Dr Yvan Butera, Minister of State in Rwanda’s health ministry, is vaccinated with Sabin’s experimental vaccine.

The spread of mpox in Uganda is “of great concern”, with some 830 recorded cases in 19 states, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Uganda’s first recorded case was in Nakasongola Prison in Central Uganda, but new cases have been reported close to the border with the Democratic Republic of Congo (DRC) while “new clusters” in fishing communities are a cause for concern, Dr Ngashi Ngongo, Africa CDC’s mpox lead, told a media briefing on Thursday.

In the past week, 61 new cases were confirmed and one death, he added.

Unlike the DRC where children make up half the mpox cases, only 12,5% of Uganda’s mpox cases are children. The majority, 63%, are adult men and clade 1b, which can be sexually transmitted, is the dominant strain. 

Meanwhile, Mauritius has recorded its first mpox case – and the UK recorded its first case of Clade 1b case in someone who recently travelled to a country with mpox, said Ngongo.

The continent’s weekly case tally increased by 2,766 cases – a similar increase to previous weeks. The vast majority of cases are in the DRC and Burundi.

Almost 900,000 mpox vaccines have been distributed to nine countries, with vaccination campaigns going well in the DRC and Rwanda. However, Nigeria postponed its planned vaccination campaign this week.

Four more Marburg cases

Meanwhile, Rwanda recorded four new Marburg cases in the past two weeks – a health worker (reported on last week) and three contacts of other cases, according to Dr Yvan Butera, Minister of State in the health ministry. Two people have also died in the past week.

Rwanda has confirmed 66 Marburg cases and 15 deaths reported, a case-fatality rate of around 23%. Close to 6,000 people have now been tested while close to 1,600 frontline workers have been vaccinated, said Butera.

The source of the outbreak has been traced to fruit bats in a mine near Kigali, which infected the index case who had visited the mine.

The Sabine Vaccine Institute has sent a further 1,000 of its investigational vaccines to Rwanda, the company reported on Thursday. These will be used for a randomized clinical trial arm within the ongoing open-label study.

Previously, Rwanda had rejected the World Health Organization (WHO) protocol, which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science.

Instead, Rwanda opted to vaccinate all trial participants  “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. 

“Under the updated protocol, sponsored by the Rwanda Biomedical Center, approximately 1,000 at-risk individuals, including mine workers, will receive Sabin’s single-dose investigational vaccine in a one-to-one randomization. Half will receive the vaccine immediately, and the other half 21 days later to align with the end of the disease incubation period,” according to Sabin.

Designed to prevent illness before exposure to the virus, Sabin’s Marburg vaccine has not yet been proven to have clinical benefit for recipients of the vaccine.

Image Credits: Sabin Vaccine Institute.

Cholera oral vaccine Sudan
A Sudanese child gets an oral cholera vaccine.

While the global stockpile of oral cholera vaccines (OCV) has been empty since mid-October, vaccine doses are being produced each week and shipped directly to countries in need, according to the World Health Organization (WHO).

“As soon as adequate quantities are produced, they are shipped to countries in need. This is why the stockpile can remain at zero for long periods. It does not mean that there is no production,” a WHO spokesperson clarified to Health Policy Watch after reporting on 18 October that the stockpile was empty.

This year, 30 countries have reported cholera outbreaks involving over 430,000 people which is driving demand for the vaccines.

Pharmaceutical company EuBiologics in the Republic of Korea is the only company currently producing cholera vaccines under the brand name, Euvichol.

However, the WHO prequalified a simplified oral cholera vaccine in April, which will “nearly double the available doses from around 45 million this year to about 90 million by 2026”, according to the spokesperson.

“But the current increase will not fully address the existing vaccine gap. The demand remains exceptionally high and is still growing, despite the increase in production.”

Huge demand

The global stockpile of the oral cholera vaccine was established in 2013 with two million doses. By 2023, this had expanded to 36 million doses. 

The stockpile is overseen by the International Coordinating Group on Vaccine Provision (ICG) consisting of the International Federation of the Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF, and WHO. 

Gavi, the Vaccine Alliance pays for the vaccine and its distribution to all eligible countries.

“The ICG has approved 14 million cholera doses for outbreak response over the last two months, a volume that represents twice the size of the current stockpile,” according to a Gavi spokesperson.

“However, while there may be short periods where all available doses are allocated to specific country requests, the stockpile is continually replenished on a rolling basis by the manufacturer.”

Investments made by Gavi and its partners to increase the volume and speed of supply have halved the timeline needed for replenishing the global vaccine stockpile this year. 

Gavi expects close to three million new doses to be made available this week, seven million in November, and six million in December, “all ready to be shipped to countries that may request them for ongoing outbreaks”.

 “In April we welcomed the arrival of a new OCV, Euvichol-S which enabled EuBiologics, its manufacturer, to produce more volumes of vaccine, faster, and at a lower cost – a key step to expanding supply amidst the ongoing acute global upsurge of cholera outbreaks,” said the Gavi spokesperson.

“The global availability of OCV has once again shown an annual increase from 38 million doses in 2023 to approximately 50 million in 2024, and is further expected to increase again in 2025, to 70 million doses,” said Gavi.

However, creating both sustainable and predictable demand for OCV, and supporting efforts towards long-term control by launching preventive programmes in endemic countries, is vital for controlling the disease, Gavi notes.

Image Credits: WHO.

A woman displays maize ears from her drought stricken garden in Mauritania. Across Africa, more and more people are at risk of food insecurity, exacerbated by climate change.

The 9th Lancet Countdown report on health and climate change shows that deaths from extreme heat, hunger, and disease, all are rising because of climate change. Authors call out governments and companies that continue “fuelling the fire” with continued investment in fossil fuels and subsidies, leading to all-time high energy-related greenhouse gas emissions, which are reducing the prospects for the survival of billions.  

People worldwide are facing a series of unprecedented threats to their wellbeing, health, and survival from the rapidly changing climate. Of the 15 indicators of  climate change-related health hazards, exposures, and impacts monitored by the Lancet Countdown on Health and Climate Change, 10 reached new records of risk, in this year’s report, released on Wednesday.  

The 50-page report is the product of contributions of 172 researchers from 57 leading research organizations and United Nations (UN) agencies worldwide, working in close collaboration with the World Health Organization (WHO). 

Years of delayed climate action are “reducing the chances of mankind’s long-term survival,” declared Green Climate Fund Director Dr Oyun Sanjaasuren, speaking at an expert panel launching the report.

“Financial resources to support the transition to cleaner, green energy but these are “unfortunately being allocated to activities that perpetuate the fossil fuel-based economy.” 

Green Climate Fund Director Dr Oyun Sanjaasuren.

More deaths

Globally heat-related deaths amongst those aged over 65 increased last year by a record-breaking 167% higher than deaths in the 1990s – substantially above the 65% increase that would have been expected had temperatures not changed (accounting only for changing demographics). 

Heat stress even from light exercise

Last year also saw an all-time high exposure of over 1,500 hours of high temperatures. This means that even light outdoor exercise such as walking or cycling posed a moderate risk of heat stress to billions worldwide, for almost 28% more hours than in the 1990s.

Because of climate change, people faced a record-high average of 50 more days of temperatures that could threaten human health.

More disease

Lead author, Marina Romanello, describes trends in extreme precipitation and drought at the launch of the Lancet Countdown report.

Another all-time high was recorded with over five million dengue cases in over 80 countries, thanks to more extreme rain as well as heatwaves, enhancing the climatic suitability for the spread of deadly mosquito-borne infectious diseases. 

Billions in economic losses

Global potential income losses are equivalent to $835 billion because of increasing temperatures leading to over 500 billion potential hours of labour lost in 2023.

More drought

There was extreme drought on almost half the landmass. Forty-eight per cent of the global land area was affected by at least one month of extreme drought, the second-highest level since at least 1951.

Heat-triggered food insecurity affected the highest number of people ever. The increase in drought and heatwave events since 1981–2010 was associated with 151 million more people experiencing moderate or severe food insecurity across 124 countries. 

“It’s the most concerning report that we found in our eight years of monitoring,” lead author Marina Romanello said at the launch. 

“Out of 15 indicators, 10 have reached record highs, new levels of threats. This means that our health is increasingly at risk, and in the heat maps where we’ve represented their values, from blue being safer conditions for health, to red, the worst conditions, you can see that very clear trend towards redder, worsening conditions across every indicator.”

Rising heat a driving factor of disease, disasters and deaths

Days ot health threatening temperature in 2019-23

Last year, 2023, was the hottest on record. 

Cross-cutting many of the health effects is the rising levels of extreme heat – with heat-related illness in multiple dimensions from more cardiovascular disease, to more work-related heat stress, and even more sleepless nights – not to mention the knock-on effects of heat-related drought on food production and hunger.

“One of the key impacts of climate change obviously comes from extreme heat and from heat exposure,” said Romanello.  

“As the temperatures rise, we see that the threats to our health associated with high temperatures is also growing, and this is particularly so for vulnerable groups like very young children, people with underlying health conditions like heart disease, lung disease, and other elderly people over 65 years of age. 

“And what we’re monitoring here is heat-related deaths of people over 65 years of age, and we see that it is more than twice the level of expected mortality if temperatures hadn’t changed. 

“So we know that it’s climate change that is driving this rapid growth in heat related mortality to record high levels this year. But obviously mortality is just the tip of what we know is a very big iceberg of health impacts of climate change that is associated with disease associated with heat stress and health conditions that are worsened by rising temperatures.” 

Fossil fuels’ share in global energy mix increased for first time in a decade 

Despite all of the warning signs, levels of energy-related carbon dioxide emissions also reached an all-time high in 2022 of 37.2 gigatons. In 2021, the share of fossil fuels in the global energy system also increased for the first time in a decade, reaching 80.3%. 

“Extraordinary rainfall hit South Asia after a summer with temperatures regularly above 40°C through the night. Look at the devastating flooding now in the Valencia area of Spain. Think of the wildfires that have torn through southern Europe, the long list of tragedies around the world goes on,” declared Helen Clark, former New Zealand Prime Minister at the report’s launch event.

“We are in a very grave situation. Climate change threats are rising as emissions continue to grow, and it often seems that the many alarms which are being raised by scientists around the world are just being ignored. Yet we cannot afford to continue down this ridiculous path, this irresponsible path where every moment of delay is being paid for in people’s lives.”

Former New Zealand Prime Minister Helen Clark.

Oil and gas production to exceed 1.5° target by 60% in 2030 – and 149% by 2040 

Despite all of the talk and promises of a “green energy” transition, governments allocated a record-breaking $1.4 trillion to net fossil fuel subsidies, dwarfing any financial commitments in support of climate action made at COP28, the report also notes. 

The world’s 114 largest oil and gas companies, covering 80% of all exploitation, have also increased their projections for levels of fossil fuel production by 2040. 

This would lead to greenhouse gas (GHG) emissions exceeding levels compatible with 1.5°C of warming by as much as 59% in 2030, and a staggering 189% in 2040. Worse still, 33 of these companies are expected to continue exceeding their 1.5°C-compatible GHG emissions by over 300% in 2040. 

Oil and gas companies higher production targets would put the planet well beyond 1.5C

Beyond 1.5° global warming above pre-industrial times, scientists have warned of increasing intensity of heatwaves, extreme rainfall, stronger storms, water scarcity, diminishing agriculture, and extinction of many species in some of the more dangerous fallouts. 

“Cure the sickness of climate inaction”

The Lancet Countdown,  established the same year that the Paris Climate Agreement came into force, aims to monitor the health impacts and opportunities of the world’s response to this landmark commitment to keep global warming below 1.5°C. 

Responding to the report, António Guterres, UN Secretary-General, said: “Record-high emissions are posing record-breaking threats to our health. We must cure the sickness of climate inaction – by slashing emissions, protecting people from climate extremes, and ending our fossil fuel addiction – to create a fairer, safer, and healthier future for all.” 

Some silver linings

There is some reason for “cautious optimism” the report points out, despite the record-breaking health harms it flags. 

The share of renewable energy reached 10.5% in 2021, almost double that of 2016. Global investment in clean energy grew 10% in 2023 to US$1.9 trillion, exceeding fossil fuel investment by 73%. Jobs in renewables also reached a record-high with almost 14 million employees in 2022, up by over a third since 2016. 

Deaths from fossil fuel-associated air pollution fell from 2.25 million in 2016 to 2.09 million in 2021, mostly due to reduced pollution from coal burning, demonstrating the life-saving potential of coal phase-out. 

However, household use of biomass as a primary cooking fuel, caused 1.24 million deaths in 2021, an increase of 135,000 from 2016.

Contrasting conclusions about fossil fuels’ contribution to air pollution

Mortality attributable to PM2·5, produced by fossil fuels and other sources, in relation to human development index (HDI) country level.

Notably, however, the Countdown’s assessment of premature deaths attributable to fossil-fuel related air pollution overall is less than half the 5.13 million estimate published by The BMJ, in late 2023. 

The assumptions and models underlying the contrasting conclusions are still being debated amongst the scientists. But according to both Lancet lead author Romanello and The BMJ lead author Jos Lelieveld, the key differences revolve around the fact that The BMJ article estimated lives that could be saved if fossil fuel emissions were eliminated, whereas the Lancet Countdown estimated deaths attributable to fossil fuels in today’s current mix of pollution sources. 

As compared to the BMJ, The Lancet Countdown also uses a different model to estimate the relative proportion of fossil fuel emissions in the total air pollution mix – leading to a different estimate of health effects.  

And finally, in the BMJ “fossil fuels elimination” scenario, there would be knock-on benefits in other sectors, particularly agriculture – which produces significant ammonia that interacts with fossil fuel-produced sulphur oxides (SOx) and oxides of nitrogen (NOx) to form significant amounts of secondary PM2.5. 

Either way, Romanello,  who along with being lead author is the Executive Director of the Lancet Countdown project at University College London, explained why public investment is vital to tackle the twin dangers of energy poverty and toxic air. 

“Globally, 4 million people and 30% of vulnerable households around the world are still using biomass, a very unreliable, very dirty source (of fuel.) 

“These are the poorest and most vulnerable in countries in the world. So this is a system of energy poverty. The direct health impact of that, beyond the health harms of energy poverty, is that people are also being exposed to toxic air inside their homes because of the persistent use of solid fuel.”

Taking it down to the country level 

In countries of South East Asia the toll of air pollution is particularly high, while fossil fuel subsidies are also at record levels. 

India saw 1.6 million deaths in 2021 due to PM 2.5, the report says. This is estimated to be equivalent to a loss of $320 billion. Over a third of these deaths were due to fossil fuels, even according to the Countdown’s more ‘conservative’ estimate of fossil fuel’s role. 

In 2022, India also allocated a record net total of nearly $58 billion in subsidies to the fossil fuel sector. Heat exposure has increased over the past few decades and this the report estimates cost the economy $141 billion in potential income loss from labour capacity reduction due to heat in 2023. The agricultural sector was the most affected, with more than $71.9 billion in potential losses. 

In the United States, historically the largest greenhouse gas emitter, there were approximately 125,800 deaths attributable to human sources of air pollution (PM 2.5) in 2021. Fossil fuels contributed to 39% of the mortality. The monetised value of premature mortality due to anthropogenic air pollution was $669 billion, whereas the fossil fuel sector received $9 bn in subsidies in 2022. Heat cost the economy a potential income loss of $103 billion last year.

The Lancet Countdown has been published days ahead of the start of COP29, the UN’s annual, mega climate conference of all governments and several institutions, agencies and civil society. 

For decades, UN Climate Change has pushed for climate action. The hottest year on record and increasing GHG emissions is a reality check on exactly what three decades of climate talks have achieved. Now, COP29 is being held in Baku, the capital of a fossil fuel-rich nation Azerbaijan, which is expanding its gas industry. 

Image Credits: Pablo Tosco/Oxfam, Lancet Countdown on Health and Climate Change 2024, Lancet Countdown on Health and Climate, 2024, Lancet Countdown on Health and Climate, 2024, Lancet Countdown, 2024, Lancet Countdown, 2024 , Lancet Countdown on Health and Climate .

Institute of Women’s Health’s Anita Mpambara Cox, former Trump officials Alma Golden and Valerie Huber and Burundi’s First Lady, Angeline Ndayishimiye, meet in Washington, DC.

Post 2020, ex-Trump officials have worked through NGOs to undermine abortion and LGBTQ rights in Africa, preparing the ground for his re-election

Despite Donald Trump’s electoral defeat as US president in 2020, his ex-officials and allies have never stopped campaigning for African countries to prevent abortion and LGBTQ rights  – in league with some of the most right-wing countries on the planet, including Russia and Hungary.

If Trump is re-elected on 5 November, he is likely to entrench opposition to abortion as a key pillar of US foreign aid. Project 2025, the controversial conservative blueprint for a Trump victory written primarily by his former officials, proposes that all US aid including humanitarian assistance, is conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

‘Sending people to their deaths’

“The return of Trump, at a time when nationalist African presidents are also prosecuting women and queer people, means sending these groups to their death,” observes Saoyo Tabitha Griffith, a Kenyan high court lawyer and women’s rights activist.

“This is not alarmist. It is purely informed by the observation of past patterns,” she tells Health Policy Watch.

One of Trump’s first presidential actions in 2017 was to prohibit foreign NGOs from receiving US government funding for health if they “provided, promoted, or discussed” abortion – known as the Expanded Global Gag Rule (GGR). 

Many family planning organisations lost their funding and women lost access to contraception in some of the continent’s poorest countries such as Madagascar and Ethiopia – ironically contributing to more unplanned pregnancies.

Banning abortion has never stopped it

But abortion bans have never stopped women and girls from trying to end unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

While the percentage of women in Sub-Saharan seeking abortions has remained constant, the number of abortions has surged with population growth.

When Trump was elected, Griffith was deputy head of the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) which works on HIV and women’s issues.

“After the Expanded Gag Rule, we saw the deaths of sex workers. We saw the deaths of women who needed safe abortions. People died because service delivery programmes shut down,” she said.

Trump’s administration also cut funding to the United Nations Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. This affected the provision of maternal and reproductive health services throughout the world – particularly in humanitarian settings.

Trump also froze the US contributions to the World Health Organization (WHO) in the middle of the COVID-19 pandemic.

In 2023, Republican congressional lobbying even put the brakes on the US President’s Emergency Plan for AIDS Relief (PEPFAR), claiming – incorrectly – that some grant recipients were promoting abortion. As a result of the right-wing lobby, PEPFAR projects now receive yearly budgets instead of five-year funding.

Ex-Trump officials prepare ground for his re-election

While legal abortion is out of the reach of most African women and girls, 19 African countries have eased access since 1994 – mostly in an attempt to reduce the maternal deaths caused by unsafe abortions.

Infographic: Abortion in Africa: 28 Years of Progress | Statista

But US groups have stoked opposition to easing abortion access in Africa, led most recently by Valerie Huber, the Trump-era Special Representative for Global Women’s Health, and Alma Golden, ex-Assistant Administrator for Global Health at USAID.

Huber was the architect of an anti-abortion pact, the Geneva Consensus Declaration (GCD), adopted in the dying weeks of Trump’s rule in October 2020 with the support of an array of global human-rights polecats such as Iraq, Uganda, Belarus and Sudan.

The GCD also promotes “the natural family” – primarly aimed at removing any recognition of the existence of  LGBTQ people.

When Biden withdrew the US from the GCD in 2020, Hungary took over the secretariat. However, Trump has confirmed that the US will rejoin the pact if he is elected “to reject the globalist claim of an international right to abortion”.

After Trump’s defeat, Huber and Golden launched an NGO called the Institute for Women’s Health (IWH) in 2021, to seek support for the GCD. The IWH is on Project 2025’s advisory board. Its Africa coordinator is Phillip Sayuni, a Ugandan anti-gay pastor, while its international programmes director, Anita Mpambara Cox, is a Ugandan American who sought election as a  Republican Senator in 2022.

Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in September in front of the flags of signatories, including Iraq, Belarus, Benin and Hungary.

In the past year, the IWH has persuaded Burundi and Chad, countries with poor human rights records, to sign the GCD. Burundi only allow abortion to save the life of a pregnant woman, not even allowing it in cases of rape and incest. Women who have abortions face prison sentences. The military dictatorship in Chad allows abortions to save a woman’s life and in cases of rape and incest.

Since forming IWH, Huber has courted several right wing African governments, including Sudan, South Sudan, Mali, Burkino Faso and Tanzania, but her closest links are with the Ugandan government.

Support from US conservative Christian groups

Supporting Huber’s anti-abortion, anti-LGBTQ crusade is a phalanx of conservative US NGOs active in Africa, particularly Family Watch International (FWI), headed by conservative Mormon Sharon Slater. FWI has been pushing the same agenda in Africa for over 20 years, and Slater and Huber both work closely with Ugandan First Lady Janet Museveni.

Several of these US groups also oppose contraception and sex education for school children known as “comprehensive sexuality education”.

The African spending of 17 conservative US Christian organisations known for opposing sexual and reproductive rights, including FWI, almost doubled after Trump’s 2020 defeat. FWI’s spending increased by 495%, albeit off a low base.

The 17 groups spent about $16.5 million in Africa between 2019 and 2022, with almost a third ($5.2 million) in 2022, the year after Biden took office, according to the Institute for Journalism and Social Change (IJSC). 

Institute for Journalism and Social Change (IJSC)

Importing US anti-LGBTQ laws

A group of US anti-rights groups have worked with conservative African politicians for decades to encourage laws that crack down on the very existence of LGBTQ people across the continent. 

In the past year, Uganda and Ghana have passed draconian anti-LGBTQ laws with the encouragement of these US groups, particularly FWI.

US conservative Christian group Family Watch International leader Sharon Slater (centre, black dress) meets Uganda’s first lady, Janet Museveni (centre, white skirt) in April 2023 to encourage the passage of the  country’s Anti-Homosexuality Bill.

FWI was one of the driving forces behind the recent Inter-Parliamentary Conference on Family Values and Sovereignty, which also received a $300,000 boost from the Russian government, according to a recent Wall Street Journal exposé. 

The conference also featured speakers who attacked routine vaccination campaigns and the World Health Organization (WHO), as previously exposed by Health Policy Watch.

However, its main agenda was to galvanise support from politicians across Africa for anti-LGBTQ, anti-abortion legislation.

The government of Kenyan President William Ruto, the country’s first evangelical leader, is considering “family values” laws to crack down on LGBTQ people and even make divorce more difficult. 

Copycat laws from US

Kenyan LGBTQ activist Āryā Jeipea Karijo says that parts of her country’s anti-LGBTQ Bill are “a direct copy” of US anti-transgender bills. 

Two concerns in the Bill – transgender people’s access to bathrooms and minors transitioning – “are not contextual to Kenya’s state of access to water as well as to meeting healthcare needs of transgender people”, Karijo says.

Kenya is struggling to provide adequate toilets in many schools and there is very little opportunity for adults to transition, let alone minors, she explains to Health Policy Watch.

“A side-by-side reading of US anti-transgender legislation and sections of the anti-LGBTQ laws that have been passed in Ghana, Uganda, and are proposed for Kenya, show that the authors are the same, and they are definitely not from the continent,” adds Karijo.

Meanwhile, Namibian LGBTQ activist Omar van Reenen notes that “anti-rights groups in the US share resources, strategies and rhetoric internationally”.

“The transnational exchange of anti-rights ideologies imported from American evangelical groups and NGOs like Family Watch International are alive and well,” said Van Reenen in a recent interview with the journal, Transcript.

Griffith sounds a grim warning if Trump wins the US election: “African women and LGBTQ people must anticipate that Trump’s return will re-ignite an ideological war with real and physical consequences on their bodies.

“Issues such as contraceptives, surrogacy, single parenting, safe abortion, HPV vaccines and sexual orientation are all going to be contested, not through science and data but by conspiracies and misinformation.”

Image Credits: IJSC.

An government health worker explaining the adult BCG vaccination to protect against TB to a beneficiary in the Indian state of Goa

In 2021, I lost a close friend to tuberculosis (TB), the world’s most lethal infection. But I cannot say anything else about this friend, where I met him or when we became close. 

The stigma surrounding tuberculosis is too impenetrable and, unfortunately, it would not be fair to my friend’s family. Still, for me, his recent death highlights the threat this disease poses, not only to the millions of people living with TB, but to their friends and family members globally.

Growing up in Pantnagar, a university town in North India, we were familiar with TB and other diseases including cholera, dengue, malaria, and typhoid fever. All of them were unfortunate. But it is only TB that we shy away from talking about, even when someone we know contracts the disease. We keep pretending that it doesn’t exist – despite all evidence to the contrary.

Updated TB numbers show progress is needed

According to the World Health Organization’s latest report, TB kills more than one million people annually, more than any other infectious disease. Every year, an estimated 10.8 million people contract the disease, but in 2023 only 8.2 million people were diagnosed, according to the World Health Organization’s 2024 TB report, released Tuesday.

Millions of people are sick but either cannot or will not seek medical help. Stigma is likely one of the reasons why; too many times, it gets in the way of preventing and treating TB. This stigma has nothing to do with whether people are underprivileged or poor or are well off and live in good places. TB is simply considered something that shouldn’t be discussed.

The WHO report shows that we have not seen significant improvements in how many people contracted the disease in 2023, how many people died from the disease, where the hardest-hit locations can be found. 

Stigma is an issue globally, in too many settings – from Nepal to South Africa, and most everywhere else. Up to 75% or more of TB patients experience stigma, with impacts ranging from delays in seeking out a diagnosis and treatment to patients ignoring preventive measures like masks that can help curb the spread of the disease.

On a personal level, TB is a health and financial crisis

Compounding matters, the economic damage caused by TB magnifies the harms of TB stigma. WHO has estimated that half of TB patients and their families experience a catastrophic impact on their household income, along with the declining health of a family member, for at least half a year. In this context, the stigma hits very hard: family budgets shrink as expenses increase, while everyone copes with a health crisis that no one can discuss.

India’s plan is to eliminate TB by 2025 and the global plan is to eliminate it by 2030. To reach these goals, we need to be bold in conversations. It’s not just about finding a cure, we must work on social stigmas. India, for example, is a very populous country. To achieve its goals, the government maintains an online data center that tracks TB statistics, but stigma persists. The trains are crowded, the cities are congested, it only takes one person to ignore their symptoms and spread the disease.

Outreach and patient empowerment can shrink stigma 

To address the stigma and enable conversations, we need stronger patient education and support initiatives so that those who have TB can be empowered as they navigate a life-threatening illness. 

Examples of this programming include the “TB clubs” in Ethiopia and Nicaragua where small groups of patients meet regularly and help each other get through the six-month treatment process. These groups reduce the social isolation that patients so often experience, which then helps alleviate the disease stigma. Patients have also asked for community engagement that provides safe spaces for people affected by TB to share their experiences and advocate for changing the social norms that reinforce stigma.

Outreach efforts that focus on TB healthcare workers are also important, as how they talk about the disease with patients and families can help alleviate some of the stigma that they experience—and TB healthcare workers also face TB stigma from those whose practices do not include TB. Helping to ease this stigma aids their patients as well.

These initiatives to reduce stigma stand out because too few have been put into practice. But as long as a strong social stigma remains attached to TB, it will be difficult to gain traction against this disease. Scientific breakthroughs in prevention and treatment will have limited value if people will not go near them.

The WHO’s plan to end TB by 2030 includes improving diagnosis and treatment services and taking advantage of current technologies, especially those that can help curb the spread of drug-resistant strains of TB, but we also need to start having the difficult discussions to address stigma.

We can develop new ways to prevent and treat the disease, but unless we include programming that encourages openness, we are only fighting half the battle.

Neelima Sharma, PhD, is a Senior Toxicologist at the Bill & Melinda Gates Medical Research Institute

Image Credits: UNDP.

In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis.

Shaka Brown was diagnosed with tuberculosis (TB) in November 2023.

“I was dropped off at the emergency room in Miami, Florida,” he recalled. “In September, I thought I’d caught the flu, but after weeks of night sweats, fainting spells, and losing my hearing in my left ear—and over 50 pounds—I knew something was wrong.”

Brown underwent ultrasounds, X-rays, and a battery of tests within hours of arriving. Then, the doctors delivered the news: he had TB.

“I told them no one gets TB,” he said. But Brown was quickly moved to a negative-pressure isolation room. “It turned out they were right. I had TB everywhere.”

Shaka Brown
Shaka Brown

The bacteria had spread from Brown’s lungs to nearly every organ in his body, including his bladder, brain, and spine. The infection had compromised his lower spine, causing sharp pain down his leg.

“The hospital had a molecular diagnostic machine, which helped them quickly figure out that I needed a specialised drug regimen. The standard treatment wouldn’t work for me,” he said.

“I started life-saving antibiotics the next day—over 15 pills every day. The TB growth was halted within a week. I remember slowly opening my eyes, surrounded by doctors who told me I was going to make it. It was only then I realised how close I’d come to not making it.”

Despite daily pills, four months later, Brown was back in the hospital, this time with seizures and unable to speak.

“The TB in my brain wasn’t going away as quickly as they hoped,” Brown said.

A week later, he underwent brain surgery to remove the infection. His doctors added anti-seizure medication to his TB regimen.

“They told me they’d stick with me every step of the way,” he added.

However, as Brown highlighted Tuesday during a presentation of new TB data by the World Health Organization (WHO), not everyone shares his good fortune.

“Twenty percent of people who get TB are never diagnosed and, therefore, never treated,” he said. “If we could just identify and treat those individuals, we could save lives. Every person we miss gives the bacteria a chance to evolve, weakening the effectiveness of current treatments. Yet, funding for research to develop effective drugs is decreasing.”

TB is top infectious disease killer in 2023

World Health Organization's 2024 Global Tuberculosis Report.
World Health Organization’s 2024 Global Tuberculosis Report.

Brown’s message was underscored by the WHO’s release of its 2024 Global Tuberculosis Report. The 68-page report offers comprehensive data on TB trends and the global response, covering 215 countries and regions, including all 193 WHO member states. It provides the latest insights into the TB epidemic, tracking global, regional, and national progress, along with the impact of key factors driving the disease.

In 2023, TB reclaimed its position as the world’s leading infectious disease killer, following three years when COVID-19 took the lead. It caused almost twice as many deaths as HIV/AIDS. Specifically, there were an estimated 1.25 million deaths in 2023, including 161,000 amongst people with HIV.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “WHO urges all countries to make good on the concrete commitments they have made to expand the use of those tools, and to end TB.”

Globally, the number of deaths caused by TB fell in 2023, reinforcing the decline seen in 2022 after increases during the worst years of the COVID-19 pandemic. However, the number of people contracting TB rose slightly to approximately 8.2 million, the highest number recorded since WHO began global TB monitoring in 1995. This represents a notable increase from the 7.5 million reported in 2022.

Of those who developed TB, 55% were men, 33% were women, and 12% were children and young adolescents.

While TB occurs worldwide, 87% of cases in 2023 came from 30 high-burden countries. The majority of new TB cases were in Southeast Asia (45%) and Africa (24%), with smaller percentages in the Western Pacific (17%), Eastern Mediterranean (8.6%), the Americas (3.2%), and Europe (2.1%).

Eight countries accounted for two-thirds of the total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of Congo.

Several major risk factors drive a significant portion of TB cases, including undernutrition, HIV infection, alcohol use disorders, smoking (especially amongst men), and diabetes.

Since 2000, TB prevention and treatment efforts have saved 79 million lives. The global gap between estimated TB cases (incidents) and reported new diagnoses (notifications) narrowed to about 2.7 million in 2023, down from around 4 million in 2020 and 2021 and below the pre-pandemic level of 3.2 million in 2019.

Drug-resistant TB remains a serious public health threat, said Dr. Tereza Kasaeva, WHO’s Global TB Program director. Presenting the data to health officials and the press on Tuesday alongside Brown, she noted that in 2023, 175,923 people were diagnosed and treated for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB)—just 44% of the estimated 400,000 cases worldwide.

Trial Finds Four New Treatment Options for Multi-Drug Resistant Tuberculosis 

Kasaeva said progress toward global TB milestones and targets is lagging, including those set for 2027. Global funding for TB prevention and care dropped in 2023. Of the $22 billion target, only $5.7 billion was received—just 26% of the goal, with low- and middle-income countries bearing 98% of the TB burden.

“With only 26% funding, it’s impossible to provide 100% access for everyone in need,” Kasaeva said.

Domestic sources provided 80% of TB funding, while international funding for low- and middle-income countries has held steady at around $1.2 billion per year. Funding for TB research also remains critically low at around $1 billion per year—just a fifth of what’s needed.

“This is absolutely insufficient,” Kasaeva said.

“We are confronted with a multitude of formidable challenges: funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant tuberculosis, a significant driver of antimicrobial resistance,” Kasaeva added. “It is imperative that we unite across all sectors and stakeholders, to confront these pressing issues and ramp up our efforts.”

‘We can end TB’

Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID)

The United States is the largest bilateral donor to global TB efforts, thanks to bipartisan support from Congress, explained Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID), who also spoke on Monday.

Since 2000, USAID has invested $4.7 billion in the fight against TB.

“We have a global TB strategy for 2023 to 2030 that focusses on our 24 priority countries,” Vincent said.

The strategy aims to ensure that 90% of people with TB, including drug-resistant TB, are diagnosed and treated. It also seeks to provide preventive treatment for 30 million people eligible for it.

“While it’s heartening to see some positive trends in our battle against TB, we must confront a harsh reality: despite our efforts, we are merely treading water, failing to make significant strides toward our goal of ending TB,” said Dr Cassandra Kelly-Cirino, executive director of the International Union Against Tuberculosis and Lung Disease, in response to the report.

“To create a world free from TB, we must urgently address the areas where we continue to fall short.”

She added, “We’re diagnosing only 48% of the individuals needed to meet the 90% target. This is unacceptable. We must ramp up testing, ensure timely diagnosis, and support effective treatment to turn these numbers around and accelerate the reduction in the global TB incidence rate.”

Similarly, Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, stated, “The big message from this year’s World TB Report is that if we act decisively, we can end TB.”

“We have momentum, tools, and leadership, but we need more funding—and we also need to dismantle human rights and gender-related barriers that prevent people from accessing the services they need,” he continued. “Winning will take political will and sustained commitment. In a world facing increasing challenges from conflict and climate change, we cannot hesitate.”

Image Credits: Stop TB Partnership, Shaka Brown's official website, World Health Organization.

The joint statement comes as the science on the effects of ultra processed foods continues to evolve.

Diets should be guided by four key principles, say the Food and Agriculture Organization (FAO) and World Health Organization (WHO) in a joint statement released this week. Their statement highlights the importance of adequate, balanced, moderate, and diverse food intake, and aims to clarify what exactly a healthy diet means. 

“With such prominence in the scientific literature and public media has come a range of definitions and perspectives about what constitute healthy diets, and how these can be achieved, while protecting the environment,” the FAO said in an introduction to the statement.

Unhealthy diets are a lead driver of non-communicable diseases like heart disease, obesity, and diabetes.

FAO and WHO released the statement alongside this year’s annual meeting of the Committee on World Food Security, where stakeholders gathered to strengthen policy responses to food crises, and the Convention on Biodiversity in Cali, Colombia.

Both events prompted the FAO and WHO to clarify the idea of a “healthy diet” while celebrating the “diversity of healthy dietary patterns.”  

Skirting questions about ultra-processed foods 

Unhealthy diets and foods
Ultra processed foods are linked to adverse health outcomes, yet it may take several more years for regulatory bodies to issue guidelines on UFP consumption.

Food intake should be adequate, balanced, moderate, and diverse, according to the statement. Diets should provide enough nutrients in a moderate and balanced way, with a wide-variety of nutrients across food groups. 

With daily media coverage of dietary advice, scientific studies on the ‘best’ diets, and the growing threat of climate change on food systems, the statement’s simple message consolidates several decades of scientific research

Yet the statement acknowledges that further research is needed before issuing recommendations, especially on ultra-processed foods (UFP), including sugar-sweetened beverages and desserts, dyed snacks, and processed meats. 

More than 50% of energy intake comes from UFP in high-income countries, and this trend increasingly mirrored in lower- and middle- income countries. 

“It’s probably going to take another several years to have a sufficient evidence base,” noted Dr JoAnn Manson, a physician and researcher at Harvard, in a recent STAT news article.

In the meantime, the WHO and FAO recommended “considering moderation” of UFP. Other regulatory bodies, including the US Department of Agriculture (USDA) and Health and Human Services (HHS), are set to issue their own dietary guidelines by the end of the year. The Dietary Guidelines for Americans, 2025-2030, edition, will also likely not include definitive advice about UFP. 

Image Credits: Scott Warman/ Unsplash, Leon Ephraim/ Unsplash.

Climate plans ‘miles short’ of averting catastrophe, UN climate chief warns ahead of COP29.

Global climate plans will cut emissions by just 2.6% by 2030, falling 40% short of what’s needed to keep a future within the Paris agreement’s 1.5C goal alive, according to a report released Monday by the United Nations Framework Convention on Climate Change (UNFCCC).

The combined emissions cut by the national climate plans, known as “nationally determined contributions” (NDCs), have increased by a mere 0.6% since last year, an insignificant change that will not affect global warming trajectories, the UN climate body said in its annual assessment ahead of next month’s COP29 summit in Baku.

“Current national climate plans fall miles short of what’s needed to stop global heating from crippling every economy and wrecking billions of lives and livelihoods across every country, said Simon Stiell, UNFCCC’s executive secretary. “Greenhouse gas pollution at these levels will guarantee a human and economic trainwreck for every country, without exception.”

As countries prepare to update their climate pledges ahead of next year’s COP30 in Brazil, time is running out to take the existential scale of the threat seriously. Since COP28, where countries adopted the UAE consensus reaffirming the 1.5ºC target established in 2015, only one nation has submitted updated climate plans under the treaty framework.

World Faces ‘Catastrophic’ 3.1C Warming after Year of Zero Climate Action

The UNFCCC’s dire assessment mirrors findings released last week by the UN Environment Programme (UNEP), which reported that no policies with “significant implications for global emissions” were implemented globally in 2023, putting the world on course for “catastrophic” warming of 3.1ºC by the end of the century.

UNEP maintains that the 1.5ºC target – which its director called “one of the greatest asks of the modern era” – remains “technically possible” if there is “immediate global mobilisation on a scale and pace only ever seen following a global conflict.”

With global emissions set to exceed 1.5ºC of warming by 2050 – and a one-in-three chance of breaking 2ºC – UNEP’s chief called for a “quantum leap” in climate policy.

Stiell echoed this urgency, demanding an immediate end to the “era of inadequacy” — and for “a new age of acceleration” to begin at next month’s COP29.

“The last generation of NDCs set the signal for unstoppable change,” Stiell said. “New NDCs next year must outline a clear path to make it happen – by scaling up renewable energy, strengthening adaptation and accelerating the transition to low-carbon economies everywhere.”

The latest warning shot 

Carbon dioxide is building up in Earth’s atmosphere at rates never before seen in human history, WMO reported Monday.

With COP29 in Baku, Azerbaijan, just weeks away, a raft of new climate research has reinforced the alarm bells set off by the UNFCCC’s findings.

Planet-warming greenhouse gases surged to record highs in 2023, reaching levels unprecedented in human history, new data released by the World Meteorological Organization (WMO) revealed on Monday.

The UN weather agency found carbon dioxide concentrations rose more than 10% in the past decade, while methane and nitrous oxide, short-lived but powerful greenhouse gases, also saw significant increases.

Carbon dioxide levels are now 51% higher than in pre-industrial times, when humans began burning fossil fuels at scale, while methane levels have risen 161% and nitrous oxide 25% over the same period, locking Earth’s atmosphere into a warming trajectory for at least the lifecycle of these gases.

 “Another year. Another record,” said WMO secretary-general Celeste Saulo. “These are more than just statistics. Every part per million and every fraction of a degree temperature increase has a real impact on our lives and our planet.”

“This should set alarm bells ringing among decision-makers,” Saulo said. 

Carbon dioxide is accumulating “faster than any time experienced during human existence” due to “stubbornly high fossil fuel” emissions, widespread forest fires, and a likely reduction in the ability of natural carbon sinks — such as oceans and forests — to absorb CO2, WMO said. 

The 2023 increase of 2.3 parts per million marked the 12th straight year of rises above 2ppm – a rate of increase that would have taken centuries to occur naturally before industrialization.

“The record levels of carbon dioxide in our atmosphere are the logical outcome of the record amounts of greenhouse gases that our economies continue to dump into our ambient air,” Joeri Rogelj, a climate scientist at Imperial College London and lead author of the report, told the Guardian. “This doesn’t need to be the end of the story.”

Earth’s systems near breaking point

The WMO report raises fresh alarms about nature’s carbon sinks — oceans, forests, plants and soil that absorb carbon dioxide — and it isn’t alone. Earlier this month, international researchers released preliminary findings indicating forests, plants and soil absorbed almost no net carbon in 2023, suggesting they could be nearing a tipping point.

These natural buffers, long taken for granted in climate models, may be failing. Earth’s natural carbon sinks absorb nearly 50% of our carbon emissions, and their collapse could be catastrophic and rapidly accelerate global warming beyond current worst-case scenario projections.

“We see a sudden drop of the land carbon sinks from extreme warming and Amazon mega-drought,” said Philippe Ciais, one of the report’s lead authors. “If this decline continues, we may see a rapid acceleration of CO2 and global warming which was unforeseen in future climate models’ projections.” 

Collapse of Atlantic current

Meanwhile, 40 of the world’s leading experts on ocean and climate science penned an urgent open letter presented at the Arctic Circle conference in Iceland last week warning that the risk of collapse of a vital Atlantic current system, known as the AMOC, has been “greatly underestimated.” 

The collapse of this system, one of the planet’s largest arteries transporting heat around the world’s oceans, would have “potentially catastrophic consequences” and trigger “devastating and irreversible climate impacts,” the letter warned. 

The worst impacts would be felt in Nordic countries and “potentially threaten the viability of agriculture in northwestern Europe,” while global impacts would include reduced CO2 absorption by oceans, major sea-level rise, and a shift in tropical rainforest belts, meaning rains would no longer fall on the forests they keep alive – triggering droughts above rainforests vital to absorbing CO2 – and flood the new regions they settle over.

“This has happened repeatedly in Earth’s history, most recently during the last ice age,” Stefan Rahmstorf, a signatory of the open letter and head of the Earth system analysis department at the Potsdam Institute for Climate Impact Research, said in an interview with the Guardian.

“These are among the most massive upheavals of climate conditions in Earth’s history,” Rahmstorf said. “I am now very concerned that we may push Amoc over this tipping point in the next decades. If you ask me my gut feeling, I would say the risk that we cross the tipping point this century is about 50/50.”

“We don’t know where the tipping point is.”

Image Credits: RecondOil.

A climate crisis protestor urges a science-based approach

Amid grim research showing global warming is happening faster than previously projected, scientists urged world leaders to  move from talk to implementation of global agreements when they meet at COP29 in Baku, Azerbaijan, next month.

Up to 600 million people already live in uninhabitable places, said Professor Johan Rockström, while introducing the 10 New Insights In Climate Science report at a media briefing on Monday.

Methane gas emissions have surged. Rising sea surface temperature is exacerbating destructive and costly El Niño weather patterns and destabilising ocean currents. Meanwhile, the Amazon Rainforest – essential for stabilising climate –  is approaching “multiple thresholds” that could trigger “large-scale forest collapse”.

Methane gas is surging in the atmosphere.

The report synthesises the “latest and most pivotal climate research published over the past 18 months”, aimed at informing the COP29 negotiators and future policy, said Rockström, who directs the Potsdam Institute of Climate Impact Research in Germany. It was produced by a consortium of globally renowned social, natural and climate scientists.

“Our conclusion is that we’ve underestimated the pace [of global warming]. The unprecedented ocean warming, for example, since 2023 has broken sea surface temperatures well beyond anything expected – a sudden 0.2 degrees Celsius jump,” he said.

“The observations we see in the ocean, the accelerated temperature rise in the atmosphere, are early signs of a system which seems to be gradually losing its inbuilt geophysical resilience.”

While mitigation is urgent, so too is the protection of forests and biodiversity “to build as much resilience as possible in the face of the rapidly rising stress due to climate change induced extreme droughts, fires and heat”, added Rockström, who is also the co-chair of The Earth League.

Heightened risk for pregnant women

Pregnant women face huge risks from climate change.

Increasingly, the effects of climate change are being measured by their impact on women and the global South.

“The progress we have made in protecting mothers and newborns over recent decades is now at risk due to our changing climate,” warned Jemilah Mahmood, executive director of Sunway Centre for Planetary Health in Malaysia.

“In a study spanning 33 countries across three continents of the global South, from South America, Asia and Africa, researchers estimated that floods alone may cause over 107,000 pregnancy losses each year,” she said.

“In India, researchers found that when pregnant women are exposed to occupational heat and stress, which affects nearly half of working pregnant women, their risk of miscarriage doubles.”

Meanwhile, research from Southern California found “significant associations” between long-term heat exposure and serious birth complications, including stillbirths, premature births, and maternal hypertensive disorders including preeclampsia and gestational diabetes, she added.

Climate change can reduce the availability of food and water, causing new mothers to travel longer distances in dangerous temperatures, compromising their postpartum recovery. Food insecurity can also result in low birth weight babies and reduce breastmilk production.

Dr Jemilah Mahmood

“These aren’t just statistics. They represent real mothers and families bearing the brunt of our changing climate,”  Mahmood warned. 

Climate change creates a “cascade of risk for maternal health”, with consequences that can span generations.

Research from three South Asian countries also found that just a 1ºC rise in annual temperature is associated with a 4.5% increase in intimate partner violence. 

This is due to “increased heat stress, irritability and aggression” and “increased heart rate, which is directly related to increased heat and dehydration”, said Mahmood.

 “Some physical changes create behavioural changes in human beings that will amplify aggression, and this is much more seen in hot weather,” she added.

Despite the severe impact on women, only 27 out of 119 countries mention maternal and sexual reproductive health in their climate commitments in the nationally determined contributions, Mahmood noted.

COP29: Report on progress

Describing the Baku meeting as a “finance COP”, Rockström said it needs to “shift the $7 trillion per year in subsidies to fossil fuels into mechanisms that allow particularly rapidly developing economies in the global South to afford and get interest rates and get credit worthiness so that they can invest in in the green technologies and avoid investment in coal-fired plants”. 

Professor Johan Rockström

Secondly, scientists have been communicating also with the United Nations Intergovernmental Panel on Climate Change (UNFCCC)  COP reform, he added.

After almost 30 years, a pile of legally binding agreements have been signed to reverse climate change –  the Paris Agreement, a global methane pledge signed by 120 countries to reduce emissions by 30% by 2030, a deforestation agreement, a loss and damages agreement, and the Sixth Assessment Report of the UNFCCC (IPCC AR 6) of 2021 requiring the world to cut global greenhouse gas emissions by 42% by 2030. 

“We even have an agreement that all countries in the world signed that we are now phasing out oil, coal and gas, accelerating this decade and following science. So now is the time to shift over into a COP logic where we start reporting on progress, being held accountable, get money on the table and share solutions, meaning sharing technologies.”

Image Credits: Mika Baumeister/ Unsplash, 10 New Insights 2024, Elizabeth Poll/MMV, 10 Insights report 2024.

Negotiations continue on health provisions in biodiversity plans as the UN summit in Cali reaches its midpoint.

Only 35 countries have submitted the national strategies required by the UN biodiversity treaty showing how they’ll meet its binding nature protection targets. While 33 of these plans recognise links between human health and biodiversity, they offer few specifics on implementation and policy, a Health Policy Watch analysis found.  Negotiators in Cali aim to bridge the gap this week by adopting a global health action plan under the treaty that provides a roadmap for meeting its health protection requirements.

Midway through the UN biodiversity summit COP16 in Cali, Colombia, delegates from nearly 200 countries remain deadlocked over rules to protect human health from Earth’s mounting ecological crisis.

UN Environment chief Inger Andersen urged delegates Thursday to break the impasse over the Global Action Plan on Biodiversity and Health, which would align conservation efforts with human health priorities as nations wrestle with implementing the landmark 2022 Montreal biodiversity treaty.

“Our health cannot be separated from the health of the planet and its many species,” she told delegates in Cali. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.”

Over the weekend

Biodiversity deal seeks health rules – but keeps them voluntary

The world agreed to protect nature in Montreal two years ago. Now in Cali, countries must figure out how.

The proposed framework would strengthen the 2022 Kunming-Montreal biodiversity agreement – nature’s equivalent to the Paris Climate Accord – which committed 197 nations to protect 30% of Earth’s land and seas by 2030, but left crucial health provisions largely undefined.

While the Convention on Biodiversity itself is legally binding, the proposed health framework would serve as a voluntary roadmap for nations. It calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules — measures experts say are vital to prevent pathogens spreading from wild animals to human communities and food markets.

The framework also emphasises protecting genetic resources crucial for new medicine development and ensuring vulnerable populations have access to nature’s health benefits. The push comes amid controversy at the UN biodiversity summit over countries’ rights to demand “benefit sharing” when genetic resources, including digital sequences, are used in drug development — a fight at the frontiers of biodiversity science that nearly derailed the landmark 2022 Montreal agreement.

Beyond the fight over genetic resources, nations broadly agree on the framework’s other targets: combating vector-borne diseases emerging from shrinking habitats, reducing chemical exposure from industry, and protecting communities from the toxic toll of mass pesticide use.

If approved, the plan’s voluntary nature, combined with history, suggests an uphill battle: the world has not met a single UN biodiversity goal since talks began in Nairobi over 30 years ago.

Sweeping New Global Biodiversity Deal Sets Out Plan for Sharing Gene Sequences

The health focus at the UN biodiversity summit reflects a broader shift in environmental diplomacy, marked by the first-ever Health Day at UN climate talks (COP28) in Dubai last year.

While biodiversity has long been valued for medical discoveries — nearly half of all pharmaceuticals in use today are originally derived from nature — scientists increasingly see ecosystem protection as vital for preventing disease outbreaks, controlling disease vectors, and limiting chemical exposure.

Biodiversity loss and climate change have emerged as the leading drivers of infectious diseases worldwide, amplifying 58% of outbreaks. The mounting threat is forcing policymakers to reckon with an increasingly inescapable truth: human survival depends entirely on Earth’s life-sustaining systems — clean water, air, and food.

“Framing biodiversity as a resource – something separate, something that gives – has led to humanity converting nature, driving species to extinction, polluting ecosystems and pumping greenhouse gases into the atmosphere,” Andersen said. “But humanity is not separate from or above biodiversity. And in a closed system such as Earth, what goes around comes around.”

Deep divisions over superbug prevention and drug development mirror COP16 tensions

The Biodiversity-Health framework is one of the most contested documents being negotiated at COP16 in Cali, Colombia this week, according to Carbon Brief.

The 24-page Biodiversity-Health framework is as one of the summit’s most contested documents, with 54 bracketed sections exposing fundamental disagreements between nations.

The disputed clauses reflect wider fault lines in Cali. Nations remain divided over whether to classify improperly disposed antibiotic waste – a key driver of antimicrobial resistance – as “pollution” alongside microplastics and heavy metals. Proposals to “avoid the inappropriate use and disposal” of antibiotics are also unsettled, despite safe disposal practices being critical to preserving the efficacy drugs that save hundreds of millions of lives annually.

The sharing of benefits from genetic resources is another flashpoint. Developing nations demand strong commitments on technology transfer, while wealthy countries insist such transfers must remain “voluntary.” Nations with major pharmaceutical industries have pushed also back against draft language that would hold companies accountable for “the misappropriation of genetic resources and digital sequence information and associated traditional knowledge.

A crucial sticking point centres on whether to include “derivatives” and “subsequent applications and commercialisation” – essentially determining if companies must share benefits when they develop new products based on initial discoveries. Without such provisions, firms could potentially avoid sharing profits from derivative drugs or applications.

Finance – the dominant issue of COP16’s opening week – is another key battleground in the health framework. Nations have yet to approve clauses that would provide financial support to developing countries, which host most of the world’s biodiversity, for implementing plans to protect it.

Of the few plans submitted, most consider health

Of 35 submitted biodiversity plans, Western Europe leads with 13, followed by Asia-Pacific with 10, while Africa filed 5, Latin America 4, and Eastern Europe 3, according to the COP16 database.

National biodiversity plans submitted before this week’s summit in Colombia summit reveal wide variations in scope and specificity for how countries intend to tackle environmental protection and human health concerns, a Health Policy Watch analysis of the COP16 database found.

Only 35 nations – just 18% – submitted biodiversity strategies, known as NBSAPs in UN jargon, by Monday’s UN summit deadline. All but Mexico and Jordan included human health concerns in their plans.

The submitted plans reflect clear regional priorities. European Union members emphasize a comprehensive “one health” approach that links human, animal and environmental welfare, focusing heavily on pesticide and chemical pollution regulation – areas where the EU leads global policy.

Colombia’s strategy takes a different focus, centering on health impacts from extractive industries, particularly mercury contamination from mining. In contrast, China and South Korea’s plans barely mention health, making single references to urban green spaces’ benefits for respiratory and mental health.

These varied approaches come as research increasingly links ecosystem destruction to public health crises, from floods to disease outbreaks. Scientists have documented two virus spillovers to humans annually over the past century, culminating in the COVID-19 pandemic.

The World Health Organization projects climate change could cause 250,000 additional deaths yearly between 2030-2050. Antimicrobial resistance already claims 1.4 million lives annually, while environmental degradation could cause 39 million deaths from 2025-2050.

The proposed health framework, though voluntary, would set higher standards than current national plans.

“From the air we breathe to the water we drink, our health is tied to the health of the planet,” said UN Environment chief Andersen. “We need a plan to protect biodiversity for the health of all species on earth.”

Critical regions and powers missing from submissions

While most nations haven’t submitted biodiversity plans required by the Montreal deal, officials say the two-year timeline was ambitious given ecosystem complexity, especially in regions like the Amazon.

Of the 17 nations hosting 70% of Earth’s biodiversity, only five have filed plans: Australia, China, Indonesia, Malaysia and Mexico. The crucial Amazon region is represented solely by Suriname, with no submissions from Congo Basin nations.

The G7 economic powers showed limited participation, with only Canada, Italy, France and Japan meeting the deadline. Among G20 members, Brazil indicated it needs more time to develop its long-term conservation strategy, while India plans to announce its commitments during the summit.

“The start was never going to be fast. I think the important thing we’re looking at is the work is underway,” UN biodiversity chief Astrid Schomaker told Carbon Brief about the limited submissions.

“Whether the deadline itself is met on the dot is not what I think we’re really looking at,” Schomaker said, adding she is “confident” this work is taking place globally. “I think our assessment is globally positive.”

Biodiversity and health deal advances, but key framework still faces hurdles

Negotiations on biodiversity and health took a step forward on Sunday as the second working group’s chair presented a draft decision – a document separate from but related to the broader biodiversity and health action plan. While the draft includes a provision to adopt the action plan, this remains in brackets, indicating no consensus has yet been reached among member states.

The draft makes several key advances, eliminating previous disputes over antimicrobial disposal protocols and removing qualifiers that made technology sharing optional. It also strengthens provisions for Indigenous peoples’ participation in global biodiversity initiatives and decision-making forums.

However, several contentious issues from the main biodiversity framework remain unresolved. These include questions of pharmaceutical companies’ liability regarding genetic resource usage and digital sequence information, whether derivatives and commercial applications should be included in fair and equitable benefit-sharing arrangements, and the creation of international oversight mechanisms to ensure countries meet their biodiversity and health commitments.

Finance remains a critical hurdle in the health and broader COP16 negotiations. While eight nations boosted the Global Biodiversity Framework Fund this week with pledges totaling $163m, bringing available funding to $400m, this falls dramatically short of global needs.

The Kunming-Montreal agreement calls for $200bn annually for nature protection – 500 times the current fund’s total, which isn’t even structured as yearly financing. Though there is broad agreement on the principle of financial support from development banks and environmental funds, the mechanisms for distribution remain hotly contested.

As with previous UN environmental negotiations, talks may extend beyond the official Friday deadline as delegates work to bridge these remaining gaps.

This article was updated to reflect progress in the negotiations 

Image Credits: CIFOR-ICRAF.