Attendees watch the inaugural address from Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, at the Multi-Stakeholder Hearing on TB in New York on 8 May.

The call and response of “Yes we can, end TB” at the Multi-Stakeholder Hearing (MSH) on tuberculosis (TB) made one thing clear — the voices of the community will be heard. With negotiations of the UN Political Declaration now underway, what does the TB community expect to see?

Members of the global TB community, including survivors, community and civil society representatives, healthcare workers, private sector representatives, academics, researchers, and parliamentarians came together for the MSH on TB at the United Nations (UN) headquarters in New York on 8 May. Many attended adjacent hearings on Pandemic Prevention, Preparedness, and Response (PPPR) and Universal Health Coverage (UHC) on 9 May.

These hearings provided an essential platform for stakeholders to voice their demands ahead of the UN High-Level Meetings (HLMs) on TB, PPPR and UHC that will convene world leaders from 20-22 September to set the agendas for these three intersecting global health challenges.

At present, we’re far from meeting the global targets to end TB by 2030, as set forth in Sustainable Development Goal 3 on health and reinforced by member states at the first TB HLM in 2018. Five years on, we need urgent transformative action to make up for lost time.

COVID-19 reversed almost two decades of progress in the fight against TB, constraining already scarce resources for essential TB services and R&D. In 2021, 10.6 million people fell sick with TB and 1.6 million people died, both figures increasing for the second consecutive year.

The TB community’s demands are clear. Stakeholders in New York shared their six Key Asks with over 45 permanent country missions to the UN on the sidelines of the hearing to inform member state negotiations of the Political Declaration on TB. 

To quote Austin Obiefuna, vice-chair of the Stop TB Partnership: “What makes a successful political declaration? Look no further than these Key Asks!”

Comments from 20 panelists and over 25 interventions from the floor echoed the shared community vision. This includes demands to ensure access to existing and new tools, particularly vaccines, human rights, gender equity, increased and sustainable funding, accountability, psychosocial and nutritional support, and clear alignment with the political declarations on UHC and PPPR.

Affected community and civil society members gather for a community briefing ahead of the Multi-Stakeholder Hearing on TB in New York City on 8 May.

So, how can member states heed the TB community’s call?

 Zero Draft of the Political Declaration: strengthening the community’s demands

The signing of the Political Declaration in September will set the agenda for the TB response for the coming five years. Following insufficient progress on the 2018 declaration, TB advocates have expressed deep concern at the lack of concrete and time-bound commitments in the Zero Draft. This includes concerns about weak commitments for financing, a rights-based approach, and equitable research and development (R&D) practices, alongside no numerical targets for scaling up the provision of diagnosis, treatment, and prevention.

Advocacy engagement at the member state level continues at full force ahead of the 20 June deadline to ensure the declaration appropriately reflects the community’s demands. TB stakeholders are now advocating for specific, accountable, and actionable commitments to ensure we reach the 2030 End TB goals.

An equitable and accountable TB response

The community is resolute in demanding an equitable, gender-responsive, rights-based, and stigma-free response. To close the gaps in TB care, this must serve the intersecting needs of all people affected by TB, with robust psychosocial services and legal protections as explicit commitments. Civil society and vulnerable groups, such as pregnant people, people living with HIV, and people who use drugs, must likewise be included at every stage, including in R&D, to guarantee a successful response.

Gender equity is one of many aspects cutting across the three HLMs. Women represent 70% of health workers but only 25% of leadership positions, while they often bear the brunt of catastrophic household costs incurred through TB. The political declarations should be a powerful tool to demand equal pay, leadership roles, and financial protections for women. Similarly, young people must be empowered to lead as the next generation of the response.

But the declaration is not enough — we need independent monitoring for accountability and compliance to avoid the pitfalls of the last five years. This will be imperative to deliver the US$250 billion investment between 2023-2030 estimated in the Global Plan to End TB.

Universal access to new and existing tools to end TB

Access to existing and new tools must be enshrined in member states’ commitments. Reaching the End TB goals requires urgently accelerated development, rollout, and access to essential new tools.

We need fast, point-of-care tests that are affordable and accessible to everyone. We need universal access to World Health Organization (WHO) recommended regimens and the development of shorter, less-toxic therapies. And with only the century-old BCG vaccine available, which is largely ineffective in adolescents and adults, we need multiple new vaccines that cover all populations – reflecting calls in a recent open letter signed by 1,188 stakeholders.

Financing commitments by research area and country-specific fair share targets that acknowledge a country’s TB burden and research and economic capacities are a precondition to accountability. In 2018, governments pledged to invest $2 billion annually in TB R&D over five years. By 2021, only 30% of the target had been invested — for TB vaccines, this was only 15%. 

The Global Plan now estimates that TB R&D requires $5 billion annually from 2023 — a fraction of the more than $100 billion spent on COVID-19 R&D by January 2021. Concerningly, the Zero Draft calls for reaching this $5 billion annual target only by 2027, risking further delays in delivering essential new tools, notably vaccines.

To move the access needle forward, we need access and transparency conditionalities that span the R&D continuum, especially for publicly funded research which accounts for 70% of annual funding for TB research. Such conditionalities seek to maximize public return on public investments that drive TB innovation and will support governments to make informed decisions on manufacturing, purchasing and procuring new health technologies. Moreover, to avoid COVID-era monopolies that drive unequal access, commitments should also support product development and manufacturing in high-burden regions.

Opportunity for cross-cutting impact

The TB community demands clear alignment across the political declarations to leverage the huge potential for impact within the three agendas. The whole-of-government and whole-of-society approach demanded throughout the hearings won’t be possible otherwise. This must be multisectoral and leadership must be centered in high burden countries.

Yet, TB was absent from the formal interventions during the hearings on PPPR and UHC, which unlike TB lacked sufficient civil society panelists. Questions remain on how well aligned the final declarations will be.

Glancing at TB, we see how effective TB services can strengthen the foundations of primary healthcare and serve as a strong marker for the attainment of UHC among communities with the poorest access to healthcare. TB infrastructure, widely mobilized in the COVID-19 response, including for surveillance, testing, and clinical trials, underscores the role of TB services in an expansive and functional health system. A fully equipped TB response and R&D pipeline would be a driving force of efficient PPPR and UHC responses.

The TB community has provided a ready-to-roll consensus-driven manual to deliver an equitable and accessible TB response. With this in hand, “yes we can, end TB”. We urge member states to heed our call. Nothing about us, without us!

Erin McConnel is a senior TB project associate at the Treatment Action Group (TAG), working to capacitate and support community advisory boards that help shape the TB research and dissemination globally. Erin joined TAG in 2022 after working in infectious disease drug development, teaching English abroad, and policy analysis for medicine access, disability, and justice.

Priyanka Aiyer is from the TB HLM 2023 Affected Communities and Civil Society Coordination Hub. She is a communication specialist experienced in designing and implementing multi-pronged campaigns at national, regional and global levels. She earlier worked with the Global Coalition of TB Advocates as the Communications and digital media officer and is also the South-East Asia representative on the Union Community Advisory Panel.

Shaun Palmer is a communication specialist at IAVI, where he leads the TB Vaccine Advocacy Roadmap (TB Vax ARM) coalition and its related global advocacy initiatives. He additionally leads communication activities for several European-funded studies and co-chairs IAVI’s Global Diversity and Inclusion Committee.

Last year’s WHA late on the Saturday night, as Committee A struggled to reach agreement.

Much of this year’s WHA agenda, being held in Geneva between 21 and 30 May, should be preoccupied with pandemic preparedness and the WHO’s budget.  But there are some obscure items for anti-rights conservatives to latch onto if they want to derail discussion – and there is growing appetite for such disruptions throughout all UN agencies.

While officially, this year’s WHA is supposed to focus on a wide range of policy issues around the three pillars of WHO’s “Three Billion” strategy, which include emergencies and pandemics, non-communicable diseases and healthier populations, a few hidden minefields scattered in the agenda threaten to create unexpected flashpoints which could divert attention from the substance of the meeting. 

They include, once again, language around sexual health, but also as well as concerns about the place of states’ sovereign rights in the pandemic treaty, an initiative on a new WHO replenishment fund, as well as the perennial debates around the demand by Taiwan to be reinstated as a WHA observer, and the status of health in the Occupied Palestinian territories. What are the potential red-herring flashpoints lurking in the shadows of a dry and detailed agenda?  Here´s a brief review of the landscape:

Anti-rights red flags?

At last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event.  

Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. This forced talks late into the night and, finally, an unprecedented vote on the vexatious guide after numerous compromise clauses failed.

The Saudi delegate in a heated WHA debate over sexual rights and terminology.

If the conservatives are scanning assembly documents for men having sex with men, they’re unlikely to find any references. But if they are intent on looking for polarising needles in the agenda haystack, some might take issue with the report on the Global Strategy for Women’s, Children’s and Adolescents’ Health. This refers to the WHO’s updated handbook on family planning, which contains references to post-abortion care and gender identity. 

These are red flags for the right-wing UN coalition of member states, Group of Friends of the Family, founded by Egypt, Belarus and Qatar to advocate for the “natural family” that is becoming more vocal and more closely aligned with US rightwing Christian groups through annual World Congress of Families gatherings.

Multilateralism under fire

This year’s WHA takes place in an even tougher environment. Russia’s ongoing war in Ukraine has polarised the international community, compounding the economic struggles wrought by three pandemic years.

“The multilateral system is under greater strain than at any time since the creation of the United Nations,” UN Secretary-General Antonio Guterres warned in an address to the Security Council last month. 

“We are witnessing a deepening climate crisis, soaring inequalities, a rising threat from terrorism, a global pushback against human rights and gender equality, and the unregulated development of dangerous technologies,” he added.  

“All these global challenges can only be solved through respect for international law, adherence to global commitments, and the adoption of appropriate frameworks of multilateral governance.”

Heightened US-China tensions may well be inflamed by the large presence of Taiwan at this year’s WHA. The US appeal for it to be reinstated as an observer has been followed by a formal request from Belize for this to be included on the agenda.

The health of Palestinians, with an unprecedented rise of Israeli settler violence accounting for 25% of casualties, is also a geopolitical flashpoint.

National sovereignty and pandemic response

Much of this year’s WHA, themed “Health For All: 75 years of improving public health”, will be around measures to counter the next pandemic – particularly universal health care and health and how to increase WHO’s finances. 

The assembly will hear and comment on progress made on two pandemic-related processes: one to amend the International Health Regulations (IHR) to make them fit for the next pandemic and the other, to draw up a pandemic accord. But both negotiations are ongoing with a deadline of next year’s WHA, so it is unlikely that conflicts will climax at this session. 

However, concerns about member states’ sovereignty are likely to be expressed, something that Russia and China have stressed in previous discussions.

Meanwhile, misinformation continues to churn outside of the WHA from those who opposed COVID-19 vaccines and lockdowns who claim that the pandemic accord will give WHO superpowers, and could lead to international “vaccine passports”.

Anti-vaxxer and US presidential hopeful Robert F Kennedy and his organisation, Children’s Health Defense, are key sources of this misinformation and have organised global protests aimed at urging countries to exit the WHO on Saturday 20 May, the day before the WHA opens.

WHO finances in the spotlight

Members of the WHO Working Group on Sustainable Finance hammer out an agreement on increasing member state contributions this week, with Germany’s Björn Kümmel on far left.

As with last year, moves to increase the WHO’s budget ceiling are also likely to be a focus of animated discussion. Member states are supposed to be increasing their assessed contributions in line with a resolution passed last year. 

The 2024/ 25 proposed budget is therefore based on the portion of members’ contributions being raised from a dismal 12% of the budget to 20%, which the WHA budget document on the budget describes as “marking a historic move towards a more empowered and independent WHO”.

During the Executive Board discussion in January on increasing WHO contributions, the Africa region expressed the expectation that WHO would channel far more resources to country and regional offices – something that the WHO has tried to do and reports that country allocation had increased from 39% in the 2018/19 to 50% in the proposed 2024/ 25 budget.

The Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance has worked hard to find a way to stabilise WHO income, making it less dependent on donors and also more efficient.

Replenishment Fund

The assembly also will discuss a proposal from the WHO’s Executive Committee for the establishment of a replenishment fund.   

Most member states accept that the WHO is underfunded and over-reliant on donors’ conditional grants, slanting the work of the body. While a replenishment fund, effectively, also involves recruiting more in voluntary donations, the process is public and therefore potentially more transparent – similar to the periodic replenishment drives conducted by organisations such as The Global Fund and Gavi, the Vaccine Alliance.  Also, typically such funds are not designated for specific donor projects – but able to be used flexibly by the organisation involved. 

Ahead of the January Executive Board meeting, the WHO’s Programme, Budget and Administration Committee (PBAC) “acknowledged WHO’s need for more flexible, predictable and sustainable financing and considered that a replenishment mechanism provided a possible solution, especially for chronically underfunded areas of the organization’s programme budget”.

Meanwhile, a fascinating recent analysis of all WHA resolutions between 1948 and 2021  was recently published in the BMJ.

It notes: “While the WHO has been criticised for its siloed approach to address global health issues, the analysis suggests that this approach is not the collective will of the WHA but may relate to the way the WHO has been increasingly funded through earmarked voluntary contributions to specific programmes.”

Whatever decisions are taken, the attention of the international global health sector will be in Geneva over the next 10 days.

Image Credits: Germany's UN Mission in Geneva .

WHO member states discuss new pandemic convention or treaty in July 2022.

Civil society is unlikely to be included in the World Health Organization (WHO)’s pandemic accord negotiations and should focus on making an impact on its content, according to a  European Union official.

“I don’t see these rules.. changing very easily at this stage. So I would concentrate efforts in working on the substance more than on the process,” Americo Zampetti, a senior leader of the delegation of the EU at the UN, told a webinar convened by the Geneva Global Health Hub (G2H2) on Wednesday.

While the EU would be “quite content” with civil society being more active in the discussion, “some other partners are not similarly keen in being open and transparent and making the best use of civil society contribution”, he added. 

“Civil society is particularly apt at advocating so I would concentrate on advocating on substance more than on process because I see the process as basically gone,” he advised.

Americo Zampetti

However, the EU would “make a very strong case” for civil society participation in the institutional machinery leading to the adoption of the agreement, and “we trust that civil society will be a very active partner in implementing any future agreement”, he added.

Margot Nauleau from Save the Children warned that governments would need to work with the people to implement new pandemic obligations.

“This must start by building trust and legitimacy in the policy process because the absence of transparency and engagement will lead to misinformation and confusion,” said Nauleau.

“The negotiations on the pandemic code and the International Health Regulations are becoming more and more exclusive of civil society,” she added. “We no longer have access to the drafting group and there is no transparency on the textual proposals that are made by member states.”

This runs counter to the WHO Constitution and the Sustainable Development Goals, she added.

To rectify this, Save the Children has three recommendations to the WHO. The first involves more civil society involvement in the negotiation and drafting by, for example, enabling them access to “all relevant documentation, including the draft, and intervene in a timely and unrestricted way during the plenary and the working group sessions of the negotiations”.

The second recommendation is to include civil society in treaty decision-making bodies, as the Framework Convention on Climate Change does.

The third involves civil society inclusion in the “monitoring and compliance mechanisms of these instruments”, as is the case for the Nagoya Protocol.

Environment and tobacco control

Yves Ladar, Permanent Representative of Earth Justice to the UN in Geneva, said that civil society had been integrally involved in a number of key environmental agreements and brought a lot of expertise to these.

One of these was Aarhus Convention, signed in 1998, which “provides access to access to information, effective public participation and access to justice in environmental matters”, said Ladar. 

Patricia Lambert

Patricia Lambert from the Campaign for Tobacco-Free Kids, was part of negotiations for the Framework Convention on Tobacco Control as legal adviser to South Africa.

Civil society fought hard to be included in the FCTC negotiations, and one of the clauses of the Convention notes that “participation of civil society is essential” in achieving its objectives, said Lambert, advising groups to “organise, organise, organise”.

“I’m very discomforted to hear that, as far as the process goes, civil society has largely been left out,” said Lambert. “What is working against you that was not present at the time of the FCTC negotiations [adopted 23 years go], is the hardening of attitudes in certain governments to civil society and to civil society participation.”

 The HIV pandemic has affected over 2.3 million people in the World Health Organization’s (WHO) European Region, with nearly 300 new diagnoses made daily in 2021. The COVID-19 pandemic and geopolitical turbulences in the region impacted the course of the HIV pandemic and the response, displacing populations, and disrupting access to care and HIV testing.

Today, living with HIV is no longer a reason for despair and the management of HIV is well codified. As there is no cure, people living with HIV undertake life-long treatment that allows them to have healthy and long lives. The effectiveness of treatment is indisputable but the estimated treatment cost per person per year remains high. In Spain, it is estimated to be €11,638, while in Germany it soars to around €32,100. In France, the cost reaches €14,821, and in Italy, it amounts to €6,300.

While the introduction of pre-exposure prophylaxis (PrEP) in 2012 was a breakthrough in HIV prevention in Europe and globally, the burden of HIV continues to fall disproportionately in certain regions, like eastern Europe, as well as on vulnerable populations that include migrants, sex workers, people who use drugs and men who have sex with men. These disparities are felt in various aspects of HIV prevention and treatment, including limited access to testing and inadequate availability and affordability of prevention tools like PrEP.

Significant economic and human rights impact

WHO Europe: HIV in Europe 2021

Although the incidence of HIV in the region may not be as alarming as in other parts of the world, its impact is significant, not only on European economies but also on the human rights of its marginalised populations.

Within this context, immunisation is a crucial means of safeguarding public health, reducing morbidity and mortality. Additionally, it delivers advantages for the social and economic fabric of nations and helps alleviate the burden on healthcare systems.

Despite the disruption caused by COVID-19 in recent years, European scientists have rallied together in the pursuit of an effective HIV vaccine, conducting several early-phase trials with the backing of funding from Horizon 2020. These trials use original technologies often not developed elsewhere. However, plans and funds to ensure their continuity are urgently required, especially given the need for larger trials to achieve conclusive results.

So, why should Europe invest in the search for an HIV vaccine? First, an HIV vaccine would naturally help control the pandemic on the continent, not only from a prevention point of view but also because HIV vaccines are key to cure and remission of the virus.

Simultaneously, the vaccine would have a tremendous impact on improving public health, not only on HIV-related issues but also on other infectious diseases. For example, the long-term research conducted for an HIV vaccine played a crucial role towards the rapid development of a COVID-19 vaccine. 

Moreover, it has proven to be critical in paving the way for the development of vaccines for other diseases not only strengthening the networks of European research institutions but improving the necessary infrastructure. Thus, investing in an HIV vaccine undoubtedly means investing in pandemic preparedness, and in global health security.

Lastly, the development and distribution of an effective HIV vaccine have the potential to improve global health equity. It would ensure that everyone, regardless of their socioeconomic status or geographic location, has access to life-saving technologies, leaving no one behind. Additionally, an HIV vaccine would further protect vulnerable populations and reduce health disparities, contributing to the fight against HIV-related stigma and discrimination. By improving prevention and providing opportunities for greater control of HIV, an HIV vaccine would have a worldwide impact beyond Europe.

Vulnerable populations

Through its Global Health Strategy, the European Union is committed to deepening its leadership in global health matters, assuring that everyone everywhere has access to the highest attainable standards of health, based on solidarity and human rights. This will be achieved by, amongst other priorities, tackling the root causes of ill health, focusing on vulnerable populations, and working towards a mechanism that fosters the development of, and equitable access to, vaccines.

As the COVID-19 pandemic made clear, the EU has an unprecedented opportunity to become a global health leader. Investing in the development of an HIV vaccine that can save the lives of people all over the world must be a fundamental part of this strategy, with positive benefits for individual health and human rights, as well as for economies and health security.

It is time to invest in R&D for an HIV vaccine. It is time to ensure that the HIV pandemic no longer poses a threat to public health and individual well-being, and by doing so, protect human rights and advance equity. It is time to end AIDS.

Frances Fitzgerald is a Member of the European Parliament, Ireland

Sirpa Pietikäinen is a Member of the European Parliament, Finland

Sara Cerdas is a Member of the European Parliament, Portugal

Cyrus Engerer is a Member of the European Parliament, Malta

Antoni Comín i Oliveres is a Member of the European Parliament, Spain

Catharina Rinzema is a Member of the European Parliament, The Netherlands

Marc Angel is a member of the European Parliament, Luxembourg

Image Credits: Ehimetalor Akhere Unuabona/ Unsplash.

Global temperature
Industrial fossil fuel emissions are one of the primary causes of global warming.

In the next four years, there is a 66% chance that global temperatures will rise by at least 1.5°C – the limit set by the Paris Agreement. There is also a 98% likelihood that the world will live through the warmest year on record. 

This is according to the latest Global Annual to Decadal Climate Update issued by the World Meteorological Organization (WMO) on Wednesday.

The WMO report points out that global temperatures are set to reach unprecedented levels in the next five years due to greenhouse gases and an El Niño event expected to develop in the coming months. 

“The annual mean global near-surface temperature for each year between 2023 and 2027 is predicted to be between 1.1°C and 1.8°C higher than the average over the years 1850-1900,” the report states.

The average global temperature in 2022 was around 1.15°C higher than the average recorded during the 1850-1900 period. 

The benchmark of comparison is the average temperature during pre-industrial 1850-1900, before fossil fuel emissions started. 

Will the Paris Agreement limits be breached?

“This report does not mean that we will permanently exceed the 1.5°C level specified in the Paris Agreement which refers to long-term warming over many years. However, WMO is sounding the alarm that we will breach the 1.5°C level on a temporary basis with increasing frequency,” Dr Petteri Taalas, the secretary-general of the WMO said in a press release. 

“This will have far-reaching repercussions for health, food security, water management and the environment. We need to be prepared”.

In 2015, world leaders at the UN Climate Change Conference (COP21) in Paris reached an agreement to reduce greenhouse gas emissions to contain the global temperature increase to 2°C in this century. The leaders further agreed to pursue efforts to limit the increase to 1.5°C and to review their commitments every five years.  

When the Paris Agreement was signed, the chance of global temperatures temporarily exceeding 1.5°C was close to zero. However, the likelihood of the temperature exceeding 1.5°C has only increased since. 

The third global stocktake is scheduled to take place in 2023, where all the parties to the Paris Agreement will take inventory of the progress towards meeting the goals set out in the agreement. 

What is driving up the temperature?

The sharp increase in the emission of heat-trapping greenhouse gases is one of the two major factors pushing up the global average temperature. 

Greenhouse gases like carbon dioxide and methane trap the sun’s heat within the atmosphere, thus increasing the temperature. While these gases are present in the atmosphere naturally, human activity and industrial emissions increase the quantity of these gases. 

The other major factor outlined in the report is El Niño. An El Niño weather pattern anticipated later this year is expected to drive up the global temperature in 2024, breaking the record set due to a strong El Niño in 2016.

El Niño is a phenomenon in which the ocean surface becomes warm in certain parts of the Pacific Ocean. El Niño phases are expected to last for around four years. The last time El Niño was active was in 2016 when the global average temperature was 1.26°C higher than the pre-industrial average.  

Regions like Indonesia, the Amazon and central America are expected to receive less rainfall compared with the average rainfall received in these regions during 1991-2020. On the other hand, regions like the Sahel (in Africa), northern Europe, Alaska and northern Siberia are expected to receive higher than average rainfall in the May-to- September period between 2023 and 2027.  

The report was released ahead of the World Meteorological Congress, scheduled to take place in Geneva, Switzerland, from 22 May to 2 June. 

Image Credits: Photo by Marcin Jozwiak on Unsplash.

Plastic Pollution
The UNEP report sets the stage for the second round of international negotiations on a global treaty to fight plastic pollution, set to begin in Paris on 29 May.

Cutting global plastic pollution by 80% by 2040 is within reach if countries and companies commit to deep systemic changes in the way the world consumes and produces plastics, according to a United Nations Environment Programme (UNEP) report released on Tuesday.

The roadmap set out by the report is remarkably low-tech: reuse, recycle, and replace plastic products where greener solutions exist. With nearly 500 million tons of plastic being produced every year, and only 9% of it being recycled, the first step to addressing the plastic crisis is to make less of it, UNEP said.

“The way we produce, use and dispose of plastics is polluting ecosystems, creating risks for human health and destabilizing the climate,” said UNEP Executive Director Inger Andersen. “This report lays out a roadmap to dramatically reduce these risks through adopting a circular approach that keeps plastics out of ecosystems, out of our bodies and in the economy.”

By eliminating unnecessary plastics like excessive supermarket packaging, boosting the use of reusable bottles and containers, and finding greener alternatives to single-use plastics, government and industry could drive plastic pollution down to 40 million tons per year in 2040. In a business-as-usual scenario, plastic pollution would jump to 227 million tons in that same period.

Achieving this 80% reduction in plastic pollution could cut global carbon dioxide emissions by 500 million tons annually, equivalent to the emissions of Canada, and result in a net increase of 700,000 jobs by 2040, mostly in low-income countries, the report estimated.

The shift to a circular plastic economy would also prevent social and environmental damages valued at $3.2 trillion, according to UNEP. These savings account for impacts on health, climate, air pollution, water supplies and damage to ocean ecosystems, among other externalities.

“When you take all those [health costs] along with the cleanup costs of plastic pollution, you get in the range of $300 billion to $600 billion a year,” Steven Stone, deputy director of UNEP’s industry and economy division and lead author of the report told WIRED. “This report is a message of hope – we are not doomed to incurring all of these costs.”

Solutions in report do not solve everything

“Even with the market transformation approach described [in the report], a significant volume of plastics cannot be made circular in the coming 10 to 20 years,” the report said.
The authors of the UNEP report acknowledge the circular economy approach is not a panacea. Even under the best-case scenario, largely viewed as theoretical by environmental groups, 136 million metric tons of plastic will end up in landfills, incinerators and the environment by 2040.

Meanwhile, recycling – which the report relies on for 20% of the projected reduction in plastic pollution by 2040 – has until now proven ineffective when it comes to plastics, a problem projected to continue as the chemical make-up of plastics becomes increasingly complex, making them harder to recycle.

Recycling capacity has also failed to scale fast enough to keep pace with booming plastic production. The 2023 Plastic Waste Makers Index, an annual report of reference that tracks the activities of companies responsible for plastic production and pollution, called recycling “at most, a marginal activity for the plastics sector.”

“Despite rising consumer awareness, corporate attention, and regulation, there is more single-use plastic waste than ever before,” the index found. “Single-use plastic is not only a pollution crisis but also a climate one.”

The UNEP report comes just weeks ahead of the second of five rounds of international negotiations on a treaty to confront plastic pollution, set to take place in Paris later this month. The first round of negotiations, which took place in Uruguay in March of last year, was attended by over 2,000 experts and delegates from more than 150 countries determined to make their mark on the landmark treaty.

Jyoti Mathur-Filipp, the executive secretary of the Intergovernmental Negotiating Committee for plastics convening the negotiations, will present a zero-draft of a legally binding agreement at the meetings in Paris, which start May 29.

“This miracle material, [plastic], has in fact become a disastrous material insofar as the way we use and dispose of it,” Andersen said. “We need to take a full lifecycle approach to plastics. If we follow this [UNEP] roadmap, including in negotiations of the plastic pollution deal, we can deliver major economic, social and environmental wins.”

Familiar battle lines at a critical juncture for plastic pollution fight

Plastic
Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia.

Plastics are everywhere. They are in our clothes, food, drinking water, blood and air. Microplastics have scaled Mount Everest, a feat achieved by just 4,000 human climbers in history, independently formed island-state sized garbage patches, and are set to outnumber fish in the world’s oceans by 2050.

Ingested microplastics are starting to alter the behaviour of cells in the internal organs of humans and animals. Their invasion of the world’s oceans is suffocating phytoplankton, interfering with the ability of oceans to work as a carbon sink.

Yet last year’s meeting in the coastal Uruguayan city of Punta del Este was the first time the world agreed on the notion of plastic pollution as a global crisis on the level of climate change and biodiversity loss, and that something should be done about it.

While recent successes on the climate and biodiversity fronts provide reason for optimism, the first round of negotiations saw the emergence of clear and familiar battle lines that foreshadow a rocky road between Paris and the final agreement, set to be ratified in 2024.

The self-styled High Ambition Coalition to End Plastic Pollution, a group of 50 countries led by Norway and Rwanda who want to end plastic pollution by 2040, sit on one side of the negotiating table. They want the outcome of the plastic treaty negotiations to be a legally binding instrument to achieve that goal.

Plastics
Top 20 global producers of single-use plastics remain effectively unchanged since the first Plastic Waste Makers Index was published in 2019.

The world’s largest energy, chemical and plastics producers – flanked by fossil-fuel-producing countries like the United States, China and Saudi Arabia – sit across from them. They are pushing for the global agreement to focus on voluntary commitments determined at the national level, rather than binding global standards.

This coalition also placed a heavy emphasis on recycling as a core building block of the international accord, a premise which has long been promoted by the plastics industry. Similar to the concept of the “environmental footprint” pushed by British Petroleum to deflect the blame for climate change from oil giants to everyday people, recycling allows plastic producers to blame the careless consumer for failing to recycle properly.

The presence of industry groups like the American Chemistry Council – which includes ExxonMobil, Shell and Dow among its near 200 members – has brought renewed criticism from environmental and human rights groups, who have grown exhausted with the UN allowing the companies responsible for environmental crises to attend high-level international negotiations intended to solve them.

ExxonMobil, the world’s largest plastic producer, touted “one of the largest advanced recycling facilities in North America” in an April earnings call where it announced a record $56 billion in annual profits. The facility can process over 80 million pounds of plastic waste per year, the company said. In 2021, Exxon produced 13.2 billion pounds of plastic polymers – 165 times what its new facility can process annually.

“What we know from historians is that since the 1950s, the industry has developed a very sophisticated system to defend their products, and that system includes lobbyists, consultants, but also scientists – and that’s what’s concerning me most,” Martin Wagner, a biologist specialized in the environmental impacts of plastics and synthetic materials at the Norwegian University and Science and Technology told Plastisphere.

“What the chemical industry has learned from the tobacco industry is that … manufacturing doubt and preventing scientific consensus on one of their products is [very powerful],” Wagner said. “Given the history of the sector to lobby for regulation that is not in any way restricting their business, I think the plastic industry’s role in negotiations should be as minor as possible.”

Image Credits: QPhia.

Landlocked equatorial Burundi is one of the poorest countries in the world – yet it scored the highest out of 58 countries for its plans to integrate health measures into its climate mitigation plan, getting an almost perfect score of 17 out of 18.

Low- and middle-income countries were far more likely to include health goals in their climate commitments than more wealthy, industrialised nations that are responsible for the majority of global greenhouse gas emissions.

This is according to an analysis published on Tuesday by the Global Climate and Health Alliance (GCHA), a coalition of over 150 health and development organisations working to tackle climate change.

The alliance analysed the climate plans of 58 countries – which are called nationally determined contributions (NDCs) in terms of the Paris Agreement on climate change. All countries that are party to this agreement have to develop NDCs to cut emissions and adapt to climate impacts, submit these plans to the United Nations Framework Convention on Climate Change (UNFCCC) and update them every five years.

The countries included in the alliance’s NDC Healthy Scorecard were those that had submitted their plans between 1 October 2021 and 23 September 2022. 

Greater ambition

“Overall, the Healthy NDC Scorecard demonstrates a trend of low- and middle-income countries showing greater ambition for protecting their citizens’ health from the worst impacts of climate change, while identifying additional wins through health co-benefits of climate action,” said Jess Beagley, Policy Lead at the Global Climate and Health Alliance. 

Each NDC was assigned a health score, with a total maximum of 18 points available across six categories – health impacts of climate change, actions in the health sector itself, recognition of health co-benefits of climate action in other sectors, economic and financial considerations, and monitoring and implementation. 

For example, countries get points for how well different parts of government are integrated to address climate change, how the health sector is being adapted to address climate threats, whether there is a budget, if the health impacts of climate change are quantified in terms of their cost, and whether there are particular targets that are set out, that relate to health, that governments can e held accountable to.

Where available, data from Climate Action Tracker has been included to evaluate the country’s level of ambition with regard to its emissions reduction target, its key commitment to mitigating climate change and limiting global warming.

“The NDC of Burundi is really exemplary,” said Beagley.  “It really does do almost the maximum in terms of integrating health into the NDC.”

Burundi’s plan includes the need to address a likely increase in the spread of vector-borne disease and flooding. A spinoff of its “vulnerability analysis” includes plans to power 455 health centres with solar energy.

Health considerations are part of its plans related to agriculture, energy, transport and water. It has a budget, indicators and timelines. 

Some wealthy nations score zero

Some wealthy nations, including Australia, Japan and New Zealand scored zero, reflecting the lack of any reference to health and climate linkages in their NDC. 

Meanwhile, the NDC emissions targets of some G20 nations, including Indonesia and Saudi Arabia, as well as of COP28 host the United Arab Emirates and COP27 host Egypt, received the worst rating available on the scale used by Climate Action Tracker. 

“Their climate mitigation targets contained in their NDCs align with over 4°C of warming, far beyond the 1.5C target agreed under the Paris Agreement, and putting the world on track for catastrophic and irreversible climate change impacts,” according to the alliance.

Jeni Miller, executive director of the Global Climate and Health Alliance.

“Although COP28 is being marketed as the ‘Health COP’, the Healthy NDC Scorecard scores make it clear that virtually none of the countries most culpable for climate warming appear to be clearly focussed on protecting the health of their citizens, or people around the world, when making climate commitments”, said Dr Jeni Miller, executive director of the Global Climate and Health Alliance. 

“This is despite promising to protect people’s ‘right to health’ when adopting the 2015 Paris Agreement, as well as endorsing the ‘right to a healthy environment’ at COP27”.

Image Credits: UNHCR.

Artificial sweeteners don’t help to control weight and may cause long-term health issues, says WHO.

Artificial sweeteners should not be used to control body weight or reduce the risk of non-communicable diseases (NCDs), according to a World Health Organization (WHO) guideline issued on Monday. 

“Non-sugar sweeteners (NSS) are not essential dietary factors and have no nutritional value. People should reduce the sweetness of their diet altogether, starting early in life, to improve their health,” according to Francesco Branca, WHO Director for Nutrition and Food Safety. 

“Replacing free sugars with NSS does not help with weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” he added. 

The recommendation applies to all people except those with pre-existing diabetes and includes all synthetic and naturally occurring or modified NSS that are not classified as sugars found in manufactured foods and beverages, or sold on their own to be added to foods and beverages by consumers. 

Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

Toothpaste, skin creams excluded

“The recommendation does not apply to personal care and hygiene products containing NSS, such as toothpaste, skin cream, and medications, or to low-calorie sugars and sugar alcohols (polyols), which are sugars or sugar derivatives containing calories and are therefore not considered NSS,” according to the WHO.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that the use of NSS does not confer any long-term benefit in reducing body fat in adults or children – and long-term use could potentially increase the risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The systematic review included 64 prospective cohort studies conducted in adults, 15 cohort studies in children, one cohort study in children and adults and 17 cohort studies in pregnant women.

Although a short-term benefit of NSS use on measures of body fatness was observed in controlled experimental settings, the WHO concluded that there was little evidence that long-term use of NSS is beneficial for body weight – and the possible long-term adverse effects in the form of increased risk of death and disease offset any potential short-term health benefit resulting from the relatively small reduction in body weight and BMI observed in randomized controlled trials. 

In addition, limited evidence for the beneficial effects of NSS use on dental caries was observed in studies of children using stevia. But this was generally only observed in studies where NSS use was compared to sugars.

“This suggests that NSS do not have any inherent properties that impact the risk of dental caries; rather, the effect is a result of displacing free sugars,” the WHO noted.

But because the link between NSS and disease outcomes might be confounded by baseline characteristics of study participants and complicated patterns of NSS use, the recommendation is conditional, following WHO processes for developing guidelines. 

“This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups,” the WHO concluded.

Industry disappointment

However, the International Sweeteners Association contested the guideline, arguing that their products “continue to be a helpful tool to manage obesity, diabetes and dental diseases”.

The association added that it is  “disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality”. 

Image Credits: Towfiqu Barbhuiya/ Unsplash.

Self-Care: A Foundational Component of Health System Sustainability

Self-care practices hold the huge potential to improve people’s quality of life, helping to manage the burden of NCDs while simultaneously developing the sustainability of health systems.

On the occasion of the 76th World Health Organization (WHO) World Health Assembly (WHA), the United for Self-Care Coalition is hosting a side event to highlight why a WHO resolution on self-care is key to achieving Universal Health Coverage (UHC). This dialogue will bring together a diverse set of stakeholders to advance the call to codify self-care as a critical component of the healthcare continuum.

The event, which will be held on Wednesday 24 May in Geneva Press Club is titled “ Self-Care: A Foundational Component of Health System Sustainability,” and will bring together policymakers, healthcare providers, academics, and patient advocates to discuss strategies for advancing health equity by integrating self-care into national health systems.

“The time to act is now. We believe that self-care is a critical component for the advancement of UHC, and we are committed to working with policymakers, healthcare providers, patients, and academia, to promote its integration into health systems,” said Judy Stenmark, Director General of the Global Self-Care Federation. “This event is also an opportunity for us, as a Coalition, to advocate for the adoption of a World Health Assembly Resolution on Self-Care, promote evidence-based interventions, and support policies and strategies that encourage the integration of self-care as a core component of people-centered care – we invite everyone to join us on this journey.”

Self-care is an indispensable solution for realising Universal Health Coverage by 2030 and should be integrated into future health and economic policy, with a focus on affordability and access. This whole-society approach is backed by research proving that person-centric healthcare is both a politically and economically viable way of managing the global spread of NCDs, especially in low and middle-income countries (LMICs).

Panel to focus on ‘crucial role’ of self-care

The panel will discuss the crucial role of self-care including today’s most significant challenges to health system sustainability, ways self-care can help advance the achievement of UHC and how a patient-centered approach can be beneficial to managing NCDs.

Panelists include Dr Slim Slama, Head of the Management-Screening, Diagnosis and Treatment Unit (MND), in the Non-Communicable Diseases Department at World Health Organization, Manoj Raghunandanan, Chair of the Global Self-Care Federation, Dr Mariet Eksteen, Professional Development Officer at the Pharmaceutical Society of South Africa (PSSA) and the Global Lead for Advancing Integrated Services in the FIP Hub, Dr Manjulaa Narasimhan from the World Health Organization, and Self-Care Trailblazer Group, Kawaldip Sehmi, CEO of the International Alliance of Patients’ Organizations and Austen El-Osta, Director of the Self-Care Academic Research Unit (SCARU) & Primary Care Research Manager at Imperial College London School of Public Health.

The session, moderated by broadcast journalist Shiulie Ghosh, will also be live-streamed.

United for Self-Care Coalition is a coalition of like-minded organisations unified by one common goal – to achieve Universal Health Coverage (UHC) by codifying self-care as a critical component of the healthcare continuum, particularly in the context of managing the burden of NCDs.

To join this in-person event, register here. To learn more about the coalition, click here.

This article is part of a supported series in collaboration with the United for Self-Care Coalition ahead of the 76th World Health Assembly.

Taiwan is set to be excluded from the World Health Assembly for a seventh straight year.

Despite a forceful message from the US calling for its inclusion, Taiwan appears set to be shut out once more from the World Health Assembly (WHA) as Chinese diplomats continue to block chances of a personal invitation by WHO Director General Dr Tedros Adhanom Ghebreyesus that would allow Taipei to attend as an observer. 

In a quick rebuttal of the US appeal, a spokesperson for the Chinese Foreign Ministry said the rejection of the “one-China” principle by the Taipei – which both the US and United Nations follow – meant “the political foundation for the Taiwan region to participate in WHA no longer exists.”

“The US statement is misguided and misleading,” Wang Webin said at a press conference in Beijing on Wednesday. “We once again urge the United States to adhere to the one-China principle, observe international law, and act on the US leader’s assurances that the country will not support ‘Taiwan independence’.”

The debate over Taiwan’s participation in the upcoming WHA has been a perennial issue since 2017, when the election of Tsai Ing-Wen’s pro-independence party prompted WHO’s director-general to stop extending the traditional invitation to the island nation to attend the WHO’s top decision-making forum in response to pressure from China.  

The debate over Taiwan’s participation has taken on added significance following a year of growing tensions in the Western Pacific region as China flexes its military might in war games and the United States increases its military support for Taiwan. 

In April, the US approved a $120 million sale of arms to Taiwan, the largest military sale to the island in over a decade. The sale coincided with a joint military exercise with Japan in the East China Sea in a show of force just beyond Chinese waters, adding weight to Joe Biden’s statement that US forces would defend Taiwan in the event of a Chinese attack. 

Last year’s assembly saw more WHO member states than ever – including Germany’s new coalition party – appealing to re-install Taiwan as a WHA observer. But in the absence of a special invitation from the director-general to circumvent the WHO member states, the mounting pressure amounted to nothing. 

US: Taiwan is a “reliable partner and vibrant democracy”  

In keeping with what has become an annual routine, the United States and other key allies of Taipei have ramped up diplomatic efforts to pressure WHO into granting Taiwan accession to the WHA, just ahead of the start of the assembly on Sunday 21 May. 

This year’s debate was kicked off by a particularly forceful statement issued by US Secretary of State Anthony Blinken, who called Taiwan’s exclusion from WHA “unjustified” and harmful to “global public health” and “security”.

“Taiwan’s distinct capabilities and approaches – including its significant public health expertise, democratic governance, and advanced technology – bring considerable value that would inform the WHA’s deliberations,” Blinken said. “Inviting Taiwan as an observer would exemplify the WHO’s commitment to an inclusive, “health for all” approach to international health cooperation.” 

Blinken also highlighted Taiwan’s significant contributions to global health, including its track record of scientific research on COVID-19, and the aid it has provided to low-income countries with which it has relations.

“Taiwan is a reliable partner, a vibrant democracy, and a force for good in the world,” he said.

China began blocking Taiwan’s participation in 2017

China, which considers Taiwan to be one of its provinces, began blocking Taipei’s participation in WHO after the election of Tsai Ing-Wen in 2016, whose Democratic Progressive Party views Taiwan as an independent state.

Taiwan participated in WHO as an observer state from 2009 to 2016 under the name “Chinese Taipei”, a designation viewed as unacceptable by the current government.

Taiwan is not recognized as an independent state by the United Nations, and the WHO is far from the only international organization from which it is excluded. Chinese efforts have successfully blocked Taipei’s accession to other major organisations such as the International Civil Aviation Organization and Interpol, which facilitates worldwide cooperation between police forces. 

Meetings dedicated to “expanding Taiwan’s participation in the United Nations system and other international forums” took place in between US and Taiwanese officials Washington DC in April, with discussions focusing on “near-term opportunities to support Taiwan’s expanded participation in the coming WHA” and “meaningful participation in non-UN international, regional and multilateral organizations”, the US State Department said.

Taiwan is a member of organizations like the World Trade Organization, Asian Development Bank and the Asia-Pacific Economic Cooperation since they do not require members to be states. 

“The one-China principle has the overwhelming support of the international community and represents the global trend,” Webin said. “This is not to be denied.” 

Drama around WHO’s relationship with Taiwan is not new

The 76th WHA marks the seventh year of headaches for WHO leadership, who have long struggled to navigate the minefield around the Taiwanese question. 

In an explosive 2020 interview by Hong Kong broadcaster RTHK news, top WHO official Bruce Aylward hung-up live on air after being pressed on the issue of Taiwan’s inclusion in the organization. 

The viral interview prompted heavy criticism and accusations of bias from Taiwan. Joseph Wu, Taiwan’s foreign minister, reposted the interview with Aylward in a tweet, saying: “Wow, can’t even utter ‘Taiwan’ in the WHO?”

Wu, who has been Tsai Ing-Wen’s foreign minister since 2018, has repeatedly criticized the WHO for its “continued indifference” to the health of Taiwan’s 23.5 million people, and has called on the organization to “reject China’s political interference.”

Accusations of bias in favor of China have also swirled around the WHO’s investigation into the origins of the SARS-CoV2 virus.  Many independent critics found WHO’s initial mission to Wuhan in early 2021 and its subsequent report on the possible causes of the virus emergence to be too “soft” on China. 

Critics noted that the initial report failed to both demand transparency from government officials regarding data on human infection from the early days of the virus’ spread in Wuhan, or adequately investigate shortcomings in food safety practices as well as biosecurity lapses in a local virus research lab. 

WHO eventually sharpened its tone vis-à-vis Beijing, bolstered by the support of new US President Joe Biden who re-engaged with WHO after a chaotic year in which Donald Trump had suspended membership to the global health body.  

But Beijing never agreed to a second mission and thus in-situ research on the origins of the virus gave way to remote analyses of available shards of data. 

Taiwanese delegation will be present on the sidelines 

Despite Taiwan’s likely exclusion from official WHA proceedings, Taiwanese experts and civil society groups may be allowed to participate in expert working groups as well as other side-events. 

The Taiwan Digital Diplomacy Association (TDDA), announced that at least 10 civil society organizations will make the trip to Geneva to participate on the margins of the WHA. 

The civil society participants say that they are organizing a parallel event to the World Health Assembly in Geneva to promote the stronger role Taiwan can have in public health diplomacy and the lessons learned from the SARS-CoV2 pandemic. 

Taiwanese civil society leaders also say that they are planning a walking demonstration through Geneva to advance Taiwan’s inclusion in the WHO as well as launching a global petition supporting Taiwan’s participation in the WHA.  

Image Credits: © Keystone: Ritchie B. Tongo .