Deputy UN Secretary-General Amina Mohammed delivers remarks at the opening of the High-Level Meeting on Friday.

The Political Declaration on Pandemic Prevention, Preparedness and Response was not approved by consensus by the United Nations General Assembly, and is likely to be put to a vote at a later stage on the UN calendar. 

Objections by the United States and a few other states appeared to block a consensus agreement on the draft text at Friday’s high-profile UN High-Level Meeting (HLM) on pandemics, pushing the issue back to the General Assembly, where it could go to a vote before the close of the Assembly’s annual session in December. 

“The United States is not in a position to support this text in full,” said the US representative at the debate. “Critical issues remain unresolved. Whether it is the inclusion of divisive ideologies that lack definitional consensus or references to an unfinished negotiation on pathogen access and benefit sharing in an agreement that failed to achieve international consensus, the United States is not in a position to support this text,” she said.  

Several delegations had come expecting to adopt the text on Friday. Peru said it hoped the declaration would be adopted “this afternoon,” while Cabo Verde referred to the declaration “we are approving today.” The Netherlands said it “regrets that member states have not been able to reach agreement on a common political outcome.”

Closing the meeting, General Assembly President Khalilur Rahman said that “while there is broad support for the text, there continue to be some observations.” The document “will be considered further by the member states in the General Assembly,” he said. No date was given before the session closed for when this will occur.

Support from Africa and Caribbean

On behalf of the African group, Cabo Verde and Burundi welcome the declaration.

The declaration drew strong support from African nations, led by Burundi, which delivered the statement on behalf of the African group, and Cabo Verde, and from major Latin American and Caribbean countries including Brazil, Mexico and Haiti, which spoke for the Caribbean Community (CARICOM) at Friday’s debate. 

In Asia, developing countries like Bangladesh said they “welcome the political declaration and its vision and call for solidarity.” 

The European Union said it remains “fully committed” to the declaration’s “overarching objective” – signaling that the 27-member bloc would not oppose the declaration’s passage.

But the EU representative also expressed reservations, stating the text “falls short of our goals” and set out “explicit red lines.” Its statement took particular issue with language in the draft text that supported heavy reliance on international trade rules allowing countries to issue “compulsory licensing” in health emergencies, saying it could undermine intellectual property. Technology transfer must be “voluntary and on mutually agreed terms,” the EU said, emphasising the importance of such arrangements with low- and middle-income countries.

Italy went further, saying that it “had concerns regarding the political declaration,” noting that it “did not support he adoption of the WHO Pandemic Agreement,  nor the 2024 amendments to the International Health Regulations,” suggesting that the changes expand the WHO’s role beyond its constitutional mandate to a degree that impinges on national sovereignty.

Italy also objected to terms such as “infodemic management,” misinformation and disinformation, saying they lack an agreed definition. It added that references to financing, technology transfer and intellectual property were “non-binding.”

Other countries also registered reservations. India called the declaration non-binding and said it “must not prejudge” the ongoing PABS negotiations. Germany said it “would have hoped for a more balanced approach,” stressing voluntary technology transfer.

Venezuela, speaking for the Group of Friends in Defense of the UN Charter, said only that the group “takes note” of the declaration.

WHO urges rapid approval of pathogen access talks

WHO Director General Dr Tedros Adhanom Ghebreyesus urges support for the UN declaration

WHO’s Director General Dr Tedros Adhanom Ghebreyesus, meanwhile, affirmed that the recent WHO agreements do not impinge on national sovereignty and urged member states to reach a rapid conclusion on the Pathogen and Benefit Sharing (PABS) annex to the WHO Pandemic Agreement, approved in 2025. 

A bitter standoff between developing countries and high-income European nations has stalled progress on the annex, which aims to hammer out a more precise, rules-based approach for ensuring immediate sharing of pathogen samples and genetic sequence data – but also guarantee benefits to developing countries that participate in sample sharing, from the drugs, diagnostics and vaccines thus produced.

“Today, I leave you with just one request, just one,” said Tedros, “Get PABS done as soon as possible. Further delays are not just delays in procedure or process. They are delays that cost all countries daily when the next pandemic arrives. 

“We can never say the world is ready enough. The threat evolves and so must we,” he added. “Is the world more ready than it was before COVID-19? Yes and no. And if you fulfil the commitments you’re making today, you will make it a yes.”

Helen Clark, co-chair of The Independent Panel and former New Zealand Prime Minister, calls for rapid conclusion of the PABS annex of the WHO Pandemic Agreement.

Tedros’ appeal was echoed by former New Zealand Prime Minister Helen Clark, co-chair of the Independent Panel, which issued a biting report in 2021 on shortcomings in global preparedness and response. She cited the recent outbreaks of hantavirus and the Ebola Bundibugyo virus as examples of heightened outbreak risks that the world faces today.

“We can and we must do better at anticipating and managing known risks before they become international emergencies.”

On the plus side, she noted how “good, updated International Health Regulations” had tightened countries’ reporting obligations to WHO, leading to a rapid WHO declaration of a public health emergency of international concern over the Bundibugyo outbreak within two days of its confirmation, with Africa CDC following a day later. 

“But we now know that the virus had been spreading for some time,” she added, noting that surveillance of emerging threats remains inadequate. 

Along with more pandemic finance, the world needs global coordination, she emphasised, urging rapid approval of the PABS annex. The 2025 WHO Pandemic Agreement cannot go to member state signature, ratification and implementation before the PABS annex is finalised, she underlined. 

“A path must be found through the current impasse in negotiations,” she said. “That path must support the fast sharing of pathogen samples and sequence information, and it must. and it must ensure guaranteed access to benefits. My call, like that of Dr Tedros, to leaders around the world is to please put your weight behind these negotiations.” 

Developing nations call for approval of PABS annex 

The PABS annex aims to set up an enforceable system for implementing a 20% set-aside of real-time health products to countries in need, as mandated in the overall Pandemic Agreement approved last year.  According to the agreement, 10% would be provided free of charge and 10% would be provided at non-profit prices.  

“Kenya supports rapid WHO access targeting at least 20% of real-time production, clear positions on sequence information, and enforceable arrangements that deliver benefits when they are most needed,” said the Kenyan delegate at the HLM, as one expression of developing country positions. 

“We must ensure that the rapid sharing of pathogens and scientific information is matched by the rapid, fair, and equitable sharing of the benefits arising from their use, including vaccines, diagnostics, and therapeutics, and that countries contributing pathogens and genomic information can meaningfully benefit from the products and technologies developed from them,” added Egypt.

Belgium told the meeting that the PABS talks had “stalled, with little progress since the 2025 World Health Assembly.” Estonia urged countries to reach a compromise no later than the World Health Assembly in May 2027. 

Pandemic Agreement Negotiator Warns Against Losing Momentum

US bilateral deals are elephant in the room of PABS negotiations

Pandemic Accords UN
“The US is not in a position to support this text in full,” said the US delegate at the High Level Meeting on PPPR. US bilateral deals also threaten the future of the international agreement forged by WHO.

The elephant in the room holding up an agreement is, in fact,  the United States’ declared opposition to any multilateral pandemic accord, one former European negotiator told Health Policy Watch just ahead of Friday’s debate.  

Instead, the US is setting up bilateral deals with dozens of low-income nations whereby it would be assured of access to pathogen data as a part of donor assistance packages, but with no express guarantees of real-time products for pandemics and health emergencies. 

In its statement on Friday, the US said it “stands ready to work directly with responsible partners” to strengthen preparedness and “stop dangerous outbreaks at their source.”

Europe is therefore fearful that should it sign onto a PABS agreement that provides for strictly linked provisions on pathogen access and benefit sharing, its pharma industries will be hamstrung, in comparison to US-based manufacturing powerhouses that face no such financial or technical limitations. 

“That’s the elephant in the room holding up a PABS agreement,” the former negotiator said, on condition of anonymity. 

“The US has pursued specimen-sharing agreements with a number of countries, although the full extent and how it will practically interact with a future PABS system is unclear,” observed one Geneva-based NGO expert. “That potentially creates a competing pathway whereby pathogens/materials could reach US actors”  – while manufacturers participating in a PABS benefit-sharing system are left out in the cold. 

Other major powers weighed in on the declaration to varying degrees. While China backed WHO’s “leading and coordinating role” and called for progress in the pandemic agreement negotiations, it did not take a firm stance on whether it supports the declaration as written.

“At present, unilateralism is causing growing shocks. The health divide continues to widen, and the gap in health financing has become increasingly evident,” China’s delegate said.

The delegate called for countries to “advance the relevant negotiations and deliberations on the pandemic agreement,” and to “urge developed countries to genuinely fulfil their commitments by providing developing countries with technological and financial support, so that no country or no one is left behind.”

Russia also took the floor, but like China, elected not to state its position on the declaration. It cited its Covid-19 vaccine deliveries to 71 countries and its own Ebola vaccine, and argued that “bureaucratic barriers and politicization should not stand in the way of saving human lives.”

Civil society and industry response to HLM declaration  

Meanwhile, NGO access groups expressed disappointment at the delays in adoption of the Political Declaration – while pharma actors issued statements of support.

“We are disappointed that UN Member States are putting off adoption of the Political Declaration, as we risk losing momentum at a time when global cooperation has never been more crucial, leaving the world less prepared for and protected from the next pandemic,” said Rachel Cohen, senior advisor at the Geneva-based Drugs for Neglected Diseases initiative (DNDi). 

“Despite this setback, we have been encouraged over the last week to hear countries repeatedly recognise that research and development (R&D), including the goal of developing medical countermeasures within 100 days of an outbreak being identified, must be at the core of pandemic preparedness efforts and equitable access must be built into the R&D process by design. UN member states can and should move ahead, especially within regional and cross-regional coalitions and alliances, to put the commitments in the draft Declaration into action.  

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) affirmed its support for a multilateral agreement governing pathogen access saying: 

“We are calling for global frameworks that support rapid and effective action by facilitating the timely sharing of pathogen samples and scientific information, strengthening research and development, and enabling regulatory cooperation. They should also support practical measures such as day-zero financing and coordinated response mechanisms that allow partners to mobilise quickly when new threats emerge. The objective must be to accelerate collaboration and innovation, not create additional barriers or complexity during a crisis.”   

One Health approaches need more development

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, including snakes, rats, hedgehogs, raccoon dogs, marmots, and hog badgers, provided a fertile ground for initial transmission of the SARS-CoV2 virus to humans.

While many member states spoke about the importance of strengthening One Health approaches, also endorsed in the declaration text, there is little detail in the text about how to do that.

Prevention of pathogens from escaping the wild into human communities through deforestation, wild animal trade, water and sanitation and other pathways, civil society actors stressed.

“We particularly appreciate the Declaration’s endorsement of an integrated One Health approach, which recognises the interconnectedness of human, animal and environmental health and the need to address the drivers of disease emergence and pathogen spillover,” said a Pandemics and Animal Welfare (PAW) Working group in a joint statement to the HLM.

“At the same time, we note that, even though most emerging infectious diseases are zoonotic, references to animals remain limited throughout the Declaration, while animal welfare receives no explicit recognition.

“To strengthen prevention efforts, member states should place greater emphasis on addressing pandemic risks at their source. This requires a clear commitment to identifying and mitigating the practices and conditions that create opportunities for pathogen spillover, including biodiversity loss, habitat disruption, wildlife exploitation and trade, and animal production systems.”

Image Credits: Nature .

World leaders on Thursday approved the first United Nations declaration on sea level rise, affirming that nations losing land to the ocean will keep their statehood and maritime rights, as a new UN report warned that up to 1.2 billion people could be displaced by 2050.

Championed by small island states, the declaration affirms a “presumption in favour of continued statehood,” including membership of the UN.

Statehood under international law has long rested on a defined territory and a permanent population, leaving low-lying nations facing the prospect that losing their land could mean losing their UN seat, their citizens’ nationality and the vast ocean zones that fund their governments. Kiribati’s territory spans 3.5 million square kilometres of ocean, but just 0.02% of it is land.

The declaration also affirms that maritime zones, once established under the UN Convention on the Law of the Sea, remain stable as coastlines retreat. It commits states to expand early warning systems and risk data, calls for more accessible finance for adaptation, and pledges to protect the rights, livelihoods and cultural heritage of people forced to adapt or move. The political declaration is not legally binding and carries no new money.

Approved without objection at a high-level meeting of the General Assembly in New York, the text now goes to a formal plenary for adoption. Countries agreed to reconvene on the issue before the end of the Assembly’s 84th session.

The United States, which has withdrawn from the Paris Agreement and moved to cut federal ocean research, did not block the text and did not take the floor during the day-long debate.

“Sea level rise is measured in millimetres, but its toll is measured in millions of shattered lives, uprooted communities and stolen futures,” Secretary-General António Guterres told the meeting. “We cannot allow countries and cultures to vanish beneath the waves.”

“The measure of our success today will not be the words we endorse, but the action that will follow,” said Tuvalu Prime Minister Feleti Teo, who told the Assembly he spoke for the “1 billion people living in countries and communities on the front line.”

Record rise

United Nations Secretary General Antonio Guterres speaks at the high-level meeting on rising seas.

Global sea levels rose a record 5.9 mm in 2024, according to Guterres’s report, which found seas are rising faster than at any point in recorded history and that the rise to date is “essentially irreversible on human timescales.”

“Greenhouse gases billowing from burning fossil fuels are cooking our planet, and the ocean is taking the heat,” Guterres said. The ocean absorbs some 90% of that excess heat.

The 1.2 billion figure, which spans rising seas, flooding, water stress and food insecurity, adds to a broader climate displacement picture in which billions face threats from extreme heat, storms and the loss of habitable land.

“When land disappears and fresh water turns to salt, competition follows and we risk a mass exodus of entire populations,” Guterres said.

The meeting came weeks after a UN report warned that holding warming to 1.5C is no longer possible, with the threshold likely to be crossed by 2030, and that colliding threats from unbalanced ecosystems around the globe could “change the world forever.”

Guterres urged that any overshoot be “as small and short as possible,” adding that “the G20 must lead, and COP31 in Türkiye must deliver.”

Current policies put the world on course for about 2.6C of warming, enough to drive roughly 60 cm of sea-level rise by 2100 and push the West Antarctic and Greenland ice sheets past points of no return.

Crossing those thresholds “would mean the extinction of many small island states, but also a catastrophic reshaping of coastlines around the world, affecting many hundreds of millions of people,” said Bill Hare, chief executive of Climate Analytics.

‘More ocean than land’

Global sea level rise over time, per NASA data.

Nearly 770 million people, roughly one in ten worldwide, live less than five metres above the high tide line. Without significant adaptation and mitigation, Guterres said, the risks facing coastal cities and communities could increase tenfold by 2100.

“Vanuatu is more ocean than land,” the Pacific nation’s representative told the Assembly. “The sea has always been our highway, our food and our heritage. Today it is also a threat.”

Across the Pacific, where relative sea levels have risen more than twice the global average, the report finds rising seas “are already forcing relocations in Fiji, Vanuatu, the Solomon Islands and elsewhere,” placing “the habitability of entire nations in jeopardy.”

In Saint Vincent and the Grenadines, 85% of the population and more than 90% of critical infrastructure sit on a narrow coastal belt, Prime Minister Godwin Friday said. In Bangladesh, 25 cm of sea-level rise by 2050 could submerge around 4% of the country’s land and upend the lives of some 10 million people, Prime Minister Tarique Rahman said, citing World Bank estimates.

“We do not come to this meeting to observe another country’s emergency,” said Kenya, where nearly a third of the coastline now falls in the highest risk category. “We come because it is already ours.”

“Rising seas are not good for anyone, not for small island developing states, not for low-lying coastal communities, not for major cities,” said General Assembly President Khalilur Rahman. “Including this one right here. The city of New York.”

Seas around New York are projected to rise 1.3 metres by the end of the century, he said, “enough to turn our august assembly hall into a very large wading pool.”

Under a low-likelihood scenario driven by ice-sheet instability in West Antarctica, the IPCC projects seas approaching two metres by 2100. The Thwaites Glacier, nicknamed the “Doomsday Glacier” and larger than England, Wales and Northern Ireland combined, would add 65 cm on its own if it collapsed.

“During storms, the sea is patient,” said the representative of the Kingdom of the Netherlands, whose Caribbean islands face sea-level rise of up to 80 cm by 2100. “It takes a little more each year, and what it takes, it does not easily return. We cannot afford to be patient in return.”

Millions displaced

Small developing island states are highly vulnerable to the effects of climate change and rely on universal diplomatic processes to ensure they hold equal weight to major global powers.
Small developing island states are highly vulnerable to the effects of climate change and rely on universal diplomatic processes to ensure they hold equal weight to major global powers.

The populations facing both sea-level rise and extreme heat, in coastal South Asia, sub-Saharan Africa and the low-lying deltas where rivers meet the sea, are where the crisis will be least voluntary and most catastrophic. Across Kolkata, Mumbai and Dhaka, more than 14 million people face immediate risk of losing their homes to permanent inundation.

“Mountainous countries and island states, which contribute least to global emissions, stand as the most acute victims of global climate crisis,” said Nepal’s representative, weeks after flash floods tore through the Himalayan country in August. “This is unjust. This is our moral failure.”

In North Africa’s Nile Delta, saltwater intrusion is contaminating land and freshwater while the same populations face worsening drought and extreme heat.

Ports carry more than 80% of global merchandise trade, Khalilur Rahman noted, and when rising water disrupts them, the effects reach food prices, medicines, jobs and household budgets worldwide. A 2020 study in the Proceedings of the National Academy of Sciences projected that by 2070, extreme heat zones now covering less than 1% of the earth’s land surface could expand to nearly a fifth, placing one in three people outside the climate conditions where humans have thrived for 6,000 years.

“No country is truly beyond the reach of the shoreline,” said Cyprus.

Trillions at risk 

Vulnerable island nations demand equal weight in fast-track and universal diplomatic processes.
Vulnerable island nations demand equal weight in fast-track and universal diplomatic processes.

In coastal megacities like Miami, New York and Guangzhou, economic engines that drive trade, finance and millions of jobs, assets valued between $2 trillion and $3.5 trillion face flooding. Globally, coastal infrastructure worth at least $1.8 trillion is at risk.

Developing states need an estimated $310 billion to $365 billion a year for adaptation. In 2023, they received $26 billion.

The Fund for Responding to Loss and Damage holds pledges of $768 million but had received only $321 million as of March 2025. Against projected loss and damage costs of $290 billion to $580 billion a year by 2030, its start-up envelope stands at just $250 million. “I am very frustrated with the, I would say, ridiculous amount that is today in the Loss and Damage fund,” Guterres said.

“The adaptation gap is not a knowledge gap,” Navid Hanif, the UN assistant secretary-general for economic and social affairs, said at the report’s launch. “It’s a financing gap.”

Guterres called for adaptation finance to triple and for the $300 billion annual climate finance goal agreed in 2024 to be a step toward mobilising $1.3 trillion a year by 2035.

“Irreversible loss and damage cannot be concealed within adaptation,” Jamaica said on behalf of the Caribbean Community, calling for support that is “grant based, not another source of debt.”

Kenya urged the UN system, development banks and climate funds “to organize themselves around the speed of the tide, not the pace of their own procurement.”

The report calls for wider use of instruments like catastrophe bonds and regional risk pools, though these were built for sudden shocks, and Cyprus told the Assembly that finance must be “designed for slow onset risks, not only sudden disasters.”

The cost of the gap falls on public services, said Trinidad and Tobago’s representative, noting that money spent on recovery “is always diverted from critical areas such as healthcare, agriculture and defence.”

Data missing as US pull back monitoring

“Africa’s coastlines remain among the least observed on earth,” Kenya’s representative said, urging states to build coastal risk mapping into national planning “so that no new school, road or clinic is built where the data already tells us the sea is coming.”

The report warns that coastal sea levels are often higher than existing assessments show, leaving tens of millions more people at risk than recognised.

In the US, the Trump administration is dismantling the Ocean Observatories Initiative, a $386 million network of more than 900 ocean sensors that has provided continuous real-time data for over a decade.

The administration’s budget proposal described NOAA’s climate programmes as part of a “Green New Scam,” accusing them of efforts to “radicalize students” and spread “baseless environmental alarm.” NOAA’s research arm faces a proposed cut from $656 million to roughly $171 million.

A day before the meeting, European Commission President Ursula von der Leyen and Canadian Prime Minister Mark Carney launched a Global Ocean Alliance to support ocean observation, with more than 30 countries pledging over $250 million, EU Oceans Commissioner Costas Kadis said.

A legal reckoning

While data and financing lag behind, international law is moving in the opposite direction, increasingly recognising the rights of at-risk nations and communities in its highest courts.

“Geography may change. Legal identity must not,” said the Maldives.

“No state will be forced to turn off their nameplate without their consent due to sea level rise,” said Liechtenstein, while Saint Kitts and Nevis told the Assembly that “a nation’s legal personality cannot depend on a climate it did not destabilize.”

The United Kingdom announced it would now start from the position of continuing to recognise a state’s statehood even if it loses some or all of its land to the sea. Australia noted the principle first appeared in a legally binding treaty it signed with Tuvalu, and is now written into the UN declaration.

In May 2024, the International Tribunal for the Law of the Sea ruled unanimously that greenhouse gas emissions constitute marine pollution that states must prevent, reduce and control. In July 2025, the International Court of Justice found unanimously that both state action and inaction on climate change can breach international law. Both cases were brought by small island states.

“People’s rights do not disappear because their homes do,” Guterres said.

The ICJ found that states’ climate obligations reach well beyond the Paris Agreement into customary and human rights law, and that breaching them can require states to stop the harmful conduct and make full reparation. Advisory opinions are not binding in themselves, but they carry the court’s authority on what existing law requires.

In May, the General Assembly voted 141 to 8 to welcome the opinion, with the United States, Saudi Arabia and Russia among those voting against. During those talks, fossil fuel-producing states pushed to cast the UN climate treaties as the only framework governing climate action, the same argument the court had already rejected.

Saudi Arabia, which joined Thursday’s consensus, said it had shown “flexibility” on references to the ICJ opinion during negotiations but that its legal position “remains the same,” rejecting any attempt “to impose anything on states outside of existing frameworks.”

Russia said states’ obligations are “codified in specialized international legal instruments” and should be discussed only “at the specific relevant platform to avoid watering down norms.”

“Vanuatu led the call for the ICJ advisory opinion and the court answered unanimously,” its representative said. “States have binding obligations to prevent climate harm, to cooperate and to protect the human rights that sea level rise affects.”

Turkey, host of the COP31 climate summit in Antalya in November, said the reasons keeping it outside the UN Convention on the Law of the Sea, the treaty anchoring the declaration’s maritime protections, “remain valid.”

“Today we are applauded for adopting the resolution,” said Cabo Verde’s Prime Minister Francisco Carvalho, who co-led the negotiations with Australia. “Tomorrow we will be judged by our ability to implement it.”

Image Credits: Unsplash/Ernests Vaga, Felix Sassmannshausen/Canva benkrut/anmuelle via Getty Images, Giorgia Galletoni .

Declared contenders at the WHO nomination deadline. Top row: Hans Kluge, Hanan Balkhy, Hanan Al Kuwari. Bottom row: Budi Sadikin, María Neira, Gevorg Tamamyan.
Declared contenders at the WHO nomination deadline. Top row: Hans Kluge, Hanan Balkhy, Hanan Al Kuwari. Bottom row: Budi Sadikin, María Neira, Gevorg Tamamyan.

Following the statutory WHO nomination deadline for the next Director-General, six candidates have now been publicly declared on the agency’s prospective candidate page. While oncologist Dr Gevorg Tamamyan has been proposed in a cross-regional nomination by Botswana, sources with knowledge of the process said Gavi CEO Dr Sania Nishtar was reportedly not nominated by Pakistan. Additional nominees, however, may remain hidden behind a month-long procedural “black box.”

As the submission window for the next Director-General of the World Health Organization (WHO) closed on Thursday (24 September), the high-stakes political race officially shifted to an active global campaign trail. The candidate pool currently stands at six publicly known contenders following Tamamyan’s recent entry.

However, the global public may not learn the complete, official candidate roster until November. Under WHO election protocols, nominating governments can request early public acknowledgement of their nominee as a “prospective candidate” on the agency’s website. But if a government chooses not to make such a request, the candidate’s filing will remain confidential until November, the agency said.

“The names of candidates and the proposals received will be published on the WHO’s website after the closure of the last Regional Committee session held this year, expected at the beginning of November 2026,” WHO told Health Policy Watch in an official statement.

Designed to ensure uniform, translated candidate dispatches to all Member States, the rule creates a two-tier transparency system. States opting for confidentiality can keep filings sealed until November, leaving unannounced contenders to campaign shielded from public scrutiny.

Until the complete candidate roster is unveiled in November, six prospective contenders have been publicly acknowledged so far – presented below in order of their official publication on the WHO portal.

1. The inside reformer: Dr Hans Henri P. Kluge (Belgium)

Dr Hans Henri P. Kluge at the WHO Executive Board.
Dr Hans Henri P. Kluge at the WHO Executive Board.

Kluge became the first candidate officially listed on WHO’s prospective candidate web portal on 21 August, following his nomination by Belgium and his transition to mandatory campaign leave. He has served as WHO Regional Director for Europe since 2020 following a WHO career and frontline MSF humanitarian work. Presenting himself as the agency’s “biggest advocate, yet also its most candid critic”, Kluge promises to devolve power from Geneva to country offices and make Primary Health Care (PHC) his signature delivery platform.

“My vision is to rebuild WHO, together with the Member States, into a 21st-century organisation that better serves all countries and their people,” Kluge emphasized in his manifesto. “WHO’s legacy, scientific authority, and convening power are unmatched, but the organization is often overstretched, under-focused, and overly bureaucratic – and that must change.”

2. The institutional regionalist: Dr Hanan H. Balkhy (Saudi Arabia)

Dr Hanan Balkhy in New York.
Dr Hanan Balkhy in New York.

Balkhy was officially listed on WHO’s prospective candidate portal on 24 August following her nomination by Saudi Arabia, having previously stepped back on official campaign leave on 4 August. A paediatric infectious disease specialist, former WHO Assistant Director-General for AMR, and EMRO Regional Director, she focuses her platform on regional self-reliance, local vaccine manufacturing, One Health biosecurity, and shifting WHO’s operational weight directly from Geneva HQ to country and regional offices.

“My running title for this campaign is a WHO the world can count on: built on trust, driven by impact, and measured by value,” Balkhy declared at an invite-only panel hosted by Concordia on the sidelines of the UN General Assembly in New York on Thursday. Addressing budget pressures and institutional delivery, she added: “How do we use our money better? One of the first things I would start with is identifying country by country their country-driven priorities … If we improve our performance, we will use less funding and use it much better.”

3. The middle-power broker: Dr Hanan Mohamed Al Kuwari (Qatar)

Dr Hanan Al Kuwari speaking at a WHO event.
Dr Hanan Al Kuwari speaking at a WHO event.

With her nomination published by WHO on 26 August, former Minister of Public Health and long-serving Managing Director of Hamad Medical Corporation, Al Kuwari positions herself as an executive system manager and pragmatic mediator. Serving as Vice-Chair of Pandemic Agreement negotiations, she leverages Qatar’s middle-power diplomacy to advance binding pathogen access and benefit-sharing (PABS) equity.

“We already know how to prevent and treat many of the diseases that continue to affect millions of people. The challenge is making sure that knowledge translates into concrete actions resulting in better health outcomes everywhere,” she wrote in her candidacy announcement on LinkedIn. “That requires a WHO that countries trust, that can act independently, that is sustainably financed, and, above all, that delivers meaningful results for people and communities.”

4. The corporate outsider: Budi Gunadi Sadikin (Indonesia)

Indonesia’s Minister of Health Budi Gunadi Sadikin.
Indonesia’s Minister of Health Budi Gunadi Sadikin.

Indonesia’s Health Minister, listed on 31 August, represents an unconventional candidacy from outside clinical medicine. A nuclear physicist and former CEO of Indonesia’s largest bank, Sadikin advocates for economic reform, Global South vaccine sovereignty, and leveraging development bank capital to bridge WHO’s funding deficits.

“As an ex-banker, I know the world is ample of liquidity and money, so there is no reason why we don’t have enough money,” Sadikin stated at the Concordia debate on Thursday in New York.

Addressing how WHO can overcome budget deficits and eliminate donor earmarking, he added: “Number one, [WHO] should refocus back to its core mandate: setting norms and standards based on science,” Sadikin said. “And number two, WHO has a very powerful convening power … to build bridges between Member States, multilateral development banks, philanthropists, and global health institutions. As long as we can build trust and credibility, money will come, and earmarking will be gone.”

5. The primary prevention advocate: Dr María Neira (Spain)

Dr María Neira at a WHO event.
Dr María Neira at a WHO event.

Spain’s last-minute nomination on 24 September introduces a prominent advocate for planetary health and primary prevention to the race for WHO’s top job. Having spent two decades directing WHO’s Department of Environment, Climate Change and Health, Neira combines field emergency care with Geneva executive tenure. Her platform calls for a “massive shift towards primary prevention” and using WHO’s normative authority to direct global capital toward environmental health drivers.

“I believe deeply in WHO. I know its people, its strengths, and how much the world asks of it. I also know that an organization can move mountains when it brings science, countries and people together around a shared purpose: better health for everyone,” she wrote in her nomination announcement on LinkedIn. “I begin this journey as I began my work in public health: with curiosity, determination, and the conviction that every life deserves our attention.”

Oncology advocate & crisis specialist: Dr Gevorg Tamamyan (Botswana)

Oncologist Dr Gevorg Tamamyan, prospective candidate.
Oncologist Dr Gevorg Tamamyan, prospective candidate.

Armenian paediatric oncologist Dr Gevorg Tamamyan enters the race as a geopolitical standout: he is the sole cross-regional nomination in the field and the only candidate proposed by an AFRO Member State, following his formal submission by Botswana.

Tamamyan is Professor and Chairman of Pediatric Oncology and Hematology at Yerevan State Medical University, CEO of the Immune Oncology Research Institute, and President of the POEM Group – a cooperative network spanning 110 cancer centres across 28 countries. He also serves as Editor-in-Chief of OncoDaily and Chairman of the Board of the Institute of Cancer and Crisis. His clinical background is further supported by fellowships and advanced training at MD Anderson, St. Jude, Harvard, and Vienna.

While Tamamyan has not yet published an official election manifesto or campaign platform, his background as a clinician introduces a distinct profile centred on non-communicable disease (NCD) burdens, paediatric health equity, and healthcare delivery in fragile, conflict- and crisis-affected zones.

Notable absences and unverified candidacies

Dr Jiho Cha, Dr Hanan Balkhy speaking, and Minister Budi Gunadi Sadikin address a WHO election panel in New York.
Dr Jiho Cha, Dr Hanan Balkhy speaking, and Minister Budi Gunadi Sadikin address a WHO election panel in New York.

Despite early speculation across global health circles and her prominent 2017 candidacy for the top post, sources close to the matter confirm that Dr Sania Nishtar, currently CEO of Gavi, the Vaccine Alliance, is not running in this election cycle. She joins other high-profile figures who have previously ruled out bids, including PAHO Regional Director Dr Jarbas Barbosa and former WHO Chief Scientist Dr Jeremy Farrar.

Health Policy Watch reached out to Gavi for official confirmation prior to publication but did not receive a response.

Questions also surround South Korean lawmaker and digital health advocate Dr Jiho Cha, as he appeared on stage at Thursday’s Concordia panel in New York alongside Balkhy and Sadikin and was announced as one of the candidates. He presented his election manifesto, “Renewing the Promise, Delivering the Future: Health for All,” centred on AI public governance and climate resilience. However, his formal nomination status could not yet be confirmed.

Under WHO election protocols, candidacies must be formally lodged by a proposing Member State. The Government of the Republic of Korea did not respond to requests for comment, while the WHO Secretariat declined to disclose information regarding individual filings ahead of the official announcement in November.

Geopolitical fault lines and financial shortfalls

The World Health Organization headquarters in Geneva, where member states will elect the next Director-General to lead the agency.
The World Health Organization headquarters in Geneva, where member states will elect the next Director-General to lead the agency.

Whoever ultimately wins the election will have to steer WHO through an unprecedented financial squeeze and deep geopolitical fragmentation.

This fiscal shock has accelerated calls to reform the global health architecture away from traditional donor dependency. Global South platforms such as the Accra Reset initiative urge a systemic transition toward domestic health sovereignty, regional manufacturing, and sustainable local financing models.

However, while political leaders champion this pivot, operationalizing it remains extremely challenging. Overburdened by mounting debt service that sees 32 African nations spend more on external debt than healthcare, most low-income countries have been unable to scale up domestic health budgets to compensate for shrinking aid.

Inside the agency, the incoming Director-General will inherit an institution undergoing its most severe structural downsizing in decades. Following the withdrawal of the United States, WHO was forced to slash its planned 2026-2027 base budget from $5.3 billion to $4.2 billion, yet it still faces an unfunded gap of up to $300 million. To absorb this shortfall, the Secretariat is eliminating over 2,300 positions – shedding roughly a quarter of its global staff – and halving headquarters departments, leaving operational capabilities stretched thin as the new leader takes charge.

At the same time, pandemic preparedness remains stymied by North-South distrust over Pathogen Access and Benefit-Sharing (PABS) negotiations. Meanwhile, climate-driven health shocks and active global armed conflicts and crises increase the risk of global health threats, while escalating superpower rivalry threatens to further politicize its technical mandate.

Campaign roadmap towards WHA80

As the confidential nomination window transitions into the public campaign phase, Member States will soon begin direct evaluations of all prospective candidates.

“At a time when multilateral institutions face growing scrutiny, transparency in leadership decisions matters more than ever. People deserve to hear candidates’ visions and understand how their leaders are chosen. That openness builds trust in the institution and the person selected to lead it,” global health policy expert Jirair Ratevosian noted, addressing the broader demand for openness in leadership selection.

The WHO Secretariat will open a password-protected web forum in November 2026, allowing Member States to submit written questions to candidates. The first live, interactive Candidates’ Forum will convene in Geneva starting 18 November 2026, providing a public platform for nominees to present their visions.

Following these presentations, the 34-member Executive Board will gather at its 160th session in January 2027 to shortlist and nominate up to three finalists. The final appointment will occur via secret ballot during the Eightieth World Health Assembly (WHA80) in May 2027, with the new Director-General taking office on 16 August 2027.

Until the Secretariat officially unveils the sealed filings in November, the full extent of the candidate field remains hidden behind the procedural curtain.

The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General

Note: For consistency across candidate profiles, the nomination dates cited in this article refer to the date each candidate was officially published and listed on the WHO prospective candidate web portal, rather than the dates of informal diplomatic announcements or internal administrative leave milestones. This article was updated on 27 September to incorporate additional expert commentary regarding election transparency and candidate visibility.

Image Credits: HPW, WHO/Christopher Black , LinkedIn/HPW, WHO/HPW, Kementerian Kesehatan, WHO, World Health Organization, Concordia/HPW.

Leaders at Guterres’ final climate summit framed renewables as national security. Developing nations asked who would pay.

The evolution in the language of climate diplomacy took its latest step at the United Nations General Assembly this week as world and diplomatic leaders framed the push for green energy as a matter of national security amid energy price shocks driven by global wars. With COP31 fast approaching, the pitch reframes renewables as a source of energy autonomy rather than a tool to save the planet, sidestepping the deadlocked fights over fossil fuel phase-outs that sank the last two climate summits.

“We have seen how fossil fuel dependence wreaks havoc, driving up costs, draining budgets, squeezing households and leaving countries at the mercy of conflicts and decisions far beyond their borders,” UN Secretary-General António Guterres told the High-Level Meeting on Climate Action and the Just Transition, convened at the 81st General Assembly in New York.

“Fossil fuel expansion continues, defying science, economics and common sense,” Guterres said, calling on every country to draw up “a credible roadmap to transition away from fossil fuels with clear timelines.” So far only Germany, France and the Netherlands have published such national roadmaps. “Emissions are still rising when they must plummet.”

The meeting marks the last climate summit Guterres will convene before his term ends in December. Climate action has been a defining cause of his decade-long tenure, during which he has accused the fossil fuel industry of treating the atmosphere like “an open sewer”, declared “the era of global boiling has arrived,” and told world leaders at COP27 in 2022 that “we are on a highway to climate hell with our foot on the accelerator.”

Yet at the Assembly, the argument dominating floor time was not that of the existential importance of climate change Guterres has spent a decade making, but one countries can sell to skeptics, finance ministers and treasuries: that clean energy is cheaper, and immune to the fossil fuel price shocks that have hit the global economy three times since 2020, from the pandemic to Russia’s invasion of Ukraine to the closure of the Strait of Hormuz.

“Neither the sun nor the wind can be blocked by any army,” Spain’s ecological transition minister Sara Aagesen told the summit, citing Madrid’s doubling of renewable capacity in eight years and now generating 56% of its power from clean sources. “Spain is better prepared to face the wars that we are seeing both in Ukraine and Iran now.”

Straits, hoaxes and ‘annihilation’

US President Donald Trump addressed the General Assembly on Tuesday, calling climate change a hoax and threatening the annihilation of Iran.

The meeting came amid a week of political turmoil likely to extend uncertainty in the Middle East and the seven-month closure of the Strait of Hormuz, sharpening the case for renewables made at the climate summit.

US President Donald Trump, addressing the General Assembly on Tuesday, weighed whether to make a deal with Iran or to “annihilate the Islamic Republic.” Iranian President Masoud Pezeshkian, addressing the Assembly the following day, condemned the US and Israeli strikes on Iran as “a grave betrayal of diplomacy.”

Across the Arabian Peninsula, Houthi advances in Yemen are threatening the Bab al-Mandeb strait, the other key waterway used to transport oil and gas, opening a new front in the trade route war and further threatening global energy supplies.

In the same speech, the US President dismissed climate change as fictional alongside “the Russia, Russia, Russia hoax, the Ukraine, Ukraine, Ukraine hoax,” and claimed it had been rebranded from global warming “because the planet was cooling, not warming, and nobody was dead.”

Yet as Trump waged a war of words on green energy policy at the General Assembly lectern, the war on the ground in Iran has both cut fossil fuel demand projections and catalysed the push for energy independence through renewables, which his administration so forcefully opposes.

“Despite all the federal efforts to prop up fossil fuels, the US got more energy from solar power than from coal, for the first time ever,” Michael Bloomberg, the Secretary-General’s special envoy on climate, told the summit.

The IEA now projects that global oil demand will decline 2.5% in 2026, the first annual drop since the pandemic, as the disruption drives countries toward renewables, electric vehicles and nuclear power. Analysis suggests much of that demand destruction may be permanent, as countries lock in infrastructure that will shape energy use for decades.

UNEP declared earlier this month that the 1.5°C warming target is no longer achievable. Under current policies, the world is heading for 2.6°C by the end of the century. A record-breaking super El Niño is expected to peak in December, with 2026 forecast to be the hottest year ever recorded.

“UN-convened cooperation and national efforts have reduced the projected global temperature rise from well over 4 degrees Celsius to 2.6 degrees Celsius,” UN climate chief Simon Stiell said. “Undeniable progress, but not enough to avoid catastrophe.”

Synergies aligned for green energy

The Hormuz crisis is the third fossil fuel price shock in less than a decade, following COVID-19’s collapse of the global economy in 2020 and Russia’s full-scale invasion of Ukraine in 2022. Each has exposed the vulnerability of economies dependent on imported oil and gas, and each has accelerated investment in domestic renewable capacity that is not subject to the same geopolitical disruption.

“Some seven months ago, the most important energy artery of the world, the Strait of Hormuz, is closed,” IEA executive director Fatih Birol told the summit. “Oil, LNG, fertiliser flows have stopped.” He said “a big chunk, if not all” of governments’ responses to the crisis were “based on clean energy choices.”

The security argument has been building since April, when 57 countries gathered at the first conference on transitioning away from fossil fuels in Santa Marta, Colombia, two months after the start of the Iran war. The framing crystallises the threats of depending on unpredictable actors in Washington, Moscow and Riyadh in favour of sources nations can control.

“For many, many years in the energy world, we had three choices in front of us,” Birol said. “Shall I choose the most secure energy option? Shall I choose the most economic energy option, or shall I choose the cleanest energy option? We had to make choices, we had to make trade-offs. But when we look at the world today, for the first time in years, all of these three objectives are getting aligned.”

UN Deadlock and Iran War Oil Shocks Push 54 Nations to Chart Fossil Fuel Phase Out

According to IEA figures, around 80% of solar and wind generation worldwide now comes in cheaper than coal or gas. Battery prices have fallen 75% in a decade. This year, the agency expects $2.2 trillion to flow to clean energy, compared with $1.2 trillion for oil, gas and coal. Stiell said renewables had already helped the world avoid “almost half a trillion US dollars in fossil fuel costs.”

European Commission President Ursula von der Leyen traced the EU’s painful education in energy autonomy, from Russia’s 2022 cutoff of gas that supplied 45% of Europe’s needs to the current Gulf crisis that, like the Ukraine war before it, was started beyond Europe’s borders and beyond its control.

“We thought we were out of the woods. No way,” she said. “Then came the closure of the Strait of Hormuz.” Since then, imported fossil fuels have cost the EU an extra €90 billion, accelerating what she called a “massive” pivot to renewables and nuclear.

“This clean electricity gives us independence, energy security, and it is affordable,” von der Leyen said.

“I know the world’s eyes are on the Gulf, and Fiji prays for peace there,” Fiji’s President Ratu Naiqama Lalabalavu said. “But consider the arithmetic. The closing of one strait is costing the world economy some $2 trillion a year, and a ceasefire can end it. More than 3 billion people live in places highly vulnerable to climate change.”

“No ceasefire will end that. The carbon we burn today stays in the sky for centuries. The atmosphere does not negotiate.”

Money, economics and “ridiculous” fund

Barbados Prime Minister Mia Mottley, a leading advocate for international finance reform, told the Assembly money must be more accessible for developing nations for them to adequately respond to the climate crisis.

The security case is inherently a national one: countries invest in their own energy independence. For developing countries and small island states that produce a fraction of global emissions but face the worst of the damage, the argument for self-reliance offers little. They need international climate finance for adaptation and recovery, and it is not arriving.

“Africa has 60% of the world’s best solar resources, yet it receives only around 2% of the global clean energy investment,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. “That is an extraordinary mismatch between opportunity and investment.” He called the cost of capital facing developing countries “a scandal of injustice.”

“Africa is not asking the world to come and rescue it. We are asking the world to stop putting obstacles in the way,” Adow said.

The obstacles are structural. Climate-vulnerable countries pay on average 1.2 percentage points more than others to borrow, meaning the finance that does exist is more expensive for those who need it most. The result is that four of every five dollars invested in clean energy have gone to advanced economies and China, according to the IEA.

At an adaptation finance dialogue on Tuesday, the Marshall Islands’ environment minister said his country spends “almost as much effort applying for funding and reporting back to donors as we are implementing.”

“If the $120 billion [in agreed adaptation finance] is not delivered, the shortfall should go directly to the loss and damage fund with interest,” its delegation added. “Of course, that is intentionally provocative.”

As climate financing falls short, five major Western oil companies have pocketed “nearly half a trillion dollars in profits” since Russia’s invasion of Ukraine against just $34 billion in international adaptation finance for developing countries, Guterres said in his major address on Tuesday. Their profits exceed the roughly $385 billion in total climate finance that developed countries provided and mobilised for poorer nations across 2022, 2023 and 2024 combined, according to the OECD.

While oil majors post record returns, the fund created to help countries recover from climate disasters sits virtually empty. Governments have pledged $822 million to the Loss and Damage Fund since it was created in 2022. Only about a third has arrived, while the fund has not disbursed a single dollar despite requests from at least 119 countries. The fund is one of many international climate finance instruments with coffers falling billions shrot of their targets.

“Let’s be honest,” Guterres said. “The amounts available in the Loss and Damage Fund are completely ridiculous.”

Road to COP31

Turkish President Recep Tayyip Erdoğan, hosting COP31 in Antalya from 9 to 20 November, billed it as an “implementation COP,” a label every presidency since COP27 in 2022 has claimed with mixed results. The agenda is deliberately fossil-fuel free, built to avoid the political torpedoes that sank the last two COPs, mirroring the messaging strategy on display at the General Assembly: winning ground on electrification, waste and construction without triggering the veto of oil-producing states that have blocked fossil fuel exit language since Dubai.

“Any proposal that fails to reconcile our climate objectives with social and economic realities will be doomed to fail,” Erdoğan said. “As inequalities in access to finance and to technology persist, it is not realistic to expect all countries to move forward all at the same pace.”

Murat Kurum, the Turkish minister presiding over COP31, adopted the day’s dominant frame. “Energy independence of the countries are now national security issues,” he said. “If countries were able to produce their energy in their borders, then this crisis wouldn’t be this effective today.”

The presidency’s agenda is built around six targets, led by raising electricity’s share of global energy from 23% to 35% by 2035, dubbed “35 by 35.” The others include halving the growth in global waste, cutting building energy intensity by 25%, and increasing circular material use to 15%, all by 2035. “If this target is agreed in Antalya, it will give a very strong and unmistakable signal to the investors, financiers, utilities, governments and beyond,” Birol said.

“Getting almost 200 countries to agree on every word is incredibly hard but incredibly important,” Stiell told the Assembly. “No single COP can fix this global crisis, but each takes meaningful steps forward.”

DRC Prime Minister Judith Suminwa Tuluka and US State Department director of planning, Jeremy Lewin, at the G20+ meeting on Wednesday.

G20+ countries pledged an additional $700 million this week to counter the Ebola outbreak in the Democratic Republic of Congo (DRC), Dr Jean Kaseya, Director-General of Africa Centres for Disease Control and Prevention, told a media briefing on Thursday.

The new pledges were made at the G20+ Foreign Ministers’ meeting convened by the United States on Wednesday on the sidelines of the UN General Assembly in New York.

The additional pledges mean that over $2.9 billion has been raised for the outbreak, which is growing at five times the rate of the previous biggest Ebola outbreak.

Describing the new money as “huge”, Kaseya thanked the US government, which is the biggest funder of the response, followed by the European Union.

“But pledges alone will not stop Ebola,” Kaseya added. “We must be able to trace every single dollar—from commitment to disbursement, from implementing partner to expenditure, and ultimately to the services delivered to affected communities. Transparency builds trust, accelerates delivery and saves lives.”

To date, the United States government has provided $887 million to combat the Ebola outbreak, and it pledged an additional $267 million at Wednesday’s meeting.

The new money will go towards “new Ebola treatment units, additional safe and dignified burial teams, mass procurements of personal protective equipment, expanded surveillance, critical health commodities, and contact tracing through trusted implementers,” the US State Department said.

Kaseya also recognised contributions from 27 African countries to address the outbreak, with confirmed cases reaching 7,820 and 3,779 deaths. Health workers account for 239 cases and approximately 50 deaths.

Nord-Kivu surge

The outbreak is “cooling in Ituri [province] while it accelerates in Nord-Kivu”, said Dr Wessam Mankoula,  Africa CDC’s head of emergencies.

In the past three weeks, new cases in Ituri – the epicentre of the outbreak – have dropped by 25% and deaths decreased by 31%. However, new cases in Nord-Kivu have increased by 56% and deaths by 19%, Mankoula told the media briefing.

The case fatality rate in Nord-Kivu is 60.5% in comparison to the national average of 48.3%.  Ongoing conflict in the province is hampering the efforts of health and humanitarian teams, people are also seeking treatment very late, and there is a shortage of health workers in the province.

However, Ituri remains by far the worst affected province, with 5,966 cases and 2 737 deaths in comparison to 1 438 cases and 872 deaths in Nord Kivu, according to the DRC’s health ministry on Monday.

High mortality in children under five

Ebola case fatality rate by age (24 September 2026)

Meanwhile, the overall death rate is highest among children under the age of five, with a case fatality rate of 62%. People over the age of 65 had the next highest CFR (43%).

Dr Daniel Youkee, the World Health Organization’s (WHO) Ebola case management team lead, explained that “young children have a lower physiological reserve and not fully developed immune systems”. 

“They require constant attention and special care. They need specific expertise, equipment and medications which are sometimes not readily available,” said Youkee.

“Standardised supply kits need to incorporate paediatric sized equipment and medication with paediatric dosage and presentation. Staff need to be trained on paediatric guidelines, including response to hypoglycaemia and ionic shock in children.”

The speed of the current outbreak is of great concern, growing from eight confirmed cases in three health zones on 15 May to the current size, affecting 63 health zones across seven provinces.

Air pollution in New Delhi in early November 2025.

New research found that after the US administration suspended its embassy air pollution monitoring initiative, air pollution increased by 23-33%, particularly in Southeast Asia and sub-Saharan Africa, where reliable monitoring data is scarce.

The US’s abrupt shutdown of its embassy air pollution monitoring program in 2025 hit regions with little publicly available data the hardest, says a study published in PNAS, which analyzed air pollution levels before and after the program suspension. 

Using satellite-based measurements, researchers from Columbia and Hong Kong Universities found that there was a clear pattern of higher air pollution after the program was shut down, particularly in areas with “poor substitutes” for US-provided data. 

Their modeling estimates a 33% increase in air pollution across the 46 cities in their study. That increase translates to roughly three times the World Health Organization (WHO) annual guidelines for PM2.5 concentrations – the fine particulate matter that can travel most deeply into the body and cause a host of cardiovascular, respiratory, and reproductive health issues. 

Independent environmental monitoring, which the US Department of State program offered until being shut down by the current Trump administration during DOGE cuts in 2025, led to lower pollution where autocratic or repressive governments withheld domestic air quality data.

For nearly two decades, US embassies and consulates have publicly reported real-time air quality worldwide, providing oftentimes the only reliable source of air quality data in some countries. 

The findings emphasize the precariousness of pollution reductions in lower-and-middle income countries without publicly accessible and trusted pollution information–and come at a time when environmental transparency is increasingly threatened. 

Regions with little monitoring face outsized impact

Embassy air pollution
Global air pollution heat map published by Swiss air quality technology company IQAir demonstrates the scarcity of monitors on the African continents and parts of Latin America.

Dr Zoey Zhou, the lead study author and a climate researcher at Columbia University, explained that the places most dependent on embassy data “were those with few publicly accessible alternatives, either because domestic monitoring was limited or because the readings were not shared with the public.

She said that pollution increases were “largest and most persistent in places with poor substitutes for the embassy data,” and she wasn’t surprised the program suspension would lead to such a notable increase in pollution. 

Across the study sample embassy and consulate locations, Southeast Asia saw the largest spike in air pollution, followed by sub-Saharan Africa and South Asia, Zhou told Health Policy Watch.

“Latin America and North Africa appear lower on average. But each regional group contains only a small number of sites, so I would describe these as suggestive patterns, rather than a definitive ranking of regions or countries,” she cautioned.

These patterns mirror recent analyses showing large disparities in philanthropic funding for clean air – with Africa and Latin America receiving only about 1% and 2% of funding, respectively. 

See related story: https://healthpolicy-watch.news/regions-with-worst-air-pollution-receive-least-amount-of-funding/

Her study also highlights the outsized role of the US State Department air quality monitoring program for citizens in countries who would otherwise have little knowledge of the state of their air. 

This holds for larger bodies such as the WHO, which relies heavily on embassy data for its consolidated air pollution data repository in about 25 cities worldwide.  

WHO said that the US EPA, which processes the air pollution information, served as the “sole source of information available to us for 11 countries: Algeria, Ethiopia, Kenya, Uganda, Sri Lanka, the Russian Federation, Tajikistan, Turkmenistan, Uzbekistan, Afghanistan, and the Lao People’s Democratic Republic.”

However, WHO told Health Policy Watch it cannot confirm that all measurements across those 21 countries were exclusively derived from US diplomatic mission locations. “We can explicitly verify embassy-sourced observations for 31 records across 16 countries for the years 2017, 2018, and 2019.”

Two decades of monitoring

air pollutants

An undated picture of air pollution in Beijing – the US State Department began its embassy air pollution monitoring program here in 2008 to provide reliable, timely, and accessible data.The embassy program began nearly two decades ago in Beijing. In 2008, the city faced intense scrutiny over its air quality prior to the Summer Olympic Games, with concerns that the smog would not only interfere with athlete performance but could also be dangerous to competitors with asthma. 

And while the country saw historic wins in cleaning up its air since the Games, the US Department of State set a precedent of air quality monitoring in countries with limited public environmental data. 

“Now the Department’s ZephAir mobile application displays EPA [US Environmental Protection Agency] air quality index information and health messaging for more than 80 overseas locations, with data from reference-grade monitors at U.S. embassies and consulates and other government partners,” the department’s website reads.

Past research has shown that the program reduced air pollution concentration levels by 2-4 microns per cubic meter – roughly 40-80% of the WHO’s recommended annual PM2.5 limit – with particularly significant drops in low-and middle-income countries where monitoring is often scarce.

No more public accountability

Embassy air pollution program
A figure from the PNAS study demonstrating increases in air pollution following the shutdown of the US State Department monitoring program.

When asked about exactly why air pollution could have so quickly spiked after air quality data went dark, Columbia’s Zhou acknowledged her team is still searching for an answer. 

“Unfortunately, we cannot say exactly which mechanism drove the increase, or separate the role of public awareness from enforcement. It is difficult to draw a clean line between the two because, in practice, they operate as a reinforcing feedback loop rather than two independent levers.”

Despite the difficulties in understanding exactly what drove the poorer air quality, Zhou pointed to research showing that making information publicly available strengthens accountability. 

“When reliable data are accessible to everyone, government agencies can investigate, businesses can respond, and citizens and journalists can press for action. That shared evidence keeps pressure on polluters and authorities to improve air quality. When that information disappears, some of that pressure weakens.”

Furthermore, controlling pollution is an expensive and continuous operating cost – one in which manufacturers can turn off abatement devices to save electricity, use fewer chemical solvents, or switch to cheaper, dirtier fuels, she explained. In other sectors, like trash burning enforcement, dust suppression at construction sites, and agricultural burning bans, rely on public oversight.

“It makes the case even stronger that relatively low-cost investments like basic open data infrastructure is a no-brainer investment in countries with little existing monitoring,” said Christa Hasenkopf, director at University of Chicago’s Clean Air Program and who was not involved in either study. 

“Once the public has access to open data relevant for their lives, they want to keep that access,” she said. Her group, part of the Energy Policy Institute at the University of Chicago (EPIC) accepts grant applications – and saw 76% of applicants propose work in countries that lost data when the State Department program ended.

Access to data connected to cleaner air

Air pollution
Air pollution protestors at Delhi’s Kartavya Path, near the historic India Gate landmark.

With some 300 million people living in cities with a US embassy monitor in 2019, researchers from Carnegie Mellon University and The University of Queensland have estimated that publicizing embassy data – and giving advocates and the public access to air quality  information – produced upwards of $127 million annually due to lives saved from lower air pollution. 

The 2022 study notes that, prior to 2008, “there were virtually no [particulate matter] monitors in non-[Organisation for Economic Co-operation and Development] countries.”

Ten years later, a third of non-OECD countries in the study sample had some form of particulate matter monitoring, with roughly one in five of these low- and middle-income countries having only local monitoring, and 7% having only embassy-administered monitoring. 

Furthermore, embassy readings are seen as more credible than those operated by local governments in many of these countries–where watchdogs have documented the tampering or manipulation of air pollution monitors. Last year, India’s capital was accused of spraying water around its monitors to make its smog situation appear less dire.

When asked for comment as to the suspension of the program, a State Department spokesperson told Health Policy Watch that the department is in the process of restoring public reporting of its air quality monitoring data and had no further comment about why the program had been discontinued.

This article was edited 25 September to include comments from the World Health Organization.

Image Credits: The Week, Kentaro Iemoto/Flickr, PNAS/ Zhou et al, Chetan Bhattacharji/HPW.

Guardiões das Chamas brigade volunteers put out a fire during a drill in Ponta de Pedras, Brazil.

Climate change and deforestation have intensified wildfires in the Amazon. Volunteer brigades have become an essential part of integrated fire management.

The loud crackles of burning twigs are the first to hit. Then, the scorched smell. Soon afterwards, columns of white and yellow smoke emerge, so thick they look solid. On the ground, flames as tall as people almost seem to disappear. 

It’s 4 pm on a sunny summer day in Ponta de Pedras, a town of roughly 25,000 inhabitants on Marajó Island in the Brazilian Amazon.  Behind the towers of smoke, volunteers at the local brigade, Guradiões das Chamas (“guardians of the flame”), are dots of fluorescent orange and yellow, moving in rehearsed synchronicity. 

“Fire can be your friend or your enemy,” Cosmerina D’Ávila, Guardiões das Chamas’ chief of brigade, told Health Policy Watch. An educator and farmer, she has witnessed wildfires surge over the years in Ponta de Pedras. 

But this is not a wildfire. It’s a drill. 

Since late 2025, the brigade has been trained as part of Marajó Sem Fumaça (Marajó without smoke), an initiative by Brazilian non-profit Instituto Ar, Brazilian climate tech Umgrauemeio and the Clean Air Fund, to mitigate the risk of wildfires on the island. 

The project combines a high-resolution camera powered by AI software that identifies early signs of smoke and sends instant text alerts, with the brigade’s technical and territorial knowledge, to improve local fire response.  

Guided by a trained wildfire responder, seven of Guardiões das Chamas’ 15 volunteers set and put out a fire in a 900m2 area in less than two hours. It was the largest drill yet, and the last one before the real deal.

From firefighting to fire management

Volunteers from the Guardiões das Chamas brigade practice using chainsaws as part of their training.

In 2024, Brazil’s fire policy went through a paradigm shift, replacing “the reactive logic of firefighting with a preventive, territorial, and integrated approach,” according to Marajó Sem Fumaça’s policy brief. 

In the past, Umgrauemeio’s innovation coordinator Julia Castro explains, a “zero fire” policy criminalized all burning, stopping traditional fire management. Without controlled fires, biofuel accumulated on the ground and led to more intense and frequent wildfires that spread into previously unburned areas.  

The new legal framework acknowledges fire as an ecological, cultural, socioeconomic, and climatic phenomenon. It also recognizes the key role played by the country’s roughly 200 volunteer brigades, as reflected in the dedicated national strategy issued in June.

“That’s the thing with fire,” Castro said. “Whether it’s good or bad depends on where, when and by whom it was set, and on whether or not it was planned.” 

Climate is changing – and so is fire

Before the drill starts, the trained wildfire responder guiding Guardiões das Chamas brigade sets a small fire to demonstrate smoke behaviour.

For traditional communities in the Amazon, fire has always been a part of life. D’Ávila recalls how her parents and grandparents used it for cooking, making pottery and clearing land for farming. 

“Fire was simply an instrument,” she said. But back then, it didn’t burn as much, she added.    

Human-induced climate change has made the Amazon almost 30 times more prone to blazes. 

“The forest is growing drier,” said Patrícia Ferrini, global health and climate expert, and coordinator of Marajó Sem Fumaça. “As a result, fires are more likely to escalate into wildfires.”

That has altered the ancestral ways in which communities related to fire, said Ferrini. Knowledge passed down through generations – from where to burn to the right time to burn  – no longer suffices to keep it under control. 

Still, the routine use of fire persists in Ponta de Pedras. Multiple times a day, Guardiões das Chamas volunteers receive smoke alerts on their phones, with photographs and geocoordinates attached. 

Not every notification warrants deploying the whole crew, though. For those like D’Ávila, familiar with the territory, the information on these alerts is often enough to discern real threats from “just a neighbor burning their trash”.  

That, she says, optimizes the brigade’s time and allows them to “focus on the wildfires that will actually cause major damage.”

Deforestation drives Amazon fires

The Amazon is the epicenter of Brazil’s fires. But unlike other biomes where they are a natural occurrence, in the world’s largest rainforest, fires are the result of what Castro calls “disturbance”, or human action. 

Deforestation is the main culprit. Burning is the fastest and cheapest way of clearing land, so it has become “one of the go-to tools for illegal deforestation,” according to Claudio Angelo, international policy coordinator at Observatório do Clima. 

In 2025 alone, more than half of deforestation in the Brazilian Amazon was driven by forest fires, accounting for 51%, while 48% was due to clear-cutting, and 1% to mining. 

In May 2025, deforestation in the Amazon reached 960 km², representing a 92% increase compared to the same month in 2024, the acting Minister of the Environment and Climate Change, João Paulo Capobianco, told Agência Brasil.

Brazil’s Greenhouse Gas Emissions and Removals Estimating System (SEEG),

Data from Brazil’s Greenhouse Gas Emissions and Removals Estimating System (SEEG), shows that 72% of all national emissions come from land use change and agriculture, and in Brazil, these activities are synonymous with land clearing.  

Deforestation also fuels a fiery feedback loop. Over the past 35 years, it has accounted for a 74% decline in rainfall and a 16% increase in peak air temperatures in the Amazon, changes that have made the forest more flammable than ever. 

This year’s El Niño has the Amazon on high alert. The prolonged and intensified droughts caused by the phenomenon’s last visits in 2016 and 2024 were followed by the worst wildfire seasons on record in the region.  

Area burned in the Amazon in 2024, following the last El Nino.

Globally, forests cover 4.14 billion hectares, or almost one-third of the world’s land area, and the current rate of deforestation is 10.9 million hectares per year, according to the Food and Agriculture Organization’s (FAO) Global Forest Resources Assessment 2025.

Fire affects an average of 261 million hectares of land annually, nearly half of which is forested.

While deforestation has slowed in all regions of the world in the last decade, South America has the highest forest loss every year.

Meanwhile, the global rate of forest expansion has also decreased, from 9.88 million hectares annually in 2000–2015 to 6.78 million in 2015–2025.

Fire impacts on human health

Volunteers at Guardiões da Chama brigade simulate a rescue of a person injured during a fire.

While the volunteers geared up and prepared to start the drill, Wemerson Ferreira rode his motorcycle back and forth with fresh coffee and ice-cold water. His home is in the lot adjacent to the field about to burn. He can’t take on the fire, but wanted to pitch in. 

Ferreira must be gone before the first flicker. “If I stay, you’ll see just how fast I start getting sick,” he told HPW. “It gets hard to breathe.”

Over the past 10 years, he has lived through two wildfires that almost devoured the family’s house and crops. Every whiff of smoke ignites a reminder in his injured lungs. 

Air pollution is the largest environmental threat to human health, with links to one in eight deaths worldwide. A major contributor to its lethality, wildfire smoke is projected to be the cause of 1.4 million premature deaths annually by the end of the century.  

Soot and smoke contain hazardous particles which, when inhaled, enter the lungs and reach the bloodstream, damaging arteries, neurons and multiple organs. In time, that can lead to cardiovascular and cerebrovascular diseases. 

Europe, which is heating faster than the global average due to climate change, experienced record-breaking fires, in the past few years.

In the Brazilian Amazon, wildfires increased respiratory hospital admissions by 38% and circulatory hospital admissions by 27% over the course of a decade. Preventing and mitigating them, Ferrini says, is a form of healthcare. 

Education is key to fire management

Cosmerina D’Ávila (right), chief of the Guardiões das Chamas brigade, explains fire management’s best practices to Ponta de Pedras residents.

Ferreira believes accurate information about fire management is life-changing, adding that he almost lost everything because of his lack of knowledge. 

Most of those who have joined Guardiões das Chamas’s training have tales of loss, said Josiane de Morais, a nursing technician and member of the brigade.

Her story was from decades ago, before her 24-year-old son was born, when her grandparents’ home caught fire. She witnessed how friends and neighbors desperately tried and failed to put it out. 

“That’s why we must go beyond firefighting, and why our work must include education,” Morais said. “So that there are no more such tragedies.”  

Marajó Sem Fumaça has made education one of its pillars, developing and distributing an informational pamphlet rooted in traditional knowledge and language, with best practices for fire management in the context of the climate crisis. 

During a drop-by to inspect the source of a smoke hotspot detected by the AI software, brigade volunteers were met by a resident already familiar with the material. 

“She had followed all the instructions,” D’Ávila said. “My eyes welled up to see that this little seed we planted has germinated and is bearing fruit.”

The bumpy waterway ahead

A Guardiões das Chamas volunteer gears up inside a room temporarily being used to store the brigade’s equipment.

A couple of days after the fire drill, Guardiões das Chamas was officially presented to the community of Ponta de Pedras. Between concerts of beloved local dance carimbó celebrating the last week of summer holidays, the volunteers got up on stage in full gear and made themselves and the brigade known.  

“Now that we’ve been properly introduced,” Morais said, “we can start our work.” 

The journey ahead, however, is uphill. Beyond the urban downtown of Ponta de Pedras, getting around depends on river levels. In winter, only boats can cross the high waters. During the summer droughts, cars and motorcycles can travel on the dirt roads — unless it rains and they get too muddy. 

This landscape is one of the many obstacles for the fire response. In spite of the support from Marajó Sem Fumaça, the brigade still lacks much of the infrastructure and resources it needs to keep going. 

Besides, Morais notes, they are volunteers “trying to do their best” – not paid employees of the brigade. They each have other obligations, so dropping everything over a smoke alert isn’t always be an option. 

Nonetheless, D’Ávila expects that things will only get better from here, “recruiting more people, getting more equipment and securing transportation.” 

As the Amazon enters a new drought season, with wildfires expected to surge, the captain of the brigade knows there are no more drills or do-overs. She knows it’s up to them to guard the flames in Ponta de Pedras, and they are “eager to get into action,” she says.

Image Credits: Amanda Magnani, SEEG.

Dr María Neira confers with WHO DG Dr Tedros during the 2025 World Health Assembly in Geneva. Her last-minute nomination will likely focus on climate and health.
Dr María Neira confers with WHO DG Dr Tedros during the 2025 World Health Assembly in Geneva. Her last-minute nomination is pushed by civil society organisations.

Spain has officially submitted Dr María Neira’s nomination for the WHO Director-General election ahead of Thursday’s statutory deadline, sources close to the matter told Health Policy Watch. The submission expands the candidate pool by introducing a focus on primary prevention and climate-related health risks to the race.

Before Neira’s nomination, a coalition representing over 100 civil society groups and senior leaders had petitioned the Spanish government to support her candidacy, framing her technical expertise as essential to address extreme heatwaves and environmental health risks in vulnerable communities. Co-led by Nobel Peace Prize Laureate Adolfo Pérez Esquivel and Dr Carlos Ferreyra of Climate, Life and Health International, the petition unites indigenous leaders, elder-rights advocates, and public health networks across Africa, Asia, and Latin America.

Observers describe her candidacy as the first real grassroots campaign for a WHO Director-General election. In an official press statement, the civil society coalition backing her nomination applauded the Spanish government’s decision to nominate Neira.

The civil society organisations urged international health leaders to address what they termed “thermal violence” – the devastating toll of extreme heatwaves on vulnerable communities across the Global South.

“Geneva’s true power lies in its moral and normative authority to bring into focus what the Global North often ignores,” the alliance declared, calling for executive leadership capable of translating climate science into urgent political action.

Health Policy Watch reached out to the Spanish government for comment prior to publication, but received no response. Neira declined to comment.

A vision focused on scientific evidence

Maria Neira posted her WHO leadership vision on LinkedIn.
Maria Neira posted her WHO leadership vision on LinkedIn.

Neira is set to enter the contest as the fifth candidate alongside Dr Hans Kluge of Belgium, Dr Hanan Balkhy of Saudi Arabia, Dr Hanan Al-Kuwari of Qatar, and Budi Gunadi Sadikin of Indonesia.

Her career combines frontline medical work in conflict zones across Africa and Latin America for organisations like Médecins Sans Frontières with two decades as former WHO Director for Environment, Climate Change and Health. In a recent LinkedIn post, Neira outlined a policy vision calling for a shift toward primary prevention to target the root causes of disease before people require treatment.

Rather than viewing environmental policy as an economic burden, she treats public health as a key benefit of clean energy, sustainable transport, and urban planning. Neira argues the agency requires a leader willing to push for policies that “the evidence demands”.

Election unfolds amid financial and geopolitical pressures

The World Health Organization headquarters in Geneva, where member states will elect the next Director-General to lead the agency.
The World Health Organization headquarters in Geneva, where member states will elect the next Director-General to lead the agency.

The election takes place against the backdrop of financial pressures across the WHO, which faces severe budget shortfalls and political divisions following the withdrawal of US funding.

Addressing the agency’s financial constraints, Neira outlines what she terms the “Health Impact from Institutional Influence Principle,” arguing that the WHO’s power relies on scientific and moral authority rather than budget size alone. By setting global standards and translating evidence into policy, she maintains the agency can guide international health action far beyond its direct funding capacity.

Following Thursday’s nomination deadline, contenders will face Member States at the first live candidates’ forum in November. The WHO Executive Board will then shortlist up to three finalists in early 2027 before the World Health Assembly casts the decisive vote in May.

See related story:

As Deadline Nears, Civil Society Urges Spain to Nominate María Neira in WHO DG Election

Editorial Note: This article was updated on 24 September to include new statements.

Image Credits: WHO, Felix Sassmannshausen/HPW.

Ghanaian President John Mahama launched the Accra Reset report in New York on Monday.

A blueprint to empower countries in the Global South to end their dependence on health aid, which includes the possible closure of international global health organisations, was launched by the Accra Reset on the sidelines of the UN General Assembly on Monday.

“A national reset without a global reset leaves us building on shifting sand,” Ghanaian President John Mahama told an event to celebrate the first anniversary of the Accra Reset. “Likewise, a global reset without domestic discipline is unfeasible. They are two sides of the same coin.”

Mahama initiated the Accra Reset a year ago when he convened a meeting of African leaders in Accra to respond to the massive and immediate cuts to health aid implemented by the Trump administration. It has since evolved into a global platform pushing for the reform of global health and aid institutions, based on empowering countries and regions.

The Reset’s plan, A Sovereign Future For Health, notes that external financing for health in Africa fell by almost 70% between 2021 and 2025.

“For many countries in the Global South, the abrupt changes in the global health financing system require rapid response and adjustments that their fiscal structures are not able to accommodate in the short-term,” it notes.

The report outlines several steps to empower aid-reliant countries, starting with “one-stop country compacts” jointly led by the Ministries of Health, Finance and Planning, and including local stakeholders and “restructured”  international partners. 

Mahama stressed that meaningful country sovereignty requires accountable governance, not simply the transfer of decision-making power from international institutions to national authorities.

Ghana’s President John Mahama warned African countries to play their part in health reform at the UNGA event on Monday.

Strategic reform of ‘Big Five’ health bodies

However, it also proposes that global health institutions “whose main business is passing money, commodities and products to countries” should be “strategically reformed” immediately, in terms of ‘the 4Cs’ – “commit, collaborate, consolidate and close”.

First up are the five global health institutions that “account for the largest flows of funds and commodities and most of the burdensome processes experienced at country level”. 

These are Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank’s Global Financing Facility; the Pandemic Fund (also housed at the World Bank) and Unitaid.

However, it also notes that disease-specific partnerships “whose separate maintenance is increasingly difficult to justify” are on the chopping block, including UNAIDS, Roll Back Malaria, Stop TB, and the Global Polio Eradication Initiative (GPEI).

Also under the microscope are product development partnerships “where rationalisation, merger and sunsetting should be considered”.  These include the Medicines for Malaria Venture, the Drugs for Neglected Diseases Initiative (DNDi), the TB Alliance, the International Vaccine Institute, and the Coalition for Epidemic Preparedness Innovations (CEPI).

Gavi CEO Sania Nishtar told the launch that her organisation’s reform, the Gavi Leap, was focused on country sovereignty, country-centred approaches and stronger regional leadership. Gavi’s investment in the African Vaccine Manufacturing Accelerator is also aimed at supporting the move to regional independence.

Welcoming the report, Global Fund executive director Peter Sands said: “Accelerating the pathway to health sovereignty should not be equated with a retreat from global solidarity. This is a new form of partnership. Ultimately, the true measure of our success is the difference this makes to people’s lives.”

Guidelines for countries

The report outlines five steps to empower countries to move away from aid dependence. The first step is “practical sovereignty”, where countries “own the decisions, the financing framework and the data required to govern their health systems”. 

They should not “merely endorse externally financed programmes”, warns the report.

Within a year, countries should develop National Health Plans (NHPs) that include multi-year health investment plans, and map domestic and external resources, financing gaps, and “a realistic financing pathway”.

“Domestic resources become the foundation for core national responsibilities, while external financing is redirected towards managed transitions, capacity development, fragile settings, regional functions, emergencies and global public goods,” the report stresses. 

In the medium-term, NHPs can start to take on the functions of international organisations over a five- to 10-year period, managed by a country-led process with international partner buy-in. 

In cases where the global health institution will close, the report calls for “an orderly, time-bound wind-down with clear dates, sequencing, and the destination of all functions is agreed on up front within a foreseeable horizon of five to 10 years”.

However, it notes that “global entities in charge of normative guidance such as the World Health Organization (WHO) and those providing global public goods and humanitarian support need to continue.

The report was developed by the Reset’s 23-member High-Level Panel on the Reform of the Global Health Architecture and Governance.

This is co-chaired by Indonesia’s Health Minister Budi Gunadi Sadikin, Kofi Annan Foundation’s Dr Elhadj As Sy, Dr Peter Piot of the London School of Hygiene & Tropical Medicine, and Dr Priscila Ferraz, from Brazil’s Fundação Oswaldo Cruz (Fiocruz).

Image Credits: Presidency of Ghana.

Civil society leaders urge Spain to back Dr María Neira's last-minute WHO Director-General nomination.
Civil society leaders urge Spain to back Dr María Neira’s last-minute WHO Director-General nomination.

With Thursday’s 24 September deadline looming, international scientific societies and civil society leaders are pushing Spain to sponsor a last-minute nomination of Dr María Neira as candidate in the World Health Organization (WHO) Director-General election.

Neira is WHO’s former Director for Environment, Climate Change and Health, and her nomination has been endorsed by Nobel Peace Prize Laureate Adolfo Pérez Esquivel and Dr Carlos Ferreyra of Climate, Life and Health International. They have joined other civil society groups to petition Spanish ministers to register her candidacy before entries close.

“Dr Neira does not merely represent a highly competent nominee for Spain, but a truly decisive planetary asset,” said the Argentine-based Citizens’ Roundtable and Planetary Civil Society in a press release on Monday.

Ferreyra emphasized that the petition represents a broader call for multilateral reform. “We believe strongly in the immediate need for democratic reform of global governance, and that includes WHO,” he said, arguing that civil society must be recognized as true UN “rightsholders” rather than simple “stakeholders.”

Madrid deliberating nomination

Despite earlier indications that Spanish authorities would pass on the current election cycle, Health Policy Watch understands that Madrid is deliberating the nomination.

At present, there are four official nominees: Belgium’s Hans Kluge, Saudi Arabia’s Hanan Balkhy, Qatar’s Hanan Al-Kuwari, and Indonesia’s Budi Gunadi Sadikin.

Neira declined to comment when reached by Health Policy Watch, while the Spanish government has not responded to official queries.

Campaign organisers said they received positive informal signals from Spanish officials. Nonetheless, Madrid faces internal diplomatic friction after launching competing international bids for the UN Food and Agriculture Organization (FAO) and the International Labour Organization (ILO).

Climate experience drives potential nomination

Mounting climate and environmental health challenges underscore civil society calls for Spain to nominate Dr María Neira for WHO Director-General.
Mounting climate and environmental health challenges underscore civil society calls for Spain to nominate Neira for WHO Director-General.

Neira recently joined the Clean Air Fund as an inaugural Senior Fellow advising on atmospheric pollution, after leading WHO’s Department of Environment, Climate Change and Health from 2005 to 2025. During her two decades in Geneva, she spearheaded pioneering WHO reporting on air quality and pollution, while firmly establishing climate change as an urgent public health crisis.

She previously served as Spanish Vice Minister of Health and President of the Food Safety Agency, following earlier WHO work coordinating global cholera control. An epidemiologist and physician, Neira began her career managing Médecins Sans Frontières emergency operations in Central American conflict zones.

Advocates argue her nomination would expand the candidate field by introducing a recognized climate expert to address the defining health challenges of coming decades, exacerbated by extreme heatwaves and environmental crises. She helped develop the global “One Health” approach connecting human, animal, and environmental health.

Backed by an international coalition anchored in Latin America and spanning the Global South, supporters include former Ecuadorian Vice Minister of Health Dr Marcelo Aguilar, Maya indigenous leader Pedro Regalado Uc Be, and Ugandan extreme heat advocate Rev. Godfrey Byamukama. Together with representatives from Small Island Developing States and age-advocacy networks, supporters contend her entry translates Spain’s 1986 universal health system legacy to the multilateral stage.

Neira calls for ‘scientifically fearless’ WHO

Maria Neira posted her WHO leadership vision on LinkedIn.
Maria Neira posted her WHO leadership vision on LinkedIn.

Outlining her leadership vision on LinkedIn earlier this month, Neira argued that WHO requires a “scientifically fearless” strategist rather than a mere administrator.

“The world does not need a personality to manage WHO. It needs a leader who can unleash its collective intelligence and lead global health,” she wrote, fuelling speculation about a potential bid.

She advocates for primary prevention, treating global health as a positive dividend of development across energy, technology, and urban planning.

With the nomination window closing on Thursday, a Spanish submission would ensure a dedicated climate advocate enters the final election contest. Whether Madrid registers her candidacy before the deadline will determine if environmental health takes centre stage in shaping global health governance.

See related story:

The Digital Campaigns Shaping Candidates’ Messages in Race for WHO Director-General

The article was updated on 22 September to incorporate comments from civil society leaders on global governance reform and Dr Neira’s technical record at WHO.

Image Credits: Alexandre P. Junior via Pexels, Felix Sassmannshausen/HPW.