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Mail & Guardian
2 days ago
- Health
- Mail & Guardian
‘It's heartbreaking': bad cancer drugs shipped to more than 100 countries
The burden of cancer is growing, particularly in low- and middle-income regions. In sub-Saharan Africa, for example, instances of cancer have doubled in the last 30 years. (File photo) Vital chemotherapy drugs used around the world have failed quality tests, leaving cancer patients in more than 100 countries at risk of ineffective treatments and potentially fatal side effects, The drugs in question form the backbone of treatment plans for numerous common cancers — including breast, ovarian and leukemia. Some drugs contained so little of their key ingredient that pharmacists said giving them to patients would be as good as doing nothing. Other drugs, containing too much active ingredient, put patients at risk of severe organ damage or even death. 'Both scenarios are horrendous,' said one pharmacist. 'It's heartbreaking.' Doctors from multiple countries told TBIJ of the drugs in question not working as expected, leaving patients suddenly unresponsive to treatment. Other patients suffered side effects so toxic that they could no longer tolerate the medicine. The variance found in the levels of active ingredient was alarming. In some cases, pills from the same blister pack contained different amounts. These findings expose huge holes in the global safety nets intended to prevent profit-seeking manufacturers from cutting corners and to protect patients from bad drugs. All the while, patients and governments with stretched resources are paying the price for drugs that don't work. A global killer Cancer is one of the biggest killers worldwide, linked to around 10 million deaths every year — roughly one in six. The burden of cancer is growing, particularly in low- and middle-income regions. In sub-Saharan Africa, for example, instances of cancer have doubled in the last 30 years. Much of the global demand for treatment is met by so-called generic drugs. These are versions of a drug that can be made once the original maker's exclusivity rights have expired and are typically made far more cheaply. The bad drugs described in this investigation were all generics. Generics are widely used in all countries but are most crucial in those with fewer resources, where costlier treatments might be beyond reach. If generics were not available in sub-Saharan Africa, for instance, 'any cancer treatment would be likely inaccessible to most of the population', said Claudia Martinez of the Access to Medicine Foundation*, an NGO. In chemotherapy drugs, the active ingredient — which fights cancer cells — is also highly toxic. Patients need to receive enough of it to treat the cancer but not so much that they overdose and suffer damaging side effects. As such, hospital pharmacists calculate doses carefully and, in doing so, rely on the amount of active ingredient being exactly what's stated on the label. Research from a Working with collaborators in Cameroon, Ethiopia, Kenya and Malawi, researchers at the University of Notre Dame, Indiana in the US, analysed drug samples from the four countries. Of 189 samples that had not expired at the time of testing, about one fifth failed. This consisted of 20 different brands of generic drugs made by 17 manufacturers (see a full list of the brands that failed 'We were all taken aback when we saw the results,' said Marya Lieberman, the professor who led the research. More than 30 manufacturers made products to a good standard. But for patients receiving the poor-quality drugs, the effects could be devastating. 'Once a person has been diagnosed with cancer, there's a limited window of opportunity for treatment to work,' said Lieberman. 'And if someone is treated with an ineffective product, they can lose that precious window.' The majority of failed drugs had too little active ingredient (for most this meant less than 88% of the amount stated on the label) while some contained too much (more than 112%). Both thresholds were decided by researchers based on international standards. 'Both scenarios are horrendous in my eyes,' said Shereen Nabhani-Gebara, vice chair of the British Oncology Pharmacists Association. 'It takes a lot of courage for someone with cancer to accept a diagnosis, but then to be short-changed like this when they are trying their best is heartbreaking — because this is someone's life.' Tracking the threat Over the past six years, these brands of drugs have been shipped to more than 100 countries in every populated continent on the planet. They range from low- and middle-income nations like Nepal, Ethiopia and North Korea, to wealthy countries such as the US, UK and Saudi Arabia. The worst-performing drug in the study is made by Indian manufacturer Venus Remedies. It is a drug called cyclophosphamide, which is often used to treat cancers including lymphoma and breast cancer. All eight samples of this Venus Remedies drug failed, with six containing less than half the amount of active ingredient claimed by the manufacturer. One contained just over a quarter of the stated dose, which according to several cancer pharmacists would be as effective as no treatment at all. The drug has been shipped to six countries, with its largest importer being Ethiopia. Wondemagegnhu Tigeneh, a clinical oncologist in the Ethiopian capital Addis Ababa, told TBIJ that he has treated patients with chemotherapy drugs he believes did not work. 'I have a suspicion that the active ingredient was lower than expected,' he said, remembering a drug he gave to a recent patient who had responded well to the first three rounds of treatment. But on the next round, their progress suddenly stopped. Because he has no means to test them, Tigeneh can never be sure of the quality of a given drug. But in his 20 years treating cancer, he has learned to notice tell-tale signs. Sometimes, for instance, there is a complete absence of side-effects such as nausea or hair loss. 'That makes it difficult to trust that particular drug,' he said. Then there are the patients whose disease he struggles to get under control, such as a patient whose response to treatment halted without warning. Rather than reducing the size of the tumour enough to enable surgery, his team has been forced to move onto a second-line treatment. If that fails, the next stage is palliative care. 'It's very sad,' said Tigeneh. 'We didn't used to see things like this.' Cancer patients in Ethiopia have far better access to treatment facilities now than they did 20 years ago. It doesn't seem, however, that the standard of medicines has kept pace. A 2020 study of cancer drugs in Ethiopia included 20 samples of cisplatin which were all found to be substandard, averaging just over half of the stated content. One researcher who tests the quality of drugs in the country told TBIJ that they find bad medicines wherever they go. Venus Remedies told TBIJ that the study results were 'not scientifically plausible' given the company's 'validated manufacturing systems and quality controls'. It said it has received no complaints or concerns about the batches in question and shared the results of its own testing that indicated they were of a good standard. It said storage conditions in the supply chain, which can affect drug quality, might have affected the researchers' test results. However, the absence of similar quality issues across the entire data set suggests this is not the case. Venus Remedies is one of three companies or regulators that queried the methodology used by the lab, saying it deviated from international standards or could give erroneous results. However, Lieberman said that, although her results are not intended for regulatory purposes, her researchers' methods are based on those used by regulatory labs and were verified for suitability, accuracy, and precision. Both the findings and methods have been scrutinised by independent academics. Toxic effects About 3 200km south of Addis Ababa, in Malawi, specialist cancer care has only been available for around 15 years. In one of the poorest countries in the world, patients depend on healthcare being free at the point of need. That means clinics have to rely on generic drugs. A pharmacist specialising in cancer care in central Malawi told TBIJ of seeing patients at his hospital overdose on methotrexate, a drug used to treat leukaemia and lymphoma. Malawi has also imported two of the brands of methotrexate the researchers in this investigation found to contain too much active ingredient: Zuvitrex, made by Zuvius Lifesciences, and Unitrexate, made by United Biotech. Neither company responded to multiple requests for comment. This sort of excess can be just as harmful as a deficit. A bad overdose can leave a patient with lifelong side effects or even kill them. As Nabhani-Gebara said: 'More is not better.' The Malawian pharmacist said patients at his hospital have suffered severe vomiting and nausea after overdosing on methotrexate, while others had to be moved onto a second-line treatment, which might not be as effective. For some patients, the side effects were so severe that they had to pause treatment entirely — giving the cancer a chance to grow. When a sample of the methotrexate in question was tested as part of a research project taking place at the time, it was found to be too high in active ingredient. 'It's very worrying,' the pharmacist said. He told TBIJ that he and his colleagues have on occasion had to stop using an entire batch of chemotherapy medicine and send samples to the national drug regulator after the medicine changed colour — a sign something is wrong with it. 'We had patients scheduled for clinic,' he said, 'and then we had to break the news to them that we don't have medicines.' Failing safety nets Countries all over the world have systems in place to stop bad drugs reaching patients. However, there are huge disparities in their effectiveness. According to Chaitanya Kumar Koduri of the US Pharmacopeia, an organisation that sets standards for medicines in the US and internationally, '70% of countries cannot take care of their own medicine quality'. Most governments have a national regulator — but their remit and resources vary hugely. And even the better-funded regulators are far from foolproof. The US Food and Drug Administration (FDA), for instance, is struggling to keep up with inspections of manufacturing plants domestically and in India and China, and has admitted that its inspections have not been a reliable indicator of drug quality. The FDA recently announced it would expand unannounced inspections at foreign manufacturing facilities, saying this would help expose those who falsify records or hide violations. It told TBIJ 'that inspections and reviews will continue to ensure [drug] safety and efficacy'. One of the countries where medicine regulation ranks the lowest, according to the WHO, is Nepal. It is also one of the biggest importers of the failed chemotherapy brands in this investigation. Despite there being more than 20 000 brands of medicine on the market there, the country's drugs regulator has set a target of testing just 22 drugs in the next 12 months — and none of them chemotherapy drugs. Narayan Prasad Dhakal, the regulator's director general, told TBIJ that its lab cannot currently test cancer drugs and admitted that the situation around quality-testing is 'a concern'. He also said that while his department has the power to recall cancer drugs based on external evidence, it has never done so. The issue is especially fraught for patients who may have travelled from remote, rural areas to get treatment that then may not even work. Laxmi Kumari, whose two-year-old son is being treated for cancer in Kathmandu, Nepal's capital, has had to procure chemotherapy drugs from private pharmacies. The treatment has cost the family nearly two lakh rupees (R30 000), equivalent to several months' average salary in Nepal, and yet they have no reassurance that it will be effective. 'We have no way of knowing the quality of the medications being used in his treatment,' said Kumari. 'We rely entirely on what the doctors recommend.' 'Neither patients nor their families have any way of knowing the quality of these drugs,' said Smriti Pokharel of the Wish Nepal Foundation, which helps children from low-income families access cancer treatment. 'Even doctors face challenges in verifying their quality. No one seems willing to take responsibility for ensuring proper treatment for cancer patients.' Race to the bottom Generic drug manufacturers are operating in a global market that healthcare professionals and experts agree is driven by one thing: price. It's a market in which those operating under a less watchful eye can find ways to undercut their competitors. This could mean scrimping on the amount or quality of the active ingredient — the most expensive component — or using cheap or outdated machinery. Research shows that the majority of substandard drugs occur due to problems with manufacturing, quality control, packaging or storage. The results can be fatal. Four children died in Colombia after being given contaminated cancer drugs in 2019. Three years later, another batch of bad medicine caused the deaths of at least 10 children in Yemen who were being treated for leukaemia. The price-driven market creates a dangerous dynamic in which the number of companies making a particular drug shrinks and shrinks until global supply is precariously dependent on just a handful of manufacturers. Should one company slip up, thousands of patients can be left without the drugs they depend on. It's a situation that played out in the US recently. Between 2018 and 2022, Intas Pharmaceuticals — the parent company of Accord Healthcare, which made the worst-performing cisplatin tested in this investigation — grew its market share of cisplatin from 24% to 62%. It also increased its share in methotrexate fivefold in the same time period. All the while, prices of both these chemotherapy drugs dropped. Then, at the end of 2022, a surprise inspection by the US drug regulator revealed a 'cascade of failure' at an Intas factory in India, where staff were seen shredding and pouring acid on quality records. The shutdown that ensued sent shockwaves across the US, with nearly every major cancer centre reporting shortfalls in chemotherapy drugs during 2023, Accord Healthcare said the batch of cisplatin that failed our testing had met all established quality standards, and shared data from internal and external studies indicating its quality. It said it has not received any market concerns related to this batch. In India, the world's largest producer of generic drugs, questions have been raised over whether manufacturers are properly punished for producing drugs that aren't fit for purpose — and whether foreign regulators have proper oversight. 'The Indian government's interest is in trying to protect the industry,' said public health activist and former Big Pharma whistleblower Dinesh Thakur. Sixteen of the 17 manufacturers identified in this investigation are based in India and five have been previously flagged by a regulator for producing substandard batches of drugs. One of them, Zee Laboratories, has been flagged 46 times since 2018. India's drug regulator told TBIJ that Zee Laboratories has been audited and given a 'stop production order', which was lifted after the company resolved the problems in question. It did not give details about when this was, which issues it pertained to or whether the company faced any consequences. It's also unclear whether the manufacturers exposed in TBIJ's previous investigation into substandard asparaginase have faced any repercussions, despite 70 000 children with leukemia being at risk. Three of those companies — Getwell Pharmaceuticals, United Biotech and VHB Medi Sciences — also made some of the substandard drugs revealed by this investigation. Thakur said there's only one way to explain the production of weak drugs by big companies: 'Somebody's cutting corners.' Meanwhile, these medicines continue to fill pharmacy shelves. Zuvius Lifesciences and GLS Pharma have supplied their failed brands to over 40 countries. And in the past two years, Venus Remedies — which made the drug that pharmacists said wasn't worth prescribing — has been awarded a series of contracts and licences, including from the Pan American Health Organization to supply several essential cancer drugs to Latin American countries. India's drug regulator defended the oversight system, saying that failing drugs are recalled and manufacturers face 'either administrative penalties or legal prosecution in court'. Getwell Pharmaceuticals, GLS Pharma, VHB Medi Sciences and Zee Laboratories did not respond to multiple requests for comment. Shortage of resources In order to ensure that people across the world have access to safe, effective drugs, the WHO has put in place a series of steps. It has compiled a list of 'essential medicines', to help countries with limited resources know what to prioritise. It checks certain drugs, active ingredients and their manufacturers to create a pre-approved list that countries can trust. The WHO also oversees a set of standards for manufacturers and drugs that many countries refer to when importing medicines. However, these measures have their own limitations. The list of recommended medicines, for example, only expanded to include cancer drugs in 2019 and experts say WHO should include more of them on the list. Shalini Jayasekar-Zürn of the Union for International Cancer Control, a global membership organisation dedicated to taking action on cancer, says it currently only encompasses two cancer drugs, rituximab and trastuzumab. 'It would be great if the list was expanded to include more essential medicines, especially for cancer,' she said. While the WHO oversees standards for manufacturers and drugs, it's up to the countries buying medicines to make sure those standards are met — which is no easy task given the resources of national regulators. Meanwhile, Thakur said that one WHO scheme — a certificate system that says a given drug meets various standards — has been undermined by companies that have found 'workarounds' to get hold of the paperwork without improving quality. 'It's not worth the paper it's written on,' he said. The upshot, experts say, is that without the comprehensive oversight seen in countries like the UK, the WHO's processes don't stop substandard medicines making their way onto shelves. Reflecting on TBIJ's findings alongside his own experience, Thakur said that the WHO was 'clearly not' delivering on its stated purpose: to promote health, keep the world safe and serve the vulnerable. The WHO did not respond to several requests for comment made by TBIJ. A high price The cruel irony is that in this race to the bottom, it is the cancer patients who are often left to foot the bill. And those who have the least pay the most. In low income countries, the cost of 58% of essential cancer medicines is paid by patients, compared with 1.8% in upper-middle-income countries. One cancer pharmacist in Ethiopia estimated that it could take over a year for a patient to save for cancer treatment. If that medicine then turns out to be faulty, they simply might not be able to afford to pay for another. 'Most people believe cancer is incurable,' they said. 'When they end up with a medicine that won't cure them, that's another tragedy.' 'For me, it's a question of fairness,' said Lieberman, the lead researcher. '[Patients] have the right to be treated with a medicine that actually is what it says it is. One that has the correct ingredients in it, that hasn't degraded, and that doesn't have things in it that will hurt them. It's too important.' * The Access to Medicine Foundation is part-funded by the Bill & Melinda Gates Foundation, one of TBIJ's funders. India, where about 20% of the world's generic drugs come from, plays a pivotal role in ensuring people everywhere can access affordable medicine. Sixteen of the 17 manufacturers of failed drugs in this investigation are based in India. While the majority of India-made drugs are safe, the country's generics industry has long been dogged by scandal. In 2013, Indian manufacturer Ranbaxy agreed to pay a fine of $500 million after its US subsidiary pleaded guilty to the improper manufacturing, storing and testing of drugs. In 2022 and 2023, Indian-made cough syrups were linked to the deaths of children in Gambia, Cameroon and Uzbekistan. And as recently as August 2024, it was reported that the regulator had found more than 50 drugs on the market to be substandard or fake, including some paracetamol and antacids.
Bloomberg
19-06-2025
- Health
- Bloomberg
Five Questions for Melinda French Gates
① Critics say philanthropy has been astonishingly ineffective at solving societal problems—that giving has increased, but problems have gotten worse. I would beg to differ. We know millions of people are alive because of the lifesaving vaccines that have been developed and given around the world. Moms and dads in low-income countries line up to get measles vaccines for their children, because you know what? A measles outbreak in their community means that kids die. Has all of philanthropy been great? No. Philanthropy is only one tool in the toolbox. Philanthropy can take a risk that we wouldn't want government to take with our taxpayer funding, but it can prove things out at scale, and then governments can come in to scale that up.
Washington Post
17-06-2025
- Business
- Washington Post
The retreat from aid is a costly mistake
It has been easy to dismiss efforts to raise the prospects of the world's poorest as an abject failure. The United Nations reported 712 million people living in extreme poverty in 2022, 23 million more than in 2019. The share of the world's population suffering hunger rose from 7.9 percent to 9.2 percent over the period. And 2.1 billion people still cook with dung, wood, charcoal and the like. But, if you zoom out, the track record of some of the world's poorest nations in improving the living standards of their own people has been surprisingly robust — better than anyone could have guessed just a quarter-century ago, when the United Nations laid out its Millennium Development Goals. 'There has been a tremendous amount of progress,' noted Esther Duflo, the economist who co-directs the Abdul Latif Jameel Poverty Action Lab at the Massachusetts Institute of Technology. 'Often without much outside money.' Much of that progress is at risk. Still picking themselves up from the devastation of the covid pandemic, and trying to work themselves out of a mountain of debt, the world's low-income countries are now being walloped by President Donald Trump's trade war. Trump's trade policies will likely dim the world's economic prospects, increase uncertainty, trigger tighter global financing conditions and weigh on demand for commodities — the poor world's main export. As the World Bank Group's chief economist Indermit Gill noted this month, 'Outside of Asia, the developing world is becoming a development-free zone.' To top this all off, some of the world's most affluent countries have decided they have had enough with development aid. It's not just the Trump administration, which tossed USAID into the wood chipper. Britain cut its aid budget to 0.3 percent of its gross domestic product, from 0.7 percent before the pandemic. Belgium, Finland, France, Germany, the Netherlands, Norway and Sweden have also cut their development assistance budgets. Justifications for the cuts include the emergence of other fiscal imperatives, such as the need for additional defense spending. But they are often wrapped up in a blunt proposition, most famously articulated by Elon Musk, formerly of the Department of Government Efficiency: that foreign aid is either wasted or frittered away by fraud. This is not only cynical posturing. It is based on the popular-yet-flawed proposition that aid fails because it cannot make poor countries un-poor. This ignores how aid actually improves the lives of people in the world's poorest countries. Leaders in Washington, London, Paris, Helsinki, Amsterdam, Oslo and Stockholm might want to observe what the world stands to lose if the efforts to improve the prospects of the poor were to falter. Consider maternal mortality. In Malawi, one of the poorest nations on earth, at the turn of the century 942 mothers died for every 100,000 births. By 2016, the number had fallen to 451. In Mongolia they declined from 200 to 49. Between 2000 and 2023 life expectancy at birth in sub-Saharan Africa increased from 52 to 63 years. In Bolivia, the share of adults who completed at least primary education rose from 51 percent to 76 percent over this period. Across all low-income countries, the share of people aged 15-49 with HIV declined from 2.7 to 1.7 for every 1,000 uninfected people. Regarding poverty, the share of people living on less than $3 per day (in 2021 dollars at purchasing power parities) across the set of low-income countries declined from 68.8 percent in 1995 to 51.8 percent in 2014. Since then, however, abject poverty's footprint has rebounded to 55.4 percent of the population. The most important upshot from these numbers is that while there still is a long way to go to provide for a decent living for hundreds of millions of destitute people around the world, there is a plausible path to get there. While most of the progress has been funded from the budgets of low-income countries themselves, disappearing aid will make their road harder. Aid plays an indispensable role, providing the sorts of things that poor countries cannot. It will be difficult, for instance, for governments in sub-Saharan Africa to replicate PEPFAR, launched in the George W. Bush administration to provide broad access to antiretroviral drugs, saving tens of millions of lives from the scourge of AIDS. It's easy to point the finger at 'waste and fraud.' One reason it is difficult to assess the value of aid programs is that their effectiveness is not usually measured carefully. Another is that the goals are often muddled, mostly by donor governments that want to please a variety of constituencies — such as, say, U.S. farmers who see food aid as a tool to increase sales. 'Corruption and waste is maybe a fourth-order issue,' said Abhijit Banerjee, the other co-director of MIT's Poverty Action Lab. But there are numerous, well-documented examples of how aid can help the prospects of the poor. Indeed, the broad story of aid, in recent decades at least, has been a felicitous one. The effort to help millions out of destitution cannot be sacrificed to the flawed idea that spending money on the poor somehow doesn't work.
Forbes
06-06-2025
- Health
- Forbes
Food Safety Depends On Every Link In The Supply Chain
Colorful fish and vegetables can be purchased at a public market. For communities to be nourished, their food supply must be safe to eat. This sounds obvious, but it's worth repeating, because every year, about 1 in 10 people worldwide (or about 600 million people) become sick from contaminated food, and 420,000 lose their lives. About 125,000 of those deaths annually are children under 5 years old—a disproportionate tragedy that comes at the expense of our future. And in low- and mid-income countries, US$110 billion is lost every year in productivity and medical expenses resulting from unsafe food, per World Health Organization (WHO) data. Addressing food safety is truly crucial not just to our lives but to our livelihoods, our economic success, and the well-being of every aspect of the food system. World Food Safety Day, on June 7, is a perfect opportunity for everyone around the globe to recommit to ensuring a safe food supply for all. 'Food safety is not just about preventing harm,' says Markus Lipp, Senior Food Safety Officer at the UN Food and Agriculture Organization. 'It is about creating confidence and trust in the food we eat, in the systems that protect us, that protect food safety and in the institutions that serve the public good for safe food.' So how do we ensure the future of food is safe? First: Food safety is not isolated—every link along the food chain must prioritize safety. Food safety begins on fields and farms, with healthy soils and positive growing practices, and continues through processing, transportation, cooking, and serving. This whole-system approach can be truly transformative. In fact, many of the 200+ diseases 'that we know can be carried by food are preventable and sometimes even eradicable,' says Luz María De Regil, Director of the Department of Nutrition and Food Safety at WHO. Second: We can't just respond to challenges that currently exist; we have to be prepared to face unprecedented and complex challenges to food safety as the climate crisis worsens. According to the WHO, the changing climate will affect the persistence and occurrence of bacteria, viruses, parasites, harmful algae, and fungi—and the vectors that spread them. 'We're going to have emerging pathogens coming in, especially given that the climate is changing…microbes like hot, humid, wet environments,' said Barbara Kowalcyk, an Associate Professor at the Milken Institute School of Public Health. Third: Perhaps most urgently, we need to champion evidence-based policymaking and global cooperation. This year's World Food Safety Day highlights this, focusing particularly on the 'essential role of science in ensuring food safety and enabling informed decision-making.' Now more than ever, we need to devote more resources to scientific progress, international collaboration, and solid regulatory frameworks—not less. But recent cuts to research funding and staff in the United States by the Trump-Vance Administration, including in food safety inspection labs, are having concerning ripple effects across the globe. Foodborne illness outbreaks could become harder to detect and contain, leading to more people in more widespread areas getting sick, experts warn. In addition, the dismantling of the U. S. Agency for international Development (USAID) shuttered several Feed the Future Innovation Labs, which brought university research to countries including Kenya, Nepal, Nigeria, Bangladesh, Ethiopia, Ghana, and Guatemala to design and implement food safety interventions in poultry production, post-harvest crop storage, farmers markets, households, and more. So this World Food Safety Day, WHO's calls to action encourage all of us—policymakers, business leaders, and eaters—to step up. Communities can find ways to apply the WHO's Global Strategy for Food Safety 2022-2030, to ensure that all people, everywhere, consume safe and healthy food. And initiatives like the GAIN's EatSafe program and the Codex Alimentarius Commission, which aims to standardize evidence-based food safety protocols in ways that respect local culture, offer models to learn from. I often think of something Abdou Tenkouano told me last year. At that time he was the Executive Director of CORAF, an organization in West and Central Africa that uses agriculture to build community resilience, and now he's Director General at icipe, which uses insect science to tackle food security, health, and environmental challenges in Africa. 'This is a global village,' he said. 'We are all interconnected, interdependent, interlinked.' And when it comes to food, we all have a responsibility to keep one another safe.
Times
19-05-2025
- Business
- Times
Use foreign exchange reserves to maintain overseas aid, Starmer urged
The government is being urged to consider leaning on Britain's £150 billion foreign exchange reserves to prevent deep cuts in overseas aid to low-income countries threatened by the withdrawal of US funding. A group of Labour MPs wants the government to maintain its commitment of nearly £2 billion to the World Bank's International Development Association, a facility for poor countries, which is in the line of fire as the UK cuts its foreign aid budget. The MPs, who include Alice Macdonald and Joe Powell, will write to Sir Keir Starmer asking the government to use the UK's Exchange Equalisation Account, a vast stock of foreign exchange reserves worth £150 billion, to offer low-interest loans to the world's poorest and most vulnerable countries. The exchange, which
