As health actors meet this week in Brasilia to refine a Health Action Plan for COP30, ending relationships with PR firms that engage with fossil fuel producers is one concrete step both civil society and UN actors could take now, two leading global health actors argue. The call is the more urgent in light of the UN’s recent selection of a media firm representing Shell to promote the upcoming UN Climate Conference (COP30), hosted by Brazil in Bélem.

Even while the health impacts of fossil fuel use and climate change surge – through air pollution, intensifying heatwaves, wildfires, and floods – many health organizations remain entangled with public relations and advertising agencies that also serve the fossil fuel industry. 

It’s a deeply troubling contradiction that must end, especially given the recent ruling by the International Court of Justice affirming that states may be held legally responsible for harm caused by fossil fuel emissions – including health harms. There is no justification for continued health sector alignment with fossil fuel interests

 For decades, fossil fuel companies have run a well-financed disinformation campaign to deny climate change and obscure the harms their products cause to our environment and our health. Their enablers? Many of the world’s top public relations (PR) and advertising agencies that once helped “Big Tobacco” deny the dangers of smoking.

 These firms don’t just write ads and press releases. They’re shaping narratives, rebranding fracked methane as “clean” “natural” gas, showcasing oil companies (the world-leading carbon polluters) as climate champions, and deflecting scrutiny from an industry that profits by accelerating climate breakdown and spreading disease.

InfluenceMap tells us that fossil fuel companies spend billions annually on marketing and lobbying, largely aimed at weakening climate regulation and conveying a false image of concern for the environment. 

According to Clean Creatives, many of the same PR and ad agencies that are greasing the wheels for fossil fuels are also being hired by health organizations, including hospitals, pharmaceutical companies and professional associations.

Conflict of interest

Take the Publicis Group, the world’s largest communication agency. In 2024, it counted major pharmaceutical clients like Pfizer, Sanofi, AstraZeneca, Merck & Co, Roche, Boehringer Ingelheim – and, at the same time, many of the world’s largest fossil fuel companies including Saudi Aramco, TotalEnergies, Ampol, Enel, Engie, PGE, and ADNOC. 

This is a fundamental conflict of interest: can a firm that promotes public health also support industries that systematically undermine it?

Fossil fuel pollution isn’t theoretical – it kills. The World Health Organization estimates that air pollution causes seven million premature deaths every year, most of them from burning coal, oil and gas.

The toxic emissions – PM2.5, PM10, nitrogen dioxide, ozone, and others – contribute to heart attacks, strokes, asthma, cancers, and serious neurological conditions. They damage fetal and child brain development, increasing risks of autism, ADHD, anxiety, depression, and reduced cognitive function. In older adults, they contribute to dementia and Parkinson’s Disease.

Then there is climate change – caused overwhelmingly by fossil fuels – which is intensifying extreme weather, spreading disease, displacing communities and exacerbating hunger and malnutrition. These effects are already hitting billions of people, particularly children, pregnant women, older adults, people in low-income communities and countries, Indigenous populations, and those with chronic illness. This is not a future threat. It’s happening now.

Health professionals hold a privileged position in society. We are among the most trusted voices. But that trust is not guaranteed. It rests on our integrity.

No credible health organization would dream of working for, or with, a PR agency that represents a tobacco company, yet many are doing exactly that when it comes to fossil fuels, perhaps unknowingly, by retaining agencies that continue to serve fossil fuel clients. 

 This is not just a reputational risk – it’s an ethical failure. A health organisation that contracts a PR firm that actively helps fossil polluters is undermining its own mission. It sends a dangerous message to the public: that it’s acceptable to fight disease with one hand while enabling its cause with the other. It’s time for the health sector to show leadership.

‘Break the Fossil Influence’ campaign

Since May, more than 60 health organizations have joined the Break the Fossil Influence campaign, pledging not to work with communications agencies that also support the fossil fuel industry. It’s a small but important step towards aligning our actions with our values.

In light of the recent UK parliament debate on fossil fuel ad bans and as cities and countries move to ban fossil fuel advertising, health institutions must take a hard look at whether their communications partners are complicit in promoting harm.

In May, United Nations (UN) Special Rapporteur on human rights and climate change Elisa Morgera released a powerful report to the UN General Assembly and Human Rights Council, outlining the need for a complete defossilization of economies, explicitly calling for criminalizing fossil fuel advertising, lobbying, greenwashing, and disinformation to protect human rights, including the right to health.  

Urgency couldn’t be greater in light of new COP30 engagement with PR firm representing Shell

We call on all healthcare institutions, hospitals, pharmaceutical companies, universities, and health professional associations to take three immediate steps:

• Join the Break the Fossil Influence initiative by committing to work only with PR and advertising agencies that do not serve fossil fuel clients.
• Audit all communication agencies you currently work with to ensure they don’t–and won’t–take fossil fuel companies as clients.
• Lead by example: make your policy public and encourage others to do the same.

 We have long fought for clean air, safe water, and protection against harmful industries. It’s time to bring that same moral clarity to the climate crisis. Refusing to work with fossil-fuel-enabling ad agencies is not a symbolic act. It’s a tangible commitment to health and truth. It strips polluters of the social licence they depend on. It tells our communities and policymakers: we are not neutral. We stand for life, not lies.

Edward Maibach is a public health professional and a member of the US National Academy of Medicine, currently serving on the Board of Directors of the Global Climate and Health Alliance. Earlier in his career, he served as a senior executive at Porter Novelli, a prominent public relations company.

Dr Jemilah Mahmood, a physician and experienced crisis leader, is the Executive Director of the Sunway Centre for Planetary Health at Sunway University, Malaysia. She is the founder of MERCY Malaysia and has served in leadership roles internationally with the United Nations and Red Cross for the last decade.

Image Credits: Markus Spiske/ Unsplash, InfluenceMap, GCHA/Paul Daylin, Center for Environmental Rights.