The UN climate negotiations have gone into overtime – again.

Early this week, the 28th year of United Nations (UN) climate summits saw its hopes for a historic agreement to end the fossil fuel era dashed by industry interests resisting efforts to phase out their use.

The negotiations extended into overtime, familiar to COP proceedings, as diplomats from nearly 200 countries attempted to bridge the global divide on the future of fossil fuels and prevent the summit’s collapse.

The fight over the final agreement intensified when a draft was released by the United Arab Emirates (UAE) presidency on Monday. It removed language explicitly calling for a total “phase out” of oil, gas, and coal from the global energy mix.

The latest draft text, released on Wednesday after negotiations pressed on into the early hours of the morning, does not include a commitment to phase out or down fossil fuels. Scientists, environmentalists, and human rights advocates say phasing out fossil fuels is essential to maintaining the 1.5C warming cap set in the 2015 Paris Agreement.

Instead, the draft calls on nations to transition “away from fossil fuels in energy systems, in a just, orderly, and equitable manner, accelerating action in this critical decade, so as to achieve net zero by 2050 in keeping with the science.”

Other significant changes include removing a directive to phase out coal use “this decade” and limits on new coal production, allowing coal-dependent nations like China and India to continue their reliance on the highly polluting fuel.

Specific targets for reducing methane and other non-greenhouse gas emissions were removed. Recognition of the “need for deep, rapid and sustained reductions in greenhouse gas emissions in line with the 1.5C pathways” was added for the first time.

‘False solutions’

“It is clear that not everyone is ready to admit the truth of what’s needed,” said Tom Evans, policy advisor at climate change think tank E3G. “This text alone might help avoid disaster in Dubai but it does not avoid disaster for the planet.”

While the first draft drew widespread criticism, reactions to the new draft are mixed. The central change in language around fossil fuels is the shift from nations “should” transition away from fossil fuels to a text that “calls on” nations to do so — a minor but significant change in U.N. language.

Over 120 countries, 72% of nations at COP, have expressed direct support for an agreement that includes phasing out fossil fuels, according to an analysis by the Pacific Islands Climate Action Network and Oil Change International on Tuesday. This marks a significant increase from COP27 in Egypt, when 80 countries called for a phase-out limited to the electricity sector.

“Overall, we get a clear signal to phase out fossil fuels… It is not the most ambitious outcome we could have landed at this COP, given the momentum from over a hundred countries demanding strong language on this, but it’s a step forward,” said Amos Wemanya, senior advisor at Renewable Energy and Just Transitions. “But we still have a lot of false solutions in the text.”

 

The mood after the first draft agreement on Monday was summarized by former US Vice President Al Gore, who criticized the draft for reading “as if OPEC [the Organization of Petroleum Exporting Countries] dictated it word for word.”

“COP28 is now on the verge of complete failure. The world desperately needs to phase out fossil fuels as quickly as possible,” Gore said. “There are 24 hours left to show whose side the world is on: the side that wants to protect humanity’s future by kickstarting the orderly phase-out of fossil fuels or the side of the petrostates and the leaders of the oil and gas companies fueling the historic climate catastrophe.”

Although the draft falls short of the “phase out” demands from more than 120 nations, environmental groups, and scientists, it is the first COP agreement to directly address the need to move away from all fossil fuels. This represents a significant shift in focus for the UN climate negotiations, which did not explicitly mention any fossil fuels until COP26 in Glasgow, where coal was first included.

“For the first time in three decades of climate negotiations the words fossil fuels have ever made it into a COP  outcome,” said Mohamed Adow, Director of the energy and climate think tank Power Shift Africa. “We are finally naming the elephant in the room.”

While the diagnosis of the climate crisis is accurately represented in the draft agreement, scientists note the solutions and actions presented fall far short of the action required to address the scale of the crisis the text describes. 

“There seems to be a total disconnect between the diagnosis and the treatment,” said Jean Pascale van Ypersele, professor of Environmental Sciences at the UC Louvain and former vice chair of the UN’s Intergovernmental Panel on Climate Change (IPCC).  “The diagnosis is that of a potentially deadly cancer, due to abuse of fossil fuels,” said van Ypersele. “The prescribed treatment is a mixture of wishful thinking and magic.” 

The current draft agreement’s sole mention of “health” as a human right, without explicitly addressing key health issues like air pollution, has disappointed global health experts following the apparent momentum generated by the inaugural Health Day at the UN climate summit.

“The difference for people’s health of phasing out only ‘unabated’ fossil fuels, versus a full fossil fuel phase-out is night and day,” said Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance. “Currently 99% of the world’s population breathes unhealthy air, with five million people per year dying prematurely due to the air pollution produced by the use of fossil fuels.”

“COP28’s only sane pathway – one that will protect people’s health – is an agreement that sets in motion the orderly and just phase out of all fossil fuels”, said Miller. 

‘We didn’t come here to sign our death sentence’ 

During a closed-door meeting at COP28 on Tuesday, as reported by The Guardian, sharp divisions emerged over the future of fossil fuels, highlighting the deep rifts that could derail an agreement crucial for the planet’s future.

Australia, representing a coalition of major fossil fuel consumers and producers including Canada, Chile, Norway, the European Union (EU), and the US, advocated for a decisive move away from these energy sources. The EU and US separately pressed for a firmer stance on fossil fuels in the final agreement.

“Overall it is clearly insufficient and not adequate to addressing the problem we’re here to address,” said EU climate commissioner Woepke Hoekstra. 

The US State Department demanded that the wording on fossil fuels be “substantially strengthened”.

Small island nations, facing immediate threats from sea level rise, see any agreement lacking a robust commitment to fossil fuel phase-out as a potential “death sentence”.

Joseph Sikulu, a climate activist from the Pacific island of Tonga, broke into tears at a press conference on Tuesday when asked about the stakes of the agreement for his and other island nations. 

“We didn’t come here to sign our death sentences and the text in its current state is that,” said Sikulu. “We know that our negotiators are in there, holding the line and they’re still fighting.” 

“In Paris, we fought for our lives for 1.5C and slowly we see it going away from our grasp every year,” added Sikulu. “[Negotiations] have now just become words.” 

John Silk, Minister of Natural Resources and Commerce for the Marshall Islands, echoed the desperate plea of small island states for their continued existence.

“We will not go silently to our watery graves,” said Silk. “We will not accept an outcome that will lead to the devastation for our country.” 

Finance disputes significant for developing nations

The debate over financing climate adaptation and green energy transitions in developing countries, which have not benefited from centuries of fossil fuel development, is as central to the final text disagreements as the phase-out language. Many developing nations view the phase-out demands from wealthy countries without accompanying funding as unfair, arguing that it fails to recognize their limited role in historical emissions.

“Rich countries say they want a global phase-out of fossil fuels, but they are refusing to fund it,” said Adow. “There is simply not enough in the current text for African countries to believe there will be finance to help them leapfrog dirty energy nor adapt to climate impacts.”

India also highlighted the omission of historical cumulative colonial emissions as a crucial oversight of the draft agreement, a criticism echoed by environmental groups and experts, who have singled out industrialized nations like the U.S., Canada, and Norway for their historical emissions and ongoing oil production expansion.

Governments Plan Massive Expansion of Fossil Fuel Production Despite Climate Crisis, UN Warns

“Many reports have clearly shown that these same countries, as they come here and pretend to be climate champions and talk about limiting temperature rise and talk about ending fossil fuels, have signed and continue to sign licenses for expansion and production of fossil fuels,” Meena Raman, of the Third World Network and a veteran of the COP process, said in reference to recent reports by the UN Environment Programme and Oil Change International. 

Governments and industry continue to expand fossil fuel production, with governments worldwide on track to produce fossil fuels at a rate 110% higher than the 1.5°C target by 2030. The top 20 oil and gas companies, meanwhile, are projected to emit 173% above the 1.5°C limit in 2040.

Raman also pointed out the draft’s failure to address the means of implementation which would allow developing countries to invest in green energy. These include can areas such as finance, technology, and capacity building, crucial for developing nations to phase out fossil fuels. 

Despite a day-one victory at COP28 to operationalize the Loss and Damage Fund, which aims to deliver financial assistance from developed nations to vulnerable countries coping with the escalating effects of climate change, the fund remains largely empty.

Demands for increased climate finance in the COP agreement, especially from the US, face domestic political hurdles, with a Republican-led Congress unwilling to allocate such funds. This standoff affects not just climate-related financing but also other areas of greater political consensus in the US, such as military aid to Ukraine.

Bangladesh, representing the 46 Least Developed Countries, expressed disappointment with the draft’s lack of a commitment to keeping global warming below 1.5C, labelling the text as weak and contradictory.

Cuba, on behalf of the G77+China group of 135 nations, argued in the meeting that the draft inadequately recognizes the primary responsibility of affluent countries in climate action and their obligation to support less wealthy nations.

China objected to including a 2025 global carbon emissions peak target in the agreement, citing the longer historical emissions of developed countries.

OPEC arrives at the party 

The complex geopolitics of oil-producing nations, especially Saudi Arabia’s role as the de facto leader of OPEC, are complicating COP28 talks. Reports from Dubai indicate that UAE’s COP28 President Sultan al-Jaber is under substantial pressure from Saudi Arabia to exclude any references to fossil fuels in the agreement. This stance is shared by other OPEC and OPEC+ members, including Iran, Iraq, and Russia. 

Al Jaber has so far resisted complying with these demands, stating on Tuesday “We must remain focused on our primary goal of keeping the 1.5C target within reach”.

Saudi pressure to eliminate any mention of fossil fuels from the final agreement follows a letter from OPEC Secretary-General Haitham Al Ghais that was leaked to The Guardian on Friday. The letter urged OPEC members to “proactively reject any text or formula that targets energy, i.e. fossil fuels, rather than emissions”.

Ghais stressed the urgent need to counter what he described as politically motivated campaigns threatening the prosperity of OPEC nations that would put “our people’s prosperity and future at risk.” 

Dan Marks, an energy security expert at the Royal United Services Institute (RUSI), explained to the Guardian that major oil producers, including Saudi Arabia, are cautious about policies aimed at reducing fossil fuel supply, due to significant national interests.

Saudi Arabia, holding nearly 300 billion barrels of oil, accounts for about one-fifth of the global oil reserves. As the unofficial leader of OPEC, which represents close to 80% of the world’s oil reserves, the kingdom plays a pivotal role in global oil dynamics.

“They have interests they need to protect,” said Marks, adding that proposals for phasing out fossil fuels could trigger instability in these oil-rich nations. 

Earlier in the year, OPEC criticized projections by the International Energy Agency (IEA) suggesting a peak in demand for fossil fuels such as coal, oil, and gas before 2030 as “overly hazardous” and “unworkable”. The oil cartel has also accused the IEA of “unjustly vilifying the [oil and gas] industry as being behind the climate crisis” as well as setting out a roadmap for the global energy system that will cause “energy chaos on a potentially unprecedented scale”.

“Clearly, there is an emerging proactive fossil coalition,” a senior EU negotiator close to the negotiations told the Financial Times after the new draft was released. “In the past, we had more silent resistance and now it seems more conscious and more focused and more co-ordinated.”

Negotiators in Dubai now face the daunting task of crafting a consensus-driven agreement that avoids outright rejection by any party. Veteran observers speculate that in the face of a potential deadlock, no agreement might be preferable. Countries desiring a robust deal are trapped between accepting a diluted agreement or none at all.

“It seems more or less impossible now to get a wording that clearly calls for the ‘phase out’ goal, as demanded by the small islands and the EU,” said Michael Jacobs, a COP veteran and professor of political economy at Sheffield University. “The OPEC states won’t agree to it, and the UAE (a member of OPEC) won’t insist on it from the chair.”

Jacobs pointed out that the summit’s most significant achievement, the establishment of the loss and damage fund, was already secured on the first day. “Even if the COP negotiations were to collapse now, this milestone wouldn’t be reversed,” he said.

“What would be lost are – sorry, but this is true – various forms of words which are not binding and won’t materially affect any countries’ immediate behaviour.” 

UN Secretary-General Antonio Guterres, who made a return trip to Dubai for the final stage of the talks earlier this week, underscored the urgency of the situation. 

“We need an ambitious outcome that demonstrates decisive climate action and a credible plan to keep the 1.5°C warming limit alive,” said Guterres. “[We must] protect those on the frontlines of the climate crisis.” 

Image Credits: Simon Evans.

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market prior to the outbreak of COVID-19, from top left: King rat snake, Chinese bamboo rat, Amur hedgehog, Raccoon dog, Marmot and Hog badger.

The powerful Group of 20 (G20) countries will host a high-level meeting on One Health in October 2024 to better prepare members to address the health of people, animals and ecosystems.

This was revealed by Alexandre Ghisleni, Brazil’s Global Health Ambassador, at a COP28 side event to launch an implementation guide for the One Health Joint Plan of Action devised by the four United Nations (UN) agencies.

Known as the quadripartite, the four are the Food and Agriculture Organization , UN Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH).

“Brazil has been very supportive of the One Health approach,” said Ghisleni. “Evidence of this was the way we have handled the avian flu cases that we’ve had this year in our country.  It was only due to very close cooperation between the Ministries of Environment, Agriculture and Health, that Brazil was able to handle these cases satisfactorily.”

Brazil, which assumes the G20 presidency next year, will host the One Health meeting to “explore in detail and at length, all the aspects related to it so we can better face the challenges of our time”, he added. 

Alexandre Ghisleni, Brazil’s Global Health Ambassador

There has been heightened awareness about the need for a holistic approach to human, animal and environmental health since the deadly COVID-19 pandemic. Both SARS-CoV2, which caused COVID-19, and MERS-CoV originate in bats. Meanwhile, there is widespread speculation that the Huanan market in Wuhan, where wild animals were kept in unsanitary conditions, was the origin of the COVID pandemic.

Mpox and anthrax outbreaks, both originating in animals, have also surged over the past two years. There is growing awareness that countries need to contain zoonotic spillovers from animals to people, and One Health is featuring prominently in the current pandemic agreement negotiations being conducted under the auspices of the WHO.

Surging vector-borne diseases

On Tuesday, the European Food Safety Authority (EFSA) released a report on the most common zoonotic diseases in the European Union in 2022, noting that there had been a marked increase in West Nile virus, which is transmitted by mosquitoes.

“Climate change is increasing the surge of vector-borne diseases. That’s why today a One Health approach integrating human and animal risk assessments is the way forward” said Frank Verdonk, Head of EFSA’s Biological Hazards and Animal Health and Welfare unit.

The number of food-borne outbreaks in the EU increased by 44%, from 4,005 outbreaks in 2021 to 5,763 in 2022, associated with a wide variety of foods, ranging from meat and dairy products to fish and vegetables. 

Dr Ariane Hildebrandt, Director-General of Germany’s Ministry for Economic Cooperation and Development (BMZ)

Dr Ariane Hildebrandt, Director-General of Germany’s Ministry for Economic Cooperation and Development (BMZ), told the launch that a “multidisciplinary approach that considers the interconnection between health, climate and biodiversity is necessary” as,  “without a healthy environment, there cannot be health for human and animal life”. 

“We will continue to work towards the goal of reducing health risks in our partner countries, strengthening human and veterinary health systems, improving early warning systems, protecting biodiversity and thus contributing to epidemic and pandemic prevention,” she added.

The guide is an operational addition to the 2022 One Health Joint Plan of Action, and  outlines three pathways – governance, sectoral integration, and evidence and knowledge – and five steps to achieve One Health implementation.

“One of our main principles when developing the guide is to make it applicable to all countries, regardless of their status of One Health implementation, and acknowledges transdisciplinary and diversity of stakeholders.” Dr Amina Benyahia, WHO head of the One Health Initiative.

“The climate emergency has far-reaching consequences that threaten all life on earth. Direct factors like heat waves and floods as well as indirect factors like changes to disease spread due to changing weather patterns are just some of the risks to the health of animals, humans, and entire ecosystems,” said Doreen Robinson, the Head of Biodiversity and Land at UNEP.

Robinson added that an “early investment in inclusive and systemic One Health approaches ensures we’re tackling such interconnected, complex issues for a healthier, more resilient future for both people and planet.”

“Despite the growing awareness of the One Health approach in recent years, the world remains vulnerable to many global threats unless this approach is translated into policies and actions, and adequately and sustainably financed,” said Thanawat Tiensin, FAO’s director of Animal Production and Health Division.

At the first-ever health and climate day during COP28, 134 countries backed a Climate and Health Declaration to place health at the heart of climate action and accelerate the development of climate-resilient, sustainable and equitable health systems.

Image Credits: Nature .

New IFRC President Kate Forbes of the American Red Cross

GENEVA – The election of the next president of the International Federation of the Red Cross and Red Crescent Societies (IFRC) was almost derailed on Monday after the body’s board tried to postpone voting to investigate sexual harassment allegations against one of the candidates, Kenya’s Abbas Gullet.

However, Kate Forbes of the American Red Cross was eventually elected after the general assembly overruled the board and pushed ahead with the election.

There was an uproar from the Red Cross and Red Crescent societies after a last-minute announcement by IFRC’s outgoing president, Francesco Rocca, that the governing board had decided to postpone elections following sexual harassment allegations against Gullet, one of the four contenders for the top job.

The alleged acts were said to have taken place between 2016 and 2018, Rocca said. Gullet, who was secretary general of the Kenyan Red Cross from 2005 until 2020, has said he would welcome an investigation into the allegations.

Rocca, who at first didn’t disclose the name of Abbas or the nature of the allegations, told the general assembly that the board had decided to launch an investigation into claims received on 28 November.

“This decision was not made lightly but is necessary to ensure the integrity of the federation and the concerned candidate,” Rocca said, arguing that free and fair elections could not be held under the circumstances.

But the announcement displeased delegates in the room, triggering heated exchanges with Rocca. 

‘Slap in the face’

The Moroccan Red Crescent said it was a “slap in the face of the societies in Georgia, Egypt, the US and Kenya”, the national societies backing the various candidates, describing it as a “manoeuvre” by the board and the presidency.

Jordan’s national chapter also protested against the last-minute postponement and said it was up to the general assembly to decide, drawing applause from the room.

Addressing the elephant in the room, the Kenyan Red Cross told the assembly that its candidate was being targeted and proposed that elections go ahead and if elected, Gullet would step aside pending the investigation.

Gullet, who was invited by Rocca to take the floor, accused the board of “double standards”, referring to Rocca’s integrity being brought into question when he was a candidate in 2017 over the fact that he went to prison when he was 19 years old for dealing drugs, to which an irritated Rocca replied that he had addressed this openly with the general assembly at that time.

The elections to replace Rocca were already mired in controversy. Rocca announced in June he would step down from the position early following conflicts of interest after his election in March as president of the right-wing government of the Lazio region, encompassing Rome.

The IFRC general assembly overruled the body’s board.

After a row over the technicalities of whether the elections could go ahead or not, the governing board walked out of the room to reconsider the matter and decided it was finally up to the general assembly, given the level of disagreement with the board.

Rocca cautioned delegates that they would have to be ready to deal with the reputational fallout of having an elected president step aside during an investigation into sexual harassment allegations.

However, the overwhelming majority voted in favour of holding the elections. The Red Crosses of Switzerland, the United Kingdom, Denmark and Trinidad et Tobago were among the few outliers to vote against.

Forbes was finally elected with 88 votes in favour out of 163 national chapters that took part in the vote. Gullet received 75 votes. Natia Loladze, president of Georgia’s Red Cross and IFRC vice-president, was eliminated in the first round, only gathering 15 votes, and Egypt Red Crescent’s chief executive Ramy El Nazer, who amassed 22 votes, decided to withdraw from the race.

The investigation into the allegations against Gullet will still go ahead, given that he is a member of the IFRC’s Standing Committee.

Second female president

Forbes was, until now, the chairman of the IFRC’s Audit and Risk Commission. She’s been an American Red Cross volunteer for 43 years and has held various positions within the IFRC over the last 17 years.

During her presentation speech earlier in the morning, she said that, if elected she would only “serve one term so I can focus on the work and not on being re-elected”. 

She also said she had resigned from her other board positions and promised she would not run for political office.

Forbes, 72, from Phoenix, Arizona, is the second woman and the fifth American to hold the position in the federation’s 104 years of existence. She took over from Rocca as soon as the assembly closed.

In short remarks, Forbes said that in what had been a “strange day”, her message was of “unity” for the global movement.

Rocca closed the meeting, echoing Forbes’s call for unity and apologising for his own mistakes during his time as president.

This article was first published in Geneva Solutions.

 

Image Credits: IFRC.

DUBAI, United Arab Emirates – Black carbon is a super pollutant and its emissions are commonly seen anywhere you see black smoke – from a tiny kerosene lamp to a massive ship. The main sources include the burning of biomass, garbage dumps, diesel vehicles, coal-fired power plants, brick kilns, wood fires, wildfires and, on the high seas, ships.

Superpollutants are sometimes referred to as short-lived climate pollutants. Black carbon (BC) has a lifespan of just one or two weeks before it falls to the earth, in comparison to carbon dioxide which has a lifespan of a few hundred years in the atmosphere. 

But in this short span, its effects are devastating. Conversely, cutting its emissions can lead to rapid health and climate action benefits. 

Jane Burston is the CEO of Clean Air Fund (CAF), one of the four organisations that produced the report, The Case For Action On Black Carbon,  that was launched at COP28 over the weekend.

The other organisations were the Center for Study of Science, Technology, and Policy (CSTEP); Berkeley Air Monitoring Group, and Orbis Air.

She explains why, despite its short lifespan, BC’s global warming potential is as bad as carbon dioxide, the biggest contributor to climate change. 

“It’s black, so when it’s in the atmosphere, it radiates. It captures energy from the sunlight and radiates heat into the atmosphere. So even though it only stays in the atmosphere for up to a couple of weeks, it has a very high global warming potential. While it’s there, it’s as bad as a ton of carbon dioxide.”

Jane Burston, CEO of Clean Air Fund.

Threat to Polar Ice Caps, Himalayas, Andes 

While BC affects its immediate area the most, in the right conditions it can spread very far. It covers polar ice caps and glaciers in soot which in turn absorb more heat and trigger more melting. 

The retreat of the Himalayan glaciers has accelerated by 50% between 2012-14 because of BC warming and snow darkening, which in turn affects the monsoon. 

“It causes a different type of cloud formation and changes rainfall patterns. So we’ve seen black carbon in India changing monsoon rainfall pattern and in West Africa the Sahel similarly,” Burston told Health Policy Watch.

It’s not just Himalayan glaciers retreat that BC has been linked to, the report says it decreases Arctic sea-ice cover in summer, advances the western United States melting season, and increases run-off in the Andean glaciers.

Panel at COP28 on black carbon: (L-R) Dr Indu K Murthy, (CSTEP), Nina Renshaw (CAF), Michael Johnson (Berkeley Air Monitoring Group) and Paula García Holley (Clean Air Task Force).

Health impacts of black carbon

BC contributes to a significant chunk of PM 2.5, or particulate matter with a diameter of 2.5 microns or less which is microscopic. PM 2.5 is usually the most tracked air pollutant, according to the report. 

Annual deaths due to fine particulate and ozone air pollution are estimated to be 8.34 million, which is more than one in 10 deaths, according to a recent report in the BMJ. More than half (52%) of these deaths are due to heart attacks, strokes and pulmonary diseases including cancer. 

“The highest total attributable mortality occurs in China, with 2.44 million deaths per year, followed by India with 2.18 million deaths per year.” according to the BMJ, November, 2023.

BC is strongly correlated with increased blood pressure levels, a high-risk factor for cardiovascular disease and strokes. It affects pregnant women and has been linked to low birth weight. 

While it’s not clear exactly how many premature deaths are linked to black carbon, the report assumes two scenarios. If BC is assumed to be equally toxic as other PM 2.5 components then it is associated with 150,000 deaths worldwide. But if BC is “significantly” more toxic then widespread reduction of BC emissions has the potential to reduce premature mortality by as much as 400,000 annually over North India’s Indo-Gangetic Plain alone. 

Aerial view of a wildfire.

“I’ve been working on a study of household air pollution intervention that we’re proud of as it is the biggest randomised control trial looking at the health effects of transitioning from biomass stoves to clean cooking LPG,” said Michael Johnson, technical director of Berkeley Air Monitoring Group. “And we found the effects on birthweight to be more strongly linked with black carbon than with PM 2.5.”

Nina Renshaw, CAF’s head of health, has studied BC for two decades: “The thinking is that the black carbon within PM 2.5 may be actually more harmful than other components of PM 2.5. There’s still research to be done in that area. But what we do know is that black carbon is particularly damaging for cardiovascular health – heart attacks, disease, strokes, neurological damage, and so on. Black carbon has also proven to have an impact during pregnancy and birth outcomes, low birth weights and so on.”

‘No brainer’ – start cutting black carbon now 

The new report on black carbon fills a vacuum as there has been far less work on it than carbon dioxide, ozone and PM 2.5. There hasn’t been much global monitoring and there ought to be more studies on epidemiological evidence and toxicology for air quality regulations.

R Subramanian from the Center for Study of Science, Technology, and Policy (CSTEP)

R Subramanian, head of Air Quality at the Center for Study of Science, Technology, and Policy (CSTEP), Bengaluru, told Health Policy Watch: “As we are moving closer to the climate tipping points, we need more levers that we can control to avoid reaching those tipping points.” 

Renshaw says it’s a “no-brainer” to include cutting black carbon emissions as part of programmes to cut PM 2.5.

“Working on particulate matter, PM2.5 in particular, is a no-brainer. That is a WHO guideline, the International Agency on Cancer Research (IARC) says that this is carcinogenic and so on. We can begin to capture black carbon and do that. So let’s go down that route as an urgency and fill up the gaps as science allows.”

Indu K Murthy, CSTEP’s head of Climate, Environment, and Sustainability,  highlights another route, via government regulation: “We’re talking about cleaner energy and clean air which is a mandate of every government in any case. And you just have to kind of bundle it along with that till we get the metrics right.

Image Credits: Nick Sorockin/ Unsplash, Marc Szeglat/ Unsplash.

Anthrax of the skin, and anthrax bacteria.

Zambia is experiencing its worst anthrax outbreak in a decade, while four neighbouring countries – Kenya, Malawi, Uganda and Zimbabwe – have also reported outbreaks, according to the World Health Organization’s (WHO) Africa region.

By 20 November, four Zambians had died, with 684 suspected and 37 confirmed cases from nine of the country’s 10 provinces. Twenty-six people developed sores on their faces, arms, and fingers after eating the meat from three wild hippopotamus carcasses.

Beyond Zambia, a further 482 suspected cases have been identified, according to the WHO. Thirteen people have died in Uganda, three people have died in Kenya, and one in  Malawi. 

Anthrax is a zoonotic disease caused by a bacteria that occurs naturally in soil and mostly affects ruminants such as cows, sheep and goats. Humans develop the disease from infected animals or contaminated animal products, and almost always need to be hospitalised after infection as it causes serious illness.

People can start showing symptoms within hours or up to three weeks after exposure. By far the most common presentation is cutaneous (skin), with itchy bumps that rapidly develop into black sores. Some people then develop headaches, muscle aches, fever, and vomiting. These cases originate from people handling infected carcasses, hides, hair, meat or bones.

Gastrointestinal anthrax causes initial symptoms similar to food poisoning but can worsen to produce severe abdominal pain, vomiting of blood and severe diarrhoea.

Pulmonary anthrax is the most serious form, initially presenting as a common cold but can rapidly progress to severe breathing difficulties and shock. 

High risk of regional spread

“Due to the scale of the outbreak in Zambia, shared ecosystem with neighbouring countries and frequent cross-border animal and human movement, there is a heightened risk of regional spread of the disease,” according to WHO.

Anthrax cases are already spreading in areas along the basin of the Zambezi, Kafue, and Luangwa rivers.  Carcasses of wild animals that float on the rivers also increase the risk of international spread to neighbouring countries. 

“To end these outbreaks we must break the cycle of infection by first preventing the disease in animals. We are supporting the ongoing national outbreak control efforts by providing expertise as well as reinforcing collaboration with partner agencies for a common approach to safeguard human and animal health,” said Dr Matshidiso Moeti, WHO’s Africa Director. 

There is a vaccine for people and animals but there is limited stock, according to WHO. The Zambian government has vaccinated more than 122,000 cattle, sheep and goats with support from Food and Agricultural Organization (FAO).

A joint One Health task force comprising the Ministries of Health and Local Government has been conducting case finding in animals and humans. The country’s veterinary department is conducting meat inspections in abattoirs and butcher shops, while the Department of Wildlife and Parks is monitoring illegal animal movements and ensuring proper disposal of carcasses. 

“The outbreaks are likely being driven by multiple factors, including climatic shocks, food insecurity, low risk perception and exposure to the disease through handling the meat of infected animals,” according to the WHO.

Image Credits: Gavi.

WHO Executive Board meeting on the health and humanitarian situation in Gaza, Sunday

In a fragile show of unity, the World Health Organization Executive Board approved a draft resolution calling for “immediate, sustained and unimpeded” humanitarian relief to beleaguered Gaza, including safe passage of health personnel and supplies, as well as ambulances and patients. 

The WHO EB move, which will clear the resolution for approval by the May World Health Assembly, represents the first-ever consensus statement on the charged conflict so far in a UN body. The draft resolution  on “Health Conditions in the Occupied Palestinian Territory” carefully sidesteps any direct references either to Hamas or Israel in a charged conflict where both Israeli and Palestinian leaders, and their allies, have accused each other of genocide and war crimes. 

Sunday’s approval of the WHO EB resolution came just two days after another UN Security Council resolution calling for a humanitarian cease-fire in Gaza was vetoed by the United States because it did not condemn the initial Hamas 7 October attack on Israeli communities, which led to the deaths of some 1,200 people, mostly civilians, and the taking of more than 240 Israeli hostages. 

US deputy ambassador Robert Wood had called Friday’s UN resolution “imbalanced”, saying that a cease fire that left Hamas in power in Gaza would “only plant the seeds for the next war.” 

The WHO EB resolution, in contrast, focusses on humanitarian relief, making only one reference in the preamble to the broader UN “appeal for a humanitarian cease-fire.” Along with general calls for the free flow of aid and relief to besieged Palestinians, it also mandates WHO to lay plans for the rebuilding of Gaza’s shattered health system.

Operative paragraphs of the draft WHA resolution approved by the WHO EB on Sunday

Tedros: It is still possible to find common ground

“I commend you …. for being willing to collaborate and compromise … In our fractured and divided world it is still possible to find common ground on even the most difficult issues,” said Dr Tedros Adhanom Ghebreyesus at the close of the extraordinary day-long EB session. 

“Of course the adoption of this resolution is only a starting point. It doesn’t not resolve the crisis, but it’s a platform on which to build,” Tedros stated. 

Breaking with its own precedent in the UN Security Council, the US supported the resolution,  co-sponsored by Yemen, Morocco and Afghanistan – albeit with “reservations”.

Those reservations, said the US, also backed by fellow EB member Canada, included the omission from the text of references to the Hamas 7 October incursions, Hamas hostage taking, and its use of hospitals and civilians as shields for military activities – as well as the preamble reference to UN calls for an immediate cease-fire.

Convening an EB meeting devoted to a single health and humanitarian crisis was unprecedented in the annals of WHO. Although a resolution denouncing Russia’s invasion of Ukraine was approved by WHO’s World Health Assembly in 2022, it was addressed in the health assembly’s regular session, as were follow-up reports and motions in the February 2023 WHO EB meeting, and the May 2023 WHA session.

Gaza health system is ‘on its knees’ 

Gaza health system overview presented by WHO’s Dr Teresa Zakaria at the special EB meeting, 10 December 2023

In the debate just prior to Sunday’s EB vote, senior WHO officials provided a detailed report of the current health and humanitarian situation in Gaza, including a first-hand report from Gaza City.  

“More than 17,000 people are reported to have died in Gaza, including 7,000 children and we don’t know how many are buried under the rubble of their homes,” said Dr Tedros, in a summary of the WHO findings.

“More than 46,000 injuries have been reported. 1.9 million people have been displaced. Almost the entire population of the Gaza Strip is looking for shelter anywhere they can find it but nowhere and no one is safe in Gaza,” Tedros said.

Fighting between Israel and Gaza’s Hamas regime resumed on 1 December after the breakdown of Qatar- and Egyptian-mediated talks over further release of the 137 Israeli hostages still held by Hamas against Palestinian prisoners in Israeli jails and detention centres, estimated at some 7,000 people – a number that has swelled since the conflict began. 

The seven-day humanitarian cease-fire in late November saw the release of some 114 hostages, mostly Israeli women and children but also including 24 Thai and Filipino nationals, in exchange for some 240 Palestinians released from Israeli prisons. Many of the released Palestinian prisoners were also women and teenage minors, including some who had been detained but not charged. 

Nowhere to flee

View of Gaza destruction from the seat of a UN vehicle

The renewed fighting has seen a new Israeli thrust into Hamas strongholds deep in southern Gaza, where most of the enclave’s 2 million people fled during the first phase of hostilities, and are now living in tents, schools and on the streets. 

“As more and more people move to a smaller and smaller area, overcrowding combined with the lack of adequate food, water, shelter and adaptation are creating the ideal conditions  for diseases to spread,” Tedros said.

“As I have said repeatedly, I deplore the barbaric and unjustifiable attacks by Hamas on Israel on the seventh of October, which killed more than 1,200 people. 

“I’m appalled by reports of gender based violence during the attacks and by the mistreatment of hostages,” added the WHO director general, with reference to Israeli claims that women killed or kidnapped by Hamas on 7 October were raped and sexually abused.

“And I repeat my call for the remaining hostages to be released. I will understand the anger, grief and fear of the Israeli people following the horrific attacks two months ago,” he continued. 

“I also understand the anger grief and fear of the people of Gaza who had already suffered through 16 years of blockade and are now enduring the destruction of their families, their homes, their communities, and the life they knew. 

“It’s stating the obvious to say that the impact of the conflict on health is catastrophic. The Gaza health system is on its knees and collapsing.”

Gaza casualties still rising

Gaza fatalities continue to rise

While the majority of Israel’s 1,297 casualties were incurred during the initial Hamas attacks on Israeli communities on 7 October, within Gaza “the trend of fatalities continues to rise, placing a tremendous burden on the already weakened health system,” said Teresa Zakaria, WHO Health Emergencies official, reporting on the casualty trends.  

“The largest proportion of fatalities recorded were amongst children, 45%, and women, 30%,” Zakaria added, referring to the Hamas breakdown of Palestinian casualties. “The number of children killed in the three weeks following 7 October, surpassed the annual number of children killed in [all] conflict zones since 2019, she asserted, citing a recent Save the Children, report. 

There have also been over 250 fatalities amongst Palestinians in the Israeli-occupied West Bank, and 94 fatalities in Lebanon as the conflict spills over regionally, Zakaria noted. 

Hospital functionality and humanitarian aid

Overview of Gaza hospital bed capacity as of 9 December 2023

Against the flood of injuries, only 14 of Gaza’s 36 hospitals are still operating, and that only partially, Zakaria said.  Of those, 12 hospitals are in the southern part of the enclave, where most people have fled. Only three have surgical capacities, while other aspects of functionality are limited by lack of fuel supplies, food and clean water.  In addition several field hospitals are operating, under the auspices of foreign donors. 

According to Tedros, there have been a reported 449 attacks on health facilities in Gaza and the West Bank and another 60 attacks on health facilities in Israel.  

Added Zakaria, “the WHO surveillance system does not have a mandate to investigate attribution of attacks,” referring indirectly to critics who have said that some of the attacks on Gaza health facilities, attributed to Israel, involved misfired Hamas or Islamic Jihad missiles.  

The combined factors of displacement and crowded conditions, lack of adequate water and sanitation, and lack of medical capacity is leading to a rising level of respiratory and water-borne illness, meningitis, Zakaria added.

While humanitarian flows have increased, with a total of 3,000 aid trucks crossing into Gaza via Egypt’s Rafah cross since aid flows began in late October, “this is not nearly enough,” Zakaria said. 

“We needed 500 trucks per day. And even during the [humanitarian] pause only 220 trucks passed for one day to meet needs, we require more crossings,” she said, concluding that WHO is “glad to hear” that the Kerem Shalom border crossing between Israel and Gaza may reopen for humanitarian convoys.  

Scenes of devastation seen first-hand

Gaza City is “utter devastation” says the WHO Representative Rick Peeperkorn.

Speaking from Gaza, WHO representative to the Occupied Palestinian Territories, Dr Rick Peeperkorn, described the “scenes of utter devastation,” he had observed during his mission Saturday to Al Ahli Baptist Hospital, located in the epicentre of Gaza’s most war-battered northern district, which Israel now largely controls. 

“Gaza City has changed beyond belief,” Peeperkorn reported. “It’s utter devastation. It’s like a wasteland, even though there are still many people, children, old men and women around. There are not only patients in the wards, but also in the library, and even the church is crowded with patients on the floor, on stretchers, on chairs. 

“Having worked for more than seven years in Afghanistan, I’ve seen some grim situations.  I’ve never seen this before,” he said, describing doctors forced to perform amputations on wounded Palestinians because they lack the necessary surgical capacity, equipment and medicines to otherwise save the limbs. 

Palestine health minister: Israel targeting ever aspect of life in Gaza 

Palestinian Health Minister, Dr. Mai al-Kaila

Palestinian Health Minister Dr Mai el-Kaila, described the situation as an “unparalleled humanitarian catastrophe that defies international law and shatters the very sense of our shared humanity.”

“Israeli military occupation forces have relentlessly targeted every aspect of life in Gaza, sparing no one – from women, children, and disabled individuals to schools or hospitals, shelters, facilities and ambulances,” said el-Kaila, speaking from Ramallah, the seat of the Palestinian Authority, which has rallied to the side of its rival, Hamas, in the Gaza emergency. 

“Even the so-called safe corridors have not been spared, resulting in the loss of hundreds, of thousands of severe injuries, to forcibly displaced individuals,” el-Kaila said.  

She noted the risks posed by the degraded sanitary conditions where 160 people, on average,  share the same toilet and 700 people share a single shower.  

 “Some 400 tons of garbage per day are accumulating,” she noted, and “medical waste at hospitals is not removed. These factors lead to increased public health threats.

She called for the “unconditional and immediate entrance of humanitarian aid including food, water and medical supplies”; cessation to the “targeting [of] essential services such as health facilities, medical personnel, water, electricity and emergency services,” and a broader UN enquiry into the conduct of the war. 

“The international community must end impunity for Israeli occupied forces, and call the perpetrators accountable for the brutal actions and crimes. Now is the time for this action;  the word cannot stand neutral while innocent lives are lost and the basic rights of the Palestinian people are compromised,” she said. 

Israel: Hamas broke the ceasefire on 7 October 

Israeli Ambassador to the UN in Geneva, Meirav Eilon Shahar

Meanwhile, Israeli Ambassador to the UN in Geneva, Meirav Eilon Shahar, denounced what she described as the double standard being displayed by many countries, when it comes to Israel. 

“Today’s session is the only session ever convened here in Geneva on a specific conflict,” she said. “No special session was called on the health situation in Syria, Yemen, Sudan or many other situations. Did the victims of these conflicts matter less or does the world play by a different rulebook when it comes to Israel?” she asked. 

“The reality  is that on October 6, there was a ceasefire with Hamas. On October 7, we woke up to a new reality when thousands of terrorists entered Israel and systematically tortured and mutilated, murdered women, men and children on an unimaginable scale. 

“They entered with one directive, spare no one, capture innocent people, rape women and girls. They directly targeted Israeli medical personnel, first responders. More than 240 people were taken hostage and 137 still remain in Gaza, including 11 months old Kfir Bibas, and his four-year-old brother, Ariel. 

“Since October 7 over 11,500 rockets have been fired indiscriminately at Israeli cities, and this continues every day, hitting hospitals, schools and residential buildings.  In response to October 7, Israel declared war on the terrorist organisation Hamas. Our operation is directed towards Hamas. It has never been against the Palestinian people. 

“I recognise the suffering in Gaza. Let there be no mistake. However, Hamas is responsible for this suffering… Israel is operating against the terrorist organisation, which operates from within, underneath, and adjacent to hospitals, schools and UN facilities. 

The Israeli ambassador also called out WHO: “Even after the scope and scale of Hamas brutality was exposed on October 7, many in the international community, including the World Health Organization, continue to give Hamas a massive free pass. WHO has shamelessly reiterated that it only knows what is happening above ground in the Al Shifa Hospital and not what is happening below…

“If this EB session serves any purpose, it will only encourage Hamas actions,” she concluded. “It  gives them a green light to use Gazans as human shields… It is a reward for Hamas disdain for the sanctity of human life. If we stop now, Hamas will carry out another October 7. They say so publicly….  This is the reality that the [EB] decision … will blatantly ignore.”

Cuba denounces alleged Israeli ‘war crimes’  

Responding to Israel’s remarks, Palestine’s Ambassador to the UN in Geneva, Ibrahim Khraishi, denied Israeli reports of Hamas missile misfires on Gaza hospitals, and Hamas tunnels and weapons caches in and around health facilities, homes and schools as “lies.” 

But he contended that Israel’s position in the conflict was not parallel to that of the Palestinians in any case. 

 “It all comes down to self determination and self-defence,” Khraishi said. “Self defence does not exist for Israel because it is an occupying power.”

During the hours’ long debate, over two dozen other nations, including India and Pakistan, Malaysia and Turkey, South Africa, Namibia and Angola, and states across the Middle East and North Africa, weighed in on the conflict, mostly focusing on Israel. 

Said South Africa, “These developments tragically form part of an ongoing pattern of over 75 years of oppression, occupation and conflict.” 

Cuba described the Israeli military actions as “genocide and a crime against humanity.”

“Namibia is deeply concerned over the increasing escalation of violence and the collective punishment of the Palestinian people by the occupying forces,” said Namibia’s delegate to the special EB session. “Basic infrastructure like housing have been reduced to rubble… The cutting of basic utilities has been weaponised to inflict further suffering on top of the bombs and bullets – and the insecurity of civilians being ordered at short notice from one place to the other, none of which are suitable for human habitation.

“But the gathering momentum is undeniable,” the delegate added, of the global political pressure being applied on Israel. “It is Namibia’s hope, having lived under similar conditions as the Palestinians are currently enduring, that justice will manage to prevail.”

US: Hamas has further genocidal intentions 

US Ambassador to the UN in Geneva, Bathsheba Nell Crocker in the 10 December EB debate over the Gaza humanitarian crisis.

Meanwhile, the US and Canada, as well as European countries such as Germany, Denmark and Paraguay, expressed varying levels of dismay, in turn, over what they described as insufficient criticism of Hamas actions in the WHO resolution. 

“We agreed not to block consensus on the text, but we do not agree with preambulatory  paragraph 8,” said US Ambassador to the UN in Geneva, Bathsheba Nell Crocker. She stressed that calls for a cease-fire,  “are not only unrealistic but dangerous. A ceasefire would simply leave Hamas in place and able to regroup and repeat what it did on October 7. Hamas does not dispute this.” 

Added the US in closing remarks: “Hamas actually does have genocidal intentions against the people of Israel, and have said so explicitly, that they would like to see Israel wiped off the map.”

Said Denmark, “We regret the resolution was not more balanced on the matter of hostages and the use by Hamas of hospitals as shields.”    

Added Germany, which described itself as the world’s largest donor to the Gaza emergency response: “Like any other state, Israel has the right to defend itself in accordance with obligations under international law.

“Hamas must unconditionally and immediately release all hostages and stop its rocket attacks, and refrain from using civilians as well as civilian infrastructure for military purposes, especially medical infrastructure, like hospitals or ambulances. We do regret that these aspects are not reflected in the current resolution.” 

Tedros’ conclusion: The medicine most needed is hope 

Despite the bitter polarisation seen, the WHO governing body remains the first in a UN fora to have made a consensus statement on the crisis, said Tedros in closing remarks following the vote by the 34-member body. But no resolution by the global health body can really address the deeper roots of the conflict, which are fuelling the crisis, he stressed. 

“I understand Israel’s need to protect it’s people from further and future attacks, and to live in peace and security,” Tedros said. 

“And I likewise understand the need of the Palestinian people to live in peace and freedom. 

“We must continue to believe that these are possible and not mutually exclusive.

“As always, the medicine that the people of Israel and the occupied Palestinian territory needs the most is not one we can deliver in a truck, or administer in a syringe.

“It’s the most precious medicine and often the most rare: hope.”

Image Credits: WHO report to the Executive Board , WHO/EMRO .

14 June 2010 – Dhaka, Bangladesh – A mom and her new born baby at the Maternal & Child Health Training Institute for medically needy in Dhaka: Maternal mortality ratio remains a very serious concern in Asia and the Pacific – especially in South and South-West Asia, which has one third of the world’s maternal deaths. Only 5% of births in Nepal and 19% in India were attended by skilled personnel in 2006. (UNESCAP 2009)

Postpartum haemorrhage (PPH), a blood loss of 500 ml or more within 24 hours of birth, is the leading cause of maternal mortality worldwide, according to the World Health Organization. Around 14 million women die a year, said Metin Gülmezoğlu, executive director of the Concept Foundation. Yet, PPH is mainly preventable. Some 99% of PPH deaths have been eliminated in high-income countries, and 99% occur in low- and middle-income countries – specifically in sub-Saharan Africa and South Asia.

Why do we have these deaths in 2023, and what can be done to prevent them?

This was the topic of a recent Geneva Graduate Institute/Global Health Centre event: “Dying for Life: Are Mothers Still a Global Health Priority?” The November 27 event was moderated by Claire Somerville, director of the Geneva Graduate Institute’s Gender Centre.

Gülmezoğlu said that there is a general lack of research and development around new solutions for PPH, in addition to a challenge of being able to implement the results of those studies that do happen in lower-income countries where women may be giving birth outside of hospitals or other traditional healthcare facilities. According to Gülmezoğlu, countries sometimes do not have up-to-date guidelines nor sufficient political support to fund them. Other times, the challenges are related to pharmaceuticals around adequate supply chain systems and quality issues.

Postpartum Haemorrhage: The role of gender inequality

There is also a question of whether the situation would be different if it were men, not women, who were dying from PPH. Gülmezoğlu said that “the issues of maternal health, contraception and safe abortion are rarely just issues of health or clinical care. They have very strong relations with access to health care, inequalities, and specifically gender inequality.”

“I suppose if this had been an issue that impacted men more broadly, or more directly, that it might be prioritised differently,” said Shirin Heidari, a senior researcher in the Gender Centre of the Geneva Graduate Institute and Founder and director of GENDRO. She said that while there is no way to prove that the situation would be different if this were a male versus a female issue, “there are indications that that would be the case. You wouldn’t speculate looking back at the history of medicine, research, and broader health agenda. We have seen a trend that issues that are related to women’s health and women’s rights have often slid down in the global health priority agenda.”

She quoted Prof Mahmoud Fathalla, who passed away earlier this year: “Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.”

However, Heidari noted that in more recent decades, women’s rights and health have gained more significant and broader attention.

PPH roadmap aims to fast-track progress toward Sustainable Development Goal target 3.1

To that end, the WHO recently completed a roadmap to combat postpartum hemorrhage between 2023 and 2030. More than 130 stakeholders developed the roadmap, which includes four strategic areas: research, guidelines, implementation and advocacy, explained Femi Oladapo, head of the Maternal and Perinatal Health Unit in the WHO’s Department of Sexual and Reproductive Health and Research, who also spoke at the event.

Specifically, the roadmap aims to fast-track progress toward Sustainable Development Goal target 3.1: To reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

The WHO stated that the roadmap is designed for key figures in public health and all parties involved in the broader maternal and child health ecosystem. This includes the global community, funding entities, researchers, innovators, industry representatives, professional associations, guideline developers, health ministries, and, importantly, the general public, focusing on women.

“Postpartum haemorrhage is something everybody wants to do something about. So, it wasn’t really difficult finding the audience and attracting people around the table,” Oladapo said. He said that the team followed the traditional WHO process of engaging stakeholders, prioritising issues, and building consensus to make the roadmap. The WHO developed an 18-person steering committee that was geographically- and gender-balanced, as well as included people with expertise from various sectors: innovators, NGOs, advocates and more.

“We made sure that everybody’s voice who needed to be there was around the table from the start,” Oladapo said. In addition, surveys, work groups and virtual meetings culminated in a three-and-a-half-day in-person event in March in Dubai.

“Even after the summit, we continue to engage regularly,” Oladapo added, noting that the roadmap does not belong to the WHO but is a roadmap that was done for all key stakeholders and that holds multiple people and entities accountable.

“We set up an accountability platform where you can see all of these key activities or milestones from now to 2030,” Oladapo described. “There is a call to action in the last chapter of the roadmap that calls on different stakeholders” – women, women’s groups, civil society organisations, professional associations, the research community and the government. “There’s something for everybody to do, and there’s a separate chapter on calls to action, on what each group should do to ensure that the goals of their roadmap are realised.”

Mamtesh, 24, has just given birth to a healthy daughter. Nearly three years ago, Mamtesh suffered antepartum haemorrhaging during her first pregnancy and her son passed away shortly after birth. This pregnancy and delivery, which took place in a government hospital, had no complications. She is happy with the hospital and the normal delivery.

‘Ministries of health have a central role to play’

Oladapo also stressed that politics plays a crucial role in ensuring the roadmap’s success and women’s health in general. He said it is also funded in countries where maternal health is prioritised, and health outcomes improve.

“Ministries of health have a central role to play,” Oladapo stressed. “So, in the development of the roadmap, we brought [representatives] around the table” from around 20 ministries of health.

These ministries are critical, for example, in ensuring research is funded and in building the infrastructure to allow for innovations. Moreover, sometimes, there is a disconnect between global evidence-based recommendations and what people are doing on the ground, and the ministries can play a central role in terms of the adoption and adaption of these recommendations, as well as ensuring that staff – at least at the hospital level – are adequately trained.

“In Nigeria, there are no user fees for maternal health, and maternal mortality has plummeted,” according to Oladapo. “In other places, where you have to pay for every little thing, women continue to die. So this is all within the hands of the ministry.”

Image Credits: UN Photo/Kibae Park/Flickr, Children's Investment Fund/Flickr .

From left to right: Martin Raiser, World Bank Vice President for South Asia, Dr Farhna Ahmed, Secretary, Ministry of Environment, Forest and Climate Change and Anna Wellenstein World Bank Regional Director, Sustainable Development, East Asia and Pacific

Air pollution and climate change have never received as much combined attention, at such a high level, as at COP28 in Dubai. The UN’s 28th Conference of Parties on climate change has seen top-level participants from the World Health Organization (WHO), the UAE presidency, and noted expert bodies discuss the estimated 7-8 million deaths annually linked to air pollution.

The nexus of air pollution and climate change is also receiving increasing attention in the development sector, as evidenced by a World Bank-hosted discussion on Friday featuring top officials from China and Bangladesh.

At the event, Zhao Yingmin, China’s Vice Minister of Ecology and Environment, described how the country has reduced the most health-damaging pollutant, PM 2.5, by as much as 55% in the past decade in prefecture-level cities across the country, administrative centers that rank second only to provincial capitals.

He and other officials at the event emphasized how China’s experience could serve as an inspiration for South Asian countries currently grappling with some of the world’s highest pollution levels.

South Asia’s air pollution claims two million lives annually

Zhao Yingmin, Vice Minister at China’s Ministry of Ecology and Environment, and Dr Farhna Ahmed, Secretary of Bangladesh’s Ministry of Environment, Forest and Climate.

Excessive air pollution across South Asia is estimated to cause the deaths of approximately two million people each year, making it one of the most polluted regions worldwide. The region is home to 37 of the 40 most polluted cities in the world.

In densely populated areas of the Indo-Gangetic Plain, which stretches from Pakistan to Bangladesh and across the Himalayan foothills of southern Nepal, PM2.5 levels in many locations exceed 20 times the World Health Organization’s recommended annual guideline of 5 micrograms per cubic meter of air (µg/m3).

World Bank Vice President for South Asia Martin Raiser highlighted the potential “triple wins” of reducing annual air pollution levels to the World Health Organization’s interim air quality target of 35 µg/m³ of PM2.5.

These benefits include a 25% reduction in emissions of CO2, carbon dioxide, and methane, a gas 28 times more potent than CO2 in terms of its global warming potential. Additionally, emissions of black carbon, another short-lived climate pollutant that accelerates Himalayan glacier melt, would be reduced by 80%. Furthermore, methane emissions could be further reduced by 25%.

“These are huge co-benefits and create a great potential for triple wins,” said Raiser. “The challenge is that to address the issue of air quality we need to work on several sources of pollutants at the same time.”

Chinese Vice Minister: How we cut air pollution

Air pollution over Shanghai, China.

China’s experience in curbing air pollution can serve as an inspiring example for other Asian nations, according to Zhao.

Zhao attributed China’s success to a multi-pronged approach implemented systematically across various sectors, including industry, transportation, and building heating and cooling.

He highlighted the replacement of old coal furnaces with energy-efficient electric heat pumps, often augmented by natural gas when economically viable, as a key strategy in the residential sector.

The World Bank also played a significant role in catalyzing early action, providing China with a $1 billion loan a decade ago to address air pollution in Beijing.

“With a modest public investment, we discovered that they could leverage more from the private sector,” Zhao noted.

Cooperation on air pollution mitigation can lower costs 

Air pollution knows no borders, making both urban-rural and regional cooperation crucial to addressing the issue, the World Bank’s Raiser stressed.

Last year’s “Striving for Clean Air” report identified six key South Asian airsheds and developed scenarios for reducing average PM 2.5 levels to the World Health Organization’s interim air quality target of 35 µg/m³.

The report found that full coordination between Pakistan, India, Nepal, and Bangladesh would significantly lower the costs of achieving this target compared to scenarios where countries act independently.

In the best-case scenario, the cost per 1 µg/m³ reduction in average PM 2.5 levels would be $278 million. However, if countries were to act alone, costs could double or even increase tenfold, reaching $780 million to $2.6 billion per 1 µg/m³ reduction.

Dr. Farhana Ahmed, Secretary of the Ministry of Environment, Forest and Climate Change in Bangladesh, called for a deepening of regional cooperation among South Asian countries to tackle air pollution.

“We all know air pollution travels long distances, crossing national boundaries and multi-country actions are extremely important in the region,” said Ahmed. “We should encourage all the countries in the region (South Asia) to enhance knowledge sharing and good practices and exchange appropriate technical know-how.”

In 2022, the “Kathmandu roadmap” was developed to outline a plan for cross-regional cooperation between India, Pakistan, and Nepal. However, India’s Environment Minister Bhupender Yadav, who was originally scheduled to attend the World Bank discussion, did not participate. Officials at the India pavilion attributed his absence to bilateral meetings.

Despite this, India is making some progress in addressing air pollution. According to a report released today by Climate Trends and the Centre for Financial Accountability in New Delhi, 100% of project finance loans in India in 2022 went to renewable energy projects, while no such loans were provided for coal projects.

“Project finance” refers to loans typically granted by governments and others for the development of a specific project and does not include equity or corporate finance. The report’s findings do not mean that new coal power projects were unfunded by other lenders, namely equity or corporate entities.

The total amount of $2.36 billion for renewable energy finance in India represents a 45% decrease from 2021 levels, according to the report.

Finance has been one of the operative words of COP28, with over $83 billion pledged in the first five days for climate action, according to the UAE presidency.

While there are no specific funds earmarked for air pollution, per se, which is typically emitted by the same sources as climate pollutants, commitments to areas such as health, clean cooking, and renewable energy, should yield air pollution co-benefits.

‘Hard part’ of COP28 begins

As COP28 enters its final days, negotiators are entering the “hard part” of the climate summit: grappling with the critical issue of phasing out fossil fuels.

COP President Dr. Sultan Al Jaber has appointed eight ministers to facilitate consensus-building in the final stages of negotiations.

“Over the next 48 hours, this team will play a crucial role in helping bring this COP to consensus around the Global Stocktake and all other mandates as part of the agenda,” Al Jaber stated. 

The possibility of a fossil fuel phase-out being included in the outcome text from COP28 has panicked oil and gas producers. A letter leaked to the Guardian on Friday showed OPEC Secretary-General Haitham Al Ghais calling on the cartel’s member states, including COP hosts UAE, to “proactively reject any text or formula that targets energy, i.e. fossil fuels, rather than emissions”.

Ghais described the need to oppose language on the phase-out of fossil fuels as a matter of the “utmost urgency”, adding: “It would be unacceptable that politically motivated campaigns put our people’s prosperity and future at risk”.

UN Climate Executive Secretary Simon Stiell acknowledged the tension surrounding fossil fuel language, stating, “We will make sure every country has a seat at the table and can use their voices. I don’t want to see diversions and political tactics that hold climate ambitions hostage.”

The opening day of the climate summit saw more than 100 countries back a complete phase-out of fossil fuels. As COP is a consensus-based forum, far more will be required to push a final deal over the line.

COP28 concludes on December 13, but past conferences have often gone into overtime to achieve consensus. The outcome texts from previous UN climate summits have to date fallen far short of the action required to limit global warming to the Paris Agreement target of 1.5°C above pre-industrial levels.

Failure to reach this target could have devastating consequences, far surpassing the current impacts of 1.2°C warming. Alok Sharma, president of COP26 in Glasgow, warned that a failure at COP28 will “push the world into climate breakdown.”

“We are literally in the last chance saloon to save our children’s future,” Sharma told the Observer in an interview on Friday. “If you’re going to keep 1.5C alive, you’re going to have to have language on a phase-out of fossil fuels.”

“The language needs to be unequivocal,” he said. “So that anyone who reads the agreed language completely understands that what we’re talking about here is a phase-out of all fossil fuels.”

Image Credits: Photologic.

Child receiving a WHO-recommended hepatitis B vaccine

The Board of Gavi, the Vaccine Alliance has approved the establishment of a new African Vaccine Manufacturing Accelerator (AVMA), a financing instrument that is to make more than $1 billion available to support sustainable vaccine manufacturing in Africa.

The board decision marks a historic reversal of past efforts which saw the agency’s massive budget for vaccine procurement concentrated on the biggest pharma manufacturers in Asia, Europe and the Americas who could offer the lowest price-per-dose on vaccines Gavi procured due to economies of scale.

While such an approach may have seemed cost-efficient a decade ago, it also reinforced a concentration of vaccine production in certain regions of the world – and amongst a few key vaccine producers, leaving little space for new omers. That, in turn, left Africa high and dry when the COVID pandemic created a worldwide demand for a new vaccine, which only one or two South African manufacturers had the expertise to produce.

At a two-day meeting this week in Accra, Ghana, the Gavi board also agreed to set up a new $500 million First Response Fund to ensure immediately available financing for the procurement of novel vaccines, in the event of a future pandemic.  The lack of available funds, up front, also pushed the Gavi-backed COVAX vaccine facility to the back of the line of COVID vaccine procurement as rich and middle income countries lined up to stock national supplies in the first months after COVID vaccines became available.

New initiatives launched – but must be sustained

Since COVID, around 30 new vaccine initiatives have been announced on the African continent, involving  various aspects of late stage R&D, active ingredient manufacturing and fill-and-finish.  But sustaining those new efforts requires continued support and investment by national governments, research coommunities, multilateral agencies – and most of all vaccine buyers.

Around 30 investment initiatives for vaccines manufacturing in Africa have been announced since COVID-19.

“Gavi, as one of the largest purchasers of vaccines in the world, is thus sending a powerful signal to global markets that it will support African vaccine manufacturing,” said the agency in its  statement on the board decision.

“AVMA aims to make up to US$ 1 billion available to manufacturers at key moments in the development process as a way of helping offset high start-up costs and provide assurance of demand. By focusing on “priority” antigens, product profiles, and vaccine platforms, as well as constructing clear incentives for both “fill and finish” and drug substance production, AVMA will also support global vaccine markets by targeting clear unmet needs and help establish a thriving, sustainable, end-to-end African vaccine manufacturing ecosystem.”

African public health officials welcomed the move.

“Gavi, the Vaccine Alliance’s AVMA proposal has the potential to be a major step in the right direction and a powerful signal to other donors and investors that African vaccine manufacturing has a bright future,” said the African Vaccine Manufacturing Initiative (AVMI) of the new Gavi platform.

“Lessons from the pandemic have highlighted the need to put vaccine equity at the heart of pandemic preparedness, prevention and response.”

“A strong #AfricanVaccineManufacturing Industry is an opportunity, not a threat,” added Africa Centers for Disease Control in a post on X (Twitter).

https://twitter.com/AfricaCDC/status/1732660651447685226

Image Credits: Dilemma Online/Twitter .

WGIHR starts its sixth meeting on 7 December.

A single oversight and compliance body may be set up to oversee both the new pandemic agreement and the amended International Health Regulations (IHR), according to  Dr Ashley Bloomfield, the co-chair of the Working Group on Amendments to the International Health Regulations (WGIHR).

Bloomfield was responding to a question about whether his group had discussed independent monitoring from Dame Barbara Stocking, chair of the Panel for a Global Public Health Convention, at the start of the WGIHR’s sixth meeting on Thursday.

Several civil society groups have called for independent oversight of the implementation of the pandemic agreement currently being negotiated by the intergovernmental negotiating body (INB) and the amended IHR.

Stocking reiterated the need for “independent assessment in both the IHR and any new treaty” because of a lack of trust between countries, as well as between citizens and governments.

“Having independent assessment is a really important way of actually making sure that there is trust in what is being done, and what is being said to be done,” said Stocking.

“We’re very aware of the importance of this issue of compliance, oversight and monitoring, including what independent monitoring might look like,” responded Bloomfield, who said that the WGIHR and the INB were first considering existing monitoring arrangements such as the independent oversight and advisory committee set up by the WHO Director-General.

Bloomfield added that the issue was featured in a new article in the IHR (Article 53) and well as in Article 54.

“Likewise, there are relevant provisions in the draft INB agreement that were discussed over the last few days,” said Bloomfield, who attended this week’s INB meeting as an observer.

“All these matters are ones that we will be considering within our individual processes, but I can say that there are already informal discussions happening about how a future oversight and compliance arrangement would be constructed that takes into account both processes.” 

He later added that there was considerable overlap between the two groups on financing and there could be a joint process on that too.

Civil society concerns

Meanwhile, other civil society organisations also raised their concerns at the open plenary of the WGIHR. 

The World Trade Organization (WTO) offered its technical expertise and experience to the WGIHR on proposed amendments that “address topics with trade-related elements” such as open supply chains, trade restrictions, unnecessary interference with international traffic and trade, the transfer of technology and know-how and to develop and diversify manufacturing capacity. 

“We have a shared interest in promoting synergies and coherence across our organisations and our legal instruments. To this end, we would welcome the opportunity to collaborate with the WHO on the development and implementation of an international pandemic response as mandated by our ministers last year,” said the WTO.

Jamie Love of Knowledge Ecology International (KEI).

Jamie Love of Knowledge Ecology International reminded the group that the WHO had adopted a resolution at the World Health Assembly in 2019 (WHA78) “on improving the transparency of markets for medicines, vaccines and other health products”. 

“Among the measures we hope can be reflected in future revisions of the IHR are measures to implement the transparency obligations in WHA78, including but not limited to those relating to the transparency of prices and units sold for countermeasures, and the transparency and collection of data on R&D subsidies, patent landscapes, and the outcomes and costs and subsidies relating to relevant clinical trials on countermeasures,” said Love.

Noting that cancer treatment was disrupted during pandemics, the European Society of Medical Oncology urged member states to “support amendments to the IHR which would build, develop and maintain health systems capacities at secondary and tertiary care levels to avoid leaving millions of patients with cancer behind in times of health emergencies”. 

Mohga Kamal-Yanni for Oxfam and the People’s Vaccine Alliance

Mohga Kamal-Yanni for Oxfam and the People’s Vaccine Alliance appealed for  “practical measures to operationalize equity of access to pandemic-related products”.

Grega Kumer of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  called for three measures to “modernise” the IHR: “One, raising the alarm early by ensuring the rapid sharing of outbreak information and immediate access to pathogens and genetic data. 

“Two, enabling the innovative ecosystem including protection incentives on IP to reinforce the pipeline for needed medical countermeasures, and third, fostering multi-stakeholder partnerships and dialogue, including with private sector, to ensure balanced and implementable approaches.”

WGIHR progress

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah Assiri.

Meanwhile, WGIHR Co-Chair Dr Abdullah Assiri reported that two inter-sessional activities have been held since the group’s last meeting in mid-November. 

“The first was an informal consultation on Article 44 and 44 A, Annex One and 10,” said Assiri. 

“The second was the joint INB-WGIHR briefing on the public health alert system [known as the public health emergency of international concern], the pandemic continuum, including definitions, criteria and the process for determining each.”

The Bureaus of the INB and the WGIHR have also held two joint meetings. The first (25 October), discussed financing mechanisms and preparations for the joint INB-WGIHR briefing. The second (6 December) continued discussions on “key areas of overlap between the two processes, particularly financing, surveillance and prevention, including One Health, capacity building and know-how”, said Assiri.

Bloomfield described Wednesday’s joint meeting with the INB Bureau as “very helpful” in enabling the two bodies to “really think further about how we progress with the work, and where there are overlaps between our two processes”. 

“I’ve certainly found it useful to be in the room during the INB meeting over the last three days and other members of our Bureau were also able to listen into those discussions as well.”

INB update

The INB ended later than anticipated on Wednesday night so its public report-back was perfunctory. 

However, INB co-chair Roland Driece reported on Wednesday that the body had established four drafting subgroups: one on prevention, surveillance, preparedness, readiness, and One Health (Articles 4, 5 and 6 of the negotiation text);  the second on sustainable production and technology transfer (Articles 10 and 11 and possibly 13); the third on access and benefit sharing (Article 12) and the fourth subgroup on financing and capacity building (Articles 19 and 20). 

These drafting subgroups held inter-sessional meetings in November and early December, and the drafting group completed a review of the proposal for negotiation text. The next INB meeting is scheduled for 19 February to 1 March 2024. 

Meanwhile, Bloomfield noted that financing is “an area where there is clearly a lot of overlap and common interest between our two processes”.

“So we will be canvassing [member states’] views on how we might progress that area of financing in a joined-up way to make sure that we coordinate and are coherent across the two processes,” said Bloomfield.