The recent hantavirus outbreak has drawn attention to a wider global health crisis, as research and development funding comes under increasing pressure.
When a hantavirus outbreak linked to the cruise ship MV Hondius claimed the lives of three European passengers earlier this year, the world took notice.
Yet the virus had already killed thousands of people globally over several decades.
The episode exposes a longstanding problem in epidemiology and health funding: Neglected diseases often only receive greater attention when they threaten Western populations.
The Andes strain of hantavirus resulted in the deaths of two people from the Netherlands and a third person from Germany, who were on the cruise ship as it sailed in the south Atlantic in April and May. But when the tragedy emerged there seemed to have been a limited awareness among Europeans generally about the virus.
Statistics
The World Health Organisation (WHO) estimates that potentially over 100,000 cases occur globally each year, with the largest number in Asia.
They are associated with a case fatality rate of <1–15 per cent in Asia and Europe and up to 50 per cent in the Americas, according to the WHO. Hantaviruses are zoonotic viruses transmitted mainly from infected rodents to humans.
They cause two major diseases. The first is haemorrhagic fever with renal syndrome (HFRS) and the second is hantavirus pulmonary syndrome, or hantavirus cardiopulmonary syndrome (HPS/HCPS).
In east Asia, particularly China and the Republic of Korea, HFRS continues to account for many thousands of cases annually, although incidence has declined in recent decades.
The WHO says, in Europe, several thousand cases are reported each year, mainly from northern and central regions where the Puumala virus – a type of hantavirus – circulates. In the Americas, HCPS is much rarer, with hundreds of cases reported each year across the continent. The US has reported fewer than 1,000 cases, while South American countries such as Argentina, Brazil, Chile, and Paraguay report small numbers of cases annually.
HCPS is the more serious disease and has a high case fatality rate, commonly between 20 per cent and 40 per cent.
According to the WHO, this makes “it a disease of major public health concern”. Currently, there is no licensed specific treatment for hantavirus.
EU
There were about 140 people on the cruise ship from 23 different countries, including Ireland. The outbreak of the virus served as “a wake-up call”, Spanish MEP Ms Leire Pajín Iraola declared, especially for European countries.
Within days of the outbreak in May, European Union (EU) ambassadors convened an emergency meeting in Brussels to discuss efforts to strengthen cross-border public health coordination.
Then, on 28 May, the EU Commission said it supported the emergency delivery of Favipiravir, an experimental antiviral identified by the European Medicines Agency as a potential treatment against hantavirus infections under clinical trial or compassionate use protocols.
“The Commission is active in preparedness and response actions linked to the access and availability of medical countermeasures. Hantaviruses were included in the 2025 comprehensive health threat prioritisation assessment, as part of the Commission’s wider preparedness planning,” according to a statement at the time.
“The Commission has consequently been funding the development of medical countermeasures against this health threat through competitive calls for proposals aimed at advancing promising candidate vaccines and therapeutics against hantaviruses.”
As evidenced by the Covid-19 pandemic, no matter where a disease originates it can travel very quickly in the interconnected modern world.
Although diseases due to hantaviruses are not on WHO’s official list of neglected tropical diseases (NTDs), they are sometimes referred to as ’emerging NTDs’ in certain endemic areas, such as parts of South America and Asia. The United Nations Agenda for Sustainable Development aims to end the epidemics of NTDs by 2030.
But global health funding for NTDs (also known as neglected infectious diseases) is very low. It is estimated NTDs get less than 1 per cent of total global biomedical research and development spending. This is despite the fact that they affect over a billion people across the world.
“NTDs are associated with devastating health, social, and economic consequences,” the WHO said in its latest global report on the diseases in December 2025.
“NTDs are mainly prevalent among impoverished communities in tropical areas, although some have a much larger geographical distribution. It is estimated that NTDs affect approximately one billion people, while the number of people requiring NTD interventions (both preventive and curative) is 1.4 billion.”
According to the report, populations suffering from a number of NTDs in poorer countries cannot afford patented or costly therapies. This results in less private sector investment since pharmaceutical research generally prioritises conditions affecting high-income countries.
Funding increases to fight these diseases typically only happen when a pathogen like Zika, Ebola, or Mpox threatens Western nations or triggers travel restrictions. But equitable and sustainable support is vital in the battle against NTDs, the WHO stressed.
“The notion of equity is woven into the fabric of the global NTD agenda. NTD programmes mostly serve marginalised communities and prioritise the needs of the most disadvantaged population groups. NTD interventions are often delivered through a primary healthcare approach, may represent the most advanced point of contact between remote communities and national health services, and are considered important steps on the path towards achieving universal health coverage by 2030,” according to the Organisation’s report.
Global aid funding
The Institute for Health Metrics and Evaluation Financing Global Health 2025 report shows the US reduced its contribution to global health cooperation by more than $9 billion (€7.8 billion) in 2025, a cut of 67 per cent. Other countries, such as the UK (-39 per cent), France (-33 per cent), and Germany (-12 per cent), also substantially reduced their funding, affecting key programmes in the fight against such diseases as HIV, malaria, and tuberculosis.
The two main global aid channels for nations affected by these and other health threats are Official Development Assistance (ODA), provided mainly by governments, and Development Assistance for Health (DAH), provided by some governments and corporate and private donations. ODA has a broader scope than DAH as it encompasses all sectors of economic development and welfare, while DAH is strictly limited to health-related programmes and disease control. Ireland contributed €1.23 billion to ODA in 2023.
Both ODA and DAH have been hit by deep cuts in recent years, however. DAH fell by 21 per cent between 2024 and 2025, dropping from $49.6 billion (€42.5 billion) to $39.1 billion (€33.8 billion), the lowest level in more than 15 years.
A study published by The Lancet in July 2026 – ‘Tracking development assistance for health, 1990–2030: Historical trends, recent cuts, and outlook’ – expressed concern that “the global health financing landscape is entering a period of sustained cuts”.
“Major reductions in DAH, particularly from historically leading donors, threaten to widen health disparities unless mitigated by increased domestic resource mobilisation or alternative financing mechanisms,” according to the study.
“Forecasts indicate continued stagnation in DAH until 2030 under current policies, reaching $36.2 billion (€31.4 billion) in 2030.”
Contraction
Another study in May by The Lancet Global Health exploring the impact of cuts in ODA was even more pessimistic.
The study consisted of an analysis of two decades of humanitarian and development assistance and the projected mortality consequences of the current defunding to the year 2030.
It concluded that continued cuts could potentially lead to the deaths of “tens of millions” more people in the coming years.
“The evidence indicates that an abrupt and severe contraction of this funding could have grave repercussions, potentially resulting in a global death toll approaching – or even exceeding – that of the Covid-19 pandemic,” the study stated.
Beyond the potentially significant human death toll, it added that these funding cuts risked reversing decades of progress in development and global health, particularly in the most vulnerable countries.
The forecasting models projected that current funding cuts, followed by severe reductions of ODA to minimal levels, could lead to 22.6 million additional deaths by 2030, including 5.4 million deaths in children younger than five years.
“Even under mild defunding scenarios that simply extend current downward trends, these excess deaths would amount to 9.4 million across all ages and 2.5 million in children younger than five years by 2030,” the study found.
“The immediate humanitarian fallout is likely to be devastating, but the medium-term and long-term consequences for global health, economic development, and social stability could be even more far-reaching.
“Beyond disrupting ongoing service delivery and community resilience efforts, this risks dismantling institutional capacities that were painstakingly built over decades of international cooperation.”
The study stated that even with the previous level of resources, “recovering from such a shock would be a long and painful process.”
“Such a downturn would not only erode the financial foundations of global solidarity, but also threaten to reverse three decades of unprecedented gains in health, education, and poverty reduction.”
ODA was established by the Organisation for Economic Co-operation and Development (OECD) in 1960 and is monitored by its development assistance committee (DAC), which coordinates international development aid. It hit an historic low in 2025, OECD data found.
“International aid from member countries and associates of the development assistance committee fell in 2025 by 23.1 per cent in real terms compared to 2024, the largest annual drop in the history of official development assistance,” according to the data released by the OECD in April.
It added that the expectation for 2026 was not positive.
“Based on a survey of DAC members and officials and published information, the OECD projects a further 5.8 per cent decline in ODA in 2026,” the Organisation stated.
This contraction would bring ODA to levels last seen in 2015 when the 2030 Agenda for Sustainable Development was adopted.
“ODA by DAC member and associate countries amounted to $174.3 billion (€152 billion) in 2025, representing 0.26 per cent of these countries’ combined gross national income (GNI), down from $215.1 billion (€187 billion) or 0.34 per cent of GNI in 2024.”
The five largest providers in 2025 were Germany ($29.1 billion), which has become the largest provider of ODA for the first time, followed by the US ($29.0 billion), the UK ($17.2 billion), Japan ($16.2 billion), and France ($14.5 billion).
This was the first year on record in which the top five providers all reduced their ODA, accounting for 95.7 per cent of the total decline in ODA overall. ODA provided by the US declined by 56.9 per cent.
In a statement in April, OECD DAC Chair Mr Carsten Staur said: “It’s deeply concerning to see this huge drop in ODA in 2025, due to dramatic cuts among the very top donors. Other DAC members are also facing budgetary, security-related or political pressures, while a few are countering the trend.”
“We are in a time of increasing humanitarian needs, strong pressures on the poorest and most fragile countries and facing growing global uncertainties and massive insecurity.”
Environment
But fighting diseases is not only a question of increasing funding for research and humanitarian assistance. Environmental measures are also critical.
This was emphasised by Dr Neil Vora, a public health physician, epidemiologist, and pandemic prevention expert. Writing in TIME magazine in May, Dr Vora said the Ebola and hantavirus outbreaks were ominous warnings because even though they are different viruses spreading under different circumstances, both come from animals.
“Ebola, for example, is a disease tied to deforestation,” Dr Vora wrote.
“The 2014 outbreak in West Africa likely began with an axe. In rural Guinea, starving communities cleared forests to make way for new farms. Those forests were previously home to bats, a natural reservoir for all kinds of nasty viruses. The bats, in turn, found new homes among local villagers.
“Last year, the WHO adopted a pandemic treaty. However, negotiators failed to agree on how to equitably share critical pathogen samples, vaccines, and medicines between richer and poorer countries during future outbreaks. If we can’t agree on how to share life-saving inventions after the fact, the prospect of robust investments in prevention seems like an even longer shot.”
Dr Vora also called on governments to increase regulation and enforcement of controls on the commercial wildlife trade.
“Live wild birds and mammals should not be sold in the streets of Wuhan, New York, or Paris,” he declared.
“Doing so is like conducting a dangerous genetic experiment in the heart of the world’s largest population centres. We need real regulation coupled with enforcement.”
He pointed out that, in 2003, the US experienced an outbreak of Mpox after people imported African rodents to keep as pets.
“The year before that, SARS had emerged, ultimately infecting over 8,000 people in nearly 30 countries. It originated in animal markets selling live wildlife. Nearly two decades later, this same type of live animal market likely sparked the Covid-19 pandemic that upended the world order and killed millions of people.”
Progress
Despite these challenges, the WHO report for 2025 highlighted global progress on a number of fronts and cited ambitious plans aimed at driving progress towards a world free of NTDs by 2030.
“Despite multiple challenges, NTD programmes continue to deliver important results, freeing large sectors of populations from these ancient diseases,” said Dr Daniel Ngamije Madandi, Director of Malaria and Neglected Tropical Diseases at the WHO.
In 2023, an estimated 1.495 billion people required interventions against NTDs, 122 million fewer than in 2022, and a 32 per cent decrease from the 2010 baseline. Between 2015 and 2021, NTD-related deaths decreased from an estimated 139,000 to 119,000. The number of people affected by NTDs declined from 1.9 billion in 1990 to just over one billion in 2021.
While NTD programmes continued to make progress in 2023–2024, performance was uneven, and climate change continued to expand vector-borne NTDs into new areas, the WHO global report said.
“Geopolitical conflicts, migration, humanitarian crises, and instability disrupt access to NTD interventions and services. Persistent data gaps and weak surveillance systems undermine strategic planning and routine programme management.
“Without funding mechanisms that empower country ownership and engage affected communities, there is a real risk of stagnation – or even reversal – of hard-won gains. To meet the road map goals for 2030, programmes must remain sharply focused, prioritise critical actions, and fully leverage opportunities for integration and innovation. Strategic planning will be essential to navigate health system crises, consolidate progress and sustain gains.”
Research and innovation
Another organisation working to improve research and innovation (R&I) in the NTD area is the Global Health European and Developing Countries Clinical Trials Partnership 3, a European and African partnership backed by the EU.
Writing in the organisation’s journal in January this year, its Executive Director Dr Michael Makanga said NTDs still affect a significant amount of people worldwide, and have a disproportionate impact on children.
“Beyond their health impact, NTDs trap entire communities in poverty,” he wrote.
However, current global annual investment in NTD R&I is estimated at around €700 million, roughly 0.2 per cent of total global biomedical R&I spending.
“At this investment rate, delivering new medicines and other missing essential health tools is extremely challenging. This slow rate of innovation also heightens the risk of antimicrobial resistance as pathogens continue to adapt to the limited existing treatments, while climate change is expanding the reach of mosquito-borne NTDs, such as dengue and chikungunya into Europe.”
Europe needs to be better prepared for NTDs, he stressed.
“Increased investment in R&I remains essential to improve detection and treatment tools, enabling faster and more effective responses to NTDs, but science alone will not be sufficient to tackle the complex challenge of NTDs. A striking example of this is that many European countries currently have no equitable access to NTD medicines. Europe must empower the next generation of scientists to build long-term capacity and resilience against future NTD threats.”
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