Studies show that air pollution is associated with worsening mental health outcomes.

Air pollution has been linked to poor brain development, as well as a higher risk of dementia and stroke. A link has also been established between exposure to air pollution and depression as well as higher suicide rates.

The subject received attention at the second WHO’s global conference on air pollution and health in Cartagena, Colombia this week.

“Air pollution is increasing the risk of new mental health problems and worsening mental health in people with pre-existing mental health problems,” Alessandro Massazza, policy and advocacy advisor at United for Global Mental Health, a global non-profit that focuses on mental health advocacy, told Health Policy Watch.

The societal costs of mental disorders due to air pollution, climate-related hazards, and inadequate access to green space are estimated to reach around $47 billion annually by 2030 — a significant portion of the massive $8.1 trillion annual price tag for the overall health impacts of air pollution.

Alessandro Massazza (right) speaking on the impact of air pollution on mental health during a session at WHO’s global conference on air pollution and health in Colombia’s Cartagena.

Around 99% of the world’s population breathes air that does not meet the air quality standard set by the World Health Organization (WHO). Exposure to high levels of air pollution claim over eight million lives worldwide every year.

“It’s not just that we’re all exposed to air pollution, not just that it affects everybody, but it affects non-communicable diseases (NCDs),” said Mark Miller of the World Heart Federation. He pointed out that NCDs are already the world’s biggest killer, responsible for 74% of all deaths annually.

“Tackling NCDs has to be one of the greater priorities for the world, no matter what sector of life that you’re in,” Miller said.

 How air pollutants reach the brain 

Burcin Ikiz, neuroscientist and director at EcoNeuro.

The exact pathway through which air pollutants reach the brain is now becoming clearer.

“The pollutants from the air enter our brains through two mechanisms. One is directly from our nasal cavities up to our olfactory bulb, but also from systemic inflammation,” Burcin Ikiz, neuroscientist and director at EcoNeuro, a research and consulting company working in global health, told Health Policy Watch.

“When the lungs get inflamed due to the pollutants in the air, those send inflammatory responses into the bloodstream, and through the bloodstream reaches the blood-brain barrier,” Ikiz explained. “Normally, our blood-brain barrier should be our protective layer that protects the brain from any outside pollutants or harmful substances. But it’s not perfect. It’s a leaky system.”

Children, the elderly population, and those living with other neurological conditions such as multiple sclerosis and Alzheimer’s are especially vulnerable, she added.

Potential pathways for air pollutants to reach the brain and create an impact

“We know less about what may be driving this association between air pollution but it’s likely to be the result of a mixture of biological (e.g., inflammation), social (e.g., not being able to go outside or socialize outdoors), and psychological (e.g., impact on mood, cognition, or sleep) mechanisms,” Massazza said.

Air pollution is also linked to poor brain development in children, starting in utero.

“Looking at pregnant women and their babies that are still in the womb being exposed to pollution, we see their brain structures changing,” Ikiz said. Post-birth, “we see them having…. developmental delays and lower IQs and so on.”

Adolescence has been identified as another crucial period during which many mental health disorders first develop.

The risk of strokes in which the blood flow to the brain is reduced, also increases due to air pollution, studies have found. Air pollution is also among the 14 modifiable risk factors for dementia.

Air pollution has also been found in several studies to be associated with depression on both short and long-term time scales, drawing attention to its impact on poor mental health outcomes.

Need for evidence-based interventions

The additional societal costs of these mental health disorders influenced by environmental factors are expected to rise further, according to an estimate that pegs it at US $537 billion by 2050, relative to the baseline scenario in which the environmental factors remain at 2020 levels.

“People with chronic and severe mental health problems often live with co-morbid non-communicable diseases such as respiratory or cardiovascular conditions, which can further increase their vulnerability to the physical health impacts of air pollution,” Massazza.

Limited research on interventions shows that significant mental health gains are seen when air pollution is reduced. One study from China demonstrates how the country’s clean air policies are not only contributing to large reductions in air pollution but have also been deemed responsible for preventing 46,000 suicides over just five years.

Significant data gaps remain, with only a handful of studies on air pollution’s impact on mental health coming from low- and middle-income countries. Experts say efforts are needed to improve research in understanding the pathways between environmental stressors and mental illness.

In September, the UN headquarters in New York will host a high-level meeting on NCDs and mental health, where the impact of climate change on NCDs and mental health is likely to be discussed.

“Clean air policies are mental health policies. From reduced energy poverty and more access to green spaces to increased physical activity resulting from active modes of transport, actions aimed at reducing air pollution have considerable potential co-benefits for mental health,” Massazza said.

Sophia Samantaroy contributed reporting. 

Image Credits: Unsplash, By arrangement, Elaine Fletcher, Air quality and mental health: evidence, challenges and future directions.

Dr Susan Monarez, newly appointed head of the US CDC (2nd left) and other US government officials meet Africa CDC Director General Dr Jean Kaseya and Dr Ngashi Ngongo in Washington.

Leaders of the Africa Centres for Disease Control and Prevention (Africa CDC) held a five-hour meeting with Dr Susan Monarez, newly appointed head of the US CDC, and other US officials on Wednesday – for the first time since the US slashed funding to Africa’s health sector.

Discussion centred on health security, funding for Africa CDC and options for health financing on the continent, Dr Ngashi Ngongo, Africa CDC’s incident management head, told a media briefing on Thursday.

“From the [US] administration’s perspective, they would like to see more of health as a business, rather than something that functions on grants,” added Ngongo. 

African programmes worst affected by the US’s abrupt termination of funding are those dealing with maternal and child health, HIV, malaria and emergency preparedness and response, said Ngongo, speaking from Washington DC, where he and Africa CDC Director General Dr Jean Kaseya are meeting a range of US leaders.

Aside from Monarez, the meeting was attended by high-level officials from the White House, the US State Department’s Bureau of Global Health Security and Diplomacy, Health and Human Services (HHS), and an assistant secretary from the President’s Emergency Plan for AIDS Relief (PEPFAR).

“We made the point, which was accepted by our American counterparts, that global health security starts with what happens outside the US,” said Ngongo, adding that the Trump administration “remains committed to addressing health security”. 

‘Health as a business’

Ngongo said that the Trump administration is interested in “exploring how can we go into a partnership that translates into health as a business”, adding that private sector opportunities exist in the local manufacturing of medicines, digitalisation of health records and the electrification of clinics.

“On programmes, we discussed malaria, HIV, and also support in the area of systems for emergency preparedness and response, in particular surveillance, laboratory capacity strengthening, and the health workforce,” said Ngongo.

The aim of the meeting, he added, was “to make sure that we understand them and they also understand the priorities for Africa CDC”. Discussions with US government officials will continue in April around the World Bank’s spring meeting in Washington, he added.

A report published in The Lancet this week predicted that, across all low and middle-income countries, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support “could cause an additional 4·43–10·75 million new HIV infections and 0·77–2·93 million HIV-related deaths between 2025 and 2030”.

If PEPFAR support is “reinstated or equivalently recovered, this reduced to 0·07–1·73 million additional new HIV infections and 0·005–0·061 million HIV-related deaths”, the modelling study adds

“Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations,” the authors note.

Funding gap

Meanwhile, Africa CDC has a funding gap of $224 million – in part due to the US walking away from a pledge made to the continent by the Biden administration.

Official development assistance (ODA) for Africa has dropped from $81 billion in 2021 and to $25 billion 2025, yet there has been a 41% increase in disease outbreaks on the continent between 2022 and 2024. 

Lack of funds, weak health systems and conflict “risk the reversal of two decades of health achievement on the continent”, said Ngongo

“We are also concerned about the risk of another African pandemic, which … would translate into more crisis, with the economic vulnerability that will push more Africans into poverty,” said Ngongo.

“But it really doesn’t help to complain. We have to be proactive in terms of thinking that, if that is the new normal, if that is the direction that the world is taking, how do we remain fit in that context?”

Options include increasing domestic financing, a “solidarity levy” on all airline tickets sold on the continent, higher “sin taxes” on alcohol and tobacco and partnerships with the private sector.

Three-pronged plan to raise funds for African health

“The European Union (EU) has already committed to imposing a minimal import levy on goods that are imported to Africa” to assist, he added.

“All that is on the backbone of the optimization of the use of resources to ensure that there is less corruption, there is less misuse and inefficiencies,” said Ngongo, adding “you cannot really leave your health in the hands of the partners”.

New mpox plan

An updated plan to address the ongoing mpox outbreak was recently completed by the Africa CDC’s Incident Management Support Team.

Its goals are to stop the human-to-human transmission, halve the burden of impact and strengthen the health system as part of countries’ epidemic preparedness and response.

“The response strategy is mainly community-centred under the leadership of community health workers,” said Ngongo.

It is a multi-sectoral approach that relies on strengthening co-ordination, digitalizing surveillance – which will assist with other diseases, and completing laboratory decentralisation.

“We need to vaccinate about 6.4 million people during the next six months on this second plan and on the case management, we target at least 80% of confirmed cases that need to be taken care of,” he added.

The total budget estimated is $429 million, of which a quarter will be for surveillance and a quarter for vaccination and logistics. 

Mpox cases rose by 22% increase over past week to 3,323 cases. Confirmed cases also rose from 381 to 925. The Democratic Republic of Congo (DRC), Burundi and Uganda account for 91% of all cases.

Surveillance was slightly improved in the DRC with 21 out of 26 provinces reporting (up from 19 the previous week) and testing up from 13% to 20% of suspected cases. There were 2,451 new cases in comparison to 2,183 the week before, with 312 confirmed cases in comparison to 150.

Sierra Leone, which has 114 confirmed cases, became the sixth country to start vaccinating people on Thursday.

WHO’s Maria Neira (center) with air pollution activists from around the world at the opening plenary of the WHO Air Pollution and Health Conference.

CARTAGENA, Colombia – From toxic methane flares in the Amazon rainforest to the death of a nine-year-old girl from London smog, the second WHO Conference on Air Pollution and Health opened Tuesday  with a series of emotional testimonials on the deadly effects of smog. 

Behind the human stories, however, stands  a mounting array of evidence about the adverse effects of air pollution on everything from newborn health to brain health and ageing that the three-day conference will explore.  

The conference is the first on the topic to be convened by WHO since 2018. It takes place at a time when the evidence about the adverse effects of air pollution on everything from newborn health to brain health and ageing continues to snowball. 

The conference sessions and side events, ranging from the emotional and artistic to the drily scientific, are covering a widening range of air pollution topics that has grown even broader since the last conference was convened. 

Some sessions cover relatively new topics for the health sector such as the  impacts of air pollution on agriculture, new knowledge on wildfires and dust storms, and opportunities for the health sector to reduce its own emissions through shifting to renewable energy and climate resilient health facility design.

Goal to halve deaths attainable with right investments

Meanwhile, a new World Bank report estimates that some two million deaths annually from outdoor air pollution can be avoided if the number of people exposed to deadly PM2.5 pollution particles above 25 micrograms per cubic meter was halved by 2040.

But investments in clean air strategies would need to increase from $8.5 billion to nearly $14 billion annually to meet that 2040 goal, said World Bank analyst Sandeep Kohli. 

$8.1 trillion is the current cost of air pollution to global GDP: WHO’s Maria Neira.

At the same time, with the costs of air pollution amounting to over $8 trillion annually, or some 10% of global GDP today, the economic gains would be immediate and significant. 

In the most optimized strategy of integrated action in the energy, transport, waste and industry, reducing air pollution emissions would yield between $1.9 and $2.4 trillion over the coming 15 years  (in 2021 dollar terms) and reduce deaths from outdoor air pollution alone by about two million annually – from about 6.2 million to 4.2 million deaths annually, according to the new World Bank Report, Accelerating Access to Clean Air for a Livable Planet.

Integrated strategies will slow warming trends

Helena Naber, Senior World Bank Environmental Economist

 Well-planned, integrated strategies would also reduce emissions of major climate “super pollutants” that have an outsized impact on global warming but also much shorter lifespans than CO2, putting the brakes on climate change if they are reduced.   

“Reducing the number of people exposed to PM 2.5 concentrations above 25 micrograms ..globally, by 2040 by half, is both feasible and can be affordable,” said Helena Naber, Senior World Bank Environmental Economist. 

 “An integrated approach, combining conventional air quality management measures, clean energy and climate policies that are designed to achieve other goals, such as energy independence reducing greenhouse gas emissions, could achieve substantial progress ….by 2040 reducing mortality that is associated with air pollution compared to current policies.”

The benefits are not only theoretical, stated Hongbing Shen, vice-minister of China’s National Health Commission, who made the long journey to the Cartagena conference site to relate the story of China’s “Asian miracle” in battling extreme levels of air pollution. 

WHO Director-General sitting out the event 

WHO Director-General Dr Tedros Adhanom Ghebreyesus at a WHO global press conference, 17 March, in Geneva. He cancelled his travel to Cartagena at the last minute.

In contrast with the high-level Chinese presence here, not a single United States government delegate was in attendance.  And against the new narrative of climate denial being advanced by the new administration of President Donald Trump, even the most compelling environmental health and economic arguments still risk being pushed aside.

Inside WHO, which is battling for survival in the wake of the US withdrawal and a deepening budget crisis, climate and environment risk being marginalized even more as there are soaring demands for the body to respond to health emergencies from a growing array of disease outbreak threats and regional conflicts. 

A telling sign is that WHO Director General Dr Tedros Adhanom Ghebreyesus will not be visiting for the high-level portion of the meeting Thursday where countries will make national commitments to reduce air pollution in line with the stated conference goal of reducing deaths from air pollution by one-half by 2040. 

Latin America venue has plusses and minuses

Vision of a greener and cleaner world by Brazilian street artist, Eduardo Kobra on the Esplanade of the Cartagena Conference Center where the WHO conference is taking place.

Another challenge is travel difficulties for African and Asian officials to the event – people from the very regions that are the world’s biggest pollution hotspots today. Due to the limited travel routes, some Asian and African participants spent 30 to 48 hours in transit.  

But the conference comes at an opportune moment for Latin America, which has relatively better developed air pollution monitoring systems, and where cities like Bogota and Barranquilla in Colombia, as well as Curitiba in Brazil, have been long-time pioneers in Bus Rapid Transit and bicycle lanes. 

About a dozen ministers of health, mostly from the continent, are expected to participate in the day of high-level commitments Thursday, where countries will outline their national objectives for reaching the 50% air pollution mortality reduction goal.  

Amazon region is becoming a risk for health  

Brazilian activist Fany Kuiru describes toxic impacts of methane gas flaring in Amazonia.

Against the political inertia, speakers in the keynote sessions – including bereaved mothers, lung specialists, youth leaders and activists – pleaded for politicians to wake up to the reality of what air pollution is doing to health, environment and communities. 

Brazilian activist Fany Kuiru described how dozens of methane gas flaring sites in areas of oil and gas extraction are killing indigenous community members in Amazonia region.  

A lawsuit against the Government of Ecuador in 2021 failed to lead to real change, as  there has been a 23% increase in emissions in 2023 in comparison to 2021, said the Kuirut, coordinator of the Organization of Indigenous Communities in Amazonia. . 

“Each gas flaring system is a death system for the Amazon and its inhabitants,” she declared. 

Throughout Amazonia the rain forest is taking a big hit from air pollution of multiple forms. 

“Forest fires, contaminants released from illegal mining… All of this evaporates into air, so that the Amazon region, which is supposed to save life, is becoming a risk for health,” said Kuiru.  

‘Every asthma attack was associated with a pollution peak’

Rosamund Kissi-Debrah describes the death of her daughter, Roberta Ella, from air pollution at age 9.

“My daughter Ella would be 21 today had she survived, and yet her legal case has only just ended,” said Rosamund Kissi-Debrah, founder of the Ella Roberta Foundation.  She has waged more than a decade long legal battle in the UK to have air pollution recorded as the cause of her daughter’s death in February 2013 at the age of nine. 

Ella was diagnosed with severe asthma at seven after being seen by a doctor for a “persistent cough that just wouldn’t disappear,” Kissi-Debrah told a plenary audience of hundreds on the conference’s opening day. 

“Over the next thirty months, she was hospitalized over a dozen times.  Her siblings had to know what to do in times of emergency,” said Kissi-Debrah.

“She survived five comas and managed to fight back from them… until the final, severe asthma attack on 15 February, at age nine.  The horror of those years is not something I would wish upon any family.”  

While the cause of death was initially recorded as “respiratory failure” an autopsy revealed that her lungs “resembled those of a smoker.”

“It wasn’t until she died and they opened her up did we really see the horrors of what was going on,” he mother said. Belatedly, the family realized that the triggers for Ella’s acute episodes and hospitalizations all were linked to spikes in air pollution along the heavily trafficked London freeway where they lived.  

‘Air pollution is killing us’

Mother and child walk through a polluted cityscape – visualization on walls of the Cartagena conference center.

“This meeting is about one thing. Air pollution is killing, killing, killing us,” declared Maria Neira, director of WHO’s Department of Climate, Environment and Health and the ‘doyenne’ of the global air pollution and health movement. 

“Have we advanced, yes,” she said. “Have we advanced to the level of commitment required, no.” 

Looking around the huge conference auditorium that looks out onto the Pacific Ocean one the one side  and onto streets choked with diesel traffic on the other, she recalled that Cartagena is the setting for Gabriel Garcia Marquez classic novel, “One Hundred Years of Solitude” that established a new style of “magical reality” in storytelling. 

“This place is a magical one and reality is here as well…We are hoping that in a few years from now, the reality will be changed,” said Neira, adding, “We need to make our lungs healthy again.”

The aspiration for a pollution-free city – transforming imagination into reality.

Image Credits: Sophia Samantaroy.

A baby gets a BCG vaccination in a Gavi-supported programme.

The United States plans to stop funding the global vaccine alliance, Gavi, which assists developing countries to buy vaccines to protect their children, according to a spreadsheet obtained by the New York Times.

Gavi is one of the 5,341 US Agency for International Development (USAID) grantees that the US intends to cut, according to the 281-page spreadsheet sent to Congress this week.

The US covers 13% of Gavi’s budget, and its vaccine programmes are estimated to have saved almost 19 million lives over its 25-year existence.

We have not received a termination notice from the US government and are engaging with the White House and Congress with a view to securing $300m approved by Congress for our 2025 activities and longer term funding for Gavi,”  Dr Sania Nishtar, CEO of Gavi, told Health Policy Watch.

“A cut in Gavi’s funding from the US would have a disastrous impact on global health security, potentially resulting in over a million deaths from preventable diseases and endangering lives everywhere from dangerous disease outbreaks.”

Responding to the news on X, Gavi said that it could save “over eight million lives over the next 5 years and give millions of children a better chance at a healthy, prosperous future”. 

An investment in Gavi will also keep the US safe, it added: “By maintaining global stockpiles of vaccines against deadly diseases like Ebola, mpox and yellow fever we help keep America safe. These diseases do not respect borders, they can cross continents in hours and cost billions of dollars.”

“Every dollar we invest in lower income countries generates a return of $54. This helps countries develop and communities thrive, taking away pressure to migrate in search of a better life elsewhere.”

‘Political decision to ignore science’

Public Citizen’s Liza Barrie said that the Trump administration’s decision “abandons 25 years of bipartisan commitment to global immunisation and undermines the very systems that help prevent deadly outbreaks from reaching our own doorsteps”.

“The administration is walking away from a $2.6 billion pledge — jeopardizing routine vaccinations for 75 million children over the next five years,” said Barrie, who heads the organisation’s global vaccine access programme.

“This isn’t fiscal responsibility. It’s a political decision to let preventable diseases spread— to ignore science, lend legitimacy to anti-vaccine extremism, and dismantle the infrastructure that protects us all,” she stressed, adding that Congress has authority over foreign assistance funding.

“The administration’s attempt to unilaterally walk away from its Gavi commitment raises serious legal questions and should be challenged. Lawmakers must stand up for the rule of law, and for the belief that the value of a child’s life is not determined by geography.”

Schoolgirls line up to receive the HPV vaccine in Central Primary School in Kitui, Eastern Kenya

The US also plans to ditch the United Nations Food and Agriculture Organization, which tracks zoonotic diseases despite the US being in the midst of a months’ long H5N1 outbreak in cattle that has also infected farm workers.

Only 898 grantees will be retained, including scaled back support for HIV and tuberculosis and food aid during humanitarian crises.

Around 60% of grants for the US President’s Emergency Plan for AIDS Relief (PEPFAR) were administered by USAID and at least eight countries are on the brink of running out of HIV medicine.

Only 869 USAID staff are still in office out of over 6,000 and the US State Department has taken control of the agency.

Earlier, Health Policy Watch reported on a leaked plan for US foreign aid which would see a new body, the Agency for International Humanitarian Assistance (IHA), take over the remnants of USAID.

The plan envisages three “pillars” for future aid thematically organised as “safer”, “stronger”, and “more prosperous”.

The “safer” pillar will cover “humanitarian assistance, disaster response, global health and food security” under a new body, which will fall under the State Department.

US Vice President JD Vance is in charge of deciding on the future of USAID.

Updated on 27 March to include comment from Gavi CEO Sania Nishtar,

Image Credits: Gavi, the Vaccine Alliance, Keystone / EPA / Karel Prinsloo / GAVI.

Panelists Rachel Huxley, Claire Henly, and Pierpaolo Mudu discussed the threat of super pollutants ahead of the WHO Air Pollution and Health Conference.

CARTAGENA, Colombia – A small group of climate pollutants– including the air pollutants black carbon, methane, and ozone – are responsible for nearly half of global temperature increases to date. 

Reducing these emissions, which only remain in the atmosphere for a few weeks to decades, could serve as the “emergency brake” critical to halting runaway climate change, said experts Monday on the eve of the second WHO Air Pollution and Health Conference.

Although these pollutants exert enormous 20-year climate-warming potential that is 80 to 2,000 times greater than carbon dioxide (CO2) per ton of emissions, their lifespan is far shorter than CO2, which remains in the atmosphere for a century or more.

These pollutants are also projected to continue warming the climate with greater potency than CO2 over the next century.

“If you reduce them today, we’ll see impacts in our lifetimes,” said Claire Henly, executive director of the Super Pollutant Field Catalyst, a US start-up NGO, at a media briefing ahead of the conference

While CO2 has received the overwhelming amount of climate mitigation attention, Henly and others argued that addressing a class of “super pollutant” greenhouse gases and particles, also known as “short-lived climate pollutants,” offers the greatest opportunity to have a rapid, and meaningful impact on both health and climate.

Henly and others identified ozone, black carbon, and methane as super pollutants because of their wide-ranging impacts on food security, health, and climate change. Slowing the rate of climate change would make it easier for the “world to adapt to climate change,” said Henly. 

Nexus of climate change, air pollution and health

It is also the nexus where health, climate, and food security concerns directly converge – leading scientists to dub them “super pollutants” precisely due to those wide-ranging impacts. 

Black carbon is a sub-component of dangerous particulate matter, associated with some 7 million deaths annually from air pollution. 

Ground-level ozone, formed as pollutants emitted by vehicles, industry and waste, is a leading factor in respiratory illness, particularly asthma, as well as damaging some 90% of global crop production every year. Methane, emitted by waste dumps, agriculture, and oil and gas flaring, is a leading precursor to ozone formation.  

Slowing emissions would also slow the rate of climate change, buying time for the world to transition to cleaner energy sources and other longer-range climate solutions, said Henly. 

Two leading super pollutant gases, methane and nitrous oxides (N2Ox), are formally recognized in the Paris climate agreement as powerful greenhouse drivers with a climate forcing potential that is 80, and 270, times more than CO2 respectively in the next 20 years. But black carbon is ignored, leading to a fragmented approach.  

Super pollutants sources chart
Compared to carbon dioxide, super pollutants exert stronger climate warming in both the short and longterm, but drop out of the atmosphere faster.

Similarly, the shared concerns of climate and health sectors around super pollutant emissions are often siloed, said Sergio Sanchez, senior policy director at the Environmental Defense Fund. Greater recognition of super pollutants as detrimental to both health and climate could help break through the barriers to more climate action, he said.

Reducing these pollutants could avoid four times more warming by 2050, as opposed to decarbonization policies alone – and also prevent some 2.4 million deaths a year from air pollution. 

Yet emissions of super pollutants, including methane, are currently on the rise.

Agricultural sector is getting more attention

Punjab environmental officers put out fires set by Pakistani farmers in Province, an annual ritual on both sides of the border that leaves the entire Indo-Gangetic Plain shrouded in smoke.

Most attention on super pollutants has focused on methane leaks from the fossil fuel industry. These occur at nearly every stage of the extraction and production cycle, with natural gas flaring the most glaring example of methane emissions. 

However, another key source of potent methane emissions is the agricultural sector, which accounts for  40% of global human-made methane emissions, with livestock, rice cultivation and crop debris being key sources. 

People often forget the fact that in some regions, such as the European Union, the agricultural sector accounts for 54% of methane emissions, noted Pierpaulo Mudu, WHO scientist.

Another 34% of global methane emissions comes from fossil fuels and 19% from rotting urban and household solid waste. Some methane is also emitted by natural sources, such as peat bogs and wetlands. Overall, two-thirds of global methane emissions come from human activities, according to the Global Carbon Project. 

Methane emissions from agriculture harder to track

Methane emissions from agriculture, however, are much harder to track and monitor than emissions from the oil and gas sector.

“In agriculture, these pollutants are not emitted in high concentrations,” said Henly. 

“The emissions are distributed, and the kind of detection, whether it’s through on the ground sensors or remote detection, is just a bit more challenging than in the oil and gas coal sectors.

Whereas previously, only big methane spikes or leaks from oil and gas installations could be detected, that is changing now, Henly said. 

Recently, new technology, in the form of higher resolution satellite imaging, has opened the way for more granular estimates from sources like agriculture.

This week’s WHO conference will therefore feature the first session ever about the links between methane emissions in agriculture, climate, and health.  Solutions that can be promoted,, experts say, include biogas capture from anaerobic digestion of crop waste and manure as well as improved compost management – so that methane gas is not produced at all.

Ozone chokes crops

But agriculture is also impacted by super pollutants, particularly ozone. It’s now estimated that ozone leads to a loss of 12% of wheat, 16% of soybean, 4% of rice, and 5% of corn production every year.  

“So we can see that the super pollutants are a real growing threat to food security,” said Rachel Huxley, Head of Climate Mitigation and Health at Wellcome Trust.

Ground level ozone (O3) is a product of the vicious cycle of super pollutant formation. Gases produced by cars and industry, crop and waste incineration, interact in sunlight, leading to ozone’s creation. 

Unlike the “good” layers of stratospheric ozone that protect the planet and people from harmful ultraviolet radiation levels, ground level ozone is harmful to crop production as well as human health. 

Inhaling ozone leads to respiratory and a host of other health issues. And when over farmland, the pollutant can dramatically disrupt staple crop growth, according to a 2025 report by the Clean Air Fund.

This week, for the first time ever, WHO is convening a meeting on agriculture, air pollution, climate and health, with the hopes of drawing more attention to these linkages within health and environment circles. 

“Everyone is obsessed with transport,” said Mudu, the WHO scientist leading the session. “Because of the visibility of the black smoke, but there are many different sources of air pollution with many sorts of invisible gases.”

Black carbon and snowmelt 

A traditional brick factory in southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of black carbon emissions.

On the other side of the coin, when urban and household waste or crop debris is burned, rather than left to rot, it produces smoke – a mixture of gases and particles, including black carbon. 

The burning of rice crop debris regularly envelopes large parts of the Indian subcontinent in billowy smoke every autumn. Burning of household and urban solid waste is also a common practice in many developing regions. 

Waste burning, together with the use of wood and charcoal for household cooking and heating, as well as in traditional brick kilns, cast a chronic pallor of smoke or smog over cities and farmland in many other low- and even middle-income regions of the world – also contributing to the formation of ozone.   

super pollutants
Super pollutants exist at the nexus of climate and air quality, making them cost effective pollutants to target.

But the tiny specks of black contained in the smoke do even more harm than other types of fine particles. They accelerate climate change in mountain regions, where they settle on snow and ice, absorbing additional sunlight and thus increasing snow and ice melt. 

Scientists estimate that  black carbon is responsible for 39% of glacier melt in certain Himalayan glaciers, and there are similar impacts being observed in the Himalayas, Alps, Andes and the Rockies, according to a 2025  Clean Air Fund report

Locally, glacier melt reduces the reliability of water sources that rural regions of Nepal and northern India rely on for crop irrigation as well as domestic use. 

But there are global implications as well. It is a major reason that the Arctic is warming four times faster than other parts of the world, increasing the chances of “dangerous climate tipping points being breached,” the report stated.

Regulation and action

super pollutants
Often “forgotten” as potent drivers of climate change and poor health, super pollutants contribute to nearly half of warming.

Regulation of super pollutants is challenging – because so many pollutants, and sectors, are involved. In the case of ground level ozone, as well, the pollution is not emitted directly, but rather is a product of reactions between methane, nitrogen oxides, and volatile organic compounds. So the precursors need to be regulated. 

Despite such complexities, the fact that black carbon as well as methane, ozone and other powerful short-lived gases – only reside in the atmosphere for weeks to decades, makes Huxley hopeful that policymakers can see the “economic sense” in cutting back on such emissions. 

“This is one of the most effective ways to keep 1.5ºC alive,” she said, referring to the Paris climate agreement goal. “This is our emergency brake on climate change.” 

The Global Methane Pledge aimed at reducing the gas, was launched at COP26 by the United States and the European Union and has so far been supported  by over 150 countries, including over two dozen African nations. 

“Methane has been globally recognized as a super pollutant since COP26, thanks to the launch of the Methane Global Pledge and the commitments made by countries since then,” said Elisa Puzzolo, Super Pollutants policy manager at the Clean Air Fund.

“Now, is the time to raise our ambition and address all super pollutants, including black carbon and troposheric ozone, to protect the climate, safeguard public health, and support most-affected regions and communities.”

Super-pollutants ‘movement’

air pollution quilt
Air pollution impacts the most vulnerable, including children showcased in a quilt from the Indian advocacy group Warrior Moms.

What Wellcome and the Clean Air Fund want to foster is a more coordinated super-pollutants “movement” that cuts across sectors – together with the UN Enviroment Programme-hosted Climate and Clean Air Coalition.

“Solutions are proven,” Puzzolo said. For super-pollutants though, the regulatory landscape is a bit more complicated. Black carbon, though harmful to health and the climate, is not included in the Paris Climate agreement because it is a particle.

“Reducing black carbon, alongside other super pollutants, is the fastest, most effective way to slow climate change, while also mitigating the enormous health impacts of air pollution,” said Jane Burston, CEO of the Clean Air Fund. “Yet to date not enough has been done.”

“Action on short-lived climate pollutants is a matter of time and temperature,” said Martina Otto, head of the secretariat at the Climate and Clean Air Coalition, which was founded over a decade ago specifically to spearhead awareness and action on superpollutants. 

“They have a higher warming potential than CO2 and don’t accumulate in the atmosphere. Cutting them turns down the heat within decades and reduces air pollution now. A double dividend that we cannot afford to miss.”

Image Credits: WHO/Diego Rodriguez, E. Fletcher/HPW, Climate and Clean Air Coalition, Punjab Enviornment Department, Climate and Clean Air Coalition, A. Bose/ HPW.

The USAID office in Washington

Civil society organisations (CSOs) globally face investigation, restrictions and harassment in dozens of countries after US President Donald Trump claimed that the US Agency for International Development (USAID) was run by “radical left lunatics” and Elon Musk claimed that several grantees supported terror organisations.

This is according to a recent survey carried out by the EU System for an Enabling Environment (EU SEE), which documents the experiences of 54 organisations, and draws on information from two global surveys involving almost 1000 CSO respondents.

There have been calls for investigations of CSOs that receive US funding in nine countries including Brazil and Hungary, and increased harassment of CSOs in 13 including Peru, Paraguay and Russia. Six countries are considering restrictions on foreign funding, including Guatemala and India.

The Nigerian National Assembly has launched investigations into the activities of USAID and nonprofits in the country “following the recent statement by a US Senator that USAID funds [terrorist group] Boko-Haram in Nigeria”, according to a Nigerian CSO.

“An investigative committee set up on 20 February 2025, by the House of Representatives will focus on the activities of CSOs in the Northwestern part of the country,” the respondent said. “If not objectively carried out, the investigation may become part of an ongoing process of attack on civil society and push for stiffer regulations, a common trend which started in 2015 and continues until today.” 

The President of El Salvador, Nayib Bukele, alleged publicly that “USAID funds had been misused by journalists, independent media, and other civil society actors as part of a global money laundering operation”, according to a CSO from that country, which said his statements  “are part of a broader pattern of stigmatisation and discrediting of civil society”.

“The most reported impact by far is increased criticism and stigmatisation of international funding,” according to EU SEE. 

Disrupting critical programmes

The abrupt halting of US foreign aid is disrupting “critical human rights, democracy, gender equality and health programmes, leaving vulnerable communities without essential support”, the survey found.

Over two-thirds (67%) of surveyed organizations have been directly impacted by the termination of USAID, with 40% of them losing 25-50% of their budgets, 

“Without swift action, many organizations that hold governments accountable, defend human rights, and support vulnerable communities may disappear altogether,” according to EU SEE.

A USAID grantee from Myanmar reported that the cuts have “severely impacted” work such as programmes on “conflict-related sexual violence, transnational repression, and Association of Southeast Asian Nations (ASEAN) advocacy”. 

“The funding cuts are causing huge shortages and closure of projects providing medical and subsistence support to the most vulnerable communities inside the country and along the border,” it added.

“The suspension of USAID funding has affected more than 60 civil society actors in Peru, putting at risk projects related to democracy, human rights, governance, the environment, and the fight against drugs,” according to a Peruvian organisation.

“The loss of international funding compromises the sustainability of many NGOs, limiting their ability to offer training, empowerment and support to vulnerable communities.” 

Indonesia received $153.5 million from USAID in 2024 and the funding freeze has left CSOs “in a precarious position”, according to an Indonesian CSO. 

“Some CSOs have had to implement unpaid leave for their staff, while others are managing to pay only half of their employees’ salaries until the review process concludes,” it added. “The ramifications of this aid freeze threaten the livelihoods of those working within these organisations and jeopardize critical programmes in health, education, and environmental conservation.” 

Sectors most affected by USAID grant terminations, according to the Global Aid Freeze Tracker.

The Global Aid Freeze Tracker, reports that the health and protection sectors have been worst hit, with particularly significant disruptions in HIV, malaria, and protection services. The second most affected category is governance, particularly anti-corruption activities, followed by projects offering economic and livelihood support for vulnerable populations, especially women and children.

Image Credits: Global Aid Freeze Tracker.

PEPFAR beneficiaries

The US Congress’s one-year reauthorisation of the President’s Emergency Plan for AIDS Relief (PEPFAR) expires on Tuesday (25 March) and there is no clarity about its future – other than that it is likely to be slashed.

The only Bill up for discussion on this date that has any connection to PEPFAR is the Reorganizing Government Act 2025, which aims to extend the authority of President Donald Trump to propose a plan to reorganise the federal government until 31 December 2026.

PEPFAR projects can continue as long as Congressional funds are allocated to them via Appropriations Acts – but that hasn’t protected those administered by the US Agency for International Development (USAID) from being terminated.

The only inkling of what a reformed and slashed PEPFAR might look like is contained in a throwaway reference to PEPFAR in a leaked plan on US foreign aid reform that is being circulated by Trump aides, as reported by Politico.  

The “blueprint” proposes that aid be organised into three “pillars” – safer, stronger, and more prosperous.

The “safer” pillar will cover “humanitarian assistance, disaster response, global health and food security”, with aid dispensed by a new Agency for International Humanitarian Assistance (IHA). 

IHA will fall under the State Department and replace the now largely defunct USAID which dispensed around 60% of PEPFAR grants.

“IHA’s mandate would be limited to the strategic delivery of humanitarian assistance, responding to disasters, enhancing global health security (including a modified PEPFAR) and promoting international food security,” according to the document.

The State Department has already taken control over PEPFAR’s website and many of the links to basic reports and HIV information no longer work.

‘Not philanthropic’

The blueprint has emerged two-thirds of the way through the Trump-imposed 90-day “pause” on all foreign investment excluding “lifesaving humanitarian aid” – although most of that has stopped too because there are no USAID employees to dispense resources.

It stresses that US aid “should not be philanthropic in nature, but must advance our direct national security, strategic and commercial interests”.

IHA’s success will be measured by “concrete metrics: lives saved, outbreaks of infectious disease contained, pandemics prevented, famines averted and measurable increases in positive perception of the United States in emerging markets”.

The reorganisation of aid will require Congress to amend the Foreign Affairs Reform and Restructuring Act of 1998, the Foreign Assistance Act, the Pay Act and provisions of the annual Appropriations Acts.

Lack of domestic funding

The blueprint notes that “leaders of some countries are simply not committed enough to the progress of their own people to merit or justify any significant commitment of US taxpayers’ resources” but that some assistance activities “disincentivize host country investments and reforms”.

Only two of the 55 African member states – Botswana and Rwanda – spend 15% of their budgets on health, yet this is something African states pledged to do back in 2001 in the Abuja Declaration.

Dr Jean Kaseya, who heads the Africa Centres for Disease Control and Prevention (Africa CDC), told a media briefing last week that some African countries relied on “external assistance” for 80% of their HIV and malaria responses.

“Overnight, everything is gone,” Kaseya said, adding that 30% of Africa’s health expenditure comes from official development assistance (ODA), and there had been a 70% cut in ODA this year from $81 billion to $25 billion.

Kaseya will be in Washington this week to lobby for the resumption of aid, and plans to meet members of the Trump administration, PEPFAR officials and Members of Congress in a bid to restore US aid.

However, he said that there were also urgent continental efforts to get more domestic resources to fill the huge gaps left by the termination of USAID grants.

PEPFAR achievements 2024
PEPFAR achievements in 2024, most of which have been reduced or terminated.

Running out of medicine

Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Nigeria and Ukraine are likely to run out of antiretroviral (ARV) medicine for HIV within the next few weeks and months as a result of USAID cuts, according to the World Health Organisation (WHO).

In Haiti, antiretroviral medicines were recently included on a special humanitarian flight to avoid a stockout, according to the Joint UN Agency on HIV/AIDS (UNAIDS)

The impact of the 90-day pause on foreign aid programs may lead to 100,000 additional HIV-related deaths this year and cause more than 135,000 babies to be born with HIV infections that could have been prevented with medications that block mother-to-child transmission, according to an estimate by researchers Khai Hoan Tram, Jirair Ratevosian and Chris Beyrer.

However, if  US assistance for HIV is not restored after the pause in April, and it is not replaced by other funding, “there will be an additional 6.3 million AIDS-related deaths in the next four years”, UNAIDS head Winnie Byanyima told reporters in Geneva this week.

UNAIDS itself may not survive as it was informed on 27 February that the US was stopping all aid to the agency with immediate effect.

Research on an HIV vaccine, a study on long-acting pre-exposure prophylaxis and a large tuberculosis research study in South Africa have come to a halt due to US funding cuts.

As HIV is a fast-mutating virus, treatment comprises a combination of three different drugs (often combined in a single pill) that target different stages of the HIV lifecycle to stop it from making new viruses.

When people stop ARVs, their immune systems weaken and they are susceptible to all kinds of infectious diseases, with tuberculosis being the most common. They also have a high risk of developing drug-resistant HIV which is far harder to treat. In addition, as their viral loads increase they are more likely to pass the virus on to others.

However, many people in the HIV sector agree that governments need to take more ownership of their HIV response. 

Ratevosian, who is a former PEPFAR chief-of-staff, Beyrer and four other Duke University colleagues have written a policy proposal that would see countries achieving 50% co-financing for HIV within five years.

A key aspect of their proposal is that funding should move to places where the epidemic is getting worse and scale up HIV prevention by rolling out the long-acting pre-exposure prophylaxis (PrEP) injectable lenacapavir to five million most at-risk people.

Dismal prospects for PEPFAR

But influential conservatives have long sought to curtail PEPFAR.  The Heritage Foundation, which authored the conservative Project 2025 blueprint for Trump’s administration, argued in 2023 that PEPFAR should be “restructured as a development rather than an emergency assistance program”.

Except in cases of rape or maternal transmission, HIV/AIDS is “primarily a lifestyle disease (like those caused by tobacco) and as such should be suppressed through education, moral suasion, and legal sanctions,” according to the foundation.

It also claimed that “as with any venereal disease, education and abstinence could end the AIDS epidemic” – although this approach has failed miserably in both the US and Africa.

While PEPFAR projects can continue – in theory – as long as congressional appropriations (funding) are available, a much scaled-down version is likely to emerge tha may well follow the Heritage Foundation’s proposals.

Image Credits: PEPFAR, US State Department.

Alekuwodo market in Osogbo is now noticeably cleaner because of the efforts of locals.

OSOGBO, Nigeria – A few years back, when the bustling Alekuwodo market in Osogbo in Osun State quietened down at night, the chaos of the day lingered. Crushed tomatoes, discarded papers, plastic wrappers, bean husks, watermelon rinds and other fruit scraps turned the market square into a suffocating mess. As the sun set, the stench would rise — a grim reminder of the day’s waste.

Ruth Adelakun, 57, acknowledges that she was part of the problem. As a locust bean seller, she set up her roadside stall under a tarpaulin umbrella to shield herself from the heat. The sweltering weather meant she drank plenty of water out of plastic sachets.

“I can drink at least five sachets a day,” she admitted, waving an empty plastic wrapper. “I used to drop them anywhere because I didn’t know it harmed the environment.”

But the harm is real. “Dirty environments breed disease-causing microorganisms,” explained Dr Mahmud Abubakar from Federal Teaching Hospital in Kebbi State.

“Air pollution increases respiratory infections, while contaminated water can cause cholera, diarrhoea, and even bladder cancer.”

Struggling with waste

Nigeria ranks in the bottom 30 countries globally for waste management — ranked 152nd out of 180 in the  Environmental Performance Index  2024 compiled by the Yale Center for Environmental Law and Policy, with a dismal score of 12.7.

Mayokun Iyaomolere, environmentalist and executive director of the environmental group, Plogging Club, warns that this negligent approach to waste fuels climate change.

“Waste ends up in landfills, releasing carbon dioxide and other harmful gases. These emissions contribute to extreme weather events like flooding, heatwaves, and droughts,” he said.

The impact of climate change is already severe, with Nigeria ranked 158th out of 182 countries for climate vulnerability.

By September 2024, flooding had affected 31 states, displaced over 641,000 people, and claimed 285 lives, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Meanwhile, rising heat levels have led to deadly heatwaves in the southwest with average temperatures of 50C last February, crippling food security and worsening Nigeria’s hunger crisis  — with the Global Hunger Index scoring the nation 110th out of 120 countries, signalling serious food insecurity.

Local hero on a mission

‘Spider-Man’ Olaunlokun Johnathan speaks to school students about litter.

Nigeria generates  0.51 kg of municipal solid waste per capita every day , amounting to an overall daily generation of 75.6 million kg, according to the World Bank. This ends up at  landfills and causes carbon emissions.

Amid this crisis, one man decided to act. Olaunlokun Johnathan, 45, doesn’t have a formal environmental science degree — he simply loves clean surroundings. In 2004, he began advocating for a litter-free Nigeria, undeterred by insults or indifference.

“Our people are part of the problem — even the regulators don’t take their jobs seriously,” he said, frustrated. “They care more about their salaries, and there aren’t enough waste-collection vehicles.”

Determined, Johnathan cleans the streets of Osogbo three times a week, picking up litter wherever he goes. Dressed in a polo shirt or orange jacket, with cotton gloves and worn-out shoes, he tirelessly works to change minds.

In 2021, Johnathan took his mission to the next level — dressing up like Spider-Man. His costume caught people’s attention, helping him spread his message to schools, markets, motor parks, and religious centers across states like Osun, Kaduna, Ogun, Oyo, and Lagos.

He taught schoolchildren to use trash bins, urged market vendors to tidy up their stalls, and showed drivers how to keep motor parks clean. Slowly but surely, his persistence paid off.

Shift in mindset

Ruth Adelakun, a locust bean seller, admits that she used to litter the market.

Meanwhile, Adelakun is now a changed woman. She keeps a sack for her waste and disposes of it properly every evening.

“I keep my trash here and empty it into the big government bin,” she said proudly.

Usman Zakariyya, a 25-year-old bean seller, also adjusted his habits after hearing Johnathan speak.

“Before, I used to leave the chaff blown out here without worrying about packing up in the evening before going home but now any time I finish the blowing I sweep and pack up them instantly,” said Zakariyya.

“When people get conscious of their environment and no longer litter, it is a window of opportunity for them to adjust to other behaviors that ultimately have environmental impact,” Iyaomolere told Health Policy Watch.

Uphill battle

Olaunlokun Johnathan cleaning the streets of Osogbo in Nigeria.

Despite his successes, Johnathan faces many challenges. People mock him, while government grants are restricted to younger advocates aged 18 to 30, leaving him without crucial funding.

“Some people thought I was mad,” he confessed. “I’ve thought of quitting, but the community needs change.”

However, today Alekuwodo market is noticeably cleaner. People pack their waste neatly, and traders sweep up as soon as they spot Johnathan.

“You won’t find trash carelessly thrown around here anymore,” he said, smiling as he waved to a watermelon seller tidying his stall.

“Sweep it clean!” he called out, his voice echoing through the square as he walked off to continue his mission — a living reminder that one determined person can inspire an entire community to change.

Image Credits: Abdullahi Jimoh.

Clean air light show and exhibits bedeck a heavily trafficked street outside of the Cartagena Convention Center hosting WHO’s Second Conference on Air Pollution and Health.

CARTAGENA, Colombia – A tour bus emits a cloud of black diesel smoke in front of Cartagena’s glittering white conference center. It is a vivid reminder that from the hottest tourist destinations to the slums of Latin America, Asia and Africa, nine out of ten people on the planet breathe dangerously unhealthy levels of air pollution every day. Thanks to air pollution, millions fall ill every year with a range of respiratory and cardiovascular diseases as well as cancers, leading to at least seven million deaths each year. 

On Tuesday, the Colombian coastal city will host the second WHO Air Pollution and Health conference 25-27 March, where global leaders are poised to call for an ambitious goal of cutting deaths from air pollution by 50% in 2040.

“Clean air is not a privilege; it is a human right,” says Dr Maria Neira who heads WHO’s work on climate, environment and health.

Indeed, air pollution is the biggest environmental risk to human health – risks that altogether account for some 25% of premature deaths every year –  as well as a major contributor to climate change, according not only to WHO, but also the world’s leading climate scientists

Solutions largely require political will

Delhi’s winter smog routinely reaches air quality ratings exceeding 50 times the level deemed safe by the WHO.

But unlike some other disease challenges, there are ready, affordable, solutions that largely require political will to implement. Neira has a ready list of WHO’s top priorities for the conference at her fingertips: 

“We need to work together urgently to scale up transitioning from coal-fired power to renewable energy,” she says, while also. “expanding public and sustainable transport, establishing low-emission zones in cities and promoting clean energy for cooking, and solar power in healthcare facilities.” 

Even so, cutting emissions enough to halve deaths from air pollution within just 15 years is a highly ambitious goal.The challenges to attainment are particularly daunting given not only the current trajectory of fossil fuel emissions – but also rollbacks to environmental and climate commitments by trend setters like the United States. 

Even so, the fact that WHO has been able to muster significant member state support for such a commitment represents a milestone in a battle to raise awareness about a health threat from fine particulates and other air pollution components that scientists first defined in the mid-1990s, and that WHO member states only formally embraced in a 2015 World Health Assembly Resolution.

And while ambitious, this year’s conference goal also provides a clear target for countries to aim for – after the WHO’s inaugural Conference on Air Pollution and Health failed to do so. 

“The science is as clear as our skies must be. We will take action to stop toxic air from polluting our health,” declared Neira in a statement to Health Policy Watch

Health community rallies around air pollution

As another reflection of growing awareness, nearly 50 million health professionals, patients, advocates, and individuals signed a call ahead of this week’s conference for urgent action to reduce air pollution. 

Signatories included more than 47 million health professionals, patients, representatives of civil society organizations, and individuals – from organizations such as the World Medical Association, NCD Alliance, and the World Heart Federation. 

“Forty-seven million people from the health community have issued a clarion call for urgent, bold, science-driven action on air pollution, and their voices must be heard,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a press statement ahead of the three-day conference event. 

“At the second WHO Conference on Air Pollution and Health in Cartagena, we hope to see concrete commitments from countries to implement those tools and save lives.”

Even so, Tedros himself will not be attending the three-day conference – a last minute cancellation perhaps reflective of the continuing budget and political woes faced by WHO in Geneva.

Among the more than 700 participants, however, are ministers of health, deputy ministers and other high level health officials from China, India, Colombia, Vietnam, and El-Salvador. A number of mayors from cities such as  London, Santiago, Quebec, as well as leaders in civil society, will be in attendance. 

Other UN-affiliated agencies, such as the World Bank, the World Meteorological Organization and the UN Environment Programme, as well as philanthropies such as Wellcome and the Clean Air Fund, are co-sponsoring as well as supporting sessions on topics ranging from finance to “super pollutants” – that warm the planet as well as polluting the air.  

Notably, no US government officials will be attending the conference – reflecting the Trump Administration’s recent decision to withdraw from WHO and as well as from multilateral global climate and environmental efforts where the US was previously a leader.

International cooperation fraught with uncertainty

The Cartagena conference comes at a time of tumultuous international relations and cuts to environmental and climate action. 

New US President Donald Trump, in particular, not only renounced the 2015 Paris Climate Accord but he has cancelled US participation and funding for clean energy development in Africa and beyond. At home, his administration has also issued a record number of orders rolling back domestic environmental regulations that limited toxic air pollution. (see related story)

https://healthpolicy-watch.news/epa-plans-to-roll-back-dozens-of-regulations-threatening-americas-health-environmental-health-experts-warn/

Historically, the US Environmental Protection Agency (EPA), National Atmospheric and Oceanic Administration (NOAA), and National Aeronautics and Space Administration (NASA) were global leaders in much of the air pollution space, participating on WHO, WMO and UNEP scientific panels. In this year’s conference, their voices will be strangely still. 

However, American academics from institutions such as Columbia University, the University of Colorado and University of California at Berkeley will still be in attendance, as will civil society groups such as the Environmental Defense Fund, Healthcare Without Harm, Client Earth and others. 

Despite the gaps, conference organizers hope the decades of research and expanding body of evidence around air pollution’s health impacts will spur individual countries to make strong national commitments to reducing air pollution – in line with the 50% by 2040 goal etched by WHO and its  “BreatheLife” awareness-raising campaign

Low- and middle income countries in Asia and Africa, struggling with a huge and still growing burden of air pollution-related diseases, can also be inspired by success stories on controlling air pollution in not only North America and Europe, but also in emerging economies of Latin America, and elsewhere. 

Countries that are unable to pledge to halve air pollution deaths within just 15 years will also be encouraged to make commitments to reducing pollution’s impacts more incrementally to at least meet one of WHO’s “interim air quality” goals, on the path to cleaner air.  

Air pollution quality table
The WHO’s air quality targets.

Countries also may pledge to act in specific sectors, such as the transport sector, through better monitoring and tighter regulatory oversight, or through new clean energy investments, for example. 

“While the challenge is immense, progress is possible. Many cities and countries have significantly improved air quality by enforcing stricter pollution limits,” said Neira. 

Expanding knowledge around health impacts

In the two days leading up to Thursday’s session on high level policy commitments, the conference will feature dozens of technical sessions on the latest science.

These will cover air pollution sources and their measurement – from household air pollution to wildfires and fracking; solutions for cities and polluting sectors such as transport and for reducing emissions from health sector facilities – and its environmental footprint more broadly. 

Notably, a widening array of health conditions have now been linked to air pollution exposure beyond the “traditional” diseases of respiratory illnesses, cardiovascular diseases and cancers.

More recent research has shed light on a growing set of linkages between high air pollution levels and health at all stages of life – from adverse birth outcomes to dementia and mental health. 

“Besides years of living with laboured breath, punctuated by asthma attacks, or clouded by cataracts, mounting evidence links air pollution to various health outcomes like low birth weight, diabetes, cognitive impairment, and mental health impacts,” said Neira.

“The evidence is indisputable.” 

Health sector’s role

A key point of cross-cutting focus will be the health sector – how health policy officials and healthcare professionals – can play a meaningful role in an issue oft-perceived largely through an “environmental” lens. 

The conference also will:

  • Take stock of global progress since the start of the 2015 Sustainable Development Goals (SDGs)
  • Showcase health, climate, gender and equity co-benefits of air pollution and energy action 
  • Harness climate and development finance to tackle air pollution and ensure a just energy transition.
  • Leverage health arguments to drive country cooperation and financial commitments.

Cultural hype to build awareness 

Cartagena 2025 conference air pollution
Air pollution simulators in “pollution pods” being set up prior to the conference.

Amid the technical panels and commitments, the conference will host a range of  interactive and cultural events open to the public on the broad esplanade that graces Cartagena’s seaside Conference Center.

Beginning on Wednesday, renowned Brazilian street artist Eduardo Kobra will develop and exhibit a large-scale mural dedicated to global environment and climate concerns on the esplanade. 

British British artist Michael Pinsky will invite public participants to an immersive air pollution experience in his “pollution pods” which will simulate different types of air pollution and sources for visitors to the dome shaped pods. 

Each pod will mimic a different type of pollutant, and its sensory discomforts, highlighting the urgency of addressing toxic air sources, Pinsky said.  

Conference participants as well as members of the public will also be able to test their lung and heart health through booths operated by the European Respiratory Society, World Heart Federation, and European Lung Foundation. 

On Monday, the eve of the conference, early bird arrivals can opt to join a six kilometer cycling tour of the city or a four kilometer run/walk – illustrating the importance of clean air to healthy, active lifestyles.

During the event, sponsored by the global non-profit Cityzens, participants will be equipped with personal sensors to get a sense of their own particulate matter exposure while exercising – beginning at 6 am before the city’s temperatures rise above 30°C. 

It’s hoped that the cultural and activities hype will bring the dangers of air pollution down to a more personal and motivational level, Neira said. 

Image Credits: E.Fletcher/Health Policy Watch, Fletcher/Health Policy Watch, Raunaq Chopra/ Climate Outreach, WHO, S. Samantaroy/HPW.

Saima Wazed, Director of WHO’s South East Asia Regional Office (SEARO) with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024

Bangladesh’s Anti Corruption Comission  (ACC) has filed two cases against Saima Wazed, director of WHO’s South East Asia Regional Office (SEARO), for fraud, forgery and misuse of power in connection with her campaign to become the WHO’s top official in the South East Asia region.

The charges against Wazed, who took office as Regional Director in January 2024 following her election by SEARO member states, are the culmination of an ACC investigation that began in January 2025, as reported by Health Policy Watch.

Her  2023 election campaign was shadowed by charges that her influential mother, former Bangladesh Prime Minister Sheikh Hasina, had used her influence to gain her daughter’s election to the post – only a few months before widespread protests prompted Hasina’s resignation and flight from the country in 2024.

According to the formal charges that now have been filed against Wazed, she is alleged to have provided false information about her academic record, during her campaign for RD, violating Section 468 of the Bangladesh Penal Code (forgery for the purpose of cheating); and Section 471 (forging a document).  The ACC alleges she misrepresented her qualifications—claiming an honorary role at Bangabandhu Sheikh Mujib Medical University, which the university disputes—to secure her WHO position. The charges were detailed to media Thursday by ACC Deputy Director Akhtarul Islam,

Wazed is also accused of having misused her power and influence to collect about $2.8 million from various banks for the Shuchona Foundation, which she formerly headed.  The ACC case did not provide complete details on how the money was then used. Those charges include: allegations of fraud and misuse of power under Sections 420 (cheating and dishonestly inducing delivery of property); , as well as Section 5(2) of the Prevention of Corruption Act of 1947.

Asked to comment on whether the Bengali government investigation of Wazed would trigger any WHO investigation of the RD and the alleged campaign misdeeds, WHO did not respond.

Charges follow other cases against high level WHO officials

Dr Takeshi Kasai, Director for WHO’s Western Pacific Region at an April 2021 COVID press conference – he was ousted from his position in 2023.

The legal action against Wazed is the latest in a series of scandals that have implicated senior leadership in WHO – at a time when it is also under unprecedented financial pressure, due to the United States’ January 2025 announcement that it intends to withdraw from the global health organization.

In March 2023,  member states in WHO’s Western Pacific Region voted to oust WPRO Regional Director  Takeshi Kasai, following allegations of abusive behaviour and financial mismanagement. His exit after an internal probe reflected a serious crisis of governance in one of the six regional offices upon which the global health agency depends to fulfil critical missions in countries.

During the period of the investigation and ouster, Dr. Temo Waqanivalu, a senior WHO official from Fiji, emerged as a potential candidate to replace Kasai as RD of the WPRO office.

However, Waqanivalu’s candidacy unravelled when he was accused of harassing Dr. Rosie James, a young UK health professional, at the October 2022 World Health Summit in Berlin. The investigation concluded with Waqanivalu’s dismissal from WHO in April 2023 –  as the Organization tried to step up its responses to sexual harassment and abuse allegations by staffers as well as recipients of WHO aid against powerful WHO officials.

Role of WHO Regional office leadership – under scrutiny

The role and position of WHO’s Regional Office leadership could become all the more important as the agency comes under under increased pressure  to improve efficiency, transparency and overall performance in the wake of the announced United States withdrawal  – the agency’s largest financial backer.

Reinforcing the leadership and prowess of the agency’s six regional and 152 country offices was core to the “transformation” initiative launched by WHO Director Genera Tedros Adhanom Ghebreyesus in July 2017, just after he took office.

Now facing a financial crisis, shifting more staff, as well as some core areas of expertise, to WHO regional centers and country offices could also serve as an inportant cost-saving measure since generous “post adjustments” based on location, are usually much lower for international staff in regions than in Geneva’s headquarters.

At the same time, to fill any enhanced role and mission, WHO’s regional offices need leadership acting professionally and above any single set of vested interests.

In the case of the South East Asia Regional Office, the charges filed against the RD, represent yet another setback in that “Transformation” journey.

WHO’s budget under the knife

Sources: WHO bi-annual HR reports, and UN salary scales, in comparison to proportion of costs attributable to entitlements and benefits. Note: Costs of P6 positions, while comparable to D1, are included in the P- category, not D category.

This year, WHO already faces a $175 million budget shortfall in 2025 as hoped-for US and other donor funds have so far failed to materialize, and an even more severe crisis in 2026 when the US withdrawal formally takes effect, and its mandatory dues of about $130 million annually cease altogether.

That’s despite reducing its 2026-2027  bi-annual budget to $4.9 billion – nearly $2 billion less than the $6.83 billion budget for the organization in 2024-25.

In a press conference on Monday, WHO Director General Dr Tedros Adhanom Ghebreyesus and other senior WHO officials described the grim impacts on WHO’s global health operations faced as a result of the loss of US contributions – representing about 15% of WHO’s annual budget. Programmes ranging from TB and malaria control to measles surveillance and humanitarian response face severe cutbacks, the officials warned.

At the same time, WHO still has not issued any response to the 10 March Health Policy Watch report detailing the bloated ranks and costs of its most senior management – with senior director positions having nearly doubled since 2017 – and costs for just 215 of WHO’s most senior staff approaching $100 million.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

 

Image Credits: X/Saima Wazed, WHO.