The U.S. provides nearly half of the aid for global health, including childhood vaccination, H.I.V. treatment and disease surveillance.The election of Donald J. Trump, with his mistrust of international institutions and his history of proposing deep cuts to foreign aid, has complicated a perilous landscape for global health organizations that were already in a frantic competition for sharply reduced funds.Organizations that support the cornerstone health programs to vaccinate children, treat people with H.I.V. and stop the next pandemic through disease surveillance, among other goals, are seeking billions of dollars from high-income countries.Their demands for support reflect mounting health challenges: Rates of infection with dengue fever are exploding in Latin America. The mutated mpox virus is increasingly transmissible between people, and there are fears that H5N1, avian influenza, is also evolving to spread between humans. Deaths from cholera, an ancient scourge, and measles are rising. The parasite that causes malaria is increasingly resistant to the drugs to treat it, and an invasive malarial mosquito is threatening African cities.The organizations seeking financial commitments and the countries that fund them have helped save millions of lives in developing countries. The global rate of child mortality has dropped by more than half in the two decades since 2000. Malaria infections plummeted as bed nets and better drugs were distributed. H.I.V. went from being the top global killer to, in many places, a well-managed chronic illness.The reality that these organizations are unlikely to get anywhere near the amount of money they are seeking is driving debate about whether — and how — the current global health system should be restructured.Global health priorities are now competing with climate change and wars for funding, and aid budgets have already been cut in major donor countries, including Britain, Germany and Japan. Health organizations are bracing for the likelihood that the second Trump administration will sharply reduce contributions from the United States, as well.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The agency recommended that the maker of Librela update its label to reflect the possibility of more serious adverse reactions.A popular drug for dogs with arthritis may be associated with a variety of potentially severe neurological effects, including seizures and a loss of muscle control, according to a recent review by the U.S. Food and Drug Administration, which approved the drug last year. In some cases, dogs have died or have been euthanized after developing these symptoms, the agency noted.The drug, called Librela, is an injection of monoclonal antibodies that is approved for arthritis-related pain in dogs. Its label lists mostly mild side effects, such as urinary tract and skin infections.But since the drug became widely available, some pet owners have reported that their dogs became seriously ill, lost the ability to walk or stand or even died shortly after receiving the drug.The F.D.A.’s analysis, which is based on more than 3,600 adverse-event reports submitted to the agency and the drug manufacturer, does not prove that Librela caused these problems or estimate how frequently they might occur.But such reviews can help regulators identify potential side effects that smaller clinical trials may have missed. The F.D.A. has alerted veterinarians to the adverse events that may be associated with Librela and recommended that the drug’s label be updated to include them.Zoetis, the company that makes Librela, said that more than 21 million doses of the drug had been distributed globally and that side effects were rare. “We at Zoetis — and I personally — stand 100 percent behind Librela as safe and effective,” said Dr. Richard Goldstein, the company’s chief medical officer.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Hospices in England are to receive £100m of government funding over two years to improve end-of-life care, Health Secretary Wes Streeting has announced.

There has been “a catastrophic rise” in deaths caused solely by alcohol in England over the past four years, prompting public-health experts to call for urgent action.

PA MediaLondon hospitals have written off more than £112m in unpaid treatment bills from overseas patients between 2018 and 2023, according to figures obtained by the BBC.

The mother of a young girl operated on by a disgraced surgeon at a famous London children’s hospital says she should never have been left in his care.

“It felt like being stabbed, I’d be on my hands and knees in pain.”

A group of Democratic lawmakers accused Georgia Pathways to Coverage, the only Medicaid work requirement program in the country, of spending little of its funding on health benefits.A group of Democratic senators said on Wednesday that they had called for a federal watchdog investigation into a controversial Medicaid work requirement program in Georgia, accusing its administrators of churning through tens of millions of dollars in funding while enrolling a fraction of the low-income residents estimated to be eligible for it.The program, called Georgia Pathways to Coverage, has been hailed by the state’s Republican governor, Brian Kemp, as an innovative approach to administering Medicaid, which covers more than 70 million people in the United States. It is the only Medicaid work requirement program currently operating.Medicaid coverage is still available in Georgia without a work requirement, but the state has one of the strictest eligibility limits in the nation. Those who receive coverage through Pathways would otherwise not be eligible for Medicaid, but they must show that they are working, enrolled in college or doing community service for at least 80 hours each month to qualify.The program, which is set to expire next year, has been closely watched by Republicans and conservative policy experts as a possible template for restructuring Medicaid in the next Trump administration. Republican lawmakers in recent months have discussed legislation that would institute Medicaid work requirements.In a letter sent on Tuesday to Gene L. Dodaro, the head of the Government Accountability Office, the Democratic lawmakers, including Georgia’s two senators, Raphael Warnock and Jon Ossoff, pointed to the high costs of the program and the way the money had been spent: at least $40 million as of June, with more than 80 percent going to administrative and consulting costs.“While hundreds of thousands of Georgians are left without the health coverage they need, taxpayer dollars are being routed into the pockets of eligibility system vendors and consultants,” wrote the lawmakers, a group that also included Senator Ron Wyden of Oregon.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Officials have discovered the virus in 645 herds of dairy cattle, more than in any other state so far.Gov. Gavin Newsom of California declared on Wednesday that the outbreak of bird flu among the state’s dairy cattle constituted an emergency, a stark acknowledgment of the increasing seriousness of the contagion’s spread.California was not among the first states to detect the bird flu virus, H5N1, in dairy cattle. But since the first identification of an infected herd in late August, the state’s agriculture department has found the virus in 645 dairies, about half of them in the past 30 days alone.The announcement follows news that an individual in Louisiana has been hospitalized with bird flu, the first severe case of infection identified so far in the United States. The declaration of an emergency gives state and local authorities the resources they need to contain the outbreak, including hiring staff or issuing contracts. “This proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,” Mr. Newsom said in a statement.“While the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus,” he said. The outbreak in dairy cattle is thought to have begun in Texas early this year. As of Wednesday, 865 infected herds have been identified in 16 states. The Centers for Disease Control and Prevention has also confirmed H5N1 infection in 61 people, and indicated another seven as “probable” cases. Only 37 of the 61 cases have been traced to interaction with infected cattle; the remaining are attributed either to exposure to diseased poultry, or are of unknown origin.Many experts, including those at the World Health Organization, have faulted the U.S. response to the outbreak. Until recently, nearly all testing of cattle and of people who may be infected with the virus has been voluntary. Bird flu does not yet spread easily among people, but every untreated infection is an opportunity for it to gain the ability to do so, experts have warned.The Agriculture Department said earlier this month that it would begin testing the nation’s milk supply for H5N1, and would require farmers and dairy processors to provide samples of raw milk on request from the government. California’s testing and monitoring system is the largest in the nation, as is the state’s dairy industry. This developing story will be updated.

Dr. Mark Hyman, a “functional medicine” proponent and longtime friend of Robert F. Kennedy Jr., is finding powerful allies in his bid to treat disease with blood tests and supplements.Dr. Mark Hyman didn’t hesitate before accepting an invitation, 14 years ago, to a weeklong white-water rafting trip with Robert F. Kennedy Jr.Mr. Kennedy, the environmental lawyer, conspiracy theorist and political scion, was bringing like-minded souls to the wild, undammed Futaleufú River in southern Chile to raise awareness about a hydropower project threatening the valley. Dr. Hyman was exactly the type of expert Mr. Kennedy forged alliances with: a doctor who bucked the mainstream and had a roster of well-heeled clients.At one point on the trip, Dr. Hyman recalled, his raft overturned, and he clung to it until the group reached calmer waters. Later, on shore, he and Mr. Kennedy indulged in a gaucho-style barbecue. “It’s a dangerous river,” Dr. Hyman said in a recent interview with The New York Times. “We survived that experience together.”The two men have bonded on many other getaways in the years since, often discussing Dr. Hyman’s preventative approach to health care, known as functional medicine. As their connection grew, so did their fame.Dr. Hyman, 65, has amassed millions of followers interested in his booming wellness empire, which includes a supplement company, a hit podcast, 15 best-selling books and a start-up health testing company with celebrity backing.And the doctor’s adventure partner, Mr. Kennedy, ascended to become an independent presidential candidate and, now, President-elect Donald Trump’s pick for the next secretary of Health and Human Services, vowing to “Make America Healthy Again.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.