The Lancet

Chronic kidney disease (CKD) has long remained at the margins of the evidence base for the cardiovascular benefits of blood-pressure lowering. The absolute risk of cardiovascular events in people with CKD is among the highest across major clinical populations.1 However, research into the cardiovascular benefits of blood-pressure lowering in this population has, for decades, relied largely on extrapolation, subgroup analyses, and secondary meta-analyses,2,3 rather than trials spanning multiple CKD stages with cardiovascular outcomes as primary endpoints.

Despite substantial progress in malaria control over the past two decades, malaria caused by Plasmodium falciparum remains a leading cause of morbidity and mortality in sub-Saharan Africa, particularly in young children.1 Achievement of malaria elimination will require complementary interventions that target different stages of the parasite lifecycle and can be implemented in different transmission settings.2 In addition to vector control, chemoprevention, and vaccination, monoclonal antibodies targeting parasite antigens have emerged as a promising strategy for malaria prevention.

The military campaign initiated on Feb 28, 2026, by the USA and Israel against Iran has rapidly evolved into a regional conflagration with catastrophic health consequences for Iran as well as for the region. The sheer ferocity and duration of the strikes of this so-called preventive action to dismantle nuclear and missile capabilities, intentionally or not, has led to violation of International Humanitarian Law (IHL) and the foreseeable collapse of civilian life-sustaining systems for Iranian citizens, including those who have suffered gravely under Islamic Republic oppressive rules and brutal crackdown.

On Aug 11, 2025, a gunman who falsely believed that mRNA COVID-19 vaccines were dangerous went on a shooting rampage at the US Centers for Disease Control and Prevention's (CDC) main campus, shattering 150 windows and tragically killing a 33-year-old CDC security officer. Staff, still reeling from firings and programmatic shifts that began with the new Trump administration, were deeply traumatised. 8 months later, the windows have not been repaired. The CDC was once the gold standard for public health leadership.

We welcome and appreciate the Correspondence from Guido Granata and colleagues. We agree that antimicrobial resistance (AMR) poses an existential global threat and has substantial implications for the sustainability of all health systems. Conflict raises the risk of inpatient AMR transmission, but we propose that strengthening infection prevention and control and reducing the burden of hospital-acquired infections are essential for improving quality of care and patient safety, whether AMR is an explicit concern or not.

Jessica R Biesiekierski and colleagues1 provide a timely and comprehensive review of non-coeliac gluten sensitivity (NCGS), emphasising substantial heterogeneity in diagnostic approaches, challenge protocols, and symptom assessment. The authors conclude that these methodological weaknesses have impeded progress towards identifying the molecular triggers of this condition. These issues were systematically identified in our scoping analysis of double-blind, placebo-controlled challenge trials, which documented the extent of methodological heterogeneity in this literature and highlighted several recurrent weaknesses.

L9LS was protective against malaria in young children in western Kenya without evident safety concerns over 6–12 months. A higher dose of L9LS might be needed to achieve high-level efficacy against malaria in young children exposed to intense perennial P falciparum transmission.

In the context of cardiovascular risk reduction, the relative benefit of blood-pressure lowering in patients with CKD is similar to that in individuals without CKD, with consistent efficacy across all CKD stages, blood-pressure thresholds, and proteinuria status. However, notably, this relative benefit is attenuated in patients with CKD and concomitant diabetes, underscoring the requirement for adapted therapeutic strategies in this high-risk subgroup. Moreover, the class-specific effects of principal antihypertensives in CKD mirror those observed in the broader population, independent of CKD stage or proteinuria status.

In prespecified analyses from the SELECT trial, semaglutide reduced major adverse cardiovascular events (MACE) compared with placebo, with only about one-third of benefit mediated by waist circumference change.1 John Deanfield and colleagues report multiple interesting findings in the placebo group. Baseline bodyweight was unrelated to MACE, whereas smaller baseline waist circumference predicted lower risk in this group. Early percentage weight change showed no linear benefit, but a significant quadratic pattern was seen, with excess events among those losing 5% or more of their bodyweight; these participants also had disproportionately higher non-cardiovascular mortality.

We thank Justin Tondt and Vernon M Chinchilli for their comments on our analyses of the relationship between adiposity measures and major adverse cardiovascular event (MACE) benefit from semaglutide in the SELECT trial. To explore evidence for weight change as a prognostic marker, mechanism of action, or both, we used three complementary approaches across treatments: primary landscape analysis, time-varying covariate analysis explicitly considering temporal relationships, and supplementary analyses considering cumulative weight loss at a fixed time point irrespective of whether it preceded or followed MACE.

Laura Mauldin's latest book begins with a story of falling in love. “I was the one”, she recalls of the start of her relationship with “J”. When J is diagnosed with leukaemia, Mauldin becomes not only her “life partner” but also her sole “life-support system” until J's death nearly 5 years later. Throughout In Sickness and in Health: Love Stories from the Front Lines of America's Caregiving Crisis, Mauldin weaves her and J's story together with those of other couples navigating illness and disability.

We thank Ole Fröbert and colleagues for their interest in our study and proposing that vaccination might protect against cardiovascular disease through mechanisms beyond infection prevention, potentially through immunomodulatory effects. We agree this is an interesting and important hypothesis.

An open letter calls for an end to a recent agreement with the UN University, based on Nestlé's history of promoting infant formula. Udani Samarasekera reports.

Amadou Alpha Sall is a Senegalese virologist who worked for three decades at the Institut Pasteur de Dakar (IPD) before joining the Coalition for Epidemic Preparedness Innovations (CEPI), in 2025, as Executive Director for Manufacturing and Supply Chain. At CEPI he is focused on strategies to expand regional vaccine manufacturing and supply chains to increase pandemic preparedness.

Experts have criticised the EU's plans to revise medical data governance, following concerted pressure from US tech companies. Paul Webster reports.

The Tisza Party promises to increase investment, rejuvenate public health, and address staff dissatisfaction. Ed Holt reports.

A global tragedy is unfolding. Withdrawal of the US Government from the fight against HIV/AIDS is causing thousands of preventable infections and deaths worldwide. Over many decades, generous investments by the American people through the US Agency for International Development (USAID), the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) brought hope and opportunity to communities affected by HIV. While multiple mathematical predictions of disaster have been published during the past year, few studies have examined the actual human consequences of America's retreat from global health.

I thank Armin Alaedini and colleagues for their Correspondence and for reinforcing the need for methodological rigour in challenge studies of non-coeliac gluten sensitivity (NCGS).

Kidney disease is a major global health issue with implications for the lives of millions of people and for the cost of health care. Yet there is surprisingly little public awareness about the symptoms of kidney disease and what it means to live on dialysis or with a transplant. In addition, medical practice and research focus primarily, and understandably, on clinical aspects, rather than the lived experience of patients.

We read with interest Craig S Anderson and colleagues’ PANDA II cluster-randomised trial of influenza vaccination in heart failure.1 Vaccination during admission improved survival and reduced readmissions at 12 months, with a number needed to vaccinate of 27. This is a rigorous and clinically important study. However, potential off-target effects of vaccination were not considered in the design or interpretation.

Influential pioneer of viral oncology who advanced knowledge of HIV/AIDS and cancer biology. Born on Feb 20, 1940, in London, UK, he died on Feb 27, 2026, in London, UK, aged 86 years

John Deanfield and colleagues reported that semaglutide reduces major adverse cardiovascular events (MACE) independent of weight loss.1 However, this conclusion relies on conditioning on a post-randomisation mediator (weight loss), which is a method known to potentially introduce collider stratification bias.2

We read with interest the Commission's Comment by Adrianna Murphy and colleagues, outlining a roadmap for the Ukrainian health system.1 A key issue requires urgent integration into the strategic framework—the emergence and dissemination of multidrug-resistant (MDR) bacteria owing to the ongoing war.2 The implications of such MDR bacteria spread are far-reaching. MDR bacteria outbreaks burden fragile health systems that are already struggling with reconstruction. Escalating antimicrobial resistance (AMR) could result in increased mortality from sepsis, prolonged hospital stays, and health-care expenditure.

Bangladesh is experiencing a measles resurgence with unprecedented numbers of severe paediatric cases. As of March 30, 2026, nationwide deaths increased to at least 38 children, including 32 deaths in March alone.1 The clinical pressure on hospitals is phenomenal: the Infectious Diseases Hospital in Mohakhali (Dhaka, Bangladesh) admitted 560 suspected measles cases in the first 3 months of 2026 compared with 69 suspected cases for the entire year before; March alone accounted for 448 of those admissions.

Nitrofurantoin was the most effective treatment and single-dose fosfomycin the least effective treatment for UTIs. Adverse events were mild. The role of fosfomycin as a first-line antibiotic for uncomplicated UTI should be re-evaluated.

Lower urinary tract infections (UTIs; cystitis) are very frequent: at least 50% of women will have at least one episode during their lifetime, and many have more than one episode,1 making it a frequent reason for antibiotic prescription. Uncomplicated lower UTIs in women are treated with short antibiotic regimens such as single-dose fosfomycin trometamol, 5 days of nitrofurantoin, or 3 days of pivmecillinam.2 Single-dose fosfomycin has been a popular choice because of its convenience, with its efficacy supported by data from a meta-analysis of randomised trials3 and low rates of fosfomycin resistance in uropathogens.

MEK inhibitors are established therapies in BRAF-driven cancers, yet their broader clinical effect is limited by toxicity, resistance, and modest durability as a monotherapy, particularly in RAS-mutant tumours. Dose intensity is often restricted by severe adverse effects, particularly dermatological, gastrointestinal, ocular, and cardiopulmonary toxic effects. Predictive biomarkers, such as tumour mutational burden, interferon signatures, and MAPK pathway activity, are emerging as crucial tools for refining patient selection and monitoring therapeutic response.

WHO was founded in 1948 as the UN agency that connects nations, partners, and people to ensure that everyone, everywhere can attain the highest level of health. As it has taken on more activities and programmes, WHO has grown enormously. Between 2017 to 2024, its workforce increased by 70% and the number of top-ranked directors nearly doubled.1 Successive global health crises, including most recently the COVID-19 pandemic, have exposed long-standing structural weaknesses in WHO's governance, financing, and operational model.

Colorectal cancer is a major global health burden, accounting for about 10% of all cancer incidence and nearly 1 million deaths worldwide between 2020 and 2022.1,2 Projections indicate that this burden will increase substantially in the coming decades, reaching more than 3·2 million new cases and 1·6 million deaths annually by 2040.3 The epidemiological landscape of colorectal cancer is evolving, with a rapid shift towards younger age at diagnosis, more advanced stage at presentation, and a higher proportion of left-sided tumours.