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.

Chile’s easily recognisable hexagonal warning labels – mandatory for products high in salt, sugar, saturated fat and calories – have had a real impact on consumer habits.

This World Food Day (16 October), Chile provides solid evidence that mandatory warning labels that target products with high salt, sugar, saturated fat and calories have reduced consumers’ appetite for unhealthy products.

Worldwide, countries are grappling with diets increasingly composed of ultra-processed products, which are associated with obesity and other non-communicable diseases (NCDs). 

The proliferation of these highly processed, additive-rich products is accompanied by the food and beverage industry’s onslaught of inescapable marketing, with much of it directed at children.

In this rapidly changing global food environment, Chile’s progressive food policy offers new insight. Through the introduction of a comprehensive policy that instituted both front-of-package labeling regulations and marketing restrictions, Chile has continually demonstrated that policy can profoundly influence consumer behavior and improve public health.

Passed in 2016, the Law of Food Labeling and Advertising, included the introduction of mandatory, black octagonal front-of-package nutrient warning labels alerting consumers to products high in sugar, salt, saturated fat and calories; marketing restrictions aimed at protecting children from pervasive food marketing and bans on the sale of ultra-processed products in schools. 

Earlier evaluations of Phase 1 have demonstrated significant decreases in purchases of products high in ‘nutrients of concern’ as well as a 73% drop in Chilean children’s exposure to TV for regulated food and beverages.

In the years since its passage, Chile’s law has provided a roadmap for similar global healthy food policies for public health researchers, advocates and policymakers.

Growing evidence that warnings work 

New research published in PLOS Medicine from the University of Chile and the University of North Carolina, Chapel Hill showed in Phase 2 of the nutrient warning label law, Chileans are purchasing significantly less sugar, salt, saturated fat and calories. 

Researchers found that households bought 37% less sugar, 22% less sodium, 16% less saturated fat and 23% fewer total calories from products with warning labels. These figures indicate that when consumers are equipped with clear, accessible information, they can make healthier choices.

Results from Phase 2 of the nutrient warning label law (Global Food Research Program at the University of North Carolina, Chapel Hill)

They also confirm what was seen by researchers after the first phase of Chile’s law – that people bought fewer items high in nutrients of concern – and these changes were even more pronounced in Phase 2. 

Critically, the data showed that these changes were equitable across socioeconomic groups – a collective win for all Chileans.

The impact of these labels goes beyond mere numbers. They serve as vital tools for empowering individuals to take control of their health in a food environment often dominated by marketing tactics designed to entice consumers toward less healthy, ultra-processed options. 

By mandating that products high in sugar, sodium, saturated fat and/or calories carry bold warning labels, the Chilean government is not just informing consumers; it’s shifting the narrative around food consumption.

A second new study published in the American Journal of Public Health examined adherence to the mandatory front-of-package labeling provision of Chile’s historic food policy. 

In the final and most nutritionally strict phase of the law, a remarkable 94% of products required to display these labels had the appropriate labels. The results of this mandatory policy represent a stark contrast to the significantly lower uptake of voluntary labeling programs in countries like Australia and New Zealand.

This compliance showcases the effectiveness of mandatory policies—when regulations are clear and enforcement is robust, industries have no choice but to adapt.

Increased knowledge shifts social norms  

These two new studies further support the efficacy of Chile’s 2016 Law of Food Advertising and Labeling. The country has seen improvements in the nutritional quality of its food supply, a development that could better the dietary quality of the population. 

Additionally, increased knowledge about food and drinks with warning labels and shifting social norms helps consumers to make healthier choices. Furthermore, these changes have been accompanied by drops in children’s exposure to harmful food marketing, due to the law’s stringent marketing restrictions.

These impressive strides have led to newer health initiatives in Chile. Recent measures expanding warning labels to alcoholic beverages that disclose calorie counts and feature safety information indicate a commitment to tackling health issues from multiple angles.

Chile’s actions have also sparked a wave of similar initiatives for other countries looking to improve their food environments and the health of their citizens.

Throughout the Americas, eight similar policies requiring black ‘stop sign’ warning labels on foods and beverages high in nutrients of health concern were rapidly adopted, mirroring Chile’s efforts. This trend demonstrates a growing recognition that health policies can, and should, prioritize public well-being over corporate interests.

In August 2021, Argentina introduced front-of-pack warning labels for ultra-processed food products.

Mandatory labels are most effective

Global health governing bodies are taking notice. To address diet-related diseases and create enabling and supportive food environments in more countries, the World Health Organization (WHO) recently released its draft guideline on nutritional labeling policies for comment. (The deadline for comments was 11 October.)

The key tenets of the Guideline include a strong recommendation for front-of-package labeling policies and the implementation of interpretive front-of-package labels. 

WHO’s leadership and action on this issue are commendable, and their draft guideline will be an incredibly helpful blueprint for member states in formulating and implementing these policies.

However, drawing from Chile’s evidence, the Guideline could be strengthened. The evaluations of Chile’s policy clearly demonstrate the necessity of mandatory front-of-package labeling systems featuring nutrient warning labels, which have been shown to be the most effective in helping consumers identify unhealthy products. 

Research has shown that Chile’s law’s mandatory regulations can be directly linked to the policy’s observed impacts – both the decline in purchases of unhealthy products and high rates of compliance. 

The lessons are clear: evidence-supported public health policies can lead to significant changes in consumer behavior, improve nutrition and, ultimately, enhance population health.

Yet, while Chile has made impressive strides, the work is far from over. Public health experts and policymakers are working to build on these early achievements to address other issues like access to affordable, fresh fruits and vegetables and the influence of social media marketing on children.

In an era where convenience supersedes health, Chile’s commitment to enacting decisive policies that support consumers in making healthier choices in their daily lives offers a path forward. 

It’s a reminder, especially in light of World Food Day 2024’s theme, “Right to foods for a better life and a better future,” that informed choices lead to healthier lives—and that policy can be a powerful tool for change.

Lindsey Smith Taillie, PhD, is an associate professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill. She is a nutrition epidemiologist focused on designing and evaluating healthy food policies.

 

Image Credits: CIAPEC-INTA, Global Health Policy Incubator .

Ensuring high quality patient care is at the heart of the Consensus Framework.

Ten years ago, global health leaders came together to agree on the first-of-its-kind international Consensus Framework for ethical collaboration between patients’ organizations, healthcare professionals, and the pharmaceutical industry in support of quality patient care. Since then, the Framework has been adopted across countries worldwide and embedded in international initiatives.

This Global Ethics Day, under the theme ‘Ethics Empowered’, members of the international Consensus Framework celebrate 10 years of the Framework as a lighthouse for ethical collaboration for the benefit of patients. In this joint op-ed, members reflect on progress made under the Framework over the last decade and announce their commitment to ensuring it is fit-for-purpose to address unfolding new realities, including the impact of new innovations, on patients’ lives.

The very first Global Ethics Day was celebrated one decade ago. This development milestone in the ethics world was engineered for the express purpose of raising awareness and driving diverse stakeholders to address the ethics issues facing their organizations and society.

It is fitting that, in this same year, entities representing the world’s patients, healthcare professionals, hospitals, and the pharmaceutical manufacturing industry also came together to forge a novel commitment: an international Consensus Framework to foster ethical collaboration.

One decade later, on this 2024 Global Ethics Day, we are thrilled to share not only the progress we have made together but also our collective ambitions for the future. A future that must find ethical collaboration at the heart of every interaction, and of every decision taken in healthcare leadership.

Ethical collaboration to advance patient health

Our journey began with recognition that health systems around the world were evolving, and continue to evolve, towards more dynamic partnerships. When establishing partnerships with the goal of improving the health of patients, it is critical that these are built on trust.

To support this, a new transnational platform was needed that represented a shared commitment to sustain fundamental ethical principles, and to create a safe space to raise ethical risks or opportunities for collective input and alignment to deliver greater patient benefit and support high-quality care.

International Consensus Framework partners celebrate a decade of collaboration: Dani Mothci, (IAPO), Dr David Reddy (IFPMA), Dr Catherine Duggan (FIP), Howard Catton (ICN), Ronald Lavater (IHF) and Dr Otmar Kloiber (WMA).

The six international member bodies of the Framework – International Alliance of Patients’ Organizations, International Council of Nurses, International Hospital Federation, International Pharmaceutical Federation, the World Medical Association, and the International Federation of Pharmaceutical Manufacturers and Associations – have collaborated on numerous ethics issues in diverse formats, co-creating several notes for guidance as well as providing bilateral and multilateral input on emerging ethical considerations affecting one or more bodies. In so doing, we utilized the Framework to enshrine four overarching principles:

  • Putting patients first
  • Supporting ethical research and innovation
  • Ensuring independence and ethical conduct 
  • Promoting transparency and accountability.

 At the same time, we used the Framework to bring outside perspectives into our work and share our expertise with others to advance ethical decision-making in health.

From global intention to national impact

The value of this innovation in process and design cannot be understated. In 2016 Canada and Peru became the first countries to adopt national-level, consensus-based frameworks spanning major local health stakeholders. From 2017 to 2024, 12 additional national-level frameworks were adopted among leading health bodies in countries as diverse as China and the United States, Kenya and Japan, Brazil and New Zealand, underscoring that a fundamental need has surfaced in favor of ethical collaboration, irrespective of a nation’s health system.

Many countries saw their framework membership expand as time progressed, drawing new voices to the “table” to advance ethical collaboration in their healthcare systems. With the approach under active consideration in many other countries today, leading international institutions from the Asia-Pacific Economic Cooperation Forum (APEC) to the United Nations and the Organization for Economic Co-operation and Development (OECD) have taken notice. And several governments, such as those in Chile and Australia, have stepped up in support of their framework process.

The theme of this year’s Global Ethics Day is Ethics Empowered, and we believe our international Consensus Framework has done precisely this. This is true both for us and for the hundreds of health bodies across the globe participating in consensus frameworks who, in turn, represent tens of thousands of companies, millions of healthcare leaders and caregivers, and billions of patients.

Consensus Framework fit for the future

As we celebrate the 10-year milestone of the international Consensus Framework for Ethical Collaboration in health, it is also crucial to acknowledge the evolving challenges that today’s healthcare sector faces.

 The rapid rise of digital platforms and the production and use of health data, including the expansion of artificial intelligence (AI) capabilities, is transforming how each of our associations and those we represent approach healthcare delivery and patient care. These innovations offer tremendous potential as well as pose new ethical dilemmas. 

The Framework, in its current form, provides a solid foundation, but we are looking to address emerging needs through the inclusion of an additional ethical principle. If successful, such an outcome would mark the first time leading health stakeholders have come together to advance ethical collaboration in health data and AI. We are showing that ethical collaboration needs to continuously adapt to meet evolving societal expectations.

We could not be prouder to celebrate Global Ethics Day by reaffirming our commitment to the Framework and its principles. The power of ethical collaboration is, and always will be, our greatest tool for building better healthcare.  

Dani Mothci, is CEO of the International Alliance of Patients’ Organizations (IAPO)

Dr Otmar Kloiber is Secretary General of the World Medical Association (WMA)

Howard Catton is CEO of the International Council of Nurses (ICN)

Ronald Lavater is CEO of the International Hospital Federation (IHF)  

Dr Catherine Duggan is CEO of the International Pharmaceutical Federation (FIP)

Dr David Reddy is Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)

 

Image Credits: CDC, Jeremy Spierer.

BERLIN – Countries worldwide, regardless of income level, can halve premature death rates by 2050, a new Lancet report presented at the closing of the World Health Summit in Berlin suggests.

Fifteen key health threats are driving premature deaths worldwide, with tobacco use leading the pack “by far”, the Lancet Commission for Investing in Health found. Targeting interventions in these areas – with over half involving maternal, newborn, child, and infectious diseases – could dramatically reduce global deaths before age 70, the Commission said.

“Sharp reductions in mortality and morbidity can be achieved by focusing on 15 priority conditions,” Dr Angela Chang from the University of Southern Denmark and lead author of the report, told a panel at the World Health Summit in Berlin on Tuesday. “Doubling down on past health investments, focusing resources on a narrow set of conditions, scaling up financing and developing new technologies can continue to have an enormous impact despite the headwinds.”

The 15 priority conditions, selected from over 17,000 internationally recognized health diagnoses, account for approximately 80% of the life expectancy gap between most regions and the North Atlantic, defined in the report as North America and Europe. 

These conditions account for 86% of the gap between China and the North Atlantic, and 74% between sub-Saharan Africa and the North Atlantic.

“There’s a 22-year gap in life expectancy between Sub-Saharan Africa and the North Atlantic, Chang explained. “Close to 80% of this gap can be explained by these 15 priority conditions, and over half of the difference can be attributed to eight infectious and maternal health conditions.”

If the global goal is met, the average premature mortality rate worldwide would fall to about 15%, matching levels currently seen in Europe and North America—today’s global benchmark.

Achieving this would mean dramatic improvements for billions, especially in low- and middle-income countries. In Sub-Saharan Africa, the worst-performing region, premature mortality sits at 52%.

Setting priorities straight

The report’s optimism is rooted in historical data. Globally, the probability of dying before 70 has halved since the 1960s, falling from 62% to 31% for individuals born in 2019.

Thirty-seven countries, including populous nations like Bangladesh, China, Japan, and Vietnam, have already halved their premature death rates in similar or shorter periods than the 26 years remaining until the 2050 target date. 

The Commission recommends public financing for essential medicines targeting the 15 key conditions driving premature mortality. It suggests mobilizing international funding and joint procurement efforts, similar to strategies used by GAVI, PEPFAR, and the Global Fund, to reduce costs for patients and governments alike.

“Inadequate access to medicines and high out-of-pocket costs are major threats to cutting premature mortality,” Chang noted. “We learned from the Global Fund’s experience how national government subsidies can steer resources towards priority interventions and reduce out-of-pocket payments.” 

While the Commission believes halving premature mortality by 2050 is globally achievable, it acknowledges this target may be “perhaps only aspirational for some countries, realistically speaking.”

“We have a tendency to focus on the new, shiny things,” Chang added. “Our message is for countries to stay focused on these priority conditions.”

‘Tobacco is the new tobacco’

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

High tobacco taxes are “by far” the most crucial policy tool for reducing premature deaths, according to the report.

“You often hear about other risk factors, but we argue tobacco is the new tobacco,” Chang explained.

Recent research suggests raising excise taxes on tobacco, alcohol, and sugary drinks by 50% could yield $2.1 trillion for low- and middle-income countries over five years. This could boost healthcare spending in these nations by 40% if directed towards health initiatives.

The Commission highlights the Middle East and North Africa as an example of untapped potential in tobacco control. With 160 million smokers and rising prevalence among youth and women, the region faces a growing health crisis.

Egypt’s smoking rates doubled between 2000 and 2018, while tobacco became more affordable in conflict-affected countries like Iraq and Syria. The region’s tobacco taxes, second-lowest globally, fall far short of the World Health Organization’s recommended 70% excise tax.

“Despite wide experience with its successful use, tobacco taxation remains a policy tool that is still greatly underused,” the Commission found. “Raising taxes on tobacco can do more to reduce premature mortality than any other single health policy.”

High risk of  ‘COVID magnitude’ pandemic in next decade

The Lancet Comission estimates there is a 23% change of a COVID-scale pandemic in the next decade.

New modeling for the Commission’s report indicates a 23% chance of a pandemic as severe as COVID-19 occurring within a decade. Unprepared health systems could see progress on reducing premature deaths plummet if caught off guard again.

“There is a high risk of another pandemic of Covid-like magnitude,” Chang warned. “To put it another way, in most years there will be zero pandemic deaths, and in some years there will be millions of pandemic deaths.”

The Commission’s analysis estimates an average of 2.5 million deaths per year due to pandemics when viewed over a long time horizon. This figure is comparable to the current annual death toll from AIDS, malaria, and tuberculosis combined, and significantly exceeds even pessimistic projections for annual climate change-related deaths in coming decades.

“People should wake up at that figure,” Helen Clark, former Prime Minister of New Zealand, warned the summit. 

The warning from the Commission comes as global headwinds from conflict, climate change and debt hammer health budgets. Neglecting pandemic preparedness could have severe consequences, particularly for poorer countries less equipped to handle sudden outbreaks.

“We need to learn the lessons not just from COVID, but from Mpox, Ebola … and avoid this panic-neglect cycle,” said Dr Seth Berkley, former CEO of Gavi, the Vaccine Alliance. “Unfortunately, I don’t think we’re doing a very good job.” 

From 1993 to Berlin 

A figure from the World Bank’s 1993 report making the case for health as an economic investment.

The Lancet Comission report is the latest in a line of studies that traces its lineage back to a pivotal World Bank report that changed the landscape of global health finance.

The World Bank’s 1993 report, Investing in Health, the only report on health ever published by the Bank, was the first to make an argument still used by health advocates and ministers across the globe: health is an investment. 

“The World Bank saying investing in health is no just a cost to society, but an investment that was justified on pure economic grounds … was revolutionary,” Berkley recalled. “Prior to this, people saw it as a cost – if you get richer, you can afford health, but this really changed the thinking.” 

The Commission’s work has expanded on the World Bank’s initial calculations, incorporating factors such as the impact of out-of-pocket health costs on economies and personal livelihoods. This broader perspective has significantly increased the estimated economic benefits of maintaining healthy societies, from the World Bank’s initial 11% to 24%.

“The important thing is that each one of these reports, including this one, says the case is better than ever for investing in health, and we need to keep talking about that, particularly at a time when the headwinds are so strong,” Berkley emphasizes.

The latest report continues this tradition, reaffirming that health investment remains one of the most effective strategies for improving both individual and societal outcomes.

“Today, the case is better than ever for going for mortality reduction,” said Dr Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health and lead author of the commission report “It’s a prize within reach. It will have extraordinary health, welfare and economic benefits.”

Image Credits: Sarah Johnson.

BERLIN – The World Health Organization secured $1 billion in pledges at a landmark fundraising event in Berlin on Monday, kickstarting a major campaign by the UN agency to overhaul its funding model and enhance its ability to tackle global health emergencies.

The billion-dollar total includes $700 million in new pledges from European nations and philanthropies at the World Health Summit. The remaining $300 million comes from previous commitments by the European Union and African Union.

German Chancellor Olaf Scholz, speaking alongside European health ministers from the German capital, stressed the importance of sustainable financing for WHO.

“The WHO’s work benefits us all. What it needs for this work is sustainable financing that gives it the certainty to plan ahead and the flexibility to react,” Scholz said. “With the money we collect at this pledging event today, we can enable many women, men, and above all children to live healthier lives.”

For WHO, long plagued by financial uncertainty, this funding marks a first step toward sustainability as the agency – and the world – faces overlapping health threats from conflicts, poverty, pandemics, noncommunicable diseases, antimicrobial resistance, and climate change.

“For far too long, WHO has operated with unpredictable, inflexible, unsustainable funding,” said Director-General Dr Tedros Adhanom Ghebreyesus. “That prevents us from delivering the long-term support that countries need.”

The $1 billion, however, is just the start. WHO aims to raise $7.4 billion by next May’s World Health Assembly to address the budget gap in its $11.15 billion strategy for 2025-28, known as the General Programme of Work 14 (GPW-14).

This four-year plan could save over 40 million lives through progress on health-related Sustainable Development Goals, stronger health systems, and enhanced emergency responses, WHO figures project. 

“Meeting these complex and overlapping challenges requires a clear plan, and the resources to implement it,” Tedros said. “Tonight, we have taken a huge step toward mobilizing the resources we need to implement that plan.”

As the echoes of applause fade from the ballroom in Berlin, the work to raise the remaining $6.4bn the agency needs to operate through 2028 begins.

“Saving as many lives as possible is what the World Health Organization aspires to,” Scholz said. “One number reflects just how lofty this aspiration is: 40 million lives. That is how many lives the WHO will be able to save over the next four years.”

Major donors yet to commit

The “investment rounds” format aims to foster competition among nations, encouraging increased stakes in the agency’s operations. Several key European players, including Spain, the United Kingdom and France, have yet to make commitments, indicating they will announce their contributions later this year.

Further WHO funding appeals are planned in Asia, the Middle East and the Americas. Potential donors from Australia, Japan and South Korea to oil-rich Gulf states are expected to help the organization edge closer to its $7.4 billion goal.

Behind Monday’s success, concerns loom about the potential impact of the US elections on contributions from Washington, traditionally one of WHO’s largest donors. During his previous term, former President Donald Trump, once again a candidate in the November race, formally disavowed the WHO and moved to suspend US funding during his previous term. 

President Joe Biden reversed this decision upon taking office in January 2021, but the potential for another policy shift worries WHO officials.

“That’s a huge fear factor,” Catharina Boehme, who leads the WHO investment round. “We would go into a dramatically bad crisis” if U.S. support were withdrawn again in January, she told Health Policy Watch.

A step towards financial stability

Member states’ vote to reform WHO’s funding last year, championed by nations like Germany seeking more stable financing for the UN global health body, led to the current “investment round” approach.

In May, the 194 member states of the World Health Assembly agreed to incrementally increase their membership fees to fund up to 50% of WHO’s annual budget by the 2030-31 cycle, up from the current 30%. This commitment requires renewal in future WHA resolutions to take full effect.

“This strategy is designed to mobilize upfront the predictable and sustainable funding we need over the next four years,” Tedros said. “It’s also designed to put WHO on a more stable financial footing, so we are less reliant on a handful of large donors.”

In 2022-23, only 4.1% of voluntary donations, about $320 million, were fully flexible. Just 14 funders contributed flexible funding, with the UK being the largest contributor at $230,000.

Germany led Monday’s pledges with $360 million, followed by the European Union with $250 million, Norway with $100 million, and Ireland with $30 million. The combined unrestricted funds from Germany and Norway alone surpassed WHO’s entire 2022-2023 budget for self-directed initiatives addressing urgent global health priorities.

“This is an investment in the future of health and in the future generations to come,” said German Health Minister Karl Lauterbach. “In a time of wars, civil wars, epidemics, pandemics, climate change and catastrophes, it is important that WHO can rely on funding which is up to the ever-increasing tasks [asked] of the agency.”

Smaller nations step up

Smaller nations and emerging economies also joined the WHO’s funding drive. Montenegro made its first-ever donation to the agency, contributing $80,000.

“From a receiver, we are becoming a contributor,” Montenegro Prime Minister Milojko Spajic said. “It’s not always the population size or the GDP size that matters – it’s also a country’s actions that matter.”

WHO has found similar enthusiasm elsewhere. Seventeen African countries habr pledged a total of $47 million, with Niger committing $2 million despite significant economic challenges. Mauritania’s president announced new African Union funds from Berlin on Monday, adding more African countries are expected to follow.

“We know that we are making this ask at a time of competing priorities and limited resources,” Tedros said. “Every contribution counts.”

Philanthropies join the effort 

Philanthropies and foundations also contributed to the WHO’s fundraising drive, with Wellcome Trust and Sanofi Foundation each pledging $50 million.

“It is member states that have the core responsibility for ensuring sustainable financing for WHO. However, as a philanthropy, we also have a role to play,” said Jan Arne Rottingen, Executive Director of the Wellcome Trust. “Given the scale and the urgency of impacts on climate change on health, we urge other philanthropies and member states to invest in WHO’s critical work.”

Some donors designated funds for specific issues, including noncommunicable diseases, mental health, and substance abuse. These targeted contributions, while less flexible, aim to bolster WHO programs in traditionally underfunded areas.

“We maintain that one of the soundest investments in global health is in WHO,” Tedros and health ministers from across Europe said in an op-ed as the summit began. “Countries are doing so, already, through their regular contributions. But there is a clear understanding that in times of crisis, this is not sufficient.”

‘Budget of a mid-size hospital’ 

The World Health Organization flag above its headquarters in Geneva.

The investment round comes against a backdrop of long-standing financial constraints that have hindered WHO’s operations for years, despite its responsibility for advancing the health of 8 billion people worldwide.

In 2022-2023, WHO’s annual budget for its operations in over 150 countries was only $6.7 billion — a mere 33 cents per person globally. The Gates Foundation spent more than $15 billion during the same period.

“WHO has the annual budget of a mid-size hospital,” said Boehme, who is leading the WHO investment round. “Two and a half billion is not enough given our reach in basically all countries in the world.”

Even if funding goals are reached, the agency’s 2025-28 budget won’t be any larger. Yet it might be more predictable, flexible, and equitably distributed if member states cooperate.

In 2022-23, 88% of WHO’s funding came from voluntary contributions, with 60% of the agency’s budget controlled by just nine donors.

WHO’s expanding role

Despite its limited budget, WHO’s roles and responsibilities have expanded over the decades. It operates as a de facto second health ministry in many impoverished regions, financing primary-care clinics, managing vaccine programs, and providing training to local health authorities.

Conflict and climate change-driven natural disasters have forced WHO to take on larger emergency response roles in more affected countries – from Ukraine to Gaza, Sudan and the Democratic Republic of Congo.

As WHO continues its fundraising efforts, the challenge remains to secure not just more funding, but more flexible funding that allows the agency to independently address global health priorities.

“The COVID-19 pandemic demonstrated that when health is at risk, everything is at risk,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus at the close of the pledge announcements. “Investments in WHO are therefore investments not only in protecting and promoting health, but also in more equitable, more stable and more secure societies and economies.”

Tedros has personally campaigned for more reliable, long-term and flexible funding since taking over the helm of the organization in 2017. Even so, he seemed satisfied with the outcomes of the first salvo of the new funding drive.

“The COVID-19 pandemic made it definitely clear that an outbreak of infectious disease anywhere in the world affects us all,” Scholz said. “Pandemics do not stop for borders. This represents a global challenge that we can only properly tackle together.”

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr.

GPMB co-chair Joy Phumaphi

While the next pathogen with pandemic potential may be lurking in a faraway creature, human behaviour will drive it to become a pandemic, according to the Global Preparedness Monitoring Board (GPMB), which issued its first comprehensive pandemic risk report on Monday.

The four riskiest human behaviours involve our global mobility, agricultural and farming practices, mis- and disinformation and a lack of trust – in science, in governments and between countries – according to the GPMB.

In 2024, there have already been 17 outbreaks of dangerous diseases, including H5N1 that has spilt over from cattle to humans and a new strain of mpox in East Africa. 

“The high likelihood that they will spread further should be a wake-up call for the global community,” said the board.

“Pandemics are not random events,” GPMB co-chair Joy Phumaphi told a media briefing before the launch. “The factors contributing to pandemics are deeply intertwined with how humans interact with the environment, animals and trade.

“Human and animal interconnections, including the trade and proximity of animal products, play a significant role in the transmissions of pathogens,” noted Phumaphi, Botswana’s former health minister.

“The increasingly rapid movement of people across countries and continents accelerates the spread of disease,” she noted. So too does the spread of misinformation and disinformation as it “undermines public trust and hampers collective efforts”. 

“Trust is a cornerstone [that is] central to pandemic response. Distrust can contribute to the emergence of new viruses and exacerbate outbreaks whereas trust between stakeholders and nations strengthens international collaboration and response efforts,” said Phumaphi.

The report also identifies “climate change, individualism, economic inequality, and conflict and instability” as key drivers of  pandemics.

We are ‘always at risk’

Kolinda Grabar-Kitarović, GPMB co-chair and former President of Croatia.

“We are always at risk. Pandemic drivers evolve rapidly, and if we don’t stay ahead, we’ll be unprepared for what comes next,” said Kolinda Grabar-Kitarović, the other co-chair and former President of Croatia.

“We need to focus on preparing for the next crisis, not just reacting to the last one. While we cannot predict exactly which pathogen will emerge, we can assess our risks and vulnerabilities and develop strategies to address them. Pandemics bring fear and uncertainty, and being unprepared only highlights that fear,” Grabar-Kitarović told a discussion on the report at the World Health Summit in Berlin on Monday.

Phumaphi stressed that collaboration and equity mitigate pandemic risks – and are also the best way to rebuild trust between countries that was broken during the COVID-19 pandemic.

However, cooperation and collaboration are “most difficult” to develop during a crisis – which is why frameworks like the WHO’s International Health Regulations and the pandemic agreement, currently being negotiated, are important, she stressed.

Weak pandemic agreement poses threat

Phumaphi told the media briefing that the release of the report had been timed to coincide with what might be the last meeting of the International Negotiating Body (INB) drafting the pandemic agreement, set for the first two weeks of November.

“We are aware of the direction that the negotiations are taking, and what we are concerned about is that this direction is actually going to fuel the spread of the next pandemic,” said Phumaphi. 

She described reports that the agreement’s commitment to equity had been watered down, as “a serious threat to our readiness”. 

WHO Director-General Dr Tedros Adhanom Ghebreyusus told the summit that the board’s report “highlights many of the key components that the pandemic agreement is designed to address: a One Health approach, equitable access to medical countermeasures, research and development, and most importantly, and most relevant for this world summit, trust”. 

Tedros added: “The global response to the COVID-19 pandemic was undermined by the lack of a coherent and coordinated approach, based on equity and solidarity. We can only face shared threats with a shared response.”

‘Adapt, protect, connect’

Board member Prof Ilona Kickbusch, chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

The report advocates three measures to counter pandemic threats: “adapt, protect and connect”.

GPMB member Prof Ilona Kickbusch told the summit that, with adapt, the board wants countries  to assess their pandemic risk drivers, involving all sectors of society.

The key to protection is strong primary health care, equity, social protection for the most vulnerable, and boosting international cooperation, added Kickbusch, who is chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

“Connect” relates to international cooperation and intersectoral cooperation, supported by dedicated funding. But it also relates to digital connection – which has helped with the spread of information but also fueled disinformation.

Without trust, innovation is ‘useless’

Victor Dzau, board member and President of the US National Academy of Medicine

Board member Victor Dzau said that while science has great progress with, for example, the rapid development of mRNA vaccines during COVID, “we’re foolish to think that science  alone will protect us”.

Scientific innovations are “useless if people don’t trust them”, said Dzau, who is also President of the US National Academy of Medicine and vice-chair of the US National Research Council.

“Whatever we do, we must address issue of trust. That means that we need to understand the root cause, including social inequity as social inequity fosters mistrust.”

Dzau said trust needs to be build “way before pandemic begins” to ensure that there is a “reservoir of goodwill, of trust, that can be relied upon when the crisis take place”. 

“During a pandemic, we need much better communication to listen more to people’s fears and fears and questions real time.”

Better ‘One Health’ tools

Panel of GPMB board members: Sir Mark Lowcock, Dr Victor Dzau, Prof Ilona Kickbusch and Christopher Elias

Board member Sir Mark Lowcock, former head of United Nations Office for the Coordination of Humanitarian Affairs (OCHA),   addressed the need for a One Health approach “linking human, animal and environmental health”.

“Those risk areas are particularly found where we have new hotspots, where there’s high levels of interaction between humans, animals and environmental stresses. We need better tools to identify those hot spots and understand the risks involved. The entry point for many countries actually is improvements to their animal health system and their food safety services,” said Lowcock, who is a former UK Permanent Secretary of the Department of International Development.

Climate change is “an amplifier of all these risks”, he added, and this needs to be addressed by “early detection, strong primary health care and overcoming the barriers to access to medical countermeasures” – and “underpinned by strong international cooperation”.

Mobility of people – and pathogens

Dr Chris Elias, president of Global Development at the Bill and Melinda Gates Foundation

“Human mobility today through trade, travel, immigration, or refugees who are fleeing conflict or climate disasters, plays in a very important role in spreading diseases, because when people move, the pathogens move with them, and that can bring novel or reemerging diseases into populations that don’t have any prior immunity,” said board member Dr Chris Elias.

“Take the example of the Omicron variant, which was initially identified in South Africa and reported promptly in late November of 2021. Within three weeks, by the middle of December, it had spread to over 70 countries, and that was in the middle of a pandemic where we were reducing the amount of movement,” said Elias, who is president of Global Development at the Bill and Melinda Gates Foundation.

Urbanisation has “skyrocketed” since the 1960, with two-thirds of people projected to live in cities by 2050, he added.

“Cities have higher population density, they have frequent commuting, and they create ideal conditions for the rapid spread of disease,” he noted.

“We have to build trust so that we can objectively assess those risks and take steps to mitigate without overreacting and causing harm to individual economies or the supply chains and creating the kind of inequity that we saw during the COVID pandemic.”

Elias concluded by noting that “one of the best ways for us to repair that trust is to have the kind of agreement we reached as a global community last year with the [amended] International Health Regulations, and to do that with the pandemic treaty, and to continue to build that sense of science driving preparedness and response.”