A medical assistant gives a flu vaccination at the Arzthaus in Zurich, Switzerland, on January 30, 2015. (KEYSTONE/Gaetan Bally)

Amidst the anticipated increase in vaccine-preventable diseases as the global population ages, a first-of-its-kind study has underscored the dual benefits of adult immunization programs.

Beyond saving lives and preventing severe illnesses, the study found these programs offer substantial financial advantages to nations by reducing the need for costly hospitalizations and emergency medical interventions and avoiding expensive productivity losses.

The research, carried out by the Office of Health Economics (OHE) and funded by IFPMA, revealed that adult vaccination programs can deliver a return of up to 19 times the investment. When considering the comprehensive range of benefits and using the most widely accepted valuation approach for each program, these programs translate into billions of dollars in net monetary gains for society. On an individual level, this equates to approximately $4637 in net benefits for a complete vaccination course, according to the study.

“The high-level results are overwhelmingly positive and offer so much value – much more value than the cost of delivering the vaccines,” Prof Lotte Steuten, deputy CEO of OHE and co-author of the report, told Health Policy Watch. “Government decision-makers should rest assured that this is a good idea, high value, and you will get more in return.”

Prof Lotte Steuten, deputy CEO of OHE
Prof Lotte Steuten, deputy CEO of OHE

Promoting Health, Productivity, and Equity

Specifically, the study looks at adult immunization programs targeting four diseases, three life-threatening illnesses and one causing severe pain and hospitalizations: influenza (flu), pneumococcal disease (PD), herpes zoster (HZ), and respiratory syncytial virus (RSV). These programs were examined across 10 countries: Australia, Brazil, France, Germany, Italy, Japan, Poland, South Africa, Thailand, and the United States of America.

Steuten said the 10 countries were chosen to provide a balanced mix of societies regarding income level, demographics, disease incidents and availability of adult vaccination programs. She said that the goal was to ensure that decision-makers globally could relate to the list of countries and find resonance with the study’s findings.

The study’s findings came from reviewing published research about how these diseases affect adults and the benefits of vaccines for health, hospitals, and society. The researchers also used a method called health economic modeling to figure out the costs versus the benefits and the money saved by using adult vaccination programs in the 10 countries.

Steuten pointed out two additional important discoveries from the study: first, expanding vaccination programs for adults can help people and their caregivers be more productive. Second, these programs can also promote fairness in health and economics within countries, especially helping those who are at risk or don’t have enough access to healthcare.

“People can stay active, and that’s very important, particularly for an aging society—for people with paid and unpaid work, such as caring for their loved ones or their grandchildren,” Steuten said.

PAHO is supporting vaccinations of indigenous people

Actionable Recommendations

The report was released ahead of World Immunization Week, and its authors noted that the findings support major global initiatives like the United Nations Sustainable Development Goals, the UN’s Decade of Healthy Aging (2021-2030), and the World Health Organization’s Immunization Agenda 2030. The latter focuses on encouraging vaccinations for all ages, stressing the importance of understanding the benefits of adult immunization and the need for national strategies that cover immunization throughout a person’s life.

The authors provide actionable recommendations for countries based on the study’s results. These recommendations include embracing a prevention-focused approach, allocating sufficient funding to enhance adult immunization programs and accessibility, and further developing the evidence supporting the value of these programs for adults.

“Increasing pressures on ailing healthcare systems, such as aging populations, are driving an urgent need to shift to a prevention-first mindset. Our report sets out a compelling case for adult immunization programs playing a key role in the shift to prevention,” concluded Steuten. “Our findings show that costs are offset multiple times over by benefits to society when governments invest in adult immunization programs.

“These returns are realized through benefits to individuals, families, and communities, providing a clear call to action to countries not already implementing or expanding robust vaccination schedules.”

Image Credits: Unsplash, KEYSTONE/Gaetan Bally, Office of Health Economics, PAHO.

Moderator Sylvie Briand, INB co-chir Precious Matsoso, Ethiopia’s Ambassador Tsegab Kebebew Daka and Australia’s Ambassador Amanda Gorely

“This is probably the most hopeful time in my professional life and the scariest time,” Dr Mike Ryan, the World Health Organization (WHO) Deputy Director General and head of Health Emergencies, told a high-level Geneva audience on Wednesday.

“Hopeful” because there is the possibility of reaching a global agreement on how to tackle future pandemics and “scary” because the world “is tearing itself apart”, Ryan explained at on pandemic agreement negotiations, convened by the Geneva Graduate Institute’s Global Health Centre, the Global Preparedness and Monitoring Board (GPMB) and Pandemic Action Network (PAN).

“What we need is a foundational agreement,” added Ryan, calling on the 194 WHO member states and multilateral organisations to “commit to a collective security arrangement where we can build the future on the strongest foundations; where there are concrete commitments to sharing [and] concrete commitments to equity”.

“Let us choose to put our communities and our populations first, and at least deal with one issue for which we have the capability, the science, the technology, but lack the will so far to put in place,” Ryan appealed to the audience, which included key players in the pandemic agreement negotiations and the process to update the International Health Regulations (IHR).

Dr Mike Ryan, WHO Deputy Director General, delivers the keynote address

‘Negotiators need to be empowered’

Ambassador Amanda Gorely, Australia’s representative to the UN in Geneva, told the meeting: “It was always our expectation that these intensive negotiations would result in a high level agreement on which we could build and that its adoption would not be the end of the process, but the beginning.”

“We have been working closely with our Ethiopian colleagues on Article 12 negotiations, which have been amongst the most intractable in terms of divergent positions,” she added.

“So we really appreciate and acknowledge the fact that the Bureau has been working very hard and indeed circulated a revised text [on Tuesday] night, which we’re all now trying to digest and prepare to engage on in the next session.”

While Australia has generally aligned itself with the Western bloc of countries, it has also played a useful role in trying to resolve differences between the key power blocs, according to insiders.

“Negotiators, who have been listening carefully to each other for many, many months, and know where common ground can be found, need to be empowered to make the agreement that we need to see happen,” said Gorely.

‘Differences are not huge’

Ethiopia’s Ambassador to Geneva, Tsegab Kebebew Daka told the same event that “the differences in the text are not huge”.

“They are mainly differences of ideas and they’re not that many. So we can come to an agreement,” said Daka, a key negotiator for the Africa group.

Like Gorely, he appealed for high-level political engagement to give negotiators “the power and flexibility they need to make compromises and find consensus”. 

“We are at a stage where we need to make decisions. We need to open direct lines of communication and provide political backing to negotiators”

While Daka acknowledged that there were still sticking points, he appealed to member states to take a “holistic view on the entire pandemic agreement” rather than dwelling on “specific articles where we have differences”.

“We need to go back to the mandate. We want to address the issue of equity and we need to have that holistic view. We need to be clear on the individual and collective responsibilities and expectations.”

Letting member states ‘hold the pen’

Meanwhile INB co-chair Precious Matsoso joked that the lessons she had learnt during the process was “how not to do things”.

“I’ll be in trouble for this, my Bureau members are going to kill me but I’ll say it anyway. Sometimes as the Bureau, we think that we must hold the pen but it’s important to sometimes allow the member states to hold the pen,” said Matsoso.

“Let them agree amongst themselves on how to do it. It is that balance because we also, as a Bureau, are looking at the timeline;, we want to meet the deadline.

“Secondly, I’ve also established that sometimes member states avoid talking to each other they avoid negotiating amongst themselves and negotiate through the Bureau. The more they talk amongst themselves, the more they engage each other, the better because that text will be owned by them.”

IHR amendments make progress

PAN executive director Eloise Todd, EU negotiator Americo Beviglia Zampetti and Bangladesh’s Shanchita Haque, with Dr Ashley Bloomfield, co-chair on the WGIHR, projected behind them.

The Working Group on Amendments to the IHR had to shift through 300 proposed amendments to the global rules that govern public health emergencies of international concern, said co-chair Dr Ashley Bloomfield.

Ryan described some of the proposed amendments as “significant improvements” that would have an immediate effect on surveillance and response. 

However, European Union’s negotiator, Minister Counsellor Americo Beviglia Zampetti said the EU would have liked some of the IHR improvements “to be a little bit more ambitious, but nonetheless we are very satisfied with the way the work has been conducted”.

A closing window of opportunity

Professor Suerie Moon, co-director of the Global Health Centre, warned that there was a “closing window of opportunity” to reach a meaningful deal on pandemic prevention, preparedness and response that was more effective and equitable than the status quo during COVID-19. 

“The concept of a political window of opportunity is real. It’s not just an abstract theory,” said Moon. “These windows open, often in response to a crisis, and they close. If you look at the headlines of the news this morning, it’s easy to see why our window of opportunity might be closing. We have in the headlines war, famine, humanitarian catastrophe, climate disasters, inflation, political extremism, and elections, to name just a few. And this is what’s on the minds of heads of state rather than pandemics today.”

Moon added that a meaningful pandemic agreement “cannot be achieved without international cooperation”.

”I would bet every single one of us, both here in the room and online, was deeply and personally affected by the pandemic. And I hope that we as a global community can mobilise the political momentum needed to support our hardworking diplomatic negotiators, many of whom have also joined us today, our hard working Bureau, our hard working Secretariat, all of whom are indeed working very, very hard night and day to close a meaningful deal. “

The South Sudan Minster of Health, Elizabeth Chuei, receives a COVID-19 vaccine at Juba Teaching Hospital in March 2021.

The latest draft of the pandemic agreement, while deferring many operational issues, keeps equity hopes alive in many aspects – including by cementing in-principle agreements on a pathogen access and benefit-sharing (PABS) system, a global supply chain and logistics network and geographically diverse “capacities and institutions” for research and development.

READ: WHO Pandemic Agreement draft_16 April 2024

The streamlined 23-page draft was sent to World Health Organization (WHO) member states on Tuesday night ahead of the final meeting of the intergovernmental negotiations body (INB) on 29 April.

The “minimum” components of the envisaged PABS system – one of the most contentious aspects of the negotiations – include the reservation of 20% of pandemic-related health products for the WHO for distribution to those most in need, and “annual monetary contributions from PABS System users”.

The basis for the PABS system, to be administered by the WHO, is “the fair, equitable and timely sharing of benefits, both monetary and non-monetary, arising from access to PABS material and information”.

But the “modalities, terms and conditions, and operational dimensions” of the PABS system will be “further defined in a legally-binding instrument, that is operational no later than 31 May 2026”, according to the draft. 

Ditto the mechanisms for a One Health approach, also to be decided in future and operational by 31 May 2026. 

As reported earlier by Health Policy Watch, the WHO’s 194 member states’ obligations to secure themselves against pandemics are codified in the draft – particularly in Articles 4,5 and 6. Meanwhile, some of the international obligations are there – but are still aspirational rather than practical.

‘Differences are not huge’

Ambassador Amanda Gorely, Australia’s representative to the UN in Geneva, told an event in the city on Wednesday that all delegations “need to come together and focus on finding consensus on these high level commitments, and on the institutional structures and further processes”.

“We have been working closely with our Ethiopian colleagues on Article 12 negotiations, which have been amongst, I think, the most intractable in terms of divergent positions. So we really appreciate and acknowledge the fact that the Bureau has been working very hard and indeed circulated a revised text last night, which we’re all now trying to digest and prepare to engage on in the next session,”  Gorely told a high-level discussion at the Geneva Graduate Institute’s Global Health Centre.

While Australia is generally aligned with the western bloc of countries, it has been working to resolve differences between the key power blocs.

“Negotiators who have been listening carefully to each other for many, many months, and know where common ground can be found, need to be empowered to make the agreement that we need to see happen.

“It’s really up to the negotiators and our governments, to enable them to be able to navigate where the landing zones are and of course, the Bureau has an essential role to play in that,” Gorely told the meeting, convened by the Geneva Graduate Institute’s Global Health Centre, the, Global Preparedness and Monitoring Board (GPMB) and Pandemic Action Network (PAN) to assess progress in the pandemic negotiations.

Ethiopian Ambassador Tsegab Kebebew Daka told the same event that “the differences are in the text are not huge”.

They are mainly differences of ideas and they’re not that many. So we can come to an agreement,” said Daka, a key negotiator for the Africa group.

What next?

So who takes this further? Once the draft has been agreed on, hopefully by the end of the INB’s ninth meeting on 10 May, it goes to the WHO’s World Health Assembly (WHA) which convenes from 27 May to 1 June. 

Once the draft and its accompanying resolution are passed by the WHA, some of the outstanding issues will need to be finalised. The WHA draft resolution proposes creating working groups on the key outstanding issues – namely the PABS system, One Health and financing – particularly to help low-and middle-income countries to implement all the provisions.

The draft’s Article 21 makes provision for a Conference of the Parties (COP) to be convened by the WHO “not later than one year after the entry into force of the WHO Pandemic Agreement”. The COP will determine the venue and timing of subsequent regular sessions at its first session, and shall “regularly” take stock of the implementation of the agreement, and review its functioning every five years.

Nina Schwalbe, head of Spark Street Advisors, who has been closely monitoring the negotiations, notes that the text “has no provision for monitoring compliance or details on state reporting requirements other than ‘periodically’,” and that also “notably missing is a working group for accountability or any type of Compliance Committee”.

Reduction in transparency

Meanwhile, James Love, director of Knowledge Ecology International (KEI), said that “there has been a significant reduction in the transparency obligations, although a few important provisions have survived, for example, on the terms in government funding agreements”.

The article Love referred to is in Article 9 (research and development), which states that: “Each party shall ensure that government-funded research and development agreements for development of pandemic-related health products include, as appropriate, provisions that promote timely and equitable access to such products and shall publish the relevant terms.”

Transparency about how public money is spent on pharmaceutical R&D has long been a demand by medicines access activists.

The clause elaborates on the types of provisions that could access, listing them as “licensing and/or sublicensing, preferably on a non-exclusive basis;  affordable pricing policies; technology transfer on mutually agreed terms; publication of relevant information on research inputs and outputs; and/or adherence to product allocation frameworks adopted by WHO.”

Love also pointed to the removal of some wording related to using TRIPS flexibilities to enable access to medicines, which he described as “unfortunate”.

Image Credits: ULISES RUIZ / Getty Imageses Contributor, UNICEF.

Negotiations underway for a pandemic agreement at the WHO headquarters in Geneva.

While the next draft of the World Health Organization’s (WHO) pandemic agreement is due to be sent to member states by Thursday (18 April), it is likely to be stripped of contentious clauses.

Instead, the draft – and indeed, the pandemic agreement to be put to the World Health Assembly (WHA) at the end of  May – will be an “instrument of essentials”; a basic text that will be fleshed out by further talks in the next couple of years, as reported recently by Health Policy Watch.

After the WHA has adopted the framework, more details will be fleshed out over the next 12 to 24 months. Thereafter, a  Conference of Parties has been proposed, but sources close to the discussions say this is only likely to convene in the latter half of 2026 – so fingers crossed that there’s no pandemic before that!

The ninth intergovernmental negotiating body (INB) meeting, from 18-28 March, was due to be the last before the WHA. But there was little agreement between the key power blocs: the European Union, UK, Japan and US; the 34-strong Group of Equity (headlined by Bangladesh, India, Brazil and Indonesia) and the Africa Group.

After days of circular negotiations and countries’ loss of patience with one another and the INB Bureau, parties resolved that the agreement to be put to the WHA would focus on areas of convergence.

This has seen the text slim from a completely unwieldy 100-page draft on 26 March, with multiple opposing clauses contained in brackets, to the current 20-pager, according to insiders.

Country obligations in, international obligations out

Likely to be in the latest draft are many of the countries’ obligations to prevent and prepare for pandemics (for example, Articles 4,5 and 6).

But many of the articles that deal with international co-operation will be delayed. For example, the operating mechanism of the contested pathogen access and benefit-sharing (PABS) system – Article 12 – is likely to be “further defined in a legally binding instrument  that is operational no later than 31 May 2026”, according to a proposal made to parties by INB deputy chair Viroj Tangcharoensathien of Thailand.

What has survived in Article 12, however, is the proposal that the WHO will get 20% of pandemic-related health goods (10% as a donation and 10% at affordable prices) to allocate to those most in need. At least that will go some way to securing a little stash of vaccines for poor countries should another pandemic sweep through the world soon.

The “modalities, terms and conditions, and operational dimensions” of a One Health approach have also been kicked down the line, to become operational no later than 31 May 2027, according to Geneva Health Files.

Also missing is are financial commitments to fund countries’ pandemic prevention, preparedness and response.

However, even the section on research and development (Article 9) has been pared down, with no obligations placed on public-funded research although there seemed to be broad consensus on that, according to a draft published by Politico Europe. 

The ninth INB meeting resumes from 29 April to 10 May where member states will iron out further issues with the slimmed-down agreement.

“Civil society continues to call for access to the resumed negotiations, while pushing for a successful conclusion to the negotiating process, a meaningful agreement, and a human rights-based approach,” according to the Pandemic Action Network.

The Moderna vaccine was unavailable in Africa for most of the COVID-19 pandemic.

“Disappointed” is how the Africa Centres for Disease Control and Prevention phrased its response to pharmaceutical company Moderna “pausing” its Kenyan mRNA vaccine manufacturing facility. 

Moderna’s decision is yet another example of how complex it is to kickstart vaccine manufacturing on the continent – an essential component to safeguard Africans against future pandemics on the continent that was simply unable to procure COVID-19 vaccines until way after developed nations.

“The demand in Africa for COVID-19 vaccines has declined since the pandemic and is insufficient to support the viability of the factory planned in Kenya,” Moderna announced in a statement last Thursday.

Back in March 2022, Moderna and then Kenyan president Uhuru Kenyatta signed a memorandum of understanding, with the company aspiring to produce up to 500 million vaccine doses a year with a focus on drug substance manufacturing.

But Moderna disclosed last week that it “has not received any vaccine orders for Africa since 2022 and has faced the cancellation of previous orders, resulting in more than $1 billion in losses and write-downs”.

Moderna’s experience mirrors that of South African generic drug company Aspen, which spent millions of dollars expanding its production facilities to make Johnson and Johnson vaccines – yet it never sold a single vial, as reported previously by Health Policy Watch.

“Unless there is security around domestic or regional procurement, you’re going to be very guarded about getting into this business ever again,” Stavros Nicolaou, Aspen’s head of strategic trade, said at the time.

However, Moderna is estimated to have made $18.4 billion in profits from COVID-19 vaccines in 2022 alone in other markets.

Moderna was a latecomer to African COVID-19 market

In its response, Africa CDC reminded Moderna that it entered the African COVID-19 vaccine market late – some time after various calls by African leaders and the African Union (AU) for “equitable and timely access to, and receipt of, vaccines”, which  “in many instances went unanswered by the international community and industry”.

When the AU’s African Vaccine Acquisition Trust (AVAT) eventually managed to acquire 400 million COVID-19 vaccines from manufacturers for the continent, none were from Moderna “simply because Moderna vaccines were not made available, despite attempts to buy [them],” said the Africa CDC, adding that less than 5% of the COVID-19 vaccines administered in Africa were from Moderna.

“Therefore, to blame Africa and Africa CDC for lack of demand for COVID-19 vaccines and therefore the reason to put on hold plans to manufacture vaccines in Africa, only serves to perpetuate the inequity that characterised the response to the COVID–19 pandemic,” said Africa CDC. 

“While other vaccine manufacturers are progressing with their plans and construction in Africa, Moderna is abandoning a commitment to build highly needed and relevant vaccine manufacturing capabilities in Africa, in truth, demonstrating that Moderna’s commitment is in fact not to vaccine equity and access to vaccine, through building manufacturing in Africa.”

Kerry's laboratory in the sky
Moderna’s clinical development manufacturing facility in the USA.

While pulling back from COVID-19 vaccines, Moderna stated that it is” actively working on the development of public health vaccines, including those for diseases that predominantly affect the African continent, such as HIV and malaria”, using mRNA technology. 

“However, these investigational vaccines are at an early development stage. Given this, and in alignment with our strategic planning, Moderna believes it is prudent to pause its efforts to build an mRNA manufacturing facility in Kenya. This approach will allow Moderna to better align its infrastructure investments with the evolving healthcare needs and vaccine demand in Africa,” said the company.

Gavi’s ‘Accelerator’ is a game-changer

Africa CDC said that it would continue to advocate, and support the establishment of a strong local vaccine manufacturing ecosystem as part of its “continental vision of producing 60% of vaccines, therapeutics, and other medical products by 2040”. 

But it acknowledged that “building vaccine manufacturing infrastructure and capabilities is complex, takes a long time, and requires significant investment”.

Vaccine platform Gavi’s decision to establish a new innovative financial mechanism, the African Vaccines Manufacturing Accelerator (AVMA),  is such an investment.

Through the AVMA, Gavi plans to make up to $1 billion available over the next 10 years to “support the sustainable growth of Africa’s manufacturing base”.

Making the announcement last December, Gavi put the current value of Africa’s annual vaccine demand at over $1 billion. 

“Africa already accounts for around 20% of the world’s population, yet the continent’s vaccine industry provides only around 0.2% of global supply,” said Gavi.

“A sustainable expansion of Africa’s vaccine manufacturing capacity would have a double payoff for the continent, contributing to the growth of a high-value biotechnology sector on the continent at the same time as supporting pandemic and outbreak prevention and response.”

The AMVA will be launched on 20 June at a high-level event in Paris co-hosted by the French government, AU and Gavi, with support from Team Europe partners.

AVMA will offer two types of incentive payments to offset some of the initial high costs of production. The first type of payment, known as a ‘milestone payment’, will be available to manufacturers that produce one of the vaccines included in the Gavi priority vaccine market group when they succeed in obtaining WHO pre-qualification (PQ).

“PQ is a form of regulatory approval that must be obtained before a manufacturer can win a Gavi-UNICEF tender . This payment is targeted to support manufacturers to offset some of the financial burden of meeting the standards for PQ, and helps to bridge the period between this pre-qualification and production,” according to Gavi.

Top-up payments per dose

The second type of payment, termed an ‘accelerator payment’, will be paid as a per-dose top-up, in addition to the market price that manufacturers receive for doses on winning Gavi-UNICEF tenders. These payments will be highest for the “end-to-end manufacture of priority market vaccines , and vaccines produced using ‘pandemic ready’ technology platforms”, while lower tiered incentives will be paid for lower-cost ‘fill and finish’ manufacturing.

“The need to ensure regional diversification of vaccine manufacturing was a key learning from the COVID-19 pandemic, when a lack of local manufacturing capacity in Africa and other parts of the world meant these countries had to wait longer for vaccines to become available,” according to a recent media release from Gavi.

 “Our determination to promote equitable access to global health and the health sovereignty of our African partners is growing further,” said Chrysoula Zacharopoulou, French Minister of State for Development and International Partnerships.

Gavi will also use the event to make the case for donors to invest in a “new era of immunisation for enhanced equitable access to health care” as well as pitching its 2026-2030 funding needs to the government leaders, partner organisations, civil society and business who are invited to the event.

Image Credits: Gavi , Moderna.

Research from Bite Back has demonstrated that Nestlé’s best-seller in the UK is KitKat – a product that is considered to be high in sugar, fat, or salt (HFSS).

Nestlé’s shareholders have a golden opportunity to call on the food giant to promote healthier lives in almost two hundred countries by backing a bold resolution at the multinational’s Annual General Meeting this week. Doing so can protect their profits in the long-haul.

Backed by a coalition of five institutional investors with $ 1.68 trillion in assets under management, the resolution calls on the world’s largest food and drinks company to transparently disclose the sales of its products by drawing on government-approved nutrient profiling methods.

In addition, the resolution urges the company to strategically boost the proportion of sales from healthier products. The resolution is supported by ShareAction, a UK charity that champions responsible investment. It coordinates the Healthy Markets Initiative (HMI), a coalition of 40 institutional investors that engages with the world’s largest food and beverage companies to ramp up access to affordable and healthy food.

The resolution comes at a time when diet-related sickness claims the lives of 11 million people a year. In the past two decades, virtually no progress has been made to stem the tide of childhood obesity. Adolescents are now four times as likely to live with obesity as compared to thirty years ago. 

While obesity is a multifactorial condition, research has demonstrated that the food industry plays an important role in shaping what we eat by flooding the places in which we grow up and live with cheap and less healthy foods. 

Obesity is a financially material issue that harms the health of the economy by driving absenteeism, presenteeism, unemployment, and lower wages. The price tag of obesity is predicted to escalate to $4 trillion a year by 2035, equating to 4% of global GDP. That is comparable to the cost of one Covid-19 pandemic every year.

First of its kind resolution 

The draft resolution going before Nestlé shareholders is the first of its kind to escalate to a vote at an Annual General Meeting (AGM) of a major food and drinks company. In the past, similar resolutions urging companies to enhance the proportion of sales from healthier products have been proposed. However, they never progressed to the voting stage because companies responded with concrete commitments to enhance access to healthier products, prompting the resolutions to be withdrawn.

The resolution is aligned with the WHO’s broader thrust to address the global upsurge in chronic diseases, as well as its Acceleration Plan to Stop Obesity and recommended “Best Buys”. The WHO’s strategy aims to foster healthy environments where healthier food is easily available, accessible, and desirable. The Best Buys harness a suite of regulatory and fiscal measures to achieve this, from subsidies for healthier foods; taxes on sugar-sweetened drinks; restrictions on the marketing and advertising of unhealthy foods; nutrition labelling policies; as well as policies to eliminate trans fats and to reduce the levels of salt, sugar, and fat in foods that are sold in public spaces like schools.

Taxes on sugar-sweetened beverages are an increasingly popular WHO “Best Buy” measure to address obesity worldwide

A need for greater transparency and ambition at Nestlé

Nestlé says it is committed to driving global improvements in nutrition. Its website states that “being transparent about our portfolio is key to building trust”. But in three years of engagement with ShareAction and the Healthy Markets investors, it has made little tangible progress to achieve those goals. 

Peer-reviewed research has demonstrated that three quarters of Nestlé’s sales across seven major markets stem from less healthy products that are high in sugar, salt, and fat. Nestlé, however, maintains that 52% of its sales come from “healthier” products, an estimate that has been contested by investors. 

Nestlé’s has deviated from standard methodology by including coffee in its estimate of “healthier” sales. Even if some of Nestlé’s coffee products may be comparatively low in fat and sugar, this is likely to have over-estimated its estimate of “healthier” food sales.

On the one hand, it is laudable that the food giant assessed the nutritional value of different foods by using a government-approved nutrition model, in this case the widely recognized  “Health Star Rating” (HSR). The HSR is used by Australia, New Zealand, and the Access to Nutrition Initiative (ATNI), which draws on the HSR to benchmark companies’ efforts to promote healthier lives.

However, in Nestlé’s disclosure of “nutritious” food sales, the food giant included coffee, infant food, and milk formula. This is likely to have inflated Nestlé’s estimate of “healthier” food sales. It has also raised eyebrows among health experts, who have pointed out that such products should not be categorized as “healthy” in this way. 

Formula milk, for instance, is not recommended by the WHO for the first six months of an infant’s life, and concerns over the aggressive marketing of infant formula as an alternative to breast-feeding remain acute. While coffee may confer some health benefits, prepared coffee products containing sugar and milk change their nutritional balance. Strikingly, research has found that a third of major coffee shops in the UK serve drinks and sweet products that surpass an adult’s maximum daily sugar intake of 30 grams in just one serving. And coffee is considered to be a “non-nutritive” product in the Health Star Rating.  

As a result of Nestlé’s deviation from the standard methodology it says it is using, its estimate of “healthier” food sales cannot be compared to its peers like Unilever and Danone UK, which have followed best practice guidelines. Unilever is paving the way in responsible reporting of its sales by providing relevant information about the healthiness of its product portfolio against six government-endorsed nutrition models. Nestlé has an opportunity to follow suit.

Targets need to align with truly nutritious foods

Nestlé’s existing target to boost sales of “nutritious” foods by 50% by 2030 will not necessarily have any positive impact on public health. The target can be met simply by selling more coffee or infant foods. The target is also aligned with Nestlé’s overall growth projections for the company (four to six per cent a year). This implies that sales of less healthy products could climb by 50% by 2030. In theory, Nestlé could achieve this target without having to increase the amount of healthier food it sells or reduce the share of less healthy food it sells. 

Meanwhile, UK manufacturers such as Premier Foods have made bold commitments to double the sales of healthier products by 2030. The giant retailer Tesco has pledged for 65% of total sales to stem from healthier products by next year. 

Nestlé could align with the approaches of such trend-setting food and beverage producers and distributors by adopting a time-bound and proportional (rather than an absolute) target to increase the share of healthier foods. Investors are not asking Nestlé to stop selling less healthy products, but to reduce its heavy reliance on their sales.

Nestlé is not the only multinational food and beverage producer that remains over-reliant on the sales of less healthy food and drinks. Still, because of its size, the food giant sells more food and drink that is high in fat, salt or sugar than any other around the globe (aside from PepsiCo). A strategic shift in its business decisions has the power to set the global norm across the entire sector, with potential to create powerful ripples across the 188 countries where it operates. 

7 out of 10 of the largest food and drinks manufacturers are over-reliant on the sales of unhealthy products in the UK

Stronger leadership in global nutrition is financially prudent for Nestlé 

A potential shift in Nestlé’s business decisions is in the interest of the public and policy-makers struggling to reach the Sustainable Development Goals by 2030. Investing in public health is also a financially prudent decision that has potential to reap tangible benefits for shareholders in the long-run. 

This is what forward-thinking investors like Legal General Investment Management (LGIM), the UK’s largest asset manager, have stressed. LGIM has emphasized that rising rates of obesity represent a “systemic” risk to diversified investors, since their returns rely on the broader health of the economy. This perspective is backed by studies indicating that broader economic factors account for 75 to 94 per cent of average portfolio returns for diversified investors.

Nestlé’s existing business decisions also carry reputational, legal, and regulatory risks – with potential to hamper its profits in the long-haul. Nestlé’s brand reputation is at stake as consumers grow suspicious of the corporate sector and increasingly demand healthier products. A recent McKinsey study in the US, France, Germany, and the UK revealed that half of consumers consider healthy eating to be a “top priority”. The survey also found that less than a third of consumers were “satisfied with the healthy options that were available at their local grocery store”. Nestlé has an opportunity to capitalize on shifting consumer demand for healthier foods. Such foresight might even protect Nestlé from significant legal risks in the future, which may carry important financial costs and implications for its brand. 

Nestlé might benefit from shifting its product sales sooner rather than later as governments tighten their grip on corporations through more stringent regulation on unhealthy foods, in line with the WHO Best Buys. In spite of industry pushback, taxes on sugar-sweetened drinks have already been rolled out in 50 countries. Even at the WHO, there appears to be growing appetite to hold health-harming companies responsible for the externalities they create.

Le poison, c’est la dose (the poison is the dose). That is what Paul Bulcke, Chairman of the Board of Directors, told ShareAction at Nestlé’s AGM last year, in response to concerns about its over-reliance on the sales of less healthy foods. We agree with Paul Bulcke. After all, that is why investors have urged the company to enhance access to healthier food options worldwide. Doing so is in everyone’s interest – the public, shareholders, and Nestlé. 

Thomas Abrams is the co-head of health at ShareAction, a UK-based charity that champions responsible investment. Thomas holds a degree in social policy and has previously led efforts at The London Early Years Foundation (LEYF) to promote food and health for the youngest children. He has also worked as an impact consultant supporting social purpose organisations to maximise their impact.

Holly Gabriel is the campaign lead for consumer health at ShareAction. Holly is a registered nutritionist with a degree in public health nutrition. She has previously worked with Action on Sugar, a UK-based NGO, to encourage the government to commit to an evidenced-based obesity strategy. Holly has also worked as a child weight management nutritionist and as a nutritionist for UK retailer Waitrose.

Svět Lustig Vijay is a senior campaign officer at ShareAction. He holds a degree in public health at the London School of Tropical Hygiene and Medicine, and has previously worked with Partners in Health in Peru on the social determinants of health, including on family health and early childhood development projects. 

Image Credits: Famartin, University of North Carolina, Nestlé, Bite Back.

First rollout of new WHO-recommended meningitis vaccine(called Men5CV) took place in Nigeria in March 2024. The vaccine protects people against five strains of the meningococcus bacteria.

Nigeria has incorporated a cutting-edge meningitis vaccine into its immunization programmes, becoming the first country on the continent to roll it out. The vaccine provides immunity against as many as five strains of deadly meningococcus bacteria, WHO announced on Friday.

“Meningitis is an old and deadly foe, but this new vaccine holds the potential to change the trajectory of the disease, preventing future outbreaks and saving many lives,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commenting on the rollout.

In light of the recent outbreaks in the north of the country, Men5CV, as the vaccine is called, could be a game-changer for combatting meningitis in Africa’s most populous country.

“We’ll be monitoring progress closely, and hopefully expanding the immunization in the coming months and years to accelerate progress,” said Prof. Muhammad Ali Pate of the Nigerian Ministry of Health and Social Welfare in a news release.

Between the beginning of October 2023 and March 11 this year, an outbreak of meningitis serogroup C led to 153 deaths among 1742 suspected cases of the disease. It occurred in seven Nigerian states in the north of the country with children aged 1 to 15 being a large part of its victims. WHO has supported the Nigerian Centre for Disease Control and Prevention, helping with disease surveillance, active case finding, sample testing, and case management. Men5CV rollout can be a decisive blow in curbing meningitis in the country.

“[T]his vaccine provides health workers with a new tool to both stop this outbreak but also put the country on a path to elimination,” Pate stressed.

Meningitis is a leading killer

Meningitis is an infection of the meninges, the protective membranes that surround the brain and spinal cord, usually caused by a viral or bacterial infection. Typical symptoms include headache, fever and stiff neck.

While infection can be caused by both viruses and bacteria, bacterial strains are the most deadly, and can lead to blood poisoning, death, or disability within 24 hours, WHO warns.

Global burden of meningitis; African countries among the most affected.

Bacterial meningitis is a leading killer of children under the age of 5, particularly in Africa, claiming 112 000  lives prematurely every year. In 2019, WHO and partners launched the global roadmap to defeating meningitis by 2030.

The aim is to eliminate bacterial meningitis epidemics, reduce vaccine-preventable cases and improving the quality of life after suffering from meningitis. The new vaccine, which would be routinely administered to children as well as to younger adults up to 29 years of age during outbreaks, can help make it happen, WHO officials said.

“Nigeria’s rollout brings us one step closer to our goal to eliminate meningitis by 2030,” Tedros highlighted.

Men5CV protects against five bacterial strains of meningitis, A, C, W, Y and X, in a single shot. Thanks to the broader protection, it offers better prospects than the current vaccine used in much of Africa, only effective against the A strain.

The new vaccination programme is funded by Gavi the Vaccine Alliance as part of their financing of the global meningitis vaccine stockpile. It was developed by PATH, a global health non-profit, and the Serum Institute of India, with financing from the UK’s Foreign, Commonwealth and Development Office.

“The promise of MenFive® lies not just in its immediate impact but in the countless lives it stands to protect in the years to come, moving us closer to a future free from the threat of this disease,” said Dr Nanthalile Mugala, PATH’s Chief of Africa Region.

Image Credits: WHO/Ayodamola Olufunto Owoseye, IHME.

Health stories are not just about medical facts; they are intricate tapestries woven with economic, political, and social threads, according to two international health journalists.

Stephanie Nolen, a global health reporter for The New York Times, and Paul Adepoju, a Nigeria-based freelance health journalist and scientist who writes for Health Policy Watch, were guests on Dr. Garry Aslanyan‘s most recent Global Health Matters podcast. They discussed blending local insights with global perspectives when covering health narratives.

“I want to hear these stories from the people who are living them, and I want to tell them from the perspective of the people living them,” Nolen said.

Adepoju went on to say, “It’s not just about ensuring that journalists issue the true voices on the ground, a true reflection of what is being reported, but people like journalists who are around and closest to these places are actually empowered and adequately trained to be able to professionally report these stories at a global, international journalism quality level.”

Uncovering Vital Health Narratives

Aslanyan rolled out this latest episode against a rising wave of misinformation and disinformation, identifying journalists as crucial players in uncovering vital health stories nationally and internationally.

Even before the COVID-19 pandemic, Nolen said she understood that health stories “are economic and political and social stories, and they’re about the most intimate moments of our lives and the things that matter the most to us, that shape how we interact with each other, but there are also always power stories, there are systems stories, and if people don’t have access to health care, then everything else going on in their lives is much less relevant.”

However, COVID helped the rest of the world realise this, too.

“COVID really changed things,” Nolen said. “Suddenly, everybody wants to read an epidemiology story. So that’s a significant difference from four years ago, I would say. Global health is just a microcosm of that larger phenomenon.”

The journalists said the challenge now lies in maintaining the relevance of these stories, ultimately aiding in the achievement of global health goals by ensuring that crucial narratives are effectively shared and highlighted.

“We need to sustain the momentum that COVID created for health stories and ensure that health stories, health issues, don’t find their way back to one tiny corner of the newspaper,” according to Adepoju. There is also the need to empower, amplify, and bring more attention to dedicated health reporting platforms because no matter what we do, there is still a limit to what a general news publication can commit to health reporting, and there are a lot of health issues.”

Nolen agreed. She said, “I think it would be really useful to move past this idea of the health page or that once a week we cover these subjects. To go back to the idea … about health stories being also political, economic, social stories, we just need to take it out of that … silo.”

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Global Health Matters.

A health worker records a patient’s blood pressure at the Rural Hospital in Paud, India.

PAUD, MAHARASHTRA STATE, INDIA – It is 11:15 on a Wednesday morning, and the March sun is hot but not yet punishing in this part of western India. Mathabai Jadhav, 65, waits patiently for her turn at the Paud Rural Hospital, some 30 kilometres from the city of Pune.

At least two dozen patients like her, mostly elderly women and men from nearby rural areas, are waiting. Some sit on benches balancing a walking stick against their legs, others on the floor. They are here to attend a “screening camp” for non-communicable diseases (NCDs) that is held every Wednesday morning at the hospital.

Four healthcare workers are in the midst of frenetic activity. One pricks patients’ fingers to draw blood and test sugar levels, another checks their blood pressure, the third dispenses government-subsidized medicines prescribed by hospital doctors and the fourth provides quick counselling on the dos and don’ts related to diet and exercise for better hypertension management.

Jadhav has lived with hypertension for nearly 14 years. “I found out when I came to the doctor regarding a wrist injury,” she said. For over a decade, she went to private practitioners but for two-and-a-half years now she has been a regular at the Rural Hospital where the medication is free.

Hypertension – a neglected condition

Hypertension, simply put, is when the pressure in the blood vessels is too high. The World Health Organization (WHO) estimates that over a billion adults between the ages of 30-79 live with hypertension. Around half of them never find out or are not treated for the condition.

This has grave consequences as hypertension is a leading single-preventable risk factor for cardiovascular disease (CVD) that killed an estimated 17.9 million people globally in 2019.

In India, 28% of adults (18+) suffer from hypertension, with 70% of cases undiagnosed, a recent large-scale study found. Moreover, 90% of those living with hypertension don’t get treatment, or their treatment is ineffective to keep their hypertension within normal range.

Scale at bottom indicates disability-adjusted life years (DALY’s) per 100,000 people lost to hypertension related to cardiovascular disease – with northeastern and southeastern India reflecting the highest burden.

Strengthening programmes in LMICs 

In the past eight years, more than 40 low- and middle-income countries, including Bangladesh, Cuba, India and Sri Lanka, have strengthened their hypertension care, enroling more than 17 million people into treatment programmes based on a WHO-recommended package of primary health care interventions (HEARTS), according WHO’s first-ever global report on hypertension, released in September 2023 on the sidelines of the UN General Assembly.

Meanwhile, high-income countries such as Canada and South Korea have achieved blood pressure control in over 50% of adults living with the condition through delivery of comprehensive hypertension programmes, WHO found. The report followed up on implementation of the global WHO HEARTS initiative first launched in 2016.

Mathabai Jadhav, 65, sits on a bench at the Rural Hospital in Paud, India.

India’s hypertension control initiative

In 2017, India, now the world’s most populous country, started the India Hypertension Control Initiative (IHCI). The pilot was rolled out across five states and reaching over 15,000 public health facilities, including primary health care centers and rural hospitals, by March 2022.

The programme relied on simple measures that can still be challenging to implement in low-resource settings: standardizing treatment protocols; ensuring the public healthcare system has the standard drugs to manage hypertension; equipping health centres with monitoring systems; and encouraging better digital or paper record-keeping to track patient progress.

Prabhdeep Kaur, the lead investigator of the IHCI told Health Policy Watch that the idea was to decentralize care and prioritize evidence-based strategies that are known to work. “Then implement them by working along with the governments on the ground and see what kind of results we get, what challenges are there, can they be scaled up or not,” she said.

This is the same approach recommended by the WHO, which has found that countries that strengthen primary healthcare (PHC) to improve hypertension management see a drop in CVD mortality as well.

WHO was also a partner of the IHCI, along with India’s premier medical research agency – the Indian Council of Medical Research (ICMR). The project received additional funding support from both the central and some state governments in India.

Reaching the global targets requires public and private collaboration  

WHO’s global target is to reduce hypertension by 33% between 2010 and 2030. WHO estimates that hypertension, as such, causes an estimated 10 million deaths annually.

An estimated 10 million deaths are attributed to hypertension around the world by the WHO.

India’s target is to reduce hypertension by a quarter by 2025, although the country has not specified a baseline year.

Getting there requires not just a nudge from the government but also active involvement of civil society and the private sector, which provides around 70% of the country’s healthcare services.

Two-pronged approach needed

While a third of all adults globally, and nearly one-third in India, have hypertension, almost another third also have pre-hypertension that requires regular monitoring, said Dr Sailesh Mohan, Professor at the research non-profit Public Health Foundation of India and Director of the Centre for Chronic Conditions and Injuries (CCCI).

“So there’s a large pool of people who are hypertensive and another pool waiting to convert to full-fledged hypertension from pre-hypertension,” he said.

If pre-hypertension is not addressed, it quickly progresses to hypertension, and managing it effectively requires a synergistic approach, he explained.

This approach involves promoting policies that reduce salt, tobacco and alcohol consumption, encourage and support an active lifestyle and healthier diet, as well as increase awareness about hypertension.

The health system also needs to be bolstered to screen patients for hypertension and provide evidence-based care.

The global incidence of hypertension has increased over the years, according to WHO data.

Hypertension management in most cases requires regular monitoring, and a relatively cheap drug once a day, which can be done by trained nurses or healthcare workers.

Aruna Kaware, NCD counsellor at the Paud Rural Hospital said on average three-quarters of the patients are above the age of 60.

“We are able to handle most patients here. Around 10-20% of the patients might need to be referred to bigger hospitals,” she said.

The state of Maharashtra where the hospital is located, has done a good job of scaling up NCD care, said Kaur.

Detection is often the first challenge

The detection of hypertension can be a challenge as patients might not always have symptoms, which is why it is called “the silent killer,” explained Mohan.

Nathu Tonde, 83, now travels to the Rural Hospital every month alone to get this medication, using a cane for balance. But he came to the health centre for an unrelated ailment, and his hypertension was detected in a routine blood pressure measurement.

Nathu Tonde, 83, sits waiting for his turn at the NCD camp held every Wednesday at the Rural Hospital in Paud, India.

One of the striking results of the IHCI initiative was the increased accessibility of basic medications – due to a major reduction in drug stockouts, reduced to less than 5% in areas where the pilot was implemented. In addition, 47% of the 740,000 patients across 4,505 health facilities who took part in the project had their hypertension within the healthy limit during their visit in the first quarter of 2021.

Technically, the five-year initiative concluded in 2022. But Kaur, the lead investigator, said the partners in the original initiative are currently working with the state governments across India to make it sustainable, as well as scaling it up further.

Countering practical challenges – patient compliance and health system capacity 

While hypertension management is relatively easy in theory, there are other practical challenges.

“People are not compliant with the medication,” said Dr Arvinder Pal Singh Narula, Assistant Professor of Community Medicine at Bharati Vidyapeeth Medical College. A key reason, especially in rural areas, is either the distance or when medicines run out.

“My village is half an hour away and transport is hard to get,” Jadhav said of the monthly trips she makes to the health centre. It also costs money to make the trip.

Kaware, the NCD counselor, said that many elderly patients come unaccompanied like Tonde had, and it is hard to explain even the basics like which medicines to take and when.

Rural Hospital, Paud in western India.

India has long focused on improving healthcare delivery by working with community health workers.

More recently, states like Maharashta have countered the shortage of doctors and nurses in rural areas by engaging traditional medicine practitioners who are re-trained in “bridge programmes” to successfully deliver primary healthcare, especially in remote areas.

These are doctors trained in Ayurvedic medicine or homeopathy who learn skills for delivering a package of modern health care measures, based on a government protocol.

Even so, Kaur too said the lack of adequate healthcare workers remains a challenge in scaling up the initiative across India.

Government services only one part of the picture

However, initiatives such as the one in Paud have clear limitations – notably in who is targeted for services.

While the Indian government provides primary healthcare in rural areas and limited secondary and tertiary care in some cities, most healthcare services are provided by the private sector.

And here, chronic disease screening and prevention are typically paid for by the patient.

Only around 41% of Indian households have a member covered by health insurance. Most Indian health insurance schemes only cover hospitalization, excluding primary health care visits and tests which are critical to the prevention, screening, and early treatment for NCDs, including hypertension.

When people are finally diagnosed, it may often be at a later stage of the disease. In addition, treatment can involve hefty out-of-pocket costs for the average person.

Leelabai Jaigude, 60, is one such case in point.  A farmer, her hypertension medicine cost her Rs 80 ($1) every month at the private clinic that had diagnosed her, she said. But when she had to shell out Rs 550 ($6.60) for a blood test, she sought out a government center.

She was fortunate enough to live near the Rural Hospital, and now receives both her hypertension and diabetes medication there.

But not everyone is so fortunate to have a government facility near them. Overall, Indians bore more out-of-pocket expenditure than the government’s expenditure on health (48.2% compared to 40.6%), according to the Economic Survey 2022.

Indian Government Health Expenditure (GHE) and Out of Pocket Expenditure (OOPE) as percent of Total Health Expenditure (THE)

Alternative models proposed 

This has left experts such as Mohan looking for examples of how NCDs can be more effectively managed in private-sector healthcare and health insurance systems.

He points to the Kaiser Permanente network in the United States as one such model that has delivered good results in hypertension management.

Kaiser Permanente, which delivers healthcare to nearly 8.2 million Americans is a “Health Maintenance Organization” (HMO), which delivers holistic, cradle to grave care from primary to hospital level for those subscribed. The model operates nearly three dozen hospitals in the US. But since patients’ pay a subscription fee, HMOs have a vested interest in preventing disease from the outset – as it reduces their costs down the line.

In India however, no comparable private-sector models exist, Mohan laments – or at least not one beyond the isolated initiatives of individual practitioners or hospitals.

“The private sector is huge and very heterogeneous. And it’s very poorly regulated. So I am not aware of any concerted program or effort,” he said.

In addition, while the government system has a hierarchy ranging from the primary to the tertiary level, in the private sector, the continuum is not as clear. Private providers at primary care level typically operate separately from hospitals and specialists.

Finally, given that the private sector is largely unregulated, it also does not have to follow the government’s protocol for hypertension prevention detection and treatment.

“The government has a protocol. They [public sector] will follow this protocol, which is not the protocol that the private practitioners will follow. They will give their own medicines,” Narula said.

Kaur acknowledged this as a problem, saying that she and her team were very conscious of that fact in their work on the IHCI: “The strategies have to be different for the sectors. And since the public sector itself had not yet taken care of NCDs, trying to then replicate those strategies in private, we felt was a little premature,” she explained.

In the coming years as the WHO works towards expanding universal health coverage (UHC) in different regions, the public and private divide, which differs enormously across countries and regions,  will throw up a unique array of challenges depending on the setting.

Universal healthcare requires healthcare to reach a large number of people, address the issue of equity, and ensure the care covers a hybrid of diseases, said Kaur. “So I feel our work tried to address all the three,” she said, of the IHCI collaboration.

Additionally, this initiative taught the researchers what best practices work, like reducing the number of drugs to just a handful and procuring them in large quantities, and what the gaps are – the patient migration and ensuring continuity of care.

“Now, many states are using the same best practices for diabetes. And going forward, we’d like to do pilots, and see which of these best practices can be used for other NCDs as well,” Kaur said.

Image Credits: Disha Shetty, © 2021 Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation, Global Hypertension Report, WHO, Economic Survey 2022.

Tackling air pollution makes economic sense, says Jane Burston, CEO of Clean Air Fund.

What is the impact of air pollution on exam results or future earnings? Can governments agree to a 2050 net-zero-like goal for a key pollutant, PM 2.5? 

Such questions are part of an appeal by a new group of political, health, policy, and finance leaders for a policy approach to air pollution that is like that against greenhouse gas (GHG) – including an “intergovernmental” plan and nationally determined targets. 

Our Common Air (OCA) has put out a call to action that seeks to present a new and hopefully, more compelling way for global leaders and financiers to address air pollution, one of the world’s single biggest health crises.   

Frustrated by the lack of progress in addressing air pollution, the call presents new targets and suggests a new framework to improve air quality. 

The group’s co-chairs, former prime minister of New Zealand, Helen Clark, and former WHO chief scientist, Dr Soumya Swaminathan, say pollution has not received the attention or funding it deserves even though the devastating health costs have been documented.

These include over seven million deaths estimated by WHO, links to heart attacks, strokes, dementia, high blood pressure, low birth weight, lung cancer, and chronic lung disease among many other ailments. About 99% of the world’s population suffers air pollution above the WHO’s guidelines. 

Commissioners and secretariat members at the Our Common Air convening in February at the Bellagio Center, Italy. Our Common Air is a new global commission of high-level government figures, renowned health experts, academics, and leading climate change specialists.

Air pollution is a health and economic crisis

OCA  was set up last year as an independent commission. Apart from Clark and Swaminathan, its 16 commissioners include current WHO and World Bank officials participating in their personal capacities, as well as climate, pollution, finance, and policy experts.

 The group is backed by the UK-based Clean Air Fund and the report – Clean Air: A Call to Action – has been prepared by the Delhi-based Council on Energy, Environment and Water (CEEW). 

But OCA is re-phrasing the argument for clean air based on sound economics as well as a change in attitude. It is proposing four planks: value clean air as an asset, finance the transition, set clean air targets for all and collaboratively track progress, and work together to achieve solutions that benefit all. 

The report has been released ahead of the World Bank’s Spring Meetings, which take place next week, and serve as an important annual moment for reflectin and dialogue on global priorities by international finance and development actors.

In a statement to Health Policy Watch, the commission says its focus on these meetings reflects the conviction that development finance institutions have a big role to play in transforming the landscape of clean air funding and action. 

Said Clark, “With every breath of toxic air endangering lives and having a knock-on effect on economies, we urgently need to take greater action on air pollution now. The upcoming World Bank and IMF Spring Meetings present a crucial opportunity for global leaders to come together and make clean air a priority.”

There are numerous problems associated with air pollution, which often affect children and old people the most.

From mitigation to protection 

The group is calling for a change in focus from mitigating air pollution as a harm to recognising and valuing clean air as an asset. It points out, for instance, that the United States found that every $1 spent on air pollution control yielded an estimated $30 in economic benefits. 

The World Bank estimates that the global cost of health damage due to air pollution amounts to $8.1 trillion a year, equivalent to 6.1% of global Gross Domestic Product (GDP). Contrast this with the $4.5 trillion needed a year by 2030 as investment in clean energy to limit global warming to 1.5°C, as estimated by the International Energy Agency (IEA).

The report urges multilateral and regional development banks to incorporate economic impact analysis into their regular processes and demonstrate the economic benefits of reducing pollution. 

It calls on insurance firms to start incorporating air pollution-related health costs in risk assessments; many are already doing so for climate change in sectors like coal mining or housing in areas battered by rising cases of unpredictable, extreme weather. 

More funding needed

The report calls for greater funding to combat air pollution. A study by Clean Air Fund, which supports OCA, showed that only 1% of international development funding ($2.5 billion per year) and 2% of international public climate finance ($1.66 billion per year) was committed to targeting air pollution over the last six years for which full data is available. 

The new report calls on all public development banks to develop metrics that ensure air quality impacts are publicised across investment portfolios. 

“Clean air does not have to be an ‘additional’ area to invest in,” says Clark. “Many of our existing public finance flows are already delivering clean air as a by-product. For example, action to reduce emissions to slow climate change also helps to cut air pollution. Our global public finance institutions should recognise and reinforce these ‘two birds, one stone’ solutions, by making clean air an explicit goal of existing programmes.”

Image Credits: Our Common Air.