In the wake of COP28, WHO will press ahead with calls for fossil fuel phase out, stepped up commitments for health sector decarbonization, and a new resolution on Climate and Health, set to go before the World Health Assembly in May 2024.

Those were key takeaways from an end-year WHO global press briefing by WHO Director General Dr Tedros Adhanom and other senior officials in an end-year press briefing Friday before the Geneva press corps.

Health and humanitarian crises associated with raging conflicts in Gaza, Sudan, Myanmar, Haiti, DR Congo and other conflict hotspots were also top on the agenda of WHO, as well as other UN agencies in as second press briefing Friday morning, looking back on 2023.

In addition, WHO warned that a more dangerous clade of mpox, the virus that swept the world in 2022 and 2023, is now being transmitted by sexual contact in the central and western Africa, including female sex workers as well as men who have sex with men – and its spread also represents a potential global threat. Even so, “not a single dollar” of donor funds has been raised to support the scale up of diagnosis, treatment, vaccination or monitoring and surveillance in DR Congo and other African states where the virus is most active and spreading, said Maria Van Kerkhove, a WHO Health Emergencies specialist.

Fossil fuels the main driver of climate change

“We single out fossil fuels because it’s not just one of the contributors, it is the major contributor to climate change,” said Dr Tedros, at the Friday afternoon press briefing. “Fossil fuels are three components – oil, coal and natural gas.  And these three combined contribute more than 75% of carbon emissions.  So if you don’t focus on the fossil fuels that contribute more than 75% to the carbon emissions, then where do you focus?

“When you focus on the major contributor, you can make progress and that is why the global community is asking for more consensus on phasing out fossil fuels.”

A landmark agreement Wednesday, at the close of the UN Climate Conference in Dubai, COP28, took the first tentative steps towards that goal. The final agreement calls, endorsed by 198 nations, for a “just, orderly, and equitable” transition away from fossil fuels in energy systems to achieve “net zero by 2050 in keeping with the science”.    A call for a complete phase out of fossil fuels, supported by 127 nations at COP28, was removed from the text after intense lobbying by oil-producing nations, led by Saudi Arabia. The reference to “energy systems” also creates a giant loophole in the calls for transition, effectively overlooking fossil fuel use in heavy industries like cement and steel industries, as inputs to fertilizers and plastics, and possibly transport.

Following a first-ever “health day” at COP28, a WHA resolution on climate and health is now being negotiated by member states, said Dr Maria Neira, head of WHO’s Department of Climate, Environment and Health.

There are also initial efforts underway to explore how health indicators could be better integrated into global measures of progress on climate change – to better underline the health connection and inspire progress, she said.

“Why not put up a health-related indicator as the ultimate demonstration of success,” she told Health Policy Watch, adding that air pollution exposures could be one relevant measure, insofar as most air pollution is created by the same sources of fossil fuel or biomass burning that contribute to climate change.  “Or how about the number of countries implementing air quality guidelines for instance, or having health incorporated into national determined contributions (NDCs)?”

Unprecedented number of health and humanitarian crises

As the climate crisis continues to exact an increasingly severe human toll, 2023 has seen an almost unprecedented number of health and humanitarian crises raging across the world, Tedros and other WHO officials at the briefing noted.

Those range from the approximately 1.9 million Palestinians displaced in Gaza amidst the ongoing Israel-Hamas war; to the war in the Sudan which has displaced over 7 million people, also causing acute, widespread hunger; a new civil war in Ethiopia, this time with rebels in the country’s Amhara region; gang violence in Haiti, and rebel violence in eastern DR Congo that has displaced a record 6.9 million people. And that list doesn’t even include Russia’s war in Ukraine, as well as protracted conflicts in Myanmar, northwestern Syria and elsewhere.

“All of these crises come at a heavy price, in term of lives lost and communities destroyed, but also in terms of the cost of delivering humanitarian aid,” said Tedros.  He called again for an immediate cease-fire and unfettered access by health workers transporting patients and bringing supplies to hospitals in all parts of the beseiged enclave, and particularly to three still-functioning hospitals in northern Gaza, an epicenter of combat.

While a recent Israeli announcement that it would open up a new crossing into Gaza from its Kerem Shalom crossing point is “very good news”, Dr Richard Peeperkorn, WHO representative to the Occupied Palestinian Territories, stressed that “we are not only talking about getting supplies into Gaza, ware talking about getting supplies to people all over Gaza.”

Sexual transmission of Clade 1 mpox raises renewed concerns

Meanwhile, WHO officials expressed growing concerns over the increasing signs of sexual transmisson of the deadly Clade 1 of mpox in DR Congo, Nigeria and neighboring countries.  While last year’s global outbreak of Clade 2 of the virus was primarily seen among men who have sex with men, Clade 1 is now being transmitted sexually to women, including sex workers in major Nigerian and Congolese cities, such as Goma, said WHO’s Rosamund Lewis, speaking at a Friday morning press briefing convened by the UN press office in Geneva.

Whereas the Clade 2 virus that trigggered a WHO declaration of a global public health emergency in 2022, has a case fatality rate of about .18%, death rates of Clade 1 are 5-8% in the DRC, which has recorded its highest-ever levels of confirmed and suspected cases this year, Lewis said.

“This is a much more serious disease,” said Mike Ryan, at the WHO Friday evening briefing. “The virus is growing in geographic dimensions, and in numbers. Anytime you see a virus breaking those geographic barriers, breaking the susceptible group barriers. You have to be very careful. 

“From a global level, we have not been able to raise any funding to deal with an ancient threat that is killing right now, spreading right now, evolving, right now,” Ryan stressed, also noting the genetic links between mpox, an orthopoxvirus, and smallpox, which was finally eradicated in the 1970s.  

“We talk about all of the casualties of war, but smallpox probably killed more people than all of the wars in  history,” Ryan added. 

Image Credits: E. Fletcher , Yoda Adaman/ Unsplash, IOM 2023, Tessa Davis/Twitter .