Should the World Health Organization (WHO) intervene on social networks and other organic platforms that are providing health information? And, if so, how?

These were pressing questions raised on Tuesday during a webinar presented by the Global Health Centre at the Graduate Institute Geneva in coordination with the Digital Health and Rights Project. 

Project researchers and participants presented their findings from a transnational participatory action research study into young adults’ experiences with digital health in Bangladesh, Colombia, Ghana, Kenya and Vietnam, raising important questions around the role that the organized health community can play in regulating organic digital health content. 

They also offered policy recommendations and good practices to help challenge structural inequalities and meet the needs of young people in their diversity based on the results of their work. 

Tabitha Ha, an advocacy manager for STOPAIDS, called on WHO to update its definition of digital health to include Google and social networks as digital health platforms, which could then enable the organization to evaluate the health content on these platforms and support local health agencies doing the same.

But Ha cautioned that while there is a need for collective approaches to managing health data on the world wide web: “If an institution like WHO was to come in, how would that change the dynamics? It could potentially influence the way people use social media to create this type of [health] content.”

Maintaining basic standards

Ha and colleague, Stephen Agbenyo, executive director of Savana Signatures, recommended that WHO works from a distance, perhaps providing supervisory support and ensuring that certain basic standards are maintained, while not interfering directly with the content creators on the ground.

WHO could, for example, communicate with large tech companies about the need for relevant sexual health information to get out to youth, including more explicit information that may, at first glance, appear to violate community standards on some social platforms.

Terry Gachie, country coordinator for Love Matters Kenya, said that her team faces consistent censorship by the social networks – especially Facebook – for posting content that could appear to violate community standards when, in fact, this is the edgy information her constituents need to learn about sexual and reproductive health. 

“We want to speak their language. But what happens in most cases is that our information is flagged, perhaps labeled as escort services or inappropriate, and then taken down,” Gachie explained. She called on WHO to bring social networks into the conversation to help find a solution. 

“We need to ensure there are consistent conversations with big tech companies in terms of what young people want to see,” Gachie said. 

Finally, the issue of regulation was raised, less as a means to control the flow of information on social networks than to ensure that people accessing the information on these networks can feel safe. 

“How do we facilitate the relationship between disseminating accurate information to people who might be at risk, who might be marginalized, and who want to hop onto this platform to access that content?” Nomtika Mjwana, project manager for the Global Network of People Living with HIV, asked. 

Nomtika Mjwana

She recommended leveraging the direct involvement of young people and the communities who use these platforms to come up with data protection mechanisms so that people can trust the platforms they are on. 

This could mean finding ways to halt data security breaches before they happen, to ensuring that when a young person enters a chat room he or she will not be met with an imposter nor need to fear that the digital voice on the other end will engage in discriminatory or insulting behavior. 

These regulations could also include rules around the use of data, so that if a person is being asked to provide information about his or her sexual orientation or identity, there is an understanding of to whom that information is going and how it will be used. 

“It’s really critiquing the way we’re collecting certain types of data and how that data is going to continue to empower the people we are getting the data from, but also just doing a thorough scan, and understanding from people that we’ve defined as prospective users of the platform or people that will access the information, what are some of their fears, and how can we very actively and proactively ensure that some of those are at least incubated in the initial stages,” Mjwana said. 

Digital transformation 

The Digital Health and Rights Project, overseen by the Graduate Institute’s Sara Davis, came about as a result of the transformation of the world’s health systems by technology. 

“The global context for our study is really this very rapid rise of the digital transformation and digital health, which was of course accelerated by the COVID pandemic,” Davis said in her opening remarks on Tuesday. “Global health and national health agencies are really embracing this trend. In 2021, the World Health Organization launched a global strategy for digital health, which called on countries to strengthen health systems with digital technologies and data.”

She highlighted how global agencies are forming partnerships with big tech companies while, at the same time, there have been a lot of concerns raised by United Nations human rights experts and scholars about threats to privacy, non-discrimination and the threat of potential privatization of public services. 

Digital Health and Rights

“In addition, because we’re working closely with people living with HIV and vulnerable to HIV, we have over three decades of evidence showing the impact of stigma, discrimination, criminalization and gender inequality on health responses, and also the impact of these things on data, access to technologies and access to power in different forums,” Davis added. “We really wondered … how these inequalities would play out in the digital transformation.”

The project research was conducted in five countries and has so far included 174 young adults between the ages of 18 and 30, in addition to 83 key informant interviews. The report released Tuesday centered on efforts in Ghana, Kenya and Vietnam, and teased the results coming out of Bangladesh and Colombia, where the team just finished the fieldwork.

Empowering access

“One of our first key findings has been specifically based on the fact that young people actually appreciate having access to digital health technologies,” Mjwana explained. “They’ve described it as empowering.”

Google came up in a number of focus group discussions and some key informant interviews, along with social media and WhatsApp, as one of the most important ways in which people find information, a community, and safe spaces to engage and address some of the concerns that they had but did not want to address by going to health facilities where they might feel judged. 

“The online space has actually afforded some people a platform to not necessarily feel that they have to out themselves,” Mjwana said.

A second finding centered around the fact that a lot of inequalities seen offline continue to play a role in the online space, such as gender, socioeconomic status, education, language, disability, sexual orientation or even location. This could mean individuals not having the funds to purchase needed technologies, or experiencing censorship, violence or harm in the online sphere. 

“We’ve come to realize how the digital divide is actually intersectional,” Mjwana said.

Issues of surveillance and regulation also came out as concerns in the study. 

When people were asked where they think their data is going, many did not know and felt this was a concern that they had to deal with on their own. Some young people assumed their data was going to a third party, while others imagined the data was going to the platform itself or even the police. 

Digital health literacy and empowerment was also emphasized, as well as having a voice in policy making and calling on health officials to bring young people into conversations as champions on social media. 

Dr Mike Ryan, one of the senior WHO officials who has survived the cut, with Dr Tedros, and Maria Van Kerkhove.

Half of the World Health Organization’s (WHO) 16-member senior leadership team at the Geneva headquarters will leave the global body at the end of November, including Chief Scientist Dr Soumya Swaminathan and Dr Mariângela Simão, Assistant Director-General for access to medicines and health products.

The announcement of the departure of the eight senior leaders was made in a short email to staff by Director-General Dr Tedros Adhanom Ghebreyusus on Tuesday, thanking the leaders for their service.

Despite the low-key internal announcement, this is the biggest single leadership change that Tedros has made since 2019, two years after he took office, when he made a set of sweeping changes as part of his “Transformation” agenda for the organization. It has been anticipated for months by Geneva insiders who say the Director-General has been itching to shake up his team since being re-elected for a second term. Additionally, there have been pressures from large donors for Tedros to streamline his senior team, which was unprecedentedly large, and some said, top-heavy.  

Although Tedros said that the officials were all leaving because their appointments are coming to an end, he has obviously chosen not to renew the appointments of a number of those who are not at retirement age and were available.

Tedros said that the departing staff members had “contributed to a significant and enduring transformation of the organisation and helped steer WHO through a global pandemic that ravaged the health and well-being of the entire world and had a profound and ongoing impact on global public health”.

Thanking them, he added that they have made “a truly positive difference, and their legacy is a strengthened and more agile, equitable, and resilient WHO”.

Health Policy Watch was the first to report on Swaminathan’s departure in early October, reporting that the Indian paediatrician’s leadership style may have been too independent for Tedros.

Medicine access stalwarts

Dr Mariângela Simão, WHO Assistant to the Director General.

Swaminathan and Simão, who came to the WHO via UNIAIDS, have consistently  championed access to COVID-19 vaccines for low and middle-income countries, often criticising wealthy countries and pharmaceutical companies for obstructing this.

Simão has spent much of her career working to expand access to medicine, particularly for those living with HIV, and she served as Director of STDs, AIDS and Hepatitis Department in Brazil’s Health Ministry between 2006 and 2010, where she led successful price negotiations with pharmaceutical companies to lower the price of HIV medication

Dr Agnès Buzyn, the WHO Director-General’s Envoy for Multilateral Affairs, was recently appointed executive director of the WHO Academy in Lyon, and the former French health minister remains on the leadership team in her new role. Former French Global Health Ambassador Stéphanie Seydoux has already been announced as her successor.

Who’s out – and who’s still in?

On his way out: Dr Jaouad Mahjour

Jane Ellison, executive director for external relations and governance and former UK health minister, is also leaving, as is Dr Jaouard Mahjour, Assistant Director-General for emergency preparedness and international health regulations. Mahjour held various positions in the WHO’s Eastern Mediterranean Regional Office.

As previously reported, Dr Ren Minghui, Assistant Director-General for universal health coverage (UHC), and communicable and non-communicable diseases, also joins the exodus. Chinese national Minghui was previously director-general for international cooperation at the National Health and Family Planning Commission of China.

South African Dr Princess Nothemba Simelela, Assistant Director-General and special adviser on strategic priorities, who has been working on cervical cancer, is also departing. Simelela previously headed South Africa’s HIV programme. 

Key managerial appointments to the major WHO work clusters made in 2019, not including DGO advisors, most of which have left or will now be departing.

Finally,  Japanese national Dr Naoko Yamamoto, Assistant Director-General for UHC and healthier populations, will also be departing. 

The departure of WHO Deputy Director Dr Zsuzsanna Jakab, the 71-year-old Hungarian who is well over the WHO mandatory retirement age of 65, is also expected to be imminent. 

Also leaving are the WHO’s chief nursing officer, Dr Elizabeth Iro and Min-Whee Kang, senior adviser in the Director-General’s Office, neither of whom are part of the senior leadership team, as such.

Surviving the cut are Dr Mike Ryan, Dr Samira Asma, Prof Hanan Balkhy, Dr Ibrahima Socé Fall, Raul Thomas and special advisers Bruce Aylward and Peter Singer, alongside Dr Chikwe Ihekweazu, who was recently appointed as head of the WHO Hub for Pandemic and Epidemic Intelligence, and Stewart Simonson, who heads the WHO’s US office. 

Other than Seydoux, no replacements have been named. However, in light of the pressure Tedros has been under from member states, particularly the US, to cut costs, it is possible that he may also cut the size of his team.  WHO staff had also complained about the swollen management team, including the pattern of appointing senior advisors housed in the DGO’s office, who were not responsible for any particular WHO cluster, and enjoy exceedingly high salaries.  

Image Credits: Twitter: @WHO, WHO.

Oral Health

Oral diseases are the most common form of noncommunicable disease (NCD) in the world. Globally, these conditions affect almost 3.5 billion people – almost half of the world’s population.

Long a neglected subject in global health circles, oral diseases affect about 1 billion more people than all five main NCDs – mental disorders, cardiovascular disease, diabetes, chronic respiratory diseases and cancers – combined, and global case numbers have increased by 1 billion over the last 30 years. Today, the WHO team responsible for its oral health agenda is still made up of just 3 people.

“It’s a huge burden,” Dr Benoit Varenne, WHO team lead for oral health strategy told Health Policy Watch. “And that burden is increasing, especially in low- and middle-income countries.”

And the world has begun to take notice. The WHO’s Global Oral Health Status Report published Friday reflects a new focus on the importance of oral diseases. Encompassing data from 194 countries, the report is the first comprehensive overview of oral disease burden worldwide.

It follows the direction set out by the World Health Assembly’s adoption of a watershed resolution on oral health in 2021, which agreed the objective of universal health coverage for oral health services by 2030.

“The adoption by WHO Member States of a historic resolution on oral health at the World Health Assembly in 2021 was an important step forward,” said WHO Director-General Dr Tedros Ghebreyesus. “WHO is committed to providing guidance and support to countries so that all people, wherever they live and whatever their income, have the knowledge and tools needed.”

First comprehensive global report spotlights glaring inequalities

Workforce availability is at the heart of failures to address the oral health threat.

Three out of every four people affected by oral health conditions live in low- and middle-income countries. Oral diseases are part of the NCD family, but have yet to be well integrated into the global NCD agenda. 

“All oral diseases show strong social gradients, disproportionately affecting the most vulnerable and disadvantaged population groups,” the report found. “People on low incomes, people living with disabilities, people who are refugees, older people living alone or in care homes, in prison or living in remote and rural communities, children and people from minority and other socially marginalized groups generally carry a higher burden.”

The patterns of inequality present in the distribution of oral disease burden globally are comparable to those seen with cancers, cardiovascular diseases, or diabetes. Oral health also shared the common risk factors of all forms of tobacco and alcohol use, as well as high sugar intake. 

“One of the key messages of this report is that we are part of NCD family because we are share the common risk factors with other major NCDs,” Varenne said.  “We have to invest on this upstream population based strategy in collaboration with other programs and in countries.”

Inequalities also exist at the sub-national level. Public and private services tend to be over-concentrated in wealthy urban areas due to the need for expensive technology to administer care, often leaving rural regions with no access to even the most basic oral health services.

Back to basics: essential care too often overlooked by oral health systems

Essential and preventative care is often overlooked by the predominant model of oral health systems. Training other medical staff to be able to administer basic oral care would be hugely beneficial to populations outside urban centers.

Oral diseases are largely preventable. On paper, the ideal oral health system should focus on the delivery of preventative care, and support patients with education in self-care practices to promote independence. Essential care is the most critical, but the current model being practiced around the work focuses on the complex.

“Most of the countries built their oral care system on the dental care models from high income countries that are based on high-technologies and specialized providers.” said Dr Benoit Varenne, leader of WHO’s oral health team. “And the workforce is more or less all concentrated in urban areas.”

Emulation of the high-income country model frequently results in “system-level failures in the model of care and provision of oral health services” which largely rely on expensive high-tech equipment and materials, highly specialized providers and too few midlevel providers,” the report notes.  

The reliance on a model contingent on a highly specialized workforce – with many roles requiring up to 7 years of education – does a disservice to the provision of simple, non-invasive pain relief of prevention treatments to populations lacking access to sophisticated oral care facilities. 

The report emphasizes the benefits of training other health professionals in the provision of essential oral health services to increase access in non-urban areas, and alleviate the stark inequality in the distribution of the highly-specialized workforce. 

At the time of writing, Sub-Saharan Africa and parts of Southeast Asia reported the lowest absolute numbers of professional-to-population ratios for oral health care in the world. 

“We hope the approaches outlined in the report will improve the situation and reduce inequalities,” Varenne said.

Ukraine
Russian airstrike hits Mariupol maternity hospital, 9 March 2022.

As the first snows fall across Ukraine, World Health Organization officials in Kyiv warn the coming winter will be “life-threatening for millions” of Ukrainians.

At a press conference in Kyiv on Monday, WHO’s European Regional Director Dr Hans Kluge called the Russian airstrikes on Ukraine’s energy and medical infrastructure “the largest attack on health care on European soil since the Second World War.”

“This winter will be about survival,” Kluge said. “Today 10 million people – a quarter of the population – are without power, and cold weather can kill.”

Russian forces have conducted 703 attacks on Ukrainian healthcare infrastructure since the start of their invasion in February. As of 16 November, 144 medical facilities have been reduced to rubble, according to Ukraine’s Ministry of Health. 

“This is a clear breach of international humanitarian law and the rules of war,” Kluge told reporters. “This war must end before the health system and the health of the Ukrainian nation are compromised any further. Access to healthcare cannot be held hostage.”

Kluge called on Russian forces to immediately open humanitarian corridors to the remaining occupied regions. Russia has so far blocked efforts by international organisations to deliver aid to the territories it controls, leaving many Ukranians cut off from the more than 9 thousand tons of medical supplies delivered by 35 countries from around the world since February. 

“This is an unacceptable situation,” Kluge said. “What’s happening in Mariupol, what’s happening in Donbas. We know there are 17,000 people with HIV in Donetsk alone who may soon run out of the critical antiretroviral drugs that help keep them alive.”  Donetsk is one of two major subregions in the historical Donbas in the eastern part of Ukraine, the other being Luhansk, where large parts of territory remain under Russian military control. 

In his appeal to the international community for further financial support for the Ukrainian health sector, Kluge outlined the actions being taken by the WHO and international partners to help Ukraine’s health system prepare for the coming winter months. 

These include repairs to health facilities, heating infrastructure and energy lifelines, and the provision of portable heating devices, medical supplies, diesel generators, and ambulances. 

“Ukraine’s medical system saves the lives of our citizens every minute – sometimes it takes minutes, so increasing the number of such machines increases the chances of providing timely and high-quality care and saving the lives of patients,” Ukrainian Minister of Health Viktor Lyashko said of the delivery of two ambulances to the Sumy region this week. 

The Government of Ukraine, WHO and key international organisations will hold a series of high level meetings to discuss support for Ukraine’s health care system over the coming days. 

“No primary health care centers” in war-torn east

WHO
WHO Europe Regional Director Hans Kluge and WHO Ukraine representative Jarno Habicht preparing to speak at a press conference in Kyiv on Monday. Journalists were warned of the possibility the session could be postponed if air raid sirens forced attendees to relocate to safety.

The most urgent mission facing the WHO and its international partners is getting aid to newly liberated territories like Kherson and Mykolaiv. Russian troops fleeing the cities left health, energy, water and sanitation infrastructure in total disrepair, spurring Ukrainian authorities to begin voluntary evacuations in the region amid fears of a humanitarian crisis brought on by arrival of the harsh Ukrainian winter. 

“In the newly liberated territories there is the big challenge non-communicable diseases, chronic diseases – diabetes, hypertension, chronic respiratory infections – because there is quite an elderly population,” said Kluge.

In Kherson, people did not have hot water or electricity for over two weeks leading up to its liberation by Ukrainian troops recently following a Russian withdrawl from the city. The Russian blockade of medical and humanitarian supplies has left food stocks running low, pharmacy shelves empty, and medical facilities without medicine. 

“In the liberated areas, there are no pharmacies,” Kluge said of his contacts with authorities and volunteer organizations on the ground. “There are not any primary health care centers functioning.”

Rolling blackouts hit homes and hospitals as winter approaches 

Kyiv
Temperatures in the Ukrainian winter can drop as low as -20°C.

Meanwhile, rolling blackouts caused by the continued Russian assault on Ukraine’s energy grid are threatening the ability of medical facilities to continue operating, and depriving civilians of heat for their homes, access primary and urgent care, clean water, and essential humanitarian services.

“Without electricity the machines in intensive care units stop working, surgeries cannot continue, and cold chain facilities needed for vaccines and medicines will be disrupted” said WHO Ukraine Representative Dr Jarno Habicht. “One can only imagine the impact on civilians across Ukraine.”

The latest WHO estimates put the average number of patients treated in the healthcare facilities forced offline by attacks across Ukraine at 421 thousand patients per month. Already short on capacity, the threat of the remaining maternity wards, blood banks, and intensive care beds not having access to the electricity needed to run incubators, refrigeration units and ventilators to Ukraine’s health systems is generating fears of a deadly winter.  

“We usually celebrate the snow,” Habicht said. “But this winter will be different.”

Almost one in five Ukrainians are unable to obtain the medicine they need. In the east, this number increases to one in three, the WHO said. Across the country, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates 9.3 million people require food and basic livelihood assistance, and 14.5 million are in need of health assistance.

COVID-19 threat heightened by arrival of winter

As of January, only one out of three Ukrainians remain vaccinated against COVID-19. It is during the winter season that respiratory infections are at their most dangerous, and coupled with the threats of pneumonia, influenza and a health care system under strain from the war effort, low-vaccination coverage poses a heightened risk. 

“Millions of Ukrainians have waning or no immunity to COVID-19,” said Kluge. “Couple that with an expected surge in seasonal influenza and difficulties in accessing health services, and this could spell disaster for vulnerable people.”

“Ukraine’s health system is facing its darkest days in the war so far,” he warned. “It is being squeezed from all sides, and the ultimate casualty is a patient.”

Elderly population at acute risk

Ivlev-Yorke
Many elderly people are not physically fit enough to evacuate by train on their own. Others are reluctant to leave their lives and homes behind.

At the onset of the war, hospitals and health facilities were asked to stop all non-emergency care in preparation for the burden of the wounded. This makes the elderly – especially those dependent on regular care for chronic diseases – acutely vulnerable. About 20% of the Ukrainian population is above the age of 60.

The reorientation of Ukraine’s medical system to wartime footing has left few staff available to provide primary healthcare for older people suffering from non-communicable diseases, and severely disrupted the availability of life-saving medications like insulin – especially in frontline regions.

“Access to healthcare, including primary care, has become extremely difficult,” Médecins Sans Frontières testified of their experience in Ukraine. “In combination with an already damaged and disrupted healthcare system, this creates serious issues for continuity of care [for patients suffering from chronic illnesses].” 

The social services relied on by many older Ukrainians have also been heavily impacted by the war, leaving many with no recourse to treatment.

The limited mobility of many elderly people also makes evacuation a more difficult task than for the young and healthy. Some choose to stay, unable to envision leaving the lives and cities they call home behind. 

Children caught in the cross-fire

A mother and her two children are evacuated from the frontlines of the Donbas region by an international team of volunteers.

War is particularly unkind to vulnerable populations, and the situation in Ukraine is no exception: children are caught in the cross-fire.

Today, some 3.4 million Ukrainian children need “child-protection interventions,” according to OCHA. These include services such as family tracing and reunification, psychological support and alternative care arrangements. 

As of 10 November, OCHA said 1.67 million children, parents and caregivers have received child-protection related support, with 650,000 children having received psycho-social support to cope with the traumatic effects of war and displacement. 550,000 caregivers – 71% of whom are women – who were provided sessions on supporting their children through the mental challenges of the war.

Caught between the mental weight of war and freezing temperatures, even warmth – absent access to clean electricity – poses its own set of dangers. 

“As desperate families try to stay warm, many will be forced to turn to alternative heating methods like burning charcoal, wood, or using generators fueled by diesel or electric heaters,” Kluge said. “These bring health risks, including exposure to toxic substances that are harmful for children.”

Many children have also been separated from their families as part of the thousands of Ukrainians forcibly deported to Russia and occupied territories since the start of the invasion. Exact numbers remain elusive, but the Ukrainian government has so far identified over 10,000 children matching this description.

Médecins Sans Frontières has reported treating patients as young as six-weeks old, and recent estimates count 437 children among the more than 8,300 civilians killed since February. The UN High Commissioner for Human Rights has confirmed an additional 505 children injured among the 10,000 injured civilians.

With no visibility on the situation in Russian occupied areas like Mariupol and casualty verification processes ongoing, the number is likely far higher.

October alone saw over 450,000 people flee to safety across Ukraine. Of these, 280,000 were people leaving the east of the country, according to the latest data from the International Organisation for Migration (IOM).

A total of 14.3 million Ukrainians have already been forcibly displaced by the conflict. As the harsh Ukrainian winter settles in, the WHO projects an additional 3 million will be forced to flee in search of warmth and safety over the winter.

Image Credits: Мstyslav Chernov, WHO, Mariusz Kluzniak, Ignatius Ivlev-Yorke, Ignatius Ivlev-Yorke.

antibiotics
Unsupervised use of antibiotics threatens the global fight against antimicrobial resistance.

A new survey of citizens in 14 WHO member states in the Balkans, Caucasus and Central Asia found that one third of respondents questioned said that their last course of antibiotics was obtained with a medical prescription.

This is at least three times more than that reported from a similar survey of 30 European Union and European Economic Area member states, in a recent survey of citizens by the European Commission, said WHO’s European Regional Office in a report of the findings issued on Monday, which marks the start of World Antimicrobial Awareness Week.

The findings were part of a wider survey of knowledge, attitudes and behaviour around antimicrobial resistance, (AMR), conducted for the first time ever in the eastern part of the WHO European Region, including the Caucasus and Central Asia.

The countries surveyed included: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, Tajikistan, Turkiye and Uzbekistan.

The findings highlight the wide gap that exists not only worldwide, but within WHO’s sprawling European Region, regarding the use of antibiotics and awareness about growing antimicrobial resistance to common drugs.

WHO’s European Region includes some 53 member states, representing a wide spectrum of economic development levels – also reflective of global development gaps more broadly.  It includes all of the EU/EEA member states as well as member states of the former Soviet Union and other former eastern bloc countries, which are not EU members.

In the WHO survey, one in three respondents said that in their last antibiotics course, they either used leftover antibiotics from a previous prescription or obtained them without a prescription over the counter from a pharmacy or elsewhere, according to the preliminary survey findings.

In addition, 50% of those surveyed across participating countries reported having used antibiotics in the last year, which is more than double that reported for EU/EEA countries for the same period.

Central and Eastern Europe and Central Asia among AMR hotspots worldwide

Number of all-age MRSA deaths attributable to AMR.

At least 1.27 million deaths per year are directly attributable to superbug resistance to common antibiotics, according to global AMR estimates released earlier this year by the Seattle, USA-based Institute for Health Metrics Evaluation (IHME) and the Global Research on Antimicrobial Resistance (GRAM) Project partners.

The deadliest pathogen-drug combination globally was methicillin-resistant Staphylococcus aureus (MRSA), which caused more than 100,000 deaths attributable to AMR in 2019, according to the IHME report. On the GBD super-region level, the number of all-age MRSA deaths attributable to AMR is largest in the Southeast Asia, East Asia, and Oceania super-region and is smallest in the Central Europe, Eastern Europe, and Central Asia super-region.

Deaths from all-age MRSA attributable to AMR are, however, largest in Southeast Asia, East Asia, and the Oceania super-region, the IHME study found, while they are proportionately smallest in Central Europe, Eastern Europe, and Central Asia super-region – where access to health care is still more robust.  Even so, according to WHO, some 35,000 people die from AMR-related infections in the EU/EEA region which represents Europe’s most developed economies.

Slow tsunami on the horizon

WHO Press Technical Briefing 11 July 2022.

“When antibiotic drugs are used too much, for too long or when they are not necessary, bacteria can become resistant to them,” said Dr Danilo Lo Fo Wong, WHO European Regional Adviser for the Control of Antimicrobial Resistance. “Without collective action, we can expect a future in which otherwise treatable illnesses, such as urinary tract infections, could once again become untreatable and procedures such as surgeries or chemotherapy too dangerous to perform.”

In the survey of 61% of respondents were also unaware that antibiotics do not work against viruses, while over half believed, incorrectly, that they were effective against colds. In the EU/EEA region, about 50% of those surveyed mistakenly believed that antibiotics kill viruses.

However, two thirds of respondents said that they understood that unnecessary use of antibiotics made them ineffective.

“Antibiotics cannot cure the common cold. A common cold is caused by a virus, against which antibiotics do not work,” stressed Dr Danilo Lo Fo Wong. “Though antibiotics will not help you, their use may lead to the development of antibiotic resistance and become a problem for you and for someone else.”

WHO Regional Director for Europe, Dr Hans Kluge, called AMR “the slow tsunami building up on the horizon.  We can take steps to make sure that people are informed about their medicines,”

See this link for more about World Antimicrobial Awareness Week events.  Link here for more WHO Resources and a joint campaign of the Quadripartite – including the global agencies dealing with animal health, agriculture and the environment.

Image Credits: Emily Brown, Healthdata.org.

Negotiations on a ‘pandemic treaty’ are starting in earnest within weeks as the World Health Organization (WHO) distributed the first ‘zero-sum’ conceptual draft of the agreement to member states on Friday – but one of the biggest conundrums is how to pay to mitigate the next pandemic. 

The COVID-19 pandemic has had a significant impact on economies, and 143 of the WHO’s 192 member states are to adopt “austerity measures’ including public spending cuts next year, while Russia’s war in Ukraine and climate crises are further challenging country budgets.

The Pandemic Fund, recently set by the World Bank, has an annual “funding gap” of $10 billion, the G20 leaders acknowledged at the conclusion of their meeting in Bali on Wednesday.

But this week the Geneva Global Health Hub (G2H2) described the Fund as an “outdated funding model dependent on colonial charity” at the launch of its report, “Financial Justice for Pandemic Prevention, Preparedness and Response”.

“There is certainly no shortage of money in this world, but redirecting it to advance health after the pandemic requires bold action. The international community instead continues to pursue outdated and opaque models, as is the case of the recently established Pandemic Fund,” said Wemos’s Mariska Meurs, co-author of the report. 

The G2H2 report proposes a number of options to fund stronger health systems to fend off pandemics, one being debt cancellation.

Several emerging and developing countries were in a dire debt crisis well ahead of the COVID-19 pandemic, while many more countries have emerged from the pandemic with higher and more unsustainable debts.

“In low-income countries, debt has increased from 58 to 65% between 2019 and 2021. Thirty nations in sub-Saharan Africa have seen a debt-to-GDP ratio exceeding 50% in 2021,” according to the report.

“Research conducted on 41 countries shows that those with the highest debt payments will spend an average of 3% less on essential public services in 2023 than in 2019,” according to the G2H2 report.

In addition, between 75 million and 95 million people would be pushed into extreme poverty by the end of 2022, according to the World Bank.

Debt cancellation and climate reparations

Nicoletta Dentico, G2H2 co-chair and report co-author.

“If the G20 had cancelled all payments due in 2020 from the 76 most indebted countries, this would have liberated $40 billion towards a pandemic response. If the cancellation had included 2021, the amount would have been $300 billion. Debt is a virus, and debt cancellation is the vaccine the world needs before the debt crisis explodes,” said Nicoletta Dentico, G2H2 co-chair and report co-author.

Debt cancellation is not such an outlandish idea in light of the “loss and damages” reparations that wealthy industrialized countries owe to developing countries for the devastations caused by their greenhouses gases emissions, the report argues.

While the World Bank keeps talking about the “debt crisis”, it is the northern countries that are indebted as “it is their ecological debt that needs to be paid”, said Dentico.

Global warming caused $6 trillion in global economic losses between 1990 and 2014, and it was time for “financial justice”, she added.

Health cuts in the name of ‘austerity’

Isabel Ortiz, Director of the Global Social Justice Program at Joseph Stiglitz’s Initiative for Policy Dialogue at Columbia University, said that there was a “tsunami of austerity cuts” ahead – yet these had always resulted in cuts to the health sector which set countries back.

Before the Ebola outbreaks in West Africa in 2014, the International Monetary Fund (IMF) had compelled Guinea, Liberia and Sierra Leone to adopt austerity measures, including limiting the number of health workers that they could hire and capping health workers’ wages, which then affected their response to Ebola, according to the report.

G2H2 co-chair Baba Aye, from Public Services International, said that austerity measures as part of fiscal consolidation had mostly led to “a massive deterioration of health conditions for entire populations”. 

“This economic model has enslaved global South countries to multiple financial dependencies, constricted their fiscal policy space, distorted their economic and human development and impoverished them,” said Aye.

Austerity usually went with the commercialization and privatization of public health services – yet “people suffered the most during COVID-19 where there was privatized healthcare or funding cuts”, added Aye. 

Despite this, the World Bank has rolled out its “private-first” approach – including in health – through its “maximizing finance for development strategy”, added the G2H2.

Meanwhile, the IMF, after a brief spending boost during the Covid-19 pandemic, has returned to pushing for ‘fiscal consolidation’ in country programs and loans, according to the report.

But there are better alternatives to austerity-related public spending cuts, said Ortiz, including increasing the taxation of corporations and wealthy individuals. 

“For instance, we can increase taxes on corporate profits, financial activities, wealth, property, natural resources, and digital services like Amazon,” said Ortiz.  

Argentina, Iceland, Spain have announced special taxation of the windfall profits of the energy sector, she added.

“All the human suffering caused by austerity cuts can be avoided. There are alternatives. Even in the poorest countries, governments can increase their budgets to ensure quality public services and universal social protection by looking at financing options such as fairer taxation, reducing debt and illicit financial flows,” said Ortiz.

Isabel Ortiz, Director of the Global Social Justice Program at Joseph Stiglitz’s Initiative for Policy Dialogue at Columbia University

Illicit financial flows to tax havens

Illicit Financial Flows (IFFs) are yet another drain on public resources that can only be tackled with radical action, according to the G2H2. 

Many of these flows involved the expatriation of profits from the countries where they were generated to tax havens.

The Eastern and Southern African region lost a staggering $7.6 billion in tax revenue in 2017 alone, due to “base erosion and profit shifting to tax havens”, according to the report.

At the UN General Assembly in 2022, the Africa Group tabled a draft resolution calling for negotiations towards a UN convention on tax cooperation, building on the long-standing call by G77 & China to establish an intergovernmental process at the UN to address global tax abuse. 

“This initiative should at least be receiving a strong indication of support in the context of the Intergovernmental Negotiating Body (INB) for the pandemic accord at the WHO,” said the G2H2.

Pakistan’s Minister for Climate Change Sherry Rehman took a lead in loss and damage negotations at COP27.

SHARM EL SHEIKH, EGYPT – In a historic first, delegates to the 27th UN Climate Conference, COP27, agreed Sunday to create a “loss and damage” fund to assist countries suffering from the impact of the climate crisis, concluding a meeting that went into two days of overdrive, with negotiations day and night.

They also added back in language about “the right to a clean, healthy and sustainable environment” into the final outcome text, which had been dropped from an earlier version.  That reference to a UN resolution approved only in July, was a precedent-setting victory for the World Health Organization and civil society advocates that had campaigned heavily for a more central role for health in climate frameworks.

“History was made today at #COP27 in Sharm El-Sheikh as parties agreed to the establishment of a long-awaited loss and damage fund for assisting developing countries that are particularly vulnerable to the adverse effects of climate change,” tweeted the COP27 Secretariat at 4 a.m. Sunday morning as delegates from the nearly 200 countries gathered at the meeting regrouped in a long-delayed closing plenary to approve a series of hard-fought agreements.

However, most of the details of how to fund the new mechanism and which countries will be prioritised for receiving the money have still not be finalized and will have to be worked out over the next two years.

Instead of a ‘burning bush, a burning planet’

“COP27 took place not far from Mount Sinai, a site that is central to many faiths and to the story of Moses, or Musa,” said UN Secretary-General António Guterres at the close of the event. “It’s fitting. Climate chaos is a crisis of biblical proportions. The signs are everywhere. Instead of a burning bush, we face a burning planet.”

Guterres said the conference had been driven by two overriding themes – justice and ambition. And along with loss and damage, progress had been made on other fronts as well, he noted: including clarity and a credible roadmap to double adaptation finance; and changing the business models of multilateral development banks and international financial institutions; among others.

EU: Stalled mitigation ambition will lead to heavier loses and more damage

Frans Timmermans, the EU climate negotiator, in closing plenary remarks

While developing countries celebrated the decision to create the fund, the European Union, Australia, Canada and other developed countries, as well as the Alliance of Small Island States, lamented the lack of progress at this year’s conference on mitigation targets that are woefully inadequate to the task of slowing the harm climate change is doing.

Countries seeking more “ambition” on mitigation gave up several battles on the mitigation front, including initiatives to incorporate oil and gas into the language about a “phase down” of coal fossil fuels.  Language about the need to ensure that global emissions peak by 2025 at the latest, and then decline after that, was also rejected by countries that want to keep expanding fossil fuel-based development.

The EU and its allies had sought to link the creation of the loss and damage fund more directly to stronger action on mitigation targets, but ultimately gave that battle up.

“The European Union came to get stronger ambition and we didn’t achieve that,” lamented Frans Timmermans, the lead EU negotiator at the closing plenary, “What we have before us is not enough for people and the planet, to address the yawning gap between climate science and our policies.

“This is a make or break decade,” he added. “To tackle climate change, all financial flows need to go to support low carbon transition. We need far more rapid reductions of climate change.  That is how you reduce loss and damage from climate change. The EU came here to make that happen.  But too many parties are not ready to step up. The mitigation programme allows parties to hide from their responsibilities. There were even attempts to roll back what we did in Glasgow [COP26].  We have all fallen short of our obligations to limit loss and damage from climate change.”

“The deal is not enough on mitigation so we were faced with a dilemma, do we walk away?” Ultimately, he said, the bloc decided not to bloc the historic creation of the loss and damage fund. But now that it has been approved, preparations for a mitigation programme in COP28 “begin today.”

Egyptian bridging proposals finally helped break the ice

Sunday’s early morning agreement on the loss and damage formula came after Saturday’s release of a series of bridging proposals by Egyptian Foreign Minister Sameh Shoukry, who holds the COP Presidency. Those proposals signaled a breakthrough in talks that almost ended in failure.

Speaking to media Saturday morning, and just before the text of the Egyptian proposals was released, Egyptian Foreign Minister and COP President Sameh Shoukry said he believed that the proposals were “balanced” and constituted “a potential breakthrough.”

Egyptian Foreign Minister Sameh Shoukry announces his new bridging initiatives at press conference Saturday morning,

Finalization of an overarching draft agreement was still going on at press time, with parties expected to agreeing on a final version late Sunday morning.

The new draft text states concretely that the COP27 “decides….to establish a fund for responding to loss and damage whose mandate includes a focus on addressing loss and damage.”  The text stipulates that the loss and damage fund would be complementary to existing funding arrangements for mitigation and adaptation.

The draft also sets forth a pathway for operationalizing such a fund, based on the creation of a “transitional committee on the operationalization of the new funding arrangements”, which would make recommendations regarding the precise institutional arrangements, modalities, governance and structures.

That transitional committee would make its recommendations based upon:  a) the development of a synthesis report by the UN Climate Secretariat; b) workshops in 2023 and c)member state and UNFCC inputs.  The transitional committee would review gaps in the current funding landscape, and “the most effective ways in which to address the gaps, especially for the most vulnerable populations and the ecosystems on which they depend,” according to the draft text.

Right to clean, healthy and sustainable environment

The new text also kept in important language stipulating that people have a “right” to a clean, healthy and sustainable environment, an unprecedented move that is seen as having great importance among the health community.

Release of the new texts brought shouts of jubilation from some civil society groups. The texts were also welcomed by delegates from developing nations such as Pakistan, a bellwether for opinions in the #G77 group of developing nations.

“We have pushed very hard until the last minute for a loss and damage fund,” tweeted Pakistan’s Sherry Rehman, “a positive outcome is close. Not perfect or optimal, but one that addresses the basic demand of developing nations. I believe if we stick to our positions, stay united, we will make landfall.”

But remained to be seen exactly how developed countries would react to the new texts and formulas, as COP27 delegates headed into an evening plenary session. On Friday, top EU negotiators Frans Timmermans had said that China and other oil-rich economies need to kick into the funding pot.  Even if they were considered developing countries in 1992, they are key emitters now and thus part of the problem.

Text emphasizing that the funding facility would look especially at solutions for “the most vulnerable populations”, was reportedly inserted into the draft to assuage those EU concerns, some observers said. But EU negotiators were also seeking a higher level of ambition on climate mitigation and the 1.5C target, as part of the package deal on loss and damage.  “We cannot accept that 1.5C dies here and today,” tweeted top EU negotiators Frans Timmermans earlier Saturday morning.

That followed Timmerman’s statements on Friday that no deal at COP27 would be better than a bad deal. See related story;

Loss and Damage Negotiations in Overdrive; Right to ‘Healthy Environment’ Drops Out

No progress on fossil fuel phase out or 1.5C

Indeed, there was little in the way of new commitments to keeping warming to the 1.5C target – even as a slew of scientific reports say that the goal is now virtually unattainable.

And the latest draft of the outcome text still fails to refer explicitly to a fossil fuel phase out or phase down for oil and gas. That was something that the EU bloc had reportedly sought to incorporate into the COP27 outcome, building upon the COP26 reference agreed to at Glasgow for a “phasedown” of coal.

Until today, the only language on fossil fuels ever incorporated into a COP document, talks about removing “inefficient” fossil fuel subsidies, but not the fuels themselves. That is despite the fact that combustion of fossil fuels is the main driving force behind climate change.  The current draft only preserves the terms agreed to at Glasgow:

28. Calls upon Parties to accelerate the development, deployment and dissemination of technologies, and the adoption of policies, to transition towards low-emission energy systems,including by rapidly scaling up the deployment of clean power generation and energy efficiency measures, including accelerating efforts towards the phasedown of unabated coal power and phase-out of inefficient fossil fuel subsidies, while providing targeted support to the poorest and most vulnerable in line with national circumstances and recognizing the need for support towards a just transition;

But bold new language on transformation of the global financial system

On a more positive note, however, this version of the text does include some bold new language on the need for a “transformation” of the global financial system in order to muster the estimated $4 trillion annually that would be needed for economies to transition to cleaner energy and other low carbon technologies.

As compared to past COP decisions focused on the so far unsuccessful efforts to create a mitigation fund of just $100 billion, this year’s text highlights: “that about USD 4 trillion per year needs to be invested in renewable energy up until 2030 to be able to reach net zero emissions by 2050, that, furthermore, a global transformation to a low-carbon economy is expected to require investment of at least USD 4–6 trillion per year.

It furthermore adds that, “delivering such funding will require a transformation of the financial system and its structures and processes, engaging governments, central banks, commercial banks, institutional investors and other financial actors.”

Those words echo powerfully back to the opening days of COP27 when leaders such as Barbados Prime Minister Mia Mottley, hearkening back to her Bridgetown agenda, called for a complete revamp of loan terms for highly indebted low and middle income nations so that they could afford to finance an energy transition.

COP27 Ending tonight?

In light of the progress made over the day, some observers were predicting that COP27 delegates would finally manage to come to an agreement tonight – instead of dragging things out into the next week, as some had predicted on Friday.

But that was by no means certain, either, in light of warnings earlier in the day by the EU’s top climate negotiator Frans Timmermans, that “no deal would be better than a bad deal”.

Meanwhile, the Alliance of Small Island States, issued it’s own warnings against moving too hastily on the sensitive issue of climate loss and damage, which represents an existential threat for low-lying, weather vulnerable nations.

“We’re in for a long night ahead at COP27,” tweeted Arthur Wyns, of the Global Climate and Health Alliance.

 

Image Credits: @sherryrehman.

Frans Timmermans, the EU climate negotiator on Friday speaking with reporters as negotiations over the bloc’s proposal on climate loss and damage headed into overtime Friday.

SHARM EL SHEIKH, EGYPT – Michael Terungwa, a solar entrepreneur in Abuja, Nigeria, will know that real progress is being made on climate change when things change in his hometown. 

When the 10-20% in customs and tariffs that he pays for cheap, imported Chinese solar panels are removed; when his customers’  solar purchases are subsidized instead of their purchases of generator oil that run with deafening noise and pollute the air; and when Africa’s richest man begins to invest in renewables – rather than fossil fuels so that he can buy and sell better, quality-assured panels, batteries and other accessories locally.

While Terungwa believes that the outcomes being negotiated by governments at COP27 could and should make a difference, he has seen, from first-hand experience in Nigeria as well as at this year´s COP, the limits of politicians as leaders of change.

He’s hoping that change will still happen. But it’ll likely come in a variety of forms. It may ride on a wave of popular demands for climate action during upcoming Nigerian elections that follow in the wake of devastating floods.  It may come in the form of mounting pressure to reform both regional and global financial institutions that continue to lend more money for fossil fuel projects than renewables, while holding low-income countries shackled with debts.  And eventually, he’s also hoping that the private sector will someday be on right side of change – including Africa’s richest man.  

“If Aliko Dankote decides to invest in renewable energy, in solar, then it will change,” concluded Terungwa, referring to the Nigerian magnate who is currently spending $25 billion to build the Dangote Oil Refinery, the world’s largest, near Lagos. 

Delegates still locked in dispute over loss and damage

Michael Terungwa runs a solar social enterprise in Abuja, and attended COP27 as the member of a Nigerian civil society group.

Terungwa spoke to Health Policy Watch in the waning days of the COP27 conference as delegates battled frantically over the terms of a proposal to create a new fund for countries’ loss and damage from climate change. 

Over the past two days, discussions have centered around a recent European Union proposal to support such a fund, but only if it is also linked to stronger commitments on climate mitigation, and receives financial backing from China, now the world´s second largest emitter, as well as Gulf states that have grown rich on oil exports.

Delegates also continued to debate the framing of the Paris commitment to the 1.5C limit for global warming. But as talks entered overtime on Friday evening, the draft outcome language now circulating was stock text, lacking the reference to “urgent” that had been injected into a G20 communique issued earlier in the week. 

The latest draft text also waters down the COP26 commitment of Glasgow to “phase out inefficient fossil field subsidies,” calling instead for countries to “phase out and rationalize” such subsidies, leaving more diplomatic wiggle room for countries to justify fossil fuel investments that lock the economies into carbon intensive development.

Language refers in passing to the “right to health”, a word that was not even mentioned in the outcome document of the COP26 Glasgow conference.  But an earlier reference to peoples’ right to the “highest attainable standard of physical and mental health” in the climate context had fallen out of the latest text circulating Friday evening – something that would have been a precedent-setting nod to the terms of the World Health Organization´s 1948 constitution.   

Without loss and damage, we cannot achieve Agenda 2030

Youths were a visible presence at the largest climate conference ever, with 35,000 participants.

Like many other civil society participants Health Policy Watch spoke to throughout the week, Terungwa was critical of the continued fence-sitting of governments on fossil fuels development, whether from leaders in the global north or south.  He supports a strong commitment to the 1.5C goal aligned with a halt to new fossil fuel investments of almost any kind. 

But he also was concerned that the lack of a strong outcome on the charged issue of loss and damage would ultimately jinx the prospects for sustainable development, condemning millions of people in climate vulnerable regions like Nigeria to an ever more precarious future.

“With no strong commitment and possible outcome as COP27 comes to an end, I am very much afraid that the thousands of Nigerians who were displaced as a result of the recent floods and are currently in internally displaced camps, will not benefit from Loss and Damage,” said Terungwa, whose enterprise also provides IDP camps with solar electricity, and attended COP as part of the Global Initiative for Food Security and Ecosystem Preservation (GIFSEP).

“I can tell you confidently that without loss and damage, we cannot achieve Agenda 2030 or the Sustainable development Goals, because all 17 goals are impacted once there is a climate disaster.  

“The sad reality is that those responsible for this crisis know exactly what to do, but sadly they are not doing it. We continue to call for justice on this matter.”

Debate over China’s participation in the fund  

Negotiations in Glasgow at COP26 almost collapsed over the question of coal. The fulcrum in Sharm el-Sheikh is loss and damage – with debates likely to extend over the entire weekend, if not beyond.

The European Union’s agreement on Thursday to include loss and damage in the outcome document was supposed to be a breakthrough.  However, the EU`s “final offer” Friday morning came with tough conditions attached. 

 “We can live with a fund, but under two very important conditions: the fund should be targeted to the most vulnerable, and it should also have a broad funding base,” the bloc´s chief climate negotiator, Frans Timmermans, vice president of the European Commission, told the press on Friday.

Translated, that means China and oil-rich Gulf nations, which may have been considered developing states when the UN Framework Convention on Climate Change (UNFCCC) was created in 1992, but are large CO2 emitters today, should also contribute financially. That is a position which China has so far rejected. 

“There we have a disagreement,” Timmermans said. The money should come from a “broad funder base” and be based on the economic realities “in 2022, not 1992.”

Without agreement, other aspects of the negotiations may crumble

COP 27
On 21 September 2022 people wait in the midday sun for the water troughs to fill with water in Marsabit County, Kenya. With an ongoing drought in the Horn of Africa, the spring is the only available water source for the whole community.

A second draft of an outcome text shared by the Egyptian Presidency Friday evening still contained placeholder text for loss and damage, but no clear language suggesting a way forward on the thorny issue.  Meanwhile, media reports said negotiators were frantically debating a last-ditch EU proposal on mechanisms for creating the fund within a two year time frame.. 

“As the hours tick by, there is still time for wealthy nations at COP27 to agree to the long-overdue Loss and Damage finance,” said Jeni Miller, Executive Director of the Global Climate and Health Alliance. “Without agreement, all other aspects of the negotiations may crumble.”

In his comments Friday, Timmermans said the bloc’s resistance to the idea of a fund was not about funding commitments, but efficiency.

 “My reluctance with a fund is I know from past experience that it takes time before such a fund is established, and even more time until such a fund is filled,” he said. “I truly believe we could move faster by adapting existing instruments.” The United States shares EU concerns about the inefficiency of a fund, preferring a “mosaic” of financial arrangements. It has yet to comment on the EU’s new proposal. 

The EU proposal hinges on the condition that countries agree to “a package deal with serious plans on mitigation” including “an agreement to peak emissions in 2025” and update NDCs accordingly, Timmermans said further.

Tensions around the right of developing nations to continue to exploit their fossil fuel resources in the name of development remain a sticking point in negotiations. But the EU stance is clear. 

“If we don’t seriously reduce our emissions, there is no amount of money on this planet that can address the issue of loss and damage,” Timmermans said. “This is our final offer. I thank all our member states for the courage to go this far, but this is it.”

1.5°C’s dying breath

Global mean temperature increase as recorded in the 2022 WMO State of the Global Climate provisional report.

A week before COP27 began, the United Nations Environment Programme’s Adaptation Report found “no credible pathway” to limiting warming to the 1.5°C limit. 

The latest draft document still “reaffirms the resolution to pursue efforts to limit the temperature increase to 1.5°C”. 

But the language is lukewarm at best, lacking the more strident tone of the recent G20 communique, which stated only last week that “The resolve to try and limit the temperature increase to 1.5C is urgent.” 

Not only that, Friday’s backslides around fossil fuel subsidies, in subtle but significant ways.  The COP26 Glasgow document calls for the “phase-out of inefficient fossil fuel subsidies.”

The COP27 draft language adds a single word laden with meaning. It calls to “phase out and rationalize inefficient fossil field subsidies,” creating wiggle room for signatories to justify investment in new fossil fuel infrastructure, and deepening their reliance on oil and natural gas. 

This in contrast to sharp warnings by not only climate scientists, but also the International Energy Agency, which has said no new oil, gas or coal development can be undertaken if the world is serious about addressing the climate crisis. 

Health makes its first appearance in draft text – then fades 

WHO humanitarian response after cyclone Idai in Mozambique. More frequent flooding and droughts are devasting Africa and Asia.

Health has long been an overlooked dimension of climate discussions despite its deadly consequences. Air pollution claims 7 million lives every year, and 65% of the pollution from human activities is from fossil fuels.

The threats of heat stress, sea level rise and drought threaten the health of older people, children and outdoor workers, as well as food and water security of over a third of the world’s current population, putting them at risk of forced migration if temperature rise is not curbed.

Determined to work health into a COP27 agenda set to define the world’s response to the climate crisis, the global health community arrived at Sharm el-Sheikh en masse. 

The WHO COP27 pavilion was packed with crowds throughout a two-week marathon of sessions on climate and health.

And when the initial draft outcome text was circulated Thursday by the Egyptian Presidency, those efforts seemed to have paid off. 

Text on ‘highest attainable standard’ for health is dropped

(Second from left) Maria Neira, WHO’s director of the Department of Climate, Environment and Health at WHO’s COP27 pavilion

The draft text referred to the need to ensure the “highest attainable standard of physical and mental health” in the world’s response to the climate crisis – language hearkening back the WHO’s 1948 Constitution for the first time ever in a climate document. 

But when the second draft of the outcome document was made public Friday night, that reference had disappeared. 

Another passage affirming “the right to a clean, healthy and sustainable environment as a human right” was also removed. That passage recalled a milestone United Nations General Assembly Resolution passed in September 2022.

The notion of health as a human right has not been completely lost.

The latest draft outcome document still calls on signatories to “respect, promote and consider their respective obligations on human rights, the right to health, the rights of indigenous peoples, local communities, migrants, children, persons with disabilities and people in vulnerable situations and the right to development, as well as gender equality, empowerment of women and intergenerational equity.”

Healthy forests: acknowledged but not funded

Oil and gas projects in Africa are set to quadruple; 90% of projectsthat overlap with sensitive forests, are in the Congo Basin, the world´s second largest rainforest.

So far, the reference to “healthy forests” and their role they serve in “climate regulation, biodiversity protection, food and water security, soil fertility and limiting forced migration” has remained intact in the latest draft. 

But the text also fails to include any provision to compensate developing countries for forest preservation – ignoring calls from the 50-member Coalition for Rainforest Nations that say finance is critical to halting the deforestation of critical ecosystems. 

Although Brazil´s President-elect Lula da Silva  vowed to end deforestation of the Latin American rainforest in a speech earlier this week, it is clear he will have to balance those promises against powerful economic interests at home.  

The Democratic Republic of Congo, meanwhile, has made no such vow. Rather, it has put large areas of the Congo Basin rainforest up for auction as oil and gas blocs. That would not only erode the integrity of the world’s second largest rain forest, but also unleash dangerous quantities of methane buried in extensive peatlands.

Without strong countervailing financial incentives, it´s unlikely that the DRC will back down.   

“The role of forests and peatlands was removed from the cover decision,” Eve Bazaiba, DRC vice prime minister told reporters on Thursday. “So we are asking ourselves, what are we doing here?”

The Children Are the Adults in the Room 

Amid the chaos overtaking the conference Friday morning, one voice broke through the noise. That voice belongs to Nakeeyat Dramani, a 10-year-old from Ghana speaking on behalf of her country’s delegation during plenary. 

“As we sit here, the fate of the most vulnerable will be the fate of the world,” she told a room of attendees and world leaders thirty to sixty years her senior. “Do not leave our communities exposed.”

Dramani’s address was a reminder of the power a youthful perspective injects into the climate conversation. 

“Remember yourself at my age,” she asked the delegates. “If all of you were to be young people like me, wouldn’t you have already agreed to do what is needed to save our planet?”

Sadly, that’s not the case.

Image Credits: @TimmermansEU, E Fletcher/Health Policy Watch, WHO Africa, World Metereological Organization, WHO, Rainforest Foundation and Earth Insights, 2022.

E-cooking
A three-stone coal cook stove in Kisumu, Kenya.

SHARM EL SHEIKH, Egypt – Electric cooking is becoming more attainable for households in Africa, and BioLPG, a climate-neutral alternative to propane, could be a cost-effective replacement to the fossil fuel variant for household cooking in some developing countries, say experts at COP27, the global climate talks. 

The spoke at a panel session on tackling the health and climate crisis through clean cooking solutions, hosted by the World Health Organization at COP27.

The emerging potential to harness energy-efficient electric cooking technologies to clean up pollution from charcoal and wood stoves used by hundreds of millions of poor households offered one bright star in the mostly dismal news about climate trends and deadlocked negotiations, emerging out of this years UN Climate Conference.

For years, clean cooking solutions have received more lip service than cash from the energy and finance ministers who hold the purse strings of energy investment. Even in countries like Nigeria, which are rich in fossil fuels, governments have been far more intent on extracting oil and gas for export than expanding modern energy access at home. 

Despite major progress over the past decade, some 775 million people worldwide still have no access to electricity. And a whopping 2.6 billion people still cook on the most rudimentary wood, charcoal or biomass stoves that emit high levels of smoke directly into homes, said the World Health Organization’s (WHO) Heather Adair Rohani at the session on “tackling the health and climate crisis through clean cooking” solutions. 

Household smoke is both an agent of climate change and air pollution. It kills an estimated 3.2 million people annually including about 237,000 children under the age of five who are more prone to pneumonia as a result of their smoke exposure. Among older people who spend much of their day next to cooking fires, deadly cardiovascular and respiratory diseases, as well as cataracts and other complaints, are a frequent outcome, Adair Rohani explained.

Inefficient cook-stoves and heating systems are also a leading source of excessive CO2 emissions, and the black carbon emitted by wood and biomass stoves is a short-lived climate pollutant that accelerates snow and glacier melt. Finally, wood gathering and charcoal production not only contributes to deforestation but also consumes excessive time for women and girls, detracting from work and education and putting them at physical risk.

Household smoke is a longstanding health and climate issue

The WHO has long viewed household cooking emissions as a critical threat to global health.

As a key impediment to women’s and children’s health and gender equality, household smoke has been an issue that WHO has championed since the early days of its involvement in climate issues – long before the global health agency began to weigh in forcefully on more sensitive topics like fossil fuels.   

Meanwhile, some of the clean cook-stove solutions that held promise a decade ago have not proven to be long-term solutions. Some “improved” biomass cook-stoves may reduce pollution emissions, but not enough to make them safe for daily use inside homes.

And certain renewable cooking solutions, like solar cook-stoves, have been met with social and cultural resistance in some settings, limiting their potential for scale-up. In many countries, large-scale government investments in clean cooking have simply failed to pan out, leaving the work to non-profit organizations, with a mixed bag of solutions and approaches.

New horizon created by improved electricity access

Despite the still yawning access gaps, the number of people without electricity in their homes declined from over 1.3 billion people in 2012 to 754 million in 2021, before rising slightly in 2022. And renewable electricity is much more affordable than it was a decade ago.

New solutions like e-cooking, which a few years ago were accessible only in middle and high-income countries, are now within reach, said Ed Brown, who leads the UK-backed Modern Energy Cooking Services initiative (MECS).

“E-cooking is becoming more feasible around African urban centres as more people gain access to reliable electricity,” he said. More energy-efficient electric induction stoves and cooking tools like electric rice cookers, are also helping that transition.

In east African countries like Kenya and Uganda, and Asian countries like Nepal, the proportion of people with sufficient electricity access to shift to e-cooking is growing, Brown said, adding, “We´re also watching developments in Tanzania, Mozambique and Malawi.”

In Kenya, over 70% electricity access

Geothermal
Located in Hell’s Gate National Park, Kenya, the Olkaria III complex is the first geothermal power station in Africa.

In Kenya, over 70% of the population now has electricity access. In Uganda it’s over 40%, and in Nepal, over 95%. 

If just 40% of Kenya´s grid-connected homes currently using charcoal for cooking can be induced to shift to e-cooking by 2030, that could yield over $600 million in climate, health and ecosystem benefits over the first five years of electrification, for $110 million in costs. This would transition an estimated 700,000 households to clean cooking sources, Brown said. 

Through WHO’s interactive assessment tool, BARHAP, the team estimates that the upfront costs of the shift to e-cooking in terms of more efficient stoves or appliances would be paid back within 9 months. It would also save: 

  • 1,203 disability-adjusted life years (DALYs) a year avoided;
  • 191million hours/yr of women’s time saved (272hrs/per household/ year);
  • 1.9 million tonnes/yr CO2eq emissions reduced;
  • 400,000 tons a year in unsustainable wood harvest reduced;

But e-cooking is hardly a panacea: some 60% of people in sub-Saharan Africa still lack access to electricity.


The drive to electrify Africa is gaining momentum as part of the Climate and UN Sustainable Energy for All agenda and initiatives by the countries themselves. 

Despite the push by many African leaders – backed by powerful oil and gas interests – to expand their fossil fuel production, green electrification is now much cheaper over the long term, at about two cents a kilowatt hour, Brown said. In some countries, it is also cheaper than charcoal, a resource often harvested unsustainably. 

Even Kenya and Uganda, which have invested far more heavily in fossil fuels than solar power, have put significant sums towards hydroelectric and geothermal electricity power generation. Renewables are now the backbone of their domestic electricity grids, generating 71% of Kenya´s power and 92% of Uganda’s. 

First ever e-cooking strategy in Kenya

Ed Brown, leader of the UK-backed Modern Energy Cooking Services initiative (MECS), speaking at COP27.

Supporting a shift to e-cooking requires a mix of measures. These range from subsidies to households for the purchase of more efficient stoves or portable cookers, to governments reducing household electricity tariffs to a level where e-cooking is more affordable than alternatives, particularly charcoal. 

“In Uganda, the government has introduced a reduced tariff for cooking. Up to a certain usage level, the price is heavily subsidized, and they’ve raised the ceiling on that,” Brown said. In Kenya, the UK-backed MECS initiative is supporting the government in the development of its first-ever e-cooking strategy.

In nearby Malawi, a new Global Green Grid Initiative, launched at last year’s COP26 in Glasgow, appears set to finance the development of Africa’s first national electric grid to be powered primarily by solar energy. The project, announced last month by the Global Alliance for Energy and the Planet – backed by Rockefeller and IKEA foundations – aims to scale up electricity access from a meagre 18% to 100% by 2030 by developing mega and mini-solar grids.

“It is true there is still significant investment in fossil fuels,” Brown concedes, reflecting on Africa’s ‘dash for gas’ that has been the talk of this year’s COP27.  “There are discussions and moves afoot for changing that. I think that as we emerge out of the energy crisis [brought on by the invasion of Ukraine], electrification will continue to get greener rather than browner.”

BioLPG – the green version of a popular fossil fuel

MECS has also been looking at how biogas production could be industrially scaled up in a number of flagship African countries with investment into bioLPG (Liquefied petroleum fuel), a chemically altered version of biogas that is the equivalent of propane. 

An assessment by the Global LPG Alliance, produced in collaboration with MECS and published before last year’s COP26, estimated that some 1.65 million households in Rwanda, Ghana and Kenya could be supplied with bioLPG for their cooking needs, cost-effectively, through the development of just five large scale municipal and farm waste to gas projects. 

Multiple health and climate benefits

The health and climate implications of this shift go well beyond the production of cleaner and greener cooking fuel. 

From a health standpoint, both municipal waste and manure are sources of dangerous pathogens and disease, particularly in fast-developing cities where waste management is weak. and these pathogens are rendered harmless during the process of anaerobic digestion that produces biogas, leaving only a slurry bi-product that is also a rich fertilizer and thus useful for food production. 

Municipal waste is also the third most potent source of global methane emissions from human activity, after oil and gas extraction and agriculture/livestock. Together, municipal waste and agro waste generate some 45% of methane emissions from human activities. Methane has 20 times the climate warming potential of CO2 over the first 20 years of its lifecycle – as well as being a precursor of ozone – which reduces crop growth and is yet another air pollution risk.  

While biogas is carbon neutral, bioLPG undergoes a stage of chemical processing that enables it to be pressurized, bottled and transported, like propane. Its carbon footprint is slightly higher than that of biogas, but its climate impact is still a fraction of LPG made out of fossil fuels. 

Waste to bioLPG and bioLNG is already happening in the global north

A year after Glasgow, MECS is now in the initial stages of making a more refined estimate of the economic, political and logistical feasibility for two of the five pilot bioLPG projects assessed earlier in Kenya and Uganda. 

Across Europe and North America, a movement to convert biogas generated from municipal waste and manure into commercial products of value to consumers is already well underway.

In North America, the efforts are largely focused on transforming raw biogas into renewable natural gas (rNG), the chemical equivalent of fossil fuel, which can be integrated into the continent’s extensive natural gas infrastructure used in heating, electricity production and vehicles. Case studies from Toronto and Minneapolis, Minnesota, among other cities, were showcased at a biogas panel session Thursday, at COP27, by the World Biogas Association. 

In Europe, where LPG is more common, fuel distributors are shifting to bioLPG in line with European Union goals. Brown noted that leading UK LPG distributors aim to convert their infrastructure fully to bioLPG. 

Tools to assess choices in light of health and climate benefits  

One of the key innovations that WHO has created for policymakers is an interactive tool that supports a cost-benefit analysis of different household energy scale-up options by policymakers and practitioners in order to quantify the trade-offs in hard numbers. 

That tool, known as BARHAP, is what allowed Brown and his team to estimate both the payback period of investment in e-cooking in Kenya, and the savings in excess morbidity and mortality, women’s labour, and climate emissions. 

“The interactive tool, which is available online, accounts for the household expenditure, the government expenditures for cleanup, looking at different interventions, the climate impacts, the time loss [in fuel gathering], etc.” said Rohani. “It helps countries to see what the different interventions are, and what can you expect in terms of that cost-benefit from a different set of different solutions.”

That tool is just one part of a Clean Household Energy Solutions Toolkit (CHEST) developed by WHO over the past several years. The toolkit contains six modules in total, including resources for local stakeholder mapping, engaging the community, monitoring evaluation, standards and testing, and communications.

The toolkit aims to support policymakers and practitioners in reaching Sustainable Development Goal 7: access to “clean, affordable, reliable, sustainable and modern energy for all” by 2030, which includes access to clean household fuels and technologies.

Assessing solutions in context

E-cooking
Replacing outdated stoves could improve the lives of millions.

“The toolkit allows policymakers to assess solutions that may be best suited to their geography, economies, culture and communities while yielding optimal reductions in air pollution and health benefits,” said Adair-Rohani.

The WHO has long championed the health benefits of clean cooking in terms of reduced air pollution exposures for women and children as well as savings in women and girls’ labour, and the “new narrative” of clean cooking is also building more on the economic benefits of “modernizing” – something that may appeal more to finance and energy ministers as well as to consumers, says Brown. 

“While progress was being made on ‘access to modern energy’ [in the form of electricity], the separation of cooking was perpetuating problems,” he said. 

Health advocates are shifting their pitch around clean cookstoves to capitalize on the “aspiration for modernisation, cleanliness and convenience”  which resonates among energy ministers and consumers to sell solutions that ultimately improve public health:

“Now we need to go to the folks that are putting money into electrification, and make sure that every electrification grid extension program that they still have is a clean cooking component.”

Image Credits: World Bank, IEA 2022 , IRENA.

The COVID-19 pandemic has been marred by uneven access to vaccines and other life-saving products.

Regional production of vaccines and other pandemic-related products – and sharing the technical know-how to enable this – features strongly in the much-anticipated first draft of the global pandemic treaty proposed by the World Health Organization (WHO) to guide future pandemics.

WHO member states will be briefed on the conceptual “zero-sum” draft on Friday in preparation for the Intergovernmental Negotiating Body’s (INB) meeting from 5-7 December, which will kick off formal negotiations.

The draft advocates for regional and country “strategic stockpiles” of pandemic response products, particularly active pharmaceutical ingredients that could be facilitated by “multilateral and regional purchasing mechanisms”.

It also suggests “international consolidation hubs, as well as regional staging areas” to ensure the streamlined transportation of supplies.

Intellectual property hot potato

Intellectual property is the most obvious hot potato. The draft offers four proposals on IP, all of which recognise the negative impact IP protection can have on prices. 

Three proposals affirm the importance of protecting IP while the more radical fourth option simply recognises that IP poses a “threat and barriers to the full realization of the right to health and to scientific progress for all, particularly the effect on prices, which limits access options and impedes independent local production and supplies”.

Various proposals are included on the TRIPS waiver, with some recognition of the need for “time-bound waivers of the protection of intellectual property rights that are a barrier to manufacturing of pandemic response products during pandemics”.

The importance of “trilateral cooperation” between the WHO, World Trade Organization and World Intellectual Property Organization (WIPO) on IP, public health, and trade, is also highlighted.

Protestors in New York City protesting against pharmaceutical companies’ profiteering.

Public funding and price disclosures

The draft also proposes measures to “encourage, incentivize, and facilitate” the private sector’s “voluntary transfer of technology and know-how through collaborative initiatives and multilateral mechanisms”. 

But where there has been “public financing of research and development for pandemic response products”, the draft proposes that measures need to be adopted to ensure “more equitable access and affordability” of these products.

These could involve “conditions on distributed manufacturing, licensing, technology transfer and pricing policies”.

In addition, public financing of R&D could result in “measures to limit indemnity or confidentiality clauses in commercial pandemic response product contracts between countries and manufacturers”.

Secret deals were a cause for serious concern for many countries and health activists at the height of the COVID-19 pandemic when vaccines were in short supply and being sold at different prices without any transparency.

The draft also proposes that “promoters of research for pandemic response products assume part of the risk (liability) when the products or supplies are in the research phase, and that making access to such pandemic response products or supplies conditional on a waiver of such liability is discouraged”.

Pfizer and Moderna in particular made countries sign onerous indemnity clauses before they agreed to supply them with COVID-19 vaccines.

‘A shopping list,’ says IFPMA

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has already indicated that it is against the draft, saying in a statement on Friday that it “does not meet the test of preserving what worked well and it is questionable whether the proposals to address the shortcomings faced in the current pandemic would work”.

“The text, while containing elements which can form a good basis to be better prepared for future pandemics, reads as a shopping list of multiple agendas and ideas which have been brought together in one document and therefore lack coherence,” added the IFPMA.

“If the draft were implemented as written today it would most likely undermine rather than facilitate our collective ability to rapidly develop and scale up counter measures and ensure its equitable access.”

It believes that a more constructive approach would be to identify and build on what worked well during the COVID-19 pandemic, such as “the R&D ecosystem”.

“The private sector developed multiple safe and effective vaccines and treatments against COVID-19 and scaled up their production in record time,” said the IFPMA. “We need to make sure that the IP-based innovation ecosystem is not undermined.  Innovation resulting in safe and effective vaccines in record time and scaling up manufacturing to historic levels involving hundreds of voluntary partnerships leaning on the capabilities available around the globe worked, together with rapid pathogen sharing were key elements of the rapid response to the COVID-19 pandemic.”

Areas of improvement include health systems strengthening and resilience and the equitable distribution of the vaccines, “which was hampered by resourcing challenges both financial and logistical, as well as the free movement of supplies and vaccines”, added the IFPMA.

 Sharing pathogens

The draft also advocates for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits”.

In addition to international and regional anti-pandemic measures, the draft advocates that member states increase domestic funding, particularly to support strong primary health care and universal health coverage.

Intensive process 

Since the WHO’s special health assembly resolved to negotiate a pandemic ‘instrument’ almost a year ago, the INB has engaged in an intensive consultation process.

The draft is the result of inputs from member states, regional meetings, relevant stakeholders, two public hearings that were open to anyone, informal, focused consultations and two INB meetings. 

Any areas covered by the International Health Regulations (2005) are not contained in the draft. 

Mohga Kammal Yanni

Responding to the draft text, Mohga Kammal Yanni, policy co-lead for the People’s Vaccine Alliance, said that it “shows that negotiations are at a crossroads”. 

“A treaty could break with the greed and inequality that has plagued the global response to COVID-19, HIV/AIDS and other pandemics. Or, it could tie future generations to the same disastrous outcomes,” said Yanni.

“The treaty gives world leaders a chance to prevent this inequality through increasing the pharmaceutical manufacturing capacity of developing countries and sharing of technology and know-how. It needs to mandate this sharing and commit countries to waiving intellectual property rules for relevant products in future pandemics. This would avoid the current inequitable access to essential medical products needed to deal with pandemics.”

The zero draft will be discussed at the third INB meeting in December, and an even more intensive process of negotiations will begin.

The INB will submit a progress report on its deliberations to the 76th World Health Assembly in 2023, and the final draft for consideration at the 77th World Health Assembly in 2024.

* This story was updated to include the IFPMA response.

Image Credits: Zhang Meifang/Twitter, People's Vaccine Alliance.