Climate plans ‘miles short’ of averting catastrophe, UN climate chief warns ahead of COP29.

Global climate plans will cut emissions by just 2.6% by 2030, falling 40% short of what’s needed to keep a future within the Paris agreement’s 1.5C goal alive, according to a report released Monday by the United Nations Framework Convention on Climate Change (UNFCCC).

The combined emissions cut by the national climate plans, known as “nationally determined contributions” (NDCs), have increased by a mere 0.6% since last year, an insignificant change that will not affect global warming trajectories, the UN climate body said in its annual assessment ahead of next month’s COP29 summit in Baku.

“Current national climate plans fall miles short of what’s needed to stop global heating from crippling every economy and wrecking billions of lives and livelihoods across every country, said Simon Stiell, UNFCCC’s executive secretary. “Greenhouse gas pollution at these levels will guarantee a human and economic trainwreck for every country, without exception.”

As countries prepare to update their climate pledges ahead of next year’s COP30 in Brazil, time is running out to take the existential scale of the threat seriously. Since COP28, where countries adopted the UAE consensus reaffirming the 1.5ºC target established in 2015, only one nation has submitted updated climate plans under the treaty framework.

World Faces ‘Catastrophic’ 3.1C Warming after Year of Zero Climate Action

The UNFCCC’s dire assessment mirrors findings released last week by the UN Environment Programme (UNEP), which reported that no policies with “significant implications for global emissions” were implemented globally in 2023, putting the world on course for “catastrophic” warming of 3.1ºC by the end of the century.

UNEP maintains that the 1.5ºC target – which its director called “one of the greatest asks of the modern era” – remains “technically possible” if there is “immediate global mobilisation on a scale and pace only ever seen following a global conflict.”

With global emissions set to exceed 1.5ºC of warming by 2050 – and a one-in-three chance of breaking 2ºC – UNEP’s chief called for a “quantum leap” in climate policy.

Stiell echoed this urgency, demanding an immediate end to the “era of inadequacy” — and for “a new age of acceleration” to begin at next month’s COP29.

“The last generation of NDCs set the signal for unstoppable change,” Stiell said. “New NDCs next year must outline a clear path to make it happen – by scaling up renewable energy, strengthening adaptation and accelerating the transition to low-carbon economies everywhere.”

The latest warning shot 

Carbon dioxide is building up in Earth’s atmosphere at rates never before seen in human history, WMO reported Monday.

With COP29 in Baku, Azerbaijan, just weeks away, a raft of new climate research has reinforced the alarm bells set off by the UNFCCC’s findings.

Planet-warming greenhouse gases surged to record highs in 2023, reaching levels unprecedented in human history, new data released by the World Meteorological Organization (WMO) revealed on Monday.

The UN weather agency found carbon dioxide concentrations rose more than 10% in the past decade, while methane and nitrous oxide, short-lived but powerful greenhouse gases, also saw significant increases.

Carbon dioxide levels are now 51% higher than in pre-industrial times, when humans began burning fossil fuels at scale, while methane levels have risen 161% and nitrous oxide 25% over the same period, locking Earth’s atmosphere into a warming trajectory for at least the lifecycle of these gases.

 “Another year. Another record,” said WMO secretary-general Celeste Saulo. “These are more than just statistics. Every part per million and every fraction of a degree temperature increase has a real impact on our lives and our planet.”

“This should set alarm bells ringing among decision-makers,” Saulo said. 

Carbon dioxide is accumulating “faster than any time experienced during human existence” due to “stubbornly high fossil fuel” emissions, widespread forest fires, and a likely reduction in the ability of natural carbon sinks — such as oceans and forests — to absorb CO2, WMO said. 

The 2023 increase of 2.3 parts per million marked the 12th straight year of rises above 2ppm – a rate of increase that would have taken centuries to occur naturally before industrialization.

“The record levels of carbon dioxide in our atmosphere are the logical outcome of the record amounts of greenhouse gases that our economies continue to dump into our ambient air,” Joeri Rogelj, a climate scientist at Imperial College London and lead author of the report, told the Guardian. “This doesn’t need to be the end of the story.”

Earth’s systems near breaking point

The WMO report raises fresh alarms about nature’s carbon sinks — oceans, forests, plants and soil that absorb carbon dioxide — and it isn’t alone. Earlier this month, international researchers released preliminary findings indicating forests, plants and soil absorbed almost no net carbon in 2023, suggesting they could be nearing a tipping point.

These natural buffers, long taken for granted in climate models, may be failing. Earth’s natural carbon sinks absorb nearly 50% of our carbon emissions, and their collapse could be catastrophic and rapidly accelerate global warming beyond current worst-case scenario projections.

“We see a sudden drop of the land carbon sinks from extreme warming and Amazon mega-drought,” said Philippe Ciais, one of the report’s lead authors. “If this decline continues, we may see a rapid acceleration of CO2 and global warming which was unforeseen in future climate models’ projections.” 

Collapse of Atlantic current

Meanwhile, 40 of the world’s leading experts on ocean and climate science penned an urgent open letter presented at the Arctic Circle conference in Iceland last week warning that the risk of collapse of a vital Atlantic current system, known as the AMOC, has been “greatly underestimated.” 

The collapse of this system, one of the planet’s largest arteries transporting heat around the world’s oceans, would have “potentially catastrophic consequences” and trigger “devastating and irreversible climate impacts,” the letter warned. 

The worst impacts would be felt in Nordic countries and “potentially threaten the viability of agriculture in northwestern Europe,” while global impacts would include reduced CO2 absorption by oceans, major sea-level rise, and a shift in tropical rainforest belts, meaning rains would no longer fall on the forests they keep alive – triggering droughts above rainforests vital to absorbing CO2 – and flood the new regions they settle over.

“This has happened repeatedly in Earth’s history, most recently during the last ice age,” Stefan Rahmstorf, a signatory of the open letter and head of the Earth system analysis department at the Potsdam Institute for Climate Impact Research, said in an interview with the Guardian.

“These are among the most massive upheavals of climate conditions in Earth’s history,” Rahmstorf said. “I am now very concerned that we may push Amoc over this tipping point in the next decades. If you ask me my gut feeling, I would say the risk that we cross the tipping point this century is about 50/50.”

“We don’t know where the tipping point is.”

Image Credits: RecondOil.

A climate crisis protestor urges a science-based approach

Amid grim research showing global warming is happening faster than previously projected, scientists urged world leaders to  move from talk to implementation of global agreements when they meet at COP29 in Baku, Azerbaijan, next month.

Up to 600 million people already live in uninhabitable places, said Professor Johan Rockström, while introducing the 10 New Insights In Climate Science report at a media briefing on Monday.

Methane gas emissions have surged. Rising sea surface temperature is exacerbating destructive and costly El Niño weather patterns and destabilising ocean currents. Meanwhile, the Amazon Rainforest – essential for stabilising climate –  is approaching “multiple thresholds” that could trigger “large-scale forest collapse”.

Methane gas is surging in the atmosphere.

The report synthesises the “latest and most pivotal climate research published over the past 18 months”, aimed at informing the COP29 negotiators and future policy, said Rockström, who directs the Potsdam Institute of Climate Impact Research in Germany. It was produced by a consortium of globally renowned social, natural and climate scientists.

“Our conclusion is that we’ve underestimated the pace [of global warming]. The unprecedented ocean warming, for example, since 2023 has broken sea surface temperatures well beyond anything expected – a sudden 0.2 degrees Celsius jump,” he said.

“The observations we see in the ocean, the accelerated temperature rise in the atmosphere, are early signs of a system which seems to be gradually losing its inbuilt geophysical resilience.”

While mitigation is urgent, so too is the protection of forests and biodiversity “to build as much resilience as possible in the face of the rapidly rising stress due to climate change induced extreme droughts, fires and heat”, added Rockström, who is also the co-chair of The Earth League.

Heightened risk for pregnant women

Pregnant women face huge risks from climate change.

Increasingly, the effects of climate change are being measured by their impact on women and the global South.

“The progress we have made in protecting mothers and newborns over recent decades is now at risk due to our changing climate,” warned Jemilah Mahmood, executive director of Sunway Centre for Planetary Health in Malaysia.

“In a study spanning 33 countries across three continents of the global South, from South America, Asia and Africa, researchers estimated that floods alone may cause over 107,000 pregnancy losses each year,” she said.

“In India, researchers found that when pregnant women are exposed to occupational heat and stress, which affects nearly half of working pregnant women, their risk of miscarriage doubles.”

Meanwhile, research from Southern California found “significant associations” between long-term heat exposure and serious birth complications, including stillbirths, premature births, and maternal hypertensive disorders including preeclampsia and gestational diabetes, she added.

Climate change can reduce the availability of food and water, causing new mothers to travel longer distances in dangerous temperatures, compromising their postpartum recovery. Food insecurity can also result in low birth weight babies and reduce breastmilk production.

Dr Jemilah Mahmood

“These aren’t just statistics. They represent real mothers and families bearing the brunt of our changing climate,”  Mahmood warned. 

Climate change creates a “cascade of risk for maternal health”, with consequences that can span generations.

Research from three South Asian countries also found that just a 1ºC rise in annual temperature is associated with a 4.5% increase in intimate partner violence. 

This is due to “increased heat stress, irritability and aggression” and “increased heart rate, which is directly related to increased heat and dehydration”, said Mahmood.

 “Some physical changes create behavioural changes in human beings that will amplify aggression, and this is much more seen in hot weather,” she added.

Despite the severe impact on women, only 27 out of 119 countries mention maternal and sexual reproductive health in their climate commitments in the nationally determined contributions, Mahmood noted.

COP29: Report on progress

Describing the Baku meeting as a “finance COP”, Rockström said it needs to “shift the $7 trillion per year in subsidies to fossil fuels into mechanisms that allow particularly rapidly developing economies in the global South to afford and get interest rates and get credit worthiness so that they can invest in in the green technologies and avoid investment in coal-fired plants”. 

Professor Johan Rockström

Secondly, scientists have been communicating also with the United Nations Intergovernmental Panel on Climate Change (UNFCCC)  COP reform, he added.

After almost 30 years, a pile of legally binding agreements have been signed to reverse climate change –  the Paris Agreement, a global methane pledge signed by 120 countries to reduce emissions by 30% by 2030, a deforestation agreement, a loss and damages agreement, and the Sixth Assessment Report of the UNFCCC (IPCC AR 6) of 2021 requiring the world to cut global greenhouse gas emissions by 42% by 2030. 

“We even have an agreement that all countries in the world signed that we are now phasing out oil, coal and gas, accelerating this decade and following science. So now is the time to shift over into a COP logic where we start reporting on progress, being held accountable, get money on the table and share solutions, meaning sharing technologies.”

Image Credits: Mika Baumeister/ Unsplash, 10 New Insights 2024, Elizabeth Poll/MMV, 10 Insights report 2024.

Negotiations continue on health provisions in biodiversity plans as the UN summit in Cali reaches its midpoint.

Only 35 countries have submitted the national strategies required by the UN biodiversity treaty showing how they’ll meet its binding nature protection targets. While 33 of these plans recognise links between human health and biodiversity, they offer few specifics on implementation and policy, a Health Policy Watch analysis found.  Negotiators in Cali aim to bridge the gap this week by adopting a global health action plan under the treaty that provides a roadmap for meeting its health protection requirements.

Midway through the UN biodiversity summit COP16 in Cali, Colombia, delegates from nearly 200 countries remain deadlocked over rules to protect human health from Earth’s mounting ecological crisis.

UN Environment chief Inger Andersen urged delegates Thursday to break the impasse over the Global Action Plan on Biodiversity and Health, which would align conservation efforts with human health priorities as nations wrestle with implementing the landmark 2022 Montreal biodiversity treaty.

“Our health cannot be separated from the health of the planet and its many species,” she told delegates in Cali. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.”

Over the weekend

Biodiversity deal seeks health rules – but keeps them voluntary

The world agreed to protect nature in Montreal two years ago. Now in Cali, countries must figure out how.

The proposed framework would strengthen the 2022 Kunming-Montreal biodiversity agreement – nature’s equivalent to the Paris Climate Accord – which committed 197 nations to protect 30% of Earth’s land and seas by 2030, but left crucial health provisions largely undefined.

While the Convention on Biodiversity itself is legally binding, the proposed health framework would serve as a voluntary roadmap for nations. It calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules — measures experts say are vital to prevent pathogens spreading from wild animals to human communities and food markets.

The framework also emphasises protecting genetic resources crucial for new medicine development and ensuring vulnerable populations have access to nature’s health benefits. The push comes amid controversy at the UN biodiversity summit over countries’ rights to demand “benefit sharing” when genetic resources, including digital sequences, are used in drug development — a fight at the frontiers of biodiversity science that nearly derailed the landmark 2022 Montreal agreement.

Beyond the fight over genetic resources, nations broadly agree on the framework’s other targets: combating vector-borne diseases emerging from shrinking habitats, reducing chemical exposure from industry, and protecting communities from the toxic toll of mass pesticide use.

If approved, the plan’s voluntary nature, combined with history, suggests an uphill battle: the world has not met a single UN biodiversity goal since talks began in Nairobi over 30 years ago.

Sweeping New Global Biodiversity Deal Sets Out Plan for Sharing Gene Sequences

The health focus at the UN biodiversity summit reflects a broader shift in environmental diplomacy, marked by the first-ever Health Day at UN climate talks (COP28) in Dubai last year.

While biodiversity has long been valued for medical discoveries — nearly half of all pharmaceuticals in use today are originally derived from nature — scientists increasingly see ecosystem protection as vital for preventing disease outbreaks, controlling disease vectors, and limiting chemical exposure.

Biodiversity loss and climate change have emerged as the leading drivers of infectious diseases worldwide, amplifying 58% of outbreaks. The mounting threat is forcing policymakers to reckon with an increasingly inescapable truth: human survival depends entirely on Earth’s life-sustaining systems — clean water, air, and food.

“Framing biodiversity as a resource – something separate, something that gives – has led to humanity converting nature, driving species to extinction, polluting ecosystems and pumping greenhouse gases into the atmosphere,” Andersen said. “But humanity is not separate from or above biodiversity. And in a closed system such as Earth, what goes around comes around.”

Deep divisions over superbug prevention and drug development mirror COP16 tensions

The Biodiversity-Health framework is one of the most contested documents being negotiated at COP16 in Cali, Colombia this week, according to Carbon Brief.

The 24-page Biodiversity-Health framework is as one of the summit’s most contested documents, with 54 bracketed sections exposing fundamental disagreements between nations.

The disputed clauses reflect wider fault lines in Cali. Nations remain divided over whether to classify improperly disposed antibiotic waste – a key driver of antimicrobial resistance – as “pollution” alongside microplastics and heavy metals. Proposals to “avoid the inappropriate use and disposal” of antibiotics are also unsettled, despite safe disposal practices being critical to preserving the efficacy drugs that save hundreds of millions of lives annually.

The sharing of benefits from genetic resources is another flashpoint. Developing nations demand strong commitments on technology transfer, while wealthy countries insist such transfers must remain “voluntary.” Nations with major pharmaceutical industries have pushed also back against draft language that would hold companies accountable for “the misappropriation of genetic resources and digital sequence information and associated traditional knowledge.

A crucial sticking point centres on whether to include “derivatives” and “subsequent applications and commercialisation” – essentially determining if companies must share benefits when they develop new products based on initial discoveries. Without such provisions, firms could potentially avoid sharing profits from derivative drugs or applications.

Finance – the dominant issue of COP16’s opening week – is another key battleground in the health framework. Nations have yet to approve clauses that would provide financial support to developing countries, which host most of the world’s biodiversity, for implementing plans to protect it.

Of the few plans submitted, most consider health

Of 35 submitted biodiversity plans, Western Europe leads with 13, followed by Asia-Pacific with 10, while Africa filed 5, Latin America 4, and Eastern Europe 3, according to the COP16 database.

National biodiversity plans submitted before this week’s summit in Colombia summit reveal wide variations in scope and specificity for how countries intend to tackle environmental protection and human health concerns, a Health Policy Watch analysis of the COP16 database found.

Only 35 nations – just 18% – submitted biodiversity strategies, known as NBSAPs in UN jargon, by Monday’s UN summit deadline. All but Mexico and Jordan included human health concerns in their plans.

The submitted plans reflect clear regional priorities. European Union members emphasize a comprehensive “one health” approach that links human, animal and environmental welfare, focusing heavily on pesticide and chemical pollution regulation – areas where the EU leads global policy.

Colombia’s strategy takes a different focus, centering on health impacts from extractive industries, particularly mercury contamination from mining. In contrast, China and South Korea’s plans barely mention health, making single references to urban green spaces’ benefits for respiratory and mental health.

These varied approaches come as research increasingly links ecosystem destruction to public health crises, from floods to disease outbreaks. Scientists have documented two virus spillovers to humans annually over the past century, culminating in the COVID-19 pandemic.

The World Health Organization projects climate change could cause 250,000 additional deaths yearly between 2030-2050. Antimicrobial resistance already claims 1.4 million lives annually, while environmental degradation could cause 39 million deaths from 2025-2050.

The proposed health framework, though voluntary, would set higher standards than current national plans.

“From the air we breathe to the water we drink, our health is tied to the health of the planet,” said UN Environment chief Andersen. “We need a plan to protect biodiversity for the health of all species on earth.”

Critical regions and powers missing from submissions

While most nations haven’t submitted biodiversity plans required by the Montreal deal, officials say the two-year timeline was ambitious given ecosystem complexity, especially in regions like the Amazon.

Of the 17 nations hosting 70% of Earth’s biodiversity, only five have filed plans: Australia, China, Indonesia, Malaysia and Mexico. The crucial Amazon region is represented solely by Suriname, with no submissions from Congo Basin nations.

The G7 economic powers showed limited participation, with only Canada, Italy, France and Japan meeting the deadline. Among G20 members, Brazil indicated it needs more time to develop its long-term conservation strategy, while India plans to announce its commitments during the summit.

“The start was never going to be fast. I think the important thing we’re looking at is the work is underway,” UN biodiversity chief Astrid Schomaker told Carbon Brief about the limited submissions.

“Whether the deadline itself is met on the dot is not what I think we’re really looking at,” Schomaker said, adding she is “confident” this work is taking place globally. “I think our assessment is globally positive.”

Biodiversity and health deal advances, but key framework still faces hurdles

Negotiations on biodiversity and health took a step forward on Sunday as the second working group’s chair presented a draft decision – a document separate from but related to the broader biodiversity and health action plan. While the draft includes a provision to adopt the action plan, this remains in brackets, indicating no consensus has yet been reached among member states.

The draft makes several key advances, eliminating previous disputes over antimicrobial disposal protocols and removing qualifiers that made technology sharing optional. It also strengthens provisions for Indigenous peoples’ participation in global biodiversity initiatives and decision-making forums.

However, several contentious issues from the main biodiversity framework remain unresolved. These include questions of pharmaceutical companies’ liability regarding genetic resource usage and digital sequence information, whether derivatives and commercial applications should be included in fair and equitable benefit-sharing arrangements, and the creation of international oversight mechanisms to ensure countries meet their biodiversity and health commitments.

Finance remains a critical hurdle in the health and broader COP16 negotiations. While eight nations boosted the Global Biodiversity Framework Fund this week with pledges totaling $163m, bringing available funding to $400m, this falls dramatically short of global needs.

The Kunming-Montreal agreement calls for $200bn annually for nature protection – 500 times the current fund’s total, which isn’t even structured as yearly financing. Though there is broad agreement on the principle of financial support from development banks and environmental funds, the mechanisms for distribution remain hotly contested.

As with previous UN environmental negotiations, talks may extend beyond the official Friday deadline as delegates work to bridge these remaining gaps.

This article was updated to reflect progress in the negotiations 

Image Credits: CIFOR-ICRAF.

Minya, Egypt
A view point in Minya Governorate. Nearly 11 million Egyptians live with diabetes, where insulin access is increasingly out of reach for those in rural areas.

MINYA GOVERNORATE, EGYPT – Nine-year-old Adam needs an insulin shot before meals, and seems unphased when his father checks his sugar levels with a finger pricking. He looks away when a small blood drop wells on the tip of his finger. Adam turns back to his plate of rice and stewed vegetables, continuing to ramble about the kids in his summer camp.

Both Adam and his father are diabetic in a rural village in Upper Egypt, where their struggle to access insulin mirrors a broader struggle across the country, and the continent. 

In a country where over 18% of adults live with diabetes, and with the number of adults living with diabetes expected to hit 20 million by 2045, diagnosis, monitoring, and medication are all difficult to come by. 

In response, Egypt is now taking significant steps to expand insulin access and diabetes prevention–in the context of rising prevalence. But financial and logistic barriers as well as  competing political priorities still leave rural families at the ‘last mile’ of service in a precarious situation. 

New diagnostics more widely available – but shortages, power cuts, and inflation threaten access

Minya, Egypt, diabetes access
Moussa, with his son Adam, shows a continuous glucose monitor in their home in Upper Egypt.

To address the growing health and financial burden of the disease, the Egyptian National Health Insurance system recently began to cover the initial cost of a glucometer for newly diagnosed people as well as 25 test strips per month. 

Yet while over-the-counter glucose monitoring ads flood US airwaves for non-diabetic consumers, many Egyptians, like people in other developing world countries, still struggle to obtain such basic devices for diabetes control. Diabetes care coverage remains below 50 percent for low- and middle-income countries, according to a Lancet estimate.

Many or most low-income and informal Egyptian laborers simply don’t have health insurance while their income are not enough to afford their monthly diabetes supplies, notes T1 International, a non-profit diabetes care advocacy group:  “It can cost someone more than 50% of their salary to get the basic diabetes supplies,” said Dr Mohamed Shabeen in a T1 article. 

insulin pens in egypt
Moussa’s stash of insulin pens and glucose monitors for the village.

Paying for test strips, monitors, and insulin are just one part of the country’s $3 billion diabetes-related annual health expenditure. The International Diabetes Federation estimates this number will rise to $4.5 billion by 2045, a concern given Egypt’s rising national debt and economic woes – with the Egyptian pound devalued by more than 50 percent and food inflation over 60 percent. 

There are also indirect costs for diabetics. For instance, Adam’s parents enrolled him in a pricier private school, over fears that in the overcrowded public schools, Adam could go into insulin shock unnoticed.

“I was worried he would go into a ketone coma (ketoacidosis),” said Moussa, Adam’s father, and English teacher who is one of the few-college educated people in his village of some 2,000 people. “I became diabetic in 2018, Adam in 2019. I noticed a lot of the same symptoms.

“When he was diagnosed, I did so much research. I had to learn about the condition because there is so little information for people with diabetes.” Moussa ended up buying a Freestyle Libre glucose monitoring system so Adam could attend school uninterrupted, but it soon became too expensive “and we’re facing a shortage.”

Villages, in Minya Governorate, like Moussa’s, struggle with affording insulin – and keeping it refrigerated during power outages.

There are several other people living with diabetes in his village, Moussa explained, and they have formed a network, providing each other with valuable social support. “We have a WhatsApp group. If someone has extra medication, they give it to me and then I distribute it to others that need it.” The summer, however, was especially challenging as 40 ℃ temperatures were accompanied by prolonged power cuts, threatening insulin refrigeration. 

Diabetes ascendant – 11 million and climbing

Diabetes coverage access
Diabetes treatment coverage remains below 50% across a variety of metrics in low- and middle-income countries.

In WHO Eastern Mediterranean Region, which includes most of the Middle East and North Africa, one in six adults now live with diabetes, making it the region with the highest prevalence at 16.2% and the second highest expected increase (86%) in the number of people with diabetes.The region also has the highest percentage (24.5%) of diabetes-related deaths in people of working age.

In Egypt, the country is now one of many facing a double burden of malnutrition (DBM)–where 21% of children under five are stunted yet over half of children and adolescents are overweight or obese. The country’s rapidly rising rates of noncommunicable diseases (NCDs) like diabetes, heart disease, and chronic respiratory diseases means that NCDs account for 82% of all deaths in Egypt and 67% of premature deaths. 

Public health experts point to the region’s lifestyle changes – a diet heavy in sugar and carbohydrates, lack of exercise, and other risk factors – as fueling the rise in NCDs. 

New domestic insulin production in limbo

Minya, Egypt diabetes
A view of the village in Minya Governorate, where the growing prevalence of diabetes threatens the village’s well being.

In terms of treatment, there is little local insulin manufacturing in Egypt as well as the rest of Africa, leaving people to depend on expensive, important supplies.  

Several big initiatives have recently been announced to change that. But their status remains unclear. In May, 2023, Eli Lilly announced a major new partnership with the Egypt-based pharmaceutical company EVA Pharma to provide the company with the active pharmaceutical ingredients (API) of insulin at a “significantly reduced price.” 

Just last month, EVA Pharma’s CEO Dr Riad Armanious declared in a press release that “locally manufactured insulin is currently a top priority, aiming for local supply and exporting it to more than 60 countries.” 

However, actual rollout of the plan still appears to be in limbo, with neither company responding when asked for comment by Health Policy Watch about the status of the new manufacturing plans.

That, despite an August statement by Egypt’s Minister of Health and Population  Khaled Abdel Ghaffar told press that the insulin shortage “would be over within three months” and that the country would produce a million more insulin vials a month, in coming months. 

He blamed a foreign currency shortage for the holdup in importation of critical raw ingredients needed to expand production, but “that the problem had been solved.”

Egypt is home to some 170 pharmaceutical factories – and state-owned companies already produce as much as 15 million vials yearly – but much of this also reportedly goes to export. This leaves Egyptians, who need some 27 million vials a year, in an even greater bind. 

Additionally, observers in the field say privately that the local products are not yet as of good quality as imported ones – something that the partnership between Eli Lilly and Eva should help address.

WHO – no further details on the rollout of manufacturing 

Egypt diabetes
Dr Loyce Pace, with WHO’s Dr Bente Mikkelsen, Africa CDC’s Dr Jean Kaseya and EVA Pharma CEO Riad Armanious at the EVA-Lilly partnership announcement last year.

Asked for comment, the World Health Organization also was unable to offer further updates on a timeline for Egypt’s rollout of its much-touted expanded insulin production. 

WHO is not a direct partner in the Eli Lilly-Eva partnership, but it has been “actively engaging with various stakeholders, including the private sector, to fulfill commitments made in the UN Political Declaration on NCDs,” said Dr Bente Mikkelsen Director, just prior to her retirement on 1 October as head of WHO’s Department of Noncommunicable Diseases, Rehabilitation and Disability (NCD).

“Several companies have responded positively to these ‘asks’, including commitments to local manufacturing,” she added, in a comment to Health Policy Watch. 

Meanwhile, in Minya Governorate, Moussa has been traveling more frequently to Cairo some four hours away by car “to get good healthcare” – after monitoring Adam’s symptoms, as well as his own, and their similarities. 

But he still hopes that he and others in his community can eventually get quality insulin and glucose monitors at a fairer price locally. 

“Right now, I’m getting them from Cairo, and we have to pay taxes and customs. It would be great for all these people in our community to be able to afford this as well.”

 

Image Credits: S. Samantaroy/HPW, The Lancet.

Lab technicians work in laboratories in Afrigen, a company in Cape Town, South Africa, selected as the WHO Vaccine Hub.

There is an urgent need for Africa to develop local manufacturing capabilities for Active Pharmaceutical Ingredients (APIs) so as to reduce reliance on imports, enhance healthcare outcomes, and stimulate economic growth. But innovative technologies and international partnerships can help stimulate African pharma growth, revolutionize API production, and ensure self-sufficiency across the continent in a post-pandemic world.

Africa’s pharmaceutical industry is at a critical crossroads, with significant progress in downstream activities but a gap in upstream manufacturing, particularly in the production of Active Pharmaceutical Ingredients (APIs). 

APIs are essential components responsible for the therapeutic effects of medications, and local production is key to achieving self-sufficiency and long-term sustainability in healthcare across the continent. The COVID-19 pandemic underscored Africa’s dependence on imported medicines, exposing a vulnerability in the supply chain and highlighting the urgent need for local pharmaceutical manufacturing infrastructure on the continent.

Building local capacity for API manufacturing will reduce reliance on imports, ensure a more affordable and reliable supply of essential medicines, and contribute to economic growth by creating jobs for highly trained professionals. 

For local manufacturers of final pharmaceutical products, this development offers economic advantages, including a shorter supply chain, the ability to order smaller, more frequent API shipments, reduced costs for quality assurance, and a lower risk of substandard products entering the market. 

Additionally, a thriving, independent API manufacturing sector is essential for a sustainable pharmaceutical industry in Africa. As long as local manufacturers remain dependent on imported APIs from India and China, the origin for more than 70% of all of Africa’s imported medicines, the continent will struggle to compete with its Asian neighbours and others. 

For tuberculosis (TB) and HIV medicines, for instance, Africa imports more than 80% of products used.

Making new strides  

Companies across Africa are stepping up production of APIs for malaria medications.

Several pharmaceutical companies in Africa are making significant strides in producing local APIs for their manufacturing processes. 

For instance, Emzor Pharmaceuticals in Nigeria is actively involved in producing APIs for anti-malaria medications, while API for Africa (APIFA) is working to enhance local pharmaceutical manufacturing capacity across Sub-Saharan Africa.

This commitment to strengthening local capabilities is also exemplified by the Pretoria-based CPT Pharma’s efforts to tackle upstream manufacturing challenges and build a more robust pharmaceutical infrastructure. We are on a mission to revolutionize API production locally. The company develops, optimizes, and commercializes cost-effective technologies for APIs that treat TB, HIV, and non-communicable diseases. 

Supported by the Industrial Development Corporation (IDC) and the Technology Innovation Agency (TIA), CPT Pharma established a pilot plant in 2017 which achieved Good Manufacturing Practice (GMP) certification and a license in 2020 from the South African Regulatory Authority (SAHPRA) to manufacture APIs. 

It serves as a proof-of-concept hub for new technologies and provides material for regulatory compliance and clinical trials.

Reducing costs and gaining international support 

Export-Import Balance of Pharmaceuticals in Africa (1970 – 2020), according to data from Development Reimagined.

Local API manufacturers must also prioritise reducing costs and promoting sustainability to be successful. Companies can develop more efficient and eco-friendly production processes by leveraging advances in synthesis technologies, catalysts, starting materials, and reactor technologies. Integrating sustainable practices from the development phase, rather than adding them later, allows for cost-effective and environmentally responsible manufacturing. This approach can help position African companies to become leaders in pharma and API manufacturing.

Support from international organizations is also crucial for local pharmaceutical manufacturers to thrive. For example, assistance from the United States Pharmacopeia (USP) helped us ensure API master file compliance and achieve World Health Organization (WHO) Prequalification (WHO-PQ) status, which is critical for global market access and regulatory approval. 

Additionally, international initiatives by entities such as German Development Agency (GIZ) have funded quality assurance training through its Support towards Industrialization and the Productive Sectors in the SADC region (SIPS) initiative in the Southern African Development Community (SADC), play a vital role in maintaining high production standards. 

In 2024, USAID selected CPT Pharma as a local manufacturing partner to adopt an innovative and more cost-effective, ‘continuous flow technology’ for producing APIs such as Rifapentine, a key drug for treating TB—including drug-resistant strains. This illustrates how international collaborations can significantly enhance local API production capacity and contribute to improving public health outcomes.

Funding remains a significant challenge 

Funding, however, remains a significant challenge for local API production in Africa. In comparison to “fill and finish” contracts that African manufacturers more commonly receive from pharma companies abroad, expanding API manufacturing capabilities requires substantial financial investment. 

In the case of CPT Pharma, this next stage of growth involves planning and construction of a new facility to manufacture Isoniazid, a critical antibiotic for first-line  TB treatments. 

Without consistent financial support, maintaining and growing API production remains a formidable challenge, not just for CPT Pharma but for similar enterprises across Africa.

By prioritizing local API manufacturing, Africa can significantly improve its healthcare systems and reduce dependence on imports. Beyond improving access to essential medicines, local API production will stimulate economic growth, create high-quality jobs, and position Africa as a global player in pharmaceutical innovation. 

More than that, it will contribute to a resilient pharmaceutical industry, one that can respond to future health crises and provide long-term benefits to public health. While the journey to self-sufficiency is long and requires significant investment, the potential rewards—in terms of both health outcomes and economic impact—are undeniable.

About the authors

Hannes Malan is the Managing Director of Chemical Process Technologies (CPT), a leading company in the field of chemical synthesis and active pharmaceutical ingredient (API) manufacturing. With a strong background in chemical engineering and extensive experience in the pharmaceutical industry, Hannes has been instrumental in driving CPT’s mission to produce high-quality APIs locally in South Africa.

Dr Gerrit van der Klashorst is the Director of Business Development at Chemical Process Technologies (CPT) Pharma. With a Ph.D. in Chemistry and a robust background in pharmaceutical development, Gerrit plays a crucial role in driving CPT Pharma’s strategic initiatives and expanding its market presence.

Kelly Chibale is a full Professor of Organic Chemistry at the University of Cape Town (UCT) where he holds the Neville Isdell Chair in African-centric Drug Discovery & Development. He is also a Schmidt Sciences AI2050 Senior Fellow, Full Member of the UCT Institute of Infectious Disease & Molecular Medicine, the Founder and Director of the UCT Holistic Drug Discovery and Development (H3D) Centre, and Founder and Director of the H3D Foundation NPC.

Hannes Malan and Gerrit van der Klashorst are directors of CPT Pharma. Kelly Chibale is a board member as well as the Founder and Director of the University of Cape Town’s Holistic Drug Discovery and Development (H3D) Foundation, which is engaged in discovery research to develop new APIs and develop innovative processes for the manufacturing existing APIs in the African context.  

Note: Health Policy Watch publishes op-eds/inside views from a wide range of public and private sector actors, deemed to illustrate critical public health challenges and solutions. However, the views, opinions and facts expressed herein are solely those of the author(s) and do not necessarily reflect those of Health Policy Watch or its editorial team.

To submit an ‘inside view’ or ‘oped’, contact us at info@hp-watch.org.

Image Credits: WHO, Tommy Trenchard/ Global Fund, Development Reimagined, CPT/South Africa .

Dr Ngashi Ngongo (Africa CDC) and Dr Jean-Marie Yameogo (WHO), the continental co-leads on mpox.

Rwanda has recorded its 63rd Marburg case, while cases of children coinfected with both mpox and measles are rising in the Democratic Republic of Congo (DRC), according to officials at the Africa Centres for Disease Control and Prevention’s (CDC) weekly media briefing on Thursday.

After 10 days of no new cases, a health worker who has been caring for Marburg patients tested positive for the virus on Wednesday night, Rwandan Health Minister Dr Sabin Nsanzimana told the briefing.

But the health worker was vaccinated a few days ago and is “doing well” with disease presentation that was “not usual”, Nsanzimana added.

“The good thing is that the person has been in a treatment centre and has no contacts outside the centre,” he added. 

Meanwhile, the source of the Marburg outbreak has been traced to fruit bats in a cave where the index case had been mining, said Nsanzimana.

Once this had been confirmed, all human activity at the cave had been stopped and the government is following up on the people working there, to make sure they they don’t develop the disease, he added.

Genome sequencing of the virus confirmed that it was both very close to the zoonotic source – the virus in the bats – and to other Marburg cases imported into the country.

This underscored the importance of a One Health approach involving experts on human and  animal health and the environment, said Nsanzimana.

Mpox testing slowly improving

Some 2,729 new mpox cases were reported in the past week – over 90% of which in DRC and Burundi, although Liberia, Kenya and Uganda reported new cases, according to Dr Ngashi Ngongo, Africa CDC’s lead on mpox.

There has been an increase in mpox patients under the age of 15 being co-infected with measles in the DRC, particularly in Nord Kivu and Sud Kivu – but it is unclear whether one disease made children susceptible to the other. 

Little more than half the children in these areas have been vaccinated against measles and there is also a high malnutrition rate, which weakens the children’s immune systems, said Ngongo.

“We haven’t yet established if the fact that you get measles, then increase your chances of getting mpox and vice versa,” he added.

The DRC’s vaccination campaign underway in six provinces, was generally going well with over 39,000 people vaccinated. Nigeria plans to launch its vaccination campaign on 29 October.

“We have 5.6 million doses of mpox vaccines that have been confirmed, of which 2.5 million are MVA-BN and three million of the LC16 from Japan,” said Ngongo.

Close to 900,000 doses of MVA-BN are available this month October, with another 700,000 potentially available in November, which he described as being “enough, at least, for the moment, to cover the plans that we have received”.

However, getting vaccines for children remains a challenge although World Health Organization (WHO) has said that the MVA-BN can be used “off label” for children at risk.

After weeks of struggling to increase testing, there had been a 37% increase in tests in the past week – and a big jump in test positivity from 36.5% to 63%.

This can be attributed to training on sample management, PCR and Gene Xpert testing, more sequencing equipment, as well as the distribution of more Gene Xperts cartridges (to run the machines), and PCR tests being set to affected countries.

No new cases have been recorded in Cameroon, Gabon, Guinea, Rwanda and South Africa in the past four weeks.

However, surveillance has been a huge challenge, said Ngongo. Only four of the 18 affected countries had reached contact tracing targets of 10 per patient.

Meanwhile, the Robert Koch Institute in Germany reported the country’s first case of mpox Clade 1b. The patient recently traveled out of the country, but it not clear where he been. Outside of Africa, Sweden and Thailand have also each reported a case of mpox 1b, the more virulent version of the .

No policies with “significant implications for global emissions” were implemented worldwide in 2023.

Global efforts to reduce greenhouse gas emissions remain catastrophically off track, with current policies putting the world on course for a 3.1°C temperature rise by century’s end, the UN Environment Programme warned Thursday in its annual “Emissions Gap” report.

To keep the 1.5°C target alive, nations must slash emissions by 42% by 2030 and 57% by 2035 – yet emissions continue to climb, hitting record highs last year.

“Either leaders bridge the emissions gap or we plunge headlong into climate disaster with the poorest and most vulnerable suffering the most,” UN Secretary-General António Guterres told reporters at the report’s launch.

“The emissions gap is not an abstract notion. There is a direct link between increasing emissions and increasingly intense climate disasters worldwide,” Guterres said. “People are paying a terrible price.” 

Despite a year marked by devastating hurricanes, droughts and floods, no country implemented policies “with significant implications for global emissions in 2023,” UNEP found.

“Another year has passed without action, and that means we’re worse off,” said Ann Olhoff, the report’s lead scientific editor. “The findings are fairly similar to last year, apart from emissions still going up.”

Twenty-nine years after international climate talks began, the sum total of global climate pledges – known as Nationally Determined Contributions (NDCs) – would allow temperatures to rise by a “catastrophic” 2.6°C, even if fully implemented, according to the report. Most major economies, including many G20 nations, are failing to meet even these insufficient commitments – let alone achieve the 42% emissions cuts needed.

By mid-century, current trajectories point to warming well above 1.5°C, with up to a one-in-three chance of exceeding 2°C. The report warns that warming is expected to intensify beyond 2100, as CO2 emissions are not projected to reach net zero under existing scenarios.

Each year of delay makes the task harder: Global emissions must now fall 7.5% every year until 2035 to keep warming to 1.5 C. For a 2 C limit, yearly cuts of 4% are needed.

“If we procrastinate, that figure will obviously grow with every year of inaction,” said UNEP Executive Director Inger Andersen. “Nations must show a massive increase in ambition in these new NDCs, accompanied by rapid delivery, or the Paris Agreement goal of holding global warming to 1.5°C will be dead within a few years.”

With nations due to update their climate pledges ahead of COP30 in Brazil next year, UNEP says this represents a make-or-break moment. The new commitments must deliver what the agency calls a “quantum leap” to avoid planetary catastrophe.

“Limiting warming to 1.5°C is one of the greatest asks of the modern era,” Andersen said. “We may not make it. But the only certain path to failure is not trying.”

Going backwards

The Emissions Gap remains unchanged since UNEP issued the last edition of its annual report last year.

In a year that demanded cuts, emissions instead rose 1.3% to record levels in 2023, with coal accounting for 65% of the increase, according to the International Energy Agency.

While record deployments of renewable energy, nuclear power and electric vehicles helped curb emissions growth, they couldn’t keep pace with rising energy demand and the impact of severe droughts on hydropower generation.

Without this rapid expansion of clean technologies, emissions growth would have been three times higher, according to IEA data.

Only one pathway identified in the report halts warming beyond 2100: All 107 countries with net-zero pledges must deliver on their promises and quickly put their plans into action. This could cap warming at 1.9°C, but UNEP has “low” confidence countries will follow through. Countries accounting for 82% of global emissions have made net-zero promises, but progress has stalled.

“Current policies, conditional NDCs, unconditional NDCs – in any of these scenarios, whether emissions peak and fall a small amount or plateau, all of them represent a lost decade,” said Neil Grant, a lead author of the report.

“Winning slowly is the same as losing when it comes to climate change.”

G20 nations must ‘do the heavy lifting’

Just six countries accounted for 63% of global emissions in 2023, with the least developed nations contributing only 3%, highlighting particular concerns about inaction among major emitters, especially the G20.

“We identified very few newly adopted policies [by G20 nations] underpinned by quantitative assessments that deliver considerable emission reduction impact by 2030 or beyond. This is very worrying,” said Takeshi Kuramochi, lead author of the G20 section of the report. “It’s been a calm past 12 months, in a negative way.”

Seven G20 members – China, India, Indonesia, Mexico, Saudi Arabia, South Korea and Turkey – have not yet reached peak emissions, a pre-requisite to achieving net zero. For G20 nations that have peaked, including the US, EU, Russia and Canada, “their rate of decarbonization would need to accelerate – in some cases dramatically – after 2030 to achieve their net-zero goals unless they accelerate action now,” UNEP found.

“We must remember that 1.5°C is not an on-off switch that will plunge the world into an era of darkness and chaos,” Andersen said. “We are operating on a sliding scale of disruption. Every fraction of a degree avoided counts in terms of lives saved, economies protected, damages avoided, biodiversity conserved.” 

“The G20, particularly the members that dominate emissions, need to do the heavy lifting,” Andersen added. “Climate crunch time is here.”

‘Wartime’ mobilization is required to keep 1.5C alive

While there is “no chance” of limiting global warming to 1.5C under current policies, UNEP insists the target remains “technically possible” – but only through “immediate global mobilization on a scale and pace only ever seen following a global conflict.” 

A sweeping transformation of energy, transport, and land use could cut 31 gigatonnes of CO2 annually – equivalent to 52% of global emissions – through existing technologies costing less than $200 per ton of carbon, UNEP estimates.

Solar and wind energy alone could deliver 27% of required emissions cuts by 2030, rising to 38% by 2035, while forest protection and restoration could contribute another 20%. Together, these measures would deliver the steep emissions cuts scientists say are needed to keep 1.5C alive.

“Nations can deliver the cuts needed by investing heavily in solar power and wind energy, in forests, in reforming the buildings, transport and industry sectors,” Andersen said. “This is a gargantuan task that requires global mobilization on a scale and pace never seen before. But it does, for the moment, remain technically possible.”

The price tag for this transformation is steep but achievable, according to UNEP. Annual investment in mitigation measures must increase six-fold to 11.7$ trillion per year by 2035 – approximately 10% of the global economy.

“These investments don’t even take all the benefits into account and the avoided damages,” Olhoff said. “It would be very costly not to invest in a green transition.”

This is a developing story and will be updated.

Image Credits: Joanne Francis.

Final phase of oral polio vaccine campaign in northern Gaza has been postponed due to escalating violence.

The final phase of a planned polio campaign in northern Gaza has been postponed due to escalating violence in the area, the World Health Organization announced on Wednesday.

“Due to the escalating violence, intense bombardment, mass displacement orders, and lack of assured humanitarian pauses across most of northern Gaza, the Polio Technical Committee for Gaza… and partners have been compelled to postpone the third phase of the polio vaccination campaign, which was set to begin today,” WHO said in a press statement. “This final phase of the ongoing campaign aimed to vaccinate 119 279 children across northern Gaza.”

Since 14 October, the campaign to administer a second oral polio dose (nOPV2) to Gaza children under the age of 10 was rolled out successfully in central and southern Gazan regions, reaching some 442,885 children, WHO said.   It followed a first-dose oral polio vaccine campaign in September that succeeded in reaching 559,161 children, or an estimated 95% of those eligible, during a series of pre-arranged ‘humanitarian pauses’ that both Israel and Hamas observed.

The campaign followed on the identification of vaccine derived poliovirus in sewage over the summer, followed by a confirmed case of the paralytic disease in a ten-month old baby.

Second round faces more challenging circumstances

However, the second and final vaccination round, which began 14 October has taken place under much more challenging circumstances, particularly in northern Gaza where Israel has launched a major new military initiative in and around Jabalia refugee camp, ostensibly to root out Hamas forces that have resumed operations in the area; on 7 October, the anniversary of the first Hamas incursion into southern Israel, a barrage of missiles launched from nothern Gaza triggered sirens in Israel as far as Tel Aviv.  Palestinians and UN human rights agencies, however, have charged that the Israeli bombardment of Jabalia is part of a campaign to “ethnically cleanse” the northern part of the 365 square kilometer enclave, to make way for renewed Jewish resettlement of Gaza.

WHO has said that the escalation in violence made the final phase of the vaccine campaign impossible to execute right now.

“Given that the area currently approved for temporary humanitarian pauses was substantially reduced—now limited only to Gaza City, a significant decrease from the first round—many children in northern Gaza would have missed out on the polio vaccine dose,” WHO said in its statement.

Mass evacuation orders issued by Israel for people still living in Jabalia and other areas outside of Gaza City, would have also impeded the campaign’s reach, WHO said. Some 20,000 people have reportedly fled Jabalya in recent days.

“To interrupt poliovirus transmission, at least 90% of all children in every community and neighbourhood must be vaccinated – a prerequisite for an effective campaign to interrupt the outbreak and prevent its further spread,” WHO said. “Humanitarian pauses are essential for its success, allowing partners to deliver vaccination supplies to health facilities, families to safely access vaccination sites, and mobile teams of health workers to reach children in their communities,” it added warning that, “a delay in administering a second dose of nOPV2 within six weeks reduces the impact of two closely spaced rounds, concurrently boosting the immunity of all children and interrupting poliovirus transmission.”

Barriers to medical evacuations and hospital resupply

The increased violence has also impeded medical evacuations as well as the delivery of vital medical supplies to still partially-functioning hospitals, WHO said in a separate statement on Tuesday.

On a high-risk mission to northern Gaza on 20-21 October, WHO managed to evacuate 14 patiens and 10 caregivers, but was prevented from delivering “critical medical supplies, blood and fuel” to two Kamal Adwan and Al-Awda Hospitals, two partially functioning facilities still serving the area.

“Despite an initial agreement, the delivery of critical medical supplies, blood, and fuel – resources essential for keeping Kamal Adwan and Al-Awda hospitals operational – was denied just a few hours before the mission began on 20 October,” WHO said in a separate statement Tuesday.

The stepped-up fighting in Gaza takes place against the background of escalating violence between Israel and Lebanon, following Israel’s assassination of Hezbollah leader and Hamas ally, Hassan Nasrallah, on 27 September.  That has included heavy Israeli bombing of alleged Hezbollah targets as far north as Beirut, and hundreds of Hezbollah missiles fired into northern and central Israeli cities daily.  Against that landscape, WHO’s Director General Dr Tedros Adhanom Ghebreyesus, last week protested the fact that nearly a dozen hospitals in southern Lebanon have been forced to curtail activities or close, while flight cancellations to Beirut airport have also impeded the delivery of vital aid to the country.

Image Credits: WHO.

Drought in Burkina Faso, yet another sign of climate change impacting health and livelihoods.

As health actors ramp up their game on climate change, in advance of the next UN Climate Conference (COP 29), the fact that global warming poses an ‘existential threat’ to health has become almost cliché. 

From extreme heat and flooding to the impact of drought on hunger and fossil fuel emissions that drive hazardous air pollution, the multiple, inter-related challenges remain difficult for policymakers to appreciate and even for scientists to measure – using classical methods of health research.   

Even so, global health actors are digging deeper beneath truisms in an effort to map, track and address a vast web of interactions – as well as synergies that could be obtained from more sustainable policies.  But as long as the world’s governments continue to pour billions of dollars of investments and trillions into fossil fuel subsidies, they face an upward battle. Meanwhile, the Green Climate Fund funded only one renewable energy project in Africa in the past four years. 

Those challenges were a cross-cutting theme at last week’s World Health Summit in Berlin, which devoted almost an entire day of its two-day event to health-related aspects of the climate question – from strategy sessions on how to amplify health and climate research and investments to the panels on the health damage done by fossil fuel investments.  Here’s a snapshot of what was discussed.  

Multiple health linkages of increasing levels of complexity

In a world dominated by medical models of research that emphasizes randomized clinical trials testing new vaccines and medicines, conclusive “proof” of the chain of climate impacts on health in many domains, remains elusive. 

But the range of unknowns and the need for more research, should not be an excuse for inaction either, say leading health voices, including Global Fund Director Peter Sands. 

“It’s absolutely true that there’s a lot about the impact of climate on health that we don’t understand, we need research – but that should not be an excuse for not doing anything. There’s much that’s a no-brainer …so we can’t let the need to know more get in the way of acting”, declared Sands at a plenary event on the closing day of the World Health Summit. 

Global Fund director Peter Sands – some climate actions are a ‘no brainer’ for health

Research methods exist, but funding lacking to draw conclusions about local impacts

In the no-brainer category, 30 years of research exists documenting the fact air pollution is a leading risk to health, killing some 7-8 million people annually – and fossil fuels are a major contributor to air pollution. Two decades of transport and health research also lends itself to clear, quantifiable conclusions about the benefits of curbing traffic, to reduce pollution and stimulate healthier alternatives like cycling and walking.  

For example, a recent study on the impact of London’s ultra-Low Emission vehicle zone documented how the ULEZ has not only reduced health damaging air pollution but stimulated more pedestrian activity, including a 40% uptick in children walking to school. That’s a knock-on effect of reduced traffic congestion However, traffic planners in developing cities that badly need to undertake such assessments, rarely have the money or technical tools to do so. They use standard traffic models that simply predict vehicle growth and, against that, recommend road-widening as economically beneficial – without regards for any externalities like air pollution, traffic injury or physical activity. 

Research linking climate and health outcomes – as a tool for policy action 

Wellcome’s Alan Dangour, Center, flanked by former Hong Kong Health undersecretary, Gabriel Leung (right) and Vanina Laurent-Ledru, Foundation S (left).

And then there are the even more complex range of ecosystem interactions – that are even more difficult to quantify in terms of linear cause and effect.  

Take deforestation, for instance. Along with leading to more CO2 release, deforestation stimulates biodiversity loss. That, in turn, affects rainfall patterns and water resource access, as well as leading to the migration of dangerous pathogens from the wild into human populations – which can in turn lead to more outbreaks, epidemics and pandemics.  

The multiple interrelationships can leave even the most expert health researchers and their funders scratching their heads over how to document such critical connections – and offer policymakers clear evidence of how unsustainable choices, e.g. how burning down a forest to expand soybeans crops for factory beef production [which also emits significant CO2], can be devastating for health in multiple arenas. 

One thing is increasingly clear, however, the old research models need to be re-invented, given the urgency of the moment, said Alan Dangour, the lead on climate change at the UK-based Wellcome Trust, one of the world’s oldest health research philanthropies, which has made climate and health a key part of its new strategic portfolio, including a $25 million grant to the World Health Organization, announced at the Berlin conference. 

The priority, said Dangour at WHS, needs to be “delivering research that is a pathway to impact rather than purely academic research- which is what academia is classically trained to do.

“We are here to say the urgency is now. The need is now. We must be delivering research that can be used… which is impactful, links to communities … and can engage policymakers and policy processes.”

Making catalytic investments in health and climate   

Nearly a 10-fold growth in donor funding at the climate and health nexus (2018-2022)

In line with the increased interest in health, donor funding at the climate and health nexus has also ballooned from less than $1 billion in 2018 7.5 – 9 billion in 2022- with further commitments since COP28, according to a landscape review of commitments by OECD donors, presented at another, more intimate WHS session, co-sponsored by Rockefeller Foundation. The Foundation has also made climate and health a key part of its strategic portfolio. 

But those investments still pale in comparison to the estimated $7 trillion in direct and indirect subsidies (2022), which the fossil fuel industry is receiving from governments, including nearly $1.7 trillion in direct subsides such as corporate tax breaks, multilateral bank and other public investments, consumer price controls and other incentives.  In terms of the other $5+ trillion in indirect, or ‘implicit’ subsidies,  air pollution impacts on health and climate damage are among the largest uncounted costs, accounting for about 30%  each, according to the International Monetary Fund.

Subsidies to the fossil fuel industry, direct and indirect (IMF 2022 data).

It’s no surprise then, that clean energy investments remain stagnant in key developing regions, such as Africa. And finance is due to be a major issue on the agenda of the upcoming Climate Conference (COP 29) scheduled for 11-22 November in Baku, Azerbaijan. There, member states are supposed to finalize an agreement on a New Collective Quantified Goal for climate finance to support low income countries’ transition to a low-carbon future.  

Against that landscape, health actors – from UN agencies to government ministries and foundations and philanthropies –  are asking themselves what kinds of catalytic investments should be at the top of the list of their ‘asks’ or conversely, at the top of donor priorities  – so as to amplify the climate and health synergies.   

A two intimae sessions on Monday and Tuesday, several dozen key players in the philanthropic world huddled together with a select group of thinkers from governments in Africa and Europe, and WHO officials to ponder the optimal entry points. Key priorities that seemed to resonate included: 

  • Investments in more climate resilient health systems – which range from energy starved clinics in developing countries to high tech, high energy modern medical centers that leave a massive carbon footprint.  
  • Investments in country- and community-based research that document health co-benefits of climate mitigation; 
  • Investments in stronger engagement and advocacy with economic sectors, like energy and climate, whose upstream climate investments affect health; currently only .5% of multilateral climate finance explicitly targets health, according to WHO. 

Demonstrating local impacts on health

Damage wreaked by cyclone Idai in Mozambique in 2022 – one of the top countries in the world, in terms of extreme climate events.

“Climate change, for many of the policymakers in our countries, is a kind of new knowledge.  And one of the barriers [to action] is a lack of evidence that demonstrates how climate change is having a serious impact on health,” said Dr Eduardo Samo Gudo, director of Mozambique’s National Institute of Health, at the WHS session. 

That, despite the fact that Mozambique has now  become one of the six top countries in the world in terms of its experience of extreme climate events, he added.  

“So looking at the components that we think are urgent in terms of investment in our countries, the first is on evidence…. While there are many other competing issues, HIV, malaria, TB, and many others, conducting vulnerability assessment of the impact of climate change on health in our country is really crucial to demonstrate to the stakeholders that make decisions,  how serious this business is, in comparison with other diseases.”

Mozambique is one of only 11 countries out of 132 low- and middle income nations that has even developed a ‘health national adaptation plan (HNAP)’ for climate change. 

But even after such an assessment has been made, the vertical structure of international aid, dedicated to specific diseases, makes it challenging to implement a cross-cutting plan.  

“Why?  Because the funding is siloed.  We have Global Fund for HIV, Gavi [the Vaccine Alliance], for immunization and so forth.” 

Finally, he said, despite considerable hype at last year’s COP about the health sector’s own energy needs, little climate funding has been directed to promoting clean energy in the health sector. 

In OECD countries, China and India, the modern health sector’s footprint is estimated to be some 5% of national climate emissions while nearly a billion people worldwide, mostly in Africa, are either served by health clinics powered by costly and efficient diesel generators or no access to reliable electricity at all. 

“Everyone forgot that the health system is also contributing to emissions. But when you look at the ‘Nationally Determined Contributions’ (NDCs), health is not there,” Gudo lamented.

Solar panels provide electricity to Mulalika health clinic in Zambia; but thousands of African facilities still lack clean, reliable energy services.

Attuning climate and health programmes to needs a community level 

Whether it’s energy, transport or more resilient health systems, changes designed by national ministries have to be attuned to the needs of the communities where they are to be implemented, said Dr Akosua A Owusu-Sarpong, Director of Health at the Accra Municipality, Ghana. And that’s another big challenge. 

“There’s little knowledge about climate change and health at the local level,” she observed. “Most of the time, these kinds of engagements are done at the national level. But you have to bring the knowledge down to the local level to understand what we are trying to attain in terms of immunization, infectious diseases, neglected tropical diseases – otherwise, the implementation becomes a challenge. 

“And when funders come in… some funders come in with their pre-prepared plan, and if that’s not what the community needs, it becomes a challenge.”

Finally, many climate-related plans that benefit health require cooperation between ministries other than health; empowering local government actors to take initiative and fund projects could help facilitate that process.    

“When it comes to the local level, we still have the same [vertical] pattern of ministries. If there was more district decentralization of ministries [such as] health, transport and environment, at the local level, they could also work hand in hand,” she said.   

Fossil fuel subsidy reform – ‘indispensable’ to health   

(Standing) Jeni Miller, Global Climate and Health Alliance at session on fossil fuels.

But to really leverage action, governments need to  close the tap on fossil fuels subsidies and investments, powering most of the planet’s unhealthy development, to achieve long-term, meaningful health benefits, panelists said at another WHS closing day session, on the fossil fuel subsidy reform as “indispensable” to a healthy energy transition. 

The meeting came against the background of a recent Clean Air Fund analysis documenting how international aid to low- and middle-income nations for fossil fuel projects increased nearly fourfold over the past year (2022-2023) to $5.4 billion.

Leading investors included: the Islamic Development Bank, Japan International Cooperation Agency, the Asian Development Bank, the European Bank for Reconstruction and Development and the World Bank’s private sector arm, the International Finance Corporation (IFC).  

And that’s only part of the picture.  Between 2020-2022, G20 countries spent $142 billion in international public finance to expand fossil fuel operations – three times more than monies invested in clean energy. And this despite a G7 pledge to stop funding such projects by 2022, according to an April 2024 study by Oil Change International and Friends of the Earth. 

Renewable energy investments (dark blue) in Africa, Latin America and South-East Asia lag far behind China, the United States and the European Union.

Health case for a just transition away from fossil fuels is really clear

“The health case for a just transition away from fossil fuels is really clear,” declared Jeni Miller, of the Global Climate and Health Alliance, which co-sponsored the session. 

“Current health systems based on fossil fuels are driving tremendous impacts on people’s health, and that’s climate change, certainly, but fossil fuels have many, many other health impacts on people, and that’s from the extraction process through transport all the way through end use. And this is happening in communities all over the world. It’s driving air and soil and water pollution. It’s also having occupational health impacts. 

“They [impacts] are borne by families when kids are out of school with asthma.. And the industry is not covering those health costs. Those health costs are borne by health systems.

“And while we know that energy access is a vitally important determinant of health, the fossil fuel approach has not gotten that done either,” said Miller, referring to the nearly 600 million Africans still lack access to electricity at home. 

An estimated 600 million Africans lack access to electricity in their homes.

In South-East Asia, millions of rural Indians have been left out of the LPG boom that has benefited urban areas, noted Sunil Mani of Canada’s International Institute for Sustainable Development.  

“Obviously the [investment by] development banks and development agencies is only a drop in the ocean compared to indirect fossil fuel subsidies of some $5.4 trillion a year,” said Nina Rensaw, of the Clean Air Fund, noting that the latter costs, largely health-related, represent an estimated 6% drain on global GDP.

Africa is one of three regions of the world where demand for oil has grown sharply over the past two years (2022-2023) – as compared to 2015-2023. [The other two are Southeast Asia and the Middle East]. 

This, at a time where oil demand had dropped in absolute terms in Europe and North America. In China, as well, the pace of growth has declined to almost ‘0’ as compared to the previous decade, according to the latest International Energy Agency data.  

Climate or not, the rush to expand oil, gas, and oil shale extraction is in full-swing, from Nigeria and Ghana in the west to Tanzania, Kenya in the east, as well as within the Democratic Republic of Congo’s rich tropical forests.  

Green Climate Fund – only one African renewable energy project approved since 2021

(On left) Sunil Mani, IISD

Meanwhile, in the online portfolio of some 200 projects of the Green Climate Fund, the world’s largest dedicated climate finance instrument, only one African renewable energy project was approved over the past four years. That  was in Ghana in 2021, according to the online dashboard.  Four other previously-approved projects involving multiple countries are still ongoing.  

This is despite the fact that clean energy grids may have the largest array of multiple, cascading for health, that can be derived from climate investments. They open up new vistas not only for outdoor air pollution mitigation, but also for electrification of homes and health facilities, with knock-on benefits to women’s and girl’s health and gender equality. When harnessed to greener urban design, they can stimulate healthier, more climate resilient cities that reduce urban heat island impacts, stimulate electrified transit, increase physical activity, and more.  

Green Climate Fund: Just one new clean energy project in Africa since 2021. Four other earlier projects remain under implementation.

Admittedly, the GCF remains chronically underfunded. it was supposed to receive $100 billion annually from donor countries already in 2020; instead its portfolio reached just $13.5 billion as of December 2023.  

But the key lever to change, observed Mani, of IISD, is not donor funding; it is political will.  

“One of the key reasons many policymakers or industry leaders argued for the continuation of subsidies for fossil fuel use [in the past] was because of its price advantage – of course made possible with government subsidies.  But in China, for example. the unit price of electricity generated by solar power is about $.20-.35 cents, as compared to $.45 for electricity generated by [conventional] thermal power. “The reasons that were used to justify the use of fossil fuels in the past don’t hold anymore.

“So, in my view, it really depends on how our political leaders commit to make a transition from relying heavily on fossil fuels to cleaner, more sustainable types of energy. 

“From a political standpoint, it is very hard for the existing industries to give up their territory to new technologies. 

“That’s why we are arguing for the market to be as competitive as possible, so that new commerce can come into the market with their so-called ‘creative disruptions’.” 

No private sector incentives for African renewables   

Solar field in Burundi, one of the few operating in Africa, generates some 7.5 MW of power. It increased national power capacity by 15% when it opened in 2020.

Against the billions allotted to oil and gas, small and medium sized solar developers in the private sector face multiple hurdles and delays in raising just a few million dollars to get projects off the ground, observed one leading private solar developer, heavily invested in Africa. 

“For all the talk and pledges about fixing climate finance for renewables in Least Developed Nations, there is virtually still none available for serious project preparation for the private sector,”  Josef Abramowitz told Health Policy Watch.  

Nine  years ago, his firm launched the first-ever solar field of 8.5 MW in Rwanda, increasing national power generation capacity by 6%. That was followed by a 7.5 MW field in conflict-ridden  Burundi in 2020, named Energy and Environment Trust Fund (EEP) Africa project of the year. The company currently has 10 other African projects in the pipeline in places ranging from Juba, South Sudan, which runs entirely on diesel generators, to Zambia. Most are still waiting for small grants or loans of $2-4 million to finalize project planning – that kind of finance is extremely scarce. 

“Project preparation means all of these studies and permits, which also get government agencies aligned and on board,” Abramowitz explained. “Once that’s all sewn together in a bankable beautiful bow, everyone is happy to put equity into these projects. But if there is no real money for project preparation, and it takes 5-10 years for a project to mature, it’s not worth it for the private sector to go in because of the high risk and long lead times. 

 “The net result is that trillions of dollars are available for project finance, which will never be unlocked and deployed without a massive increase in pre-development grants to platforms with pipelines and proven teams.”

Image Credits: Gellscom/CC BY-ND 2.0., Yoda Adaman/ Unsplash, US Centers for Disease Control and Prevention, HP-Watch, SEEK/World Health Summit, International Monetary Fund , WHO, UNDP/Karin Schermbrucker for Slingshot , IEA , Statista.com, Green Climate Fund, Energy and Environment Partnership Trust Fund Africa .

The venue of COP29 in Baku, Azerbaijan.

The United Nations (UN) climate change meeting, COP29, will feature a Health Day on 18 November as part of the negotiations in Baku, Azerbaijan.

The World Health Organization’s (WHO) Maria Neira said that the global body wants to ensure that health is “very prominent” in all the member states’ climate negotiations, which run from 11-22 November.

“We have two objectives. One is making sure that everybody understands that the climate crisis is a health crisis, and that climate change is negatively affecting our health, and we need to respond to that,” Neira told a media briefing on Wednesday.

“The second objective is to convince all the negotiators, participants, and member states that whatever they do to mitigate the process of climate change will have enormous potential health benefits,” said Neira, who directs the WHO’s Department of Public Health, Environment and Social Determinants of Health.

The Health Day will kick off with a high-level meeting on the Baku Initiative on Human Development for Climate Resilience, which aims to strengthen human development to address climate change, particularly in education, health, social protection, and green jobs and skills.

COP29 presidency official Elmar Mammador

“As part of the Baku initiative’s guiding principles, we emphasize the importance of science, knowledge generation and sharing as a part of the climate action,” COP presidency official Elmar Mammador told the briefing.

Other events focused on food, agriculture and water have health implications, while a high-level roundtable on 19 November on One Health “highlights the interconnectedness of human, animal and environmental health”, he added.

Mammador said that nine declarations had been finalised so far and some also offered opportunities for health interventions, including green energy, organic waste and pathways to resilient and healthy cities. 

A high-level meeting on resilient cities will be held on 20 November, which includes the integration of health in city planning.

“The President’s Climate and Health Continuity Coalition will have as one of its focus areas a platform where stakeholders can share reports and research findings on climate and health, and on biodiversity and health. Human health is inseparable from the health of our ecosystems, and biodiversity is essential to safeguarding human health,” said Mammador.

The WHO, in collaboration with the Wellcome Trust, is also hosting a Health Pavilion at the COP29 which aims to “ensure health and equity are placed at the centre of climate negotiations”, according to WHO. 

“It will offer a rich two-week programme of events showcasing evidence, initiatives and solutions to maximize the health benefits of tackling climate change across regions, sectors and communities,” said Neira.