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

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

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

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

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

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

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

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

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

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

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

Claims of insufficient consultations and misalignment?

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

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

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

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

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

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

Saudi Aramco’s economic stake in more fossil fuel expansion

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

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

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

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

Battleground Africa 

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

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

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

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

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

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

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

Developed nations calling for healthier, low carbon development

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

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

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

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

 Clean, reliable energy in low-income countries 

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

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

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

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

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

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

One Billion People Lack Access to Health Facilities with Reliable Electricity

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

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

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

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

Disruptive agenda?

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

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

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

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

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

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

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

 

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

Nigeria’s AMR plan was recognised as a best practice by the WHO.

From hospitals facing up to 80% antibiotic resistance to gonorrhoea that is resistant to almost all treatment, antimicrobial resistance (AMR) is a serious and growing problem, countries told the World Health Assembly (WHA) on Tuesday.

But it has been 10 years since the global action plan on antimicrobial resistance was adopted, and the WHA endorsed the World Health Organization’s (WHO) proposal to present an updated plan to next year’s assembly.

This also follows a request from the United Nations High-Level Meeting on AMR last year for an updated global action plan by 2026.

By 2024, over 170 countries reported that they had national AMR action plans, but only 29% of countries had costing, budgeting and monitoring implementation. Member states also reported that a lack of financing and technical capacity are key constraints.

Slovenia outlined the damage already caused by AMR: “In 2021, AMR was linked to nearly five million deaths, over one million directly. This is not a future threat, it’s a present crisis. ”

“A particularly alarming example is drug-resistant gonorrhoea, once easily treatable, it is now resistant to nearly all antibiotics, raising the risk of untreatable infections, infertility and increasing HIV transmission,” said Slovenia.

“Preventing infections is our first line of defence,” added Slovenia, urging countries to focus on “improving infection control, hygiene, waste management and vaccine access” to reduce both infections and antibiotic demand.

‘Critical blindspots’

Bangladesh described AMR “misuse in animal health, pharmaceutical runoff in the environment, and weak regulatory oversight beyond the human health sector” as “critical blind spots that must receive the same priority as the human health interventions”. 

Nigeria’s second national action plan on AMR launched in 2024, focuses on “domestic resource mobilisation and multi-sectoral engagements.”

“With surveillance systems operational in multiple human, animal and environmental health laboratories and a dedicated national budget line now in place, Nigeria has met the who 2025 minimum standards for infection prevention and control (IPC) and is proud to have been recognised in the WHO 2024 global IPC report as a global best practice,” said the country representative.

But Nigeria acknowledged “lingering challenges”, and to address these, it is “prioritising sustainable, innovative financing, decentralised governance and sub-national capacity-building, expansion of surveillance into primary and community health sectors and integrating stewardship efforts across the health system”.

Indonesia told the WHA that it needs support in “strengthening surveillance efforts, laboratory infrastructure and R & D”. It supports an updated plan that will guide AMR “governance, financing, workforce development and concrete strategies to address socioeconomic determinants of AMR”.

Barbados, whose Prime Minister Mia Mottley chairs the Global Leaders Group on AMR, called for accelerated action on AMR and “sustained technical and financial support, especially for small island developing states”. 

Spain, which confessed to being one of the biggest consumers of antibiotics in primary healthcare, said it had implemented controls in 2014 that had slowed this trend. 

“We’ve launched a new plan for 2025-2027 focused on strengthening surveillance, professional training and research and development for new antibiotics and therapeutic alternatives,” Spain told the WHA.

Numerous countries reported financial challenges in addressing AMR, including countries such as Micronesia, whose AMR efforts were supported by the US Centers for Disease Control (CDC)  However, several countries reported getting support from the UK-based Fleming Fund.

The WHO will submit a draft of the updated report to next year’s executive committee.

WHO is urging countries to work to create a framework to regulate and standardize traditional medicine products.

The World Health Assembly delivered a landmark victory for traditional medicine and indigenous cultures Monday evening, approving a strategy that calls for increased investment in research and integrating ancient healing practices into modern healthcare systems worldwide.

The approval marks a breakthrough moment for advocates of traditional medicine, with nations across Asia, Africa, the Middle East and Latin America celebrating the decision. Iran called it “a visionary yet realistic roadmap” to integrate thousands of years of medical like its own.

But the strategy text shows WHO walking a careful tightrope, embracing practices that represent “accumulated wisdom and healing practices passed down through generations” while demanding they meet modern scientific evidence standards that could take decades to satisfy.

The strategy that will be in place between 2025-2034 was passed after an intense discussion that saw the European Union voice concerns about quality and safety, embodying the tension between empirical science and millennia-old traditions at the heart of the UN health body’s move.

“We urge the organization to be firm and vocal against harmful and or inefficient practices that may be disguised as alternative medicines,” said the delegate from Poland who made a statement on behalf of the EU and its 27 member states.

The strategy does not imply a preference for TCIM practice over biomedical practice, WHO said. While acknowledging traditional medicine’s “immense value” as a “vast repository of knowledge,” the strategy consistently emphasises that integration must be “scientifically valid” and “evidence-based.”

“It seeks to harness the potential contribution of TCIM to health and well-being based on evidence,” the strategy reads. “It is also designed to prevent misinformation, disinformation and malinformation.”

More than 80% of the world’s population in over 170 of the 194 WHO member states use traditional medicine of some form. In some industrialized countries like France and Canada, usage reaches nearly half the population. 

The WHO’s move reflects recognition of a field that serves billions of people worldwide and acknowledges the significant contributions of indigenous cultures to medicine. Around 40% of pharmaceutical products have their origins in traditional medicine, according to the WHO.

“The history, the cultural heritage, the ancestral knowledge…all anchor our traditional medicine work,” said Dr Bruce Aylward, Assistant Director-General for Universal Health Coverage at WHO, while assuring countries of WHO’s support as they find the best ways to integrate their traditional practices in their national systems.

Between Tradition and Evidence

78th Session of the World Health Assembly

This strategy begins what will be a long and expensive process to standardize and regulate care with traditional methods. Hurdles lie ahead, from financing and research capacity to government wrangling over how to establish global standards.

The scale of the task is enormous: systematically studying thousands of years of accumulated knowledge to meet regulatory standards for integration into national health systems. Yet no countries nor WHO made any pledges for further investment in traditional medicine research, and the strategy contains no funding figures either.

“I think that what’s new in this [final] version that wasn’t there before is also looking at the cross-sector value of traditional approaches and learning. There is this big section on protection of indigenous practice and knowledge, and how we can learn from them,” said Tido von Schoen-Angerer, a Geneva-based physician and President of the Traditional, Complementary and Integrative Healthcare Coalition (TCIH).

The central challenge remains evidence. WHO is encouraging countries to integrate traditional medicine into their national health systems, but only when supported by rigorous scientific research that much of traditional medicine currently lacks.

“I don’t think anybody expects WHO to recommend something that is not fully evidence-based,” Schoen-Angerer said. But at this point, while there is strong evidence for some traditional medicine, there is next to nothing for others.

Schoen-Angerer told Health Policy Watch that there was opposition to this draft from Europe, though Asian, African, Middle-Eastern and Latin American countries were largely onboard.

“You have very good evidence for some methods like acupuncture, mindfulness, et cetera, for certain herbs, and you have less evidence for other practices,” Schoen-Angerer said, adding that the WHO’s push for more investment will help create more evidence in the coming years.

This view received pushback from Switzerland-based civil society group Medicus Mundi International Network—a reaction that puts the tension of applying modern science to ancient tradition on full display, raising the question of whether tradition can ever be truly “scientifically valid” by Western paradigms.

“The WHO’s draft Traditional Medicine Strategy (2025–2034) recognizes the value of traditional and Indigenous healing but falls short by privileging Western scientific paradigms over Indigenous epistemologies,” said the delegate from the organization.

“Centering ‘evidence-based’ validation risks displacing practices rooted in land, culture, and spirituality,” she added.

The Funding Challenge: Big Ambitions, Modest Resources

WHO wants countries to spend on research, but the strategy lacks concrete funding commitments—a familiar challenge in the current global health arena. No countries, groups or WHO itself made new funding announcements in Geneva during the passing of the strategy.

The expectation is that WHO’s new strategy will encourage countries to allocate more funding for research, but the strategy places far more burden on member states than on WHO itself.

While directing countries to “establish a national research agenda” and “allocate dedicated resources,” WHO’s own commitments are limited to developing guidelines and technical documents.

The lack of WHO investment likely stems from its own financial crisis. The organization is currently facing a $1.5 billion budget deficit after already slashing its budget by nearly a quarter.

In 2022, India gave WHO $85 million over ten years to build evidence and towards the setting up of WHO Global Centre of Traditional Medicine in Jamnagar. 

Historically, such specialised areas struggle for funding. Women’s health, for example, receives only about 10% of U.S. National Institutes of Health funding.

Conversation on Standardizing Care

WHO’s latest strategy on traditional medicine asks countries to invest in research and create evidence

Traditional medicine spans both oral and codified forms of medicine, and this draft seeks to get countries to work towards creating unified standards—a complex task given the vast diversity of practices across cultures and continents.

“We urge WHO to support countries in developing context-sensitive methodologies, including those that encompass non-codified and oral traditions, to ensure scientific rigour,” a delegate from Thailand said.

The EU, which had already pushed back against the strategy prior to this week’s vote, urged WHO to be guarded as it engages with the industry to prepare standards.

“We strongly recommend preventing conflicts of interest in line with FENSA (Framework of Engagement with Non-State Actors), when engaging with industry and practitioners to devise regulations, and standards for TCIM products and activities,” the delegate from Poland said.

Balancing Rights of Indigenous People with the Challenge of Spurious Products

The WHO’s endorsement has created new opportunities for countries to address a persistent challenge: how to protect legitimate traditional medicine practices while cracking down on fake cures and fraud operations under the cover of spirituality.

Such problems are already widespread globally. For instance, the Indian company Patanjali, which claims to sell products rooted in India’s traditional medicine system of Ayurveda but is embroiled in several lawsuits for “false and misleading” claims. The company in its early years saw fast growth due to its branding and benefited from a relatively lax regulation system for traditional medicine products. 

African nations like Comoros and Togo acknowledged that while TCIM is widely used in their countries, the sector remains unregulated and training the providers remains a challenge.

“It has a great deal of potential, and it has been practised for a very long time by our ancestors. However, it is not within a framework or well-regulated,” the delegate from Comoros said.

In many small island nations, indigenous people are the custodians of TCIM. In others, TCIM is often the only available healthcare for large parts of the population.

“Our traditional medicine, while not fully aligned with the formal, traditional, complementary and interpretive medicine definition, is rooted in local customs, indigenous knowledge and natural resources,” said the delegate from Micronesia, a group of islands in the Pacific Ocean. “We see these practices as important to supporting our health systems and advancing universal health coverage.”

Thailand, too, said it was important to uphold the rights of indigenous people and ensure that any profit made from using local biodiversity and indigenous knowledge ought to be shared with them—a contentious issue that will get pushback from pharmaceutical companies, who argue that paying for access to resources would hinder innovation. 

Image Credits: WHO, WHO, WHO.

Panel discussion: Addressing the Global Crisis of Substandard and Falsified Medicines – A Panel Discussion Enhancing the Work of WHO Member States Mechanism through Regional Engagement, Stakeholder Collaboration and Operation Agility
Panel discussion addressing the Global Crisis of Substandard and Falsified Medicines.

GENEVA, Switzerland — One in 10 medicines in low- and middle-income countries are substandard or falsified, a pervasive health crisis the World Health Organization (WHO) estimates kills over one million people globally each year.

As the cost in millions of lives and billions of public health dollars from falsified medicines rises, member states at the 78th World Health Assembly agreed on Monday to postpone crucial reforms to WHO’s mechanism to combat these dangerous products.

Citing a need for “extended meetings” to develop a new framework and “theory of change,” the assembly deferred reforms to the WHO Member State Mechanism on Substandard and Falsified Medical Products (MSM) until at least late 2025.

The mechanism’s steering committee will meet for annual talks in November 2025, then present findings to the WHO executive board in January 2026. The board will then submit recommendations to the 79th World Health Assembly, where nations will finally vote on the reforms they delayed Monday.

The bureaucratic timeline means effective measures remain stalled until at least May 2026.

Until then, what Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products, termed an “urgent need for coordinated international response” remains unmet.

“This issue remains one of the most pressing challenges to public health worldwide,” Nakatani told the assembly, pointing to recent tragedies involving contaminated cough syrups, the alarming rise of falsified weight-loss drugs mimicking semaglutide—the diabetes medication known as Ozempic that has become a cultural phenomenon for weight loss—and synthetic opioids infiltrating medicine supplies.

The delay leaves the international response to the falsified medicines epidemic in a holding pattern as the lucrative illicit trade fueling the crisis generates unprecedented profits.

Estimates place the counterfeit medicine market’s value at up to $432 billion per year—more than 200 times WHO’s annual budget—making pharmaceuticals the world’s largest illicit activity ahead of human trafficking, arms sales, and narcotics.

Countries will continue their national efforts to combat the falsified medicines crisis despite the stalled reforms.

Yet within this crisis, as nations seek funding for domestic surveillance systems, WHO has acknowledged it lacks the resources to provide the support countries need. WHO officials said widespread cuts to global health, humanitarian aid, and development assistance worldwide complicate funding for both the global mechanism and essential domestic capacity building.

“Given the financial crisis facing WHO and countries,” said Dr Alex Ross, Director of Organisational Learning at WHO, the reforms being postponed include revisiting the scope and priorities of the mechanism.

Despite Ross’s frank assessment of the funding gap, the WHO’s review of the falsified medicines mechanism endorsed by member states in Geneva offers no specific budget figures or targets to address the “financial sustainability concerns” it repeatedly cites.

The shortfall will hit the most vulnerable countries hardest as they struggle to fund surveillance improvements amid stretched public health budgets and lack resources to strengthen regulatory systems that could better protect their populations from the threat of counterfeit medicines.

Africa bears the heaviest burden, with an estimated 18.7% prevalence of falsified and substandard medicines—nearly double the average in low- and middle-income countries worldwide.

“Millions of people in Africa continue to die from preventable causes due to substandard and falsified medical products,” the African bloc, representing the continent’s 47 nations, told the assembly.

A 2023 UN Office on Drugs and Crime report documented a devastating toll in sub-Saharan Africa alone: 267,000 annual deaths from falsified antimalarial drugs and 169,000 from fake antibiotics for childhood pneumonia.

“These are not isolated events,” Nakatani warned the assembly. “These are symptoms of the systemic vulnerabilities in the regulatory oversight, supply chain security, and global information sharing.”

A global problem

Rutendo Kuwana, WHO’s team lead for substandard and falsified medicines incidents, quantified the cost to health systems at a UN side event during the assembly, placing estimated losses at $75 million to $200 million each year treating victims of these faulty medical products.

“We have issued several product alerts recently, including with regards to some contaminated medicines and toxic syrups that caused the deaths of more than 300 children,” Kuwana said.

The children’s deaths he referenced include over 300 who died in 2022 in The Gambia, Indonesia, and Uzbekistan from cough syrups contaminated with diethylene glycol and ethylene glycol—industrial solvents used in place of pharmaceutical-grade ingredients.

The situation is deteriorating: in 2023, the number of substandard and falsified incidents reported to WHO doubled compared to 2019.

Beyond contaminated medicines, Kuwana warned of the alarming rise of nitazenes, synthetic opioids more powerful than fentanyl that have been linked to a surge in overdose deaths across Europe and North America, with UK authorities reporting a spike in nitazene-related fatalities in 2024.

“People are purchasing illegal narcotics and taking them, assuming they contain ecstasy or something like it, but they are also adulterated with these nitazenes,” Kuwana said.

“This is not only in LMICs but in high-income countries,” he added. “No country is immune.”

A Failing System

WHO officials told the assembly that the agency’s evaluation of the falsified medicines mechanism, presented to its executive board in January, reinforced long-held concerns about its efficacy.

“It confirms what many of us have long observed, that while the mechanism remains a vital platform, persistent challenges, particularly in securing sustainable funding and ensuring consistent engagement, continue to hinder its full potential,” said Dr Chikwe Ihekweazu, WHO Regional Director ad interim for Africa.

He noted that “public awareness of the dangers of substandard and falsified products is still low” and “many countries lack robust surveillance systems for emerging threats such as adulteration of medicines with highly potent and dangerous synthetic opioids.”

Despite the challenges, progress is being made.

Forty-five of 47 African nations now have focal points integrated into WHO’s surveillance system, a significant increase from just five at the time the report was presented to the executive board in January, leading to 39 alerts between 2020 and 2025.

National Success Stories

Panel discussion: Addressing the Global Crisis of Substandard and Falsified Medicines – A Panel Discussion Enhancing the Work of WHO Member States Mechanism through Regional Engagement, Stakeholder Collaboration and Operation Agility
Panel discussion: Addressing the Global Crisis of Substandard and Falsified Medicines – A Panel Discussion Enhancing the Work of WHO Member States Mechanism through Regional Engagement, Stakeholder Collaboration and Operation Agility.

Nigeria exemplifies what aggressive national action can achieve.

The country’s drug regulatory agency has conducted inspections of over 11,000 shops, seized and destroyed more than 140 trucks of banned or unregistered products, and developed risk-based classifications for domestic manufacturers, Dr Adebisi Jaiyeoba, Deputy Director of Nigeria’s National Agency for Food and Drug Administration and Control said in Geneva.

Nigeria is promoting local production of six key medicines to reduce dependence on imports vulnerable to counterfeiting.

Dr Ketut Putu Yasa, head of the Indonesian College of Thoracic and Cardiovascular Surgery, described the scope of the challenge: “This is a global health emergency.” He called for more coordinated regulatory systems across countries and greater supply chain transparency.

In the Eastern Mediterranean region, conflict and fragile health systems have created ideal conditions for counterfeit medicines to flourish—one example of many global hotspots.

War disrupts regulatory oversight, destroys supply chains, and creates desperate populations willing to accept medicines from questionable sources. Yemen’s situation is particularly dire, with reports indicating that significant proportions of medicines enter through illicit channels, exacerbated by the country’s civil war since 2014.

The problem extends across Western Asia, where a Global Initiative Against Transnational Organized Crime report found that up to 35% of the region’s medicines—from antibiotics and vaccines to insulin and chemotherapy drugs—are illicitly sourced. Countries including Iraq, Lebanon, Syria, Turkey, and Iran face severe medicine shortages that criminal networks exploit.

The economic desperation fueling this trade creates a vicious cycle: counterfeit medicines cost 10 to 50 times more than legitimate versions when addressing shortages, yet are also sold at below-market prices to attract buyers who cannot afford genuine drugs. This dual market traps both the desperate and the economically vulnerable.

“Substandard and falsified medications compromise the effectiveness of healthcare, increase morbidity and mortality and erode public trust in health services,” the Eastern Mediterranean regional bloc declared. “Unfortunately, such products are circulating with increasing frequency due to limited regulatory capacity, exacerbated by the COVID-19 pandemic.”

“Conflicts and fragile health systems have all contributed to this problem,” the bloc stated.

Youth Joins the Fight

Experts in the field also emphasised engaging patients and youth as key to combating falsified medical products.

“We need to ensure patients’ voices are part of surveillance, planning and evaluation,” said Dani Mochi, CEO of the International Alliance of Patients’ Organizations, noting that patients can aid awareness, report dangerous products, and advise regulatory agencies.

Tanushree Jain, Chairperson of Public Health for the International Pharmaceutical Students’ Federation, called for “intergenerational solutions” and suggested a dedicated fund for youth engagement.

“Allow youth champions to act as local leaders to fight [substandard and falsified] products,” Jain urged. “They can play a pivotal role… and energize and mobilize their peers.”

Image Credits: Guilhem Vellut, Maayan Hoffman.

Dr Tedros (centre) welcomes the restrictions on digital marketing of breastfeeding substitutes in Committee A.

The World Health Assembly has finally closed a loophole used by infant formula manufacturers to market their product: digital marketing.

Back in 1981, when the International code of marketing of breast-milk substitutes was adopted by the World Health Organization (WHO) and UNICEF, digital marketing did not exist. Updated regulations were introduced in 2012 , but this too was before the widespread targeting of consumers via social media platforms and their targeted algorithms. 

The World Health Assembly approved a resolution on Monday that gives member states the opportunity to get technical support from the WHO on how to implement its guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes”.

The resolution, put forward by Brazil and Mexico, also calls on the WHO Director-General to compile country lessons and challenges in implementing the guidance, and report back on progress in 2028.

“This resolution will help us to push back” against those promoting breastmilk substitutes, Director General Dr Tedros Adhanom Ghebreyesus told delegates in Committee A after they had passed the resolution.

Dr Bruce Aylward, WHO Deputy DG for Universal Health Coverage, added that the WHO was working with partners “to develop artificial intelligence tools that will help you identify violations against national laws to help with the enforcement”.

Global sales of formula milk were estimated to reach $164.76 billion in 2024.

Mothers interviewed by  a multi-country study. reported being “targeted by online marketing and being inundated by marketing for formula milk including promotions prompted by their search behaviour for infant feeding advice and information”.

In addition, a “suite of alternative formulas presents formula milk products as satisfying all possible needs”. 

The committee also resolved to incorporate the World Prematurity Day into the WHO calendar during the discussion on 

Some 13.4 million babies are born preterm, and preterm birth complications are the leading cause of death amongst children under the age of five, according to the resolution.

“With extremely pre-term children, the probability of death in a low income country is over 90% in the first few days of life, and it’s less than 10% in high income countries,” said Aylward.

Sexual and reproductive rights

The resolutions were adopted as part of a discussion on the Global strategy for Women’s, Children’s and Adolescents’ Health, tabled at the WHO executive board. 

The report highlights that countries are off track to reach the targets of the Sustainable Development Goals (SDG) related to maternal, newborn and child mortality by 2030. 

The maternal mortality rate is only expected to drop to 176 deaths per 100,000 live births whereas the SDG target is 70 deaths per 100,000 live births, said Tedros.

“The 60 countries who are not on target, should accelerate. I think focus on the 60 countries will be very, very important. There are proven tools to make that happen.

“But the concern that we have is that, in many countries, investment is declining, especially in maternal health and child health, so our call is to reverse that,” he added.

Poland, speaking for the EU, pushed for a rights-based approach to sexual and reproductive health.

Poland, on behalf of the European Union and nine candidate member countries, spoke about the need for sexual and reproductive health to have a human rights approach

“The EU reaffirms its commitment to the promotion, protection and fulfilment of the right of every individual to have full control over and decide freely and responsibly on matters related to the sexuality and sexual reproductive health, free from discrimination, coercion and violence,” said Poland. 

“The EU further stresses the need for universal access to quality and affordable comprehensive sexual and reproductive health information education, including comprehensive sexuality education and healthcare services.”

Finland, speaking for its Scandinavian neighbours and several surrounding countries, explicitly articulated that women should have access to safe abortion.

This sentiment was echoed by Germany, which stated: “We are concerned about the growing health disparities, and must ensure a human rights-based approach to health with gender equality and equity at the centre, whilst addressing gender-based and age-related violence. Access to comprehensive SRHR services, including modern contraception, safe abortion and post abortion care and comprehensive sexuality education are essential.”

There was no pushback from countries that would usually object to references to abortion, and the the committee session passed without disagreement.

 

Hungry children wait in line at a soup kitchen in northern Gaza in May.

Vital medical aid from World Health Organization supply trucks has yet to reach the beseiged Gaza enclave since the doors of an 80-day blockade inched open a week ago, said Hanan Balkhy, WHO’s director for the Eastern Mediterranean Region, at a UN-Geneva press briefing on Monday.

The chaos on the ground in Gaza, against a widening Israeli war and a halting resumption of some humanitarian aid deliveries, contrasted sharply with the largely symbolic vote by the World Health Assembly on Monday authorizing WHO to “raise the flag” of Palestine along that of other WHO member states.

The decision to ‘raise the flag’, approved by a vote of 95-4, was the fourth measure on the status of Palestine and the crisis in Gaza to come before the WHA in its 2025 session.  Only the Czech Republic, Germany, Hungary and Israel  voted against the measure, while 27 member states abstained.

“The WHA’s endorsement of this decision would … send an important message to Palestinians that they have not been forsaken. It would demonstrate that the Palestinians right to self determination is inalienable, and as such, cannot be subject to a veto, nor erased,” said South Africa’s delegate, during the WHA debate.

Eastern Mediterranean Regional Director Hanan Balkhy at a UN-Geneva press conference on Monday.

On the ground in Gaza, meanwhile, no WHO trucks of medical supplies have so far been allowed entry to  the beseiged enclave since Israel first began to allow some aid deliveries to resume last week, easing an 80-day blockade. Balkhy said 51 WHO trucks were poised and waiting to enter from Egypt’s El Arish crossing point.

As of Friday, while 415 humanitarian aid trucks had been cleared to cross into Gaza, only 115 had been “collected”, and none had been allowed to enter the northern part of the enclave, which is seeing the heaviest fighting now, she added, quoting a Friday briefing by the UN Secretary General, Antonio Guterres.

The UN numbers corresponded roughly with those of Israel’s military coordination arm, COGAT, which reports that 388 trucks entered the enclave since the beginning of May. But many trucks have also been overhwlemed by hungry Gazans before UN aid agencies could collect and deliver the aid in a more systematic aid. See related story:

WHO Director General Appeals to Israel to End Deepening Food Crisis and Conflict in Gaza

Balkhy said that 43% of essential medicines are at “zero-stock” levels in addition to 64% of medical supplies and 42% of vaccines, citing data from Gaza’s Hamas-controlled Ministry of Health. Patients with chronic and life-threatening conditions—including kidney failure, cancer, blood disorders, and cardiovascular disease—are among the most affected, she added, saying, “WHO’s stocks in Gaza are dangerously low and will run out soon,” citing problems with dozens of products from common antibiotics to cesarean delivery kits.

Since 2 March, 57 children have reportedly died from the effects of malnutrition, Balkhy added, also citing Gaza Ministry of Health data. And 71 000 children under the age of five are expected to suffer from acute malnourishment over the next eleven months, if conditions don’t change radically.

Delays in mounting of private Gaza humanitarian aid effort

Her comments came against a day in which Israel’s planned opening of private aid distribution points for Gaza aid, intended to sidestep UN agencies and Hamas, was reportedly delayed for a second time.

That followed Sunday’s resignation of the Jake Wood, head the Gaza Humanitarian Foundation, the private entity that had been awarded a tender by Israel to deliver the aid, with US approval.

In a statement distributed by the Foundation, Wood was quoted saying that plans for the distribution hubs would not meet the “humanitarian principles of humanity, neutrality, impartiality and independence, which I will not abandon.”

Various UN organizations have also declared that they won’t cooperate with the Geneva-based GHF, which had earlier said it would distribute some 300 million meals in its first 90 days of operation. In an interview with CNN,  UNICEF’s James Elder described the plan as “unworkable” – with only a “handful” of distribution points.

“Think about a mom who has a couple of children and her husband has been killed.  And she has to walk three or four miles in a militarized zone to pick up aid and then walk back,” Elder said. He noted that the plan would also force most Gazan’s to relocate to the southern part of the tiny enclave to access any aid at all.

In a WHA meeting last week, WHO’s Health Emergencies Executive Director Mike Ryan had asserted that “we will work with anything that works” – but added that the UN agencies already had a proven track record of aid delivery – demonstrated during the last ceasefire.

Sudan is another, ignored, flashpoint

Another devastating crisis that is not getting the attention it deserves is Sudan, Balkhy asserted in her meeting with UN journalists Monday.

“Simultaneous outbreaks—cholera, polio, measles, dengue, malaria—are overwhelming a health system shattered by conflict. Access to care is vanishing, as violence displaces millions and blocks life-saving aid. Hunger and malnutrition affect 25 million—including 770,000 children facing severe acute malnutrition this year. Immunization rates have plunged to below 50 per cent, from 85 per cent before the war,” the EMRO Regional Director said.

“Attacks on health and vital infrastructure are rampant,” she said noting that drones have also hit Port Sudan and other aid entry points.

Throughout the conflict,  WHO has delivered over 2,500 metric tonnes of supplies, and supported hospitals treating over 1 million people, including ,75,000 children for severe acute malnutrition. Some 30 million people have received vaccines for cholera, measles, or polio. And in November 2024, Sudan introducted the malaria vaccine, reaching 35,000 children so far.

“But aid cuts are threatening progress,” she added. “The health pillar of Sudan’s Humanitarian Response Plan is just 9.7 per cent funded. WHO’s response has a 67 per cent funding gap,” she pointed out, calling for “sustained support to save lives and rebuild Sudan’s health system; unimpeded access and international support for cross-border humanitarian operations; and an immediate end to attacks on civilians, civilian infrastructure and health care.”

Image Credits: WHO .

Crater at the former Soviet Union nuclear test site Semipalatinsk, in present-day Kazakhstan, one of the supporters of a WHO update on the health effects of nuclear war.

For the first time since the 1990s, the World Health Organization has been asked by member states to update its assessment on the health impacts of nuclear war, although not without significant resistance, led by Russia and North Korea, but also including many other major nuclear states. 

The resolution calling for an updated assessment of the “effects of nuclear war on public health” was approved by a margin of 84-14 votes with 28 abstentions.  

It was sponsored by a dozen nations, including Western Pacific, African and former Soviet states that were deeply affected by nuclear tests of the 1950s and 60s, while opposition was led by the Russian Federation along with (DPRK) North Korea. 

Europes two leading nuclear powers, the United Kingdom, France, also voted no along with ten other European states, including Germany, Poland, Hungary and the Czech Republic, on the mandate to update WHO’s guidance, saying it would duplicate the work of other UN nuclear and non-proliferation bodies. India and Pakistan, both nuclear powers, also abstained. 

Duplication or not? 

India, along with other nuclear powers, abstained from voting to refresh the WHO’s analysis of nuclear war’s health impacts.

“The international community has always known that a nuclear war would have devastating consequences upon all humankind. This was written into the preamble of the Non-Proliferation Treaty of 1968, it’s been reaffirmed many times since, and is at the core of our efforts to avert such a war,” said the UK delegate, speaking on behalf of about 16 European member states. 

“No update to existing WHO studies could materially alter that established understanding of the devastation of nuclear war.”

Added India,  “We are neither convinced of the added value of initiating another study on this subject, nor of WHO being the relevant forum. We therefore abstained.”

Furthermore, the work WHO is mandated to do would “duplicate that of other international bodies when a constrained WHO budget is driving an urgently needed prioritization exercise,” the UK delegate maintained, referring to a 2024 mandate by the UN General Assembly for such a study.

“Of course, people understand the consequences of a nuclear war, but a constant reminder would also be important,” responded WHO Director General Dr Tedros Adhanom Ghebreyesus. “And as many of you have already said, it’s not new for WHO;  There were reports in the 1980s and 1990s.”  

WHO Director General Dr Tedros Adhanom Ghebreyesus – WHO will coordinate with UN to avoid duplication.

“So we can consider this, as you suggested, as an update,” he added, stressing that WHO could do the update cost-efficiently in collaboration with other UN bodies engaged in the discourse over nuclear weapons and disarmament. 

WHO produced two series of reports on health and nuclear war, with the last more than 30 years old.  Those included the “Effects of Nuclear War on Health and Health Services” in 1983 and 1987, followed by a 1993 report on “Effects of Nuclear Weapons on Health and the Environment,” Chuck Johnson of the NGO International Physicians for the Prevention of Nuclear War noted.

“This will extend study on both of these issues,” Johnson said, adding that it would cover “a broader area of public health than the UN General Assembly study” mandated last December.

He added that the European “No” votes on the measure also were a “very NATO-influenced vote.  No NATO country voted yes” he observed, referring to the North Atlantic Treaty Organization’s 32 members.

African and Asia Pacific nations make emotional plea for closer examination of nuclear war’s health impacts 

Health effects of nuclear war transcend borders and generations – South Africa at Monday’s World Health Assembly

The support of many WHO member states for the review was palpable, and at times highly emotional. Pacific Island states recalled the legacy of nuclear testing in their region, which left long-term health and environmental scars.    

“To this very day, survivors and their descendants are still in pain, suffering and continue to perish from the effects of nuclear weapons and nuclear war,” said the delegate from Samoa. 

“While science and technology have advanced, evidence-based information on the health and environmental impacts of nuclear weapons remains stagnant at WHO.… Now is the time for WHO to renew its mandate and have an updated, comprehensive report. We urge all states to do what is morally right and support this resolution… We should continue the pursuit of the truth, for the truth shall set us free.” 

Algeria, meanwhile, noted it was the only African nation that had suffered the effects of nuclear testing during the colonial period – but those effects are still being felt. 

“We are are still suffering from what we experienced during the period of colonialism as a result of the adverse effects of nuclear tests that took place during that era,” said Algeria’s representative, “We are in a situation still today where large parts of the Algerian Sahara are still suffering from the impacts of what happened. 

“People still have serious diseases and disabilities because of high rates of radiation.  We see, for instance, more cancer there than in other parts of the country. There are also more cases of children born with physical deformations, because at that time, the colonial powers didn’t even bother appropriately disposing of nuclear waste, and they didn’t tell us precisely where the testing was carried out.”

Numerous co-sponsors of the WHA resolution know the health effects of nuclear war and weapons first-hand, “as they hail from states which were the blast sites or experienced the fallout from nuclear tests,” South Africa observed. 

“Not only were they robbed of their loved ones, together with the land of their ancestors, but their bodies still carry the scars. 

“As Africans, we too know the damage caused by the nuclear tests which were conducted on our continent. The effects transcend national borders, go beyond the impact on health of current conditions, to future generations, and pose repercussions for human survival, and we therefore welcome the provision for updated studies. 

“In this regard, it is the tragedy of this nuclear legacy which underpins the urgent need for a nuclear weapons free world now more than ever, we owe it to the victims of these deadly experiments and their families, together with the hibakusha, to ensure that we save succeeding generations from the unacceptable suffering that they still confront.” 

Correction:  We originally reported that the United Kingdom, France and Germany abstained from the vote. In fact, they all voted ‘no’.

Image Credits: Comprehensive Nuclear-Test-Ban Treaty Organization.

Committee A adopted a resolution on strengthening the health workforce

Several countries at the World Health Assembly (WHA) called for enforcement clauses to be included in the World Health Organization’s (WHO) code on international recruitment as wealthier countries continue to recruit health workers from poorer countries.

Regions will take up discussion on how to strengthen the code, based on an expert advisory group’s assessment, and their suggestions will be tabled at next year’s WHA, delegates at the current WHA resolved on Monday (26 May).

Countries also passed a resolution aimed at accelerating action on the global health and care workforce.

The resolution requests the WHO Director-General to prioritize resources to support policy development and implementation of the health and care workforce priorities outlined in the Global Strategy on Human Resources for Health: Workforce 2030.

This includes fostering regional and global collaboration, and supporting member states to manage and develop their health and care workforce.

By 2030, there will be a global shortage of 11.1 million health workers and there is fierce competition for doctors and nurses in particular.

South-South collaboration

Small island developing states (SIDS) and African countries were outspoken about their battles to retain health workers.

Jamaica, Samoa and Barbados  all spoke of struggling to retain staff despite improving pay, working conditions and training, owing to “aggressive recruitment” of their health workers.

Jamaica said that “South-South collaboration” has been the only successful strategy to address the shortage of specialist nurses.

“Jamaica extends its appreciation to our long standing partner, Cuba, we engaged partners such as Nigeria and new partners, the Philippines and India,” the country noted.

Through collaboration with the Pan American Health Organisation (PAHO), Jamaica is developing a human resource for health policy and action plan and conducting a health labour market analysis. It should be noted that the latter is the first for the English speaking Caribbean. 

“The ongoing migration of our health care workers poses a serious threat to our health system. We urge the WHO and international partners to amplify advocacy on its impact in SIDS like Jamaica, and to actively promote fairer, more ethical recruitment by high income countries.”

Barbados called for a “binding framework to protect health worker rights and align migration with national priorities”.

Africa faces ‘critical challenges’

Ghana, speaking for Africa, said that the region “continues to face critical health workforce challenges, including acute shortages, gender inequities, skill imbalances and the maldistribution of personnel”. 

These issues have been exacerbated by migration, limited funds and “fragile working conditions”.

“The evolving healthforce migration requires that Western countries that demand Africans must contribute to the training of more workforce,” said Ghana.

Sudan reported that the conflict has had a “devastating impact on the already strained health workforce sector, where a sizable number of health workers have left the country or displaced internally due to the security situation. Those who remain in the front line are subjected to major risks, strain and work overload.”

Meanwhile, the small country of Eswatini acknowledged that it was unable to employ 10% of its health workforce because of financial constraints.

Zimbabwe endorses a “global solidarity fund to help mitigate the impact of health work in immigration in low and middle income countries”.

Community health workers

Thailand for South-East Asian Region (SEARO) reported that the region had 4.2 million community health workers that played a vital own role in healthcare services.

SEARO wants the development of a “global health and care workforce compact, accompanied by a five year roadmap aimed at strengthening national workforce capacity and addressing the projected global health workforce shortages”.

Poland, speaking for the European Union and candidate members, stressed that “protection from any form of violence, discrimination, unsafe working conditions, and respect for human rights, as well as due appreciation in all its forms, are preconditions for attracting and retaining the health workforce”.

In light of the shortage of health workers, Poland stressed the importance of “digital upskilling” to address the digital health transition. 

“The WHO Academy offers a unique opportunity to strengthen the skills and capacities of human resources in health,” Poland noted, of the new facility hosted by France.

“Health policies must promote equity and gender responsive approaches support women’s meaningful participation and leadership. Currently, women form 70% of the health workforce, but hold less than 25% of senior roles with a 24% pay gap,” Poland noted.

Dr Bruce Aylward, WHO Assistant Director-General of Universal Health Coverage, said that there that been an increase in the projected gap for health care workers by 2030.

“That is alarming, especially in the context of official development aid cuts that are already hitting some of the most important cadres, like community health workers.”

Smoke billows from chimneys in Poland – generating both air pollution and climate emissions of CO2.

In an eleventh-hour move, World Health Assembly member states on Monday deferred a final vote on a draft WHO Action plan on Climate Change and Health until Tuesday morning – in an effort to find a last-minute compromise with a bloc of oil-rich states trying to put the plan on ice.

The move followed a Russian-backed Saudi initiative over the weekend to postpone approval of the Action Plan until 2026, with the support of other members of WHO’s  Eastern Mediterranean Region.

But in a nearly three hour debate on Monday, few other member states appeared ready to fall in line.

After it appeared unlikely that opponents could muster the votes to delay the plan for a year, WHA delegates recessed into evening consultations in an effort to find an eleventh-hour consensus – and avoid a ballot that would be embarrassing for any losers.

In their comments at the WHA on Monday, dozens of states from Africa, Asia, Europe, the Americas and Pacific Islands, expressed support for the action plan and its immediate approval. The plan maps ways in which WHO can support low- and middle-income nations to adapt to climate change and reduce future health impacts, including impacts on health systems.

CBDR is a legal concept in the 2015 Paris agreement, but doesn’t belong in an action plan, argued the UK delegate.

During the debate, a number of high income states, including the United Kingdom and Australia, as well as developing countries nations expressed differences of opinion over some of the plan’s references to broader UN principles, particularly the “common but differentiated responsibilities (CBDR)” of rich versus poorer nations to take climate action.

The CBDR concept, while embedded in UN climate frameworks, is out of place in an action plan, complained the UK.  India, on the other hand, maintained that “any global plan must align with existing international agreements under the UNFCCC and the Paris Agreement. Central to this is the principle of common but differentiated responsibilities and respective capabilities, which safeguards equity and fairness in global climate action.”

Either way, the action plan remains a voluntary framework and not a legal instrument, its proponents argued. And against the differing interpretations of some passages in the  plan, most agreed that there is an overriding urgency to approving the measure at this year’s WHA session.

‘No time to lose’

Peru, on behalf of nearly 50 states across the Americas, Asia and Europe, calls for immediate adoption of the climate and health plan.

“Instead of delay we need to accelerate actions to address the health impacts of climate change – already visible all over the world,” declared Peru, on behalf of nearly 50 nations across the Americas, Asia and the Western Pacific, Africa and the European Union. “Now, there is no time to lose.”

Mozambique, speaking for the 47-member African Region, said that the group also supported “full adoption of the global action plan on climate change and health.”

Referring to the increased frequency of drought, cyclones and flooding being seen in the region, he added, “the African region is disproportionally impacted by climate change, and although our continent contributes minimal to the global emission it bears the greatest burden… We call for urgent action to build climate resilient health systems across the continent.”  

Unusual rearguard move

The rearguard action by oil-rich member states against the climate action plan was an unusual move, insofar as it follows on from a new resolution on Climate Change and Health that was approved overwhelmingly by the Assembly just last year. At that time, as well, more than  three dozen WHA delegations spoke on behalf of the measure, the first on climate since 2008. See related story:

New Climate and Health Resolution Wins Strong Support from WHO Member States

“The very survival of our species will depend on this,” Colombia said at last year’s debate in May 2024,  deploring the dearth of climate finance for developing nations which have contributed the least to the climate problem.

This year’s Action Plan is supposed to provide just that – helping vulnerable nations access climate finance to bolster their climate resilience in ways that benefit health.

The Plan also aims to empower health sector engagement with climate actors in other sectors that generate significant climate pollution harming health, e.g. transport, household energy, agriculture and nutrition. Finally, it is supposed help health facilities become more climate resilient and support tens of thousands of energy-poor health facilities the world over to gain access to clean and reliable electricity sources.

While Russia decried the plan as duplicative and costly, at $168 million over the coming 2.5 years, its near-term costs are covered by dedicated funding, other member states underlined. And the plan’s costs are still only a fraction of the costs of other resolutions approved at this year’s WHA – some of which have no committed funding at all.

Air Pollution road map endorsed – but meeting target impossible without more climate action

In contrast to the headwinds encountered by the climate plan, a new WHO road map on air pollution and health received a resounding endorsement from all WHO regions, including EMRO, in a debate earlier on Monday. The ambitious measure aims to halve deaths from human-produced sources of air pollution by by 2040.

Helena Naber at the launch of a World Bank report on climate and air pollution synergies at WHO’s Air Pollution and Health Conference in Cartagena, Colombia.

But most experts agree that reducing air pollution is technically impossible without complementary shifts to cleaner energy sources that would also planet-warming fossil fuel emissions.

In fact, in a business-as-usual scenario,  air pollution “will only get worse” over the next 15 years – and that is even if all existing climate and clean air commitments are met, warned the World Bank’s Helena Naber, senior World Bank environmental economist, at an event in Geneva on Friday. She referred to a new World Bank analysis “Accelarating Access to Clean Air for  Liveable Planet,” launched in March.

“Even if countries successfully implement all their energy climate and air pollution control policies and measures that are announced or planned now over the next 15 years, by 2040 we will still see a rise of 21% in the number of people who are exposed to PM 2.5 levels above [the WHO annual guideline] of five micrograms per cubic meter, and this will be due to combined effects of population growth and economic expansion,” Naber said.

“And as a percent increase, the highest will be in Sub-Saharan Africa,” she said.

Conversely, halving the number of people exposed to high PM 2.5 concentrations (above 25 micrograms/cubic meter) by 2040 is feasible and affordable – but only if countries adopt a more “integrated” approach that accelerates the clean energy transition and reduces greenhouse gas emisions, Naber said.

Rising human health and financial costs of climate inaction

Solar panels provide electricity to Mulalika health clinic in Zambia, enabling reliable function of core health services while reducing pollution from diesel electricity generation.
Limiting global warming to 1.5ºC reduces GDP losses by two-thirds.

Meanwhile, the human health and financial costs of non-action on climate change are rising steadily over time – as average temperatures remain at record highs and the impacts of extreme weather grow.

One study published last year by the Swiss Federal Institute of Technology in Zurich (ETH Zurich) and partners, predicted a 10% loss of global GDP if global warming continues to 3ºC – with the worst impacts in less developed countries.

At the same time, limiting global warming to 1.5ºC could reduce the global economic costs of climate change by around two-thirds.

Large proportion of air pollution deaths are from fossil fuel sources

The opposition to the climate change and health action plan is all the more ironic insofar as a large proportion of deaths from air pollution are due to emissions from fossil fuels.

Although estimates vary depending on the method of analysis, between 2-5 million air pollution related deaths can be attributed to emissions from fossil fuel-producing sources.

Notably, diesel fuel which produces high levels of health-harmful particulate pollution, including black carbon “superpollutants” that also accelerate warming, ice and glacier melt.  Emissions of methane, a highly potent climate gas that leaks from oil and gas production, also contribute to the formation of ground-level ozone responsible for a significant chronic respiratory diseases and asthma.

“The Eastern Mediterranean has the highest air pollution sources of all member state regions,” noted Libya, in a statement in support of the WHO Air Pollution Road Map, on behalf of the same EMRO member states that are trying to stall the WHO Climate and health action plan.  “Although natural sources such as [sand] storms are a significant factor, addressing the anthropogenic sources is crucial to improving air quality in the region,” said the delegate.

Of the roughly 7 million premature deaths from air pollution that  annually worldwide, “85% of those deaths are attributed to non communicable diseases, including heart disease, stroke, chronic obstructive pulmonary disease and lung cancer,” the delegate also noted.

In 2015, Saudi Arabia also led an initiative by the EMRO region to block the World Health Assembly’s approval of a first-ever resolution on air pollution on health. Saudi delegates argued in closed door debates that air pollution was largely a product of wood and biomass burning – not fossil fuels – something African member states rejected. After a series of closed door, late-night negotiations, Saudi Arabia and the EMRO bloc it led agreed to go along with the landmark resolution. But the agreement was contingent on the revision of references linking air pollution and climate change, watering down those associations.

Since then the science around the linkages has become even more unequivocal – with more evidence pointing not only to the direct impacts of air pollution created by fossil fuel burning – but also the increased impacts of fossil fuel sources on emissions of super-pollutants, and impacts of air pollution on health when combined with extreme weather, such as heat waves.

Image Credits: Janusz Walczak/ Unsplash, UNDP/Karin Schermbrucker for Slingshot , IIAS.ac.at.

Prof Helen Rees in front of the derelict building that has become the Hillbrow Clinic in Johannesburg, where her institute is based.

“We don’t need faster horses, we need a new model of global health,” says Professor Helen Rees, who received the World Health Organization’s (WHO) 2025 Dr Lee Jong-wook Memorial Prize on Friday for her “outstanding contribution to public health”.

“If there isn’t going to be money, we shouldn’t be trying to run the same things on a third of a budget.

“We have to restructure, focusing on what is going to give us the best return on investment –  things like immunisation, and maternal and child health,” she told the award ceremony last Friday, hosted by the Korea Foundation for International Healthcare (KOFIH) and the Geneva Graduate Institute. 

Rees has spent her entire distinguished career finding solutions to some of the most pressing global health problems, including malnutrition, HIV, cervical cancer, tuberculosis, and access to medicines for low- and middle-income countries (LMICs). 

Although the University of the Witwatersrand in Johannesburg, where she has been based for three decades, faces enormous funding cuts following the immediate withdrawal of US funds, her instinct is to seek solutions.

“The sudden withdrawal of funds is really tough because we’re dealing with patients facing the withdrawal of services; with participants on studies that have suddenly stopped; with people losing their jobs in large numbers who were providing unique services around things like HIV and TB,” Rees told Health Policy Watch before her award ceremony last Friday.

“But the point is now, we have to sit up and say: What is the reset dial? “We need to innovate, prioritise and use digital and AI solutions.”

Leapfrogging to most effective technology

Rees is urging a “rethink of global health” encompassing “global governance, financing, health services, research and [how to] leapfrog to the most effective technology”, she told the award ceremony. 

First, governments and regions need to take more responsibility for the health of their citizens, she says. Back in 2001, African leaders adopted the Abuja Declaration in which they pledged to spend at least 15% of their budgets on health, yet a quarter of a century later, only Rwanda, Botswana, and Cabo Verde has consistently done so.

“Country budgets need to be redirected to health services, and the ‘sin taxes’ [on tobacco, alcohol and sugary drinks] can also be considered. But debt relief needs to come into this. Over 50% of low-income countries are at risk of a debt crisis and the development banks and multilateral organisations also need to rethink what is their model.”

She warns that if there is a substantial rise in HIV infections as a result of the withdrawal of US funding, this will “create a huge reservoir of immunocompromised individuals” that will “facilitate the emergence of new pathogens”.

Wealthier countries need to persist with official development assistance (ODA) to the poorest countries, even if only to protect themselves.

Prof Antoine Flahault, chair of the Geneva Health Forum; WHO’s Dr Suraya Dalil; Prof Helen Rees; Dr Jerome Kim of the International Vaccine Institute and Dr Margaret Chan, former WHO Director-General.

Joining Rees on a panel after her award, Dr Jerome Kim, director-general of the International Vaccine Institute, agreed on the need for a global restructuring, and urged “end-to-end thinking”.

“We can’t just have a vaccine. We have to have a plan to use it. We have to know that it’s going to be cost-effective. We’re not just developing vaccines for the companies. We’re developing them to be used and to have impact,” said Kim.

“The rotavirus vaccine was approved in the US in 2006. It was approved by WHO and recommended in 2009. Now, in 2025, 60% of the world’s children still don’t receive all the doses of rotavirus vaccine,” Kim pointed out.

Innovative financing

Rees cites MedAccess, which she chairs, as an organisation that is looking at getting health products needed by LMICs “through innovative financing, health and volume guarantees”.

We need “better, smarter technologies, that make health services easier to administer, medicines easier to store and transport.

To address the worldwide shortage of health workers, resulting in crowded clinics and overloaded nurses, Rees wants technology “to enable patient-responsible care”, such as tools to self-monitor chronic conditions.

There needs to be facility-level digitisation to manage clinic appointments, ensure patients are collecting medication and identify outbreaks.

Then, says Rees, “we need to make the products we deliver easier for patients”. A key example is long-acting lenacapavir, an antiretroviral medicine that prevents HIV via two annual injections.

Finding solutions for the most vulnerable 

British-born, Rees has spent her career based in southern Africa finding solutions to health problems of people living in poor settings in roles ranging from paediatrician to researcher, academic, policy-maker, drug regulator and international adviser.

The common thread in all these roles is her desire to improve the lives of those most vulnerable – social justice values she gets from a family of Welsh coalminers, trade unionists, teachers and preachers.

Rees and her South African husband, Dr Fazel Randera, met when they were medical students in the UK and, on graduating, they went to newly independent Zimbabwe to apply their skills.

Rees was a paediatrician, and her malnourished little patients inspired her and colleagues to encourage parents to fortify the maize meal they were weaning their children on by adding locally grown nuts. 

Looking at the bigger picture to find population-level solutions was a no-brainer for Rees from the start.

Solving problems with research and technology

Prof Rees in the Hillbrow Clinic.

“It is really about identifying the problem, prioritising a research agenda, and then looking for appropriate technology, then looking at implementation, science, policy, governance, finance, access and community and trust,” Rees told the award ceremony of her professional approach.

Rees’s 10 essential lessons

Understanding this essential chain “took a while”, and has come through many years of experience.

In 1980, she and Randera left Zimbabwe for South Africa, where they were quickly drawn into trying to address the effects of apartheid from Alexandra Clinic, a donor-funded health oasis in a densely crowded Black-designated township in Johannesburg.

“The townships were on fire,” says Rees. “The first grant I ever got was to set up an emergency services group for youth in townships who were being shot, were being frightened and persecuted. We trained them in emergency first aid, and we gave emergency equipment.”

By the time South Africa overcame apartheid in 1994, HIV was emerging as a major challenge – particularly for young women.

Rees started the Wits Reproductive Health and HIV Institute (Wits RHI) at the University of the Witwatersrand, which has become one of the country’s most important research institutions.

The institute is based at Hillbrow Clinic, an inner-city slum in Johannesburg, where a collection of derelict buildings was transformed.

“Where I have physically worked has always integrated the needs of underserved communities with research and clinical services,” Rees explains.

Several key trials have been run from the clinic, which also provides healthcare to the community, particularly to mothers and children.

Building a new country

“How do you jump from clinical to research and then into policy and governance?” Rees asks, then answers by saying that South Africa was “looking towards a new country” in the late 1980s.

She was drawn into this quest, first assisting in writing a new health policy for the government-in-waiting, then working on several clinical trials that guided policy, including pioneering research on human papillomavirus (HPV) vaccines and operational research on infectious disease control strategies in the most vulnerable settings.

Then she jumped into governance when appointed to chair of the board of South Africa’s medicines regulator, the Medicines Control Council (MCC).

One of the unexpected challenges she encountered as a regulator was when former President Thabo Mbeki denied that HIV causes AIDS, and pressured the regulator not to approve nevirapine for prevention of mother-to-child HIV infection.

Precious Matsoso delivered congratulations to Rees on behalf of the South African government at the award ceremony.

She and the Registrar of Medicines, Precious Matsoso, who recent co-chaired the WHO pandemic agreement negotiations, registered nevirapine anyway – and cemented the principle of science over politics.

Rees still chairs the board of the South African Health Products Regulatory Authority, the successor of the MCC. 

More recently, she has assisted African countries with the Ebola, COVID-19, and monkeypox epidemics on several groups, including as chair of WHO’s African Regional Technical Advisory Group on Immunization and a member of the WHO African Regional Emergency Preparedness and Response Technical Advisory Group.

She also chairs and participates in several global WHO expert scientific committees on global vaccine policy and health emergency preparedness, and served on the WHO Strategic Advisory Group of Experts on Immunization (SAGE) for several years.

Back home, Wits RHI is leading a vaccine trial for TB vaccine (funded by the Gates Foundation and Wellcome Trust), and researching how to roll out lenacapavir, the long-acting antiretroviral for pre-exposure prophylaxis.

In recognition of her immense contributions to science and public health, she has received numerous prestigious awards, including the Order of the Baobab of the Republic of South Africa, the Gold Medal of the South African Academy of Science and an Officer of the Order of the British Empire (OBE).

But Rees said that her greatest achievement is her family. She has three children – raised with “benign neglect”, she laughs – and four grandchildren.

Image Credits: ARD.