Drought in Burkina Faso, yet another sign of climate change impacting health and livelihoods.

As health actors ramp up their game on climate change, in advance of the next UN Climate Conference (COP 29), the fact that global warming poses an ‘existential threat’ to health has become almost cliché. 

From extreme heat and flooding to the impact of drought on hunger and fossil fuel emissions that drive hazardous air pollution, the multiple, inter-related challenges remain difficult for policymakers to appreciate and even for scientists to measure – using classical methods of health research.   

Even so, global health actors are digging deeper beneath truisms in an effort to map, track and address a vast web of interactions – as well as synergies that could be obtained from more sustainable policies.  But as long as the world’s governments continue to pour billions of dollars of investments and trillions into fossil fuel subsidies, they face an upward battle. Meanwhile, the Green Climate Fund funded only one renewable energy project in Africa in the past four years. 

Those challenges were a cross-cutting theme at last week’s World Health Summit in Berlin, which devoted almost an entire day of its two-day event to health-related aspects of the climate question – from strategy sessions on how to amplify health and climate research and investments to the panels on the health damage done by fossil fuel investments.  Here’s a snapshot of what was discussed.  

Multiple health linkages of increasing levels of complexity

In a world dominated by medical models of research that emphasizes randomized clinical trials testing new vaccines and medicines, conclusive “proof” of the chain of climate impacts on health in many domains, remains elusive. 

But the range of unknowns and the need for more research, should not be an excuse for inaction either, say leading health voices, including Global Fund Director Peter Sands. 

“It’s absolutely true that there’s a lot about the impact of climate on health that we don’t understand, we need research – but that should not be an excuse for not doing anything. There’s much that’s a no-brainer …so we can’t let the need to know more get in the way of acting”, declared Sands at a plenary event on the closing day of the World Health Summit. 

Global Fund director Peter Sands – some climate actions are a ‘no brainer’ for health

Research methods exist, but funding lacking to draw conclusions about local impacts

In the no-brainer category, 30 years of research exists documenting the fact air pollution is a leading risk to health, killing some 7-8 million people annually – and fossil fuels are a major contributor to air pollution. Two decades of transport and health research also lends itself to clear, quantifiable conclusions about the benefits of curbing traffic, to reduce pollution and stimulate healthier alternatives like cycling and walking.  

For example, a recent study on the impact of London’s ultra-Low Emission vehicle zone documented how the ULEZ has not only reduced health damaging air pollution but stimulated more pedestrian activity, including a 40% uptick in children walking to school. That’s a knock-on effect of reduced traffic congestion However, traffic planners in developing cities that badly need to undertake such assessments, rarely have the money or technical tools to do so. They use standard traffic models that simply predict vehicle growth and, against that, recommend road-widening as economically beneficial – without regards for any externalities like air pollution, traffic injury or physical activity. 

Research linking climate and health outcomes – as a tool for policy action 

Wellcome’s Alan Dangour, Center, flanked by former Hong Kong Health undersecretary, Gabriel Leung (right) and Vanina Laurent-Ledru, Foundation S (left).

And then there are the even more complex range of ecosystem interactions – that are even more difficult to quantify in terms of linear cause and effect.  

Take deforestation, for instance. Along with leading to more CO2 release, deforestation stimulates biodiversity loss. That, in turn, affects rainfall patterns and water resource access, as well as leading to the migration of dangerous pathogens from the wild into human populations – which can in turn lead to more outbreaks, epidemics and pandemics.  

The multiple interrelationships can leave even the most expert health researchers and their funders scratching their heads over how to document such critical connections – and offer policymakers clear evidence of how unsustainable choices, e.g. how burning down a forest to expand soybeans crops for factory beef production [which also emits significant CO2], can be devastating for health in multiple arenas. 

One thing is increasingly clear, however, the old research models need to be re-invented, given the urgency of the moment, said Alan Dangour, the lead on climate change at the UK-based Wellcome Trust, one of the world’s oldest health research philanthropies, which has made climate and health a key part of its new strategic portfolio, including a $25 million grant to the World Health Organization, announced at the Berlin conference. 

The priority, said Dangour at WHS, needs to be “delivering research that is a pathway to impact rather than purely academic research- which is what academia is classically trained to do.

“We are here to say the urgency is now. The need is now. We must be delivering research that can be used… which is impactful, links to communities … and can engage policymakers and policy processes.”

Making catalytic investments in health and climate   

Nearly a 10-fold growth in donor funding at the climate and health nexus (2018-2022)

In line with the increased interest in health, donor funding at the climate and health nexus has also ballooned from less than $1 billion in 2018 7.5 – 9 billion in 2022- with further commitments since COP28, according to a landscape review of commitments by OECD donors, presented at another, more intimate WHS session, co-sponsored by Rockefeller Foundation. The Foundation has also made climate and health a key part of its strategic portfolio. 

But those investments still pale in comparison to the estimated $7 trillion in direct and indirect subsidies (2022), which the fossil fuel industry is receiving from governments, including nearly $1.7 trillion in direct subsides such as corporate tax breaks, multilateral bank and other public investments, consumer price controls and other incentives.  In terms of the other $5+ trillion in indirect, or ‘implicit’ subsidies,  air pollution impacts on health and climate damage are among the largest uncounted costs, accounting for about 30%  each, according to the International Monetary Fund.

Subsidies to the fossil fuel industry, direct and indirect (IMF 2022 data).

It’s no surprise then, that clean energy investments remain stagnant in key developing regions, such as Africa. And finance is due to be a major issue on the agenda of the upcoming Climate Conference (COP 29) scheduled for 11-22 November in Baku, Azerbaijan. There, member states are supposed to finalize an agreement on a New Collective Quantified Goal for climate finance to support low income countries’ transition to a low-carbon future.  

Against that landscape, health actors – from UN agencies to government ministries and foundations and philanthropies –  are asking themselves what kinds of catalytic investments should be at the top of the list of their ‘asks’ or conversely, at the top of donor priorities  – so as to amplify the climate and health synergies.   

A two intimae sessions on Monday and Tuesday, several dozen key players in the philanthropic world huddled together with a select group of thinkers from governments in Africa and Europe, and WHO officials to ponder the optimal entry points. Key priorities that seemed to resonate included: 

  • Investments in more climate resilient health systems – which range from energy starved clinics in developing countries to high tech, high energy modern medical centers that leave a massive carbon footprint.  
  • Investments in country- and community-based research that document health co-benefits of climate mitigation; 
  • Investments in stronger engagement and advocacy with economic sectors, like energy and climate, whose upstream climate investments affect health; currently only .5% of multilateral climate finance explicitly targets health, according to WHO. 

Demonstrating local impacts on health

Damage wreaked by cyclone Idai in Mozambique in 2022 – one of the top countries in the world, in terms of extreme climate events.

“Climate change, for many of the policymakers in our countries, is a kind of new knowledge.  And one of the barriers [to action] is a lack of evidence that demonstrates how climate change is having a serious impact on health,” said Dr Eduardo Samo Gudo, director of Mozambique’s National Institute of Health, at the WHS session. 

That, despite the fact that Mozambique has now  become one of the six top countries in the world in terms of its experience of extreme climate events, he added.  

“So looking at the components that we think are urgent in terms of investment in our countries, the first is on evidence…. While there are many other competing issues, HIV, malaria, TB, and many others, conducting vulnerability assessment of the impact of climate change on health in our country is really crucial to demonstrate to the stakeholders that make decisions,  how serious this business is, in comparison with other diseases.”

Mozambique is one of only 11 countries out of 132 low- and middle income nations that has even developed a ‘health national adaptation plan (HNAP)’ for climate change. 

But even after such an assessment has been made, the vertical structure of international aid, dedicated to specific diseases, makes it challenging to implement a cross-cutting plan.  

“Why?  Because the funding is siloed.  We have Global Fund for HIV, Gavi [the Vaccine Alliance], for immunization and so forth.” 

Finally, he said, despite considerable hype at last year’s COP about the health sector’s own energy needs, little climate funding has been directed to promoting clean energy in the health sector. 

In OECD countries, China and India, the modern health sector’s footprint is estimated to be some 5% of national climate emissions while nearly a billion people worldwide, mostly in Africa, are either served by health clinics powered by costly and efficient diesel generators or no access to reliable electricity at all. 

“Everyone forgot that the health system is also contributing to emissions. But when you look at the ‘Nationally Determined Contributions’ (NDCs), health is not there,” Gudo lamented.

Solar panels provide electricity to Mulalika health clinic in Zambia; but thousands of African facilities still lack clean, reliable energy services.

Attuning climate and health programmes to needs a community level 

Whether it’s energy, transport or more resilient health systems, changes designed by national ministries have to be attuned to the needs of the communities where they are to be implemented, said Dr Akosua A Owusu-Sarpong, Director of Health at the Accra Municipality, Ghana. And that’s another big challenge. 

“There’s little knowledge about climate change and health at the local level,” she observed. “Most of the time, these kinds of engagements are done at the national level. But you have to bring the knowledge down to the local level to understand what we are trying to attain in terms of immunization, infectious diseases, neglected tropical diseases – otherwise, the implementation becomes a challenge. 

“And when funders come in… some funders come in with their pre-prepared plan, and if that’s not what the community needs, it becomes a challenge.”

Finally, many climate-related plans that benefit health require cooperation between ministries other than health; empowering local government actors to take initiative and fund projects could help facilitate that process.    

“When it comes to the local level, we still have the same [vertical] pattern of ministries. If there was more district decentralization of ministries [such as] health, transport and environment, at the local level, they could also work hand in hand,” she said.   

Fossil fuel subsidy reform – ‘indispensable’ to health   

(Standing) Jeni Miller, Global Climate and Health Alliance at session on fossil fuels.

But to really leverage action, governments need to  close the tap on fossil fuels subsidies and investments, powering most of the planet’s unhealthy development, to achieve long-term, meaningful health benefits, panelists said at another WHS closing day session, on the fossil fuel subsidy reform as “indispensable” to a healthy energy transition. 

The meeting came against the background of a recent Clean Air Fund analysis documenting how international aid to low- and middle-income nations for fossil fuel projects increased nearly fourfold over the past year (2022-2023) to $5.4 billion.

Leading investors included: the Islamic Development Bank, Japan International Cooperation Agency, the Asian Development Bank, the European Bank for Reconstruction and Development and the World Bank’s private sector arm, the International Finance Corporation (IFC).  

And that’s only part of the picture.  Between 2020-2022, G20 countries spent $142 billion in international public finance to expand fossil fuel operations – three times more than monies invested in clean energy. And this despite a G7 pledge to stop funding such projects by 2022, according to an April 2024 study by Oil Change International and Friends of the Earth. 

Renewable energy investments (dark blue) in Africa, Latin America and South-East Asia lag far behind China, the United States and the European Union.

Health case for a just transition away from fossil fuels is really clear

“The health case for a just transition away from fossil fuels is really clear,” declared Jeni Miller, of the Global Climate and Health Alliance, which co-sponsored the session. 

“Current health systems based on fossil fuels are driving tremendous impacts on people’s health, and that’s climate change, certainly, but fossil fuels have many, many other health impacts on people, and that’s from the extraction process through transport all the way through end use. And this is happening in communities all over the world. It’s driving air and soil and water pollution. It’s also having occupational health impacts. 

“They [impacts] are borne by families when kids are out of school with asthma.. And the industry is not covering those health costs. Those health costs are borne by health systems.

“And while we know that energy access is a vitally important determinant of health, the fossil fuel approach has not gotten that done either,” said Miller, referring to the nearly 600 million Africans still lack access to electricity at home. 

An estimated 600 million Africans lack access to electricity in their homes.

In South-East Asia, millions of rural Indians have been left out of the LPG boom that has benefited urban areas, noted Sunil Mani of Canada’s International Institute for Sustainable Development.  

“Obviously the [investment by] development banks and development agencies is only a drop in the ocean compared to indirect fossil fuel subsidies of some $5.4 trillion a year,” said Nina Rensaw, of the Clean Air Fund, noting that the latter costs, largely health-related, represent an estimated 6% drain on global GDP.

Africa is one of three regions of the world where demand for oil has grown sharply over the past two years (2022-2023) – as compared to 2015-2023. [The other two are Southeast Asia and the Middle East]. 

This, at a time where oil demand had dropped in absolute terms in Europe and North America. In China, as well, the pace of growth has declined to almost ‘0’ as compared to the previous decade, according to the latest International Energy Agency data.  

Climate or not, the rush to expand oil, gas, and oil shale extraction is in full-swing, from Nigeria and Ghana in the west to Tanzania, Kenya in the east, as well as within the Democratic Republic of Congo’s rich tropical forests.  

Green Climate Fund – only one African renewable energy project approved since 2021

(On left) Sunil Mani, IISD

Meanwhile, in the online portfolio of some 200 projects of the Green Climate Fund, the world’s largest dedicated climate finance instrument, only one African renewable energy project was approved over the past four years. That  was in Ghana in 2021, according to the online dashboard.  Four other previously-approved projects involving multiple countries are still ongoing.  

This is despite the fact that clean energy grids may have the largest array of multiple, cascading for health, that can be derived from climate investments. They open up new vistas not only for outdoor air pollution mitigation, but also for electrification of homes and health facilities, with knock-on benefits to women’s and girl’s health and gender equality. When harnessed to greener urban design, they can stimulate healthier, more climate resilient cities that reduce urban heat island impacts, stimulate electrified transit, increase physical activity, and more.  

Green Climate Fund: Just one new clean energy project in Africa since 2021. Four other earlier projects remain under implementation.

Admittedly, the GCF remains chronically underfunded. it was supposed to receive $100 billion annually from donor countries already in 2020; instead its portfolio reached just $13.5 billion as of December 2023.  

But the key lever to change, observed Mani, of IISD, is not donor funding; it is political will.  

“One of the key reasons many policymakers or industry leaders argued for the continuation of subsidies for fossil fuel use [in the past] was because of its price advantage – of course made possible with government subsidies.  But in China, for example. the unit price of electricity generated by solar power is about $.20-.35 cents, as compared to $.45 for electricity generated by [conventional] thermal power. “The reasons that were used to justify the use of fossil fuels in the past don’t hold anymore.

“So, in my view, it really depends on how our political leaders commit to make a transition from relying heavily on fossil fuels to cleaner, more sustainable types of energy. 

“From a political standpoint, it is very hard for the existing industries to give up their territory to new technologies. 

“That’s why we are arguing for the market to be as competitive as possible, so that new commerce can come into the market with their so-called ‘creative disruptions’.” 

No private sector incentives for African renewables   

Solar field in Burundi, one of the few operating in Africa, generates some 7.5 MW of power. It increased national power capacity by 15% when it opened in 2020.

Against the billions allotted to oil and gas, small and medium sized solar developers in the private sector face multiple hurdles and delays in raising just a few million dollars to get projects off the ground, observed one leading private solar developer, heavily invested in Africa. 

“For all the talk and pledges about fixing climate finance for renewables in Least Developed Nations, there is virtually still none available for serious project preparation for the private sector,”  Josef Abramowitz told Health Policy Watch.  

Nine  years ago, his firm launched the first-ever solar field of 8.5 MW in Rwanda, increasing national power generation capacity by 6%. That was followed by a 7.5 MW field in conflict-ridden  Burundi in 2020, named Energy and Environment Trust Fund (EEP) Africa project of the year. The company currently has 10 other African projects in the pipeline in places ranging from Juba, South Sudan, which runs entirely on diesel generators, to Zambia. Most are still waiting for small grants or loans of $2-4 million to finalize project planning – that kind of finance is extremely scarce. 

“Project preparation means all of these studies and permits, which also get government agencies aligned and on board,” Abramowitz explained. “Once that’s all sewn together in a bankable beautiful bow, everyone is happy to put equity into these projects. But if there is no real money for project preparation, and it takes 5-10 years for a project to mature, it’s not worth it for the private sector to go in because of the high risk and long lead times. 

 “The net result is that trillions of dollars are available for project finance, which will never be unlocked and deployed without a massive increase in pre-development grants to platforms with pipelines and proven teams.”

Image Credits: Gellscom/CC BY-ND 2.0., Yoda Adaman/ Unsplash, US Centers for Disease Control and Prevention, HP-Watch, SEEK/World Health Summit, International Monetary Fund , WHO, UNDP/Karin Schermbrucker for Slingshot , IEA , Statista.com, Green Climate Fund, Energy and Environment Partnership Trust Fund Africa .

The venue of COP29 in Baku, Azerbaijan.

The United Nations (UN) climate change meeting, COP29, will feature a Health Day on 18 November as part of the negotiations in Baku, Azerbaijan.

The World Health Organization’s (WHO) Maria Neira said that the global body wants to ensure that health is “very prominent” in all the member states’ climate negotiations, which run from 11-22 November.

“We have two objectives. One is making sure that everybody understands that the climate crisis is a health crisis, and that climate change is negatively affecting our health, and we need to respond to that,” Neira told a media briefing on Wednesday.

“The second objective is to convince all the negotiators, participants, and member states that whatever they do to mitigate the process of climate change will have enormous potential health benefits,” said Neira, who directs the WHO’s Department of Public Health, Environment and Social Determinants of Health.

The Health Day will kick off with a high-level meeting on the Baku Initiative on Human Development for Climate Resilience, which aims to strengthen human development to address climate change, particularly in education, health, social protection, and green jobs and skills.

COP29 presidency official Elmar Mammador

“As part of the Baku initiative’s guiding principles, we emphasize the importance of science, knowledge generation and sharing as a part of the climate action,” COP presidency official Elmar Mammador told the briefing.

Other events focused on food, agriculture and water have health implications, while a high-level roundtable on 19 November on One Health “highlights the interconnectedness of human, animal and environmental health”, he added.

Mammador said that nine declarations had been finalised so far and some also offered opportunities for health interventions, including green energy, organic waste and pathways to resilient and healthy cities. 

A high-level meeting on resilient cities will be held on 20 November, which includes the integration of health in city planning.

“The President’s Climate and Health Continuity Coalition will have as one of its focus areas a platform where stakeholders can share reports and research findings on climate and health, and on biodiversity and health. Human health is inseparable from the health of our ecosystems, and biodiversity is essential to safeguarding human health,” said Mammador.

The WHO, in collaboration with the Wellcome Trust, is also hosting a Health Pavilion at the COP29 which aims to “ensure health and equity are placed at the centre of climate negotiations”, according to WHO. 

“It will offer a rich two-week programme of events showcasing evidence, initiatives and solutions to maximize the health benefits of tackling climate change across regions, sectors and communities,” said Neira.

Kenyan manufacturer Synergy’s new medical oxygen manufacturing unit is unveiled in Mombasa, supported by Unitaid.

A sod-turning ceremony in Mombasa, Kenya, on Tuesday marked the launch of the East African Programme on Oxygen Access (EAPOA), which aims to massively boost access to medical oxygen in the region.

Unitaid is investing $22 million in support for Kenyan manufacturers Hewatele and Synergy, and Tanzania Oxygen Limited to set up Africa’s first liquid oxygen regional manufacturing initiative. 

Medical oxygen is an essential lifesaving medicine used to treat a wide range of diseases and chronic heart and lung conditions including pneumonia, COVID-19, advanced HIV infection, severe tuberculosis and malaria. It is also vital for maternal and newborn survival as well as in surgeries, emergency, and critical care. 

Yet many parts of sub-Saharan Africa remain severely under-resourced with some countries accessing less than 10% of the oxygen they need.

The initiative is projected to save 154,000 lives in the two countries alone over the next decade, with the three manufacturers expanding the production capacity threefold by over 60 tons per day, enabling treatment of thousands of additional patients each month.

“The key role of medical oxygen at all levels of care cannot be over-emphasised. Kenya’s drive towards universal health coverage requires uninterrupted access to all health products and technologies including medical oxygen,” said Harry Kimtai, Principal Secretary of the Ministry of Health of Kenya.

“I congratulate Unitaid and all their partners for making funding available and providing technical support to make this possible. We look forward to working together to continue advancing initiatives that boost availability of other health products and technologies apart from medical oxygen”

 

“This is Africa’s first regional manufacturing approach to increasing access to medical oxygen,” according to Unitaid, which is working with governments in both countries and other partners.

“The program aims to expand medical oxygen production by 300% in East Africa and reduce oxygen prices by up to 27%, making it more affordable for health care systems across the region, and enabling treatment of thousands of additional patients each month,” added Unitaid in a media release.

The Clinton Health Access Initiative (CHAI) will lead on market strategy, while PATH will focus on community and civil society engagement. 

Blended financing

“Using an innovative blended financing approach that combines grants awarded to Unitaid by Canada and Japan, concessional loans, and support from MedAccess through volume guarantees, this program will strengthen the capacity of Kenyan and Tanzanian oxygen suppliers, fostering competition in the market and ensuring a sustainable, affordable oxygen supply across East and Southern Africa,” according to Unitaid.

 The EAPOA aims to develop a regional network of liquid oxygen production facilities, known as air separation units, to ensure medical oxygen reaches underserved communities. 

Air separation units produce bulk liquid oxygen, which is the gold standard for medical applications, with compact storage, economic efficiencies, and high purity level. However, building these units requires significant capital investment.

Aside from the Mombasa facility, other facilities are planned in the Kenyan capital of Nairobi, Kenya, and Tanzania’s Dar es Salaam. 

These will serve as the key hubs for the production and distribution of liquid medical oxygen to their home countries and their neighbours, including Malawi, Mozambique, Uganda and Zambia. 

Medical oxygen is essential for treatment many illnesses.

“The Mombasa facility is just the beginning of a larger effort to transform oxygen access across Africa,” said Unitaid executive director Dr Philippe Duneton. 

“Medical oxygen is critical for saving lives, yet too many health facilities in this region struggle with access. By working together with Kenyan and Tanzanian manufacturers and other partners, we are ensuring that oxygen is no longer a luxury but a basic right for all patients, especially in times of critical need.” 

The program is part of a broader Unitaid strategy to increase regional and local production of essential health products in Africa, in line with continental initiatives to enhance health security, such as Africa CDC’s Partnership for the Harmonization of African Health Products Manufacturing. 

“The Project will focus on three main aspects ensuring its sustainability,” said CHAI country director of East and Southern Africa, Gerald Macharia.

“Well-placed infrastructure selected in partnership with Ministries of Health, longer-term budgeting for liquid oxygen supply, and the grant/ loan /volume guarantees available to companies, which aim to facilitate lower pricing, patient access, and regular payment for services in the long-term.” 

Meeting in Nepal for the International Lead Poisoning Prevention Week 2024
A lead poisoning prevention workshop in Kathmandu, Nepal organized by the Ministry of Health and Population (MoHP) and WHO Country Office for Nepal.

The US Environmental Protection Agency (EPA) recently announced a new ruling that requires drinking water systems to replace lead pipes within 10 years. 

The rule also strengthens requirements to locate lead pipes, improve testing for lead in water, and ensure that exposure is minimized while lead pipe replacement efforts are underway.

“Families like yours, exposed to lead in the water–they deserve better… We’re finally addressing an issue that should have been addressed a long time ago: the danger lead pipes pose to our drinking water,” said President Biden earlier this month. 

The EPA estimates that up to nine million US homes are served through legacy lead pipes across the country, many of which are located in lower-income communities and communities of color, “creating disproportionate lead exposure burden for these families,” the agency said in a press release.   

To remove the millions of lead pipes still in use, the EPA has tapped $2.6 billion from the Bipartisan Infrastructure Law. The agency estimates that the public health and economic benefits of the final rule are estimated to be up to “13 times greater than the costs,” including protecting 900,000 infants from low birthweight, preventing 2,600 cases of ADHD, and reducing 1,500 cases of premature death from heart disease each year following the ruling. 

Sources of lead in drinking water
The EPA’s new ruling could over two thousand cases of ADHD and protect nearly a million infants from being born with low birthweight each year.

The Biden Administration’s announcement came just two weeks before International Lead Poisoning Prevention Week, which highlighted the persistent threat of lead for the world’s children population. 

“Lead continues to be one of the greatest public health concerns,” said Dr Maria Neira, World Health Organization (WHO) environment director. “Urgent action is required from member states to prevent exposure to lead.”

The United Nations Children’s Fund (UNICEF) estimates that one in three children have blood lead levels at or above 5µg/dl – levels that can cause lifelong neurological, behavioral, and health problems like anemia, hypertension, and toxicity to reproductive organs. “The science is clear,” noted an EPA statement, “lead is a potent neurotoxin and there is no safe level of exposure.”

Both the EPA and US Centers for Disease Control and Prevention (CDC) recommend having children tested for lead as the best way to determine exposure, especially if living in a house built before 1978.  

High risk of elevated lead in South Asia 

Lead exposure hot spots
South Asia, Africa, and parts of South America are lead exposure hotspots.

UNICEF’s landmark 2020 lead poisoning report exposed the scale at which children are exposed to high levels of lead. Of the 815 million children estimated to have elevated blood lead levels, nearly half live in India, Pakistan, Nepal, and other South Asian countries. 

The reasons for higher exposure, the UNICEF report notes, comes from a high prevalence of unsafe lead-acid battery recycling, and contaminated spices, ceramics, and toys. Children can also be exposed to lead in soil, dust, air, and water.  

Fewer regulations and enforcement leaves industries lacking environmentally safe practices, and the absence of blood lead screening make it difficult to protect children from lead hazards. The report also cites poor nutrition as a risk factor for higher lead absorption in lower-and middle-income countries. 

Brochures for healthy homes and lead prevention
Educational materials in Rochester, New York, for people at higher risk for lead poisoning.

“With few early symptoms, lead silently wreaks havoc on children’s health and development, with possibly fatal consequences,” said Henrietta Fore, UNICEF’s Executive Director at the time, at the report launch.

“Knowing how widespread lead pollution is — and understanding the destruction it causes to individual lives and communities — must inspire urgent action to protect children once and for all.” 

“Since the 1970s, efforts to reduce lead in paint, gasoline, water, yards and even playgrounds have resulted in considerable success in reducing blood lead levels among children in the United States,” wrote the report authors.

“The issue of lead poisoning is not new, but our understanding of the scope and scale of its impacts and feasible solutions has never been better. Proven solutions exist for low- and middle-income countries, those most burdened by this challenge. Those solutions can be implemented today.”

Image Credits: S. Samantaroy/HPW, WHO, EPA, UNICEF.

Rwandan Health Minister Dr Sabin Nsanzimana (left) and WHO Director General Dr Tedros Adhanom Ghebreyesus address a media briefing in Kigali on Sunday.

After a full week of no new Marburg cases, Rwanda appears to have contained one of the biggest recorded of the deadly virus outbreaks – and with a low case fatality rate of 24%.

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, who visited the country over the weekend, praised the level of Rwanda’s critical care for patients as well as how the country deployed high-level leadership  to address the viral haemorrhagic fever, which often kills over 80% of those infected.

“Two of the patients we met had experienced all of the symptoms of Marburg, including multiple organ failure, but they were put on life support, they were successfully intubated and extubated, and are now recovering,” Tedros told a media briefing in Rwanda on Sunday.

“We believe this is the first time patients with Marburg virus have been extubated in Africa. These patients would have died in previous outbreaks.”

Intubation involves inserting a tube through a patient’s nose or mouth into their windpipe (trachea) to help them breathe. This tube can be connected to a ventilator. Extubation is when the tube is removed.

Tedros added that Rwanda had worked for many years to “strengthen its health system, to develop capacities for critical care and life support that can be deployed both in regular hospital care and in emergencies”.

However, he warned that Marburg is “one of the world’s most dangerous viruses, and continued vigilance is essential”.

The outbreak will only be declared over once no new cases have been recorded for 21 days, potentially on 5 November.

Sabin’s vaccine candidate used

Although there are no approved vaccines or therapeutics for Marburg, Rwanda fast-tracked the trials of a vaccine candidate from the Sabin Vaccine Institute, and an antiviral drug, remdesivir.

On 5 October, Sabin delivered 700 doses of its single-dose candidate vaccine, followed by a further 1,000 on 12 October.

These have been used to vaccinate health workers “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. Patients’ close contacts have also been vaccinated.

Rwanda developed its own trial protocol after rejecting the WHO’s protocol which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science. Rwanda opted to vaccinate all trial participants at once.

However, the remdesivir trial does involve a control group.

“The swift initiation of the open-label trial was set in motion on 26 September, when the Rwandan President’s office contacted Sabin CEO Amy Finan to request assistance with the outbreak response,” Sabin said in a statement.

Rwanda officially declared the outbreak the next day.

“In an outbreak, every moment counts, and our seamless collaboration with the Rwandan government was key to accelerating the process,” said Finan.

Sabin’s manufacturing partner, Italy-based ReiThera, produced the drug substance and filled and finished doses for shipment to Rwanda.

“On our side, we moved quickly by leveraging our experience with other outbreaks and having vaccine doses and supporting documents ready, thanks to a strong partnership with ReiThera,” Finan added.

Sabin’s team only consists of 15 staff members, but Finan said that “their dedication, along with that of our Rwandan colleagues, BARDA [the US Center for the Biomedical Advanced Research and Development Authority] and other partners, enabled us to mobilise so rapidly. 

“This remarkable effort highlights the power of partnerships and preparedness in addressing urgent public health needs,” said Finan, who also visited Rwanda over the weekend.

Meanwhile, Tedros congratulated Rwanda for the speed with which it initiated trials of both vaccines and therapeutics, adding that the WHO hopes that these trials “will help to generate the data to support approval of these products for future outbreaks”.

Belen Calvo Uyarra, the European Union’s Ambassador to Rwanda, also praised the country’s rapid response to containing the virus.

“Respect to the government of Rwanda and the Rwanda Ministry of Health for proactive leadership, rapid and robust continued response, and professionalism of health workers,” Uyarra posted on X.

She and Tedros also visited the site of the BioNTech vaccine manufacturing facility, announced two years ago to facilitate local production of vaccines. 

“I was very pleased to see the significant progress in construction,” said Tedros.

“One of the key lessons of the COVID-19 pandemic was the need to expand local production of vaccines to avoid the inequitable access to vaccines that we saw, and we’re pleased to see the way Rwanda and BioNTech are investing in local production.

“You know how Africa was treated when the vaccines arrived, with vaccine inequity and vaccine nationalism, and we hope these strategic investments will fix the inequity problems we faced during COVID.”

 

European cities
Experts at the yearly Lancet International Health lecture argued that green urban planning can improve health.

Cities that fail to take meaningful climate action face a future of severe degradation with infrastructure collapse and environmental deterioration, warned climate and health experts at the yearly Academy of Medical Sciences & The Lancet International Health Lecture in London. 

“Madrid’s climate in 2050 will resemble Marrakech’s climate today. I don’t think we want that,” said Professor Mark Nieuwenhuijsen, the keynote speaker. To stave off this scenario, cities must adapt with health priorities at the forefront. “For our cities, we’re looking towards solutions that reduce CO2 emissions and also improve environment, equality and, of course, liveability and health.”

By 2050, two-thirds of the global population is expected to live in a city. Yet climate change is increasingly threatening human health in urban areas, where swaths of asphalt and concrete exacerbate rising temperatures. Climate change accounts for 37% of heat-related deaths, leaving cities especially vulnerable to heat waves and extreme heat. 

Dr Mark Nieuwenhuijsen argues that urban planners must consider health is designing the future of cities.

Preventing climate-related mortality in cities requires urban planning with an intentional health focus, commented Nieuwenhuijsen. He argued that smart urban planning reduces greenhouse gas emissions and promotes health, but only if we can break away from an “addiction” to fossil fuels.

“We know that these fossil fuels are responsible for more than 5 million deaths each year because of air pollution.” Despite the growing knowledge of the health burden of fossil fuels, cities continue to sprawl “with Europe leading the way.” Fossil fuel use has led to “car-centric asphalt-dominated urban planning and extensive urban sprawl, which have detrimental effects on health,” said Nieuwenhuijsen.

Sprawling urban areas increases car dependency, even though public transport systems and active transportation – like walking and cycling – are more cost effective. 

Compact vs green cities – policies that include the best of both models

European cities categorization
Four different European city configurations vary in their health and environmental effects–with compact cities being the lowest emittors yet having the highest mortality rates compared to less dense cities.

In Europe, where many cities are growing faster than their populations, high population density has potential advantages like shortened commute times, decreased care dependency, higher energy efficiency, and decreased building material consumption.

The more compact a city, the more efficient. Yet compact cities have potential drawbacks, including higher mortality rates, traffic density, air and noise pollution, and excess heat. 

Nieuwenhuijsen presented European cities as falling into one of four groups: compact high-density cities, open low-rise medium-density cities, open lowrise low-density cities, and green low-density cities. Analyzing cities across these categories show a split: cities either fall into higher mortality but lower greenhouse emissions, or lower mortality but higher emissions.

A city like Barcelona – compact and high-density -–can expect to have a 10-15% higher mortality rate, poorer air quality, and stronger heat island effect, but lower emission, explained Nieuwenhuijsen. Overall, the researchers estimated that poor urban planning results in 20% of premature mortality. “Barcelona is a wonderful city, but it has too much air pollution, too much noise, not enough green space.”

“In contrast, greener and less densely populated cities have lower mortality rates, lower air pollution levels, and a lower urban heat island effect, but higher carbon footprints per person.”

This dichotomy – where current urban configurations are either high emitters with better health quality, or lower emitters with worse health – means that cities must implement policies that better health and reduce emissions. Nieuwenhuijsen believes that both are possible. 

Policies that lower air pollution levels and reliance on cars, and increase green space, cycling lanes, and physical activity would “substantially reduce the mortality rate,” he argued. 

Super blocks, green space, and 15-minute cities

Barcelona superblocks
Barcelona is one a several major cities implementing innovative urban planning to improve environmental and human health.

Several cities have begun implementing innovative urban models that bridge the goals of lower emissions and healthier environments, especially in how they use public land.

“A lot of our public space in our cities is, at the moment, actually used by cars. I mean, in Spain, 69% of public space is used by cars because our roads are also public space. Parking is public space. I mean, this is the kind of space that we could use in a much better way,” commented Nieuwenhuijsen.

In Paris, a vision to become a “15-minute city” – where all major destinations can be reached within 15 minutes of the home – has increased investments in bike lanes and car-free zones.

Barcelona’s “superblocks,” London’s low traffic neighborhoods, and the Vauban Freiburg car-free neighborhood are all promising solutions to reduce premature deaths and increase green spaces.

 Nieuwenhuijsen and other experts convened at the event pointed to these examples and others as evidence that urban design changes are possible. 

Several Chinese cities have also embraced the intersection of urban planning and novel technologies to prevent flooding through their Sponge city designs, commented Dr Maria Neira, the World Health Organization’s director of Public Health, Environment and Social Determinants of Health. 

“More and more we need to be prepared to work with urban planners, the architects working at the city level. And I have the impression that sometimes they are better prepared, more advanced, more engaged and more passionate, than our public health officers working at the city level,” said Neira.

“So we need to sort it out and create these very strong arguments for our public health officers as well, to push at the city level, at the Urban level, for engagement with the Urban healthy urban planning.” 

Image Credits: Michele Castrezzati, Fons Heijnsbroek, The Lancet, The Lancet.

Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the background emissions from household, traffic and industry..

DELHI, INDIA – North India’s air quality index (AQI) is rising sharply, having already crossed 300 in parts of the region, indicating “very poor” levels. And it is expected to worsen as winds shift towards Delhi and farmers intensify their autumnal practice of burning crop waste. 

The sharp seasonal increases have come yet again this year in Delhi, India’s capital, despite Delhi’s state government announcing a more comprehensive annual Winter Action Plan compared to previous years. 

The widespread practice of exploding firecrackers will likely add to worsening pollution loads during the upcoming Hindu festival of Diwali, celebrated at the end of the month, taking the AQI over 400, or “severe” for prolonged periods. The AQI index reflects a composite of hazardous pollutants, including fine particulates (PM2.5), ozone (O3), and nitrogen dioxide (NO2). 

In three different sessions over the past three weeks, India’s Supreme Court lashed out at the federal government’s Commission on Air Quality Management (CAQM) for failing to take enough pre-emptive action.  It specifically censured the Commission for its continued impotence in controlling rice crop stubble burning – a still widespread practice in rural provinces which spreads smoke across the region.  

In its last hearing on Wednesday, the Supreme Court specifically set a one-week deadline to prosecute violators and slammed the northern state governments of Punjab and Haryana for failing to stop farmers from burning crop stubble, despite repeated directives by the Court. 

On 14 October, the Delhi state government, meanwhile, banned manufacturing, storage and selling of firecrackers until January 1, 2025. But routinely low enforcement of those rules typically encourages widespread evasion. And outside of Delhi, neighbouring states haven’t taken action.  

Real time AQI levels in Delhi on Friday, 18 October, crossing the threshold from unhealthy to hazardous.

Rising pollution levels follow three months of relative respite 

Comparison of seasonal trends in air pollution levels from 2023-2024 – WHO’s PM2.5 daily guideline level is 15 µg/m3.

The rising pollution levels follow three months of relative respite. 

From July to September, AQI levels ranged from “moderate” (101-200) to even “satisfactory” (51-100),  including days of the cleanest air quality that New Delhi and most of north India has seen this year, thanks largely to an extended period of monsoon rains. 

But then by the end of September, air pollution levels began their seasonal rise once more,  foretelling another annual crisis.  

The Supreme Court’s directives to the CAQM, are unlikely to make a significant difference, say experts and activists. The body is unlikely to heed its orders and individual officials usually aren’t held personally accountable to the court. And the Delhi state government’s Winter Action Plan, expanded to 21 action points this year from 15 last year, remains feeble and ineffectual.

“The Supreme Court may have best intentions – but it really comes down to who is going to make it happen. I don’t see decisions taken in court solving anything,” Jai Dhar Gupta, a Delhi-based activist, told Health Policy Watch. 

Air pollution levels could even be worse than previous years

Peak air pollution levels in the Himalayan foothills and Indo-Gangetic plain that extends from Pakistan to Bangladesh across northern India.

It’s an annual story that continues to be repeated over the past decade or more. In the autumn months, India’s south-westerly monsoons recede, winds still and temperatures fall trapping pollution closer to the ground.  At the same time, rural crop burning begins and household heating commences, gripping the landlocked Himalayan foothills and Indo-Gangetic plain in a toxic haze as PM2.5 level soar. The 700,000 square kilometre region is home to half a billion Indians, as well as hundreds of millions more people in Pakistan, Nepal and Bangladesh who share the airshed. 

After a dip in average pollution levels in 2023 across India, there have been hopes that positive trends would continue. 

But with the continued lack of action at pollution sources, key air quality scientists who spoke to Health Policy Watch, and asked not to be named, were not optimistic. 

Some were even predicting that average pollution levels in the upcoming winter could be much worse than in previous years, especially as the India Meteorological Department is predicting a colder winter 2024. But freak weather patterns of meteorology, temperatures, wind and humidity can change things unexpectedly. 

Gupta, who tracks the pollution indicators closely, also is not optimistic. 

“According to the (meteorological) predictors I’ve been following, I’m expecting winds to turn on the 23rd (October). The entire Indo -Gangetic plain will be in the downwind path of the smoke from farm fires. It’s going to be hell.”  

Dust-related air pollution in decline – not combustion 

PM 2.5 in decline – but mostly due to better dust control, rather than curbs on the trajectory of fossil fuels and their emissions.

The pessimistic projections come as something of a wake up call – since some recent analyses have suggested that India’s air pollution levels were finally in a period of decline. 

Data presented at a seminar hosted by the Energy Policy Institute at the University of Chicago in September showed a drop in average PM 2.5 and PM 10 concentrations from 2019-2023. 

However, most of that decline was attributable to new dust control measures undertaken in cities. And at the same time, combustion sources and their emissions have been increasing business as usual.  

That has been reflected in current economic indicators – which show increases in sales and consumption of diesel, petrol, coal and imports of petcoke, a byproduct of oil refining, used in manufacturing – all key pollution producers. 

“While we are seeing a drop in PM 2.5 mainly coming from the dust management activities in the cities, on the fossil fuel combustion side, the story is still continuing,” said the prominent Indian air quality researcher Sarath Guttikunda, at a University of Chicago webinar panel presentation in September. 

Farmers as a political tinderbox – and that has limited agricultural reforms 

Punjab, India – Crop burning reduces soil quality and worsens air pollution. But politicians haven’t manage to get it under control.

The nuanced look at the trends underlines how more fundamental reforms in key pollution contributors have advanced in fits and starts.  

Crop stubble burning at its peak can contribute up to 30% of the pollution load of adjoining cities. But farmers are a political tinderbox for all political parties. 

Attempts to reduce crop-burning emissions at source, by incentivizing farmers to process their rice crop stubble, turn it into compost, or plant more traditional and less water-intensive legumes and other crops, have been underway. 

But they have still failed to really take off, says Gupta, due politicians’ fears of confronting the powerful farm lobby. “Who is going to have that conversation with farmers?” he asks, a nod to the political clout Indian farmers have. “No party wants to lead on health and environment,” he says.  

For example, the Aam Aadmi Party, which currently rules Delhi and won Punjab State in 2022, spent years blaming Punjab’s then-governing Congress Party for failing to restrain farmers from burning crop residue. 

However, it is now strangely silent – because its own party’s government has been unable to solve the problem in Punjab as well.

Other observers note that some progress was seen in 2023 in curbing crop stubble burning through increased fines and enforcement.  No-burn incentives were also offered in Punjab State to make alternative means of processing the crop waste more financially attractive. But it remains to be seen whether that trend will continue this autumn. 

Even so, the Supreme Court recently lashed out at the CAQM sharply for its failure to curb stubble burning in both Punjab and Haryana states, noting that changes have not gone nearly far enough. 

Urban air quality plans also falling short

On another front, the country’s National Clean Air Programme (NCAP) has fallen far short of fallen far short of its goals, according to a recent report by the Indian Center for Science and Environment.  

Amongst the 131 cities covered by NCAP, most have so far failed to meet the target of reducing air pollution concentrations by 20-30% as compared to 2017 levels. 

And the lion’s share of the investments made were focused on dust control measures, such as paving roads, filling potholes, and deploying mechanical sprinklers and sweepers, the CSE report shows. Less than 1% was spent on controlling toxic emissions from sources like industry, and around 40% of funds weren’t spent at all. 

At the same time, the government’s own data has shown that more than 50% of all sanctioned posts in state pollution control boards and committes are lying vacant, reflecting the continuing lack of investment in strategic planning to clean India’s air. 

Reactive, short-term measures 

Smog towers erected in Delhi – failed to reduce levels of PM2.5 particles.

That has left state and national government officials scrambling to institute mostly reactive, short-term actions, such as temporary curbs on construction, traffic and physical activity, when a crisis actually hits. 

Called “Graded Response Action Plans,” these actions are triggered when AQI breaches “poor,” “very poor,” and “severe” levels.

This year’s 21-step ‘Winter Action Plan’ also includes deploying drones to monitor pollution hot spots, creating artificial rain and instituting “green” awards in addition to the tried (and failed) steps of road traffic rationing and construction dust mitigation  – none of which address an actual reduction of emissions at source. 

“They’re now talking cloud seeding! It just makes no sense at all. Ridiculous!,” says Gupta.

Delhi also has set up ‘smog towers’, at huge public cost, which were supposed to act like outdoor air purifiyers, absorbing pollution, but in fact lie practically defunct. Citizen groups have long stated that these are entirely unsupported by science. 

“As far as the Delhi government’s winter action plan is concerned, it is a very feeble attempt to look like they’re doing something. There is no meat in it,” Gupta said.

“Given the Aam Aadmi Party has been in power [in Delhi] for the last ten years, what is clear is this; either they don’t care enough to fix it – or they are plain incompetent,” he added, referring to the opposition party that controls the Delhi state government as well as a key pollution-producing rural state, Punjab. 

“This isn’t rocket science. Beijing and Mexico brought their pollution down,” he said, adding in the same breath “but at least Delhi is talking about doing something – others – Haryana and Uttar Pradesh – aren’t even doing that,” he said, referring to other states with heavy pollution loads from crop stubble burning, where Prime Minister Narendra Modi’s Bharatiya Janata party holds the balance of power.

Local emissions also a big background contributor 

Bumper to number traffic in Delhi’s haze of 2nd November, 2023, when PM 2.5 levels in this location were over 450 micrograms/cubic metre (µg/m3).

In cities like Delhi, the background pollution load also remains unsustainably high –  even before seasonal contributors like stubble burning, firecrackers, and biomass heating began to make things worse.

“If you just take Delhi today – 20 million people, 10 million cars, 20,000 tonnes of waste, increasing construction, burning brick kilns – nothing has changed on the ground that could lead to reduced emissions,” said one data scientist who has been tracking India’s pollution for nearly 25 years and predicts another highly polluted north Indian winter. 

“There has been no behaviour change either. So why would the base pollution load decline? It’s just going up.”

This was apparent in early October, for instance, when the AQI had sharply worsened even before smoke from a single firecracker or farm fire had begun to drift towards the city.  

This wasn’t because farmers hadn’t started burning crop stubble – satellite images showed that they had. But wind direction (being south-westerly) was still blowing smoke away from north India’s areas of highest population density. 

Within the next week, wind direction will change, bringing more and more smoke from burning fields in neighbouring states – directly to urban centres in the National Capital Region, and into the lungs of the 46 million people living there. From this point, things are likely to spiral downwards, like they do every year.

Despite bans in Delhi, firecrackers celebrating the annual Hindu Diwali festival, India’s biggest festival, will smother the north Indian plains with even higher pollution levels around the 31 of October.  Post-Diwali, PM2.5 peaks of 3,000 microns have been recorded on some days in past years. And these levels will remain persistently high, with some troughs and peaks, until nature comes to the rescue in January with winds, rains and rising temperatures. 

Delhi is seen as ground zero – but levels may be higher elsewhere

According to the 2024 Air Quality Life Index, produced by the University of Chicago’s Energy Policy Institute (EPIC), the exposure of northern Indians’ to excessive levels of PM2.5 results in nearly 12 years lost of life expectancy, as compared to what it would be if the WHO Air Quality guideline for PM2.5 of 5 micrograms/cubic metre (5 µg/m3), as an annual average, were met. 

For Indians overall, life expectancy is cut by around 5.3 years from exposure to the tiny particles, which penetrate the lungs and travel through the blood stream to almost every organ of the body – causing strokes and hypertension, as well as lung diseases and cancers.   

Among India’s metropolitan areas, New Delhi’s ‘National Capital Region’, with its high population density and proximity to national government offices, is probably the most closely measured and monitored city for air quality.  

While Delhi has typically been the poster child for the region’s pollution woes, experts have often pointed out that there are many areas in north India that may even be more polluted than Delhi – due to lack of precise measurement, slip under the radar, experts note. 

CAQM – a ‘toothless tiger’ 

In its three weeks ago, the Court specifically referenced the CAQM saying it has vast powers including directing closure of polluting units, which it wasn’t using. “There has been total non-compliance of the CAQM Act. Have committees been constituted? Please show us a single step taken. Which directions have you used under the Act? You are silent spectators. You are doing nothing,” the court said. 

Observers note that while the Supreme Court can issue directives, it is up to the state, its politicians and bureaucrats (especially the police) to ensure implementation and enforcement. 

And that is not the case, as the Court noted by its own admission in yet another hearing last Wednesday, when it called out the air quality bureaucrats of the CAQM as a “toothless tiger”.

Image Credits: Flickr, Aqicn.org, CEEW/compiled from data by the CBCP/unpublished, University of Chicago , University of Chicago/EPIC Clean Air Program, Neil Palmer, Care for Air India.

Dr Jean Kaseya and Dr Sabin Nsanzimana.

While Rwanda appears to have its Marburg virus outbreak under control with no new cases reported in the past three days in Rwanda, mpox continues to spread – now affecting 18 countries with 3051 new cases in the past week.

Since declaring the Marburg outbreak three weeks ago, Rwanda has confirmed 62 cases, of which 15 have died, 38 have recovered and nine cases are still receiving treatment with the majority improving, said Health Minister Dr Sabin Nsanzimana on Thursday.

“The case fatality rate overall is 24% and we’ve vaccinated 856 people,” Nsanzimana told an Africa Centres for Disease Control and Prevention (CDC) briefing, describing the trend as “very encouraging”.

As the vaccine is “investigational”, its rollout required more rigorous consent, sampling and documentation, but demand for it has been “very high”, he added.

the vaccines you are providing highly accepted, especially among healthcare providers. Around 90% of those infected are health workers and their close contacts from the intensive care units of two hospitals that treated the very first patients. The index patients was co-infected with malaria which slowed the diagnosis of Marburg, which has similar symptoms.

Rwanda’s health ministry has also tested over 4,000 people “to make sure we don’t miss any cases”, added Nsanzimana.

He attributed “intense activity on the ground”, ring vaccination [vaccinating the close contacts of people with Marburg] and new antivirals for the turnaround in what is the biggest Marburg outbreak ever recorded. 

The virus, which is from the same family as Ebola and, in some outbreaks, has killed over 80% of those infected.

While the zoonotic origin of the outbreak is still unknown, Nsanzimana said Rwanda will be reporting its findings on the the serology and gene sequencing of the virus within a few days. At the same time, it has a team on the ground hunting for the source of the virus.

Mpox ‘not under control’

Mpox cases have now been identified in 18 African countries, with new additions being Zambia and Zimbabwe. In the past week, 3051 new cases have been reported – including two male prisoners in Uganda.

“Mpox is not under control,” warned Africa CDC Director-General Dr Jean Kaseya.

Despite calling a continental meeting in April to warn countries of the risk, cases have risen exponentially: from slightly under 6,000 then to 42,438 suspected mpox cases at present – although only 8,113 have been clinically confirmed.

A rapid test to diagnose mpox is in the pipeline and will transform the testing landscape, said Kaseya.

Kaseya flagged the threat to internally displaced people (IDP), particularly in the Democratic Republic of Congo (DRC), and prisoners – both groups characterised by close contact.

In the eastern DRC, conflict has displaced some 2.5 million people who are now living in camps in close quarters with limited access to water, sanitation and hygiene. 

The two Ugandan prisoners were initially diagnosed with chicken pox – which has small lesions that are itchy not painful like mpox.

DRC vaccination plan includes MSM, transgender people

The DRC’s vaccination campaign started two weeks ago in three provinces – North Kivu, South Kivu and Tshopo – and is “moving well”, said Kaseya, who hails from DRC.

The country’s plan includes men who have sex with men (MSM) and sex workers, as mpox can be sexually transmitted.

In DRC, same-sex sexual contact is not outlawed as it is in many of the other countries currently affected by mpox – Uganda, Burundi, Kenya, Tanzania, Zambia and Zimbabwe.

“When are talking about MSM, we are clear as Africa CDC. We are saying all human beings have the same rights, and we are supporting countries to plan vaccination for all of them, including men having sex with other men,” said Kaseya empathically.

“We are proud and we are glad to see in DRC that we have MSM included,” he added.

Kaseya said that early messaging about mpox Clade 1B only being associated with sexual transmission was wrong – as was the failure to talk about MSM as the main mode of transmission iun the 2022 outbreak.

“There was the stigma talking about men having sex with other men as the main transmission mode of mpox. But if we put it in the context in Africa, that one in some countries is still a taboo. 

“We believe with our effort, what we are doing is sensitizing countries, and we are proud to see that DRC are mentioning that.”

He added that risk communication and community engagement involving “people who are openly saying we are these key populations” was also important.

Uganda tightened its anti-LGBTQ laws recently and, while it plans to test all 1,087 prisoners who possibly had contact with the two prisoners recently diagnosed with mpox, it is unclear how it will approach MSM as a mode of transmission other than to crack down further on smae-sex activity.

Dr Tedros Adhanom Ghebreyesus.

Two days into the second round of vaccinating children against polio in Gaza, World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyesus made an urgent appeal for a political solution to the war.

“People we have saved today or vaccinated today, end up being killed tomorrow, so what’s the point?” Tedros asked at a media briefing on Wednesday.

“The level of destruction, especially in Gaza, is just unbelievable. I don’t know if [Gaza] can be inhabitable. More than 70% of its infrastructure is gone. So I don’t think aid is the issue. To be honest, the focus should be on addressing the conflict politically and focusing on bringing peace.”

The WHO and UNICEF are in ongoing negotiations with Israeli authorities for “area-specific humanitarian pauses” to enable the polio vaccination campaign, said WHO’s Gaza representative Dr Rik Peeperkorn.

At least 90% of children need to be vaccinated against polio for there to be community protection, a target that was achieved a month ago in the first round – but before Israel intensified its attacks on northern Gaza.

“You need an area-specific humanitarian pause because you will have 60 to 70 fixed [vaccination] sites and hundreds of mobile teams, which need to move around. But most important, the parents need to be able to bring the children in all safety to those mobile teams and those fixed sites,” said Peeperkorn.

Dr Rik Peeperkorn: Need to move out of ‘polio bubble’.

Pathways for medical evacuations

However, Peeperkorn said there was a need to move out of the “polio bubble” to address the multiple of other health needs in Gaza.

Since May, only 282 patients have been medically evacuated (medivaced) to other countries – primarily the United Arab Emirates (UAE) for treatment, said Peeperkorn.

“We estimate that more than 12,000 critical patients need to be medivaced outside Gaza, so we need regular, sustained medivac procedures. 

“We need medical corridors, and the first one to be restored is a traditional referral pathway, which is from Gaza to East Jerusalem and the West Bank. That should be restored. The hospitals in the West Bank and East Jerusalem are ready to receive those patients,” he said, pointing out that, in the past, the majority of patients seeking treatment at these hopitals were canver patients.

“The second corridor is to Egypt and to Jordan, and from there, to other countries [if they] are willing to accept those specific cases as needed.”

Peeperkorn noted that a quarter of the 98,000 injured Gazans – some 24,000 to 25,000 people – “will need lifelong assistive support, rehabilitation services, and many of them will need also additional specialized surgical operation.

“So also a huge [number] of them need to be medivaced outside of Gaza, including, of course, the trauma cases.”

Slow pace of aid

“In the first half of October, only one UN mission out of 54 to northern Gaza was successfully facilitated. The rest were denied, canceled or impeded,”said Tedros.

“We asked Israel to give WHO and our partners access to the north so we can reach those who desperately need aid.”

After nine failed attempts, the WHO and partners were finally able to deliver medical supplies and fuel to the Kamal Adwan and Al-Sahaba hospitals in northern Gaza on Saturday, added Tedros.

“On Monday, the courtyard of Al Aqsa Hospital in Deir al Balah was hit by an air strike, the eighth time that Al Aqsa hospital compound has been attacked since March this year. Under international humanitarian law, all actors have a duty to ensure health care is protected and not attacked,” said Tedros.

Israel has repeatedly claimed that Hamas military forces frequently operate from Gaza’s hospitals, as well as holding Israeli hostages in some hospital wards, in earlier periods of the war. In the case of the Al Aqsa debacle, the army acknowledged shelling the compound, which reportedly killed three people and wounded 40, saying it was targeting a meeting of Hamas commanders. Overnight Friday, Israel also reportedly cut off the electricity and fired into the upper floors of the Indonesian hospital, in northern Gaza, killing at least two people, according to the Palestinian Wafa news agency. Further weekend attacks were reported around northern Gaza’s Kamal Adwan and al-Awda hospitals, hobbling their services as well.

At the WHO briefing, WHO’s Principal Legal Officer, Steven Solomon, reiterated that, in terms of International Humanitarian Law, “all combatants should understand that health facilities and health workers are off limits. Targeting them or militarizing them are both prohibited.”

‘Similar story in Lebanon’

“It’s a similar story in Lebanon, where, since the escalation of hostilities began one month ago, WHO has verified 23 attacks on health care that have led to 72 deaths and 43 injuries among health workers and patients,” said Tedros.

“Hospitals are already under massive strain as they deal with an unprecedented influx of injuries while trying to sustain essential services.

“A growing number of health facilities have had to shut down, particularly in the south, due to intense bombardment and insecurity. Almost half of all primary health care centers in conflict-affected areas are now closed, while six hospitals have been fully evacuated and another five partially evacuated today,” said Tedros.

Lebanon’s Ministry of Public Health has confirmed a case of cholera in north, and WHO has “activated the cholera preparedness and response plan to strengthen surveillance and contact tracing, including environmental surveillance and water sampling”, added Tedros.

In August, Lebanon’s Health Ministry commenced a cholera vaccination campaign targeting 350,000 people living in high risk areas, but this was “interrupted by the escalation in violence”, Tedros noted.

–Updated 20.10.2024 with weekend reports of conflicts around northern Gaza hospitals.

Dirty smoke billows from chimneys in Poland.

Europe is now poised to deliver cleaner, healthier air – thanks to adoption this week of the revised Ambient Air Quality Directive (AAQD) by the European Union. This marks a crucial victory for the health and wellbeing of millions across the EU and serves as a beacon for the clean air movement worldwide.

The AAQD underpins Europe’s air quality standards, and its revision is a significant breakthrough in addressing the public health crisis of air pollution. 

Each year, air pollution cuts short the lives of nearly 300,000 Europeans, contributing to respiratory illnesses, cardiovascular disease, and other serious health conditions, according to the EU’s impact assessment report.

Improving air quality is a public health imperative. It’s also crucial for the environment and the economy, making the case for stronger EU-wide legislation even clearer.

A healthier future

The revised AAQD brings Europe’s air quality standards closer to the World Health Organization’s (WHO) air quality guidelines. It sets tougher, legally binding limits on harmful pollutants like nitrogen dioxide (NO₂) and fine particulate matter (PM2.5), representing a doubling of ambition for these two major pollutants, in line with WHO’s interim targets. 

These pollutants have long been linked to severe health impacts that are particularly harmful for vulnerable groups, such as babies and young children and people with certain conditions such as Chronic Obstructive Pulmonary Disease. 

By delivering cleaner air, the AAQD could mean the difference between a lifetime of illness and a healthy future for future generations.

The AAQD also strengthens the monitoring and measuring provisions for air quality, introducing air quality roadmaps to support progress ahead of its 2030 deadline. The new rules bring about a fairer regime for people affected by air pollution as the rules for access to justice and compensation for those whose health have been impacted by dirty air have been improved.

Some of the most polluted regions within member states can delay meeting the new targets for up to 10 years (until 2040) under certain conditions. Although these derogations (or exceptions) provide more leeway than originally envisaged, the compromise, alongside strict conditions for delays, ensure that none of the 27 Member States are left behind. 

Significant impact if properly implemented

Overall, the Directive remains a significant win with ambitious targets and tightly regulated conditions for any delays. Importantly, the initially proposed ambition on limit values remained intact following the two-year legislative process, despite widespread pushback against legislation falling under the EU Green Deal, indicating the scale of this victory for clean air campaigners.   

One of the key reasons for the AAQD’s success is that it is both an environmental law and a critical public health intervention. By recognising that air quality is a matter of life and death, policymakers have acknowledged the need to protect the most vulnerable in our society. 

The impact of the new legislation in Europe will be significant if the AAQD is properly implemented. The new rules can prevent more than 55% of premature deaths linked to air pollution in the EU. That’s not just a number – that’s hundreds of thousands of people, each with families, who will live longer, healthier lives.

In addition to delivering significant health and environmental benefits, improving the air we breathe makes economic sense. Investing €6 billion annually in cleaner air will deliver up to €121 billion in benefits (according to the EU’s analysis). 

That’s equivalent to building hundreds of new hospitals or creating hundreds of thousands of new jobs in green industries. Echoing this analysis, the Brussels-based think tank, Bruegel, estimated that implementing clean air measures could boost economic growth by €50 to €60 billion every year[3] and save  approximately €600 billion each year in the European Union, the equivalent to 4% of GDP.

Ripple effect

The importance of the AAQD extends beyond the EU’s borders. By taking decisive action, the EU has positioned itself among the global leaders in air quality management, setting an example for other regions grappling with similar challenges. 

Air pollution is a global problem, responsible for eight million premature deaths annually worldwide, as reported in the British Medical Journal, and the EU’s solutions will, I hope, inspire other countries to pursue stronger actions.

Ongoing engagement and sustained political will are key to ensuring the success of these measures. The real test will come as member states move to transpose the Directive into law and work to implement these new standards. 

National and local governments will need to invest in cleaner technologies, green transport and clean heating while improving air quality monitoring and ensuring that enforcement is taken seriously.

Let’s celebrate this moment, but also remain focused on the work that still needs to be done. Air pollution is an invisible killer, shortening lives and ravaging our communities. With this new Directive, we are fighting back.

Jane Burston founded and leads the Clean Air Fund (CAF), a global philanthropic organisation working with governments, funders, businesses and campaigners to create a future where everyone breathes clean air. Before setting up CAF, Jane worked as head of Climate and Energy Science in the UK government. Prior to that, as head of Energy and Environment at the UK National Physical Laboratory, she managed a team of 150 scientists working in air quality, GHG measurement and renewable energy. 

 

Image Credits: Janusz Walczak/ Unsplash.