WHO Director-General Dr Tedros Adhanom Ghebreyesus, (left) and Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health (middle) in conversation with Ravi Agrawal, editor-in-chief of Foreign Policy (right).

Specific health actions need to be included in countries’ climate targets – officially called the Nationally Determined Contributions (NDCs) – according to several health advocates speaking at the UN Climate Week in New York City over the past week.

“Our agenda should be health-centric,” said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), speaking on the sidelines of the annual UN General Assembly.

“We need to use the resources wisely, meaning targeting those populations, affected populations and then from there of course you can move to the rest because resources are limited,” Tedros said.

The demand for a holistic view in framing NDCs to ensure a “healthy and stable future” in was also reiterated in a signed letter by 20 leading civil society organizations and sent to officials at the UN Framework Convention on Climate Change (UNFCC), the entity supporting global response to climate change.

The rise in extreme weather events, such as heatwaves and floods, are directly impacting health and healthcare facilities. 

Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health, called for health to be “embedded in the NDCs”. 

“We need to have health metrics, and we need to stop thinking about it as a sunk cost, but rather as an investment,” Kerry said. 

Centering health at COP

This decade, health has already gone from being a side note at the annual UN Climate Conference of Parties (COP) to having a day dedicated to the subject at the last COP in Dubai, United Arab Emirates (UAE). 

Both the Baku (Azerbaijan) COP presidency, which will  host this year and the Belém (Brazil) COP presidency, which will host next year, said that they aim to integrate health into climate conversations further.  

“Brazil was hit this year with the biggest dengue epidemic for ever, and this was the very consequence of the climate change and the high temperature that we are facing in Brazil and in all of the world,” said Ethel Maciel, Brazil’s Secretary of Health Surveillance and Environment.

She added that health equity will be a major focus and that Brazil has appointed a specific coordinator to work on the link between climate change and health equity.

The speed and extent of action though rely also on resources. For instance, the UAE recognized that having the resources and universal health coverage helps as they have the building blocks for what you need to be healthy. 

“We would say, for the nationally determined contributions, please embed [and] institutionalize targets for health in there, be they things like the impact of air pollution on health, be they heat stroke, be they mental health issues, number of events prevented. Whatever they are, please institutionalize certain metrics of health inside your nationally determined contributions,” urged Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs. 

Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs

Dr Maria Neira, WHO’s director of Environment, Climate Change and Health, drew attention to the fact that access to renewable energy will improve health by reducing air pollution.  

“So now we need to use health as a motivation. The health argument that we are taking to the COPs has to be extremely strong, and we are the ones that needs to engage,” she said, referring to the health sector.  

Working with cities for impact

It has become clear over the years that national governments are slow to move on climate targets. In addition, when it comes to the climate and health link, a range of stakeholders are needed for effective response. 

The Baku COP Presidency has an initiative on climate resilient cities of which health will be a big part. 

Patty O’Hayer, global head of corporate affairs at Reckitt, said that city mayors need to be supported to bring out change as they have a unique perspective and don’t work in silos. 

“Cities give you that kind of umbrella way that you can look at all of those aspects and make sure that you’re spending your time, your effort, your energy around the social determinants of health, decarbonizing the health care systems and thinking about public health in a much more holistic way,” she said. 

 

 

Health workers examine an mpox patient

Governments and donors have pledged around $1 billion to combat Africa’s mpox outbreak in the past few weeks, with the US pledging $500 million this week, said Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention.

But the continent’s response is confounded by poor surveillance, problems with testingm virtually non-existant contact tracing (less than 4%) and insufficient knowledge about transmission, Kaseya tols a media briefing on Thursday.

Africa CDC and the World Health Organization (WHO), who are coordinating the continental response, were due to meet US Health Secretary Xavier Beccera late Thursday to discuss how the US money would be allocated.

However, the White House stated earlier in the week that the money will address a range of needs identified by the Africa CDC and WHO, including “training frontline health workers, disease surveillance, laboratory diagnostic supplies and testing, clinical case management, risk communication and community engagement, infection prevention and control, and research”. 

The Pandemic Fund has made $129 million available for 10 countries, while African countries have availed around 10% of funds raised.

Vaccine donations hit 4.3 million

Some 4,3 million vaccine donations have also been pledged. The bulk – three million – are from Japan for the Democratic Republic of Congo (DRC), the epicentre of the outbreak. The US also promised one million vaccines this week.

The Coalition for Epidemic Preparedness Innovations (​​Cepi) has allocated around $72 million (in partnership with vaccine producer BioNTech) for mpox vaccine development, and $145 million to support the expansion of the manufacturing capacity in Africa, especially in Rwanda, said Kaseya. 

But only a small percentage of the vaccine donations have touched down on African soil. The DRC is due to roll out its vaccination efforts next week but it has to navigate poor roads, lack of trained staff and armed conflict.

Given the scarcity of vaccines, vaccines will be confined to priority groups starting with the contacts of confirmed cases and healthcare workers, explained Dr Ngashi Ngongo, Africa CDC’s Chief of Staff, at a media briefing on Thursday.

Dr Ngashi Ngongo, Africa CDC Chief of staff

Others priority groups are “key populations, meaning commercial sex workers and men and having sex with men”, children, people in refugee camps, prisoners, truck drivers, cross-border traders and those who are immunocompromised, particularly those living with HIV.

Fifteen African countries have reported mpox cases since the beginning of the year while a further 15 are vulnerable, Kaseya told the media briefing.

In the past week, 2,910 new cases have been reported but only 436 have been confirmed, said Kaseya. Since the beginning of the year, over 32,000 suspected cases have been reported yet less than one-fifth have been confirmed.

Major weaknesses in surveillance, laboratories and research are confounding efforts to stem the spread of mpox. 

“Our immediate priorities are enhanced surveillance, contact tracing and laboratory testing,” said Kaseya.

Only about half the suspected mpox cases are being tested, and around 40% positivity rate  – but the results were tainted by the quality of the specimens, poorly trained staff as well as tests picking up other diseases such as measles and chicken pox, explained Ngongo.

About a third of cases have no apparent links to other cases, but Ngongo said this was likely because contact tracing is weak – with health workers only reaching around 3% of those who had been in contact with cases.

“Community-based surveillance is weak because the community health workers and community health programs have not been involved fully involved into the mpox response,” Ngongo noted. 

The mpox incidence management team, headed by Africa CDC and WHO, is encouraging countries to increase the number of community health workers, and the DRC plans to roll out the 40,000 community networkers, he added.

West’s failure to act on mpox Clade I

Africa CDC Director-General Dr Jean Kaseya.

Kaseya said that “our colleagues from Western countries” are also responsible for the huge rise in mpox cases in Africa.

“When we had the mpox public health emergence of international concern in 2022, they focused just on Clade II because that was in Europe and the US. They knew that there was a Clade I in Africa but didn’t conduct research on Clade I.”

Clade I has mutated into Clade Ib, which appears more infectious and more deadly. But because of international neglect, there is no rapid test for Clade I.

“We do not have a full understanding of the epidemiology of mpox and the transmission dynamics,” said Kaseya. “What are some of the factors that, for example, explain the high numbers of children that are being infected?

“About 80% of unknowns are mostly because our colleagues and partners didn’t want to see the reality,” he added.

Africa CDC has also sounded the alarm about possible cross-border transmission via truck drivers, who were key in transmitting HIV across the continent.

“Uganda’s 212 cases are just the tip of the iceberg. Knowing the cross border movement, mostly with truck drivers, and the weakness of our surveillance system, no one can say that these 212 suspected cases are accurate,” said Kaseya.

 He also questioned whether Tanzania, which has not officially reported any cases, really is mpox-free given its proximity to affected neighbours.

Image Credits: Africa CDC.

UN High Level Meeting, presided over by heads of FAO and UNEP (far left), and WHO WOAH (right), approves new declaration to fight AMR.

A UN High Level Meeting on Antimicrobial Resistance (AMR) pledged to reduce by 10% deaths from drug resistant bacteria over the next six years in a new declaration on the “silent, slow-motion pandemic” that could kill some 39 million more people by 2050.

Thursday’s milestone statement, the first on the topic since 2016, also pledges to raise $100 million to fund the updating of countries’ AMR action plans and their implementation. 

It also formalizes the standing of the Quadripartite secretariat made up of the World Health Organization (WHO), UN Environment (UNEP), the Food and Agriculture Organization (FAO), and the World Organization of Animal Health (WOAH), as the body coordinating global AMR response across the human, animal and environmental sectors.  

 Step forward despite no target for reducing animal antibiotic use

Mia Mottley, Prime Minister Barbados, at press briefing on on AMR threat before the HLM session.

The final draft of the declaration failed to include an earlier target to reduce the animal use of antibiotics by 30% by 2030, due to pressure from meat-producing nations and the farm industry. 

This, critics say, remains a serious shortcoming in the final draft as livestock use comprises as much as 73% of global sales of a range of antimicrobial agents (including antibiotics, antivirals and antiparasitics). 

Even so, the initiative was hailed as a major step forward in spurring more action on trends that few governments have fully recognized until very recently. 

“This declaration.. is an impressive blueprint for action,” declared Barbados Prime Minister Mia Mottley, who has become a global leader and advocate on AMR. 

“But the truth is the hard work starts tomorrow,” she said. “We’ve set a very, very modest target of $100 million [for national plans of action] and I hope that we can reach out to the leaders within the private sector, the pharmaceutical industries, the meat industries, all of the various players. 

“Because, as I’ve said very often with climate, unless they have a plan to live on a different planet, then we have to define the win-win solution for us all.”

No country is immune

WHO Director General Dr Tedros Adhanom Ghebreyesus at the UN High Level Meeting on AMR.

 “No country is immune to this threat, but low and middle income countries bear the greatest burden,” WHO Director General Dr Tedros Adhanom Ghebreyesus warned in his remarks.

“The threat of AMR cuts across the health of humans, animals, agriculture and our environment, and so must its solutions,” Tedros added.  “That’s why WHO, FAO and UNEP are working together closely with the World Organization for Animal Health (WOAH) in a One Health approach.” 

While 90% of countries have developed AMR action plans, only 11% of countries have allocated budgets to implement those plans, he said. 

As next steps, Tedros said that WHO and other members of the Quadrapartite would set up an independent science panel to produce a major report synthesizing evidence for more action on AMR by 2025.  WHO would also update its decade old global strategy on AMR by 2026. 

Deaths from superbugs 

New drug resistant bacterial strains are emerging more and more rapidly after the introduction of new antibiotics: WHO

Drug resistant bacteria are estimated to have killed an estimated 1.14 million people in 2021, and were somehow associated with the deaths of 4.71 million people, according to estimates published in The Lancet in mid-September. 

In the declaration, countries committed to reducing annual AMR deaths by 10% using a 2019 baseline level of mortality. In that year, 1.27 million deaths were attributed to drug resistant bacteria while 4.95 million deaths were somehow associated with drug resistant infections.  

Should global efforts to curb AMR fail, drug resistant pathogens could become the number one cause of death by 2050, warned Mottley at a press briefing just ahead of the High Level Meeting.

That would mean just going to the dentist, or getting cut doing garden work could lead to life threatening infections for some people “purely because of the ineffectiveness of the antibiotics,” Mottley warned.

“This, therefore, is a press conference not for us with grey hairs, so much, but for the young people in the world because they are the ones who will have to face the possible threat of a reversal of a century of medical progress in what we dub the ‘silent, slow motion pandemic,'” Mottley said.

Even so, AMR has already hit millions of families in the world, including her own, with tragic results, she added: “When I started this journey, I didn’t know it would become personal for me and my family, and I pray that no family has to experience what we did with respect to the loss of someone purely because of the ineffectiveness of antibiotics to be able to deal with infection.”

Four pronged assault – priorities for health and environmental sector 

The declaration outlines a four-part strategy to combat AMR. It calls for more careful use of antimicrobial agents in healthcare, farming, and animal sectors, alongside improved management of untreated sewage and hospital emissions. These emissions create environments where microbes from urine and feces can mutate and develop resistance to antibiotics, which are also released by hospitals and communities.

There is an urgent need for new antibiotics in many classes – and too few products in R&D.

Tedros, Mottley and others also called out the alarming dearth of new antimicrobials in the product pipeline. 

The number of pharma firms working on new antibiotics has declined substantially since 2000 due to the perception that there is little profitability in producing new products that can’t be used in large volumes, precisely because that may foster a spiral of new resistance risks.  

Mottley said that antibiotics should be recognized as a “global public good” with “dedicated financing”’ that goes beyond commercial investments.  

“I hope, therefore, that the World Bank in the general discussion as to its own reform and its movement towards the finance of global public goods and the guardian of global public commons, will be able to see appreciable progress in its reform efforts, so that this can be one of the early beneficiaries…  because…, this is as much an existential crisis.” 

Tackling fake medicines, sewage discharge and hospital emissions

Inger Andersen, United Nations Environment Programme at the UN High Level Meeting.

Tackling fake and substandard medicines, which can also lead to emergent resistance, is another huge priority cited in the declaration. And along with reducing overuse of antibiotics at risk of becoming impotent, as per WHO’s AWaRe classifications, there is a need to improve access to the right antibiotic formulations in low- and middle-income countries, where many more people still die from lack of any access whatsoever, Tedros emphasized. 

Moreover, some 56% of sewage effluent discharged is untreated, leaving cesspools of pathogens to breed and develop in lakes, rivers and aquifers of developing countries, in particular, pointed out Inger Andersen, Executive Director of the UN Environment Programme. 

Prevention is key to stop antimicrobials from leaking into our environment from municipal wastewater, from municipal waste, as well as wastewater from pharmaceutical production, hospitals, and farms that over use and intensify crop production sprayed with antimicrobials, Andersen added.  

“The pharmaceutical sector can strengthen inspection systems, change incentives and importantly, we can change subsidies and ensure adequate waste and waste management containment,” Andersen said. 

“The food and agriculture sector can take preventive action to limit the use of antimicrobials and to reduce the discharge from crops and terrestrial and aquatic, marine and animal and fish production facilities and the healthcare sector can improve access to high quality, hospital-specific wastewater treatment systems.

“This will take political determination, she stressed. “This will take leadership. These actions and more must be backed at the highest level, with policies, with laws and with regulations to reduce effluent releases.”

Animal use remains ‘elephant’ in AMR arena

Most of the world’s antibiotics sold are consumed by livestock not people – where they are often use as growth promoters or to prevent, rather than treat, infections.

But in terms of sheer volumes of use, antimicrobial use in the livestock sector remains one of the biggest threats to curbing AMR trends. It is estimated that some 73% of antimicrobials sold globally are used in livestock production, including continued use of antibiotics as growth agents in many nations.

Dropping the 30% target for their reduction significantly weakens the armory of the new declaration, observers said. 

“The AMR political declaration heralds a major shift in the global health response for AMR notably with the inclusion of commitment for targets and accountability including the recognition of the Quadripartite Joint Secretariat as the central coordinating mechanism as well as the call to establish an Independent Panel” said Dr Haileyesus Getahun, CEO of the South-South HeDPAC partnership. He led the foundation of the Quadripartite Secretariat, and served as its first director, in a previous role at WHO. 

“But it is very disappointing to see that the Muscat Manifesto targets on the 30% reduction of antimicrobial use in animals is not included, despite endorsement by 47 countries, ” he added, referring to a November 2022 declaration issued at the end of a High-Level Ministerial Conference on AMR hosted by the Sultanate of Oman in Muscat as part of the lead-up to the 2024 UN High Level Meeting. 

“Commitment for the targets would have galvanised county-level action not only to strengthen the animal health system but also the research and development for alternatives to antimicrobials,” Getahun said.

“It is unfortunate that there was a major push back by the animal food industry who were able to influence some member states and even divide the Quadripartite organizations on this very topic.”

WOAH cites its plans for action in animal sector

Emmanuelle Soubeyran, WOAH Director General, speaking at the UN HLM.

There is, however, increasing recognition that overuse of antibiotics and other antimicrobials also represents an economic threat to the meat and dairy industry as the drugs will also become less effective in animal populations, asserted new WOAH Director General, Emmanuelle Soubeyran, at the HLM meeting.

“Drug resistant pathogens could jeopardize food security for over two billion people globally, more specifically on livestock, if no action is taken,” she said. 

“The impacts of AMR on livestock could reduce global GDP by $40 billion per year,” she said.  “But achieving a global 30% reduction in animal antimicrobial use within five years can raise [global] GDP in 2050 by €14 billion. 

“Thus, the World Organization for Animal Health welcomes the political declaration in alliance with our four priorities.”

Improving access to animal vaccination as an alternative to antimicrobials

Soubeyran said that improving access to animal vaccinations for vaccine-preventable diseases can reduce unnecessary use of antimicrobials. 

“We welcome your commitment to define animal vaccination strategies with clear implementation plans… and we’ll update the priority list of diseases of which vaccines could reduce antimicrobial use.”

At the same time, she admitted that the animal sector needs to do more to reduce its use of drugs deemed by the WHO to be “highest priority” for use in human health – and not animals. 

“The use in animals of highest priority antimicrobials to human health has been globally reduced to 16%,” she said.  “Regulation, awareness campaign, trainings, and public private partnerships have allowed such developments. 

“But we strongly encourage all of you, all of our members, to accelerate along this line. So, the important gaps still observed in the compliance with our international standards are closed.”

Economic carrot and stick

Since 2015, WOAH has seen the number of countries reporting quantitative data on antimicrobial use in animals increase three-fold, with 130 member states [of 183] now reporting, she added at a press briefing just before the HLM.

At the same time, the Paris-based WOAH, unlike FAO, WHO and UNEP, is not a UN-affiliated agency. Member states’ reports of their antimicrobial use are voluntary and not made public, leaving researchers to cull regional and country data from surveillance data on international drug sales in the animal health market. 

For instance, a  2019 WOAH report on trends in use of antibiotics as growth promoters, showed a decline in the practice. But not all 183 member states report data, and WOAH does not name the 45 countries that did report but continue antibiotic use for growth promotion.  

Among countries that continue to use antibiotics as growth promoters, the overall use of antibiotics is much higher overall, without much regard for risks, Soubeyran acknowledged. 

“Some 76% of WOAH members still using antimicrobials as growth promoters have not carried out a risk assessment … and countries using antimicrobials for growth promotion in livestock have an estimated average of 45% higher antimicrobial use than countries that do not use growth promoters.” 

Despite the resistance to change, emerging new economic data showing how antimicrobial abuse in livestock could lead to big economic losses over time, while judicious use will yield economic benefits, could begin to make a difference to the industry and policy makers. 

 “It is something very important to say to the sector,” she said. 

Image Credits: Yvan Hutin/WHO, IFPMA, Flickr: Paul van de Velde.

Nearly 4.1 billion people, roughly half the planet’s population, experienced unusually hot temperatures between June and August, in what was Earth’s hottest season on record.

Climate change made these high temperatures three times more likely, according to the latest report by Climate Central, a US-based non-profit of scientists and science communicators that conducts research on climate change.  

The average person experienced 17 extra days of risky heat because of climate change during this period. Risky heat days are when temperatures are hotter than 90% of the temperatures recorded in a local area from 1991-2020. Heat-related health risks rise when temperatures climb above this local threshold.

The report looked at 22 regions across 218 countries and territories using the Climate Shift Index (CSI), a metric developed by Climate Central and launched in 2022, that quantifies the influence of climate change on daily temperatures.
The report is among the growing pieces of evidence on the deadly impact of heat. In July this year UN Secretary-General António Guterres called on countries to act on heat by protecting vulnerable populations and by investing in early warning systems. 

The health impacts of climate change have also been discussed at the ongoing climate week in New York as well as the United Nations General Assembly.

Hottest season on record

The effects of human-induced climate change, mainly from burning fossil fuels, were evident in all regions of the world in the form of extreme heat, climate scientists found.  

The heat was so bad that one in four people on the planet had no break from climate change-driven heat. On every day in June, July, and August, they experienced unusually warm temperatures made at least three times more likely by climate change. 

Global exposure peaked on 13 August, by which time 4.1 billion people or roughly half (50%) of all people worldwide experienced unusual heat at CSI level 3 or higher.

Over two billion people or 25% of the global population experienced 30 or more days of risky heat that were made at least three times more likely by climate change. 

This heat can worsen underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases, according to the World Health Organization (WHO).  
Heavy rainfall, deadly floods and storms, and raging wildfires were also exacerbated during this period. 

Global phenomenon

The areas affected by deadly heat were spread around the world. This included nearly the entire population of the Caribbean and at least three in every four people in Western Asia, Micronesia, Northern Africa, and Southern Europe. 

As many as 72 countries, home to more than 2.3 billion people, experienced their hottest June–August period since at 1970. The average person in these countries experienced a very strong influence of climate change on 34 of the 92 total days from June-August.

Around 180 cities in the Northern Hemisphere where June to August were the summer months had at least one dangerous extreme heatwave. Heatwaves were calculated as a place having at least five consecutive days with temperatures hotter than 99% of temperatures recorded in that city from 1991-2020.

Across these 180 cities, extreme heat waves of this intensity and duration are, on average, 21 times more likely today because of human-caused climate change, the report found. 

Influence of climate change 

The report did not just look at the heat extremes but also the influence of climate change.

Of the 22 regions analyzed, the highest regional average temperature anomalies were in Eastern Europe. The region experienced temperatures 1.9°C above normal, and 14 days with temperatures very strongly influenced by climate change.

Western Asia, Southern Europe, Northern Africa and Eastern Asia were other regions that saw temperatures significantly above normal for several days.

WHO and the World Meteorological Organization (WMO) are already working together to draw attention and respond to the health impacts of heat on human health. 

Guterres has reiterated the call for limiting temperature rise to 1.5°C by phasing out fossil fuels and scaling up investment in renewable energy to prevent further heat escalation. 

Image Credits: Dikaseva/ Unsplash.

Dr Ethel Maciel, Brazil, (center) talks about the interlinkages between Climate, One Health and AMR at a panel on the margins of the UN General Assembly.

NEW YORK CITY – Brazil is advancing two major health-related declarations – on climate and One Health and on local medicines production – that it hopes to have ready for the upcoming G20 Summit that it is hosting in Rio in November.

Despite political pushback, Brazil’s Deputy Minister of Health expressed hopes that the two declarations would be ready in time for the November Summit, marking the end of Brazil’s G20 Presidency. 

“I’m a believer. So I think that in the end of the June 20 presidency, we will have these two declarations in place,” said Vice Minister Dr Ethel Maciel.

She was speaking at a side event Tuesday on Pandemics, Climate and Conflict hosted by the Pandemic Action Network (PAN),  ahead of a UN High Level Meeting on Antimicrobial Resistance (AMR), scheduled for Thursday. 

The G20 Leaders’ Summit is scheduled for 18-19 November in Rio de Janeiro, and will be attended by 19 member states, plus the European Union and the African Union. 

The declaration on local production of medicines and vaccines aims to accelerate the recent drive to expand  pharma manufacturing in low- and middle-income regions that found themselves unable to secure significant supplies of critical health products during the COVID pandemic, Maciel said.

“The pandemic showed us the importance of local production in the regions, because if we cannot depend on only one or two countries for our pharmaceutical components; we need to have capacity-building in the region.”

G20 Climate and health declaration to have AMR focus

From global climate change to drug resistant microscopic bacteria – trends are deeply interlinked.

The declaration on Climate and One Health. meanwhile, will have a specific focus on AMR  – the growing trend of superbugs that do not respond to available antibiotics, antiviral or anti-parasitic medicines, she noted. 

“Health is a very important argument to climate change, because the health sector is at the frontier of climate change; we are the first sector that has the impact, that has suffered the impact of the climate change,” Maciel said.  “And we took AMR as a pathway for work on the One Health approach,” she added.  

The wide-ranging event featured over a dozen global health government and agency leaders, as well as ‘Elders’, Helen Clark, former New Zealand Prime Minister; Ellen Johnson Sirleaf, former Liberian President; and Juan Manuel Santos, Former President of Colombia.

Climate change, AMR and pandemics

A participant is prepared for a blood test as part of a clinical trial of new TB drugs that can overcome drug resistant pathogens.

Maciel and other panellists underlined how the issue of climate change, AMR trends, and pandemic risks are all deeply interlinked but not well understood. 

An estimated 1.14 million people died in 2021 from drug resistant bacterial diseases alone, while a total of 4.71 million people die from bacterial conditions that may have some association to drug resistant pathogens. And that number could double by 2050, with a total of 39 million AMR-related deaths between 2025 and 2050, according to the latest estimates, published by The Lancet, in mid-September.  

So far, most of the policy emphasis on combatting AMR has been focused on the more judicious health sector use and administration of antibiotics, antivirals and other drugs in humans – as well as research to develop new drug solutions. 

However, the even wider use of such drugs in industrial livestock and fisheries production, as well as plant agriculture, has been largely neglected by global health leaders. 

More than 73% of all antimicrobial drugs sold globally are used in animals not people – highlighting their large contribution to AMR trends – and pandemic risks.  Even so, targets for reducing animal antibiotic use were dropped at the last minute from the draft text of the UN High Level declaration on AMR, to be approved Thursday, under pressure from a coalition of meat-producing nations.  

Trends in animal antimicrobial sales also correspond with growing AMR hotspots in Asia, the Americas and parts of Europe and southern Africa, according to recent research by the Swiss-led Zurich Resistancebank.org.

Unsustainable practices in these sectors also contribute to deforestation, coastline degradation, and biodiversity loss – which in turn drive climate change.  

These, in turn, exacerbate conflicts over land and resources when communities face drought, a loss of livelihoods and displacement. 

It’s a complex web of connections that gets far too little attention, said Joanne Liu, former International President of Médecins sans Frontières and now a professor of global health at McGill University in Canada.

“Climate and conflict, that’s really, honestly, a toxic mix,” Liu said. “It’s an amplifier of existing problems.” 

Tackling AMR to address One Health and climate 

Firefighters battle blazes in Brazil’s Pantanal region, the world’s largest tropical wetland, in August 2024.

Brazil is currently at a nexus of many One Health and climate issues, which have also been highly politicized, Maciel noted.

The country is battling wildfires, many set deliberately by loggers, ranchers and others who support the policy lines of former president Jair Bolsonaro,. They aim to continue deforesting the Amazon and the Pantanal, the world’s largest tropical wetland, to expand grain, livestock and mineral production – without any regard to the climate impacts. 

The number of fires in the country have more than doubled compared to last year – darkening the skies over cities from Buenos Aires to La Paz, Bolivia. The fires are so vast – with one-half burning in pristine forests – that critical tipping points for some of the world’s most important carbon sinks may soon be breached. 

“In Brazil, we have a very polarized country as here in the US and people that follow one politician, they don’t believe in climate change,” Maciel said. “We have a lot of wildfires that people are setting by themselves. More than 50 people are under investigation by the Supreme Court for setting fires… because they don’t believe in climate change.”

Health on the pathway to COP30 in Rio

Industrial livestock production and related antibiotic use, has multiple knock-on impacts for health, AMR – and climate.

Against this background, Brazil’s push in the G20 to win approval for a declaration on One Health and Climate aims to bring this complex thicket of issues down to a more practical level, the Brazilian vice minister said. 

One Health is a ‘very abstract’,” she noted, whereas AMR is beginning to be understood as a tangible health threat. “We hope, with this declaration, that climate change and a One Health approach will be linked with AMR.” 

At the same time, the G20 resolution is not a foregone conclusion. The negotiations to arrive at a diplomatic consensus on the text have been much more difficult than expected. There will be another meeting of G20 negotiators in Rio, ahead of the Summit, to attempt to finalize a text. 

If consensus is achieved, Brazil also hopes it will build momentum toward a major emphasis on health at next year’s UN Climate Conference (COP30), which the country is hosting in Rio. 

A first-ever Climate and Health Day was convened at last year’s COP28 Conference in Dubai.  A second health day is now planned for COP29 in Baku – with the possible launch of a new Health and Environment Coalition, according to WHO. 

But health and climate advocates are looking to the Rio conference in 2025 to outshine everything else – an aspiration shared by Brazil.  

“We started in the Cop 28 with the Health Day, and now in COP 29 [Baku 2024] there will be a Health Day.  And at COP 30, we want a big Health Day in the climate change conference,” said Maciel. 

Trust in science 

Although evidence about the vast array of linkages between climate, health, and disease risks is constantly expanding, disinformation remains a huge problem in terms of getting policymakers to accept the evidence, and move on it, Maciel observed.  

Trust in science remains a key challenge, agreed John-Arne Røttingen, CEO of the UK-based Wellcome Trust, one of the world’s largest philanthropic funders of research.  

“Climate is also worsening climate sensitive infectious diseases, and people are concerned about climate,” he said.

“So how can we better really understand the already existing health impacts from climate both directly due to heat and extreme weather events. And how can we take climate action that will also deliver health benefits here and now? 

“I think people need to see a here and now benefit.

“And although this is driven by science and scientific solutions, we also need to work on the broader issue of trust in science, trust in scientific knowledge, and the solutions that can be derived from science.”

Image Credits: Staicon Life/Flickr, TB Alliance, Van Boeckel et al, ETH Zurich, Diego Baravelli/GRAB via Environmental Justice Foundation (EJF)., Commons Wikimedia.

European Health Forum underway in Bad Hofgastein, Austria.

BAD HOFGASTEIN, Austria — Declining health is driving more citizens to support far-right, populist parties and reducing overall participation in the democratic process, according to a new review of studies from a World Health Organization-backed (WHO) think tank.

The report, released Wednesday by the European Observatory on Health Systems and Policies, analyzed 97 studies at the intersection of health, democracy and populism. 

“There are two findings. One of them is that ill health reduces political participation. The other, possibly more shocking, is that ill health leads to a substantially larger likelihood that you’re going to vote for whatever your local populist radical right party is,” said Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan.

Europeans who report worse health have much lower trust in political actors and lower satisfaction with democratic and health institutions

Europe faces a perfect storm of health challenges that could shake its political foundations, the study warns. An ageing population, rising chronic illness rates, and COVID-19’s after-effects combine with looming threats from climate change, conflict-driven migration, and widening income gaps. 

These pressures have exposed weaknesses in health systems and put health at the center of the European political battleground for the foreseeable future, with over half of Europeans saying health is their top political priority, according to Comission data.

“The stakes if you’re an elected politician are really high,” Greer said. 

The report found that people in poor health are significantly less likely to vote, often by margins of 10 to 20 percentage points compared to healthier individuals. This trend has been documented across Europe, the United States, and Canada.

When those in poor health do vote, they are primarily supporting far-right populist parties. Greer pointed to the 2016 Brexit referendum as an example of how health issues can influence major political outcomes. 

“Moving from self-reported fair to poor health makes you about 16-20% more likely to vote for the populist radical right,” Greer explained. “It is mathematically possible that the number of people in the United Kingdom whose health state deteriorated as a fairly clear consequence of the Cameron government’s austerity budgets and who therefore voted for Brexit is larger than the Brexit victory margin.” 

Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan

Protecting health, rebuilding trust in democracy

“Policies that protect health and ability are not only essential to preserving the economic and social well-being of Europe – but they may also be essential to rebuilding trust in democracy and democratic institutions,” the authors state.

While the study focuses on how health influences political behaviour, experts caution that the relationship between health and politics is complex and potentially bidirectional. For instance, research has shown that political affiliations can influence health behaviors, from Trump supporters frequently rejecting COVID-19 precautions in the United States to Labour supporters in the United Kingdom more likely to smoke. 

Untangling the causal relationships between health, socioeconomic factors, and political preferences presents significant challenges. However, the authors argue that the mounting evidence is compelling enough to warrant serious attention from policymakers.

“To be clear, population health is unlikely to be the primary driver of the rise in anti-democratic politics,” the authors explain. “Even so, the connection between the two highlights an important shortcoming in the performance of democratic institutions: people in poor health have systematically low trust in their health systems and governments.” 

Mistrust in political actors and dissatisfaction with democratic and health institutions are widespread throughout Europe

The shift towards populism marks a dramatic change from historical patterns. Until recently, people in poorer health typically favored left-leaning parties that supported greater health and social protections. However, the rise of right-wing populist movements has provided a new outlet for voters frustrated with existing institutions.

“Why does becoming seriously sick seem to lead to this change in political behaviour? The answer is trust,” Greer said. “People whose health status gets worse tend to lose trust in the healthcare system, the political system, the elements of society at large, and they tend to lose a sense of agency.”

This loss of trust appears to be driving support for parties that promise to reshape what they describe as a “failing” political establishment, even when these parties often oppose public health measures.

The study cites examples such as the National Rally in France, the Alternative for Germany (AfD), and Vox in Spain as typical European populist parties that have attracted support from voters in poor health.

Historical data identified in the report suggests this is not a unique phenomenon. German communities with worsening mortality in the 1930s became more supportive of the Nazi Party, while Italian cities hit harder by the 1918 influenza pandemic showed greater support for the Fascist Party in the 1924 election.

“Governments are moving through uncharted waters, facing new crises that threaten both health and the long-standing political order,” the report states. “A better understanding of the interplay between these forces and their impact on political thought and action can help policy-makers protect not only the health of populations but also democratic institutions.” 

If we aren’t fixing health – why expect votes? 

Clemens Martin Auer, President of European Health Forum Gastein

Minutes before the new data was presented, Clemens Martin Auer, President of the European Health Forum Gastein, challenged the health policy experts in attendance: Does anyone believe our system is properly addressing the impending crises of health workforce shortages? 

No hands were raised. 

“The healthcare sector has to be clear that it contributes to populism,” Martin Auer said. “Stop just talking about problems without operationally solving them… … just wait until they throw our incompetence to solve health problems to delegitimise democratic legitimacy.” 

Martin Auer didn’t mince words at a closed-door presser earlier Wednesday either. Populism, in his view, isn’t just about finger-pointing. EU citizens keep flagging health as their top concern and demanding reform in the sector. And when they don’t see the changes they’re after? Well, their ballots are doing the talking.

“We have to act, we have to make people not vote for populists, and we have to act in these areas where people are affected by health policy measures,” Martin Auer said. “Every single person is affected by the healthcare sector. 

“If we don’t do anything, that is why people support populists.”

EU Health Commissioner controversy

Ursula von der Leyen outraged European health advocates and MEPs with her selection of Olivér Várhelyi to be the bloc’s next health commissioner. 

Meanwhile, Austrian Health Minister Johannes Rauch joined the chorus of European officials alarmed at the appointment of a far-right, EU-skeptic, Viktor Orban loyalist with no health experience to lead the bloc’s health policy for the next five years. 

“This is a very important department,” Rauch said on Wednesday, speaking at a closed-door press briefing at Gastein. “I am worried that if a representative of an EU-hostile government is appointed, this will lead to problems.” 

Olivér Várhelyi, Hungary’s nominee for EU commissioner, has faced fierce backlash from Brussels insiders since Commission Chief Ursula von der Leyen announced last week he would head Health and Animal Welfare in her next commission.

European Parliament members have ample reasons to oppose Várhelyi’s appointment as health commissioner – chief among these an incident last year when he was heard on a hot microphone calling MEPs “idiots.”

MEPs also remain furious at his unilateral declaration last year that the EU would cut off all aid to Palestinians, which he had no authority to do and was quickly overruled by Von der Leyen. His close ties to Israeli officials, including meeting with Prime Minister Benjamin Netanyahu and Defense Minister Noav Gallant after the International Criminal Court issued arrest warrants for their arrests for war crimes, have left MEPs worried he could impact EU assistance to Gazans. 

Former staff and Hungarian officials are also not fans of Várhelyi, variously describing him to Politico as “incredibly rude,” having an “appetite to humiliate,” and running his office in an environment of “emotional terror.” 

Várhelyi’s loyalty to Orban has also raised fears that, should he be appointed, no action at the EU level on abortion protections or reproductive rights will be possible during his mandate – a goal many states had hoped to advance. 

The complex European health portfolio handed to Várhelyi is set to include major files such as a complete revamp of EU pharmaceutical regulations, the European data space, and building a European Health Union, continuing efforts to combat cancer, and promoting preventive health,” von der Leyen said.

Várhelyi is also viewed in some MEP circles as being friendly to pharmaceutical interests given his three years as the leader of the EU’s intellectual property rights division from 2008 to 2011 – a potential conflict of interest given that, as Commissioner, he would oversee the reworking of pharmaceutical regulations. 

His appointed has to be agreed to by the European Parliament’s environment and health committee, and there is widespread expectation that he is unlikely to get past the MEPs represented there. 

But if he does, some solace can be found in that he is not the only Commissioner with power to influence health given the EU’s labyrinthine structure.

Health-related responsibilities will be spread across several portfolios. Commissioners from Spain and Romania will share oversight of certain health tasks, while a Belgian representative will focus on emergency preparedness and medical supplies. Meanwhile, France’s nominee to the Industrial Strategy role is set to spearhead efforts in biotechnology and pharmaceutical policy development.

Image Credits: European Commission.

Geneva Graduate Institute panellists David Evans, Erika Placella, Nathan Sussman (chair) and Alegnta Gebreyesus.

Financing for public health is dwindling in many countries, sapped by COVID-related economic difficulties, debt repayment and “poly crises” such as climate and conflict. 

“In the current economic conditions, the only way [some countries can spend more on health] when their overall government spending is going down, is to give more priority to health in government budgets,” said David Evans, visiting professor in interdisciplinary programmes at the Geneva Graduate Institute (GGI) told a recent event on health financing organised by the institute.

But, Evans warned: “Historically, when your government expenditure is falling, giving more priority to health is often very politically difficult. It doesn’t happen very often.”

“Some of you are involved in the push to have more money for pandemic preparedness and response. It’s very worthy, but if the budget is going down, where is that money going to come from?” asked Evans, who described competition between different urgent needs as a “zero-sum game”.

Development assistance for health in 2021

However, he said there was much diversity within low-income countries and middle-income countries, with some facing economic contraction or stagnation while others were progressing.

“It might be time to think about changing the criteria under which countries get development assistance.”

Evans also identified some opportunities including debt restructuring, special drawing rights at the International Monetary Fund (IMF) and the reform of international financial institutions to direct more money to countries most affected by economic crisis.

Development Assistance for Health: challenges and opportunities.

Seeking complementarity

Erika Placella, head of health at the Swiss Agency for Development and Cooperation (SDC), agreed that the “competition for replenishment” with a “proliferation of funds and the fragmentation of initiatives” was “a zero-sum game”.

“In this zero-sum game, there is a race to find the smallest comparative advantage and the sexiest narrative,” said Placella.

Every international negotiation forum and resolution calls for a dedicated fund and new global health instruments are also being introduced, she added.

“So it is a very fragmented landscape, [and] it’s very difficult to navigate it.”

SDC was pushing for “complementarity” at a global level, said Placella.

“I’m going to take off with the pandemic preparedness and response from the Swiss government. First of all, instead of supporting new ventures and new narratives and new funds, we tried to adapt the mandate of existing organizations to the current context and needs and to promote complementarity. 

“A lot of our partners already had pandemic prevention, preparedness and response (PPR) functions, but in our narrative, it was not understood as such,” she said.

Organisations such as UNAIDS, the Global Fund and FIND include PPR, she noted.

“So we are trying to leverage and to build on what partners were already contributing to in the PPR space, instead of further fragmenting the financing landscape.”

The Swiss government’s health funding uses “many instruments to support health”, including global and thematic work supported through large health organisations including the World Health Organization (WHO) as well as bilateral cooperation.

These different avenues are important to address bottlenecks, she added.

“We also take a systematic approach to avoid further fragmentation. For example with mpox, we are supporting strengthening the primary health care services to include sexual reproductive health services.”

Ethiopia’s dependence

Ethiopian health diplomat Alegnta Gebreyesus said that almost half of her country’s health expenditure depends on overseas development assistance (ODA) so the funding crunch could impact on all aspects of health.

To mitigate this, Ethiopia is discussing setting up a health fund – “a sort of basket fund” which will cover a range of key health issues, with government matching donor investment in some of these.

The fund “would cater for resilience, health system strengthening, equity and, of course, preparedness for pandemics,” she added.

But high prices for medicines, vaccines and other medical commodities can only be addressed by building “a conducive environment for sustainable local manufacturing” at country and regional level – covering research and development, supply chain and logistics, the regulatory system, technology transfer and know-how.

Joyce Ng’ang’a, senior policy advisor at WACI Health.

Kenyan Joyce Ng’ang’a, senior policy advisor at WACI Health, a Nairobi-based health advocacy organisation, said the current global health landscape is already in a poly crisis involving pandemics (COVD-19 and now mpox), food shortages and climate change. 

“We need to make health a priority. We need to make health a political agenda. I believe that there is enough money in the world to fund health and to replenish the global health institutions,” said Ng’ang’a.

“As civil societies and communities, we refuse to accept that there’s not enough money to fund systemic issues for health,” she said, calling for a health approach that started by tackling the social determinants of health.

“By the time cases are coming to the health facility or hospital, the community health system has failed because there should have been preventive and promotive care at community level.

“Most LMICs now have a deliberate strategy on community health and how health is structured, and at the basic unit is the primary level, which is a prevention and health promotion.”

The ECDC chief said the move is part of a broader strategy to increase global public health cooperation before the next pandemic.

The European Centre for Disease Prevention and Control (ECDC) will sign an official memorandum of understanding with its Japanese counterpart next month, the director of Europe’s largest public health agency announced Wednesday.

“Next month I will sign a cooperation agreement with the Japanese Center for Disease Control,” said Pamela Rendi-Wagner, who took over the agency in June.

Her remarks came at a closed-door press briefing on pandemic preparedness at the European Health Forum in Gastein, Austria. She said the deal was part of a wider European effort to expand global cooperation within and outside the EU to better prepare for future pandemics.

“Scientists [globally] need to understand each other before the crisis, not during the crisis,” Rendi-Wagner said. “We learned our lessons from the pandemic.”

The ECDC chief added that the agency has deepened its ties with many other centres for disease control globally since the COVID-19 pandemic, including a four-year partnership with Africa CDC signed in 2021 with financial support from the European Commission.

The memorandum of understanding with Japan will add the country to a list of CDCs that have signed such agreements with the European agency, including those in the United States, China, Mexico, the United Kingdom and South Korea.

ECDC collaborators without official agreements include regional CDCs in Africa, the Caribbean and Gulf states, as well as Israel, Singapore, Thailand and Australia.

In her closing remarks, the ECDC chief warned global public health authorities that the window to prepare for the next pandemic “will close” and urged immediate action.

“Only joint and cooperative preparedness will allow us to cope with pandemics in the future,” Rendi-Wagner said.

Image Credits: ECDC.

Clinician monitors telehealth platform
A clinician monitors a Pan-American Health Organization-developed telehealth platform in Trinidad and Tobago.

Investing in as little as $0.24 per patient per year in digital health interventions – telemedicine, mobile messaging, and chatbots – could significantly lower the burden of non-communicable diseases (NCDs), says a new report from the World Health Organization (WHO) and the International Telecommunication Union (UTI). These interventions could avert 2 million deaths and 7 million acute events and hospitalizations over the next decade. 

The report comes as the United Nations General Assembly meets in New York City this week. 

Non-communicable diseases cause 74% of all deaths globally and are on track to cost $30 trillion in lost productivity by 2030. 

The newly released publication highlights the promise of digital health interventions in tackling this growing crisis, especially through expanded healthcare access. Behavioral choices fuel many NCDs, says the report, and digital health could enable individuals to “take control of their own health and well-being” through personalized health content delivery.

Digital health interventions proved to be powerful tools in managing NCDs during the COVID-19 pandemic, from electronic vaccine passes to telemedicine, but the report warns that the rollout of these technologies requires widespread access, and guardrails to protect patient data. 

“The future of health is digital,” said WHO director-general Tedros Adhanom Ghebreyesus and Doreen Bogdan Martin, ITU secretary-general in a statement. “We must work together to promote universal access to these innovations and prevent them from becoming another driver of inequality. While the new technologies hold great potential, strong governance, ethics, digital skills and equity are essential to realize their potential and to avoid risks such as unethical data collection and biases encoded in artificial intelligence.”

Chat bots, telemedicine, online counseling could “close gap” of NCD care

Digital health benefits for NCDs
Th report found that up to 2 million lives could be saved in the next decade if countries invest in less than 25 cents per patient yearly.

Chronic conditions typically require long-term management, which is often unavailable at primary health care level in many low- and middle-income countries. 

So digital health solutions “can help patients to track their symptoms, manage their medications and monitor their progress over time,” the WHO report notes.

Patients, healthcare providers, and the public can use these tools for diagnosis, treatment and management and for disease prevention through diet and  lifestyle interventions. 

Digital health interventions span a host of technologies, including: online programs for patient education; mobile apps, virtual reality, and other telehealth and telemedicine technologies for rapid diagnosis and treatment; connected and wearable devices for monitoring health conditions; as well as online peer support and counseling. Meanwhile, the health sector is incorporating artificial intelligence and big data-enabled apps to diagnose, monitor, and support NCDs. 

“The digital revolution has the potential to unleash a health revolution,” said Bogdan-Martin at the report release, on the margins of the UN General Assembly’s Summit for the Future in New York City. 

Digital tools can support individuals in understanding their risk factors for NCDs, WHO said in a statement. “Four major risk factors linked to our everyday environment – tobacco use, unhealthy diet, the harmful use of alcohol and physical inactivity – drive responses in our bodies that also increase NCD risk: raised blood pressure, obesity, raised blood glucose and raised cholesterol.” 

Mental health conditions – prevention and treatment

The report warns that in addition to NCDs, mental health conditions present a looming concern – and one that is in dire need of more healthcare coverage, including through digital solutions. In 2019 alone, nearly a billion people lived with a mental disorder, of whom only a “fraction” received care. These conditions account for the largest proportion of years lived with disability, and lead to a higher risk of premature death. 

With expanded healthcare delivery options, argues the report, people with mental health conditions are more likely to seek timely care. For a person living with dementia, for example, a service like mobile messaging with a doctor provides discreet access to support. 

These measures can continue to optimize health service delivery and influence health-related behavior, especially when it comes to preventing and managing NCDs, says the report.

COVID-19 pandemic shed light on digital health potential

digital health strategies for NCDs
Digital health can help prevent non-communicable diseases through education, monitoring, and increased access to care.

With healthcare systems disrupted during the COVID-19 pandemic, many providers switched to offering digital services when possible. Health systems quickly turned to online counseling, telemedicine, and digital vaccine records to continue providing care.

“Although interest in digital health grew during and after the pandemic, few solutions have scaled successfully,”  Alexey Kulikov, deputy head of secretariat for the UN NCD Task Force, told Health Policy Watch. “A key challenge has been the use of siloed, monolithic systems that lack integration with broader digital infrastructure, making them hard to manage. The report promotes ‘smart’ investments in digital health, emphasizing a whole-of-government, collaborative approach that focuses on interoperability and cross-sector integration for long-term success.”

Now, for patients in rural or underserved areas, the benefits of digital health measures means telemedicine is here to stay to overcome the barriers to accessing health care, including geographical distance, transport and cost.  “Additionally, digital health contributes to environmental sustainability by reducing the need for travel through
telemedicine and virtual care, thereby lowering healthcare’s carbon footprint,” noted Kulikov.

While significant progress has been made in combating NCDs, the integration of digital health technologies into mainstream health systems remains a “challenge,” the WHO said in a statement. For countries still developing internet infrastructure, digital health programs must first overcome internet access issues, and begin developing digital health strategies. 

Only 60% of countries have such a strategy, and many are slow to integrate new technologies into existing health infrastructure, the WHO notes. Which is why the report highlights the urgency for country-level investments in digital infrastructure.  

“We call for greater collaboration between the health and tech sectors, including the development of strong digital public infrastructure, essential for the delivery of digital health services that can benefit people everywhere without leaving anyone behind,” said Bodgan-Martin.

Image Credits: PAHO, WHO , WHO.

Over 130 United Nations member states convened in New York City Sunday and Monday for a long-anticipated Summit of the Future  that aimed to press the “reset button” on stalled global development goals and polarized geopolitical debate.

The event, held  just ahead of the annual debate in the U.N. General Assembly, kicked off with the adoption of the “Pact for the Future,” alongside two key annexes: a “Global Digital Compact” and the “Declaration of Future Generations.”

The non-binding declarations cover the world’s most critical global issues, including: peace and security, sustainable development, climate change, digital cooperation, human rights, gender equality, and empowering youth and future generations.

The pact outlines 56 specific “actions” that member states need to take, underscoring the growing complexity of threats to global peace, highlighting the dangers of nuclear conflict, and confirming the core principles of the United Nations.

A central promise of the pact is accelerating progress on the 2030 Sustainable Development Goals (SDGs), which aspire to universal healthcare access, the eradication of extreme poverty and hunger, the promotion of gender equality, climate and environmental sustainability and the expansion of education worldwide.

“With so much dividing us and with so many wars going on, I think we can salute yesterday’s agreement and that we came together and be able to agree on ambitious targets,” said Norwegian Prime Minister Jonas Gahr Støre, speaking at Monday’s session.

“The pact for the future provides a vision for this across all the UN’s three main pillars that should be solutions… First, we have reaffirmed our commitment to international law, including human rights… Those who deliberately breach it must be held accountable.”

Address climate change and transform energy systems

“Second, we urgently need to address climate change, cut emissions, transform our energy systems and protect the environment,” he said, noting that addressing climate also requires increasing climate finance and investments and providing provide sufficient and timely debt relief to deeply indebted low- and middle-income countries.

The pact also calls for the global community to work towards an inclusive, open and secure digital future for all, he noted, pointing out that “some 2.6 billion people remain excluded from the digital world. For too many people also they lack access to electricity.”

Finally, he called for “preventive diplomacy and peace building” to be at the center of global efforts on sustainable development, including “a more transparent, inclusive and effective Security Council with great limitations to the use of veto,” as well as a greater presence of under-represented groups in global governance.

Is this pact a genuine path forward, or is it another lofty rhetoric exercise?

Despite the bright notes, many critics question the real-world impact the pact will have, in light of the world’s geopolitical polarization and stalled progress already seen on most SDGs.

“It was great to see people clapping for the new Pact, but the lagging SDGs problem is not one of planning but rather execution.  Let’s clap louder for results,” Peter Singer, a former top advisor to Director General Tedos Adhanom Ghebreyesus, told Health Policy Watch. “That means complementing SDGs with GSD (Getting Sh*t Done): better governance, scaling innovation, and translating data into delivery.”

Only 17% of the 2015 SDG targets are on track to reach the 2030 Goals, Singer pointed out in a blog published just ahead of the Summit.

“Rather than critically examine why the SDGs are off track and support countries to overcome these obstacles, the U.N. comes up with a new list of things it wants to accomplish,” Singer continued. “But if you failed to accomplish the last thing you promised and now do not critically examine the underlying reasons for that failure, why would anyone believe you could accomplish the next big thing?

“This is the same for health as it is for every SDG.  SDGs are fought and won in countries, but the UN can start by ‘cleaning its house from the inside out.’”

Guterres hails the pact as ‘step-change’

Defying the doubters, U.N. Secretary-General Antonio Guterres hailed the adoption of the Pact for the Future, at the start of the two-day summit as a “step-change towards more effective, inclusive, networked multilateralism.

“Excellencies, throughout my life, whether as an activist or at the United Nations, I have learned that people never agree on the past. To rebuild trust, we must start from the present and look toward the future,” Guterres said.

U.N. Secretary-General Antonio Guterres
U.N. Secretary-General Antonio Guterres

The pact, negotiated over the past nine months, represents the fruits of a dialogue launched in 2020 as the United Nations marked its 75th anniversary with a “global conversation” on people’s hopes and fears for the future. That dialogue set the stage for what would eventually become the Summit of the Future four years later.

Guterres had long championed the need for both the summit and the pact, emphasising that global crises have exposed the urgent necessity for U.N. reform and the transformation of international financial systems. These crises include ongoing conflicts in Russia/Ukraine, Israel/Gaza, and Sudan, insufficient progress on climate change, mounting national debt, and the unregulated rise of new technologies.

“I called for this Summit because 21st-century challenges require 21st-century solutions: frameworks that are networked and inclusive, drawing on the expertise of all humanity,” Guterres said in his opening speech on Sunday “Our world is heading off the rails, and we need tough decisions to get back on track.”

Specifically, he has called for major reforms to global institutions, including changes in the structure and rules governing the 15-member U.N. Security Council, where constant vetos by Russia, China and the United States of initiatives backed by rivals have progressively weakened the clout of the global body.  Guterres has also stressed the importance of redesigning multilateral finance and developing a system of global governance over the use of artificial intelligence.

Philemon Yang, President of the 79th U.N. General Assembly
Philemon Yang, President of the 79th U.N. General Assembly

Cameroon’s Philemon Yang, President of the 79th U.N. General Assembly, echoed these sentiments as he opened the event, saying, “We stand at a crossroads of global transformation, facing unprecedented challenges that demand urgent, collective action.” He continued, “The commitments embodied in the pact and its annexes reflect the collective will of member states. They must guide our actions to promote international peace and security, accelerate the sustainable development goals, foster just and inclusive societies, and ensure technologies serve the common good of humankind. We must move forward together in a spirit of solidarity and multilateral cooperation.”

Throughout the summit’s two days of speeches and presentations, delegates discussed the pressing need for a transformed United Nations capable of addressing today’s intertwined political, social, economic, and ecological crises. Key issues raised included failing to meet sustainable development and climate change goals, rising global military expenditures, and the need for debt relief to low-income nations that cannot afford to provide basic services.

Nearly half of the world’s population live in countries spending more on debt than health or education

“Our delivery and commitments made on sustainable development and climate change have been so much less than what was committed,” said Michael D. Higgins, President of Ireland. “The failure to achieve peace, eliminate acute global poverty, hunger or the consequences of climate change and biodiversity loss have been accompanied by a return to an arms race. Last year, global military expenditure increased by 6.8% to $2.44 billion, the highest ever recorded.”

Michael D. Higgins, President of Ireland
Michael D. Higgins, President of Ireland

Some 3.2 billion people live in nations that spend more on debt interest payments than on essential services like education and healthcare, Higgins added. Along with gaps in basic social services, the debt burden also leaves them with insufficient resources for making capital investments in the energy transition and sustainable development.

Charles Michel, President of the European Council
Charles Michel, President of the European Council

“We need to make our international financial architecture more effective and more inclusive,” agreed Charles Michel, President of the  European Council, the European Union’s governing body.

“Developing Countries need more private and public money now. We must also tackle that problem because we cannot accept that low- and middle-income countries must choose between fighting poverty and fighting climate change. They must do both, and we must support them to do both.”

Reforms in the UN Security Council

Kuwait, meanwhile, stressed the need for reforms to the U.N. Security Council, including fairer geographic distribution of Security Council membership.

Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah
Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah

“We agree with the Secretary General when he said that it is impossible to put the future for our children and grandchildren through an order or a system that was built by our forefathers without taking into account the future of young people,” said the Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah.

“We are required today to work on introducing serious and practical changes to the global economic governance system, to networks of financial security, to international tax cooperation. We must reform multilateral development banks and address the problem of sovereign debts.”

Harnessing Technology

The challenges and opportunities presented by new technologies, particularly artificial intelligence, was another topic at the center of discussion.  Member states also stressed the importance of ensuring more equitable access to digital tools essential to education, healthcare, poverty alleviation and sustainable development.

“We believe that science and technology are foundations of a sustainable environment. Therefore, we are working on the digital transformation of our economy and providing an integrated and comprehensive database to support decision-making,” said Mohammed Shia’ Al Sudani, the Prime Minister of Iraq. This requires equitable access to AI tools and the capacity to benefit from AI and other digital technologies in a “responsible and moral way” he emphasized.

Jamaica's Prime Minister, Andrew Holness
Jamaica’s Prime Minister, Andrew Holness

Jamaica’s Prime Minister, Andrew Holness, expressed similar sentiments, adding that “admittedly, new technologies, such as artificial intelligence and robotics, create new challenges to security and some livelihoods. However, they also create important opportunities, especially for young people, and hold great potential to empower generations, transform economies, and solve complex challenges. So great is the potential, in fact, that we must emphasise the importance of international cooperation to address the challenges and harness the opportunities, especially for the benefit of people in developing countries.”

War and peace: Addressing ‘double standards’

The ongoing destruction of war in regional hotspots, particularly Ukraine and Gaza served as a grim backdrop to discussions.

garbage accumulates in gaza, raising risk of polio
Garbage accumulates in Gaza, contaminating water supplies and raising the risk of polio.

Kuwait’s Al-Sabah called for ‘universal adherence’ to international law and conventions, and the elimination of double standards. He pointed to the situation in Gaza as an example of the U.N. Security Council’s failure to prevent aggression and highlighted the damaging consequences of inconsistent enforcement of international law.

He further urged the international community to prioritise reforming global governance, and to establish a more inclusive, effective, transparent, and accountable Security Council.

Qatar, a key player in the Israel-Hamas negotiations over a ceasefire in exchange for a release of Israeli hostages still held by Hamas, also referred to the Gaza conflict, stressing that development cannot be achieved without solid peace, security, and stability foundations.

“Qatar maintains its efforts in mediation to prevent and resolve conflicts in a peaceful manner,” said Prime Minister Sheikh Mohammed bin Abdulrahman Al Thani.

“We reiterate our call to reach a ceasefire agreement and to release all hostages,” Al Thani said. “We call on the international community to take a clear and decisive stance against violations of international humanitarian law and human rights law.”

Japan, meanwhile, addressed the “increasingly dire situation” around nuclear disarmament and non-proliferation, nearly 80 years after American nuclear bombing raids on the Japanese cities of Hiroshima and Nagasaki.

“No matter how difficult the path to a world without nuclear weapons may be, we cannot stop our progress,” said Japan’s Prime Minister, Fumio Kishida.

Call to action on adolescent health

Another aspect of Summit emphasis was the future of the world’s youths. And related to that, WHO issued a call on the summit margins for greater attention to the mental, sexual and reproductive health of adolescents.

“Promoting and protecting the health and rights of young people is essential to building a better future for our world,” said Tedros in one of Monday’s breakout sessions, that saw the launch of a WHO report on adolescent health.

The WHO report found that least one in seven adolescents globally now suffer from a mental disorder; close to one in 10 teenagers is obese; and sexually transmitted infections are on the rise.

“Failing to address the health threats that adolescents face – some long-standing, some emerging – will not only have serious and life-threatening consequences for young people themselves but will create spiralling economic costs,” Tedros pointed out.

He condemned efforts to restrict young people’s access to sexual and reproductive healthcare, and sex education, which he said were a result of the recent pushback against gender equality and human rights in some countries and societies.

He emphasised that policies imposing strict age limits on young people’s access to vital reproductive health services, will only boomerang, leading to more HIV/AIDS and other sexually transmitted infections, as well as other spiraling health impacts on societies.

There are around 1.3 billion adolescents globally today – more than ever before.

“Adolescents are powerful and incredibly creative forces for good when they are able to shape the agenda for their wellbeing and their future,” said Rajat Khosla, executive director of the Partnership for Maternal, Newborn and Child Health, which co-hosted the launch of the WHO report. “Leaders must listen to what young people want and ensure they are active partners and decision-makers.”

Image Credits: Screenshot, UNRWA , Reproductive Health Supplies Coalition/ Unsplash.