WHO member states applaud following late-night approval of WHA resolution on Climate Change and Health

WHO member states approved the first resolution on climate and health to come before the World Health Assembly in 16 years – even as 50°C temperatures in Delhi, flooding in southern Brazil and devastating Caribbean storms are driving home the message to more and more countries that climate change is real.

In several hours of late-night debate, states large and small, landlocked and ocean-bound, described in painful detail, their efforts to cope with growing trends of climate-triggered storms and drought, sea level rise, and food insecurity – all leading to more deaths and disability from noncommunicable diseases (NCDs), health emergencies, vector-borne diseases as well as mental health impacts. 

Developing countries along with rich nations also detailed new plans to promote greener health systems and climate-smart food production, ban single-use plastics, and better manage urban waste and other forms of environmental contamination – noting their deep inter-relationship with climate action. 

Shift from ‘adaptation’ to low-carbon health systems and intersectoral action

Traffic jam in Dhaka (Bangladesh) – Fossil fuel burning, including for transport, exacerbates climate change as well as air pollution that kills millions every year.

Whereas the last resolution adopted by the WHA in 2008 focused mostly on health sector “adaptation” to climate change, the new resolution carves out a much broader and more proactive roll for member states and their health sectors in efforts to shape future trends as well as respond to the inevitable.  Among the measures, it urges member states to commit to:

  • “Decarbonization” and “environmentally sustainable health systems, facilities and supply chains;” including consumption, procurement, transport, and disposal of water, energy, food and waste, as well as medical supplies, equipment, pharmaceuticals and chemicals, “with a view to lower greenhouse gas emissions,” without compromising health care provision and quality;
  • Multisectoral cooperation between national health ministries and other national authorities on environment, the economy, health, nutrition and sustainable development, “for a coherent and holistic approach to building resilience and addressing the root causes of climate change;”
  • Resource mobilization, including funding from multilateral development banks, climate funds, health funds and “innovative sources”;
  • Awareness among the public and health sector on the interdependence between climate change and health, “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour.”

“The very survival of our species will depend on this,” said Colombia’s delegate during a late evening debate over the draft resolution, to which over three dozen countries signed on as co-sponsors. He deplored the dearth of climate finance for developing nations which have contributed the least to the climate problem.

Colombia: ”The very survival of our species depends on this.”

“Sadly, climate ambition is still not supported with adequate and sufficient finance to respond to the huge needs of this crisis. Every year, finance gutters growing to the tune of billions of dollars, we’re not seeing a clear path to a tangible solution,” he said. 

Broad mandate – but still silent on core issues

The words “fossil fuels” or even “clean energy” don’t appear in the text – something civil society groups such as the World Heart Federation and some member states, including The Netherlands,  which co-sponsored the resolution along with Peru, lamented. 

Even so, the Dutch delegate expressed hope that WHO’s example of achieving net zero in its own operations – a feature of WHO’s new four-year strategy (2025-2028), would inspire member states to do the same, saying:  

“The Netherlands believes transitioning away from fossil fuels is a public health imperative and hopes the new WHO roadmap to net zero will inspire member states to follow suit.”

Extreme weather driving awareness

Mexico’s delegate describes how extreme weather has sensitized Mexicans to the “urgency” of climate action.

Despite such gaps in the text, nation after nation talked about how the reality of the devastating effects of extreme weather and sea level rise is driving more awareness of the need to act. 

That included small island states, such as Jamaica, and the Dominican Republic, and larger nations, from Pakistan to upper-income Mexico and high-income New Zealand. 

“Our delegation would like to approach this matter with a sense of urgency given the effects of the climate crisis that we’re living through,” Mexico said. “According to the World Meteorological Organization, Mexico had the weather event with the highest economic losses during 2023 – hurricane Otis,” she added, noting that in recent weeks, the country has now been facing a severe heatwave. 

“Climate change undermines the very foundations of our societies, threatening the security of our food systems and the safety of our homes and livelihoods. small island developing states including our sisters and brothers in the Pacific face threats to their very existence,” said New Zealand.

Clean and green healthcare 

Workers affix solar panels to roof of a new hospital in Alberton, South Africa. Opened in 2022, it features natural lighting, on-site grey water treatment and recycling.

Member states from the United Kingdom to Indonesia also applauded the resolution’s strong stance on advancing clean and greener health care – including through the new WHO Alliance for Transformative Action on Climate and Health (ATACH). 

Launched at the UN Climate Conference (COP 26) in Glasgow in 2021, nearly 100 member states have joined the initiative, which promotes climate resilient health facilities – through knowledge exchange and voluntary country commitments to a stepwise set of low-carbon and, ultimately, net-zero targets.

“Indonesia is in the process of integrating a performance indicator on climate resilience and health facilities in the health sector master plan – meaning net zero emissions in health facilities by 2030,” said one delegate, describing the country’s plans and progress. She called upon WHO to support member states in accessing investments from the Green Climate Fund “and other financing mechanism dedicated to climate and health for promoting the implementation of green hospitals.” 

One Health, ecosystems and climate-smart agriculture

Ethiopia’s initiative has made tree planting a culture among Ethiopians, with more than 30 million people taking part every year during the summer rainy season,

Delegates’ statements also reflected an  increasingly nuanced understanding of the interlinkages between climate stability, biodiversity, sustainable food production and health. 

One Health – an issue that has become a volleyball in the pandemic agreement talks between rich and poor countries – even received a positive reference mention in the climate and health resolution – which a numbe of developing countries underlined as important.

“It’s important to bear in mind the importance of the One Health approach in the climate and health work,” said Colombia,”in particular, given the needs of protecting vital vital ecosystems like the Amazon, which is the most biodiverse ecosystem in the world –  and that plays a key role in climate in global health. “

Said Mexico, “climate justice for small scale farmers must also be coupled with the transformation of the food system”. She referred to the country’s ban on farm chemicals like glyphosate, as well as genetically modified corn. The Mexican moves have been hotly opposed by agribusness. But critics say both the GMO corn and glyphosate, a pesticide, have knock-on consequences for ecosystems, human health, livelhioods and sustainable food production.  

Ethiopia, meanwhile, is planting billions of trees to combat deforestation, soil erosion and flooding. The initiative has made tree planting a national past-time – although some critics have said it  needs better planning. In parallel, the country is promoting more “climate smart agriculture,” to improve nutrition and reduce biodiversity loss; improved urban waste management and electrification of transport. 

But finance remains key, Ethiopia’s delegate also underlined saying: “We urgently need increased international financing, technology transfer and capacity building support to protect our people from the climate.” 

Curbing plastic hazards 

Plastic
Most plastics that are produced end up in landfills, the oceans, and open waste dumps of developing countries.

Plastics pollution was also described as a dangerous blight to health, climate and environment by countries as diverse as Thailand and Tanzania.

The new climate resolution should help measures to “reduce plastic pollution in the health sector”, observed Thailand, adding that the country is also “working to reduce exposure to micro-plastics, which have been found in human food, water, and air – causing oxidative stress, neurotoxicity, and developmental toxicity,” said the country’s WHA delegate, noting a recent ban on single use plastic bags, as well as initiatives to better manage health sector waste, much of it from plastics.

While not specifically mentioned in the climate resolution, most plastics are produced by by products of fossil fuel extraction, as the International Council of Nurses noted in a statement – and therefore the issues are intertwined.

Over the past 30 years, plastics production increased fourfold, with growth rates still rising exponentially

And the fossil fuels industry has ambitious plans to increase plastics production over the next 25 years – compensating for possible slackening of demand in the transport and energy sectors.

UN member states’ are meanwhile also engaged in tough negotiations over a treaty to curb plastic waste – facing off against stiff industry interests. WHO has proposed that it join the global treaty talks, providing expert advice to negotiators, and to a UN Environment Science Policy Panel on chemicals, waste and pollution. The panel is set to convene in Geneva for it’s third meeting from 17-21 June.   

Russia protests WHO offer of health expertise to UN science panel on chemicals, waste and pollution 

Russia’s delegate objects to linking, plastics pollution, health and climate.

The WHO proposal to join the UN Environment Science Panel, as well as member state references to the linkages between health, climate and plastics brought a stiff response from the Russian Federation:

“We’d  like to draw your attention to how inadmissible it is to shift our focus from the issue of the impact on health of climate change – and pollution through plastic waste in order to focus on combating plastic itself,” the Russian delegate stated. “We must ensure an impartial, objective comprehensive comparison of plastic products with products made using alternative materials.”  

“Russia cannot support the idea of WHO providing Secretariat functions for the Science Policy Panel to contribute further to the sound management of chemicals and waste,” the delegate added. . 

He also called for WHO to keep the health care sector out of the center of deliberations over new UN treaty on plastics pollution – despite healthcare’s outsize consumption of single use plastics.

“We do not support the proposal that the main goal of the international treaty on plastic should be the issue of health care,” said the Russian delegate, disassociating the Federation from references to the WHO ATACH initiative on health sector resilience, as well. 

‘Gender equality’  

Prior to it’s approval, the draft climate and health resolution also was the focus of a back door struggle on its references to gender-related language, also led by Russia and other socially conservative  states.  

To reach consensus, references to “‘gender responsive/sensitive’ climate action and health systems” were removed from the final draft. That was in response to critics who said the words could imply recognition of  LGBTQI groups  – whose activities are banned and even criminalized in many countries around the world. 

The final draft saw just one single reference to “action on climate change and health that is more integrated, coherent and advances gender equality, in line with Sustainable Development Goals.”

Even so, the Russian Federation disassociated it from that reference, as well, after the draft was aprpoved, saying that terms like gender in/equalities “does not enjoy agreement.” 

Retorted Belgium, on behalf of the European Union: “We are rolling back on many years of substantial progress on human rights and gender, reducing our ability to mitigate climate change and of WHO to lead effective programs on the ground.” 

Image Credits: Flickr – joiseyshowaa, https://www.netcare.co.za/News-Hub/Articles/environmental-sustainability-at-the-heart-of-new-hospital-design, Tiksa Negeri / Dialogue Earth, Photo by Hermes Rivera on Unsplash, Plastics Atlas, 2019.

Rwandan Health Minister Sabin Nsanzimana, the Heart Foundation’s Trevor Shilton, NCD Alliance CEO Katie Dain and Karen Sealy of the Trinidad and Tobago NCD Alliance.

GENEVA – Just six countries in the world are on track to meet global targets to reduce non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), cancer, chronic respiratory diseases and diabetes.  At the World Health Assembly (WHA) this week, every country – rich and poor – lamented their struggles to contain rising NCDs, which now cause three-quarters of global deaths.

Progress has been made since the last UN High-Level Meeting on NCDs seven years ago, sector leaders said at a sideline meeting organised by the NCD Alliance and the World Heart Federation on Thursday. But with current global NCD targets set to expire in 16 months when the next UN High-Level Meeting on NCDs will be held in New York, the world is “badly off track,” said Dr Bruce Aylward, World Health Organization (WHO) Assistant Director-General on Universal Health Coverage.

Bente Mikkelsen, WHO’s NCD Director, said it is “purely immoral” that only half the estimated 1.3 billion people who have hypertension were aware of their condition, although the diagnosis is simple. Undiagnosed hypertension is a major cause of strokes. While some 42 million people die from NCDs each year, many deaths could be averted with early detection and treatment.

“Four and a half billion people don’t have access to basic services, and two billion people are suffering financial hardship when they try to access life-saving services. This is a catastrophe,” said Aylward. “We can’t solve the NCD problem without financial protection. The poor in our societies need to be able to access medicines and services they need for free and that is a responsibility of governments.”

Expanded definition of NCDs 

In just seven years, the global NCD agenda has seen significant expansion, said Katie Dain, CEO of the NCD Alliance. The definition now firmly includes mental health and neurological conditions, and air pollution is recognized as a key risk factor. WHO’s Mikkelsen added that the links between climate change and NCDs are also now recognized.

Governments are starting to see addressing NCDs as an investment rather than purely an expenditure, with growing country-level leadership and involvement of people living with NCDs, Dain noted.

Rwandan Health Minister Sabin Nsanzimana said his country recently equipped 58,000 community health workers with blood pressure machines, a “very easy and cheap means of diagnostic screening.” Rwanda’s mortality rate began shifting from infectious diseases to NCDs around 2015, prompting the creation of an evidence-based, culturally sensitive NCD plan.

Nsanzimana noted that some lifestyle challenges are rooted in past community practices, making it difficult to encourage people to cut certain foods and drinks that are “strongly rooted in culture and society.”

“You tell people too much milk isn’t healthy, while mothers and grandmothers always said milk is everything,” he explained. Nsanzimana warned countries that not managing NCDs early leads to “complicated treatment” for issues like cardiac arrest and renal failure.

WHO’s Bente Mikkelsen addresses the meeting, alongside Loyce Pace, Ashley Bloomfield and Bruce Aylward.

Building community trust

New Zealand’s Ashley Bloomfield, co-chair of the Working Group on International Health Regulation amendments, also emphasized the importance of building community trust. “We’ve had tremendous success in tobacco control. Our adult daily smoking rate is now under 7%. In the early 2000s, over a third of our indigenous Maori girls aged 14 smoked daily. It’s now 3%,” he said.

Bloomfield added that effective communication to build public trust was a key lesson learned during the pandemic, citing New Zealand’s successful COVID response that minimized deaths and prevented health system overload by “keeping the virus out until we had high vaccination rates.”

“Fundamental to that was building public trust, so people understood the why,” said Bloomfield. “Effective communication to build trust in the population … helped to minimise deaths and prevented our health system from being overwhelmed.” 

Karen Sealey, executive director of the Trinidad and Tobago NCD Alliance, said her group of 13 organizations successfully lobbied for years to establish a health ministry NCD unit. The alliance is now so well trusted that it assisted with the ministry’s pandemic vaccination drive.

Community involvement in health

“Next year’s NCD High-Level Meeting needs to represent a massive step change, with a significant focus on ground-level action and implementation, where the biggest gap is,” Dain said.

Community health system involvement is a timely topic, as the WHA adopted a “social participation” resolution this week.

The resolution urges member states to “implement, strengthen and sustain regular and meaningful social participation in health-related decisions across the system as appropriate, taking into consideration national context and priorities,” and suggests “facilitating capacity strengthening for civil society to enable diverse, equitable, transparent and inclusive social participation.”

Conservative countries targeted this resolution for its use of “gender-responsive,” as reported by Health Policy Watch. In the final resolution, this term was replaced by “gender equality”.

The ongoing 77th World Health Assembly in Geneva, Switzerland

The World Health Organization (WHO) has urged stakeholders in the health sector to collaborate in reorienting health systems towards a primary healthcare approach, a key priority in helping more people access universal health coverage (UHC). The organization has also called on countries to increase domestic spending on health and for banks to fund climate and health projects.

Speaking at a roundtable discussion during the ongoing World Health Assembly in Geneva on Wednesday, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphasized that investments in health and UHC should be seen as an investment in healthy, productive, and resilient societies.

“Fundamentally, UHC is a political choice,” Tedros said. “But it’s a choice that must be translated into budgetary action.”

Currently, more than half the world’s population lacks coverage for essential health services, and nearly one in four people have suffered financial hardship or incurred catastrophic expenditures to access health services. Progress in reducing maternal and child mortality has also stalled in recent years.

“For this agenda to succeed, it must be embedded in national leadership,” said Dr. Githinji Gitahi, Group Chief Executive Officer of Amref Health Africa. “Unless the national ministers of health, ministers of planning, ministers of finance lead the way for accountability, transparency and national plans, it is going to be difficult to implement.”

Dr Githinji Gitahi, Group Chief Executive Officer of international health and development organisation Amref Health Africa

As extreme weather events rise due to climate change, attaining UHC has become even more important. Kazakhstan’s Minister of Healthcare, Dr Akmaral Alnazarova, shared their experience in handling recent floods that affected nearly 80% of the country, emphasizing the role of primary healthcare in providing 90% of basic medical services and ensuring continuous access during emergencies.

During the roundtable, Japan announced plans to establish a hub for UHC in Tokyo in collaboration with WHO and the World Bank, inviting countries and stakeholders to collaborate and share learnings from its own experience in delivering UHC.

The Finance Conundrum

Finance remains a crucial challenge to scaling up UHC, especially for low- and middle-income countries with limited capacity. The WHO is pushing for more domestic public financing as the most sustainable solution and urges countries to prioritize spending on healthcare through a multi-sectoral approach.

“There isn’t a financing gap. There is just money that is not moving towards the right things. There’s plenty of money out there,” said Mariana Mazzucato, Chair of WHO’s Council on the Economics of Health for All.

Despite Mazzucato’s assertion that there is no financing gap, the WHO itself faces a significant funding shortfall. The organization has secured only $4 billion of the $11 billion needed to fund its four-year work plan, GPW-14, which was approved by the World Health Assembly on Monday.

Mariana Mazzucato, Chair of WHO’s Council on the Economics of Health for All

Low- and middle-income countries, as well as Small Island Developing States, are grappling with the highest debt repayment rates in 25 years and the escalating costs of being on the front lines of the climate crisis. These nations have openly expressed their difficulties in raising funds to finance the ambitious goal of UHC.

More than half of the world’s poorest countries, home to 2.4 billion people, are being forced to cut public spending by a combined $229 billion over the next five years, according to Oxfam.

In 2021, low- and middle-income countries allocated 27.5 percent of their budgets to debt service, which was twice their education spending, four times their health spending, and nearly 12 times their social protection spending. Sixty-two countries worldwide currently spend more on refinancing foreign debt than on health care.

Multilateral development banks, meanwhile, are slowly beginning to prioritize climate and health projects. The European Investment Bank, which serves all 27 European Union member countries, no longer funds fossil fuels and is expanding its investments in health systems. The World Bank currently has $35 billion invested in health system financing across 100 countries and plans to expand into new geographical areas.

However, despite public commitments, many private banks continue to invest billions in coal projects, while green projects in developing countries struggle to secure funding due to perceived high risks and low profitability. The cost of borrowing money in developing countries is often prohibitively high, with interest rates two to three times higher than those in wealthy nations.

“Since 2,000, 30% of member states have made progress in expanding both service coverage and financial protection towards UHC,” Tedros said. “It is vital that all international funding is better aligned with national plans, priorities and systems.”

Image Credits: Twitter.

As the World Health Organization moves to put climate and health at the centre of its work, experts say research gaps could threaten its ability to act effectively.

GENEVA – The World Health Organization has made climate change its top priority in its four-year work plan adopted at the World Health Assembly this week, but significant gaps in climate health research could hinder the UN health body’s efforts, experts warned at the Geneva Health Forum on Tuesday.

Current research on the effects of climate change on health is heavily skewed towards the global north and China, while countries most vulnerable to climate change, such as Small Island Developing States, remain understudied. Additionally, most studies focus on the direct health effects of climate phenomena, overlooking the impact on non-communicable diseases (NCDs), which are the primary drivers of the global disease burden.

“Most of the research has been focused on temperature-related health risks and hazards followed by infectious diseases,” said Dr Ming Yang, Senior Editor at Nature Medicine at a session on “Safeguarding Health from Climate Change.” Organized by the Vanke School of Public Health in Shanghai, China and the University of Geneva, the session came on the closing day of the three-day Forum, which brought together leading scientists with field practitioners on the margins of the 2024 World Health Assembly.

“There’s been very little research when it comes to other health outcomes like NCDs, maternal and child health, mental health, the impact of climate change on healthcare systems, extreme weather events and on diets and food security.”

Dr. Ming Yang, Senior Editor at Nature Medicine.

The health implications of climate change on NCDs range from mental health stresses caused by extreme weather to increased cardiovascular diseases from wildfire smoke, malnutrition from droughts, and increased risk of vector-borne diseases. The WHO recently acknowledged an insufficient understanding of the impacts of climate change on malaria and other neglected tropical diseases.

Climate change can affect many of the leading risk factors for premature deaths, such as malnutrition, air pollution, high blood pressure, tobacco use, unhealthy diets, high blood sugar, obesity, high cholesterol, kidney dysfunction, and occupational hazards, according to The Lancet. As the global health burden of NCDs continues its rise, experts at the Forum highlighted the crucial importance of expanding climate research to explore its impact on these illnesses. 

“No one is talking about obesity, heart disease – the real disease burdens,” said Dr Anders Nordström, Former Ambassador for Global Health at the Swedish Ministry for Foreign Affairs. “We are not getting it right with the epidemiology.”

Recent decades have seen a sharp rise in the number of nations facing severe threats from climate change and its health repercussions.

Ahead of the World Health Assembly, the WHO noted that published research on climate and health has too often focused on “low-disease burden countries with high access to quality healthcare”, while the world’s poorest nations, most at risk for climate disasters according to the IPCC, have seen little research quantifying the health effects of climate change.

“Climate change is not just about heat waves,” Yang emphasized. “It’s about extreme weather events like wildfires, floods, and tropical cyclones. It’s also about the increasing damages of air pollution. We are only beginning to understand the chronic health impacts of climate change on cardiovascular and respiratory disease, renal and neurological outcomes, and especially mental health.”

The disparity in climate health research becomes even more pronounced when examining climate adaptation versus mitigation. A recent WHO review found that a mere 34% of malaria and NTD studies addressed mitigation strategies, while only 5% explored adaptation methods.

This adaptation deficit mirrors the broader global climate action landscape, as affluent nations fail to fulfill their commitments to assist climate-vulnerable regions in adapting to a warming world.

Developing countries received just $21 billion in international financial flows for climate adaptation in 2021, according to the UN Environment Programme (UNEP). However, UNEP estimates that these nations need between $194 billion and $366 billion per year for adaptation alone. With the climate crisis escalating, the funding gap is expected to increase even more.

The WHO’s GPW-14 plan, which sets climate and health as its centrepiece while funding the UN health body’s global activities from emergency response to a full range of health issues, brings the financial scope of the climate challenge into perspective. With a target budget of $11.1 billion, the WHO has secured only $4 billion and plans to raise the rest at a late 2024 fundraiser.

“Clearly climate change is the most important crisis,” said Maria Neira Director of the Public Health, Environment and Social Determinants of Health Department at the WHO, “Now, what’s next?”

Image Credits: Project LM/Flickr, Matt Howard/ Unslash.

Verde's Minister of Health, Filomena Mendes Gonçalves.
Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Cabo Verde, a group of 10 islands in the Central Atlantic Ocean, was declared malaria-free in January. This milestone makes it one of the 43 countries and territories globally recognised with this certification by the World Health Organization (WHO).

Cabo Verde is only the third country in the WHO African region to be certified malaria-free in the past 50 years, following Mauritius in 1973 and Algeria in 2019.

The African continent bears the heaviest malaria burden, with around 95% of global malaria cases and 96% of malaria-related deaths occurring there in 2021, according to WHO. The most affected are impoverished rural communities, where children under five and pregnant women suffer the most, according to the Global Fund.

The latest World Malaria Report revealed that there were approximately 608,000 malaria deaths worldwide in 2022. Additionally, the number of malaria cases saw a significant increase in Pakistan, Ethiopia, Nigeria, Uganda, and Papua New Guinea compared to the previous year.

Cabo Verde’s certification means that the transmission of malaria by local Anopheles mosquitoes has been stopped across the country for at least three years. Additionally, the government has shown it can effectively prevent malaria from returning.

So, how did Cabo Verde achieve success?

On Wednesday, Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves, shared five steps for malaria eradication that worked for her country: strong political engagement; surveillance and rapid response; a multi-sectoral approach, where the government worked closely with the community; international partnerships with organisations such as WHO and the Global Fund; and diligence – once the disease appears eradicated, a plan to prevent re-establishment is required.

Cabo Verde eliminated malaria after implementing a strategic plan from 2009 to 2013, focusing on expanded diagnosis, effective treatment, and increased surveillance, According to WHO. To prevent imported cases, free diagnosis and treatment were offered to international travellers and migrants.

In 2017, the country improved its response to an outbreak, achieving zero Indigenous cases for three consecutive years. During the COVID-19 pandemic, Cabo Verde maintained progress by enhancing vector control, malaria diagnosis, and surveillance, particularly at entry points and high-risk areas.

Impact of climate change

Cabo Verde’s story took centre stage at an opening discussion on the third day of the Geneva Health Forum. The event, run in collaboration with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and on the margins of the 77th World Health Assembly, focused on vector-borne diseases, including neglected tropical diseases, exacerbated by climate change and other environmental factors.

The Geneva Health Forum, organized by the University of Geneva, brings together key global health scientists and policymakers with medical practitioners and other field actors.

Last week, WHO and Reaching the Last Mile published a major review in the Transactions of the Royal Society of Tropical Medicine and Hygiene, analysing 42,693 articles on climate change and vector-borne diseases. The study found that rising temperatures and changing weather patterns alter the spread of these diseases, posing significant health risks and straining healthcare systems. As mosquitoes and other disease vectors expand their range, the report showed, the risk of these diseases reaching new, unprepared areas increases.

Samal, a father from Nepal, contracted visceral leishmaniasis (black fever) in 2022. He became so ill that he lost 15 kilograms and was unable to work for three months. Samal lost nearly 100,000 Nepalese Rupees as a farmer and woodcutter, equivalent to three months’ wages.

Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health
Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health

His nephew and brother also caught the disease. Fortunately, Samal received treatment and survived. However, as Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health, explained, “Many are not so lucky.”

Nepal, a village in the foothills of the Himalayan Mountains, sits about 1,300 meters above sea level. Historically, temperatures seldom rose above 30 degrees Celsius. Today, they regularly soar past that mark, bringing with the heat many new diseases like black fever, which thrive in dark and humid environments.

“Nepal is now breeding grounds for sandflies,” which causes black fever, Elphick-Pooley said. “If untreated, it is fatal in over 95% of cases. Samal’s story shows the catastrophic impact of climate change on individuals, families, communities, and entire countries.”

Climate change has dealt a blow to Nepal’s fight against black fever, said Elphick-Pooley. The country, which had seen cases plummet from 2,200 to under 300 in ten years and was on track to eliminate the disease, must now postpone its goal of eradication.

Countless other countries are experiencing a similar phenomenon, facing a rise in diseases from dengue to malaria. Pakistan reported a staggering 900% increase in dengue cases following severe flooding, as revealed at the United Nations Climate Change Conference last year.

Authorities, even in affluent European nations, are now on high alert for dengue outbreaks, with health agencies warning that threats will soon emerge in the southern United States and previously unaffected regions of Africa.

The WHO and Reaching the Last Mile report indicated that better evidence was needed to understand the link between climate change and these diseases. It also noted a lack of evidence tied to mitigation and adaptation.

But Elphick-Pooley said that “while generating more and better evidence is critical, we cannot let gaps in evidence stop us from moving. We cannot stand still while waiting for better evidence; we must act based on what we know now. We are already seeing the impacts of climate change. This is urgent.”

She called on health leaders to develop new treatments, disease management, and prevention strategies to advance a disease-elimination agenda.

“We already know how to treat or prevent many of the 21 NTDs. let’s do it,” Elphick-Pooley said.

Malaria in the United States

The link between climate change and vector-borne diseases has even alerted the U.S. Department of Health and Human Services.

Loyce Pace, assistant secretary for global affairs in the department, said the country has been having the conversion “about our friends in Brazil who are facing a crisis.” She said Brazil’s floods are not only producing hundreds of thousands of climate refugees but precipitating additional waterborne diseases “in a way that is absolutely putting these constraints not only on the public health system” but on the people.

Moreover, the Centers for Disease Control and Prevention (CDC) identified a handful of locally acquired mosquito-transmitted malaria in Texas and Florida last year. Locally acquired mosquito-borne malaria has not occurred in the United States since 2003.

“These mosquitoes are getting smarter,” Pace said. “They’re getting better at what they do. They’re showing up in places they’re not supposed to, like Maryland, down the street from Washington, D.C.. This is happening in real time. This is not a tomorrow problem. This is a problem today.”

She said the U.S. is prepared to take a one-health approach and called on other countries to do the same.

“It’s not hopeless, right? We have this problem in front of us, but we absolutely do have the solutions we need to deploy,” Pace said. “I trust that we can get it done together.”

Image Credits: Geneva Health Forum.

Israel scored a tactical victory Wednesday evening when World Health Organization (WHO) member states agreed in a vote of 50-44 to amend a draft decision denouncing the health situation in the Occupied Palestinian Territories, with a reference calling for the release of some 125 Israeli hostages still held by Hamas. Another 83 member states were absent or abstained from the politically-charged vote.

The original draft WHA decision was led by Algeria and supported by some 35 member states, including Russia, Egypt, Colombia, Cuba, Venezuela, and Iran.

The decision denounces  “acts of violence,” the “use of starvation of civilians” and the “wanton destruction of health facilities”  –  and calls upon the “occupying power” to fulfill its obligations under international law,” including replenishment of medical supplies, safe passage of fuel and health supplies and additional humanitarian assistance.  

WHA debate on issue adjourns while member states debate next moves

South Africa’s delegate speaks on behalf of the original resolution condemning the health situation in Gaza, and other Israeli-occupied territories.

As of publication, it was unclear if the draft decision, with the amendment referring to Israeli hostages, would indeed be brought to a vote.  Immediately following the vote on the amendment, Egypt, on behalf of the co-sponsors, requested that it be withdrawn altogether.

However, WHO rules would require Israel’s agreement to withdraw the Algerian-led resolution, now that Israel’s amendment has been approved.  Ultimately, the WHA debate on the draft decision was adjourned until later Friday. That leaves both Israeli delegates and the resolution’s supporters, including sworn enemies such as Iran, unsure of what to do next. Neither side will want to cede more diplomatic points to the other.

At the debate preceeding the vote on the amendment, dozens of member states, from Africa, Latin America, Asia and Europe, as well as Palestine that holds observer status, deplored the humanitarian situation that has been created by Israel’s war on Hamas in Gaza, including the interruptions in humanitarian aid, destruction of health facilities, and the recent deaths of displaced Palestinian civilians sheltering in a supposedly safe zone near Rafah from a nearby Israeli aerial bombing.

“The international community should exert all efforts through the various instruments at our disposal to improve the ongoing humanitarian catastrophe in the occupied Palestinian territory, including Gaza,” said South Africa’s delegate to the Assembly, referring to South Africa’s case against Israel for alleged genocide before the International Court of Justice.

Israeli Ambassador to Israel, Meirav Eilon Shahar calls for a vote over an amendment on Israeli hostages held by Hamas.

Speaking to the assembly, Israeli Ambassador Meirav Eilon Shahar said  “a decision that does not also condemn the militarization of health facilities by terrorists in Gaza has no intention of improving the health conditions on the ground… A decision on health that does not demand the immediate and unconditional release of all hostages – who are held by a terrorist organization, raped and tortured – is an unforgivable moral failure.”

Wednesday’s debate was only the first of two scheduled by the assembly on the war in Gaza and its humanitarian fallout, which has led to the displacement of over 1 million Palestinians, and over 34,000 deaths, along with severe hunger and malnutrition in parts of Gaza.  Some 1,200 Israelis died and more than 250 were taken hostage during the October 7 Hamas incursion into Israeli communities that triggered Israel’s invasion of Gaza.  While an estimated 125 hostages, including over a dozen sick and elderly people, young women, and several young children are still being held in Gaza, it’s unclear how many are still alive.

Second Gaza resolution has wider support

A second draft resolution  on Gaza, to be considered tomorrow, has much wider WHA suport and is likely to be adopted by consensus.  It makes a call on “all parties to fully comply with their obligations” under the 1949 Geneva conventions, and ensure “unimpeded, safe, and unobstructed” passage for medical personnel.” 

That resolution, which was the focus of a special session of WHO’s Executive Board on 10 December, was approved by consensus, including with support from the United States, Israel’s closest ally, in what was then a first such vote in the UN system. 

That draft resolution to be considered Friday, makes no direct mention of either the Israeli  hostages or Palestinian prisoners held by Israel. 

But Article 2  “reaffirms that all parties to armed conflict must comply fully with the obligations applicable to them under international humanitarian law related to the protection of civilians in armed conflict and medical personnel.”

US Secretary of Health and Human Services Xavier Becerra

GENEVA – The United States believes a “good deal” is within reach on the pandemic agreement, with parties “close to consensus,” Secretary of Health and Human Services (HHS) Xavier Becerra told reporters at the US Mission in Geneva on Wednesday.

“There is a clear consensus that we can’t let the status quo be upon us if another pandemic comes,” Becerra said, adding that the US believes it has given the talks their “best shot”. “We’re so optimistic because everyone gets it. It’s not just our health. It’s our economies. It’s our security that’s at stake.”

Despite some disagreements, “the contours of the agreement are in place,” Becerra said, expressing optimism that countries would leave this week’s World Health Assembly (WHA) with “something” to show that the World Health Organization (WHO) is ready for the next pandemic.

Spain’s Dr Fernando Simón (centre), flanked by Thiru Balasubramaniam of Knowledge Ecology International (left) and Dr YuanQiong Hu (right) of Médecins Sans Frontières.

Key Spanish negotiator Dr Fernando Simón echoed the sentiment, stating that differences between countries are not significant.

“Faster is the best. There is no perfect treaty, but if we don’t get this pandemic agreement, we risk getting a trade agreement, not a public health agreement,” Simón said at a meeting at the Médecins Sans Frontières headquarters.

One or two-year delay?

However, US Ambassador Pamela Hamamoto cautioned WHA delegates on Tuesday that the pandemic agreement might take one or two years to conclude, citing “fundamental differences” on “complex technical issues that require extensive deliberation and carefully crafted workable solutions.”

US Ambassador Pamela Hamamoto at WHA77

The 47 African member states of the WHO are pushing for the pandemic agreement to be concluded and presented to a special WHA by year’s end.

The upcoming US presidential election on November 5 could impact the negotiations, particularly given the high level of disinformation surrounding the pandemic agreement in the US.

Should Donald Trump win the US election, his administration is likely to scupper the pandemic agreement – and possibly pull out of the WHO altogether.

‘We shouldn’t leave Geneva with nothing’

But Becerra and Loyce Pace, HHS Assistant Secretary for Global Affairs, were both upbeat, intimating that it was now up to other parties to pick up the pen and sign the deal. 

“If we can get this across the finish line, I think what we show – with the pandemic accord and improved International Health Regulations – that we’re ready to take on these challenges so that never again will we suffer a pandemic [like COVID-19],” said Becerra.

Loyce Pace, US HHS Assistant Secretary for Global Affairs

“Frankly, we shouldn’t be leaving Geneva and going home with nothing, not after all that’s been done,” Pace said. “The world needs us to update our global health security architecture. The world needs world leaders and public health leaders to truly commit to what’s required.”

The US is also pushing hard for the amendments to the International Health Regulations (IHR) to be adopted this week. The IHR governs countries’ conduct during “public health emergencies of international concern”.

“We don’t know how long it’s going to be before we get another type of COVID-kind of tragedy. We don’t want to wait,” Becerra said. “We made it unambiguous and clear what we could offer and also what we could accept.

“The elements of a big deal are already on the table. And that’s why, again, we feel optimistic, because those are pretty good deals. It’s just a matter of now finally making sure everybody says: ‘We’re ready to sign on the dotted line’,” he added.

A new WHA drafting committee met most of Wednesday to work out a process for adopting both measures and may report back to the WHA as early as Thursday.

Some African countries have linked their support for the IHR amendments this week to their timetable for the pandemic agreement. But this position is not monolithic. Botswana, for example, supports the IHR’s adoption this week.

Russia indicated on Tuesday that it opposed the adoption of the IHR this week, so the issue might go to a vote.

Additional reporting by Elaine Fletcher. 

Panelists at an IFPMA side event
Panelists Catherine Priestley, Jo Jewell, Monika Arora, Francesco Branca, and Ad Adams, with moderator Shiulie Ghosh (far right) at the IFPMA-World Heart Federation- World Obesity Federation side event in Geneva.

GENEVA – Cardiometabolic diseases, a group of non-communicable diseases (NCDs) including cardiovascular disease, stroke, diabetes, and non-alcoholic fatty liver disease, are on the rise globally, threatening life expectancy gains and burdening vulnerable economies with excess healthcare costs.

These diseases already contribute to over 30% of global deaths each year. With one billion people now living with obesity, projections suggest that by 2035, 50% of the world’s population will be affected, leading to premature deaths and a growing economic burden.

“Non-communicable diseases are only going in one direction. They are increasing,” Dr Christopher Tufton, Jamaican Minister of Health, remarked at a World Heart Federation (WHF) and World Obesity Federation (WOF) event in Geneva on Monday. “It is at a catastrophic level. It concerns all of us wherever we are.”

Low- and middle-income countries, despite their relatively young populations, are driving the alarming rise in global obesity. Obesity rates in these countries are expected to soon match those in high-income countries, a significant shift from the trend observed just a decade ago, said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization.

Cardiometabolic diseases pose a particularly severe threat to low- and middle-income countries, not only jeopardizing hard-fought life expectancy gains but also burdening their already fragile economies with excessive healthcare costs, endangering the sustainability of their health systems and diverting funds from other crucial areas of healthcare.

“The data suggests that we’re seeing a reversal of the gains that we’ve made in life expectancy,” Tufton said, highlighting the impact on his home country Jamaica. “The opportunity to live up to an average of 75 years is now under serious threat.”

Non-communicable diseases accounted for 77% of all deaths in Jamaica in 2020, with age-standardized mortality rates showing significant increases in deaths from diabetes, hypertension, and heart disease over the past decade.

Rise of cardiometabolic diseases in children and adolescents, fueled by targeted advertising

 

The increased rate of deaths from cardiometabolic diseases in countries like Jamaica is not just a consequence of an ageing population. It is also the result of a progressive rise in deaths across all age groups, from children and adolescents to adults.

Dr Monika Arora, Vice President of Research and Health Promotion at the Public Health Foundation of India (PHFI), argued that much of the reason for the rise of obesity in younger children stems from advertising and hidden additives.

“Advertisements for foods high in fat, salt, and sugar — the exposure was much higher in children’s [TV] channels than young adult channels, meaning the industry very clearly wants them to be hooked on to their products early on,” she said.

India, a country that struggles with both undernutrition and overnutrition, now has the third-highest number of people living with obesity globally, largely due to aggressive advertising targeting children and the rise of ultra-processed foods (UPF). The urban poor are the hardest hit, as cheap food options often come in the form of ultra-processed foods, while fresh fruits and vegetables remain too costly.

“They don’t have any means for physical activity, and they don’t have [access to] food which is healthy and cost-effective,” said Arora. Urban air pollution further compounds the barriers to exercise, as the air quality is often too dangerous for walking or running outdoors, she added, in an interview with Health Policy Watch.

Ultra-processed foods can be deceptively hidden, such as the additives found in milk products marketed for children.

“There’s a whole culture about feeding children milk. The milk additives are claiming 20% better growth, better height, and better immunity, and nobody’s checking where these studies are published — these are filled with high-sugar products,” Arora explained. “These are all hidden calories. So even in urban settings where people are cutting down on sugar, they don’t realize that these are ultra-processed foods, and they continue to feed children with products that are harmful.”

The long-term consequences of childhood obesity and the predatory tactics that fuel it are staggering for individuals and health systems alike. A 2015 National Institutes of Health study of over 200,000 US children found that obese children and adolescents were nearly five times more likely to be obese as adults compared to their non-obese peers.

The study showed that 55% of obese children become obese adolescents, 80% of obese adolescents remain obese in adulthood, and 70% will continue to be obese beyond age 30.

“These young people are going to have a life-long exposure to this condition,” Branca warned.

Growing economic burdens globally

Graph of rising economic impact of obesity
Lower and middle-income countries are seeing rising economic impacts due to obesity, according to data from the World Obesity Atlas.

As more low- and middle-income countries struggle with obesity and other cardiometabolic diseases, the economic impact of these conditions continues to grow.

In Jamaica, for example, the total economic impact of obesity is projected to reach $524 million by 2025, with the burden on GDP expected to be 3.9% by 2035, according to Tufton.

The global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve, according to the World Obesity Federation’s World Obesity Atlas 2023. The report notes that at almost 3% of global GDP, this cost is “comparable to that of COVID-19 in 2020.”

“It’s also about framing the societal value for patients, healthcare systems, and economies of taking action and avoiding those costs, which for obesity alone is estimated to be $4 trillion if we don’t take action,” said Jo Jewell, Novo Nordisk Director of Cities for Better Health & Head of Obesity Health Equity.

Comprehensive prevention, treatment, and management are crucial, Jewell noted, with partnerships between the private sector, healthcare sector, and governments to reach those most in need within communities.

Basic screening for conditions like hypertension, blood pressure, and diabetes is essential, and governments should work to bring screening to the people, Tufton added. Knowing these numbers provides a basis for healthcare providers to give meaningful advice and “encourage” behaviour change.

“It is about taking screening to the people,” Tufton said, “as opposed to encouraging people to come to the health centres or the clinics or your private practitioners to get screening.”

“Children live what they learn”

Minister of Health of Jamaica at an obesity side event
Jamaica Minister of Health Christopher Tufton speaks at an IFPMA-World Heart Federation-World Obesity Federation event.

Government policies targeting individual behaviour are a core component of plans to tackle the obesity epidemic. However, reflecting on the power of targeted advertising and hidden additives in ultra-processed foods, Branca noted that individuals are not solely responsible for obesity. This marks a paradigm shift in how the disease is perceived, as an individual’s obesity was previously viewed predominantly as a personal failing.

Policies that only target individual behaviours are “clearly” not sufficient, Branca said, and must be paired with policies that create environments allowing people to make healthy choices, such as controlling marketing, eliminating trans fats, and lowering food prices.

This approach extends to helping children make good decisions about nutrition from early childhood onward. The “captive environment” of schools and the educational programs they provide have the potential to influence community-level change through nutrition and exercise initiatives, multiple experts on the panel noted.

The success of these childhood education programs depends on working closely with school authorities to provide a supportive environment, including less unhealthy food, physical education, and empowerment to make healthy food choices.

“When we work with children in school settings, we are definitely able to influence their behaviours, whether it is healthy eating and being more physically active,” said Arora.

Including children and young adults in decision-making plans around nutrition, she added, is key to ensuring “sustainable behaviour” and empowers them not to “go back home and resort to unhealthy food.”

“We believe that our youngsters could be great teachers of the adults by making an impression on them in schools,” Tufton added. “If we were to modify what they consume, and encourage them to consume in a more balanced way, combined with physical activity, then they will grow hopefully to follow that pattern and become a healthier adult over time.”

Image Credits: S. Samantaroy/HPW, World Obesity Federation.

IFPMA
IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28.

GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations.

This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide.

The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca.

Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy.

The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them.

This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.”

Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress.

“It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.”

The monoclonal antibody revolution

Covid-19 monoclonal antibodies

Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example.

“They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money.

Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence.

“We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.”

AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added.

Gavi: Partnerships crucial as health budgets tighten 

IFPMA
From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK.

Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”.

Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.”

Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually.

Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts.

In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced.

The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets.

Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed.

“We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.”

Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies.

“Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.”

Image Credits: Raisa/Flickr.

The crowded WHA meeting room where the pandemic discussions are taking place

GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. 

Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them.

Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

“My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. 

Strong positive signal

The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”.

“The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU.

“Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.”

The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain.

The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June.

Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”.

“There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.”

France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days.

Pandemic agreement process unclear

It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted.

At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement.

First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan.

Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations.

South Africa’s Ambassador Mxolisi Nkosi.

Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA.

Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus.

However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”.

She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”.

Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO.

The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement.

These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired.