Patients undergoing chemotherapy for cancer.

New cancer cases are projected to increase by a massive 77% between 2022 and 2050 – mainly as a result of tobacco, alcohol, obesity and air pollution.

Ageing and population growth are also factors pushing new cases from 20 million in 2022 to an expected 35 million in 2050, according to the Global Cancer Observatory  released by the International Agency for Research on Cancer (IARC) on Thursday.

The IARC research, published every two years, covers 185 countries and 36 cancers with data drawn from countries themselves.

Lung cancer was both the most common cancer and the leading cause of cancer deaths in 2022 – likely because of “persistent tobacco use in Asia”, according to the IARC, which is the World Health Organization (WHO)’s cancer agency .

There were 2.5 million new lung cancer cases (12.4% of total cases) and 1.8 million deaths (18.7% of total) in 2022 – with men being more likely to succumb than women.

Breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal cancer (1.9 million cases, 9.6%), prostate cancer (1.5 million cases, 7.3%), and stomach cancer (970 000 cases, 4.9%).

However, colorectal cancer was the second biggest killer (900 000 deaths, 9.3%), followed by liver cancer (760 000 deaths, 7.8%). Breast cancer, which is the biggest killer of women, was the third highest cause of cancer mortality with 670 000 deaths (6.9%), closely followed by stomach cancer (660 000 deaths, 6.8%). 

Absolute numbers of cancers per continent in 2022

Low-income countries face doubling of deaths

In terms of the absolute burden, wealthier countries with a high human development index (HDI) – a measure of life expectancy, education rates and income – are expected to experience the greatest absolute increase in incidence, with an additional 4.8 million new cases by 2050 compared. 

Yet the increase in incidence is most striking in low HDI countries, which face a projected 142% increase, and in medium HDI countries (99%). Cancer deaths are projected to almost double in 2050.

“Those who have the fewest resources to manage their cancer burdens will bear the brunt of the global cancer burden,” says Dr Freddie Bray, IARC’s head of the cancer surveillance told a media briefing this week. 

Bray also called for better cancer data, as a number of countries do not have cancer registries.

Global cancer burden 2022

 

The Global Cancer Observatory was released alongside a WHO survey on cancer care on the eve of World Cancer Day on 4 February.

Only 39% of 115 countries surveyed covered the basics of cancer management as part of their financed core health services for all – ‘health benefit packages’ (HBP) – according to the WHO survey.

People living in poorer countries had much worse outcomes thanks to later diagnosis and often unaffordable treatment

In countries with a very high HDI, one in 12 women will be diagnosed with breast cancer in their lifetime and one in 71 women die of it.  But in countries with a low HDI, only one in 27 women will be diagnosed and one in 48 women will die from it.

“Women in lower HDI countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying of the disease due to late diagnosis and inadequate access to quality treatment,” explains Dr Isabelle Soerjomataram, IARC’s deputy head of cancer surveillance.

Meanwhile, cervical cancer was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death. It is the most common cancer in African women with significant mortality although it can be eliminated as a public health problem through the scale-up of the WHO Cervical Cancer Elimination Initiative.

Female cancer mortality: Africa compared to Europe

“Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients, significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world, but also within countries,” says Dr Cary Adams, head of the Union for International Cancer Control.

“Where someone lives should not determine whether they live. Tools exist to enable governments to prioritise cancer care, and to ensure that everyone has access to affordable, quality services. This is not just a resource issue but a matter of political will.”

Unaffordable treatment

WHO’s global survey of health benefit packages also revealed significant global inequities in cancer services. 

Lung cancer-related services were four to seven times more likely to be included in standard health benefits in high-income than lower-income countries. On average, there was a four-fold greater likelihood of radiation services being covered in a HBP of a high-income than a lower-income country. The widest disparity for any service was stem-cell transplantation, which was 12 times more likely to be included in a HBP of a high-income than a lower-income country.

“WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, WHO’s Director of Noncommunicable Diseases (NCDs). 

“WHO, including through its cancer initiatives, is working intensively with more than 75 governments to develop, finance and implement policies to promote cancer care for all. To expand on this work, major investments are urgently needed to address global inequities in cancer outcomes.”

Image Credits: Roche.

Gaza man walks across a pile of rubble.

The World Health Organization (WHO) was able to get medical supplies to Nasser Hospital in southern Gaza on Monday but trucks attempting to deliver food were delayed near the checkpoint then were raided “by crowds who are also desperate for food”, said Dr Tedros Adhanom Ghebreyesus, the global body’s Director-General.

Despite challenges including heavy fighting in the vicinity, Nasser Hospital – the main hospital serving the south – continues to offer health services but at a “reduced capacity”, he added.

“The hospital is operating with a single ambulance. Donkey carts are being used for transporting patients,” Tedros told the WHO’s weekly press conference on Wednesday.

“WHO continues to face extreme challenges in supporting the health system and health workers. As of today, over 100,000 Gazans are either dead, injured, or missing and presumed dead,” he added.

Tedros warned that the risk of famine in Gaza is “high and increasing each day with persistent hostilities and restricted humanitarian access”.

Dr Tedros Adhanom Ghebreyesus

He also described the decision by various countries to freeze aid to the United Nations Relief and Works Agency for Palestinian refugees (UNRWA) as “catastrophic”.

“No other entity has the capacity to deliver the scale and breadth of assistance that 2.2 million people in Gaza urgently need,” added Tedros, echoing a statement released earlier in the day from the Inter-Agency Standing Committee that coordinates humanitarian aid amongst the United Nations agencies, including the WHO. 

Israel has claimed that UNRWA staff members were involved in, or assisted, the Hamas attack on Israel on 7 October. The UN has launched an  investigation and some staff members have already been fired.

However, the WHO’s executive director of health emergencies, Dr Mike Ryan, dismissed a claim by an Israeli diplomat that the WHO was “colluding” with Hamas.

“We cooperate with NGOs but collude with no one,” Ryan told the press conference, adding that such a claim endangers WHO staff in the field.

Ryan described the environment for health workers as “frantic” and “terrorising”, as they tried to  do more and more with less and less, while Tedros said that both health workers and patients were surviving on one meal a day.

“The humanitarian space is is very constrained,” said Ryan. “Every aspect of what the agencies and NGOs are trying to do is constrained. We are constrained in bringing assistance in across the border. We’re constrained in how we store it. We’re constrained in  how we can distribute it, with so many distribution plans being denied or being impeded.

We’re constrained in the number of health facilities that are operational.”

Towards Zero Leprosy

Yohei Sasakawa, WHO Goodwill Ambassador for Leprosy

Meanwhile, Tedros also addressed leprosy, one of the world’s neglected tropical diseases (NTDs), a day after global NTD Day and three days after international Leprosy Day.

“One of the oldest and most misunderstood diseases in the world is leprosy,” said Tedros.

“The world has made great progress against leprosy. 

“The number of reported cases has dropped from an estimated five million a year in the mid-1980s to about 200,000 cases a year now. Although it has now been curable for more than 40 years, it still has the power to stigmatise. Stigma contributes to hesitancy to seek treatment, putting people at risk of disabilities and contributing ongoing transmission,” said Tedros.

Yohei Sasakawa, the WHO Goodwill Ambassador for Leprosy, appealed for assistance to spread the message globally about leprosy’s symptoms and treatment in order to achieve “zero leprosy”.

Massive stigma

Sasakawa said that the disease still existed in 100 countries.

“Over the past 50 years, I have visited leprosy endemic areas in over 120 countries,” said Sasakawa. “Everywhere, I met with countless numbers of people who have been abandoned, not only by society, but even by their own families and are living in despair and in solitude.”

He said that many people ignored initial signs of the disease – discoloured patches on their skin – because it was initially painless.

“We need to carry out extensive work to do our [Zero Leprosy] campaign to find the hidden cases, now that the drugs are available free of charge worldwide,” he stressed.

“I believe it is an opportune time to give another strong push to achieve zero leprosy by strengthening active case detection and prompt treatment.”

Image Credits: Care International .

 

 

 

Amina, an 18-year-old noma patient from Yobe state, has been disfigured since early childhood, and has a habit, like many noma survivors, of hiding her scars behind a veil.

A milestone World Health Organization (WHO) decision to recognise noma (cancrum oris or gangrenous stomatitis) as a neglected tropical disease (NTD) is the result of a longstanding campaign waged for over a decade by global health researchers and advocates in Geneva and beyond. Proponents believe that inclusion can offer noma’s victims the hope of new investments and eventually treatments for one of the world’s least understood diseases.

The WHO decision in December 2023, came shortly ahead of the fifth annual World NTD Day, observed on Tuesday (30 January).

Noma is a severe gangrene disease in the oral and facial regions that predominantly afflicts undernourished young children, typically between the ages of two and six, usually residing in areas marked by extreme poverty. It starts as inflammation of the gums but progresses rapidly, damaging facial tissues and bones if not promptly addressed.

Some 140,000 people – most in sub-Saharan Africa – are diagnosed with the disease a year, according to Dr Maria Guevara, International Medical Secretary for Médecins Sans Frontières (MSF), speaking at a May 2022 event on the margins of the World Health Assembly. The disease currently has a 90% fatality rate, she said. It is most prevalent in West Africa, parts of Central Africa and Sudan, although there are also cases in Asia and South America.

What explicitly causes noma is still unknown, but doctors believe it is the result of a bacterial infection that attacks children who have weakened immune systems as the result of a previous illness, such as measles or tuberculosis.

“Noma’s inclusion on the NTD list is the result of a campaign that has lasted over 10 years,” according to Dr Eric Comte, director of the Geneva Health Forum, which has been active in promoting awareness around the disease over the past months and years. “Several organisations and personalities were involved in this campaign.”

International Society for Neglected Tropical Diseases (ISNTD) and MSF hosted a Geneva Press Club event in May 2023, coinciding with the 76th World Health Assembly, to advocate for its inclusion and helped facilitate networking amongst noma stakeholders.

Noma recognition: impact

The WHO decision was lauded by these stakeholders, who now have very high expectations that the move could lead to several benefits and significant changes in visibility and awareness.

The inclusion on the NTD list “can stimulate research on the disease, particularly on its causes, treatment, and prevention, as researchers may be more inclined to focus on disease recognised by the WHO,” explained Marlyse Morard, director of Sentinelles, a Lausanne-based NGO fighting noma in the field. “The allocation of financial resources is likely to increase.”

Morard said they also expected improvement in prevention and control, mainly through training healthcare staff and epidemiological surveillance.

“Large-scale public awareness campaigns remain essential, as early detection of the disease reduces its impact and saves lives,” she said.

“The creation of awareness programs requires meticulous planning to ensure that they are effective. Improved coordination between public and private stakeholders is crucial, especially when it comes to fighting diseases like noma, which can lead to the stigmatisation of affected people.

“Awareness-raising is a powerful tool to promote a better understanding of the disease,” she continued. “Also, a disease recognised by WHO as a neglected tropical disease can benefit from increased political commitment and the creation of national disease control programs for countries that do not have them.”

She said the expectation included facilitated access to healthcare and reconstructive surgery, as well.

An individual with Noma
An individual with Noma

Noma challenges ahead

However, Morard noted that it was unlikely that these expectations would be met too quickly, as they would depend on each country’s legislation and their commitment to international guidelines.

“It is important to note that the fight against noma is complex and requires the long-term commitment of multiple stakeholders, including affected communities, governments, non-governmental organisations, political and religious leaders and international health agencies,” she said.

Comte expressed similar sentiments, noting that including noma on the NTD “is good news, but it is only a first step. We must now mobilise to establish an action plan and a roadmap against noma through collaborations between WHO Geneva, WHO Afro, the ministries of health of the countries concerned and civil society, which implements actions on the ground.”

WHO has said that there are multiple risk factors associated with this disease, including:

  • poor oral hygiene;
  • malnutrition;
  • weakened immune systems;
  • infections;
  • and extreme poverty.

Although the disease is not contagious, it tends to strike people when their body’s defences are down.

To help halt noma, countries need to run early detection programs for gingivitis, facilitate access to vaccinations, strengthen their clean drinking water systems, improve sanitary facilities, and enhance food support programs, Morard said.

Treatment generally involves antibiotics, improving oral hygiene with disinfectant mouthwash and nutritional supplements.

“If diagnosed during the early stages of the disease, treatment can lead to proper wound healing without long-term consequences,” Morard said.

Survivors face severe social impact

“In severe cases, though, surgery may be necessary. Children who survive the gangrenous stage of the disease are likely to suffer severe facial disfigurement, have difficulty eating and speaking, face social stigma and isolation, and need reconstructive surgery.”

Noma survivor Mulikat Okanlawon, an advocate and hygiene officer at the Noma Hospital in Sokoto, Nigeria, described the effects of noma on her life as follows: “I recovered from the disease, but it left a deadly mark on my face, which stopped me from interacting with people and being a part of the community. I could not go out. I could not go anywhere. I could not even look at myself in the mirror like other children.”

“I always cried… I often wished that I had not survived,” she added, speaking at one recent global health event.

Morard said, “It is truly tragic that noma continues to exist because it is a preventable and treatable disease. Those most severely affected will bear the burden for their entire lives due to late diagnoses or inadequate treatments. The persistence of noma serves as a poignant reminder of health inequalities around the world and underscores the importance of collective action to combat diseases linked, among other factors, to poverty.”

Eradicating noma, she continued, “represents a true challenge and requires strong willpower.”

Mulikat, a 33-year-old former patient originally from the south of Nigeria, moved to Sokoto 17 years ago to undergo facial reconstructive surgery. 

Recent NTD achievements

There have been successes. For example, Sentinelles, Morard’s organisation, has been operating in Niger for the past 30 years, including running awareness-raising activities in coordination with the National Noma Control Program and health authorities. Working with local hospitals has helped ensure noma patients to access reconstructive surgery. Sentinelles also provides support and training for residents and medical staff, which has helped prevent the disease.

Some 1.34% of children aged 1-6 in Niger developed noma – some seven to 14 cases for every 10,000 children aged 0-6, according to an article published in the peer-reviewed journal Health in April 2023. The scientists said this was higher than the incidence of the whole sub-Saharan region.

Last week, at the WHO Executive Board meeting, a representative of the WHO Africa region shared some NTD successes in general, noting that between 2021 and 2023, 10 countries were certified to have eliminated at least one NTD: Lymphatic filariasis (elephantiasis) was eliminated Moreover, some 42 countries have been certified free of guinea worm disease.

WHO’s Dr Jérôme Salomon (center) provides an update on NTDs, including noma’s inclusion in the WHO list, at the WHO Executive Board meeting 22-28 January.

Noma was the first disease to be added to the WHO NTD list in over five years. Scabies and snakebite envenoming were added in 2017. There are currently 21 diseases or groups on the WHO NTD list.

At the Executive Board meeting, WHO Director-General Tedros Adhanom Ghebreyesus updated the delegates on the progress since the WHA73(33) road map for neglected tropical diseases was adopted at the World Health Assembly in November 2020. He shared the following statistics:

  • There was a 25% reduction in people requiring interventions against neglected tropical diseases between 2010 and 2021.
  • The Southeast Asian region had the highest proportion of people requiring intervention against NTDs in 2021 at 52%, followed by the African region (35%). All other areas made up less than 5%.
  • Some 14.5 million disability-adjusted life years were lost to NTDs in 2019, compared to 16.3 million in 2015.

However, the report showed that NTD programs were “severely impacted” by the COVID-19 pandemic and have not yet recovered.

“Much remains to be done to overcome the devastating impact caused by a restriction of movement, disrupted supplies of medicines and other health products, and repurposing of health staff in response to the pandemic,” the report said. “Today, financial support is still far less than before the pandemic and remains limited at all levels, thus jeopardising activities in countries, hampering meaningful planning, and preventing effective coordination at global and regional levels.”

A Global Health Council NGO representative responded to the report by highlighting the inextricable ties between poverty and inequality and NTDs. The representative also noted significant gaps in research and development tools needed to control and eliminate these diseases.

“We call on member states to sustain and expand investments to accelerate R&D of safe and affordable treatments for NTDs and improved diagnostics, particularly for NTDs with specific unmet needs for use in primary health care settings,” the representative said. “We urge WHO member states to collaborate to explore regulatory and manufacturing pathways to facilitate simultaneous or aligned pre-qualification and regulatory approval processes of in vitro diagnostics to accelerate market access.”

Germany, too, emphasized R&D, while Russia focused on the need for increased surveillance.

Others, such as the United States, urged WHO “to undertake the necessary internal reforms to strengthen the functions and operations of the program to support member states in reaching NTD goals, including by reinforcing WHO leadership through accountability, transparency, predictability and equity; filling normative gaps; and ensuring strong data systems enabling reliable surveillance, monitoring and evaluation.

“We also call for well-aligned leadership within the WHO neglected tropical diseases department with the ability to work effectively across sectors,” the US representative said.

Image Credits: Claire Jeantet – Fabrice Catérini / Inediz’, Wikimedia Commons.

Pandemic
A healthcare worker wearing PPE disinfecting a street in the early days of the COVID-19 pandemic.lder

World leaders have a duty to deliver “an effective, legally-binding pandemic accord” by May to prevent the devastation wrought by COVID-19, according to a group of influential leaders and organisations.

The call came in an open letter issued on Tuesday, the fourth anniversary of COVID-19 being declared a global emergency, and was signed by The Elders, The Global Preparedness Monitoring Board, The Independent Panel for Pandemic Preparedness and Response, Pandemic Action Network, The Panel for a Global Public Health Convention, and Spark Street Advisors.

Signatories include former presidents, prime ministers, health ministers and academics.

The accord needs to ensure that “all countries have the capacity to detect, alert, and contain pandemic threats, and the tools and means required to protect people’s health and economic and social well being”, according to the letter.

To succeed, the accord needs three key ingredients, they assert.

The first is equity, ensuring that “every region must have the capacities to research, develop, manufacture, and distribute lifesaving tools like vaccines, tests, and treatments”. 

Second, the accord needs to map out a “pathway to sustained financing for pandemic preparedness and response”, including “the additional $10.5 billion per annum needed for the Pandemic Fund to fill basic gaps in low and middle-income countries’ pandemic preparedness funding”. 

Thirdly, countries need to be “held accountable for the commitments they make via the accord”, including via independent monitoring and a regular Conference of Parties. 

The World Health Organization (WHO) is hosting the pandemic accord negotiations, with the deadline the World Health Assembly (WHA) in May. However, there are still a multitude of disagreements between countries.

Delay proposed

Last Thursday, during the WHO’s executive board meeting, Poland suggested that it might be better to delay the pandemic accord to ensure an “ambitious, clear and consistent” agreement.  

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate.  

“And here I would like to share with you our concern that it would not be beneficial if time pressure leads to a weakening of our ambition, and the quality of the final document.  It is time to ask if we will be ready to present an agreement on a draft pandemic treaty by May 2024?” 

However, Norway, the UK and others  rejected Poland’s suggestion. 

But WHO Director General Dr Tedros Adhanom Ghebreyesus also expressed his concern at the start of the executive board about the gulf between countries on a range of issues at the intergovernmental negotiating body (INB).

Tedros also condemned the global misinformation campaign that is pushing the “lie” that a pandemic agreement will “cede sovereignty to WHO and give the WHO Secretariat the power to impose lockdowns or vaccine mandates on countries”.

“We cannot allow this milestone in global health to be sabotaged by those who spread lies, either deliberately or unknowingly. We need your support to counter these lies by speaking up at home and telling your citizens that this agreement and an amended IHR [International Health Regulations] will not, and cannot, cede sovereignty to WHO and that it belongs to the member states,” said Tedros.

Image Credits: Photo by Maksym Kaharlytskyi on Unsplash.

A gas-fired grill being used in place of a traditional coal-fired one to cook kebabs in Delhi. Burning coal is banned for much of winter as a pollution control measure.

Ten years ago, India’s appalling air pollution made headlines. But $1 billion dollars of investment, new policies and a health crisis have done little to address this situation. Is there still hope? 

If you have a fever, you measure your temperature. If there’s a storm,  you measure the wind and rain. If there’s a stock market crash or boom, you can accurately measure your pennies. It’s the same with the air you breathe. ‘Measure what you treasure’ is the axiom and this needs to be embraced far more whole-heartedly in India’s battle against high air pollution. 

Air pollution is a debilitating global crisis linked to more than 8 million deaths globally, including more than 2 million deaths in India every year as well as losses for the Indian economy estimated at $95 billion. 

It is also a cloud over an ascendant India’s image. As a recent Economic Times editorial pointed out: “Air pollution in Indian cities is real and needs cleaning for both optics and spiration.”

The extent of the country’s air pollution was revealed by recent data published on the completion of five years of an ambitious and landmark government plan, the National Clean Air Programme (NCAP). 

In the last five years, over $1 billion of government funding (INR 96 billion Indian Rupees) has been released to well over a hundred cities to cut air pollution. But only about 60% has been spent, and only 16 cities managed to meet the targeted cuts as per a recent analysis. More and better data can arguably improve policy responses and local interventions. 

The NCAP was launched in January 2019, initially to cut pollution by 20% to 30%. Two years ago, this target was increased to a 40% cut by 2026. 

The programme has also introduced improvements including speedy policy interventions such as shutting schools and banning construction vehicles and old vehicles – most commonly implemented in Delhi. 

The backbone of any such policy intervention is data and in this case air quality monitors. In India, where over four deaths every minute annually are linked to air pollution-related cardiovascular and lung diseases as well as cancers, this backbone needs strengthening. 

The government’s air monitors have increased from 134 five years ago to almost 550 today. These are continuous and real-time. It’s a vast improvement, not just in numbers but geographical spread. Before 2019, Delhi – often in the headlines for its terrible air quality – had far more monitors than massive and populous states like Uttar Pradesh and Maharashtra, roughly the size of the United Kingdom and Italy. 

Since 2022, the number of monitors in Mumbai has shot up by 50% to 30, providing better ground-level reporting that helps to identify local pollution sources. But its air pollution levels are also up 38% since 2019, possibly due to much more post-pandemic construction. 

However, these monitors are simply not enough as most are in the cities and as vast areas are not covered. Some estimates put the number required at 4,000.  An analysis of satellite data recently showed the geographical extent of worsening air pollution across two decades. 

 

Need for more real-time AQ monitors

Real-time or continuous ambient air quality monitoring stations (CAAQMS) have proven to be the most useful in cutting pollution in other countries. Under NCAP, however, about two-thirds of the almost 1,500 monitors are manual. This is not ideal, something that’s been acknowledged by the government itself. 

While the real-time monitors can report air pollution on a minute-to-minute basis, the manual ones are meant to report data only twice a week. 

CAAQMS data is automated, while the manual system is prone to human error, and real-time data is useful for quick policy interventions versus a slow process based on manual monitoring. Some states have addressed this gap of insufficient real-time monitors by using low-cost sensors, especially for rural areas. 

Need for greater data transparency

Pollution in Delhi  typically peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources

There is a far larger network monitoring emissions, both air and water, at source, which several categories of heavily polluting industries must also maintain by law. The monitors are known as online continuous emissions/affluent monitoring systems (OCEMS). There are about 3,700 of these. 

The government states the data is open to the public but in most cases, it is not accessible. According to government officials responding to questions in Parliament on 19 September 2020, the reason for this is that much of the data is “reported by industries on self-monitoring and reporting purposes and not owned or generated by the CPCB [Central Pollution Control Board, the main agency responsible], hence not shared in the public domain.” 

This is not only an issue of transparency but also concerns public health and tax-payers money that funds the CPCB, which in turn hosts this data on its central portal. More data and better data with greater transparency can only help improve policy action.

Are funds being used effectively?

So-called ”smog towers” have been a popular political bandaid – but they don’t reduce air pollution.

Perhaps the greatest challenge in reducing air pollution is revealed in the funding and spending, with 40% of the budget allocated to cities unspent as per recent government data. 

It’s a complex issue as a lot depends on local factors ranging from implementation to meteorological issues. For instance, both Greater Mumbai and Kolkata spent over INR 6 billion. But PM 2.5 levels rose 38% in the former and fell 16.7% in the latter. 

Varanasi spent only about a third of its INR 2.29 billion but improved the most, cutting air pollution by 72%. 

Delhi, despite being the most polluted, received only about INR 380 million as per this data, which is less than 51 other cities listed, and it spent only about Rs 10 crores. More research is required to understand how funds are allocated and if they are being used effectively. 

China’s precedent – billions invested in air pollution solutions

China, which had terrible air pollution for years, has spent close to  $3 billion spanning a decade from the time it held the 2008 Olympics. About $1 billion came in loans from the World Bank with funds being disbursed based on achieved deliverables. A study shows that from 2013 to 2022, the annual average concentrations of major air pollutants decreased significantly: PM2.5 decreased 66.5%; SO2 decreased 88.7%, a result of banning coal in and around Beijing; NO2 decreased 58.9% and PM10 decreased 50%.4.

The air pollution action, apart from the ban on domestic coal burning, included new rules and regulations, identifying accountable parties, and public education for behavioural and lifestyle changes.

While India and China’s political systems are fundamentally different – multi-party democracy with free and fair elections vs. single-party rule. a somewhat similar path has been followed in the sub-continent.  In December, the Indian government released a detailed roundup of funds released and actions supported in some 131 Indian cities, reflecting increased attention to the problem. 

There are new rules, there is increased monitoring, there are many studies and research papers and most notably a new, empowered agency, the Commission for Air Quality Management (CAQM), whose jurisdiction is limited to Delhi and the surrounding region. However, accountability and implementation are yet to deliver widespread and deep cuts in India’s pollution.

About a decade ago both Delhi and Beijing were alternatively the most polluted cities in the world. Last year, Delhi was ninth and Beijing was the 489th most polluted globally. 

At least 92 Indian cities exceed WHO’s standard, Delhi most polluted

Back to the NCAP analysis, Delhi’s pollution has only seen a marginal dip of under 6% since 2019, although there have been some successes like the 2023 Diwali, which was the least polluted festival period in the past six years. Fireworks are widely used during the festival and usually send pollution levels soaring. 

The new data shows Delhi to be the most polluted city in India last year, with PM 2.5 averaging 102 micrograms/cubic metre. That’s over 20 times the WHO’s safe standard of five micrograms. In all, 92 Indian cities exceeded the WHO’s guidelines – although for the other 39 cities of the 131 that have received support for air pollution reductions, there is insufficient data to draw conclusions.

More roads and parking lots being built in Delhi – against expert advice

Accepting and following the science is one of the most helpful things officials can do. Offering a glimmer of hope in that direction, Delhi pollution control officials conceded last year that smog towers don’t work – something that scientists and experts have long contended. But political optics won the day and a central Delhi tower was reopened (only to be shut down again over non-payment of salaries.) 

In Ghaziabad, bordering Delhi, the air quality has shown improvement but there were reports of controversial ways allegedly used to ensure lower pollution levels measured, including spraying water at a monitoring site and relocating a monitor from a crowded place to a greener one. These may well be aberrations, but such doubts need to be addressed speedily by officials. 

In Delhi, road dust is removed by vacuums mounted on trucks, and run on polluting diesel generators. A low-hanging fruit could involve switching the fleet of diesel-run air pollution control machines to electric ones. 

Much more pragmatism, however could be shown in promoting clean public transit over gasoline and diesel vehicles – a major factor in fossil fuel emissions. Officials, especially in Delhi and its neighbouring areas, have long neglected bus and pedestrian transit – although there is an excellent metro network. The latter could also provide the backbone for a much broader shift away from private vehicles to urban transit and non-motorized transport. Reducing fossil fuel emissions, of which vehicles are a major component, would reduce air pollution levels in Southeast Asia by more than 65% according to The BMJ assessment. On a global level, some 5.13 million of the estimated total 8.34 million deaths from air pollution annually are from fossil fuel emissions, The BMJ estimates.

Huge air quality gains would be seen from a 50% reduction in fossil fuel emissions in Southeast Asia.

Huge air quality gains from a 50% reduction in fossil fuel emissions – including shifts to clean public and non-motorized transport.Instead, despite recent, high-level policy advice from a Delhi government commission, which advocated for better public transit, more roads and parking are constantly being built for private vehicles in the capital. Vehicles are a significant source of pollution, about 40% in Delhi. So in the very short term, slashing metro fares as pollution rises bears immediate results in reducing ambient pollution. This can be funded by an existing environmental levy on petrol and diesel – about INR 7.8 billion is lying unused. 

Some lifestyle changes are also required both at a policy and community level. For instance, the government’s cooking gas scheme, Ujjwala, has helped about 80 million beneficiaries switch from burning biomass. 

Delhi’s famous kebabs have been traditionally cooked using coal. Coal for cooking is banned for much of winter, as are wood-fired pizza ovens. One solution is a gas-fired grill. But the owner of such a kebab joint can’t wait to start using coal again, insisting that “the taste is better”. Ditching coal-fired kebabs or polluting private vehicles for cleaner options is still a challenge, as the foul air we breathe appears to be insufficient motivation, at least for now. 

Image Credits: Chetan Bhattacharji, Flickr, Care for Air India, The BMJ.

The executive board meeting was wracked by political and ideological conflicts.

An alliance of conservative World Health Organization (WHO) member states and right-wing US organisations has halted the process of granting a reproductive health organisation “official relations” with the global body.

Meanwhile, a similar member state grouping objected to the use of “WHO LGBTQI+ community” in a routine human resources report that the Director-General tabled at the WHO executive board (EB) meeting on Saturday.

These actions have compromised the WHO secretariat’s “technical, science-based approach to health” and independence, according to other member states at the EB, as the “culture wars” once again polarised and paralysed the global health body.

‘Routine’ discussion erupts

Discussion at last week’s EB on an apparently routine agenda item – relations with non-state actors (NSAs) – was initially deferred amid rumours that Russia objected to the WHO secretariat’s proposal to grant official relations to the Center for Reproductive Rights (CRR).

The EB can grant “official relations” to groups with “sustained and systematic engagement in the interest of the WHO,” according to a report to the EB by the Director General.

Official relations are based on a collaboration plan between the WHO and the NSA that is “structured in accordance with the General Programme of Work and Programme budget and is consistent with the Framework of Engagement with Non-State Actors (FENSA)”.

However, an intense discussion finally erupted at the EB on Friday night over the WHO secretariat’s proposal that the CRR be granted official relations. 

Threatening letter from US right-wingers

By that stage, a letter from leading US right-wing groups, fronted by the Center for Family and Human Rights (C-Fam), had also been sent to EB members objecting to relations with the CRR – and bizarrely using misinformation to press their point.

 Extract from Pro-Life Letter on CRR WHO Status

“Giving special status to the Center for Reproductive Rights will further fuel the culture wars undermining the WHO’s mission to tackle health issues. It confirms fears that WHO’s new accord on pandemic preparedness will be used to undermine national laws related to abortion,” they claimed.

This is precisely the argument being used by global conspiracy theorists, many with links to anti-vaccine groups, that are trying to undermine the WHO as it seeks to better equip the world to address the next pandemic.

The US group, which includes organisations with zero connection to health such as the Center for Military Readiness and iRapture, also threatened that CRR recognition would “expose WHO to loss of funding under future pro-life US presidential administrations”.

C-Fam has also led a campaign to prevent the renewal of the US President’s Emergency Plan for AIDS Relief (PEPFAR), endangering the lives of thousands of people, particularly in Africa, who are dependent on PEPFAR for their antiretroviral medication.

‘Incompatible’ rights

The CRR works in the US, Africa, Asia and Latin America to advance women’s and girls’ access to reproductive health services, including abortion in countries where that is permitted.

The WHO, which has already worked with CRR, envisioned that the CRR would support its work on “promoting and disseminating WHO guidance, statements, tools and strategies on sexual and reproductive health and human rights, as and when appropriate, at global, regional and national levels”. 

Yemen kicked off objections to the Center for Reproductive Rights.

Objections to WHO relations with CRR were voiced first by Yemen, speaking on behalf of the East Mediterranean Region (EMRO). 

It claimed that the “efforts” of non-state actors in relations with WHO must “be in line with national laws”, and that the CRR “has principles that run counter to our regional principles”.

Russia concurred, speaking on behalf of several conservative member states where women’s rights and access to reproductive health are restricted – namely  Algeria, Bangladesh, Egypt, Indonesia, Iran, Iraq, Nigeria, Pakistan, Palestine, Saudi Arabia and Sudan.

“States are responsible to their citizens for the activities taken at the side of WHO,” said Russia.

“Taking into account that the Center for Reproductive Health and Rights (sic) is promoting the sexual rights of girls which do not exist on an international level, are fundamentally incompatible with universal recognised human rights and are legally unacceptable in at least half of the WHO member states and are illegal in a number of countries, we are expecting a further sharp reaction from the citizens and organisations of these countries,” added Russia, apparently alluding to the US letter.

“WHO mandate does not provide ground for work promoting sexual rights,” it added.

Meanwhile, Cameroon on behalf of the 47 African member states, expressed “concern about entry into official relations of non-state actors that do not respect the culture and the values of the member states. We would like therefore, to delay the admission process in order to better understand the implications of this decision.”

‘Undermining the secretariat’

The decision on the CRR status at WHO has been referred back to the WHO’s Programme, Budget and Administration Committee (PBAC)

However, a wide range of member states including the US, Canada, Brazil and the European Union, supported the CRR’s application.

Furthermore, Mexico on behalf of 25 member states – largely European and Latin American – warned that the WHO secretariat’s “neutrality and authority to fulfil its functions, as requested by member states through FENSA, is being undermined”, accusing the member states who were objecting of “politicising routine decisions that we should trust the secretariat to make in the framework of its mandate”.

“The strength of WHO lies in its technical, normative and science-based work. We call on all member states, and in particular EB members, to safeguard WHO’s technical, normative and independent role,” Mexico added.

The decision has since been deferred to the EB’s Programme, Budget and Administration Committee (PBAC) meeting in May – but it is hard to predict how the WHO will decide on this polarising issue.

LGBTIQ+ ‘unrecognised concept’

Meanwhile, on Saturday afternoon another controversy emerged over what would normally have been a mundane report – the Director General’s report of the International Civil Service Commission that covers issues related to staff relations, pay scales and benefits. This mentioned the “WHO LGBTIQ+ community” in a section on “diversity, equity and inclusion”.

“We have the use of terminology which spreads concepts which are not recognised by everyone and which are in contradiction with the values and religious beliefs of quite a large number of countries,” said Russia.

Meanwhile, Syria not only asked for the sentence to be removed but urged the WHO “to refrain from including references of this nature and future reports and official documents”.

Conversely, nearly three dozen other countries, including the US, Canada, Europe and a number of Latin America countries,  expressed support for the Director General’s commitment to diversity equity and inclusion, and gender equality in the workforce. 

“We support the efforts of the secretariat to promote a decent working environment for all staff regardless of the community to which they belong, including those belonging to the LGBTIQ+  community,”  said Denmark, on behalf of the 32 nations. 

Ultimately, the EB agreed with the chair’s proposal to “note” the report along with the “divergence of views that exist on the board as a whole”.

Additional reporting by Elaine Fletcher.

Qatar’s Dr Hanan Al Kuwari, chair of the WHO executive board.

The African region is accelerating the implementation of the global roadmap for neglected tropical diseases (NTDs), and 10 countries have eliminated at least one NTD since 2021, Dr Matshidiso Moeti, World Health Organization (WHO) regional director for Africa told the body’s executive board last week.

Togo eliminated four NTD, while Egypt eliminated lymphatic filariasis and trachoma has ceased to be a public health problem in Morocco. Moreover, 42 countries in the region will also be certified free of guinea worm disease before 2025, said Moeti.

The countries were guided both by the WHO global framework and using the Africa region’s Framework for the Integrated Control, Elimination and Eradication of Tropical and Vector-borne Diseases in the African Region  for 2022 to 2030.

“The strides made by the WHO African region and other WHO regions result from strong country leadership and effective partnerships,” said Moeti. 

She emphasised the role of the expanded special project for the elimination of neglected tropical diseases (ESPEN), which enabled countries to pool resources and work closely with the global NTDs community. She urged the board to sustain ESPEN’s funding in order to expand its successes as the region moves to the last miles of NTD elimination. 

“We must maintain and accelerate our progress by sustaining political commitment, enhancing multisectoral actions through effective partnerships and mobilising additional domestic and international funding to achieve the NTD roadmap goals,” Moeti concluded.

The roadmap sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups as well as cross-cutting targets aligned with the Sustainable Development Goals. It is based on three foundational pillars: accelerated programmatic action, intensified cross-cutting approaches, and changing operating models and culture to facilitate country ownership.

Appeal for flexible funds

Senegal expressed its commitment to align with the roadmap “to speed up efforts in prevention, control, and elimination of NTDs”, and urged the WHO to increase flexible funding for NTDs within Universal Health Coverage (UHC) efforts, emphasising the need for collaboration and domestic funding.

Cameroon, aligning with previous statements, praised the WHO’s roadmap and emphasised its commitment to national plans for NTDs. The country outlined specific goals for 2024-2028, including the interruption of Guinea worm disease and leprosy transmission. Cameroon highlighted the need for cross-sectoral collaboration, calling for mobilisation of human resources and domestic financing.

Meanwhile, Germany reiterated its dedication to the fight against NTDs, emphasising the Kigali Declaration on NTDs. Germany dwelt on improving access to quality health services, expanding water, sanitation, and hygiene initiatives, and investing in social security. 

The United States called for internal reforms within WHO to strengthen NTD programs and ensure accountability, transparency, and equity.

Non-state actor the Global Health Council (GHC) called for improved access to new drugs for NTD and better diagnosis ,as central to accelerating progress and meeting the goals of the roadmap.

“We call on member states to sustain and expand investments to accelerate R&D of safe and affordable treatments for NTDs and improved diagnostics, particularly for NTDs with specific unmet needs for use in primary healthcare settings,” the GHC said.

To accelerate market access for diagnostics, it recommended the exploration of regulatory and manufacturing pathways by the WHO and member states, to facilitate simultaneous or aligned prequalification and regulatory approval processes.

While highlighting the inextricable link of NTDs to poverty and inequality, it noted that the increased attention in recent years has brought new resources to the fight against NTDs and fuelled research breakthroughs.

“Yet very significant gaps remain in the arsenal of tools needed to control and eliminate these diseases, underscoring the need for research and development (R&D) of new tools,” it noted. 

Injecting new urgency into the fight against AMR

Member States also discussed antimicrobial resistance (AMR), which they framed as a growing and existential threat that hasn’t seen the sustained political attention it demands. 

The need for new actions is further supported by the WHO’s global action plan on antimicrobial resistance which is coming to an end in 2025.

Germany expressed its support for the WHO’s global AMR initiative and emphasised collaboration with academia, the private sector, and civil society. They asked that attention be on increasing investment and innovation in quality-assured, priority,  new and improved antimicrobials, novel compounds, diagnostics, vaccines, and other health technologies to fight AMR.

Morocco, speaking on behalf of the Eastern Mediterranean region, emphasised the diverse challenges faced by countries in the region. The representative stressed the importance of adapting responses to the varied contexts, emphasising the need for a coordinated, cross-cutting approach. They advocated for strengthening health systems, particularly in vulnerable and conflict-affected areas, and urged action beyond hospitals to include primary care, emergency, and public health programs.

“We believe that in our region, we have a very diverse picture. Therefore, in our response to AMR, we have to ensure that it is adapted to these different contexts if it is to be effective,” said the Moroccan representative.

Second UN high-level meeting on AMR

The US supported the continuation of AMR as a priority for the WHO, especially as the world prepares for the second UN General Assembly high-level meeting on AMR in September.

“We urge WHO to be fully inclusive of all partners, including Taiwan, and support Taiwan’s participation as an observer to the World Health Assembly, truly embodying the meaning of health for all,” said the U.S. representative.

Japan emphasised the importance of political momentum in addressing AMR and called for strategic allocation of resources at the national level. The Japanese representative highlighted the need for international collaboration, citing the example of Taiwan’s significant public health achievements. Japan pledged support for the implementation of National Action Plans on AMR in collaboration with the WHO and member states.

“In the September second UN high-level meeting on AMR, we have a good opportunity to increase the political momentum for countermeasures. The Government of Japan would like to contribute to promoting the implementation of the National Action Plan on AMR,” stated the Japanese representative.

Rwanda, speaking on behalf of the WHO Africa region, emphasised the urgent need to accelerate the implementation of national action plans on AMR and acknowledged progress made by member states in developing these plans.

“We take note of the report and call for effective implementation of all strategic and operational priorities by all members and stakeholders,” said the African region representative.

Problems with national AMR plans

According to the WHO DG’s report on AMR, while 178 countries had developed multi-sectoral national action plans on AMR as at November 2023, only 27% of countries reported implementing their national action plans effectively and only 11% had allocated national budgets to do so. He also fragmented implementation of national action plans in the human health sector, which he observed is often limited to hospitals, despite the vast majority of antibiotic use being outside hospitals. 

“Capacity to prevent, diagnose and treat bacterial infections and drug resistance, and the evidence base for policy development, are very limited in low- and middle-income countries. The integration of antimicrobial resistance interventions in health systems, and inter-dependencies with other health systems capacities and priorities, are often not recognized in strategies for universal health coverage or health emergencies,” the DG reported.

He proposed three urgent strategic priorities for a comprehensive public health response to antimicrobial resistance in the human health sector, notably surveillance of both antimicrobial resistance and antimicrobial consumption; the development of new vaccines, diagnostics and antimicrobial agents; and measures to make these accessible and affordable.

 

Somalia is leading development of new WHA decision that aims to tackle persistently high rates of maternal, newborn and early childhood mortality.

WHO’s director general says the battle against maternal mortality has stalled; Somalia calls for a new WHA resolution committing to stepped-up action on maternal and child deaths, a leading global health inequality. 

The battle against maternal mortality has stagnated and high rates of deaths continue to plague sub-Saharan Africa, as well as other low- and middle-income nations, said World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus on Friday. 

“Progress has stalled, and still, a woman dies every two minutes,” he stated.

He was referring to a bleak report from February 2023 showing the world is far off track for achieving Sustainable Development Goal (SDG) target 3.1 for reducing maternal deaths to less than 70 per 100,000 live births. 

As of 2020, there was an average of 223 deaths of mothers per live births and in sub-Saharan Africa the death rate was 536 per 100,000 live births, according to the UN inter-agency report.

Friday’s debate at the WHO Executive Board meeting revolved around a draft World Health Assembly (WHA) decision led by Somalia for consideration at the upcoming WHA in May (WHA77). It is aimed at addressing the stark global disparities in maternal, newborn and child health that persist, falling far short of the targets set out in the 2030 Sustainable Development Goal targets on reducing maternal mortality (SDG 3.1) and ending preventable deaths of newborns and children under five years of age ( SDG 3.2). 

Opening the discussion, Somalia's representative painted a vivid picture of the leading factors, which are deeply rooted in health inequalities between high- and low-income countries. 

"The tragedy of this statistic is that most of these deaths in mothers and their children are preventable or treatable with known effective interventions," he lamented.

“We know that 70% of maternal deaths are due to direct obstetric causes,” he said, reciting a list of factors including hypertension, sepsis, abortion and embolism.  

Health system bottlenecks, including cost and capacity constraints, are responsible for an estimated 30% of deaths, he said.

 “We are deeply concerned by these preventable tragedies," he added. “The intent of the resolution is to galvanise action on the direct costs of maternal and child mortality, and also to propose interventions to address the root causes.”   

Adding to the discussion, Afghanistan's representative highlighted the unprecedented challenges faced by the nation. Political turmoil, economic collapse and restrictive Taliban policies have created barriers to essential healthcare services, particularly affecting women.

"The lives and well-being of millions of Afghan women and children hang in the balance. We cannot remain passive observers in the face of such a humanitarian crisis," urged Afghanistan's representative.

Many countries are off track

A draft decision was proposed by Egypt, Ethiopia, Paraguay, Somalia, South Africa and United Republic of Tanzania to accelerate progress towards reducing maternal, newborn and child mortality in order to achieve SDG target 3.1 and SDG target 3.2 after data was shared that showed it is likley that more than four out of five countries (80%) will not achieve their national maternal mortality targets, 63 countries will miss their neonatal mortality targets and 54 countries will miss the under-five mortality target by 2030.

The draft decision called for focused, urgent and coordinated course-correcting, and country-led action for maternal, newborn and child survival.

According to the DG’s report, there is ample evidence on effective interventions to monitor and improve the health and well-being of women and children. He noted that multiple strategies have been developed that incorporate this evidence so as to support countries in identifying the high-impact interventions that should be included in their national health sector plans. 

These strategies include the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016−2030); Ending Preventable Maternal Mortality; Every Newborn Action Plan; the Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030; the Child Survival Action call; and the Global Accelerated Action for the Health of Adolescents initiative. 

He noted that countries that are off track from reaching 2030 maternal and child mortality targets could accelerate progress toward national and global health targets by adopting such strategies and implementing them at scale.

Global Support and Urgency

A wide range of countries, from the United States to Ethiopia, speaking on behalf of the WHO African Region, voiced strong support.

 The United States voiced its unwavering support for the resolution, emphasising strategic approaches to reduce preventable maternal, newborn and child deaths. 

"We recognize that ending preventable maternal newborn and child deaths is critical to achieving universal health coverage and the promise of the SDGs," stated the U.S. representative. 

“There is strong consensus among many member states around several strategic approaches to accelerate progress by expanding coverage and equitable access to an integrated package of:  

  • High quality essential health and nutrition services for women and children. These approaches include first, reinvigorating country leadership and commitment to accelerate progress on this crucial unfinished agenda.
  • Second, adopting a multi pronged approach to maximize investing resources and attract reclaiming and third, aligning and reorienting our investments to strengthen primary healthcare delivery capacity.
  • Finally, prioritizing the hardest to reach the poorest remotest and historically marginalized communities."

Other member states echoed those messages, calling for intensified technical assistance to catch up after years of progress lost, including during the COVID pandemic.

“We are extremely alarmed about being off track with targets,” said Ethiopia, on behalf of the African Region of the WHO, which includes 47 Sub-Saharan African member states. Countries in the regions are also “still struggling” with the legacy of the COVID-19 pandemic, including a present-day shortage of healthcare workers and a socio-economic crises. 

Gender equality and universal access to sexual and reproductive health services

Germany, Norway and others call for universal access to reproductive and sexual health services as key to reductions in maternal mortality.

While the proposed resolution, designed to galvanise global action, could be adopted during the next WHA, some key portions of the draft text, remains in [brackets] - signaling a lack of member state agreement. Notably, these paragraphs revolve around gender equality; empowerment of women and girls; and access to sexual and reproductive health services  - reflecting their political sensitivity for many member states.   

Even so, Germany, Norway and Australia, as well as a range of non-state actors, underlined the importance of women and girls' education as well as "universal" access to sexual and reproductive health services as critical to reducing maternal mortality. 

“Access to sexual and reproductive health and rights including access to free and safe abortion is crucial. Women's rights to bodily autonomy is an essential part of achieving maternal health,” said Norway. “We find it encouraging that levels of adolescent pregnancy and childbearing have declined, but the fact that that 1.5 out of 1,000 young girls give birth before their 15th birthday is still far too many.” 

WHO commends decries stark statistics

WHO's Bruce Aylward decries the stark disparities between rich and poor countries in maternal, newborn and child mortality at WHO EB 154

Dr Bruce Aylward, Assistant Director-General, Universal Health Coverage, Life Course, commended Somalia for reigniting the conversation about a crucial yet alarming global issue, but he expressed concern for the challenges ahead.

"We keep talking about this as these are preventable deaths, and indeed they are, but sometimes that sounds like well, this is an easy problem to solve," Aylward said. "And again, as we've heard, this is a very difficult problem to solve."

He noted the uphill battle against systemic challenges like workforce shortages, out-of-pocket payments, and inadequate infrastructure.

Tedros - ‘stay hopeful’ 

"While there are huge barriers, there has been some very rapid progress in countries where the political will was actually there, both to reorient their systems toward a primary health care approach, and to make the reduction of maternal mortality a national priority," Aylward stated. 

Tedros stressed the need for tailored measures: "The progress is not there, and the recent report from February 2023 is showing that we are off track, and chances to achieve the SDGs are actually dwindling. But still, I think we need to stay hopeful and we should believe that we can achieve it, especially if we do the right things," he asserted.

He called for political will and commitment from every country: "But as we have said when we presented the DPW 14 maternal and child health, that will be one of the top priorities, and we hope together to make a difference and achieve the SDGs by 2030."

As the session concluded, Dr. Tedros highlighted the board's readiness to proceed with the report and draft decision, signifying the collective acknowledgment of the urgent need to accelerate progress in reducing maternal, newborn and child mortality.

Image Credits: UN, World Bank .

New WHO initiatives on climate and plastics follow on from a first-ever Health Day at a UN climate summit (COP28) in December 2023 in Dubai.

A first-ever WHO initiative to join global negotiations on a plastics treaty, as well as the first WHO decision on climate and health since 2008, are set to come before the World Health Assembly in May, following a strong show of member state support for both measures on the closing day of this week’s Executive Board meeting in Geneva. 

The draft decision on climate change and health, led by eight member states, including Peru, Kenya, the United Arab Emirates and the United Kingdom, reflects the wealth of new evidence on the linkages between climate and health that have come to light over the past 16 years. The draft includes an estimated 5% contribution of the health sector to climate emissions, although that data also remains bracketed leaving in question if it will be included in the final draft. 

With regards to a treaty on plastics pollution, currently being negotiated under the leadership of the UN Environment Programme (UNEP), WHO told EB members that it wants to address health aspects of that long-neglected agenda in the context of the plastic treaty negotiations.  

Plastic waste is contaminating air, land and water resources, and the food chain, with potential health harms, experts have warned.

It proposes that the agency provide formal health-related inputs into the new treaty instrument, including about particularly hazardous plastics or polymers that should be phased out, as well as playing an active role in a UN science-policy panel on plastics pollution. 

Both the climate and the plastics initiatives appeared to garner wide support from the 34-member Executive Board, as well as member states observing the proceedings from across the Americas, Europe, Asia and Africa.

“We support the WHO to take a more active role in global chemicals management to protect human health,” including inputs to the plastics treaty now being negotiated on “the importance of the issue of plastic pollution, chemicals and microplastics and potential harmful implications” to health,” said  Switzerland, speaking on behalf of nine member states, including Canada, Colombia, Costa Rica, Excuador, El Salvador, Mexico,Panama and Norway. 

One member state, Russia, however, voiced strong objections to the twin initiatives. Climate change is already a part of WHO’s programmes; addressing the health issues related to plastics pollution goes beyond WHO’s mandate, Russia’s representative to the EB said. 

Civil society complains about lack of reference to fossil fuels  

Maldives delegate links tobacco and plastics pollution.

At the same time, a range of non-state actors rapped the WHO member states for failing to even refer to “fossil fuels” as a driver of climate change in the draft climate and health decision, with one NGO suggesting that WHO should treat fossil fuels like tobacco.

“We urge member states to take a stand against the fossil fuel industry and its influence as done with the tobacco industry,” said one NGO, Public Services International. The agency’s remarks were echoed by at least three other civil society groups but by few member states.

The NCD Alliance asked member states to incorporate language in the draft decision “calling for reductions in fossil fuel use as the most significant driver of climate change and air pollution.” 

Responding to those remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus, described fossil fuel phase out as “crucial.”  But he stopped short of explicitly asking that such a reference be included in the draft decision being negotiated.  

“What was agreed during the COP28, the phase out of fossil fuels is very, very crucial,” Tedros said. “And that’s not without reason, because fossil fuels contribute more than 70% of greenhouse gas emissions – fossil fuels, meaning oil, natural gas and coal. 

“So that’s where the focus should be in order to get the 1.5 degrees centigrade [ceiling of global warming]. That was already agreed. So thank you so much for underlining the importance of focusing on fossil fuels, and as many of you have rightly said, there is a good reason to do that.” 

With respect to tobacco and fossil fuels, the Maldives highlighted the inter-linkages between the issues in more than just rhetoric. 

“The huge amount of plastic waste produced by the tobacco industry, some of which are disposed with their deadly chemical content, must be addressed in this treaty in a way that does not allow the tobacco industry to greenwash their tactics.” stated the Maldives delegate, commending WHO for its “comprehensive and … focused approach in supporting vulnerable nations” on both climate and plastics pollution. 

Tame, but still urging a more proactive stance  

 

Dr Tedros Adhanom Ghebreyesus has strong words about fossil fuel phase-out but member states avoid issue in draft WHA decision.

Indeed, the new WHA initiatives create a much broader scope for action on interlinked climate and plastic pollution issues, even if the framing and terms used reflect delicate balance of member state interests and the organization’s inherent political conservative. 

Some 20% of fossil fuels production eventually winds up as plastics products, highlighting the synergies that exist between unsustainable energy production and unsustainable  consumption and disposal of plastics products.  

WHO’s 2008 resolution on climate and health focused only on a very brief, discrete set of issues related largely to health “vulnerability” to climate change and “adaptation” measures the health sector could promote. The new draft decision carves out new territory, even if hesitantly, urging health actors and health systems to play a more proactive role in the climate policy arena. 

That includes not only active initiatives to reduce health sector emissions, but public awareness-raising about the “interdependence between climate change and health,” as well as intersectoral  “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour…” that address “ the root causes of climate change.” 

Finally, the draft document calls upon WHO to clean up its own house by “firmly integrating climate across the technical work of the WHO at all three levels” and develop a “Roadmap to Net Zero by 2030 for the WHO Secretariat, in line with the UN Global Roadmap.” That will be a big lift for an agency whose pre-pandemic carbon footprint was one of the largest in the UN family – from air travel to routine procurement of heavy-duty diesel vehicles for regional and country offices. 

“We’re not talking about the future. It’s about now,”  declared Tedros with respect to the initiatives, saying that, “both mitigation and adaptation is key.”

He said: “We need to push while saying that, by the way, the health sector also contributes 5% [of GHGs]. And that’s why we should start from the health sector as well.”

Greening health systems 

Map of ATACH members- green shading shows states committed to “low carbon and sustainable” health systems.

Indeed, the boldest feature of the draft WHA decision is the explicit request to WHO to support member states’ development of “decarbonization” of “health systems, facilities and supply chains.” 

That “request” also refers in detail to the long chain of climate impacts associated with the enormous quantities of water, energy, food, medical equipment, drugs and chemicals that modern health facilities consume, and the waste and emissions they produce.  

The draft promotes further development of an “Alliance for Transformative Action on Climate and Health (ATACH),” a new WHO-led platform on development of sustainable health systems.

ATACH, launched in June 2022, has gained further traction since WHO helped lead the first-ever Health Day in December 2023 at the UN Climate Conference in Dubai. Some 75 countries are now committed to creating “low-carbon health systems” and 29 countries even setting net zero targets for sometime between 2030 and 2050.   

But limiting GHG emissions of health systems should only be promoted “when doing so does not compromise health care provision and quality, in line with relevant WHO guidance,” the draft decision recommends. 

The draft text also remains full of brackets, suggesting continued member state disagreements on the fine points of language linking climate action to factors like “healthy environments … more sustainable life choices” and “air quality,” and even to longstanding legal agreements like the United Nations Framework Agreement on Climate Change and the 2015 Paris Climate Agreement.  

More attention to noncommunicable diseases 

Norway, the US, and a number of non-state actors also underlined the importance of climate impacts on non-communicable disease, particularly with regards to extreme heat, with the NCD Alliance calling on member states to include reference to NCDs, as well as to fossil fuels, in the new WHA climate decision. 

 

Image Credits: AfricaNews, WHO , WHO .

Immunisation progress is uneven across regions and countries.

Global levels for routine immunisations are still lagging behind pre-pandemic rates, with uneven progress in different countries, World Health Organization (WHO) officials said at a session of the Executive Board on Friday.

In its report to the EB, the WHO has documented that the current progress is not enough to meet the WHO’s Immunization Agenda for 2030.

Childhood vaccinations have been amongst the worst-hit, member states agreed. The number of zero-dose children who did not receive any DTP (Diphtheria, tetanus, and pertussis) vaccine doses in 2022 stood at 14.3 million, well above the 2019 level of 12.9 million children.

“In the African region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019,” the WHO report stated.

On the positive side, many countries are preparing to roll out the HPV vaccine for protection against cervical cancer – the fourth most common cancer amongst women that killed an estimated 342,000 in 2020.

“Despite initial signs of recovering global coverage rates of DPT vaccines still hovered below pre-COVID-19 pandemic rates,” a representative of Gavi, The Global Vaccine Alliance, told member state participants at the meeting.

The Gavi representative described WHO’s target of reducing the number of zero-dose vaccine children by 50% by 2030 as “ambitious and urgent.” The Gavi delegate also encouraged countries to include the new malaria vaccine and HPV vaccines in their national immunisation programmes.

 

Vaccine roll-outs globally have been lower than the targets due to the pandemic-related disruptions.

Access and cost continue to be barriers

Several countries in Africa are reporting outbreaks of measles as one in five children do not have access to vaccines.

Cameroon, speaking on behalf of 47 countries in WHO’s African Region, said that Africa needs more financing mechanisms like Gavi, transition grants, debt swaps, and development bank loans.

“It is undeniable that immunisation is worth investing in, both as core primary service as well as a key measure for pandemic preparedness and response,” the representative said.

Not just low-income countries but middle-income countries, as well, spoke of the cost of vaccinations as a major financial burden.

“The rising costs of new vaccines present a significant hurdle, impeding their seamless integration into national immunisation programs, especially in middle-income countries,” Malaysia’s representative said. “It remains critical for global partners to explore avenues that enable the provision of more affordable vaccine supplies within these regions.”

Day five of the 154th session of WHO’s Executive Board.

14% of Yemeni children under the age of one have received no vaccinations at all

Apart from the immunisation stalled by the pandemic, raging conflicts have meant that children are going without routine immunisation. In Gaza, there is no functioning healthcare system to speak of at the moment, as Health Policy Watch reported from an earlier session.

In Yemen, around 80% of the population and one-third of the country is controlled by the Houthis, a rebel group.

“We face several challenges,” the representative of Yemen told the board. “Fourteen percent of children under one have received no vaccine doses whatsoever in the northern region, which are not under the control of the legitimate government.

“The Houthis [rebel group] are not putting in place national vaccine campaigns, and this will have serious consequences on the children of Yemen, as well as on neighbouring countries and the world in the future.”

Backed by Iran, Houthi rebels are fighting to overthrow the recognised government in Sanaa, and now control significant swathes of the country. The group has in the past called COVID-19 vaccines “biological warfare.”

Countries prepare for HPV rollout

Several countries described their plans to roll out the HPV vaccine for adolescent girls and young women. Timor-Leste said that it plans to launch HPV vaccination later this year.

Along with Gavi, the European Society for Medical Oncology (ESMO) also made a statement supporting the ambitious HPV rollout.

“Given that prevention offers the most cost-effective, long-term strategy for cancer control, ESMO urges the WHO member states to include the routine vaccination of girls and boys against human papillomaviruses in their national programmes,” ESMO’s representative said.

While Thailand appreciated the global push, the representative from the country offered a note of caution.

“Too much confidence in the HPV vaccine can be harmful as the protection rate against cervical cancer is only 70%. Cervical cancer screening and avoiding unprotected multiple sex partners are still crucial,” the representative from Thailand said.

Image Credits: Unsplash, WHO, WHO.