A health facility in Sopore in Kashmir’s Baramulla district. Mental health facilities are scarce in Kashmir.

SRINAGAR, India – Areeba* tucks a strip of tiny blue pills into the back of her mathematics textbook before heading to class. It’s become second nature.

“Half when I can’t sleep. One if I can’t walk,” says the 22-year-old university student, her voice calm, as if describing a cold remedy. “I don’t really want to take them, but it’s the only way to get through the day.”

Across Kashmir, India’s northernmost and politically volatile region, young people are self-medicating to cope with anxiety, sleeplessness and depression. The strains of decades-long conflict, repeated lockdowns, and recent flare-ups–including a drone strike and extended power blackouts during cross-border tensions in May–have left many struggling to find mental health care.

While India’s National Mental Health Mission has expanded services across several states, Kashmir remains critically underserved. With limited access to therapists, trained counsellors or psychiatrists, antidepressants, sedatives and illicit narcotics have become people’s primary coping mechanisms and are often obtained without prescription or follow-up.

Panic attack in the dark

Zubair Iqbal, a 20-year-old undergraduate in Sopore, recalls the night of 9 May vividly: “It was around 9pm. I had packed my bag for a flight to Delhi the next morning. “But because of the tension with Pakistan, it got cancelled. My mother came and said, ‘Zubair, come downstairs – we’ll eat in the blackout’.”

Iqbal was puzzled when the power went out, then heard what felt like “a thousand thunderstrikes.”

“My brother said it was just thunder, but I knew it wasn’t. It was a drone attack.”

He collapsed inside the house. “My legs were shaking. I couldn’t see properly. My heart was racing. I thought I was dying.”

The next day, he asked his father if he could see a doctor.

“My father said, ‘We won’t travel 40 kilometres to Srinagar for this. It’s nothing–you were just scared. Let’s go to the peer sahib (faith healer).’ I wanted to cry.”

Instead, Iqbal looked online for the name of an antidepressant, then went to a local pharmacy and bought it over the counter.

Hidden in plain sight

A clinical psychologist in downtown Srinagar, who requested anonymity because of workplace restrictions, says Zubair’s experience is typical.

“Because of the conflict and some of the highest unemployment rates in India – female unemployment here is 53.6% – symptoms of trauma are normalized,” she says.

She sees over 100 patients a day, many adolescents.

“Every other teenager between 15 and 18 reports some mental health concern. Many fear the schools will close again if the war escalates. Others worry their parents will lose their jobs. But very few actually seek therapy.”

Her observations reflect existing data. A 2015 survey by humanitarian group Médecins Sans Frontières (MSF) found that 1.8 million adults in Kashmir’s valley – about 45% of the population – experienced significant mental distress. Almost one in five people showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed symptoms consistent with depression, according to the study.

According to government Census figures from 2011, there were just 41 psychiatrists for the entire Jammu and Kashmir region, home to 12.5 million people. 

Mental health experts believe that the number has barely doubled in the past 14 years, leaving much of the population without access to specialized care.

Médecins Sans Frontières teams raise awareness about mental health in Kashmir.

‘We were just trying to survive’

Kubra Aziz, 24, lives in Uri, a village just 3km from the Line of Control, the heavily militarized border with Pakistan. She fled with her family to Baramulla during recent shelling in May.

“We left at night,” she recalls. “My cousin, who has a history of mental illness, began hyperventilating.”

They took shelter in a local college, where Kubra says her cousin screamed all night.

“The next morning, I took her to the district hospital, but the psychiatrist was on leave.”

That, she says, is routine: “Even when there’s a doctor, they may have 1000 patients. They’re overwhelmed. Misdiagnoses are common.”

In the absence of therapy, many Kashmiris turn to pills and substances – prescribed or not.

“Most people either buy psychiatric medication from pharmacies or turn to charas, tobacco, or anything that numbs the brain,” Kubra says.

One young man, Nadeem*, left Kashmir for Saudi Arabia three years ago.

“I was unemployed and addicted to hash. My family thought leaving Kashmir would help,” he says.

He quit drugs after moving abroad, but returned home recently amid renewed violence.

“The stress is back. I’m trying to hold on. But I don’t know how long I’ll last.”

A 2022 report from Kashmir’s only government-run drug de-addiction centre showed a 2,660% increase in patients since 2016. Doctors say most patients are not recreational drug users, but they are self-medicating trauma.

“I plan to leave again,” Nadeem says. “People from age 10 to 40 are trapped in addiction. Just look at the schoolkids.”

No therapists in schools

Residents of Kashmir seek health at one of the health facilities in the region during recent conflict between India and Pakistan.

Aman Bhat, a 17-year-old high school junior in Budgam district, says his missionary-run school has no mental health services.

“We don’t have a counsellor,” Bhat says. “If someone is anxious or depressed, there’s no one to talk to. Mental health is something we don’t even have words for here. We say, ‘My heart feels heavy.’ That’s it.”

Many of his classmates chew tobacco to manage stress. “What else can they do?”

In villages, Bhat notes, “We don’t have real hospitals like other parts of India. What do we have?”

Learning from Gujarat

Despite the scale of Kashmir’s mental health crisis, the region lacks community-based support models proven successful elsewhere in India, such as the Atmiyata program, which means “shared compassion” in Marathi.

Atmiyata was launched in Mehsana district of Gujarat in 2017 which comprises of 645 villages. Atmiyata Mitras – trained community volunteers – identify people in distress and provide up to six sessions of basic, evidence-based counselling in homes or local temples.

Volunteers use smartphones to screen culturally relevant films about unemployment, alcoholism, domestic violence, and other root causes of mental distress – issues that are difficult to talk about.

When symptoms exceed what a volunteer can handle, Mitras guide patients through India’s District Mental Health Programme, even accompanying them to clinics.

Because mental health and poverty are often intertwined, Mitras also help families apply for disability pensions, job schemes and social benefits.

What Kashmir needs now

“If the recent trauma in Kashmir has taught us anything, it’s that medication alone is not the answer,” says Dr Sameena Qadri, a South Asia-based public health psychiatrist. 

“Antidepressants and sedatives offer short-term relief. But without therapy, follow-up care and social support, the root causes remain untouched.”

This conversation is urgent as global leaders prepare for the UN High-Level Meeting (HLM) on Non-Communicable Diseases (NCDs) and Mental Health on 25 September. The meeting aims to ensure that 150 million more people worldwide gain access to affordable mental health care by 2030.

The HLM zero draft includes the target of 80% of public primary health care (PHC) facilities having essential mental health medicines and technologies available by 2030.

“These targets sound ambitious,” Qadri says. “But they must be grounded in places like Kashmir, where the mental health crisis is visible in pharmacies, schools and homes.”

She advocates for a multi-tiered, district-wide care system, with trained community volunteers delivering support and referring severe cases. She also calls for mobile mental health clinics and tele-psychiatry.

“School-based counselling is essential, especially in conflict zones. Children grow up with trauma and no outlet. Without care, we risk losing a generation.

“These aren’t luxuries,” she says. “They’re urgent needs.”

Call for global partnerships

“We need partnerships between governments, civil society and global health organizations to scale community care. The most vulnerable can’t wait for a perfect system. They need access now,” Qadri urges.

“Mental health is not a luxury. It’s dignity. You can’t talk about peace or sustainable development while millions suffer in silence.”

Kubra agrees: “We always talk about peace. But how can there be peace when people are breaking inside, and no one hears them?”

Until models like Atmiyata are adapted to Kashmir and scaled, young Kashmiris will continue to medicate their distress in silence – behind schoolbooks, in back-alley pharmacies and bedrooms darkened by blackout curtains, both literal and emotional.

*Not their real names.

 

Image Credits: MSF, Arshdeep Singh.

Dr Louisa Dunn, an investigator on the TB PRACTECAL clinical trial, consults with a patient.

In Nukus, Uzbekistan, 34-year-old surgical nurse Dilaram was devastated when she was diagnosed with drug-resistant tuberculosis (DR-TB). 

But instead of facing the standard treatment, including nearly 15,000 pills to be taken over two years and painful injections causing severe side effects, she could enrol in TB-PRACTECAL, the MSF-led clinical trial testing an all-oral, six-month regimen for DR-TB. 

After completing treatment with virtually no side effects, she returned to work and to caring for her two young daughters. This trial transformed her TB treatment journey and recovery. 

This profound revolution in her treatment journey is not a coincidence.  It is a result of years of dedicated clinical research, shaped by experiences of people like her and driven by significant contributions and efforts from public and non-profit organisations working closely with people affected by TB in low-resource settings.

TB-PRACTECAL, a landmark clinical trial led by Médecins Sans Frontières (MSF), not only identified an all-oral, six-month regimen for DR-TB,  but it is also the first clinical trial for which the detailed costs, €33.9 million, were published in the journal PLOS Global Public Health. 

This stands in stark contrast to the opaque norms of pharmaceutical research and development (R&D), where there is no transparency about what it costs to develop new medicines although high drug prices are often justified based on high R&D costs.

This moment is more than a medical milestone. It marks a critical step toward accountability in medical innovation and demonstrates  to all stakeholders that transparency in R&D is both possible and essential. 

When costs are hidden, governments—and organisations like MSF that purchase medical products—lose the leverage to negotiate affordable prices. We therefore ask: what does the pharmaceutical industry have to hide? If their costs are truly high, why not publish them? They refuse because transparency would undermine their ability to charge whatever prices they like, even for lifesaving TB medicines.

Costs of TB-PRACTECAL clinical trial

TB-PRACTECAL was a phase 2b-3 adaptive trial, which means it was designed to test how well different treatments work and confirm those results in a larger group of people, while also adapting the study design over time based on early results. 

The trial tested three new regimens for DR-TB against the standard of care. The total cost of €33.9 million was further broken down into 27 cost categories, enabling a detailed analysis of the key cost drivers of the trial.

Current estimates for the full R&D costs of developing a new drug range from €40 million to €3.9 billion, depending on the methodology used. Estimates for phase 2 and phase 3 pharmaceutical clinical trials alone range between €4.7 and €133 million. 

While the overall cost of TB-PRACTECAL fits within this range, several factors pushed its cost higher. These include the fact that it was both a phase 2b and phase 3 trial combined, it included multiple sub-studies, ran for a long duration of five years, and required significant investment in health facilities and infrastructure to carry out the trial. Medicine costs were also high. The cost of Bedaquiline alone made up 46% of all medicine expenses.

Breakdown of the cost of the TB-PRACTECAL trial.

Why transparency matters

The TB-PRACTECAL trial was conducted in resource-limited settings in South Africa, Uzbekistan, and Belarus – countries with a high prevalence of DR-TB. In 2022, the trial confirmed that a shorter, all-oral regimen using bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) could treat patients in six months or less, with significantly higher cure rates and fewer side effects compared to the previous 18–24 month regimens that relied on painful injections and caused severe side effects. 

After publication of the trial results, the World Health Organization (WHO) recommended the regimen as the preferred treatment for rifampicin-resistant TB. It has since been adopted for use in 40 countries. Sustained advocacy by TB activists and MSF played a crucial role in pushing for price reductions of key newer drugs, including bedaquiline and pretomanid, making broader rollout of this regimen possible.

Historically, pharmaceutical companies have justified sky-high drug prices under the pretext of recouping R&D expenses without ever disclosing the actual costs. For life-threatening diseases like TB, this secrecy costs lives.

MSF and TB activists witnessed this with bedaquiline, a core drug that is now an essential part of all DR-TB regimens. Although it was developed with substantial public funding, the pharmaceutical company Johnson & Johnson charged an exorbitant price, citing the need to recoup high R&D costs and sustain future innovation. 

Academic research showed that public investment in bedaquiline was up to five times greater than private investment. Civil society and health advocates used this information to successfully push for a price reduction. 

This transparency marked a turning point in the fight for access to this medicine and demonstrated the critical role of R&D cost transparency in enabling affordable access. The justification of high prices due to high R&D costs is a recurring argument from the pharmaceutical industry that MSF has encountered repeatedly when addressing the high cost of lifesaving medicines. 

This can no longer remain an evidence-free zone, which is why MSF chose to play its part by publishing the detailed cost breakdown of the TB-PRACTECAL trial.

We are calling on all funders and implementers of clinical trials – governments, product-development partnerships (PDPs), philanthropic organisations, academics, institutions, and pharmaceutical companies – to publicly disclose their R&D costs. MSF has developed a Clinical Trial Cost Reporting Toolkit to support publishing clinical trial costs, building on our own experiences.

Medicines shouldn’t be a luxury

Every year, 1.3 million people die of tuberculosis, making it the world’s deadliest infectious disease, disproportionately affecting people in low- and middle-income countries. Countries like India, which bear the world’s largest burden of TB and DR-TB, need timely access to the latest WHO-recommended treatments at affordable prices. However, exorbitant pricing has long stood in the way of widespread implementation of these regimens.

Without generic competition, national TB programmes struggle to widely implement updated WHO guidance on treatments that rely on newer, and often more expensive drugs.

The global community cannot afford another delay like the one we saw with bedaquiline, where people with DR-TB in low- and middle-income countries were left behind for over a decade. To truly end TB, we need to dismantle the barriers of cost, control, and corporate secrecy that continue to undermine access.

What needs to change

At MSF, we do not accept funding from pharmaceutical companies. From the front lines of conflict to work done with communities battling epidemics, our work is rooted in compassion, equity, and medical ethics. 

We took a big step to openly share our trial costs because we believe that when public resources are used, the public deserves accountability.

We urge the global health community to support transparency in medical R&D. We ask all stakeholders to recognize that transparency is not a threat but a lifeline. Without it, access to care remains a privilege for the few; with it, it becomes a shared responsibility to protect the many.

Six years ago, the World Health Assembly adopted the transparency resolution that urges all member states to “take appropriate measures to publicly share information on the net prices of health products”.  

All governments must take urgent steps to enact legislation mandating the disclosure of disaggregated R&D costs, including clinical trial costs, especially where the R&D has received public funding.

We will keep speaking out against systems that put profits ahead of people—because no one should be left to suffer, or die, from a disease that could be treated, simply due to hidden costs. Secrets cost lives.

Farhat Mantoo is the Executive Director of Médecins Sans Frontières (MSF) South Asia, with over two decades of leadership experience in humanitarian operations across Asia, Europe, and East Africa.

Bern-Thomas Nyang’wa is the Medical Director of Médecins Sans Frontières (MSF) Netherlands. He was the Chief Investigator of TB-PRACTECAL and has extensive TB clinical, programmatic and research experience.

 

Image Credits: Oliver Petrie/ MSF.

An oil rig operates off the coast of Denmark.

Over 30 health organizations representing 12 million doctors, nurses, and public health professionals globally have pledged to no longer work with advertising agencies that partner with the fossil fuel industry, citing conflicts of interest and the resulting health effects from industry disinformation campaigns.

The organizations span five continents and include prominent groups such as Médecins Sans Frontières, The Lancet, the World Organisation of Family Doctors, and the Yale Centre on Climate Change and Health.

For decades, oil and gas companies have employed PR and lobbying tactics strikingly similar to those of the tobacco industry: seeding doubt about established science, creating front groups, and pushing misleading narratives to stall regulation despite overwhelming evidence that fossil fuel pollution harms human and planetary health.

Yet many of the same PR and advertising agencies employed by health groups to promote healthy habits, vaccinations, and cancer prevention have continued partnering with fossil fuel companies, spreading misleading messages that downplay or deny these health harms and delay action needed to curb emissions.

“The same PR firms spreading fossil fuel disinformation are also working with health organizations—a clear conflict of interest for health,” said Shweta Narayan, Campaign Lead at the Global Climate and Health Alliance (GCHA). “Fossil fuels are making us sick, and the companies behind them are spending millions on advertising and PR to cover it up.”

Air pollution from fossil fuel combustion causes more than five million premature deaths annually. Burning oil and gas has been linked to increases in respiratory illnesses, cardiovascular diseases, cancers, and adverse pregnancy outcomes.

“As health professionals guided by humanitarian values, we have a responsibility to speak out when public health is under threat,” said Dr Maria Guevara, international medical secretary for Médecins Sans Frontières. “Fossil fuels are at the heart of a growing global health crisis, and the PR and advertising firms that help obscure this reality undermine efforts to protect lives.”

Cutting ties 

Royal Dutch Shell headquarters in The Hague, Netherlands.

The health sector often relies on professional advertising and PR services for public health messaging, including cancer awareness, infectious disease prevention, and vaccine uptake.

In 2020, the World Health Organization hired Hill+Knowlton to fight COVID-19-related disinformation. Scientists and environmental groups have widely criticised the company for its oil and gas portfolio, including clients ExxonMobil, Shell, Chevron and Saudi Aramco.

Edelman, the world’s largest PR company with over $1 billion in revenue, exemplifies this contradiction and the scale of the challenge.

The company assembled a task force of global health and pharmaceutical companies, including Novo Nordisk, GSK, and Roche to “accelerate the transition to net zero health systems” in India and China—a campaign hailed as groundbreaking public-private collaboration.

Yet Edelman won the bidding war for Shell’s worldwide public relations account in 2024, extending their decades-long relationship in a deal worth tens of millions—one of the agency’s most lucrative contracts. In March, Shell abandoned a key climate target for 2035 and weakened another goal for 2030.

While Edelman publicly states it “believes climate change is the biggest crisis we face as a society,” the firm creates “innovative promotional campaigns” for Shell, including a video game where users imagine themselves as engineers “keeping the lights on.”

The Climate Investigations Center describes Edelman as “the dominant PR firm for trade associations that promote an anti-environmental agenda.”

“Just like health leaders once stood up to Big Tobacco and its advertising, it’s time to stand up to Big Oil,” said Jeni Miller, GCHA executive director. “Organisations are demonstrating that they won’t help spread fossil fuel disinformation, and will use every tool they have, including their ad and PR dollars, to protect people’s health and the planet.”

Building on healthcare’s trusted voice

Ipsos Global Trustworthiness Index 2024.

With doctors and nurses consistently ranked among the world’s most trusted professions, advocacy groups believe their voices are essential to reframing fossil fuels as a health crisis rather than just a climate issue.

“We are trusted voices in the community,” said Dr Viviana Martinez Bianchi, president-elect of the World Organization of Family Doctors. “We are uniquely positioned to inform, explain, and speak about the equity implications. We can counteract this disinformation and mobilize public understanding and action.”

The decision to cut ties with these PR firms aligns with a broader movement to place health at the heart of climate policy and counteract the “commercial determinants of health,” where corporate practices from sectors like tobacco, ultra-processed food, and fossil fuels shape conditions for disease.

“We see the effects first-hand in vulnerable populations,” Bianchy explained, citing patients with asthma exacerbations, cardiovascular conditions, and poor respiratory health, all linked to pollution exposure.

Decades of scientific studies have linked fossil fuel activities to rising rates of asthma, heart disease, heat-related illness, infectious disease spread, and mental health stress during climate-related disasters—evidence that health professionals say has forced them to act.

“We, the health community, have a duty to warn humanity about the profound health harms from burning fossil fuels and to act on that knowledge,” said Edward Maibach, Director of the George Mason University Center for Climate Change Communication. “We must refuse to work with any marketing agency that works with fossil fuel companies.”

Industry disinformation campaigns

Plastic waste sorting
Over 30 metric tonnes of plastic are burned each year, mostly in lower and middle income countries, leaving millions exposed to toxic air pollutants.

For over fifty years, fossil fuel companies have run multi-billion-dollar campaigns to misinform, lobby, and confuse the public about the climate crisis, varying their messaging strategy by region and audience.

In the global North, these tactics focus on “greening” the gas industry by positioning fossil fuels as climate solutions.

The playbook includes shifting blame to individuals through concepts like the personal carbon footprint, which British Petroleum popularised in 2004 with a calculator that encouraged people to tally up how their morning commute, grocery runs, and vacation flights were heating the planet.

The industry also championed plastic recycling, rolling out blue bins across American driveways while chemical giants like Chevron, DuPont, and Exxon knew the technology to recycle at scale did not exist.

Plastics are now a key justification used by nations and companies to pursue higher fossil fuel production, even though only 9% of plastic ever produced has been recycled. The technology to recycle complex polymer plastics at scale still does not exist decades later.

In the global South, fossil fuel-producing nations and companies promote oil as essential for economic and sustainable development, according to Vivek Parekh, an analyst with London-based climate risk think tank Influence Map.

Saudi Arabia made this argument while trying to block the climate resolution at last week’s World Health Assembly, saying: “As an oil producing sector, we are aware of our role in [energy] transformation, but can’t ask developing countries to pay the price for transformation when they are not responsible for the problems.”

Saudi delegate explains their take on the WHO Climate Change and Health action plan in WHA debate.

“The fossil fuel industry dominates the lobbying landscape,” Parekh said. “What we see is the industry’s attempt to weaken and obstruct climate policy, despite clear economic, health and climate benefits.”

At major UN climate conferences, fossil fuel lobbying groups have dramatically outnumbered health organizations. Nearly 2,500 fossil fuel lobbyists attended COP28 in Dubai—more than delegates from the ten most climate-vulnerable nations combined.

At November’s plastic treaty negotiations, 220 fossil fuel and chemical industry lobbyists descended on Busan, forming the largest single delegation and outnumbering host South Korea’s 140 representatives as well as the European Union and its 27 member states.

The oil giants got what they came for, successfully derailing what was meant to be the final treaty adoption session by opposing any caps on plastic production.

This strategy has led UN Secretary-General António Guterres to call fossil fuel companies the “godfathers of climate chaos.”

“It’s an almost comical conflict of interest that Big Oil’s spin doctors are also in charge of communications for the UN climate talks,” Dr. Geoffrey Supran, a Harvard researcher who studies fossil fuel disinformation tactics, told environmental news website DeSmog.

Despite some victories, including a Dutch court upholding The Hague’s ban on fossil fuel advertising and Energy Australia apologizing for greenwashing, greater transparency is needed as the industry’s activities continue undermining climate action.

“We can’t be neutral,” added Dr. Jemilah Mahmood, executive director of Malaysia-based Sunway Centre for Planetary Health. “Our Hippocratic Oath goes beyond just treating disease to preventing it.” Like the tobacco industry, she argued, fossil fuel companies “manipulate the truth,” leaving marginalized communities polluted and vulnerable to health risks.

Image Credits: CC, IPSOS, SweepSmart, Health Policy Watch .

Mahmoud Ali Youssouf, chairperson of the African Union Commission, and Bill Gates, chair of the Gates Foundation.

Philanthropist Bill Gates announced on Monday that the majority of the $200 billion he plans to donate over the next 20 years will be spent in Africa.

The focus will be “on partnering with governments that prioritise the health and wellbeing of their people”, Gates told government leaders, diplomats and partners during an address at the African Union headquarters in Addis Ababa, Ethiopia.

“By unleashing human potential through health and education, every country in Africa should be on a path to prosperity – and that path is an exciting thing to be part of,” Gates said.

He called on  primary healthcare (PHC) to be prioritised, emphasizing that this “has the greatest impact on health and wellbeing.”

 “With primary healthcare, what we’ve learned is that helping the mother be healthy and have great nutrition before she gets pregnant, while she is pregnant, delivers the strongest results. Ensuring the child receives good nutrition in their first four years as well makes all the difference.”

Gates singled out Ethiopia, Rwanda, Zimbabwe, Mozambique, Nigeria, and Zambia for showing bold leadership that harnesses innovation, from expanding frontline health services to deploying advanced tools against malaria and HIV, and safeguarding PHC.

 “I’ve always been inspired by the hard work of Africans even in places with very limited resources.” He added, “The kind of field work to get solutions out, even in the most rural areas, has been incredible,” said Gates

Gates also spoke about the transformative potential of artificial intelligence, noting its relevance for the continent’s future. 

Drawing a parallel to the continent’s mobile banking revolution, he said that “Africa largely skipped traditional banking and now you have a chance, as you build your next generation healthcare systems, to think about how AI is built into that.”  

He pointed out that Rwanda is using “AI-enabled ultrasound to identify high-risk pregnancies earlier, helping women receive timely, potentially life-saving care.”

 “In Ethiopia and Nigeria this week, Gates will see first-hand the state of health and development priorities in the wake of foreign aid cuts, and he will affirm his and the foundation’s commitment to supporting Africa’s progress in health and development over the next 20 years,” according to a media release from the Gates Foundation.

Image Credits: African Union.

Flavour additives are designed and packaged to appeal to young people, hooking the next generation on tobacco and nicotine products.

As the world observes ‘No Tobacco Day’, the World Health Organization (WHO) has called on governments to ban all flavours in tobacco and nicotine products, including cigarettes, pouches, hookahs and e-cigarettes – which are playing an increasing role in hooking young people to tobacco products.

Over 50 countries have banned flavoured tobacco, but manufacturers are getting around it with online sales of various types of flavours that can be added to cigarettes, e-cigarettes and other tobacco products, according to a series of new WHO policy briefs on the issue.

Examples of common tobacco and nicotine flavour accessories.

Flavours like menthol, bubble gum and cotton candy are particularly popular amongst youth. And because they mute the harshness of tobacco and nicotine, they make those products more attractive to use.

Paired with flashy packaging and social media-driven marketing, flavours have also increased the appeal to young people of nicotine pouches, heated tobacco, and disposable vapes. Some 8 million people a year die prematurely from tobacco-related deaths.

The accessories market offers a work-around to countries’ bans on flavoured tobacco and nicotine products.

Different types of flavours are designed and packaged to appeal to young women, children, and other target groups.

“Flavours are fuelling a new wave of addiction, and should be banned,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “They undermine decades of progress in tobacco control. Without bold action, the global tobacco epidemic, already killing around 8 million people each year, will continue to be driven by addiction dressed up with appealing flavours.”

Flavour accessories remain largely unregulated, WHO notes.

“We are watching a generation get hooked on nicotine through gummy bear-flavoured pouches and rainbow-coloured vapes,” said Dr Rüdiger Krech, WHO Director of Health Promotion. “This isn’t innovation, it’s manipulation. And we must stop it.”

Image Credits: Chemist 4 U/Flickr, WHO , Arom-Team.com.

Air pollution remote sensor India
Remote sensing equipment and camera capturing real-world emissions data of vehicles in India as they drive by.

New research shows how 310 premature deaths and 230 new children’s asthma cases can be prevented every day over the next 15 years if governments act against polluting vehicles and accelerate the move to electric vehicles.

Pollution from fossil-fuel vehicles is most lethal for two age groups, those above the age of 65 and those under five, a new study shows.

Five countries, China, the United States, Indonesia, India, and Mexico, are estimated to have the most road transport-attributable cases for children and older people in 2023. For lower-income countries, transitioning to cleaner transport is difficult for most countries, particularly as several are dumping grounds for heavily polluting vehicles from richer countries. 

In 2023, there were 251,500 new asthma cases in children linked to nitrogen dioxide (NO2) from road transport.  Back in 2015, tailpipe emissions were linked to 385,000 fine particulate matter (PM2.5) and ozone- (O3) related deaths globally, with road transport accounting for 64% of these mortalities.

Among those who conducted the research are the International Council on Clean Transportation (ICCT), widely known for exposing Volkswagen’s diesel emissions cheating scandal, along with George Washington University and the University of Colorado Boulder. 

The authors say this study fills a crucial gap in existing literature and provides important evidence needed to support governments at all levels.

They provide a detailed analysis of how different policies could improve health outcomes across more than 180 countries and 13,000 urban areas. The study warns that vehicle pollution could cause up to 1.9 million premature deaths and 1.4 million new cases of asthma in children by 2040 unless strong policy action is taken now.

At its core, the science is straightforward: vehicle exhaust releases tiny particles (PM2.5) and gases like nitrogen dioxide (NO₂) and volatile organic compounds (VOCs), which then react in sunlight to form ground-level ozone — a harmful pollutant. These pollutants penetrate deep into the lungs and bloodstream. In young children, these trigger asthma. In older adults, it raises the risk of heart and lung diseases and early death.

The report suggests a pathway to save these millions of lives and asthma cases in children. The report emphasises that no single policy is enough. A combination of interventions is needed to tackle the crisis. 

Saving the most lives

Accelerating the switch to electric vehicles could cut air pollution and save many lives.

The best case scenario they evaluated would mean a country adopting and enforcing modern vehicle emission standards (like Euro 6 and eventually Euro 7), accelerating the transition to electric vehicles (EVs), phasing out older, more polluting vehicles, and ensuring that the electricity grid becomes cleaner, so that EVs don’t simply shift pollution from roads to power plants.

The largest gains from adopting this mix would be visible in low and middle-income countries (LMICs) that are yet to adopt Euro 6 equivalent standards. Currently, richer nations are dumping polluting vehicles in LMICs.

Implementing the best standards in these countries could achieve 56% and 63% of the total benefits of all identified measures combined for avoidable premature deaths and new paediatric asthma cases, respectively.

Halving air pollution by 2040

China, India and the USA are among the five hotspot countries portrayed here, in terms of avoidable deaths in top ten urban areas. Row a) is PM2.5- and ozone-attributable premature deaths and (b) NO2-attributable new paediatric asthma cases. Yellow labels show cumulative share of avoidable burden from the top ten urban areas, and brown data labels show their corresponding share of population from applicable age groups in the region.

The newly peer-reviewed study released this month aligns with the WHO’s 15-year goal to cut air pollution-linked deaths by half. On 26 May, all WHO regions endorsed this plan at the World Health Assembly in Geneva. The World Bank’s assessment is that if it’s business-as-usual, there will be a rise of 21% in the number of people who are exposed to PM 2.5 levels above [the WHO annual guideline] of five micrograms per cubic meter.

While the goal is a reduction in vehicular emissions, the report highlights the pathway for the next 15 years would be combining Euro 6 (and eventually Euro 7) and ambitious electric vehicle (EV) policies. This could avoid an additional 323,000 (39%) premature deaths and an additional 419,000 (100%) new paediatric asthma cases cumulatively worldwide from 2023 to 2040, compared to focusing on EVs alone (EV). 

But for countries that have already adopted Euro 6/VI-equivalent standards, an ambitious EV transition is vital to achieve further emissions reductions.

The new report, an updated version of a study first reported by Health Policy Watch here, identifies the most vulnerable countries by various criteria. 

Five hotspot countries 

The global hotspots for these impacts are not surprising given the density of population and vehicles. China, India, Indonesia, the United States, and Mexico together account for the largest number of avoidable deaths and new asthma cases linked to nitrogen dioxide from road transport.

Roads account for 93% of carbon emissions from Indian transport, compared with 84% in the US and 81% in China. 

“India ranks among the top five countries with the highest number of premature deaths and pediatric asthma cases from road transport emissions, with COPD and NO₂-related asthma posing major health burdens,” Amit Bhatt, ICCT India’s managing director told Health Policy Watch.
“Children under five and adults over 65 are especially vulnerable, underscoring the need for targeted policies. Though urban youth under 20 make up just 33% of the population, they account for up to 68% of avoidable NO₂-related asthma cases, highlighting the urgent need for city-level interventions. Accelerating EV adoption and ensuring a clean power grid offer India significant health and environmental gains.”

Populous middle-income countries, namely China, India, Pakistan and Indonesia, the report says, have the highest potential avoidable health impacts. These countries lead in avoidable premature deaths and ‘years of life lost.’ China, Egypt, Indonesia and India have the most avoidable new paediatric asthma cases.

Poor countries, those with lower social development indices, are likely to experience increases in new paediatric asthma cases due to growth in populations under 20 years old and changes in exposure. 

Cities are especially critical. Although urban areas house only a third of the world’s children, they account for 68% of avoidable pediatric asthma cases. 

This makes city-level action, like low-emission zones, public transport electrification, and walkable infrastructure, crucial in the fight for clean air.

Image Credits: ICCT, Ernest Ojeh/ Unsplash, ICCT.

Africa needs 6.4 million mpox vaccines in the next few months to address the outbreak, which is now concentrated in Sierra Leone, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Three-quarters of Africa’s confirmed new mpox cases are in Sierra Leone, all concentrated in high-density areas in all districts, with 648 confirmed cases in the past week. Yet the country only has around 10,000 vaccine doses.

Meanwhile, Ethiopia reported its first three cases this week: parents and their baby who were diagnosed in Moyale, a town in the Oromia district near the border with Kenya.

“Given also the proximity of Somalia, and knowing all the challenges that are there, we need to be really very bold and aggressive to control this outbreak at the source so that it doesn’t expand further,” according to Dr Ngashi Ngongo, Africa CDC’s mpox incident manager.

The 16,915 confirmed cases for the first five months of this year are almost as many as the total for the entire 2024.

Mpox vaccinations are being carried out in seven countries, and while the Africa CDC has appealed for more vaccine donations, the 1.5 million LC16 vaccines from Japan are estimated to finally arrive over the weekend.

Nineteen African countries have active mpox cases, and 2,836 new suspected cases were reported in the past week. 

Meanwhile, 20 countries have cholera outbreaks affecting some 127,409 people, and addressing this is on the agenda of the African Heads of State meeting on 2 June, according to Ngongo

Seventeen member states have measles outbreaks, seven have dengue in seven member and four have Lassa fever.

WHO says there is an 80% chance that at least one of the next five years will exceed 2024 as the warmest on record.

Global temperatures are expected to remain near record levels over the next five years, and there is an 80% chance that at least one of the next five years will exceed 2024 as the warmest on record.

This is the key takeaway from a new report from the World Meteorological Organization (WMO). The temperature rise is expected to worsen the climate impacts on countries, their economies, and sustainable development.

“We have just experienced the 10 warmest years on record. Unfortunately, this WMO report provides no sign of respite over the coming years, and this means that there will be a growing negative impact on our economies, our daily lives, our ecosystems and our planet,” WMO’s Deputy Secretary-General Ko Barrett said.

There is an 86% chance that at least one of the next five years will be more than 1.5°C above the 1850-1900 average, which is commonly known as the pre-industrial era, after which the use of fossil fuels began on a large scale.

The Arctic region continues to warm at a higher rate than the global average, and that risks pushing up the rate of sea level rise.

This report comes a few months after WMO’s State of the Global Climate 2024 report, which confirmed that 2024 was likely the first calendar year to be more than 1.5°C above the pre-industrial era. It was also the warmest year in the 175-year observational record of the world.

In 2015, following the Paris agreement, world leaders agreed to limit global warming to 1.5°C. But this report of the WMO now projects that there is a 70% chance that the five-year average warming for 2025-2029 will be more than 1.5 °C.

For now, though the long-term warming that is an average of temperature over decades, typically over 20 years, remains below 1.5°C.

Rising global temperatures

The average global mean near-surface temperature that combines temperatures for both air and the sea surface is predicted to be between 1.2°C and 1.9°C higher for each year between 2025 and 2029, when compared to pre-industrial era.

The report forecasts that there is a 70% chance that the five-year average warming for 2025-2029 will be more than 1.5°C shows that the warming is intensifying.

This forecast is up from 47% in last year’s report (for the 2024-2028 period) and up from 32% in the 2023 report for the 2023-2027 period.

The WMO reiterated that every additional fraction of a degree of warming matters. It drives more harmful heatwaves, extreme rainfall events, intense droughts, melting of ice sheets, sea ice, and glaciers. It also worsens heating of the ocean and rising sea levels.

Fast warming Arctic region, wetter Sahel

The warming in the Arctic region is predicted to be more than three-and-a-half times the global average over the next five extended winters (November to March). This risks melting its large reserves of ice and pushing up the rates of sea level rise.

On the whole, the warming in the Arctic is projected to be at 2.4°C above the average temperature during the most recent 30-year baseline period (1991-2020).

This is likely to result in reductions in sea-ice concentration in the Barents Sea, Bering Sea, and Sea of Okhotsk, which are in the Arctic region.

Precipitation patterns are also projected to change, with wetter-than-average conditions projected for the semi-arid Sahel region in Northern Africa for the May-September period between 2025 and 2029, according to the report.

Similar conditions are predicted for northern Europe, Alaska, and northern Siberia.

The South Asian region has also been wetter in recent years, and the report forecasts similarly wet periods for the 2025-2029 period.

However, drier-than-average conditions over the Amazon are predicted.

Continued monitoring is essential, but is under threat

The scientific community has repeatedly warned that warming of more than 1.5°C risks unleashing more severe climate change and extreme weather, and every fraction of a degree of warming matters.

“Continued climate monitoring and prediction is essential to provide decision-makers with science-based tools and information to help us adapt,” Barrett said.

However, with funding cuts to US federal agency National Oceanic and Atmospheric Administration (NOAA), weather and climate observations available for climate reports has begun to fall.

Reports like this one from the WMO rely on multiple data sources from a range of organizations to validate their findings, which the defunding of NOAA has affected in recent months.

These reports are meant to provide policymakers with the updates they need ahead of the UN climate change conference, COP30, that will take place later this year.

This is an important COP as it will consider updated climate action plans from countries known as Nationally Determined Contributions, in which countries list the actions that they commit to taking to cut down their carbon emissions.

This report is produced by the UK’s Met Office, which is acting as the WMO Lead Centre for Annual to Decadal Climate Prediction. It provides a synthesis of the predictions from WMO-designated Global Producing Centres and other contributing centres around the world.

Image Credits: WMO/João Murteira.

WHO-Director General Dr Tedros Adhanom Ghebreyesus addresses the 78th World Health Assembly.

Adopting a pandemic agreement and securing a 20% increase in member states’ fees to support the World Health Organization (WHO) were the 78th World Health Assembly’s greatest achievements.

“The words ‘historic’ and ‘landmark’ are overused, but they are perfectly apt to describe the adoption last Tuesday of the WHO pandemic agreement. Likewise, your approval of the next increase in assessed contributions was a strong vote of confidence in the WHO at this critical time,” said WHO Director General Dr Tedros Adhanom Ghebreyessus at the end of the WHA on Tuesday.

Other significant decisions involve new targets to reduce the impact of air pollution; the first ever resolutions on lung health and kidney health, measures to restrict the digital marketing of infant formula and baby food – and even a strategy on traditional medicine.

But the United States’ absence from the WHA cast a long shadow over proceedings, not least of all because it has left a 21% hole in the WHO’s budget.

Despite increased disease outbreaks and the proliferation of non-communicable diseases, the global body has to retrench staff and merge departments.

The WHO’s 36-year-old polio eradication programme faces a budget cut of 40%

Numerous member states are also reeling from significant cuts to their own health budgets since the Trump administration’s shuttering of the US Agency for International Development (USAID), downscaling the US President’s Emergency Plan for AIDS Relief (PEPFAR), and outlawing its National Institutes of Health from contracting foreign sub-grantees.

‘Mired in bureaucratic bloat’

The US chair at the WHA remained empty for the first time in history.

The only contact the US had with the assembly was via a six-minute video message at the opening plenary from Health Secretary Robert F Kennedy Jr. 

In contrast to messages of support and appreciation for the WHO from world leaders, Kennedy described the body as “mired in bureaucratic bloat, entrenched paradigms, conflicts of interest and international power politics.”

Accusing the WHO of being beholden to China and “corporate medicine”, Kennedy invited member states to join the US in creating “new institutions”.

Then, on the final day of the WHA on Tuesday, Kennedy posted pictures on social media with Argentinian President Javier Milei and a gold chainsaw, saying that they’d had a “wonderful meeting … about our nations’ mutual withdrawal from the WHO and the creation of an alternative international health system based on gold-standard science and free from totalitarian impulses, corruption, and political control.”

Given the intensity of member states’ discussions about increased assessed contributions (membership fees) and their across-the-board expressions of gratitude for WHO guidance in tackling a range of health challenges, it is unlikely that many countries will leave the WHO to join a Trump-Kennedy alternative.

Throughout the WHA, member states expressed appreciation for the WHO, particularly its technical assistance and support in addressing specific health challenges.

‘Weaponising food’ in  Gaza

Votes rather than consensus decided two major tension points during the WHA. The first involved the occupied Palestinian territory, particularly in light of Israel’s 80+-day aid blockade.

The WHA eventually passed an updated version of a 2023 measure denouncing the devasting impacts on Palestinians the war, and a decision on “health conditions in the occupied Palestinian territory and occupied Syrian Golan”. This requests the WHO Director-General to monitor and report back on a range of issues including “acts of violence against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties”; malnutrition and famine; Palestinian access to water, sanitation and shelter, as well as Israel’s obligations to the territory.

In solidarity with Palestine, which is not a full member state, the WHA raised its flag at the assembly, and a tearful WHO Director-General Dr Tedros Adhanom Ghebreyesus appealed to Israel to allow sufficient aid into the territory where half a million people face immediate starvation, stating: “It’s really wrong to weaponise food, to weaponise medical supplies.”

Tension over climate action

Katarzyna Drążek-Laskowska, director of the Polish health ministry’s International Cooperation Department, chaired Committee B.

However, by far the biggest tensions emerged during discussion on a WHO Draft Global Action Plan on Climate Change and Health, with Saudi Arabia – backed by Russia and the Eastern Mediterranean Region (EMRO) – trying to delay its approval for another year.

Despite WHO consultations on the plan since last July, the Saudi alliance claimed insufficient consultation as the reason for trying to block the plan.

The 15-page plan hinges on three action areas: 

  • Leadership, coordination and advocacy, aimed at ensuring “the integration of health in national and international climate agendas and vice versa”;
  • Evidence and monitoring, aimed at creating “a robust and relevant evidence base”  for  policy, implementation and monitoring;
  • Country-level action and capacity-building to “promote climate change adaptation efforts to address health risks and support mitigation efforts that maximize health benefits”.

Debate on the plan pitted African nations that are part of EMRO against the 47 African countries in the Africa region, with the role of Egypt being particularly noteworthy.

During the pandemic agreement negotiations, Egypt chose to negotiate alongside the Africa region yet on climate, it switched back to EMRO and was a vociferous campaigner for delaying the plan.

While EMRO deployed various procedural moves to delay the plan, the Africa region supported its full adoption, said Mozambique on behalf of the 47 African member states.

“The African region is disproportionally impacted by climate change, and although our continent contributes minimally to the global emission, it bears the greatest burden,” said Mozambique.

However, when the final vote was called, the EMRO group decided to abstain rather than vote against the plan, which was passed by 104-0 with 19 abstentions.

Katarzyna Drążek-Laskowska, director of the Polish health ministry’s International Cooperation Department, who chaired the mammoth climate discussion in Committee B, praised delegations, saying that multilateralism meant “unity not uniformity”.

“Consensus may not always be easy, but it remains our strongest foundation,” said Drążek-Laskowska, who also chaired the budget discussions that saw member states agree to a 20% increase in their membership fees.

Under the new budget, assessed contributions (member states’ fees) will make up 40% of the WHO’s base programme budget of $4.2 billion for 2026-27. The core budget does not include emergency humanitarian appeals or polio programmes, which bring the total budget target up to $6.2 billion.

Now that the WHA has ended, two crucial processes lie ahead. The first involves concluding negotiations on the annex to the pandemic agreement dealing with the Pathogen Access and Benefit Sharing (PABS) system.

‘Critical’ pandemic agreement annex

Dr Tedros presents a ceremonial gavel to Namibian Health Minister Dr Esperance Luvindao, who chaired Committee A

Namibian Health Minister Dr Esperance Luvindao, who chaired Committee A that adopted the pandemic agreement, said that the outcome “reflects compromise, while it advances global collaboration, equity and access”. 

“We also look ahead to the next phase of negotiation on the pathogen access and benefit sharing (PABS) system, which will be critical to the success of future preparedness efforts,” said 31-year-old Luvindao, who assumed her position as the youngest ever African health minister in March.

An Intergovernmental Working Group (IGWG) will guide the PABS negotiations, and is due to conclude talks on annex by next year’s WHA. Only then will the pandemic agreement be open for ratification and once 60 countries have ratified it, the agreement will enter into force.

UN High-Level meeting on NCDs

The other process involves concluding negotiations on the political declaration for the United Nations High-Level meeting on NCDs and mental health in September.

A significant portion of Committee A’s time was devoted to discussion on NCDs, as countries across the globe struggle to curb these.

Only 19 countries – 10 from Europe – are on track to reduce NCD-related mortality by 30% by 2030, and the WHO has spent decades working on strategies to assist member states, including its 16 Best Buys interventions to address NCDs.

Kennedy told the WHA in his video address that the US is “fundamentally shifting the priorities of our health agencies to focus on chronic diseases”. This would include removing food dyes and other harmful additives; investigating the causes of autism and other chronic diseases; seeking to reduce consumption of ultra-processed foods, and supporting “lifestyle changes that will bolster the immune systems and transform the health of our people”, he said.

But the US could learn from nations that have spent decades tackling NCDs, including European nations that have substantially fewer harmful food additives than the US because of EU laws.

Interference in countries’ policies from harmful industries, particularly the tobacco, alcohol and ultraprocessed food industries, are a major obstacle to reducing NCDs – and high taxes on these is a significant deterrent to their consumption.

Paying tribute to WHO member states at the close of the WHA, Tedros said that all the resolutions adopted “express the collective will of the nations of the world, the United Nations, to work together on a shared approach, to share problems”.

No nation can address the magnitude of health challenges facing the world alone.

Image Credits: WHO, WHO/X.

Final vote on the WHO Climate Change and Health Action Plan shows the “green” lights of approval by 109 member states

A new WHO Climate Change and Health Action plan was approved by a key World Health Assembly (WHA) Committee Tuesday evening – after hours of high-stakes, high-drama parliamentary maneuvers by a cluster of oil-rich World Health Organization (WHO) member states to shelve the plan failed.  

WHO member states accepted the original plan by a vote of 109-0, with 19 abstentions. Hours earlier, the WHA rejected a Saudi-led initiative to delay approval of the plan for another year by a vote of 86-23 with 11 abstentions. The Saudi initiative was backed by Russia as well as other countries of WHO’s Eastern Mediterranean Region (EMRO), which includes oil rich Gulf states, and Iraq, Iran and Libya.

A final vote on the actual climate and health action plan was delayed for hours by a range of procedural and technical maneuvers, including two more sets of proposed amendments proposed by EMRO, which failed, as well as a series of debates and procedural questions about how to vote and the order in which the voting should take place.  

The debate was unusual as it focused on an action plan linked to a new WHA resolution on Climate Change and Health that had already been approved last year by an overwhelming majority of WHA members. As the very last item on this year’s packed WHA agenda, it also delayed the closing of the entire Assembly by several hours.

Near 6 pm Egypt’s delegate proposed yet another last-minute amendment “in the spirit of consensus” which provoked another procedural vote, when Peru asked to close the debate.

Egypt proposes a third amendment to the action plan “in the spirit of consensus.” Peru then asks to close the debate.

As the amendments and procedural motions dragged on for hours into the evening, delaying the final vote for longer and longer, it was clear that opponents of the measure were exhausting member states, but proponents remained in the room to see the measure over the goal.

“We’re really testing the rules of procedure today,” quipped WHO legal counsel, Derek Walton at one point.

Even after all of the amendments were exhausted and it appeared that the plan had finally been adopted by consensus, Egypt’s delegate objected once more, saying that the EMRO region could not support it.

That led to the final, definitive ballot by member states on the action plan –  which was overwhelmingly approved.

Claims of insufficient consultations and misalignment?

Saudi delegate explains the take on the WHO Climate Change and Health action plan in WHA debate.

The plan’s opponents maintained that there were insufficient consultations, although WHO and member states held multiple rounds of talks with member states at regional and global level over the past year.

In its statements Monday and Tuesday, Saudi Arabia also seemed to suggest that WHO should not be supporting developing countries’ efforts to access clean energy or mitigate emissions because historically they pollute less.

“As an oil producing sector, we are aware of our role in [energy] transformation, but can’t ask developing countries to pay the price for transformation when they are not responsible for the problems,” said the Saudi delegate, during the initial debate.

Saudi Arabia wanted a postponement of the action plan until next year, until the plan “can be aligned with different national contexts… and to take due account of national diversity.”

But in the final ballot of the day, Saudi and other EMRO states abstained from voting rather than be counted amongst the plan’s opponents.

Saudi Aramco’s economic stake in more fossil fuel expansion

Saudi has a clear national political and economic stake in defining WHO’s climate and health agenda as narrowly as possible.  

Its own state-owned oil company, Saudi Aramco, has the biggest fossil fuel expansion plans of any major oil and gas multinational, overshooting a 2022 International Energy Agency’s scenario for net zero emissions by more than any other multinational. 

Saudi Aramco: the fossil fuel company with the highest overshoot of the International Energy Agency’s net zero emissions scenario (2022).

WHO’s advocacy around shifting health facilities to cleaner and renewable energy sources, and around the co-benefits to health that low-carbon transport, cities, and economies may rub member states that aspire to keep the world on a fossil fuel economy for decades to come in the wrong way.   

Battleground Africa 

Oil and gas projects in Africa set to quadruple (2022); 90% of projects in sensitive forests, are in the Congo Basin, the world´s second largest rainforest.

Sandwiched in the middle of the debate are low-income countries, particularly in Africa, whose governments stand to benefit from large oil and gas projects – but are also bearing the biggest brunt of climate’s impacts. 

As Mozambique’s delegate stressed Monday, on behalf of the 47 African member states: “The African region is disproportionally impacted by climate change, and although our continent contributes minimally to the global emission it bears the greatest burden.”

The African group supported the “full adoption of the global action plan on climate change and health,” he concluded. 

Africa, with its low present-day levels of fossil fuel consumption and emissions but rich mineral reserves locked in rich tropical forests, peatlands, and offshore, represents one of the last frontiers for multinational oil and gas companies to both expand extraction and consumption dramatically, keeping the world on a firmly fossil fuel trajectory for another 50 years. 

In contrast, Asia, led by China, is investing more heavily in renewables. Even India’s massive Adani Group is now investing heavily in solar, wind and hydropower,  even if  coal and oil remain economic mainstays for CEO Gautam Adani, a close associate of Prime Minister Nahrendra Modi.  

India’s Adami Group promotes its green energy plans on its website.

Developed nations calling for healthier, low carbon development

Conversely, many European and other developed nations want WHO’s work to also focus on healthier, more low-carbon strategies that reduce the trajectory of future climate emissions  – alongside adaptation to the inevitable.

Those nations have called on WHO to support national plans for healthier non-motorized and electric transport; urban and building design; as well as nutrition options which also reduce carbon emissions. They have also called on health facilities efforts to “decarbonize” their own high-emissions operations. 

“As a health community, we therefore have a two-fold responsibility firstly, promoting climate measures by positioning the health argument as a strong driver of increased climate ambition,” said Poland, speaking on behalf of 34 member states, including the European Union. 

“This means stimulating broader awareness and education in climate and health and incentivizing other sectors, such as the transport sector on active mobility and the food sector on sustainable and healthy diets.”   

 Clean, reliable energy in low-income countries 

Solar panels being affixed to a hospital in Alberton, South Africa.

Beyond the rhetoric and oft-artificial divide of adaptation and mitigation, African nations appear eager to get WHO’s help to introduce cleaner, greener energy for thousands of  health facilities that lack reliable power, or those that lack any reliable power at all. 

As Mozambique said: “We call for urgent action to build climate resilient health systems across the continent.”  

A 2023 WHO study estimated that 12-15% of health facilities in South Asia and SubSaharan Africa respectively lack access to any electricity at all. 

About half of the health centres in sub-Saharan Africa also lack reliable electricity, according to WHO data. This shortage disrupts essential services such as emergency care, maternal health services, and vaccine refrigeration.

And one billion people worldwide are served by health facilities with no electricity or unreliable electricity services.  See related story: 

One Billion People Lack Access to Health Facilities with Reliable Electricity

Through its ATACH initiative, WHO has been working with countries to build climate resilient and low-carbon sustainable health systems. 

Its efforts have been supported by the International Renewable Energy Agency (IRENA) as well as foundations and philanthropies that are helping health actors access finance as well as plan energy systems that not only bring them electricity, but also ensure their financial sustainability.  

IRENA, as well as the International Energy Agency have long argued that the distribution of health facilities in rural Africa is such that renewable energy or hybrid systems, delivered through mini-grids, are the only affordable and practical solution – than grid power, delivered from centralized, fossil fuel plants. 

Central and eastern Africa have the highest proportion of health facilities with no electricity access – 50% or more in some regions.

Disruptive agenda?

But such initiatives, however modest, are also potentially disruptive. If the politically weak health sector demonstrates that it can electrify with renewables, then why not other more powerful productive sectors, like agriculture, and households? 

The African Development Bank’s Power Africa Initiative, launched by US President Barack Obama in 2013, has been supporting efforts to develop renewable energy grids in rural and off-grid locations – as the quickest and cheapest way to electrify African communities and households. 

Some 600 million Africans lack any electricity access whatsoever, and thus rely upon polluting wood and other biomass for cooking as well as kerosene for lighting — leading to one of the world’s largest disease burdens from household air pollution exposures. 

A majority of the world’s population still without access to clean cooking energy is in the developing world.

Meanwhile, an ambitious new African Energy fund aims to connect about 300 million Africans to electricity, through stepped up development of renewable sources, through a new $40 billion African Energy Fund, part of a new ADB initiative launched in February.  

But in the wake of the collapse of USAID, a major Power Africa partner, and the withdrawal of the United States from African clean energy initiatives, their fate remains unclear. US policy, heavily oriented towards more fossil fuel extraction at home and abroad, is unlikely to support renewables in Africa for the duration of the Trump Administration’s term. 

While the US was not present at this World Health Assembly, if they had been, they would have been cheering on the Saudi and Russian efforts. 

 

Image Credits: Health Policy Watch , Rainforest Foundation and Earth Insights, 2022, Adani Group , Netcare-Alberton Hospital, WHO, T20 Policy Brief, July 2023.