Displaced Gazans live amongst garbage and ruins.

WHO and other UN and international relief agencies heartily welcomed Wednesday’s announcement of a long-awaited  Israeli-Hamas ceasefire. Israelis and Palestinians, meanwhile, began an anxious countdown, hoping that the agreement would indeed take effect as planned Sunday – even as Israel and Hamas traded accusations Thursday that the other was trying to torpedo the accord.

“Wednesday’s announcement of a ceasefire and hostage release deal between Israel and Hamas is, of course, wonderful and long overdue news,” said Tedros on Thursday, at the launch of  WHO’s 2025 Health Emergency Appeal, for $1.5 billion dollars.

“It is just about the best news we could have hoped for to start the new year,” Tedros added at the first WHO global press conference of 2025.  “We welcome this news with great relief, but also with sorrow that it has come too late for those who have died in the conflict, and with caution, given that …the deal has not yet been confirmed.  Although the agreement would only come into effect on Sunday if both sides are committed to a ceasefire, it should start immediately. We urge Israel’s cabinet to approve the deal and all sides to honour and implement it.

WHO Director General Dr Tedros Adhanom Ghebreyesus at WHO briefing Thursday.

Noting the ongoing conflict-related health crises raging in dozens of countries around the world, as well as disease outbreaks and natural disasters around the world, he added:  

“We can only hope that this agreement [between Israel and Gaza] will not be the only one this year, and that we will also see an end to wars and insecurity in Ukraine, Sudan, Haiti, DRC, Myanmar and elsewhere,” he observed, noting that WHO responded to 51 emergencies in 89 countries last year, and estimates that some 300 million will need emergency health assistance this year.  “In Sudan, almost two years of civil war and catastrophic displacement have left 70% of those facilities non functional, and in Ukraine, more than 2000 attacks on health care over almost three years of war have caused significant damage and eroded hope.”

Meanwhile, UN Secretary General António Guterres called on both Israel and Hamas to facilitate the rapid, unhindered, and safe humanitarian relief for all civilians in need, saying, “It is imperative that this ceasefire removes the significant security and political obstacles to delivering aid across Gaza so that we can support a major increase in urgent lifesaving humanitarian support,” he told reporters at UN Headquarters, warning that “the humanitarian situation is at catastrophic levels.”

Agreement in three phases 

Hostage families gather in Tel Aviv to express hope – but also fears that pending hostage deal will leave many captives behind for an unforeseen period.

The agreement calls only for the release of some 33 of the estimated 98 Israeli hostages still being held captive in Gaza in the first phase during an initial 6 week (42 day) ceasefire – some of whom may have already perished but have not been confirmed dead, according to the Qatar and US brokers of the deal in statements Wednesday night. 

Those hostages set to be release right away include the ill, people over age 50, women still in captivity, and two infants/toddlers, of the Bibas family, who also are still being held by Hamas – although the group has said that they died some  months ago in an Israeli attack. 

Israel would, in turn,  release more than 1700 Palestinians now in Israeli jails, and withdraw away from the Gaza enclave’s most heavily populated areas, and closer to Israel’s border. A surge in humanitarian aid would also follow, including the Israeli evacuation of some, but not all, posts around Gaza’s southernmost Rafah border crossing with Egypt. Reopening of that crossing, closed since Israel’s occupation of the border area last year,  would help expedite a aid deliveries from Egypt and medical evacuations from Gaza.

While displaced Gaza Palestinians are also supposed to be allowed to return to their homes, it appeared likely that Israel would retain control of a central Gaza Netzarim corridor that could curb the flow of Palestinians now in the south back to homes in Gaza City and its environs. Most of the enclave’s two million people have been displaced at one time or another during the war.

It also appeared likely Israel would remain in control of the northernmost band of the Gaza strip, closest to many of Israel’s communities that were attacked by Hamas on 7 October, which killed some 1200 Israelis, mostly civilians, and took 240 hostage. That is likely to include the central “Netzarim corridor” dividing Gaza from north to south, as well as border areas north of Jabalya refugee camp and Beit Hanoun, which also saw some of the heaviest fighting in late 2024, including the Israeli occupation of Kamal Adwan hospital and it’s closure in the last week of December.  

Healthworkers leaving northern Gaza’s Kamal Adwan Hospital in December after Israel’s occupation of the facility, which it claimed was shielding Hamas fighters.

Conclusion of second phase, remains unclear

During the initial 42 day ceasefire period, negotiations would continue over details of a second phase, which would presumably involve the release of the remaining Israeli and foreign hostages – all men under the age of 50 – as well as a more complete withdrawal of Israeli troops from the 360 square kilometre enclave. Significantly, however, the details of Phase 2 have not yet been fully agreed to by the warring parties. 

A final Phase 3 of the deal, if achieved, would see the definitive end to the war, and the launch of a multi-billion Gaza reconstruction plan, according to the US Secretary of State Anthony Blinken,  who unveiled the key elements of the plan Wednesday evening.

“As for the details of the second and third phase, they will be agreed upon during the implementation of  the first phase, said Qatar’s prime minister Mohammed Al-Thani in a separate press briefing Wednesday evening. “We have faith.. We are committed, we will do everything possible to ensure that this deal is implemented as agreed and will bring us peace; it depends on the parties, acting in good faith.”

Celebrations and last minute crisis and jitters 

Celebrations in Gaza Wednesday evening after news of a ceasefire deal.

News of the agreement led to massive street celebrations in Gaza, where Palestinians have endured 467 days of war, and over 46,000 casualties, with slightly more than half being women, children or older people according to Gaza’s Palestinian authorities, where Hamas continues to retain control – despite the devastating Israeli invasion and months of occupation. 

 

In Israel, hostage families gathered with supporters in a major Tel Aviv square with hopes that their ordeal, too, may soon be over.  But many families and friends of the hostages also expressed anger over the facts that two-phased deal, leaves most of the remaining male hostages in Hamas captivity for the time being. And if negotiations over the second stage break down, that would and effectively constitute a “death sentence” for them – in view of the long months of confinement in tunnels with no access to clean air, water, adequate food or medical care.

Those fears were exacerbated on Thursday as Prime Minister Benjamin Netanyahu declared that Hamas was trying to make last minute changes to the agreement – and said he would postpone the Israeli cabinet meeting to approve the deal until Hamas clarifications were received. Meanwhile hard-right Israeli cabinet members threatened to resign in protest over the ceasefire plan – although Netanyahu still appeared to have sufficient votes for its approval.

Both Israeli and Palestinian critics also pointed out that the deal agreed to by Israel’s government now, was effectively the same one that had been on the table since May or June of 2024. The only reason that Netanyahu had agreed now was because his fears of angering incoming US President Donald Trump had now become a bigger concern than the Israeli prime minister’s fears that the hard right wing of his government might trigger its collapse.   

$10 billion needed just to rebuild Gaza health system  

Al Shifa, Gaza’s largest hospital, on 23 November 2024: After being severely damaged earlier in the war, it’s back in service at least partially, but most Gaza hospitals have been damaged somehow, and only about half are functioning at all, according to WHO.

Looking forward, WHO’s new emergency appeal aims to muster initial humanitarian support to Gaza’s shattered health system in the first phases of the ceasefire, said WHO Representative to the Occupied Palestinian Territories, Dr Rick Peeperkorn at Thursday’s press briefing.  But Gaza will need some $3 billion over the next 1.5 years and $10 billion over the next 6-7 years to rebuild its health system.  

“The destruction is so massive,” Peeperkorn said. “All hospitals are either damaged or partly destroyed, and the same applies for the primary health care clinics. When my team came back with these  initial assessments, it was even more than $3 billion for the first one and a half year, and then actually $10 million for the five to seven years, I was a little surprised that we’re just talking about health.”

He said that the focus of the coming weeks, where the full implementation of all three phases of the deal remains uncertain, should be “pragmatic humanitarian support.”

“But assuming that the ceasefire processes, which is three phases, that it progresses to a lasting peace, that we rapidly expand this early work of rehabilitation and reconstruction.”

Urging Palestinian authorities to plan a more comprehensive health care package

WHO is also initiating discussions with the West Bank-based Palestinian Authority’s on the provision of a more comprehensive primary healthcare package for Palestinians as part of post-conflict recovery, Peeperkorn noted. Due to the spotty coverage of public health services and insurance coverage, West Bank Palestinians pay a huge amount of their health costs out of pocket for private health services – and are frequently forced to turn to expensive, hospital-based care for many more basic procedures. This in a time when they, have also been hard hit economically by the Israeli closures imposed by the war.

“It’s also, of course, an opportunity to relook as sectors, including the health sector,” said Peeperkorn.  “How can we now really base it [Palestinian health services] properly on Comprehensive Primary Healthcare, which was not always the case; it was more in hospital-centered system. How can we work with an updated Essential Health package for Palestine, an updated Essential Health package, which should be the basis of our investments. A lot of work was done already before the crisis on this, and we’re working with government partners to further update that. And those processes should guide any any investments.”

Both Peeperkorn and Tedros also repeated earlier  appeals for a dramatic increase in the pace of medical evacuations of sick and wounded Gazans abroad, following the cease-fire agreement. 

“The ceasefire deal offers an opportunity for expedited medical evacuations for over 12,000 people, including many children, who urgently need lifesaving care outside Gaza. We hope the deal will be sustained, because lives depend on it. Peace is the best medicine!” said Tedros, in an X post.

Image Credits: X/Good Morning America, Middle East Eye , X/GMA , @WHO.

A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents.

Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday.

The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024.

“We seem to be living in one of the most divided times since the Cold War,” the report notes.

“Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”.

The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. 

Current risks

State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. 

“The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes.

The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes.

“Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks.

“The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.”

In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”.

Conflict over Taiwan also cannot be ruled out, it notes.

“The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns.

Extreme weather events and “geo-economic confrontation” are the next biggest current concerns.

Short-term risks

Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”.

The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”.

Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk.

To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies.

Longer-term risks

Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings.

There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed.

The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents.

While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat.

Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes.

Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes.

“Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF.

“Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.”

Global fragmentation

However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”.

But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration.

“Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.”

Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions.

Image Credits: UNICEF/UNI501989/Al-Qattaa.

Obesity is growing fastest among children and adolescents

Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms.

So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology.

There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease.

The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity.

It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness.

All-or-nothing

“The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says  commission chair Professor Francesco Rubino.

“Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London.

“Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. 

“On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.”

Nuanced approach

The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. 

The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and  adolescents. 

These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints.

Pre-clinical obesity is defined as “obesity with normal organ function”. 

“People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission

BMI limitations

Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”.

“Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel.

“But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US.

“Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” 

Appropriate care

“This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia.

Image Credits: Commons .

A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that.

If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health?

“The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University.

According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General.

“But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch.

However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. 

“The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.”

US is by far largest donor 

The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). 

Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5.  

US contribution to WHO in the 2024-25 biennium

China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As  China is still classified as a “developing country”, it benefits from lower rates.

But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China.

In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. 

China’s contribution to WHO in the 2024-2025 biennium

Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. 

When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China.

Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body.

WHO’s top 25 donors for 2024/25

China favours bilateralism

Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave.

But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. 

Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists,

“[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article.

“Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.”

While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN.

Europe is preoccupied by Ukraine; turns to the right

Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. 

“Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU.

With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine.

In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries.

In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal.

The EU has thus neither the means nor the will to cough up more for global health.

Russia
ICRC members unload supplies in Ukraine.

‘Anti-globalist’ Trump to chop UN fees

Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”.

An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. 

Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights.

During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion.

During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”.

During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. 

Leadership vacuum

But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. 

The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence.

Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population.

The US may also weaken its own health if its steps outside the WHO.  It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold.

However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”.

Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition.

Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC.

Firefighters battle a blaze in California’s September, 2020 record-breaking fires.

Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings.

“In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA).

Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.”

Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.”

The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. 

“Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.”

Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. 

The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. 

The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. 

California wildfire
A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire.

“Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. 

“Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.”

Wildfire smoke: Gases, particles, and toxic chemicals

Wildfire smoke and health diagram
Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects.

Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. 

Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects.  This smoke is often undetectable, with no obvious smell or haze. 

“While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. 

Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.”

The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. 

The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. 

Wildfires ‘reversed’ clean air gains

PM2.5 levels in western US. Spike from wildfires
PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California.

Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires.

Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. 

Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. 

Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks.

The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. 

Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires.  

This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions.

Masking, staying indoors, using air filters

Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. 

The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. 

The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.”

wildfire triggered spikes in air pollution
Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program.

Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.”

This is a developing story. For more information, visit CalFire.

Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program.

Dr Faustine Ndugulile (centre) flanked by outgoing WHO Africa

The World Health Organization’s (WHO) Africa regional committee meets on Tuesday (14 January) to decide on the process for nominating a new regional director following the shock death of Dr Faustine Ndugulile.

Ndugulile was elected regional director at the WHO Africa regional conference in the Republic of Congo last August.

His appointment was due to be ratified by the WHO’s Executive Board meeting next month, but he died in India in late November while undergoing medical treatment for an undisclosed condition.

The sole focus of Tuesday’s special virtual meeting of the WHO Africa region is to work out how the next regional director, who serves for five years, should be chosen.

Ndugulile secured 25 of the 46 votes at the August conference, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

There are 47 member states in the WHO Africa region as seven North African countries that are predominantly Muslim are part of the WHO Eastern Mediterranean Region.

The regional meeting needs to decide whether it will re-open nominations for the position, hold new elections based on the three remaining candidates or simply choose the runner-up as the next regional director.

According to the WHO’s Constitution, regional committees “shall adopt their own rules of procedure (Article 49)”. 

Meanwhile, Article 52 stipulates: “The head of the regional office shall be the Regional Director appointed by the Board in agreement with the regional committee.” 

“Both the Regional Committee and the Executive Board have a role in the process.  The Regional Committee nominates a candidate, and the Executive Board appoints the Regional Director.  The Regional Committee and Executive Board are each responsible for their own part in the process,” according to a WHO spokesperson.

However, the WHO did comment on questions related to the likely process or whether the incumbent, Dr Matshidiso Moeti, will remain in the position until the new candidate is appointed. Moeti has served two terms (10 years) as regional director and is not eligible for re-election.

The remaining three candidates have all worked for the WHO in various capacities. 

Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. 

Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but has also worked for WHO Africa. 

Sambo is the WHO Representative to The Democratic Republic of the Congo.

A healthworker in Pakistan tests a man for hepatitis C.

Picture a young woman in rural Sindh in Pakistan, fatigued from years of battling an undiagnosed illness, unable to care for her children or fulfill her potential. 

But a simple diagnostic test and a 12-week treatment for hepatitis C could transform and save her life. 

This story is no longer a distant dream. With the government’s recent pledge of $250 million to eliminate hepatitis, Pakistan is poised to turn its staggering hepatitis burden into a model of success. 

However, for this vision to materialize, there is an urgent need to tackle systemic barriers and adopt a person-centered approach to testing and care that addresses the challenges faced by diverse segments of society. 

The Scope of the Problem 

Pakistan bears an astounding hepatitis burden, with 10 million people affected by hepatitis C (world’s largest population of people living with hepatitis C infections) and four million living with hepatitis B. 

These diseases silently claim lives, contributing to liver cancer and liver failure at alarming rates. Every 20 minutes, a Pakistani dies of hepatitis C-related complications.

Hepatitis elimination, as stated in the WHO’s Global Health Sector Strategy, is achievable but requires significant interventions. As a populous country with a large disease burden, Pakistan is positioned to play a flagship role in regional elimination efforts. Success here would not only save millions of lives but also demonstrate the feasibility of hepatitis elimination in resource limited settings. 

Barriers to Hepatitis Testing in Pakistan 

Despite progress, multiple structural, systemic, and person-level barriers impede the path to hepatitis elimination.

Pakistan’s hepatitis response is hindered by significant structural and policy gaps. The underfunding of national programs leaves hepatitis testing and treatment services unable to meet demand.

Centralized testing policies prioritize urban tertiary care facilities, neglecting the needs of rural communities. Programs heavily rely on unpredictable funding streams. Compounding this is a widespread stigma affecting both patients and healthcare providers, particularly in marginalized communities. 

The healthcare system struggles with limited resources and a shortage of trained personnel, especially in rural and underserved regions. Diagnostic facilities are inadequate, and weak surveillance systems result in data gaps that hinder evidence-based decision-making. Missed opportunities for integration with other health services, such as tuberculosis and HIV programs, further exacerbate inefficiencies in hepatitis care delivery.

At the individual level, patients face significant barriers to accessing care. Testing and treatment costs remain prohibitive for many, particularly for advanced diagnostics like virologic testing. 

A lack of awareness about hepatitis symptoms and risks discourages individuals from seeking care. Additionally, the high costs and logistical challenges of traveling to centralized healthcare facilities make it even harder for rural populations to access timely diagnosis and treatment.

Person-centered way forward 

A man is vaccinated against hepatitis in his community.

To address these barriers and make the new national hepatitis elimination program effective, Pakistan must embrace person-centered care using the recently released operational guide from the World Health Organization (WHO). This approach prioritizes the needs, preferences, and circumstances of individuals at every stage of care. Below are seven key strategies to operationalize this vision.

Decentralizing testing and treatment services is essential to improving access, particularly for rural and underserved populations. Integrating these services into primary and community healthcare centers will allow individuals to access care closer to home.

Expanding point-of-care testing in remote areas can provide rapid diagnosis and significantly reduce turnaround times for results. Additionally, deploying mobile clinics to underserved regions can bridge critical gaps in care delivery, ensuring that even the most marginalized populations receive timely testing and treatment.

The national programme must ensure financial accessibility by subsidizing diagnostic costs, particularly for virologic testing which remains prohibitively expensive for many. Securing funding from donors and international organizations can help sustain affordable diagnostic tools and treatment options, ensuring financial protection for vulnerable populations.

Strengthening healthcare systems is crucial for delivering person-centered care. Training healthcare providers to offer respectful and stigma-free services is a vital first step. Supply chains must be strengthened to ensure the consistent availability of affordable diagnostic kits and treatment regimens. Furthermore, leveraging technology such as telemedicine can enhance access to care and enable real-time tracking of hepatitis cases, improving overall system efficiency.

Engaging communities is critical to overcoming barriers such as stigma and lack of awareness. Partnerships with local leaders, NGOs, and civil society organizations can help raise awareness and encourage testing. Culturally sensitive public awareness campaigns are also needed to address misconceptions, improve risk perception, and promote the uptake of testing and treatment services.

Differentiated service delivery models with care tailored to individual needs can improve outcomes and reduce the strain on healthcare systems. Uncomplicated cases can be treated at primary care levels, while complex cases are referred to tertiary care centers. Targeted “micro-elimination” strategies in high-prevalence areas can focus on specific populations, enabling efficient and localized hepatitis elimination efforts.

A robust surveillance system is vital for identifying disease hotspots and monitoring progress. Establishing hierarchical systems and using digital tools for data collection and visualization can support evidence-based decision-making, ensuring resources are directed where they are most needed.

Finally, integrating hepatitis testing into existing health services can maximize resources and increase reach. Combining testing with HIV, tuberculosis, and maternal health services can streamline care delivery, while including hepatitis testing in routine health checkups and immunization drives ensures greater coverage and early diagnosis.

Call to Action 

By addressing the hepatitis crisis, Pakistan can become a model for other nations in South Asia and beyond. Its large-scale elimination efforts, if successful, could inspire global confidence in the feasibility of achieving the WHO’s 2030 targets. 

The recent funding pledge by the Prime Minister reflects strong political will, but sustained commitment by all provinces is needed to translate plans into action. 

Hepatitis elimination in Pakistan is feasible, but it requires a paradigm shift toward person-centered care, equitable resource allocation, and strong political commitment. As WHO highlights in its new operational guide, hepatitis elimination is not just a health goal but a step toward social equity and justice. 

Dr Nida Ali is a Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a program of the Task Force for Global Health. The Coalition pursues worldwide elimination of viral hepatitis by strengthening local capacity and bringing together global partners to share knowledge and experiences related to prevention, testing and treatment.

Image Credits: Nida Ali.

Last year was the hottest on record, bringing a range of natural disasters including fires and floods.

Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement.

Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder.

“Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday.

“These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change.

About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’.

Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record.

Sea Surface temperatures also increased

The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with  record highs across nearly one third (27%) of the extra-polar ocean.

Globally, the monthly average SST reached a new record in March of 21.07°C.

Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean.

In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea.

The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April.

In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year.

Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans.

The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024.

Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere.

Heat also compounds air pollution’s toxic effects

The increased prevalence of heat waves due to climate change is leading to more frequent and intense periods of poor air quality, meaning more people are exposed to dangerous levels of pollutants. This is especially concerning for vulnerable populations, such as the elderly, children, and those with pre-existing respiratory or cardiovascular conditions. 

For instance, high temperatures act as a chemical catalyst, interacting with pollutants like nitrogen oxides (from sources like car exhaust) to produce ground-level ozone, a harmful respiratory irritant. Ozone is a major component of smog and can cause respiratory problems, especially for those with asthma or other lung conditions. Additionally, heat can exacerbate wildfires, releasing smoke and particulate matter into the atmosphere, further degrading air quality. 

Heatwaves can dry out vegetation, increasing the risk and intensity of wildfires, like the ones seen recently in the Los Angeles area. Wildfire smoke contains a mix of harmful pollutants, including particulate matter and gases that contribute to respiratory issues and other health problems. Besides ozone and wildfire smoke, heat can also increase the levels of other pollutants like particulate matter (PM2.5) and biogenic volatile organic compounds (BVOCs), further contributing to air pollution’s health impacts. 

Heat waves and high air pollution levels often coincide because they share similar weather patterns, like high-pressure systems with low wind speeds and little precipitation, which allows pollutants to accumulate. This creates a dangerous “compound effect,” where the combined impacts of heat and air pollution are more severe than the sum of their individual effects. 

Human-induced heat

For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030.

However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. 

Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface.

Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report.

Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”,  according to the report.

“Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo.

“Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW)

“These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.”

Image Credits: Unsplash, C3S/ECMWF.

Indian farmworker Balaso Salokhe can no longer work because of severe asthma

YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. 

“In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened.

Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition.

So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. 

Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden.

Asthma triggers

Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. 

These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. 

Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found.

Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023.

Lack of rural air pollution warnings

“Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. 

India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. 

 In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. 

In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas.

India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. 

But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring.

Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. 

With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However,  burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found.

Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. 

Burning the residue from crops such as sugarcane is driving air pollution in rural India.

Breathlessness

“During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution.

Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. 

His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” 

In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. 

“Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital.

His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. 

Limited research

Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain.

 “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. 

There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added.

“More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.”

A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. 

Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. 

“The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. 

Lack of affordable solutions

Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, 

Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. 

Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. 

However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. 

“I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said.

Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. 

“We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.”

She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks.

With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. 

Image Credits: Sanket Jain.

A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier.

The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month).

“Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes.

The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin.

“Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study.

Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France.

Ethical questions

But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month.

In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”.

There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients.

None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it.

Author disputes

Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported.

Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. 

The corresponding author, Didier Raoult, did not respond to the deadline to address concerns.

However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola,  Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”.

Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19.