A technician weighs cannabis buds.

Cannabis should be avoided during adolescence and early adulthood; in pregnancy, by people prone to mental health disorders and while driving, according to experts in a study published in The BMJ on Thursday.

Cannabis contains over 100 cannabinoids, of which tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most clinically relevant. THC can induce a psychoactive “high” and can foster dependence, as well as other adverse psychiatric health effects.  Conversely, CBD has certain anti-psychotic and anti-anxiety properties and one purified form, Epidiolex®, has even been approved by the FDA as a medication for certain forms of epilepsy.

The BMJ study confirmed that CBD is indeed effective in helping people with epilepsy, while some cannabis-based products containing THC can help ease multiple sclerosis, chronic pain and inflammatory bowel disease in affected adults.

The researchers based their findings on 101 meta-analyses on cannabis and health conducted over 20 years (2002-2022), grading evidence as high, moderate, low, or critically low certainty in randomised trials – and as convincing, highly suggestive, suggestive, weak, or not significant in observational studies.

“An increasing number of studies have examined the effects of cannabinoids on health and other outcomes, but most findings are observational and prone to bias, making it difficult to draw firm conclusions,” according to the BMJ in a media release.

“To address this, an international team of researchers set out to assess the credibility and certainty of over 500 associations reported between cannabis and health in 50 meta-analyses of observational studies and 51 meta-analyses of randomised controlled trials, pooling data from hundreds of individual studies.”

Increased risk of psychosis

There was an increased risk of psychosis associated with THC-containing cannabis in the general population, particularly in adolescents, and with psychosis relapse in people with a psychotic disorder.  

The researchers also found an association between cannabis and depression and mania, as well as detrimental effects on memory, and verbal and visual recall.

Observational evidence suggested a link between cannabis use and motor vehicle accidents, while pregnant women who used cannabis use had an increased risk of having a small, low birth weight baby.

Cannabis-based medicines were, however,  beneficial for pain and muscle stiffness (spasticity) in multiple sclerosis but increased the risk of dizziness, dry mouth, nausea and drowsiness. 

For chronic pain, cannabis-based medicines reduced pain by 30%, but increased psychological distress. 

For cancer, some cannabinoids reduced sleep disruptions but resulted in increased gastrointestinal events.

Cannabidiol (CBD) was, on the other hand, beneficial in reducing seizures in certain types of epilepsy, particularly in children – but came with an increased risk of diarrhoea.

Weak evidence

This umbrella review is the first to pool observational and interventional studies on the effects of cannabinoids on humans, but the researchers note that most outcomes associated with cannabinoid use are supported by weak evidence, have low to very low certainty, or are not significant.

They also point to other limitations in the study, particularly the wide variations in the make up of cannabis products, such as the proportion of psychoactive THC. Additionally, not all individuals will experience the same effects of cannabis on their mental health and cognition.  And randomised trials might not be representative of the real-world population. 

Nevertheless, the researchers conclude that law and public health policymakers and researchers “should consider this evidence synthesis when making policy decisions on cannabinoids use regulation, and when planning a future epidemiological or experimental research agenda.” 

Millions are addicted

According to the Global Burden of Disease 2019 study, around 24 million people worldwide are addicted to cannabis, particularly men and people in high-income countries. 

In Europe, over the past decade, self-reported use of cannabis within the past month has increased by almost 25% in people aged 15-34 years, and more than 80% in people aged 55-64 years.

The potency of cannabis has also increased in Europe, with the THC content associated with the ¨high¨ and subsequent adverse psychiatric increasing from 6.9% to 10.6% between 2010 and 2019.

Image Credits: Unslash.

climate emissions
Fossil fuels are the primary cause of the climate crisis. Governments are spending trillions every year to prop up their production.

Global fossil fuel subsidies surged to a record $7 trillion in 2022 – $2 trillion more than in 2020, the International Monetary Fund (IMF) has said in its 2023 report on fuel subsidy trends.

The increase comes despite the mounting damage being caused by climate change, and clear scientific evidence that phasing out subsidies would save millions of lives in the near term from air pollution, as well as from extreme weather over time.

The whopping $2 trillion subsidy increase over the past two years came as governments raced to protect consumers from the spike in energy prices caused by Russia’s invasion of Ukraine. The return of global consumption to pre-pandemic levels also contributed to the rise, the IMF said.

“As the world struggles to restrict global warming to 1.5 degrees Celsius and parts of Asia, Europe and the United States swelter in extreme heat, subsidies for oil, coal and natural gas are costing the equivalent of 7.1% of global gross domestic product,” IMF researchers said in a press release accompanying the publication of the report.

“That’s more than governments spend annually on education (4.3% of global income) and about two-thirds of what they spend on healthcare (10.9%).”

Direct tax breaks for fossil fuel production and use more than doubled

Explicit subsidies, which are direct payments or tax breaks to fossil fuel producers or consumers, have more than doubled since 2020 to reach $1.3 trillion. However, these subsidies still only make up 18% of the total, and are expected to decline as energy prices stabilise and the global economy continues its recovery from the pandemic, the IMF said.

The remaining 82% of fossil fuel subsidies are implicit, meaning they are not directly paid by governments. Instead, they take the form of undercharging for the environmental and health costs of fossil fuels, such as the damage caused by air pollution and climate change.

Underpricing for local air pollution and global warming accounted for nearly 60% of global fossil fuel subsidies in 2022, according to the report. These implicit subsidies are projected to grow in the coming years as developing countries increase their consumption of fossil fuels to match that of advanced economies, the IMF said.

Record government spending on fossil fuel subsidies is the support beam holding up the “pervasive underpricing” of fossil fuels around the world, the IMF said, with some 80% of coal and 27% of natural gas sold at below half their real cost. 

This underpricing leads to excessive consumption and emissions, which contribute to global warming and impact health. The report estimates that properly pricing fossil fuels would avert 1.6 million premature deaths from air pollution by 2030.

The International Monetary Fund (IMF) estimates that governments subsidized $5 trillion in environmental costs for fossil fuels last year. However, the report’s authors noted that other methodologies find much higher numbers. 

A recent study published in Nature put the total cost of fossil fuel subsidies at around $12 trillion, nearly doubling the IMF’s $7 billion estimate. If the numbers from the Nature study are correct, then governments spent more money on fossil fuel subsidies than on healthcare globally last year. 

Eliminating subsidies could slash carbon emissions by one third by 2030

The IMF estimates that eliminating subsidies and imposing corrective taxes that incorporate the cost of health and environmental costs of burning oil, gas and coal would slash global carbon emissions by 34% by 2030, just 12% shy of the target set by the United Nations to keep global warming below 1.5 degrees Celsius and achieve net zero by 2050.

The report found that fully reforming fossil fuel prices would also raise substantial revenues, worth about 3.6% of global gross domestic product (GDP).

Green investment push shows subsidies work – but must change direction

Protests for more climate action in Glasgow, Scotland outside of the COP26.

The role played by subsidies in encouraging the burning of fossil fuels has long been recognised by scientists, governments and international organisations. G20 governments committed themselves to eliminating inefficient fossil fuel subsidies all the way back in 2009 and reiterated this commitment a decade later at COP26 in Glasgow in 2021.

But these words ring hollow as G20 countries continue to lead the way in providing fossil fuel subsidies globally. China is by far the biggest contributor, with $2.2 trillion in subsidies, followed by the United States with $760 billion, followed by Russia with $420 billion, India with $350 billion and the European Union with $310 billion.

The World Bank said in July that these “toxic” subsidies are wreaking “environmental havoc” and called for the trillions of dollars subsidising fossil fuels to be redirected towards climate action.

“China’s dominant role in critical mineral processing is the result of decades of targeted industrial policy which has significantly subsidized domestic industry,” according to a recent report by the Aspen Institute.

The United States, China and the European Union, meanwhile, have put in place massive subsidy packages to incentivise green investments.

The Inflation Reduction Act passed by the Biden administration has made $369 billion in funding and incentives for clean energy projects in the country, leading to a windfall of nearly $300 billion in new green investments – from battery semiconductor manufacturing plants to solar and wind farms – in the United States in 2022.

The European Union is working on its own green finance package to lure similar investments to the bloc. China, which already has a sizeable edge in critical sectors of the green economy such as EV batteries, rare earth and critical mineral processing, and solar panels, is also in on the green race.

The race for green energy supremacy is already reshaping the global economy. Reworking the financing of fossil fuels on a similar scale might do the same.

Image Credits: Chris LeBoutillier.

A researcher working on an mRNA vaccine at Afrigen, South Africa’s mRNA hub.

The best way to pandemic-proof the world is through ‘last-mile innovation’ based on strong regional and subregional research and development (R&D) hubs that can tackle disease outbreaks before they become pandemics.

These hubs should be led by local scientists and have the capacity to adapt established technologies without intellectual property restrictions to produce vaccines, treatments and diagnostics to address threatening pathogens.

This is the argument put forward by a group of health experts in a paper published this week in The Lancet amid three separate global negotiations aimed at improving the world’s response to future pandemics.

They assert that there has been too much focus on building new vaccine manufacturing facilities in developing regions and argue that the Pandemic Fund and development banks could finance “R&D for the common good rather than just vaccine manufacture and distribution through a market approach”. 

“As we have seen again during COVID-19, a system that largely relies on market dynamics to drive the research, manufacture and marketing, results in highly inequitable access and preventable deaths, particularly in developing countries,” said co-author Dr Soumya Swaminathan, former Chief Scientist, World Health Organization (WHO).

“Our proposal, which centres on equity from the start, would give researchers from developing countries greater ability to quickly and collectively contribute to solutions to infectious outbreaks in their regions. When each region has that ability, all of the world is better protected from pandemic threats, which are only going to increase due to climate change.”  

Speed is essential

“Time and again, developing countries are left waiting for tools like vaccines developed by others, while wealthier countries produce and access them first,” said Helen Clark, one of the authors and former co-chair of The Independent Panel for Pandemic Preparedness and Response. 

“The deadly lessons from COVID-19 demand transformative change, starting with action to ensure that all regions have the technology and capacities required to develop products that stop outbreaks before they spread worldwide. That’s not only equitable, it’s strategic.”

Dr Els Torreele, the lead author, explained that “in outbreak control, speed and versatility are of the essence, so having the ability to rapidly adapt the most suitable existing technology to local needs is critical”.

“The opportunity for ‘last-mile innovation’ will let researchers develop and produce products people can use, where they live, for the outbreaks in their regions,” added Torreele.

Dr Amadou Sall, Director of the Institut Pasteur de Dakar in Senegal, added that “given available technologies and in the wake of a pandemic that has led to some 24 million excess deaths, there should be no question that we need a new model – one that fully empowers all regions to be self-reliant”.

“Many of these technologies have been available for decades now, and others have been developed with public funds. It’s time to make them available in Africa and on other continents,” said Sall, who is also a co-author.  

Sharing mRNA technology

Professor Petro Terblanche, who heads the WHO’s mRNA technology development and transfer programme in South Africa, explains that if, for example, mRNA technology is made accessible, “researchers can innovate and develop vaccines that address local or regional health needs and are suited to optimal delivery into local and regional health care systems”.

The authors also make a strong case for a common goods approach to R&D, in which the ownership and control over technologies that are critical for public health are governed collectively and in the public interest.  

They cite the CERN research facility in Europe, which is jointly funded by 23 countries, as an example of a sub-regional R&D hub. 

“The public sector is already investing billions in research, which is then often sold or handed out to the private sector who decide whether or not to develop products based on profit potential,” said Dr Joanne Liu, a Canadian paediatrician, former International President of Medecins sans Frontieres (MSF) and member of The Independent Panel.

“We’re saying, tools to protect lives and stop outbreaks from crossing borders must be common goods – and must and can be funded with that mindset.” 

Timely intervention

The authors’ call comes as the Intergovernmental Negotiating Body (INB) working on a pandemic accord is set to meet in Geneva next week to continue negotiations. Issues of equitable access to pandemic countermeasures are being negotiated in specific articles on research and development and on technology sharing and co-development, and are considered some one of the most difficult areas to solve. 

The G20 Health Ministers also recognised the need for “sustainable global and regional research and development networks to facilitate better access to VTDs (vaccines, treatments and diagnostics) globally, especially in developing countries” at its meeting last week.

Meanwhile, the United Nations High-Level Meeting on pandemics is set for 20 September in New York, and will adopt a political declaration mapping out how to address future pandemics.

Image Credits: Rodger Bosch for MPP/WHO, Kerry Cullinan.

WHO Director-General Dr Tedros Adhanom Ghebreyesus arriving at the 73rd meeting of the WHO Africa region.

After a two-week hiatus in negotiations, United Nations (UN) member states this week received a third draft of the Political Declaration being developed for the High-Level Meeting on Pandemic Prevention, Preparedness and Response on 20 September.

The declaration was supposed to have been finalised by early August and put under silence procedure but member states failed to agree on a number of clauses and negotiations were interrupted by the northern hemisphere summer holidays.

Last week, bilateral meetings resumed and sources told Health Policy Watch that member states finally received an amended draft this week.

Slow pandemic accord talks

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus expressed concern this week about the slow pace of negotiations on the pandemic accord, warning that it may not be completed by the May 2024 deadline.

“I’m concerned that negotiations are moving slowly and that the accord may not be agreed in time for next year’s World Health Assembly (WHA). I urge all member states to work with a sense of urgency with a particular focus on resolving the most difficult and contentious issues,” Tedros told WHO Africa’s regional meeting at its opening on Monday.

“This is a unique opportunity that we must not miss to put in place a comprehensive accord that addresses all of the lessons learnt during the pandemic with a particular emphasis on equity. This region has more to gain from a strong accord than any other so I urge you to continue engaging actively in the negotiations to make sure the needs and expectations of Africa are heard,” added Tedros.

The Intergovernmental Negotiating Body (INB) in charge of developing the accord to present to the WHA is set to meet again on 4-6 September.

Tedros also referred to the negotiations to amend the International Health Regulations (IHR) currently underway, describing the IHR as the “cornerstone of detecting and responding to disease spread internationally”.

“But as the COVID-19 pandemic laid bare, there are serious gaps in compliance and implementation which must be addressed. We need an IHR that’s fit for purpose,” said Tedros.

“The proposed amendments now being discussed by member states address many crucial areas including compliance, cooperation, and more efficient communication. We must learn the lesson of COVID-19, which is that global threats require a global response that is based on coherence and mechanisms for cooperation, rooted in solidarity and equity.”

The Working Group on IHR meets again on 2-6 October for the fifth time and is expected to debate the definition of a pandemic, amongst other issues.

“Crucially, the new global architecture cannot be designed, built or managed by those with the most power, money and influence. It must be designed, built and managed by all member states and partners in a truly inclusive process,” Tedros urged.

Dr Tedros addressing the opening of the 73rd WHO Africa regional meeting

Botswana’s approach to health is an example to the African continent, with strong leadership, investment in research and development and universal health services available for a nominal charge, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya was speaking on Monday at the opening of the World Health Organization (WHO) Africa regional committee meeting being held in Botswana’s capital, Gaborone.

“Botswana was the first African country to achieve 70% coverage of COVID-19 vaccines because of the strong leadership of the president and the allocation of adequate resources to procure vaccines,” said Kaseya.

“Its investment of 1-2% of its GDP to research and development is why Botswana is one of the leaders in the development of vaccines for animals. Knowing that the next pandemic will be a zoonotic one, it means that Botswana will play a key role in addressing this issue in Africa,” he added.

Africa CDC head Dr Jean Kaseya

Kaseya added that he was surprised to learn that Botswana’s citizens were able to “access to all the healthcare that they need” by only paying a 15-cent contribution for every dollar charged.

Kaseya said that Africa needed to prepare for the next pandemic by pushing local manufacturing of vaccines and medicines and ensuring there was “enough funding for pandemic prevention, preparedness and response”.

The African region had failed to submit a regional application to the Pandemic Fund, unlike the Caribbean, Asia and Latin America and needed to ensure it made an application during the next call for proposals to fund a joint emergency action plan, he added.

The WHO Africa region excludes some of the countries in the far north of the continent that associate more closely with Arab states and are part of the Eastern Mediterranean Region (EMRO).

HIV laboratory declared WHO centre of excellence

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyusus told the meeting that Botswana’s National HIV Reference Laboratory has been designated as a WHO Collaborating Centre of Excellence “in recognition of the laboratory’s excellence in the field of HIV diagnosis and the potential of deeper collaboration with WHO in advancing the health and well-being of people living with HIV”.

“In 2021, WHO certified Botswana for reaching the silver tier on the path to eliminating mother-to-child transmission of HIV. And in 2022, Botswana reached the 95-95-95 targets for testing, treatment and viral suppression of HIV, one of only five countries to do so,” said Tedros, referring to the targets of 95% for testing all people, putting 95% of those with HIV on treatment, and achieving viral suppression in 95% of people living with HIV.

“Botswana is a model to show anything is possible, added Tedros. Peace is possible. Stability is possible. Democracy is possible. Growth is possible, even to an upper middle-income country or even even higher. Africa can grow. Africa can be stable, Africa can be peaceful. Africa can be a democratic continent,” added Tedros.

Botswana has a small population of 2.6 million people and has made its wealth from minerals.

Urgency of universal health coverage

Matshidiso Moeti

WHO Africa Regional Director Dr Matshidiso Moeti, who hails from Botswana, also expressed pride in her country’s health milestones. 

“It is one of the countries where direct payments for healthcare is almost non-existent,” said Moeti. “With a minimal nominal contribution, people have access to everything that is available in the country and transferred outside of it [for other treatment]. It is an example of how to make sure that payments are not a burden to the customer. I’m very proud of this.

“We could take many examples and I’ll just cite a couple. For example, the mother-to-child transmission of HIV has been reduced to less than 5%, and Botswana has been the first high-burden country in the world to achieve this milestone.

“HIV transmission rates have fallen from 40% of the sexually active age group in 1999 to below 1% this year. What an achievement for a nation that once had the highest HIV prevalence rate in the world.”

In contrast to Botswana, Moeti pointed out that “public spending on health is low in the majority of our countries, and Africa is home to two of the three poorest people who pay directly out of pocket for their health care.” 

Meanwhile, Tedros said that every WHO member state needed to “radically reorient health systems towards primary health care as the foundation of universal health coverage”.

“Nowhere is more important than here in our continent. Across the region, hundreds of millions of people lack access to essential services or are pushed into poverty by catastrophe out-of-pocket spending. Closing these gaps must be top of the to-do list for every member state,” urged Tedros.

Climate change threat

Moeti and Tedros both urged African member states to take measures to mitigate the effects of climate change on their citizens’ health.

“We have seen Europe burn literally over the past few months. Here in our region, prolonged drought in the Sahel, and also in the greater Horn of Africa and cyclones in southern Africa have increased morbidity, mortality and human suffering,” said Moeti.

“These phenomena are taking a heavy toll on health services. We are working with partners to support our member states in their efforts to provide essential health and nutrition services to affected countries and communities.”

She said that an African regional initiative to combat the health consequences of climate change on the continent had been launched in May on the sidelines of the World Health Summit, while the Climate-Health Africa Network for Collaboration and Engagement (CHANCE) had been formed in 2021 to assist countries in southern and east Africa to address climate change.

Meanwhile, Tedros encouraged all African member states to participate actively at COP28 in the United Arab Emirates, which will feature a day dedicated to health for the first time.

“Health systems are increasingly dealing with the consequences of climate change in terms of communicable and non-communicable diseases, and the impacts of more frequent and more severe extreme weather events,” said Tedros.

WHO's New Leadership Team
The World Health Organisation is losing track of the evolution of COVID-19 as governments lose interest in reporting data about the virus.

Fewer than 20 countries worldwide still report COVID-19 hospitalization and ICU data to the World Health Organization (WHO), leaving the UN health body blind to the impact and evolution of the virus in most of the world, agency leaders said Friday.

The decline in data reporting is a major setback for the WHO’s efforts to track the pandemic. Without reliable data, the WHO cannot accurately assess the burden of disease, identify new variants, or target its resources where they are most needed.

“We don’t have good visibility of the impact of COVID-19 around the world,” said Dr. Maria Van Kerkhove, who leads the WHO’s COVID-19 task force. “It is really important that surveillance continues, and this is on the shoulders of governments right now.”

Out of the 243 countries and territories party to the WHO, the UN health body has data on cases for just 103 of those. Only 19 countries and territories continue to report hospitalization data, while just 17 report data on cases that end in the ICU. The number of countries reporting COVID-19 deaths has fallen to 54.

“While we are certainly not in the same situation that we were in a year ago or two years ago, SARS-Cov-2 circulates in all countries right now,” said Van Kerkhove. “It is still causing a large number of infections, hospitalizations, admissions to the ICU and deaths.”

The current set of dominant COVID-19 variants can still cause the “full spectrum” of disease, from asymptomatic infections to severe disease and death, Kerkhove said.

The continued circulation of the virus also puts individuals at risk of joining the millions of people around the world suffering from the effects of long COVID. Research into the prevalence of long COVID worldwide estimates the number of people affected as high as 65 million — likely a vast underestimate.

“COVID remains a global health threat, and data available to WHO continues to decline,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said at a media briefing on Friday. “We continue to call on all countries to strengthen surveillance, sequencing and reporting so we can assess the risk of new variants.”

Image Credits: Guilhem Vellut.

A health worker provides treatment to a malnourished child in Yemen.

For most people, electing the regional director – or chief health officer – for the Eastern Mediterranean Region (EMRO) of the World Health Organization (WHO) will not set the pulse racing.  Is this just another shuffling of chairs around the world’s bureaucratic table? Even among global health nerds, it will trigger just a faint tremor.

Yet the role matters to 22 countries spanning the Arab World from Morocco to the Gulf and extending across West Asia to Pakistan. They come together as the Regional Committee for the Eastern Mediterranean to select a new regional director on 10 October to helm the health aspirations of over 700 million hopeful people.

EMRO is one of six regional offices, the directors of which have almost complete authority for executing WHO’s health policies and programmes under its decentralised constitution.  

EMRO’s regional director election comes at a time of health’s increased geopolitical importance due to unpleasant global competition around the COVID-19 pandemic.  Today’s heavily securitised world has also realised that the might of nations is measured not just by guns. Healthy people make content, creative citizens and, ultimately, stronger nations.

EMRO’s life-and-death lottery

WHO EMRO is made up of 22 countries that differ vastly in income and health expenditure.

How is EMRO doing? Its people live 71.4 years, a little under the global average of 73 years. But this hides grave inequalities from Qatar’s 80 years to Somalia’s 55.4 years. Five other nations don’t make it past 66 years.  It is similar with maternal mortality: 620 Afghan women lose their lives for every 100,000 live births, compared to 223 globally. Kuwait does best with seven mothers’ deaths while seven countries are way off the SDG target of 70 maternal deaths per 100,000 live births by 2030.

Why does the region’s heath lag so far behind?  The main cause is that this is the world’s most conflict-torn corner, with two-thirds of its people directly and indirectly affected. Furthermore,  healthcare is brutally instrumentalised with facilities and workers attacked in Yemen, Syria, Iraq, Afghanistan and Pakistan.  Food has been denied in several conflicts with Sudan and Somalia generating starvation headlines and stratospheric malnutrition rates. 

Furthermore, glaring socio-economic gaps hallmark the region. Some of the world’s richest countries – Qatar, the United Arab Emirates (UAE), Saudi Arabia, Bahrain, Kuwait and Oman – are in the same administrative group as Pakistan, Palestine and Egypt, which barely get into the middle-income category, while others like Afghanistan and Yemen remain mired in abysmal poverty.   

This life-and-death lottery is detailed in WHO’s own health observatory, EMRO expends $669 per capita on health – half of the average global spending.  That is skewed further by profligate nations spending $1500-2500, masking other countries that spend less than $150 per person. 

Thousands of Somalis escaping drought and conflict are living in sprawling settlements on the outskirts of towns, like this one in Baidoa in south-central Somalia.

The new regional director needs courage

In such a diverse and divided region, the new regional director will have their work cut out. For starters, they must go courageously where others fear to tread and defend humanity by speaking out without fear or favour. But they must also be astute in walking the fine line between promoting health as a bridge for peace and over-politicising health’s humanitarian mission.

It is our human tendency to get de-sensitised to long-standing suffering and inequalities. Therefore, the incoming regional director will have to be super-human. They must feel stronger outrage about unfairness and injustice, possess greater compassion for misery, burn more intensely with urgency,  be smarter at delving into root causes and shine a brighter light on the path ahead.

Of course, these virtues are nowhere to be found in the sober language of the regional director’s job description. But they should be core considerations for EMRO member states. Can they rise above their usual politicking to unite for the collective good, knowing that the massive health risks they face know no boundaries?

They have six impressive candidates with a range of qualifications and experiences to choose from. Iraq has nominated pharmacologist Najim Abbas Jabir Al-Awwadi and Morocco has proposed former health minister Anass Doukkali. Pakistan has suggested health systems expert Abdul Ghaffar and Iran has put forward health policy professor Ali Akbari Sari. Sudan has nominated its goodwill health ambassador Ahmed Farah Shadoul and Saudi Arabia has proposed the sole woman, clinical and public health specialist Hanan Hassan Balkhy.  If elected, she would be EMRO’s first-ever female regional director, other WHO regions having passed that milestone earlier.

 Consolidation or change?

Whoever is elected, it is not too early to consider their desired legacy from a potential  5-10 years in office. Will they be a transformer or consolidator of business-as-usual?

The business-as-usual approach will see the incumbent – however technically proficient and managerially efficient  – see illusionary progress while presiding over strategic decline. To elaborate: even if the WHO/EMRO leadership does little, health indicators will continue to improve in most countries. Because, thanks to external stimuli, especially the private sector, they will get richer, stabilise some conflicts, improve governance here and there, expand key health capacities, and roll out new technologies wherever they prove useful. 

But such gains are threatened by bigger vulnerabilities. Climate change is heating the Mediterranean and the Middle East at twice the global average with devastating environmental and health impacts. Five of the 10 biggest disasters over the past two years were spawned here, including massive floods, droughts and earthquakes. 

In August 2022, massive floods in Pakistan displaced some 33 million people.

Some 127 million people – 37% of the world’s humanitarian caseload – come from this one region due to a combination of disasters, conflicts, and displacement. WHO’s middling performance on humanitarian assistance in this region needs urgent augmentation.

Concurrently, as the region ages, the burden from non-communicable diseases (particularly diabetes, cardiovascular and lung conditions and cancers) increases. Already 70-80% of deaths occur from NCDs. Other conditions such as substance abuse are surging.

Thus,  business-as-usual in EMRO implies regression. We already see this with continuing neglected tropical diseases such as leishmaniasis, and the emergence of new pandemic-potential agents such as MERS, or the re-emergence of old conditions such as tuberculosis and polio.  

Health systems are struggling in the Middle East and West Asia where health professionals are scarce in poor countries and, although sufficient in the rich ones, skewed towards specialised hospitals. Universal health coverage (UHC), the aspiration that all should receive quality healthcare without personal financial hardship, is still a dream when nearly half the population don’t access 16 essential services.

Healthcare demand will always outstrip provision and traditional health system mantras can never catch up. Will WHO EMRO’s new leader be capable of thinking outside the box? It means breaking old moulds and casting new ones – causing discomfort within WHO and member states. Will they have the guts for that?

Look inwards first for resources

Even if the incoming regional director goes down the egg-breaking, omelette-making track to transform healthcare, they can’t do it on their own. They must build partnerships and garner significant additional resources.

This must start internally inside WHO where its over-staffed headquarters operates out of Geneva, the world’s third most expensive city. Fortunately, WHO Director General Dr Tedros is committed to decentralisation, and although he faces resistance to pushing that through, the incoming regional director should hold him to that pledge. Meanwhile, they must do their utmost to radically reshape EMRO’s regional and country offices to make them investment-worthy.

The new regional director should resist holding out the begging bowl to traditional OECD (mostly Western) donors. The pennies received are not worth the self-respect expended. Multilateral development banks should be pushed to do more. But the real resourcing transformation must be within the region. After all, generosity towards the needy and suffering is an integral part of the region’s dominant religion and culture.

Gulf states are already giving more: $ 9.2 billion in official development assistance in 2022 led by Saudi Arabia ($6.2 billion) and UAE  ($1.4 billion). But such aid tends to be volatile and skewed towards emergency relief and the health sector’s share is small. The regional director must be politically skilled at changing that and establishing long-term health investment – and not donor-recipient – relationships.

Is all this too much to ask from the new WHO EMRO regional director?  No – because it is do-able. Anything less is a betrayal of trust and a missed opportunity to better the lives of people who deserve better.

Mukesh Kapila is a physician and public health specialist who has worked in 120 countries, including as a former United Nations (UN) Resident and Humanitarian Coordinator in Sudan and a UN Special Adviser in Afghanistan.

 

Image Credits: WHO Yemen, Mercy Corp/ TNH, Rahul Rajput.

Amidst the vibrant rhythms of Africa, a less audible rhythm beats – an alarming rise in cardiovascular diseases (CVDs) and non-communicable diseases (NCDs). Between 50% and 88% of deaths in at least seven African countries are due to NCDs, according to the 2022 World Health Organization (WHO) Noncommunicable Disease Progress Monitor. Yet, the realm of research has yet to fully recognize the magnitude of this symphony. 

The cacophony of these diseases is not confined to developed nations; Africa bears witness to their increasing impact, largely unseen by the global research community. Against this backdrop, we stand resolute in our commitment to shifting the focus to the African narrative in cardiovascular medicine.

Closing research disparities: Unravelling the findings 

We are two young cardiologists, both graduates of Egypt’s esteemed medical schools. One of us went on to pursue his career in the United States, where he is now a rising researcher at the Department of Internal Medicine at Yale School of Medicine in New Haven, Connecticut. The other, determined to make a difference in his country, dedicated himself to the demanding work of a physician-scientist in Egypt.

Our paths converged when we decided to address the striking lack of randomized clinical trials (RCTs) in Africa. This scarcity robs the continent of vital disease-specific and population-specific data, which stalls progress in clinical outcomes. This deficiency has global implications, as it dampens cardiology research on a global scale by preventing researchers from tapping into a vast, diverse, and treatment-naive population.

Our journey led us to a comprehensive evaluation of African-led clinical trials in cardiovascular medicine over the past three decades. We recently published our findings in a research letter in the journal Circulation: Cardiovascular Quality and Outcomes.

About 80% of RCTs came from 3 countries (Egypt, Nigeria, and South Africa). Yet, 37 African countries didn’t produce a single RCT.

Our analysis revealed a stark reality: only approximately 2% of published and registered clinical trials in cardiovascular medicine originated from Africa. However, within this fraction, we found a tale of perseverance and determination.

We examined a total of 179 trials from African countries from 1990 to 2019. Egypt, South Africa and Nigeria were the most notable contributors, with Egypt leading the way. The number of African-led trials surged over the past decade, with 2010 to 2019 witnessing a remarkable increase.

The primary outcomes assessed in the trials included biochemical and cardio-metabolic markers, hemodynamic outcomes, clinical events, and patient-related outcomes. African trials often had small sample sizes, few participating centers and short follow-up periods.

The impact of published trials from different countries was measured using the H-index, a metric that gauges the impact of scientific research by tracking how many times a published paper is cited by other researchers. South African publications had the highest impact score, followed by Egypt and Nigeria. A significant number of trials were not published as open access, and risk of bias assessment showed that a significant number of studies had unclear or high risks of bias.

It is estimated that only 2000 cardiologists practice in Africa (≈1 cardiologist for 600,000 individuals)

Collaborations transcended borders, as African centres actively participated in 45 multinational trials, contributing valuable insights to global research endeavors. On the issue of funding, the researchers noted that 91 trials did not disclose their funding sources, while 20 disclosed no external funding. Of the remaining 68 trials, 35.7% had funding from private sources, 28.6% from academic sources, 28.6% from governmental sources, and 7.1% from non-governmental sources.

Our research letter underscores several critical points. First, there is a need for increased investment in training cardiovascular researchers, beyond just cardiologists, to strengthen the research workforce in Africa. Second, it is important to allocate more resources for research and development in African countries, in line with the local disease burden and international recommendations.

Third, initiatives like the Clinical Trials Community platform and the Pan-African Clinical Trials Registry have the potential to improve research infrastructure and collaboration. Lastly, there is a need for multifaceted interventions to address barriers to clinical research in Africa, including regulatory frameworks, electronic medical records adoption, and institutional partnerships.

Forging a new path: Towards inclusivity and impact

Of the 179 trials included, 54 (30.2%) were performed in collaboration with another African (n=42) or non-African center (n=33), most commonly in Europe and the USA.

Together, we can overcome the disparities impeding Africa’s research progress. Our findings have revealed challenges that, once addressed, could amplify the continent’s contributions. Trials across the continent often have limited sample sizes, are conducted at a small number of participating centres, and have short follow-up periods. The intricate dance of collaboration also extended beyond African borders, with European and North American centers partnering to enhance the scope and impact of research.

To unleash the true potential of African-led clinical trials, key changes are needed. Increased investment in training for cardiovascular researchers, beyond just cardiologists, would enrich the research landscape. Clinical research is a cornerstone of sustainable progress, and local governments must invest more in it.

A symphony of change 

As the curtain falls on our story, the call for change echoes. To harmonise Africa’s cardiovascular research and amplify its impact on the world, we need multifaceted interventions. Expanding clinical research sites, standardising regulatory frameworks, and widely adopting electronic medical records will strengthen Africa’s research infrastructure.

Open-access publishing and robust institutional partnerships are our allies in the journey towards progress. The song of African science, once muted, now crescendos as we work to break down barriers and illuminate a path toward equitable cardiovascular knowledge. In this rhythm of change, we are architects of transformation, orchestrating a symphony of research that resonates far beyond the boundaries of continents and borders.

Dr Ahmed Bendary is Associate Professor in the Cardiology Department at Benha University, a member of the Egyptian Society of Cardiology and a Fellow of the European Society of Cardiology (FESC). He also serves on the Board of the Egyptian Association of Vascular Biology and Atherosclerosis (EAVA), is part of the abstract reviewing committee for the European Society of Cardiology (ESC) Congress and serves as associate editor for The Egyptian Heart Journal (TEHJ).

Dr Abdelrahman Abushouk is an Internal Medicine Resident at Yale-New Haven Hospital. He earned his medical degree from Ain Shams University.

Image Credits: CC.

A fire in a favela in Brazil: Poorer countries are least equipped to mitigate the health effects of the climate crisis.

The 28th United Nations climate conference, scheduled to open on 30 November in Dubai, has pledged to elevate health issues, but non-communicable diseases – which are set to become dramatically worse as temperatures rise – are nowhere on the agenda. Prevention of climate– and heat-related diseases need to be on the formal Conference of Parties (COP) 28 negotiating agenda – not just on the sidelines.

Humans are facing unprecedented health impacts from heat

Wildfires across Canada, Hawaii and Algeria, killer heat waves from Texas to India, China, southern Europe, and Morocco, and summer temperatures in the middle of the winter season in Argentina and Chile. The relentless, heat-related effects of climate change are more and more manifest – along with their human toll in terms of deaths and diseases from acute heat stroke to chronic kidney disease.   

As UN Secretary-General Antonio Guterres said recently: “The era of global warming has ended. The era of global boiling has arrived. The air is unbreathable and the heat is unbearable. And the level of fossil fuel profits and climate inaction is unacceptable.” 

And the impacts on health are mounting faster and faster. 

According to the latest report of the Intergovernmental Panel on Climate Change (IPCC), the world could see over nine million climate-related deaths annually by the end of the century in a high emissions scenario – more than any other disease risk factor we face today.

Amongst the growing list of climate-related health effects – which range from vector-borne diseases to hunger and undernutrition – non-communicable diseases (NCDs), particularly those linked to extreme heat, have received far too little attention. 

This is despite the fact that heat-related mortality, also linked to cardiovascular disease and other NCDs, will rise significantly by 2030 particularly under high emission scenarios, according to the IPCC.  Asia, North Africa and the Middle East will be most seriously affected – but Europe and North America will also be badly affected. 

The Intergovernmental Panel on Climate Change’s projection of climate-related deaths.

Extreme heat, NCDs and ‘wet bulb temperature’ survival threshold 

To understand how deeply and directly extreme heat affects health, it’s important to look at the basic physiology of how we humans function in “normal” temperatures and cope with temperatures that rise above our comfort levels.   

Our human thermometer is attuned to maintaining a body temperature of about 37 ℃.  We can tolerate higher temperatures for short intervals if we don’t exercise or work hard, have adequate shade and water and dress in clothes that permit sweating to self-regulate. 

This is how people have survived in tropical and desert regions for millennia. However, even in these regions, daytime temperatures remained, on average, around 32℃ – well below body temperature, with even lower night temperatures.  

Above a certain threshold, humans can only survive for a few hours since we cannot reduce our body temperature by sweating. This threshold, called the “wet–bulb temperature”, is a measure of the combination of temperature and humidity. Visually, imagine a wet cloth wrapped over a thermometer. 

Theoretically,  the wet bulb temperature threshold of survivability is defined as 35℃ – and this is for only a few hours of exposure. However, for healthy adults pursuing normal activity levels outdoors, the safe range is considered to be closer to 30℃–32℃.

The wet bulb temperature threshold also varies geographically in hot – dry and warm – humid climates so there is not one absolute defined threshold for human survival.

For instance, 37℃ in a relative humidity of 50% would be equivalent to a wet-bulb temperature of 28.3 C But with 99% humidity, air temperature of 37.5 C would be equivalent to a wet-bulb temperature of 37 C as well – above the survivability threshold. 

Another metric called the wet bulb globe temperature (WBGT) measures heat stress in direct sunlight. It is similar to the wet bulb temperature but also takes into account wind speed and solar radiation, and is often used to set heat exposure limits for outdoor workers.

What is clear, however, is that as the world warms, more tropical and temperate regions are seeing temperatures rise more frequently beyond the safety zone for more hours and days in the year.  This is now happening visibly, very much along the lines of scientific predictions.  

We have already breached the 1.5℃ target over land  

World Meteorological Organization, August 2023

The 2015 Paris Agreement set a global temperature limit of 1.5℃ above pre-industrial levels, based on knowledge of the harmful ecosystem and health impacts of temperatures rising above this threshold.  

Yet the average global temperature increase since pre-industrial times is already 1.15 ℃ according to the World Meteorological Organization (WMO). On land, we have already passed the threshold of 1.5℃ warming, with a mean temperature increase of 1.59 ℃ since pre-industrial times, according to the IPCC.

This last July was the hottest month ever on record, WMO recently warned. And with the arrival of El Niño, the warming phase of surface waters in the tropical Pacific Ocean, we are going to surpass the 1.5℃ threshold for parts of every year. 

“WMO is sounding the alarm that we will breach the 1.5°C level on a temporary basis with increasing frequency,” said WMO Secretary-General Petteri Taalas on 17 May. 

El Niño, he warned, “will combine with human-induced climate change to push global temperatures into uncharted territory. This will have far-reaching repercussions for health, food security, water management and the environment. We need to be prepared.”

This will push nearly one-third of humanity outside the earth’s “human climate niche” by the end of the century with “high temperatures linked to issues including increased mortality, decreased labour productivity, decreased cognitive performance, impaired learning, adverse pregnancy outcomes, decreased crop yield, increased conflict and infectious disease spread,” says Professor Chi Xu at Nanjing University in China. 

While until now, most land areas of the earth have been habitable, even if conditions may sometimes be harsh, but by the end of this century, large areas of the populated world will be virtually uninhabitable. 

The drought in the Horn of Africa has impacted approximately 4.5 million Somalis, and around 700,000 people have been forced to leave their homes.

Heat-related increases in chronic disease 

So what are the health impacts of the temperature rises that we are seeing? In acute instances, extreme heat can lead to sudden organ failure and death. 

Anecdotally, we’ve already seen many more such cases during this year’s summer in the northern hemisphere. A 13-year-old girl cycling home from school, was one of 15 people that perished in extreme heat in Japan and the Republic of Korea in the first weekend of August. 

In June, the deaths of a 14-year-old boy and his stepfather in Big Bend National Park in Texas in 48°C heat also gained a lot of attention in US media. 

But the stories that hit the headlines are only the tip of the ‘heat–berg’. Uncounted numbers of outdoor workers, such as farmers and construction workers, are likely to have died from heat-related conditions over the past months and weeks. A 44–year–old road worker in Milan and two construction site workers in Jesi and Brescia were among the workers who died from heat this summer, for example. 

Over time, however, chronic extreme heat exposure also can trigger or exacerbate a range of NCDs such as kidney disorders, hypertension, and chronic cardiovascular and respiratory diseases – leading to more premature deaths.

And as usually happens, it is the elderly, children, pregnant women and outdoor workers – a large proportion of which are also poor and marginalized – who are among the worst affected. 

Heat and workers’ health 

With regards to outdoor workers, few countries have yet paid sufficient attention to heat-related health. In the US, for instance, the federal Occupational Safety and Health Administration (OSHA), lacks any kind of official labour standard for heat and health standards to protect workers. 

In some cases, laws have even moved backwards. The Texas State Legislature recently passed a bill nullifying local ordinances in the cities of Austin and Dallas that required employers to give construction workers water breaks of 10 minutes every four hours. The bill was signed into law in late June, just as a deadly heat wave gripped the state. 

Indeed, by any public health standard, this is the opposite of the direction in which we need to move to create decent work and workplaces in the climate change era. Indirectly, as well, heat waves pose a particular threat to livelihoods, socioeconomic output and reduced labour productivity – affecting mental health, nutrition and other health determinants. 

Heat stress among workers, if not properly managed, can also lead to injuries and significant losses of productivity. 

A construction worker in Texas, where the state legislature recently removed some health protections for outdoor workers.

Other NCD risks related to climate change 

Heat is not the only climate-related driver for NCD morbidity and mortality – which is in turn responsible for 74% of the total global deaths. 

Climate change depletes food supplies, increasing hunger and malnutrition in multiple pathways. These include direct damage to crops, livestock and fish catches from rising land and ocean temperatures, as well more complex ecosystem events – for example, pest invasions such as the massive locust swarms seen over the past couple of years in the Horn of Africa.

Increasingly, low-income countries in Africa and elsewhere are also experiencing a triple burden of undernutrition and malnutrition, including micronutrient deficiencies; overweight and obesity, as a result of increased consumption of sugary drinks and other industrialized, ultra-processed foods, and decreased consumption of fresh, indigenous food varieties. As a  result, more people living with diabetes, hypertension and cancers in developing countries.

Due to rising sea levels, freshwater systems in vulnerable Small Island Developing States (SIDS) are threatened by the increased salinity of groundwater supplies, which is increasing daily salt intake of island inhabitants – and thus risks of hypertension and related NCDs. 

A multi-year drought in Uruguay has had severe consequences for the freshwater supply, leading the authorities to add brackish water to the drinking water supply, enhancing dangerous salt levels. 

People living with NCDs also are at particular risk during and after extreme weather events such as floods and storms, which interrupt routine healthcare services and access to life–saving medication, such as insulin. The displacement and trauma of extreme weather also exacerbate mental health conditions – a factor highlighted at the recent Ministerial meeting on SIDS.

Addressing the heat and health crisis 

While rich countries are affected as well, it is often the same low- and middle-income regions most vulnerable to the effects of climate change that are also the least prepared to cope with its health impacts – including heat-related ones. 

Of the 17 million premature deaths annually from NCDs, some 86% already occur in low- and middle-income countries.  

So what can we do to combat and counter these trends?  We must act both in climate forums like COP28, as well as in global health forums and national health systems and across sectors nationally, regionally and globally. 

Stronger health systems : NCD diagnosis, prevention and treatment are poorly integrated into primary health care and universal health coverage (UHC) of many low- and middle-income countries, and these interventions are often not considered part of UHC. 

Primary healthcare facilities lack simple diagnostic technologies to measure blood pressure, blood glucose levels, and peak expiratory flow (an indicator of respiratory diseases). 

They also lack basic medicines listed in WHO’s Package of Essential NCD (PEN) interventions. Investments must be strengthened to cope with today’s already large NCD burden – and prepare better for tomorrow – including more heat–related diseases. 

Additionally, facilities in many low-income countries lack even a minimum functioning infrastructure for energy, clean water, sanitation and waste. Ensuring these services is essential to ensure the uptake of modern technologies for the prevention, detection and control of NCDs. Next month’s UN High-level meeting on UHC is an opportunity to strengthen the commitments.

Early warning, heat action plans and workers’ health: During California’s recent heat waves, the City of Los Angeles opened “cooling centers” to protect people who lacked adequate home cooling. 

With emergencies now becoming routine, more cities and countries need to consider the development of heat and health guidelines and action plans. 

As part of this, occupational health standards should be assessed and strengthened, to protect workers better from climate-related and particularly heat-related diseases. and particularly for outdoor workers. WHO may be called upon to support this process with evidence-based guidelines with regard to safe temperature thresholds for outdoor work, and relief measures such as the provision of shade, water, and cooling breaks and devices.  

Advocacy at COP28 

At COP28, we in the health sector need to advocate for increased recognition of the health problems associated with climate change – problems which the recent series of extreme heat waves may be finally raising to the top of our political awareness. 

This needs to go beyond rhetoric and lead to greater access for the health sector to international climate financing, such as the Green Climate Fund, and the Loss and Damage Fund, as well as through the World Bank and regional development banks.

Investments in policies to reduce greenhouse gas emissions should be recognized and assessed in terms of their co-benefits for health as well as to climate – such as transforming food systems to make them more sustainable and resilient as well as healthier. 

We need to retool tax and financial incentives for linked climate and health actions. This includes the removal of harmful subsidies not only on fossil fuels but on agricultural commodities like sugar and intensive livestock production. 

Two years ago, the COP26 Health Programme and the Alliance for Transformative Action (ATACH) were launched by WHO and partners outside the formal COP agenda. It established building blocks to protect the health of people from climate change, such as addressing the barriers faced by countries to access finance to address climate change and health. 

Proactive climate measures can improve health 

Well-designed climate mitigation measures can not only avoid increases in NCDs but can even reduce existing NCD risk factors, blunting the epidemic increase in such diseases.  For instance, measures to ensure clean energy and transport will reduce air pollution; policies to promote walking and biking may reduce weight and lower blood pressure. 

Policies supporting the production and consumption of healthy, locally produced fresh foods, particularly plant-based foods, and discouraging excessive red meat consumption, would lower greenhouse gas emissions in agriculture and result in healthier diets. 

In addition, planting trees and shrubs with crops could both increase the resilience of crops to droughts and excessive rainfall runoff, reduce CO2 emissions as well as improve health.

We have illustrated some of the ways in which climate change and NCD are interlinked and suggested that actions to manage them must be aligned. These two crises have one thing in common: they can be prevented. 

Going beyond ‘health’ rhetoric to action  

But this requires strong and deliberate policies by brave political leaders – as well as more explicit recognition of the health impacts of climate change and the co-benefits of mitigation and adaptation in all aspects of climate action. 

It appears long forgotten, but Parties to the UNFCCC are committed to considering the public health implications of their climate policies. We need formalized discussions on how to fully integrate health-incentivising climate policies into countries’ nationally determined contributions (NDCs) under the Paris Agreement, and the reporting requirements for National communications. This should include the systematic quantification of health co-benefits of climate change mitigation and adaptation commitments – which would reduce the huge burden of NCDs. 

Only after such health impacts and benefits are fully counted, can health also have the seat it deserves at the table of climate funding and investment decisions.  

During the seven years we have left to fulfil the 2030 Sustainable Development Agenda and to achieve the target of a one-third reduction in premature deaths from NCDs, which is intertwined with our climate agenda, we need to see a lot more courage from national governments and leaders than we have seen in the past 30 years. 

Human health is in fact the lynchpin in the two processes.

The declaration of a COP “Health Day” and a Health Ministerial Meeting at the Climate Conference are important steps. But this needs to be followed by concrete action to reduce and reverse our planet’s spin into an abyss of worsening climate and human health impacts – including NCDs, which constitute the biggest global health epidemic of our time.

Dr Bente Mikkelsen

Dr Bente Mikkelsen is WHO’s Director of the Department of Non-communicable Diseases.

Dr Maria Neira is WHO’s Director of the  Department of Environment, Climate Change and Health 

Marit Viktoria Pettersen is a consultant for the WHO’s Integrated Service Delivery in the Department of Noncommunicable Diseases.

Image Credits: Denys Argyriou/ Unsplash, UN-Water/Twitter , Josh Olalde/ Unsplash, WHO, World Economic Forum, Maria Neira.

climate emissions
Fossil fuel combustion is a leading source of global warming and harmful air pollution.

Almost 50 organisations have written to the head of the upcoming United Nations climate change meeting, Conference of the Parties (COP) 28, calling for substantive progress against air pollution, which they describe as “the nexus of climate and health”.

With 100 days to go until COP28 in the United Arab Emirates, the groups organised by the Clean Air Fund, have written to president-designate Dr Ahmed Al Jaber, asking him to “put air pollution firmly on the agenda and to catalyse national commitments and international funding to improve air quality”.

“Air pollution is a pervasive public health crisis and an accelerator of climate change,” the letter notes.

The letter anticipates that the global stocktake process to evaluate progress towards meeting the goals of the Paris Climate Change Agreement, which concludes at COP28, “will be a devastating reality check, showing that countries are massively off track from their commitments”.

“Ninety-nine percent of the world’s population breathes air that fails to meet WHO guidelines. The main drivers of air pollution are also sources of greenhouse gases, the largest culprit being the combustion of fossil fuels. 

“This interconnectedness means that a full stop to burning fossil fuels is essential to unlock the enormous co-benefits of clean air. We emphasise that clean air cannot be solely achieved by carbon capture technologies, which do not address all toxic pollutants and particulates, such as black carbon which also accelerates warming. Only measures which result in better air quality will deliver the public health co-benefits of climate action.”

The letter reaffirms the Global Alliance on Health and Pollution’s most effective interventions to reduce fine particulate matter (PM2.5) and carbon dioxide emissions to improve heath involve replacing coal with renewable sources of energy for total power production; replacing diesel and gasoline-powered vehicles with electric vehicles; eliminating uncontrolled diesel emissions and preventing crop burning and forest fires.

It adds a further demand for “comprehensive air quality monitoring to demonstrate progress towards WHO Air Quality Guideline levels and campaigns to demonstrate the benefits of clean air to health, families, and communities to further build public support for climate action”.

“COP28 must deliver tangible progress to end all fossil fuel subsidies, as a way to unlock progress across the negotiations,” the signatories state.

A recent report from the World Health Organization noted that the global high emissions trajectory continues, nine million people per year will die annually from climate-related causes by the end of the century.

 

Image Credits: Ella Ivanescu/ Unsplash, Chris LeBoutillier.