In a region plagued by rising childhood obesity, Latin America’s chief public health organization is defending its willingness to partner with one of the world’s largest candy companies to support immunization activities in vulnerable communities — saying it would have applied ample safeguards against corporate influence in the execution of a proposed health program. 

And yet, within months of announcing earlier this year a multiyear collaboration with Ferrero Group — owners and creators of brands such as Ferrero Rocher, Kinder and Nutella — the Pan American Health Organization (PAHO) quietly walked it all back. 

The partnership’s initial announcement drew outcry from health advocates over what they see as a conflict of interest and an alliance that would contradict PAHO’s mission. But that’s not why the organization called off the partnership, it says. “The decision not to proceed was the result of PAHO's internal review process," the agency told The Examination. It declined to comment on the pushback from local organizations.

Ferrero did not respond to requests for comment. In a press release the company issued with PAHO about the partnership, Philip Myers, Ferrero’s chief institutional affairs and corporate communications officer, said the company’s involvement reflected a "commitment to supporting children and families in vulnerable conditions and contributing responsibly to concrete public health initiatives.”

The abandoned alliance between PAHO and Ferrero illustrates the dilemma that public health organizations face as government dollars shrink and critical programs go underfunded, experts say. To fill the budgetary gap, agencies like PAHO are turning to companies and making deals that could present conflicts of interest. The partnerships offer opportunities for the ultraprocessed food industry, too, which enjoys few restrictions when teaming up with international organizations and can gain direct access to governments to push its own interests.

"There is a conflict of interest there because Ferrero has intervened to block policies" recommended by PAHO, said Alejandro Calvillo, who heads the consumer rights organization El Poder del Consumidor. "How can you form an alliance with a company that is blocking the policies you are recommending?"

Ecuador first

In January, PAHO announced a new partnership with the ultraprocessed chocolate food giant Ferrero to "support public health initiatives across the Americas." The three-year collaboration would have supported “initiatives that contribute to improving the health and wellbeing of children, adolescents, and families in vulnerable conditions," according to the release dated Jan. 13. 

As part of the plan, PAHO said it and Ferrero planned to strengthen "immunization services in communities affected by violence in Ecuador" — particularly in Guayas and Manabí, two coastal provinces that have among the country’s highest rates of violent crime. The release noted that the health organization and food company were exploring collaborations in Argentina, Brazil, Chile, Colombia and Mexico, all countries where Ferrero has a strong market presence and local factories. 

The statement did not explain why the initiative would have targeted crime-ridden communities. Nor did it mention that Ecuador has seen rising rates of childhood obesity. Approximately one in three school-aged children there is overweight or obese, according to the 2018 National Health and Nutrition Survey, the latest available. 

The problem begins early in life for Ecuadorian children. According to the National Survey on Child Malnutrition, roughly 5% of children under five are overweight. Among infants aged 6 to 23 months, 75% consume sweetened foods and beverages and 6% eat salty or fried foods, according to Unicef’s 2025 Childhood Nutrition Report. 

Announcing its deal, however, PAHO focused on the value of alliances like the one with Ferrero, the world’s third-largest candy company. "Partnerships are essential to advancing public health when they are grounded in shared values, strong ethical standards, and respect for the independence of public health institutions," PAHO Director Dr. Jarbas Barbosa said in the release. 

Some public health advocates were quick to react. In March, Colansa, a prominent network of researchers and civil society organizations dedicated to improving public health across Latin America, sent a private letter reviewed by The Examination to Barbosa. It warned that the deal would create a conflict-of-interest scenario that could compromise PAHO’s work and credibility in the region. (Colansa declined to comment for this article.) 

“Through strategies such as lobbying, public-private partnerships, rhetoric emphasizing individual responsibility, ties to decision-makers, image-polishing, and self-regulation practices, Ferrero has sought to delay, weaken, and block policies that threaten its commercial interests,” the letter said, urging PAHO to terminate the deal. 

PAHO’s Barbosa responded with his own letter sent to several actors that had objected to the Ferrero deal. 

In his letter, obtained by The Examination, Barbosa said that “given the potential for conflicts of interest, strict safeguards were applied.” The partnership had seen a "rigorous review process" under the World Health Organization’s Framework for Engagement with Non-State Actors, or FENSA, a tool designed to shield the World Health Organization and its regional arms like PAHO from corporate influence. The framework explicitly bans deals with weapons and tobacco companies yet leaves a significant loophole for the food and beverage industries. 

Barbosa wrote that he decided to cancel the Ferrero deal because "relationships with the private sector can be subject to misinterpretations.” 

The immunization campaign would be financed through alternative funding sources, he added. 

In an email exchange with The Examination, PAHO confirmed the contents of its initial release and said the immunization activities were set to start in late January — until it decided not to move forward. 

PAHO "retained full authority over the project's design, implementation, monitoring, and communication, and the collaboration did not involve the promotion or endorsement of Ferrero or its brands," the agency said. 

The agency has since removed its press release from its website without explanation. (Copies can still be found elsewhere online.) 

PAHO told The Examination that it deleted the release because the deal was never executed. The agency did not respond to questions about the nature of its negotiations with Ferrero, or whether a new partnership would be considered in the future. 

The Examination tried to speak with PAHO’s Barbosa about the deal at an unrelated event during the United Nations General Assembly last week. He referred a reporter to Mariana Faria, PAHO’s acting director of external relations, partnerships and resource mobilization, who said the deal wasn’t related to any funding cuts and would have netted just $50,000. PAHO did not confirm or deny the amount in a follow-up email.

Ecuador’s health ministry said it wasn’t aware of the partnership and referred all questions to PAHO. 

Health experts remain critical. When he heard about the cancelled partnership, Kent Buse, a health policy professor at Monash University Malaysia, grew concerned that "the Regional Director did not acknowledge the problematic nature of the partnership,” he wrote in an email to The Examination. 

Buse and three other scientists co-authored an article published in the BMJ medical journal criticizing the Ferrero partnership as “inconsistent with PAHO’s guidance to prevent and manage conflicts of interest in policy development and implementation." Buse told The Examination he believes it's long past time to close the food loophole in the WHO’s FENSA guidelines, which allow agencies to work with ultraprocessed food manufacturers, even though their products have caused measurable health problems. 

WHO should “update FENSA with more robust safeguards on engaging with ultraprocessed food corporations to protect its technical independence, ethical standards, and crucial role in defending health in Latin America,” Buse and his colleagues wrote in their BMJ article. 

A funding scramble

The scuttled PAHO-Ferrero partnership comes at a moment when global health governance faces a severe funding crisis. Numerous countries have shrunk their aid budgets in recent years. In 2025, the Trump administration slashed U.S. international aid and pulled the country from participating in United Nations entities. 

The U.S. has not paid its assessed membership contributions to PAHO since 2024 and owes the organization over $134 million. The Trump administration hasn’t allocated any funding for PAHO in its 2027 budget proposal, which refers to the agency as "corrupt” and without “independence from inappropriate political influences." 

In the wake of those cuts, experts note, institutions across the globe have been left financially vulnerable, forced to make up the difference elsewhere.

PAHO mobilized $552 million in voluntary contributions from at least 30 new partners during the 2024–2025 biennium, a considerable increase from the $160.5 million in 2022-2023, according to the organization’s public reports. 

"We have diversified our funding sources, expanded our partnerships, and demonstrated that we can deliver high-quality technical cooperation with greater efficiency," Barbosa said in PAHO’s 2025 annual report in March. "Against a backdrop of reduced funding for international health, the Pan American Health Organization once again demonstrated what it has shown for over 120 years: its capacity to adapt, deliver, and advance health for all in the Americas."

Other international organizations also have been criticized for alliances with controversial food companies while seeking to expand programming. Not long after the PAHO-Ferrero controversy erupted, the United Nations University Institute for Water, Environment and Health (UNU) announced a new partnership with Nestlé — a food giant involved in controversies over baby formula recalls, harmful marketing tactics, worker abuses and environmental contamination. The alliance is meant to build a curriculum for students and researchers in the food and nutrition sector. 

In April, health scientists and advocates published a petition calling for an end to the Nestlé-UNU partnership. More than 800 people have signed it so far. “At a time when global food systems are under intense scrutiny for their role in driving malnutrition in all its forms, including a startling increase in diet-related chronic disease, the integrity and independence of nutrition education and professional development must be held to the highest standard,” the letter said.

In a statement, Nestlé said “we fully respect academic freedom, scientific integrity, neutrality and independent education.” UNU did not reply to a request for comment.

Laura Schmidt, a health policy professor at the University of California, San Francisco, told The Examination that cuts might affect organizations’ budgets, “but that's no excuse for getting into bed with a transnational ultraprocessed food corporation.”

Industry pressure vs. public health

Ferrero maintains a major footprint in Latin America’s growing economies. Present in more than 50 countries, the company announced that its total global capital investment for the financial year 2024 increased by 18% to 958 million euros, including in the U.S. and Chile. The company reached up to 18.4 billion euros in revenue. 

Ecuador was the first country where the company sought to expand its regional presence from Europe roughly a half century ago. According to Forbes Ecuador, 80% of Ferrero's production in the South American country is exported to major markets across Latin America.

The corporation is now pushing beyond chocolate, consolidating its hold on the region's ultraprocessed food market. Last year, Ferrero acquired American food manufacturer WK Kellogg Co. for $3.1 billion. This year, it acquired Bold Snacks, a protein shake and bar manufacturer in Brazil, for an undisclosed amount. It also purchased the U.S.-based natural granola brand Purely Elizabeth for $850 million. The two more recent acquisitions help diversify its products and gain turf in the new and trending “healthy food” arena. 

Meanwhile, the company has aggressively lobbied across Latin America, particularly in Colombia, Brazil and Mexico. An analysis of public lobbying records from 2014 to 2022 published in The Lancet reveals that Ferrero enlisted the Italian Embassy to pressure the Chilean Ministry of Health. The diplomatic push aimed to counter strict food labeling and marketing regulations that resulted in Chilean authorities banning the company's iconic Kinder Surprise chocolate eggs from store shelves.

In Mexico, Ferrero joined other ultraprocessed food and alcohol corporations in saturating the courts with more than 40 legal challenges in 2020 against front-of-package warning label regulations. Most of these actions alleged problems with the process used to modify the labeling regulations, among other issues. Between 2010 and 2025, food and beverage companies filed at least 239 lawsuits to overturn or modify health regulations across six countries (the U.S., UK, India, Brazil, Mexico, and Colombia). According to research by Quinto Elemento Lab and Lighthouse Reports, 80% of these lawsuits were in Mexico.

Such lobbying pressure is unfolding against a backdrop of worsening global health metrics. Worldwide, the prevalence of childhood obesity has increased steadily or accelerated in most low- and middle-income countries across Asia, Africa, Latin America, the Caribbean and Pacific Island nations, according to data published in Nature. 

In Ecuador, a 2024 study published in Pediatric Research warned that "the high prevalence of obesity in Ecuadorian children and adolescents is a public health concern.”

The National Assembly of Ecuador’s health committee is set to debate a bill that would legally classify obesity as a recognized disease, with a potential vote by the end of 2026. If passed, the country would become one of the few in Latin America to write this classification into law.

The proposal, according to committee member Cristina Jácome, comes amid mounting scrutiny over transparency and corporate ties in public health management. Jácome, who has pushed for front-package labeling initiatives, criticized corporate partnerships like the agreement between Ferrero and PAHO and called for clear limits on industry involvement. 

"Such alliances shouldn't happen," Jácome said, noting that strict regulations often result in food-industry pushback. "They haven't blocked anything directly because it doesn't affect them yet. But once this law comes out, they’re going to jump."

Additional reporting by Maria Pérez and Sasha Chavkin