreading of toxic dust, are no longer possible.

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Even further, another investigation released by Human Rights Watch on March 5 accuses the Zambian government of worsening pollution in Kabwe by issuing licenses for mining and toxic waste processing.

Cleanup efforts have not dealt with the “source of contamination”: the waste at the former mine, the report states. Instead, it details, “mining, removal, and transport of the waste has generated more lead dust and spread it to other parts of Kabwe, resulting in huge additional health risks for people who have already been exposed to toxic lead for decades.”

An inter-ministerial committee to address the contamination, announced in April 2024 by the President Hakainde Hichilema, has not yet been officially established, according to Human Rights Watch.

toggle caption Tommy Trenchard for NPR

Zambia’s Minister of Mines and Minerals Development, Paul Kabuswe, told NPR the government was “determined to deal with the issues of lead pollution in Kabwe.”

“At some point, Kabwe was described as the most polluted town in the world – it’s going to take time to remediate a town like that,” he said. “The problem is big and deep, and requires a lot of time and resources to deal with.”

If new mining licenses were issued, he said, it was because the area “still has other minerals apart from the lead” – but the government would act “decisively” if anyone was found to have “exacerbated the issue of pollution”.

“Everyone who was part of the pollution in Kabwe must take responsibility,” he said, calling on nongovernmental groups to hold to account the “foreign companies” that were involved in the former lead mine.

Kabwe’s mayor Patrick Chishala praises the progress but readily admits that more should be done. He believes the city should be treated “as a special case” by the government. A former high school teacher, Chishala personally witnessed the effects of lead pollution on his young students.

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“We have declared war between the people of Kabwe and the lead,” he says. In addition to testing and treatment, community mobilizers like Asabi have been charged with raising awareness in affected communities. “The most important thing that we have done is to inform the people,” Chishala says. Now the key issue, he says, is to ensure that every lead surface is finally covered. “We want to see one day a city free from lead,” he adds.

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Some experts, including Caravanos, fear that might be impossible – and that the only real solution is to move people away. The former mine “may forever remain a contaminated site,” he says.

But for Mable Besa, who has raised her children and grandchildren in her house in Makandanyama township, moving isn’t a viable option, mainly for financial reasons. One of her sons still scavenges at the mining dump, for lack of better employment opportunities. “There is nowhere to go,” she sighs.

Julie Bourdin is a freelance journalist based in South Africa. She covers human rights and climate-related stories across Africa and Europe. She’s trudged through abandoned mines, dived in Cape Town’s icy waters and flown over Lesotho’s mountain Kingdom.

Tommy Trenchard is an independent photojournalist based in Cape Town, South Africa. He has previously contributed photos and stories to NPR on the Mozambique cyclone of 2019, Indonesian death rituals and illegal miners in abandoned South African diamond mines and won a World Press Photo prize for the images in his story for NPR on clashes between elephants and people in Zambia.

Mumbai’s iconic pav bread might soon be toast

toggle caption Indranil Aditya for NPR

MUMBAI, India — Every morning, when the city of Mumbai sleeps, the staff of Yazdani Bakery wake up to knead dough, cut it into little pieces and pop it into the oven. By dawn, they’re ready with their most popular offering: a thousand pieces of pav, which flies off the shelves as soon as the bakery opens.

Pav is a soft and fluffy bread, with a crusty top and a distinct smoky flavor. It resembles a Parker House roll except there is no egg in the pav’s dough. The word originates from the Portuguese word for bread — pao. It arrived in India with Portuguese traders who sailed into nearby harbors more than 600 years ago and brought with them a taste of home.

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It became a street food fixture in the 19th century, when the port city was emerging as a textile hub, drawing workers from nearby towns and villages to its cotton spinning and weaving factories.

“Pav is what Bombay’s working-class blue-collar workers were eating, especially those who were far from home without the infrastructure to create Indian food for them,” says Mumbai-based food anthropologist Kurush Dalal , referring to the city by its former name.

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Since then, Mumbai’s population has grown ten times over the past century to 12 million . This teeming port city is home to Bollywood, stock markets, billionaire industrialists and millions of migrants, of collars blue and white, living in slums and skyscrapers. Mumbai’s textile factories today are hulking shells of their past, overgrown by wild fig trees.

But pav remains a working class staple. A stack of six — called a ladi — costs less than 25 cents.

A bread’s hazy future

But now, pav’s survival is in peril.

In February , the government announced that it would ban wood-fired bakeries across the city in the next six months. The order came a few months after the Mumbai-based Bombay Environmental Action Group published a study claiming that over the course of a year, pollution from Mumbai’s 1,000-odd wood-fired bakeries was as harmful to each resident as smoking 400 cigarettes.

But critics say this is a case of misplaced priorities — of picking on the little guy. “The pollution that is emitted from these bakeries is nothing compared to the pollution that construction sites are contributing or the road repair sites are contributing,” says former town council representative Makarand Narwekar .

toggle caption Indranil Aditya for NPR

He points to the massive makeover being undertaken by Mumbai’s civic body to remake the city’s roads, which has only worsened dust and traffic. A study by the Indian climate-tech group Respirer Living Sciences found Mumbai’s air was unsafe for nearly half of 2024.

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Ravi Andhale, chief of the pollution control board, acknowledges that wood-fired bakeries aren’t the worst offenders in Mumbai. According to the Bombay Environmental Action Group study they only contribute 3% of the city’s particulate matter pollution – referring to matter in the air smaller than 10 micrometers in diameter). But “just because your share is little — you should not do anything — is not acceptable,” he says.

And the lead author of the study which spotlighted how polluting wood-fired bakeries are says one reason why they’re being targeted is that it’s just easier to solve that little slice of the problem.

“As far as the pollution from construction, infrastructure and vehicles go, they have a lot of complexities,” says Hema Ramani, an environmental consultant who works on legal and policy issues. “That’s why we said let’s look at faster, quicker, smaller transitions that can happen. Then you move on to the bigger ones.”

Ramani says she doesn’t want the bakeries to shut shop, only switch to a cleaner fuel like natural gas or electricity. The government can help, she says, by subsidizing the equipment or transition costs.

But Nasir Ansari, president of the Bombay Bakers Association, says that would increase the cost of the pav by more than a half. “Pav is often the food of the working-class. Even a small price rise makes a huge difference. A few months ago, we had raised the price of a stack of six by three rupees” — a couple of pennies. “We still had customers asking me why I did that.”

toggle caption Indranil Aditya for NPR

Why pav is beloved

It’s not just about the cost, pav bakers say. The wood-fired bread is part of Mumbai’s cosmopolitan heritage, a melange of indigenous and colonial traditions.

This Portuguese-origin bread is now eaten with a fried potato snack called ‘vada,’ a buttery vegetable mash called ‘bhaji’, or spiced chicken or lamb mince called keema. “They’re also great vessels for mopping up all kinds of gravies and curries — and just about everything Indian,” says Dalal.

toggle caption Indranil Aditya for NPR

Perzon Zend, owner of the Yazdani Bakery, says losing the wood-fired pav would take away something intangible from Mumbai’s cosmopolitan heritage. He points to his own family history: Zend’s ancestors came from Iran more than hundred years ago — and set up Mumbai’s most iconic Iranian restaurants and bakeries — where their key product is a Portuguese-origin bread. It’s been a great business for the family. He taps his potbelly to demonstrate.

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“I definitely want clean air in Bombay,” says Zend. “But I don’t want to be the smallest and the easiest target.”

And he thinks the method of baking is the key to success. “You can’t beat the wood-fire,” he says. “In America, you smoke the chops and that smokiness is everything. It’s like that with pav too.” Those made in electric ovens, he says, “taste like cardboard.”