UN experts have likened plastics pollution to a “toxic tidal wave” threatening human rights, health, and the environment.

The third round of international negotiations over a global plastics treaty has ended in a stalemate, leaving nations no closer to an agreement to stem the tide of plastic pollution that is choking the planet and endangering human health. 

The week-long talks at UN Environment Programme (UNEP) headquarters in Nairobi marked the halfway point towards the 2024 deadline set for nations to hammer out a binding international treaty addressing the “full life cycle” of plastics, as set out in a UN resolution adopted by 175 countries in 2022.

While UNEP Executive Director Inger Andersen expressed optimism regarding the “forward motion of the negotiations towards a treaty that ends plastic pollution,” environmentalists, scientists, and civil society painted a different picture.

With only two rounds of negotiations remaining, a small but determined group of fossil fuel and plastic-producing nations, led by China, Russia, Iran and Saudi Arabia, is impeding progress and imperilling the prospects of a landmark treaty.

Petrochemicals are the building blocks of plastics and consume more fossil fuel-based energy than any other industry globally. Over 99% of virgin plastics are derived from chemicals sourced from fossil fuels.

“These negotiations have so far failed to deliver on their promise laid out in the agreed upon mandate to advance a strong, binding plastics treaty that the world desperately needs,” Ana Rocha, Global Plastics Policy Director of the Global Alliance for Incinerator Alternatives (GAIA) said in a statement. 

“We have only one year and two negotiating meetings left to hammer out this treaty, and we can’t afford to indulge the interests of a select few,” Rocha added. “They have nothing to lose, and we have everything to lose.”

Zero-draft marred by ‘endless debate’

The recent round of negotiations marked the first time delegations could debate a “zero-draft” of the treaty, a crucial stage in the process intended to allow countries to refine language, establish definitions for key terms, and define the treaty’s scope and power.

However, what began as a 31-page draft ballooned to a sprawling “revised zero-draft” of over 100 pages by the end of the week. The rapid expansion of the document – which now includes challenges to the definition of terms like “plastics” and “life cycle” – has raised concerns among national delegations and environmental groups, who fear that the extensive text will be more difficult to negotiate and narrow down to a final treaty.

In the final hours of the negotiations, a bloc of like-minded countries comprising Saudi Arabia, Iran, and Russia, stymied efforts for inter-sessional work between major negotiating sessions. This leaves the process without a framework to debate the extensive text between negotiations, or a clear path forward as it enters its next phase in Ottawa, Canada.

The Center for Environmental Law (CIEL), a non-profit observer to the negotiations, said the outcome sent “a clear warning that entertaining endless debate by those few who want to block progress at every turn is a recipe for inertia and eventual disaster”. 

“It’s clear the present process cannot overcome the coordinated opposition of those who block consensus and progress at every turn,” CIEL President Caroll Muffett said in a statement. “Absent a major course correction, Canada will host a polite but massive failure when talks resume in Ottawa next year.”

The outgoing chair of the International Negotiating Committee (INC), which is overseeing the negotiations, Gustavo Adolfo Meza-Cuadra Velasquez, was less pessimistic: “These past 10 days have been a significant step forward towards the achievement of our objective to develop an international legally binding instrument to end plastic pollution,” said Velasquez. “But it has also recalled [for] us that much remains to be done both in narrowing down our differences and in developing technical work to inform our negotiations.”

Production expands as plastics crisis mounts

In 2023, the “Plastic Overshoot Day”, the date when the amount of plastic waste outweighs the world’s ability to manage it, occurred on 28 July.

The plastics industry generates around $600 billion a year, and the oil and gas industry that produces the chemical components to make plastics is the eighth largest in the world, valued at $6.9 trillion annually.

Plastic production has quadrupled over the past 30 years, reaching 450 million tons in 2022, a remarkable figure for such a lightweight material. More than half of the nine billion tons of plastic ever produced have been generated since 2000.

The plastic industry is dominated by fossil fuel titans like Saudi Aramco, the world’s largest oil producer, and ExxonMobil, the global leader in plastic production. By 2025, plastics and other petrochemicals are forecast to be the leading cause of growth in oil demand. 

Industry estimates project that plastic production could double in the next 10 to 15 years and triple by 2050. Meanwhile, fossil fuel giants like ExxonMobil, Dow, Shell, Saudi Aramco and Sinopec are investing heavily in building new factories and retrofitting oil refineries around the world to increase petrochemical production to meet those targets. 

Under the cover of climate commitments, governments are following suit. 

Petrochemical production index in key countries and regions, according to a 2023 study by the University of Lund.

“While governments are committing to action on climate change and have signed up to initiatives tackling global plastic pollution, massive investments are being made to expand the production capacity in the petrochemical sector, not least in the Middle East, China and the USA,” according to a 2023 study by the University of Lund. “This has to a large extent flown under the radar of the public.”

UN experts have likened the explosion of plastic pollution to a “toxic tidal wave” threatening human rights, health, and the environment. But oil and gas producers have no plans to slow production. Instead, they see plastics as a lifeline. Petrochemicals yield significantly higher profit margins than transport fuels — margins oil and gas producers are counting on to offset the anticipated fall in demand for fossil fuels on energy markets as renewables increase their share of the global energy mix. 

“The petrochemical industry needs plastic as a safe haven from carbon liabilities,” a 2021 study by the International Pollutants Elimination Network (IPEN) found. “Increasing plastic production offsets falling demand for its fossil fuels.”

“With petrochemical companies avoiding fossil fuel carbon liabilities by massively increasing plastic production, the amount of plastic waste generated is set to climb dramatically,” the study added. 

‘Best intentions’ meet obstruction

Plastic
The majority of plastics that are produced end up in landfills in poorer countries. This practice is sometimes referred to as “waste colonialism.”

The UN-led talks aim to produce a legally binding treaty to defuse this plastic “time bomb”, and UNEP’s Andersen has described the negotiations as a “once-in-a-planet” opportunity.

The majority of the 150 nations that attended the treaty negotiations in Nairobi remain committed to crafting a legally binding agreement to combat the escalating plastics crisis. 

Over 100 countries support bans or phase-outs of the most harmful and unnecessary plastics, while 140 advocate for a legally binding treaty over a voluntary one, according to tallies by the World Wide Fund (WWF).

But leading fossil fuel and plastics producers, including Russia, China, Saudi Arabia, Iran, and the United States firmly oppose legally binding caps or phase-outs on plastic production. 

They maintain that the plastics crisis can be effectively addressed downstream through investments in recycling technology and waste management infrastructure. These arguments mirror the stance of the petrochemical industry dating back to the 1960s, when plastic production first exploded.

The INC is a consensus-based forum, meaning all countries must agree to the treaty’s language for it to be accepted. Environmental groups have accused fossil fuel interests of exploiting this consensus requirement to undermine the talks.

“The majority had the best intentions and worked to find commonalities among diverse global perspectives, but the entire process was continually delayed by a small number of member states prioritising plastic and profit before the planet,” said Erin Simon, head of plastic waste and business at WWF.

Fossil fuels lobbyists swarm Nairobi negotiations

An analysis led by the CIEL found that at least 143 fossil fuel and chemical lobbyists attended the negotiations in Nairobi, marking a 36% increase since the previous round held in Paris in June. Six lobbyists attended the talks as part of official member-state delegations. 

The surge in industry representation in Nairobi mirrors the record-breaking attendance of the fossil fuel industry at last year’s COP27 UN climate summit in Egypt, where over 600 lobbyists were present — a 26% year-on-year rise.

Lobbyists at the plastics treaty negotiations surpassed the combined delegations of the G7 nations and the 70 smallest UN member states present. They also outnumbered the 64 diplomats representing the Small Island States by more than two to one.

Small Island States, which are on the frontlines of both the climate and plastics crisis, spearheaded efforts throughout the week to centre the treaty on plastic production limits to protect human and environmental health, and human rights.

“However, the influence of a group of fossil fuel and plastic-producing countries overpowered these perspectives,” Break Free From Plastic, a non-profit observer group, said in a statement on Monday. 

“The bullies of the negotiations pushed their way through, despite the majority countries, with leadership from the African Bloc and other nations in the Global South, in support of an ambitious treaty,” said Rocha. “Plastic is burning our planet, destroying communities, and poisoning our bodies. “This treaty can’t wait.” 

Plastics
Top 20 global producers of single-use plastics for the year 2021. The list remains effectively unchanged since 2019.

The outsize influence of fossil fuel interests on the treaty process has led to criticism from scientists and environmental groups of UNEP’s handling of the negotiations. They have called on the INC secretariat to implement stricter conflict-of-interest policies.

At a press conference on the opening day of negotiations, Andersen acknowledged the presence of industry at the negotiations, but added that both UNEP and the INC secretariat “listen to all sides, but do not have specific engagements with one sector or another”.

“A large slice of the industry, what they’re asking for is a level playing field. What they’re asking for is predictability. What they’re asking for is knowing what the market will be like, five years, 10 years out so that they can plan” said Andersen. 

“I think that’s fair because if you are in the business of innovating, you need to know where you’re going and what might be routes you may wish to take,” she added. 

The Global Partnership for Plastics Circularity (GPPC), a petrochemical industry group formed in response to the 2022 UN resolution calling for a binding treaty on plastic pollution, asserted in a statement that the recent round of negotiations had “made progress towards an effective and practical plastics agreement.”

However, the GPPC, whose membership includes ExxonMobil, Shell, Chevron, and Saudi Aramco, emphasized the need for increased support for recycling technologies and waste management.

“This can be best accomplished by creating demand signals that will unlock investments in product design innovations, collection and recycling infrastructure, and financing systems that incentivise circularity to keep used plastics out of landfills, incinerators and our environment,” the GPPC said. 

Plastics
Un-recycled plastics have knock-on effects on the environment, emissions, biodiversity, and human health.

Yet decades of scientific research and media investigations tell a different story: Recycling and waste management, touted as the primary solutions to the plastics crisis by the industry and plastic-producing nations, are not working. 

As of 2018, only 9% of the 8.3 billion tons of plastic ever produced had been recycled, while 12% was incinerated and 79% ended up in landfills or the environment. In 2023, 43% of plastic produced globally is mismanaged and therefore “likely to end up in the Earth’s air, water, or soil”, according to the 2023 Plastics Overshoot report.

“This means 68,642,999 tons of additional plastic waste will end up in nature this year,” the study found. If current production and waste management trends continue, an estimated 12 billion tons of plastic waste will be in landfills or the natural environment by 2050.

The capacity to recycle plastic has also struggled to keep pace with the rapid growth of plastic production. The 2023 Plastic Waste Makers Index, an annual benchmark report that monitors the activities of businesses responsible for plastic production and pollution, characterized recycling as “at most, a marginal activity for the plastics industry.”

This problem is expected to worsen as the chemical composition of plastics becomes more complex, posing greater challenges for recycling and safe disposal.

“We cannot protect our climate, our biodiversity, or our health unless we reduce plastic production. This is inarguable, but more than halfway through the treaty negotiations, we are charging towards catastrophe,” said Graham Forbes, global plastics campaign lead at Greenpeace. 

“Plastic directly harms each of the 8.1 billion people on this fragile planet, but our leaders have effectively chosen to treat petrochemical companies as the only stakeholders worth listening to,” added Graham. 

Health loses if treaty fails 

“The Plastic Forecast combines research on atmospheric plastic dynamics with traditional weather forecasts to estimate the daily ‘plastic fall’ in an easy-to-understand weather report for Paris,” according to the Minderoo Foundation.

During June, while delegates were in Paris for the previous round of negotiations, the city used nearly 4,000 kilograms of plastic, according to the Minderoo Foundation Plastic Forecast. Converted to microplastic particles, that figure represents over four trillion individual plastic fragments. 

“Our atmosphere contains plastic particles that fall to the ground consistently – even more so when it rains,” the Minderoo Foundation study found. “The study confirms plastic particles in our atmosphere are constantly being deposited on the ground, even without rainfall. Plastic is falling all the time, all over the world.”

Plastics have been found at the bottom of the Mariana Trench, the deepest point in the ocean, and atop the summit of Mount Everest, the Earth’s highest mountain, and have become a common feature of what remains of coral reefs. 

Microplastics, meanwhile, will outnumber fish in our oceans by 2050 and have founded island state-sized garbage patches in the ocean. Last week, Chinese scientists published new research showing the presence of microplastics in clouds above Eastern China. The researchers say that the presence of microplastics in clouds could have a number of implications for the weather. 

Plastics are in our blood, lungs, breast milk, food, water and air. Microplastics are altering the behaviour of cells in the internal organs of humans and birds through a new illness scientists call “plasticosis”. 

People now consume around five grams of microplastics a week simply by eating, drinking and breathing, yet their impacts on human, environmental and animal health are still largely unknown. 

Plastic
Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia.

“We are performing a population-scale human experiment on the health impacts for this generation and the next with respect to these massive chemical exposures,” CIEL’s Muffett told Health Policy Watch. “The array of health exposures is the aspect of the plastics crisis that is really just coming to light.”

Over 3,200 of the 13,000 chemicals so far identified in plastics are known to have at least one toxic effect on human and environmental health. Another 5,000 have not been adequately studied, leaving the world in the dark about their potential impacts on human and environmental health.

The economic costs of inaction on the chemical and plastic pollution crisis could be as high as 10% of global GDP, according to UNEP. 

The Endocrine Society estimated in a 2020 study that just four chemical families used in plastics cause over $400 billion in human health costs every year in the United States alone – a figure its authors called “a conservative estimate” due to the low number of chemicals studied. 

“Just for those few chemicals, the costs are tremendous,” Martin Wagner, an environmental toxicologist at the Norwegian University of Science and Technology and member of the Endocrine Society explained in an interview.

“If you extrapolate that to a global scale, just based on what we know about a few endocrine-disrupting chemicals in plastics, it makes total economic sense to do something about it.”

The Scientists’ Coalition for an Effective Plastics Treaty, meanwhile, found that Canada spends an estimated $684 billion in health costs every year due to its population’s exposure to bisphenol A, a chemical commonly contained in food packaging and drink cans.

Image Credits: Photo by Hermes Rivera on Unsplash, QPhia.

Pregnant women, newborns and young children are uniquely vulnerable to the effects of climate change.

If government subsidies for fossil fuel were removed and redirected to addressing the impact of climate change on health, this would free up some $6 trillion or 75% of what is spent on health annually, said Agnes Soucat from the French Development Agency.

Soucat also called for scrutiny of agricultural subsidies “and how they contribute to our food system, and how this contributes to biodiversity loss and health impacts, such as impact on diabetes and cardiovascular diseases”.

Governments should eliminate the “harmful subsidy mechanism to reduce or suppress the adverse effect on the environment, animal and human health”, and substitute it with “smart environment and health taxation for one sustainable planetary health”, such as taxes on fossil fuel andcarbon, she proposed.

Soucat also pointed out there there are over 500 public investment banks worldwide with  $2.5 trillion of public investments. If only 10% was “mobilised” for investment in health, this would represent 10 times what is currently available in development aid.

Agnes Soucat from the French Development Agency (AFD).

Soucat was addressing Tuesday’s launch of a Call for Action for policies and action to protect pregnant women, babies and children from climate-related health risks, by United Nations (UN) agencies ahead of the global Conference of the Parties (COP28) negotiations on climate change in Dubai.

According to the Call, climate response policies should prioritise pregnant women, newborns and children, who are particularly vulnerable.

Babies more at risk from air pollution

UNICEF’s Abheet Solomon pointed out that babies “breathe more rapidly than adults while their lungs are still developing”, and this puts them at a greater risk of developing respiratory illnesses when exposed to air pollution.

“This is why, every day 1000 newborns die, simply because of air pollution-related risks,” said Solomon.

“Infants are less able than adults to regulate body temperatures and have a higher metabolic rate, meaning that they’re more susceptible to the effects of extreme heat,” he added. UNICEF estimates that one in three children are currently “highly exposed to heat waves”.

Children’s under-developed immune systems also put them at greater risk of infectious diseases, including malaria and dengue. Meanwhile, children are also vulnerable to natural disasters – one-third of deaths in the recent floods in Pakistan were children.

“When pregnant and lactating mothers are exposed to climate shocks and stresses, the negative effects not only affect their health, but also foetal development,” said Solomon.

UNFPA’s Wllibald Zeck stressed the importance of protecting vulnerable women and girls in the poorest countries who were heavily affected but contributed the least to climate change.UNFPA was also concerned about disruptions to sexual and reproductive health services.

“Climate change is affecting the health of all of us – infectious diseases, non-communicable diseases mental health, of course, heat waves, malnutrition, displacement – everything,” said Maria Neria, the World Health Organization’s (WHO) director of environment.

“It took us at least 10 years to make sure that we have a health day at COP,” added Neria, in reference to 3 December being set aside at COP28 to discuss health and climate.

After this, “no country has an excuse for saying they didn’t know” about the effects of climate on health, said Neria. She  added that the WHO was also pushing for governments to ensure that their health systems are climate-resilient and to mobilise finances to respond to the climate “shock”.

“The causes of climate change and the causes of air pollution, which is killing seven million people every year, are overlapping and relate to the combustion of fossil fuels,” said Neria. “This dependence on fossil fuels needs to stop.” 

The Call to Action was released by WHO, UNICEF and UNFPA alongside an advocacy brief by the Partnership for Maternal, Newborn and Child Health (PMNCH).

The PMNCH advocacy brief reinforces the Call to Action by outlining specific recommendations for different stakeholders – including governments, global financing mechanisms, donors and foundations, private sector and civil society – for ensuring that the health needs of women, children and adolescents are better addressed in climate policies, financing, and programmes.

Image Credits: Michael Duff/ UNFPA.

People seeking shelter at a refugee near the Chad border with Sudan. 

Following seven months of fighting in Sudan, there are outbreaks of cholera, measles, malaria and dengue in the country.

An estimated 6.2 million people – about one in eight – have been forced to flee from their homes since the fighting between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in mid-April, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

About three million of the displaced people are children, the largest child displacement crisis in the world.

The Office of the High Commission for Human Rights OHCHR has also raised concerns about women and girls being abducted, forcibly married and held for ransom.

“Disease outbreaks are increasing due to the disruption of basic public health services, including disease surveillance, functioning public health laboratories and rapid response teams,” said OCHA in its latest update released on Sunday.

“In addition, insecurity, displacement, limited access to medicines, medical supplies, electricity, and water continue to pose enormous challenges to delivering health care across the country.”

No healthcare services

OCHA estimated that 65-70% of the population lacks access to healthcare, while 70-80%  of hospitals in conflict-affected areas are no longer functional. 

Meanwhile, almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states as of 12 November, according to the Federal Ministry of Health and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states by 12 November, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Twenty million people face hunger

Meanwhile, the World Food Programme (WFP) has warned that “over 42% of Sudan’s population – more than 20 million people – face hunger. This is the highest number ever recorded in the country”.

“In addition to conflict, increasing food and fuel prices, the pre-existing economic crisis, protracted displacement, poor harvests and climate shocks, such as floods and droughts, are the main drivers of food insecurity,” reports the WFP, noting that 2023 food prices are 29% higher than last year and 228% higher than two years ago.

UN agencies and NGO partners in the country report that they have only received one-third of the funding that they need to implement the 2023 Sudan Humanitarian Response Plan – $856.2 million of the required US$2.6 billion. 

An estimated 18.1 million people need assistance but humanitarian organisations have reached about 4.5 million people with multi-sectoral life-saving assistance and 5.5 million people with livelihood support since the start of the conflict. 

 

Image Credits: World Food Programme.

Emission
“Present trends are racing our planet down a dead-end 3C temperature rise,” UN Secretary-General Antonio Guterres said on Monday.

The world is on a trajectory to heat up by nearly 3°C this century unless governments take “relentless” action to cut greenhouse gas emissions, according to a new report released Monday by the United Nations Environment Programme (UNEP).

The Emissions Gap report, an annual assessment by UNEP that measures the difference between government pledges to combat climate change and the emissions reductions scientists say are necessary to avert planetary catastrophe, found that current policies are leading to between 2.5°C and 2.9°C of warming above pre-industrial levels by 2100. 

A 3-degree Celsius warming scenario would unleash a cascade of catastrophic consequences, including the displacement of over a billion people, the collapse of ice caps leading to uncontrollable sea level rise, widespread biodiversity loss, frequent and devastating extreme weather events, and the endangerment of critical carbon sinks like the Amazon and Congo Basin rainforests.

The average daily global temperature surpassed 2°C above pre-industrial levels for the first time ever on Friday, marking a historic milestone in the escalating climate crisis as world leaders prepare to gather in Dubai for the annual UN climate summit later this month. 

The 2.06°C average global temperature recorded by the European Union’s Copernicus climate change service on November 17.

“Humanity is breaking all the wrong records when it comes to climate change,” said Inger Andersen, Executive Director of UNEP. “The world must change track, or we will be saying the same thing next year — and the year after, and the year after, like a broken record.” 

The report determined that projected 2030 emissions must be slashed by at least 28-42% compared to current policy scenarios to align with the 2°C and 1.5°C goals of the Paris Agreement, respectively. Even if governments were to fully implement their Nationally Determined Commitments (NDCs) under the Paris Agreement – a big if – warming would still reach 2.9°C, according to the report. 

The current emissions trajectory will see the world exceed the emissions threshold required to meet the 1.5C target by around 22 gigatonnes in 2030 – roughly equivalent to the combined emissions of the United States, China and the European Union. 

“The emissions gap is more like an emissions canyon — a canyon littered with broken promises and broken lives,” UN Secretary-General Antonio Guterres said in a media briefing on Monday. “All this is a failure of leadership and a betrayal of the vulnerable.”

Global GHG emissions under different scenarios and the emissions gap in 2030 and 2035.

Anne Olhoff, the report’s lead scientific editor, stated that the findings remain “essentially unchanged” from last year’s report. The 2022 edition found “no credible pathway” to 1.5°C and concluded that “inadequate progress on climate actions means the rapid transformation of societies is the only option.”

“The only way to maintain a possibility of achieving the temperature goal of the Paris Agreement is to relentlessly strengthen mitigation actions this decade,” said Olhoff. “All countries must urgently accelerate economy-wide low carbon transformations and the transformation of global energy systems.”

With the window of opportunity to avert the worst effects of climate change rapidly narrowing, the reduction targets outlined in the report currently appear far out of reach. In 2022, global greenhouse gas emissions rose by 1.2%, setting a new record of 57.4 Gigatonnes in the planet’s atmosphere. Current projections indicate a mere 2% decline in global emissions from 2019 levels over the same period.

Governments worldwide are planning to produce 110% more fossil fuels in 2030 than is compatible with the 1.5°C target, while the top 20 oil and gas companies alone plan to produce emissions 173% above the 1.5°C target in 2040, according to recent reports by the UN and medical journal The Lancet.

This surge in coal, oil, and gas extraction by governments and private sector fossil fuel companies is set to unleash over 3.5 times the carbon emissions allowed under the 1.5°C warming limit and nearly exhaust the entire carbon budget for 2°C, according to UNEP.

Committed CO2 emissions from existing fossil fuel infrastructure, compared with carbon budgets reflecting the long-term temperature goal of the Paris Agreement.

“Governments can’t keep pledging to cut emissions under the Paris Agreement and then greenlight huge fossil fuel projects,” said Andersen. “It is throwing the global energy transition and humanity’s future into question.”

When the Paris Agreement was ratified in 2015, the probability of global average annual temperatures temporarily surpassing 1.5°C was close to zero. Today, those odds have ballooned to 50% for the 2022-2026 period, according to the World Meteorological Organization (WMO). 

The most optimistic emissions scenario outlined in the Emissions Gap report puts the chance of keeping annual global temperatures below 1.5°C at a mere 14%. The worst-case emissions scenario presented an upper limit of 3.8°C of warming, more than doubling the 1.5°C target set by the Paris Agreement.

“We know it is still possible to make the 1.5°C limit a reality, and we know how to get there,” said Guterres. “We have roadmaps from the International Energy Agency and the IPCC — and it requires tearing out the poison root of the climate crisis: fossil fuels.”

Global greenhouse gas emissions hit a new record of 57.4 Gigatonnes in the planet’s atmosphere in 2022.

A single pyrrhic victory is hidden beneath the gloomy findings of the UNEP report: the Paris Agreement has spurred some, albeit wholly insufficient, action on climate change.

Global greenhouse gas emissions, which were projected to rise by around 16% by 2030 at the time of the Paris Agreement, are now on track to increase by just 3% compared to 2015 levels. Since 2015, a total of 149 signatory countries to the agreement have updated their climate commitments, with nine countries doing so since COP27 in Egypt last year.

These nine countries’ commitments will lead to a reduction of around 0.1 Gigatonnes of emissions. However, to achieve the 2°C pathway, the world must reduce emissions by 18 Gigatonnes, while a 29 Gigatonne decrease is necessary to stay on track for 1.5°C.

Despite the Paris Agreement’s modest progress, the world continues to fall behind on climate action, and records are being broken at an almost monthly rate.

In September 2023, global average temperatures reached 1.8°C above pre-industrial levels, surpassing the previous record by an unprecedented 0.5°C. According to the European Union’s Copernicus Climate Change Service, this year is almost certain to be the warmest on record.

“Leaders cannot delay any longer; we are out of road. COP28 must set us on a path to immediate and dramatic climate action,” said Guterres. “The crucial aspect is our addiction to fossil fuels. It is time to establish a clear phase-out with a time limit linked to 1.5°C.”

Image Credits: UNEP.

A doctor in the DRC examines a patient. Working conditions for doctors are extremely challenging in many African countries.

As the Global North poaches African doctors, healthcare falls to overworked and unmentored interns, some of whom learn medical procedures from YouTube.

Fifteen of the world’s (fiscally) richest countries have over 55,000 African doctors in their health systems, a new data analysis by The Continent shows. These are doctors who qualified before entering those countries. 

The United Kingdom is the top culprit, followed by the United States, France, Canada, Germany and Ireland, in that order. 

Of the African countries being drained of doctors, an analysis of the latest data from the Organisation for Economic Cooperation and Development shows that Egypt has lost the most, followed by Nigeria, South Africa, Algeria and Sudan. 

These countries have consequently paid a significant price in the quality of healthcare they can offer their own residents. 

Egypt, for example, has the lowest doctor-to-patient ratio of its north African neighbours. In many of the drained countries, there are so few trained doctors left that the bulk of healthcare falls to doctors in training: medical interns. 

‘Treated like we are nobody’

Research in Uganda and Kenya details the cost to those interns. The study titled “We were treated like we are nobody” was published this month in the British Medical Journal for Global Health and is based on data on more than 700 medical interns in the two countries, as well as interviews with 54 junior doctors and 14 consultant physicians.

It found that medical interns are suffering from burnout and stress because they are working unreasonable hours and frequently don’t have superiors to train and supervise them. Their working conditions continue to have the same challenges that drive more experienced doctors to seek greener pastures. 

The research found that the lack of support and supervision also “threatened individuals’ well-being and the quality of care being delivered”. 

“Many reported working unreasonable hours – as long as 72 hours – due to staff shortage,” according to Yingxi Zhao, one of the researchers. 

“Sometimes interns were the only staff managing the wards or had to perform certain procedures unsupervised. These included cases where interns had to learn how to perform Caesarean sections from YouTube.” 

Threat to patients’ and doctors’ lives

Such conditions threaten not just the lives of patients but the trainee doctors too. Research by the World Health Organization (WHO) found that people who work 55 or more hours a week had a 35% higher risk of suffering a stroke and a 17% higher risk of dying from ischemic heart disease, compared to those who worked 35-40 hours. 

The Kenya and Uganda findings echo those of a Nigeria study published in May in the Public Library of Science journal. 

Researchers interviewed 628 early career doctors and nearly 40% said they felt overwhelmed by their work. About 16% said they wanted to quit the profession and twice as many said they experienced anxiety. 

The researchers in both studies recommend capping the hours that medical interns and junior doctors work. But limited training facilities and continuing brain drain make the doctor-to-patient ratio so low that reducing working hours is all but impossible. 

By a large margin, the best doctor-to-patient ratios are in Libya and Algeria – 22 and 17 doctors for every 10,000 residents respectively. But even Libya and Algeria compare poorly to the top importers of African doctors, the UK and US, which have between 32 and 37 doctors for every 10,000 people. 

To a doctor looking for a liveable work-life balance, going to the Global North is a no-brainer. 

Lucy Nyokabi, a medical trainee at a Nairobi hospital, says her workload is overwhelming and she often doesn’t have safety equipment or the supplies to do the job properly, like oxygen masks.

“My family supports me in getting the things that I need for the job. I have to remind myself that I need this training to excel at the actual job,” she says.

This makes leaving attractive: “We all hope to work outside the country. I believe the conditions are better out there.” 

First published in The Continent. Subscribe to this free weekly newspaper by emailing read@thecontinent.org

Image Credits: DNDi.

Nearly one million Somalians were affected by flooding in 2020, as the effects of climate change intensify.

With the annual United Nations (UN) climate conference, COP28, due to start at the end of the month, climate-vulnerable countries have reiterated that wealthy countries should cut down their carbon emissions, provide finance to vulnerable countries, and help with technology transfer so all countries can transition to a greener economy faster. 

Meanwhile, recent meetings between the world’s superpowers and biggest polluters, the US and China, offer a glimmer of hope that there might be some progress on reducing greenhouse gas emissions.

“From our perspective, we first of all call for a truthful global stocktake, truthful to our successes and also failures so all countries can face the truth that we in the vulnerable countries already know,” said Tony La Viña, associate director for Climate Policy and International Relations at the Manila Observatory in the Philippines. 

He was addressing a press conference convened last Thursday by Allied for Climate Transformation By 2025 (ACT2025), a coalition that represents voices and expertise from all over the world committed to understanding and amplifying the climate priorities of vulnerable countries and ensuring they are heard at UN climate negotiations. 

Roughly half of the world’s population lives in countries that are vulnerable to the changing climate, according to climate scientists, and ACT25 representatives called for COP28 to be the place where the rich countries to deliver on climate finance and up their climate ambitions.

ACT25 members expressed alarm at the latest data from the World Meteorological Organization’s (WMO) November bulletin shows that greenhouse gas levels in the atmosphere have reached record levels, and will continue to trap heat and drive climate change for many years.

 

Climate and health

Chukwumerije Okereke, director of the Center for Climate Change and Development at Nigeria’s Alex-Ekwueme Federal University Ndufu-Alike, called for more attention to be paid to the connection between climate and health

“I come from the part of Nigeria that has begun to see more incidence of malaria as a result of the changes in weather patterns,” he said. “There are quite a range of different health issues. Flooding is one of the biggest challenges faced in Nigeria. And after each flood, we see an escalation of cholera and other health-related challenges.”

For the first time, a day has been set aside at COP28 to do precisely that.

The World Health Organization estimates that the direct damage costs to health is estimated to be between US$ 2–4 billion per year by 2030. Reducing emissions of greenhouse gases could result in very large gains for health, particularly through reduced air pollution.

China-US pledge

Earlier this month, US and China’s climate envoys met and reaffirmed their commitment to working together to address the climate crisis according to the Sunnylands statement released after the meeting.

The two envoys expressed commitment to implementing previous agreements, including “the effective implementation of the UNFCCC and the Paris Agreement, reflecting equity and the principle of common but differentiated responsibilities and respective capabilities, in light of different national circumstances, to achieve the Paris Agreement’s aim in accordance with its Article 2 to hold the global average temperature increase to well below 2 degrees C and to pursue efforts to limit it to 1.5 degrees C, including efforts to keep 1.5 degrees C within reach.”

Meanwhile, according to the White House statement following last week’s meeting between US President Joe Biden and China’s President Xi Jingping, the two leaders “welcomed recent positive discussions between their respective special envoys for climate, including on national actions to reduce emissions in the 2020s, on common approaches toward a successful COP28, and on operationalising the Working Group on Enhancing Climate Action in the 2020s to accelerate concrete climate actions.

The US is ready to work with China to address “transnational challenges, such as health security and debt and climate finance in developing countries and emerging markets,” it added.

ACT25 members welcomed the recent US-China energy deal that aims to triple renewable energy globally by 2030 and deliver a meaningful reduction in carbon emissions in the power sector by the end of this decade. This is significant given the two countries are among the top two carbon emitters. 

G20 countries, a group of some of the world’s largest economies that are together responsible for over 80% of the global carbon emissions made a similar pledge in September this year during their meeting in New Delhi, India to expand renewable energy.

Mark Bynoe, assistant executive director of the Caribbean Community Climate Change Centre

But Mark Bynoe, assistant executive director of the Caribbean Community Climate Change Centre, said: “It seems like, rather than scaling back, we are continuing to experience and to see that we are investing more in oil and gas. 

“Countries that would have said we need to take a conscious decision of moving away are now investing in oil and gas. The subsidies that we need to cut back on is now increasing towards oil and gas,” added Bynoe.

The International Monetary Fund has estimated that the subsidies given to fossil fuels have surged to $7 trillion. 

Demand rising for private finance

However, vulnerable countries do not expect any radical change at COP28, with the meetings not delivering much gains, year after year. But they also haven’t written off the process, as it is the only global place for global climate negotiations.

“Largely, as we have recognized, most of these agreements are gentleman’s agreements. They are not binding and as a result, it is difficult to hold the country to something that they would have pledged to,” said Bynoe.

The ACT25 members are now also beginning to talk about private finance to address the gaps in climate finance – mainly stemming from wealthy countries not providing the resources necessary to assist low- and middle-income countries to mitigate climate change.

“We need from the corporate, the financial, the private sector, greater involvement, greater transparency and a commitment to make sure that the resources are mobilised towards the global south, towards those most in need,” Maria Laura Rojas Vallejo, executive director of Transforma in Colombia.

Image Credits: AP.

In the worst week of air pollution in the Indian capital this winter, rural farm fires on average contributed to 25% of urban pollution concentrations. Hundreds of kilometres to the north, Punjab, the main source of the pollution, had missed a government-declared target to halve the number of seasonal crop stubble fires – although progress is being made. Health Policy Watch looked at the plight of Punjab farmers and why government tactics so far have failed to curb crop burning in Gurdaspur, Punjab and Delhi.  

GURDASPUR, PUNJAB – Harpinder Singh of Badehari village in northwest Punjab stands with smoke all around him, as the fumes from burning rice paddy stocks from his farm and those of his neighbours, billow up, beginning a long, airborne journey to India’s capital, Delhi. 

He’s one of thousands of farmers, in this strategically located rural state north of the capital, who is setting fire to the stubble to quickly clear his fields for the winter-time planting of wheat. And despite government efforts to encourage alternatives, burning the crop waste remains the cheapest and easiest method.  

“We are the ones who suffer due to stubble burning. We are the ones who inhale this air. We are helpless and left with no option but to burn. Government has failed to help us and look into our problems.”

Punjab missed its target to halve the number of crop stubble fires following this autumn’s rice harvest – although progress is being made.  As of 16th November, there had been 33,000 incidents of crop burning – about a third less than last year.

Why farmers burn paddy stubble

Farmers in Gurdaspur, Punjab, speak to Health Policy Watch. Top: Harpinder Singh. Bottom left: Jaspal Singh. Bottom right: Mukhtar Singh. Picture: Bishamber Bittu

It’s a practice followed largely by small-scale farmers who find it very economical to do so. Many are now being told it damages soil nutrients. Most, like Harpinder Singh, know the smoke hits their families’ health before it hits faraway Delhi. 

Farmers like Singh say they are ready to stop growing rice if the government were to set an assured price on replacement crops – such as millet, bulghur, oilseeds, and other traditionally grown pulses and legumes, which also consume less groundwater, a scarce resource in Punjab, and happen to be healthier options too.

But for now, it’s a matter of simple economics. The central government offers a minimum support price, a guarantee of sorts, for the rice paddy harvest; for this year’s harvest, it was INR 2,183 or about $US 26 per quintal – a unit of mass commonly used in the grain trade equal to 100 kilograms. 

Thanks to the support price, the returns on rice growing, which produces a stiff stalk that cannot easily be ploughed back into the earth, are better than the other options.  There is a very narrow window in which farmers have to harvest the paddy crop, get rid of the stubble, and then prepare the land for wheat. Labour to mechanically remove the stubble is expensive, government-furnished machines can be both expensive and unavailable in a timely manner for small or marginal farmers. 

In conversations with Singh and a few other farmers in Gurdaspur, a district also bordering Pakistan, the narrative is strikingly similar.  

Input costs are INR 15,000-20,000 ($180-$245) for seeds, labour, fertilisers, and pesticides. Then there’s diesel to run generators for pumping water. At the end of the day, farmers say they’re fortunate to make around INR 10,000-20,000 ($120-254) per acre. Over a third of the approximately 1.1 million land holdings in Punjab are managed by small and marginal farmers.

‘No option but to burn’

Mukhtar Singh says, “With land holdings 2 to 2.5 acres what do you expect? Weather is not favourable, our crops get destroyed. The government has not compensated us for flood-affected crops. We are left with no option but to burn as it doesn’t cost.”

“We are lucky we can get food for our family otherwise living conditions are difficult,” Harpinder Singh says. “Expenditure is huge per acre. Seven hundred for cutter (machines), INR 2500-2600 for pickup, INR 4000-5000 for sowing, Diesel is expensive, INR 3500 for pesticides. The total overhead cost is about INR 15,000 per acre. If God is bountiful there is a profit, otherwise, a farmer‘s fate is doomed.” 

Jaspal Singh says, “Our earnings depend on fate. Floods this year have destroyed us. Our expenditure is INR17,000 to 20,000 per acre. If we leave rice what should we grow? We don’t get a good MSP [government guaranteed price] on oilseeds, pulses etc.”

How much of Delhi’s pollution is from farm fires?

The smoke began getting bad on 2nd November. There were over 20,000 fire incidents in just the first week of the month. Hundreds of kilometres downwind, Delhi became swathed in thick and extremely hazardous air pollution. 

Delhi’s smog was so thick that visibility fell drastically and schools were shut for two weeks. Peak pollution levels reached 600-800 µg/m3 (micrograms per cubic metre) on 3rd and 4th November in parts of the Capital and its bordering cities, whereas the WHO’s safe guideline is an average of 15 µg/m3 for 24 hours. After several days of this, farm fires came under scrutiny from India’s Supreme Court.

The situation is repeated annually and it remains complex but the nuance is important. Several states burn the stubble but the focus is on Punjab as most of the fires happen there. 

It’s done largely by small-scale, lower-income farmers trying to maximise their earnings. It invariably leads to a political blame game. The courts get involved. Scientists and experts continue to point out that this is a year-long battle and plead, once again, for year-round action. And questions are raised why after millions of dollars allocated and at least a decade of extreme winter pollution nothing seems to get done. 

Farm fires are not the only significant source of Delhi’s pollution

Air pollution researchers have underlined the direct correlation between fires burning north-west of Delhi and its air pollution.  Punjab’s fires are also visually dramatic with copious amounts of smoke rising from farm fields. 

This is coupled with dramatic satellite images showing smog from crop fires in both Punjab and Haryana (the state lying between Punjab and Delhi) as well as neighbouring Pakistan travelling across much of the Indo-Gangetic Plain. That plain stretches about 2,000 kilometres across northern India south of the Himalayan foothills east to Bangladesh. 

Although Punjab is a small state (bigger than Taiwan, smaller than Sri Lanka) at the western end of this, such images paint a compelling picture of crop stubble burning as a major source of Delhi’s pollution. 

Even so, other sources should not be ignored, experts point out, underlining the importance of nuance. 

While the Punjab may account for 93% of the fires burned across northern India, so far this season, it doesn’t account for most of Delhi’s pollution, they say. The daily contribution of the smoke to Delhi’s pollution from stubble burning from outside is tracked and reported daily by the Air Quality Management Department of the Central government.

In the most polluted weeks, farm fire contribution to air pollution averaged 25%  

The Indo-Gangetic plain stretches about 2,000 kilometres across northern India south of the Himalayan foothills east to Bangladesh.

For the worst pollution week this season, i.e. 2nd to 8th November, Delhi’s PM 2.5 averaged 292 micrograms/cubic metre according to data analysed by Health Policy Watch. The stubble burning contributed 25%. 

Currently, the central government’s Decision Support System for Air Quality Management attributes 10-15% of the pollution to Delhi vehicles; another 5-10% to road dust, construction, energy and other sources in the megacity; and up to 30% from neighbouring areas in the broader Delhi area, known as the National Capital Region (NCR). Other sources include thermal power plants, industries and household fires for cooking and heating. 

So while the farm fires may push air pollution into a ‘severe’ category,  75% of the capital’s pollution still comes from other sources. Once the farm fires largely end around mid-November, these other sources continue to be produced and remain trapped in the atmosphere around the city during the remainder of the winter season, which is characterized by low winds and low rainfall.

Politics gets in the way of real solutions  

As Delhi got smothered and the health crisis hogged the headlines, two leading political parties battled it out once more – the Bharatiya Janata Party (BJP), headed by Narendra Modi, which governs India, and Aam Aadmi Party (AAP) which governs both the states of Delhi and Punjab. 

India’s environment minister, Mr Bhupender Yadav, called the Delhi state chief minister, Mr Arvind Kejriwal and AAP party leader a “liar” – accusing the party of not providing farmers with an alternative to crop burning, and turning Delhi into a “gas chamber”. 

He cited data showing 93% of almost 25,000 fires till 9th November were from Punjab, a state controlled by the AAP.

AAP’s Ms Reena Gupta hit back saying Prime Minister Modi’s “WhatsApp university minister only knows how to peddle lies against @ArvindKejriwal.” 

She cited data showing Punjab’s fire count was down 55%, the sharpest decline in two years. AAP’s strategy has also been to point out that pollution solutions is not a Delhi or a Punjab problem alone – but a pan India, i.e., central government problem. 

Reforming government farm subsidy policies to support alternative crops, whose harvest residue doesn’t need to be burned, for instance, is an issue that can best be resolved by the central government, not individual states. 

‘Slight declines’ won’t help as fires go below a key threshold 

The rival claims aren’t entirely wrong or right. They must be read along with other data and inputs which calls for a nuanced understanding. 

With reference to the data cited by AAP, there is indeed a substantial reduction of fires compared to a year ago, says weather and air pollution modelling expert Dr Gufran Beig. 

But a much lower threshold of fires needs to be attained, in order to prevent large quantities of smoke from travelling to Delhi, he also explains. 

Beig was the founding project director of the Central government’s System of Air Quality and Weather Forecasting and Research (SAFAR), the first government agency to report daily on “source contributions” to Delhi’s pollution. [Unfortunately, since Beig´s retirement, SAFAR has discontinued that service, leaving analysts exclusively dependent on just one reporting source, the central government´s Decision Support platform]. 

Beig estimates the seasonal or monthly threshold to be around 500 to 700 fires this season, as compared to the 25,000 fires seen so far. 

Imagine the route from Punjab and neighbouring Haryana states to Delhi as a wind tunnel or a ¨pipeline¨, he says – one formed by geographic and climatic conditions.

“Regular, non-stop fires mean pollution is being continuously pumped into Delhi. A slight decline in farm fires doesn’t help. There’s a threshold level of about 500-700 fires. 

If there’s sufficient wind speed then the pollution rises up to a height of 1-1.5 kilometres. By the time it gets to Delhi 150-200 kilometres away, this channel of smoke loses energy, descends and gets trapped in Delhi’s stagnant air. If the number of fires drops to 3,000-5,000 [in the season] it hardly makes a difference,” he said.

‘Murder of people’s health’: Supreme Court calls upon law enforcement to halt crop fires 

A picture from the same window in Delhi two months apart. Above: AQI 78, 8th of September, 2023, below: AQI 479, 3rd November, 2023

Back in Delhi, and after the first week of ‘severe’ air pollution, when PM 2.5 levels rose above 250 micrograms/cubic metre, India’s Supreme Court stepped into the political fray with strong comments of its own – aimed at the central government. 

Choking air quality is responsible for the “murder of people’s health“, the court stated, in an order on 7 November. 

The burning of crop residue in Punjab, as well as other neighbouring states, including Haryana, Uttar Pradesh and Rajasthan, is a key factor behind the massive spike in Delhi’s air pollution every winter, the court told the central government. 

“We want it stopped. We don’t know how you do it, it’s your job. But it must be stopped. Something has to be done immediately.” 

In its order, the Supreme Court lamented, “The residents of Delhi have been struggling with health issues because we do not seem to find a solution year after year” before directing the four states to stop crop burning “forthwith” and made the in-charges of local policy circles responsible, under the supervision of each state’s two top-most police and civil officials. 

Within the first two days, about 250 police cases were filed by the State of Punjab’s administration against farmers – up from a total of only 18 on the day before the court order.  

For several days, the fire count fell sharply from almost 2,600 on 7 November to less than 850 two days later. Then on 10 November, fires rose again averaging almost 2,000 a day over six days till 15th November. The share of stubble fire in Delhi’s overall pollution load remained a little lower – 19.5% as compared to 25.7% for six days prior.  But that was still enough to push Delhi’s pollution to the category of ‘severe’.

Political solutions, not policing, are needed  

Delhi’s haze of 2nd November, 2023: The barely visible building is about 700 metres away, when the hourly PM 2.5 level in this location was a little over 450 micrograms/cubic metre (µg/m3). The WHO’s safe limit for a day is 15 µg/m3.

Many point out that this is not a policing problem but a political and policy challenge. Farmers, a politically sensitive sector of India’s economy and society, should not face legal action for burning fires when pure economics leaves them few other options. 

The farm sector accounts for about 45% of India’s workforce so applying the ‘polluter pays’ principle here, to marginalized smallholders, would also be political suicide. 

What’s needed, more fundamentally, experts, backed by the Supreme Court say, is a shift away from rice paddy growing in Punjab. 

Rice is not a staple locally. It was not grown traditionally as there is insufficient water in the region. In Sangrur, one politically important constituency, the water table has fallen by 25 metres in the past two decades. Sangrur is also one of the areas of Punjab where there have been the most crop stubble fires. 

Rice began to be grown widely in Punjab only several decades ago, when in the face of food shortages, the central government incentivized local farmers to begin cultivating the crop, offering them a  minimum support price (MSP), an assured price. 

The Supreme Court has called for a policy push to drop the rice subsidy and shift it to other crops. It’s a plan that’s been bandied about for years but the court now wants this done quickly. 

Ineffective use of funds to support mechanical management?

Current policies of both the Centre and the state, each governed by rival political parties, are under scrutiny. But in both cases, they have focused largely on incentivizing mechanical management of the crop stubble – rather than tackling the thorny subsidy issue. 

To this end, the Central Government allocated about US$ 400 million to a number of rural states for crop residue management. Reports show that 30% of these funds have gone to Haryana which has only 7% of the fires, while only 46% of this has gone to Punjab which has 93% of the fires. 

In Punjab, meanwhile, the state government also made assurances at the start of the harvest season that it would supply balers, and machines to remove the stubble and fold it into bales rather than burning it. The bales can be used for several purposes including to a limited extent in thermal power plants. 

The plan was to remove 11.5 million tonnes of stubble which is about half of how much was estimated to be produced this year. About six weeks later, a report shows that only 3.3 million tonnes was managed mechanically – or just 15% of the total stubble residue which needs to be removed. 

The Punjab government could supply only about 500 of the over 1,800 balers initially proposed. There have been similar problems with other machines, called Happy Seeders, which can sow the wheat crop, while simultaneously turning over the rice stubble in fields. 

Tens of thousands have been provided for hire by the government with a 50% subsidy on rental fees. But there are frequent complaints that either there aren’t enough to go around on the few, post-harvest days all paddy farmers usually need them or that even the reduced fees are too much.

Farm fire crackdown: Shaky implementation 

There have meanwhile been a series of reports alleging that Punjab State or local officials allegedly swindled farmers out of the subsidies that they were supposed to receive for the lease of stubble removal machinery. 

Another report suggests there’s a systemic way adopted to avoid satellite detection of farm fires by starting these after surveillance ends. In one case, farmers reportedly forced an official who had arrived on the scene to prevent stubble burning, to actually light such a fire – in protest  against the crackdown on fires without attractive alternatives. 

Health Policy Watch tried to contact at least three representatives of the Punjab government including the minister in-charge for a comment. As of publication, none had replied. 

Meanwhile, Harpinder Singh, the farmer from Gurdaspur, says he was offered the lease of a “Super Seeder – another machine that can mechanically grind the stubble, at a subsidised price. 

“But even after that it is beyond the reach of a marginal farmer,” he lamented, adding that manpower to bind the ground stubble into bales is also unavailable. 

“We are the ones who suffer due to stubble burning. We are the ones who inhale this air. We are helpless and left with no option but to burn. Government has failed to help us and look into our problems.”

-Bishamber Bittu reported on this story from Punjab.

The World Health Organization’s expertise in the relationship between intellectual property and public health goes back decades. Efforts to sideline it pose a serious threat to global health.

Health Policy Watch recently reported that some European countries at the World Health Organization (WHO) Pandemic Agreement negotiations maintain that intellectual property (IP) negotiations belong at the World Trade Organization (WTO) rather than the WHO.

If they mean to say that new WTO laws cannot be established at the WHO, they have a point. But if the objective of these countries is to silence IP debates at the WHO amid the current stalemate at the WTO on whether to extend the 17 June 2022 Ministerial Decision on the TRIPS Agreement (which only applied to vaccines) to therapeutics and diagnostics, this stratagem is quite cynical.

This resistance to discussing IP at the WHO, often equated with “undermining IP,” is not new. Similar objections arose in 1998 during the formulation of a new WHO medicines strategy. The European Union (EU) echoed concerns raised by the pharmaceutical industry regarding a draft resolution on the WHO’s medicines strategy, arguing that “no priority should be given to health over intellectual property considerations.” The United States (US) took a similar approach, voicing concerns that work on the draft WHO medicines strategy could undermine IP and set out a strategy to obstruct its adoption.

No Pandemic Accord Without Intellectual Property Protection, says German Health Minister

The question of whether the WTO needs new rules to address access to medical products is up for debate. The existing TRIPS Agreement provides ample scope for the protection of public health, including special crisis measures to ensure access to health technologies to respond to a pandemic.

Moreover, the 2001 WTO Doha Declaration on TRIPS and Public Health explicitly states that the TRIPS Agreement “does not and should not prevent members from taking measures to protect public health”. The Declaration also affirms that TRIPS  “can and should be interpreted and implemented in a manner supportive of WTO members’ right to protect public health and, in particular, to promote access to medicines for all”. 

The Pandemic Agreement currently being negotiated at the WHO can play a key role in operationalising these flexibilities. A pertinent analogy is the 2013 Marrakesh Treaty, known as the “Treaty for the Blind”, which facilitated access to published works for visually impaired individuals.

Negotiated under the auspices of the World Intellectual Property Organization (WIPO), the treaty created binding obligations for WIPO member states to implement mandatory TRIPS exceptions and limitations to copyright to ensure the availability of reading materials for blind and vision-impaired individuals.

Preventing discussions on IP in the context of pandemic preparedness and response at the WHO would be a grave mistake. We do not need further evidence than the gross inequities in access to pandemic countermeasures we have seen during the COVID-19 pandemic to know that a robust public health approach to IP protection is necessary to ensure equitable access globally. 

WHO’s medicines strategy and intellectual property

The World Trade Organization’s office in Geneva, Switzerland.

The assertion that IP discussions belong exclusively to the WTO and not the WHO reflects a lack of understanding of the WHO’s long-standing role in IP and health debates over the past three decades. Discussions on the impact of IP rules on public health have been occurring at the WHO since before the WTO was even fully operational.

In 1986, when the WHO adopted the Revised Drug Strategy (RDS) to improve access to essential medicines and promote rational medicine use, developing countries raised concerns about the potential impact of the General Agreement on Tariffs and Trade (GATT) – which would later form the WTO in 1995 – on essential medicines policies.

The WHO’s RDS relied heavily on the availability of generic medicines, which countries feared could be threatened by the new IP rules being negotiated under the GATT. While the IP issue was raised, it was not a central focus at the time.

Ten years later, this had changed. The International Conference on National Medicinal Drug Policies, which reviewed the RDS, recommended in 1995 that international efforts be made to “analyse and address” the consequences of international trade agreements such as the GATT on “access, rational use of drugs, quality, safety and efficacy, local industrial development and other aspects of the national medicinal drug policy”. 

“Health issues should be considered as the policies are being formulated,” the RDS review added.

In 1995, the WTO had just been established, and with it came the obligation for its Members to introduce 20-year patents “in all fields of technology”, including for pharmaceutical products.

The World Health Assembly resolution on the WHO’s Revised Drug Strategy was passed while negotiations on the GATT, the precursor to the World Trade Organization, were still underway.

WHO member states debated the consequences of the new WTO rules at the World Health Assembly (WHA) in 1996, and set out a role for the WHO to look into the effects of the new global trade rules on public health, and especially their effect on access to medicines. 

The resolution on the Revised Drug Strategy (WHA49.14) adopted by the WHA requested that the WHO study and report on the impact of the WTO’s activities on national drug policies and essential drugs and formulate recommendations for collaboration between the WTO and WHO. 

In 1997, the WHO’s Drug Action Program published the study “Globalization and Access to Drugs: Perspectives on the WTO TRIPS Agreement,” written by German Velasquez and Pascale Boulet, known as the “Red Book”. The study marked the first comprehensive review of the new WTO rules and their implications for access to medicines. 

In 1999, the World Health Assembly adopted resolution WHA52.19 on the Revised Drug Strategy that further strengthened the WHO’s mandate to work on trade issues. It noted the importance of “ensuring that public health interests are paramount in pharmaceutical and health policies”. Specifically, it instructed the WHO to: 

“Cooperate with Member States, at their request, and with international organizations in monitoring and analysing the pharmaceutical and public health implications of relevant international agreements, including trade agreements, so that Member States can effectively assess and subsequently develop pharmaceutical and health policies and regulatory measures that address their concerns and priorities, and are able to maximize the positive and mitigate the negative impact of those agreements.”

The phrase “relevant international agreements, including trade agreements”, was widely understood as a reference to the WTO TRIPS Agreement.

As a result, the WHO expanded its work on IP and health, an ongoing effort which continues to this day. The most recent example of this work is the WHO’s collaboration with UNITAID to provide guidance to countries on accessing affordable generic versions of COVID-19 therapeutics that are under patent protection in their territories.

The 2008 WHO Global Strategy on Intellectual Property

Perhaps the most noteworthy contribution of the WHO in the area of IP was the work of the WHO Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH) established by the WHA in 2003 (WHA56.27). The CIPIH report, published in 2006, paved the way for the adoption of a WHA resolution (WHA59.24) on “Public health, innovation, essential health research and intellectual property rights” that same year.

Subsequently, the World Health Assembly adopted the WHO Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA-PHI) in 2008. This comprehensive strategy outlined the WHO’s work on IP and presented actionable steps to be taken by member states.

In 2015, the WHA extended the GSPOA’s timeframe to 2022. The Strategy’s impact was far-reaching, kickstarting the establishment of the Medicines Patent Pool by UNITAID and WHO and the discussions on an R&D treaty, ultimately leading to experimentation with innovative R&D financing mechanisms. 

The GSPOA continues to serve as the cornerstone of the WHO’s work on IP and public health to this day.

The past decade, WHO has actively participated in the Trilateral Collaboration alongside the WTO and WIPO. This collaboration encompasses the preparation of reports on IP, access to medical technologies, and innovation, the most recent of which was published in 2020. The WHO would struggle to contribute meaningfully to the Trilateral collaboration if it cannot discuss IP in-house. 

IP issues and access to medical products resurfaced as an urgent matter during the COVID-19 pandemic.

In the early days of the pandemic, the WHO moved swiftly to establish the COVID-19 Technology Access Pool (C-TAP) in May 2020 to facilitate the voluntary sharing of IP as well as technical know-how for scaling up the production of medical products needed to respond to the pandemic. C-TAP is currently being repurposed to address future pandemics more broadly, an issue that is also on the table at the Pandemic Agreement negotiations.

In summary, the WHO has a longstanding history of debating and advising on the impacts of IP on innovation and public health. Those who now argue that intellectual property policy is the exclusive domain of the WTO are either ill-informed or ill-intentioned.

Image Credits: World Trade Organization.

UNICEF Measles vaccination campaign in Tergol, Ethiopia.

Measles cases and deaths have skyrocketed worldwide, with 37 countries experiencing large or disruptive outbreaks in 2022 compared to 22 in 2021, according to a joint report by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC).

The report, published on Wednesday, highlights the devastating impact of declining vaccination rates on the measles situation globally. An estimated 9 million measles cases were reported in 2022, a 18% increase from 2021. Measles deaths also surged by 43%, reaching an estimated 136,000, mostly among children.

“The increase in measles outbreaks and deaths is alarming, but unfortunately, not unexpected given the declining vaccination rates we’ve seen in the past few years,” said John Vertefeuille, director of CDC’s Global Immunization Division. “Measles cases anywhere pose a threat to all communities where people are under-vaccinated.”

The report attributes the surge in measles outbreaks to a decline in vaccination coverage, with 33 million children missing out on a measles vaccine dose in 2022. The global vaccine coverage rate for the first dose stands at 83%, and for the second dose at 74%, both well below the 95% coverage needed to protect communities from outbreaks.

Low-income countries, where the risk of death from measles is highest, continue to bear the brunt of the crisis, with vaccination rates as low as 66%. Over half of the 22 million children who missed their first measles vaccine dose in 2022 reside in just 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Madagascar, Nigeria, Pakistan, and the Philippines.

“The lack of recovery in measles vaccine coverage in low-income countries following the pandemic is an urgent call to action,” said Kate O’Brien, WHO Director for Immunization, Vaccines and Biologicals. “Measles is the inequity virus, it will find and attack those who aren’t protected. Every child, no matter where they live, deserves the protection of the measles vaccine.“

CDC and WHO are urging countries to prioritize measles vaccination and to work with global stakeholders to reach the most vulnerable communities. They also emphasize the need for robust surveillance systems and outbreak response capacity to rapidly detect and respond to measles outbreaks.

Image Credits: Flickr – UNICEF Ethiopia.

Healthcare workers treat a patient with drug-resistant TB in Myanmar,.

Clinical trial results presented at the Union World Conference on Lung Health in Paris on Wednesday provided evidence to support the use of four new, improved regimens to treat multi-drug resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB). 

The endTB clinical trial found three new drug regimens that can deliver similar efficacy and safety to conventional treatments while reducing treatment time by up to two-thirds. It also found a fourth regimen that can be used as an alternative for people who cannot tolerate bedaquiline or linezolid, staples in current World Health Organization (WHO) -recommended regimens for MDR-TB.  

The endTB consortium, made up of Médecins Sans Frontières (MSF), Partners In Health (PIH), and Interactive Research and Development (IRD), began this Phase III randomized controlled trial in 2017.

A diverse group of 754 patients from Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa were enrolled and included teenagers and people with comorbidities like substance-use disorders.

It evaluated five nine-month treatment regimens against the standard of care, with three of the drugs showing favourable outcomes in 85-90% of participants. 

“We stand on the cusp of a significant breakthrough in the battle against MDR, a disease that disproportionately affects impoverished populations around the globe,” said Professor Carole Mitnick, co-principal investigator of the study. 

“But the cost of some drugs remains a barrier. One example is delamanid which is still priced at 12-40 times higher than it should be according to an independently estimated cost to produce the drug,” said Mitnick, Professor of Global Health and Social Medicine at Harvard Medical School.  

MDR/RR-TB is caused by a TB bacterium that is resistant to rifampicin, one of the most powerful first-line antibiotics, and also sometimes resistance to isoniazid as well. Roughly half a million people fall sick with MDR/RR-TB each year, and many die from it. 

Although a range of MDR-TB regimens are now in use around the world, many people are still treated with conventional treatments that take up to 24 months, are ineffective (only 59% treatment success in 2018), and often cause terrible side effects, including acute psychosis and permanent deafness.

All-oral treatments

“For far too long, MDR-TB has loomed as a formidable threat with limited, poorly tolerated treatment options, but today, we unveil evidence for multiple innovative all-oral, shortened regimens that will allow patient-centred, individualized treatment of MDR-TB,” said MSF’s Dr Lorenzo Guglielmetti, co-principal investigator.

“What makes these results even more remarkable is the diversity, and resulting generalizability, of this Phase III randomized controlled trial.”

The trial was funded by Unitaid, whose executive director, Dr Philippe Duneton, praised the “gold-standard research”.

“The drugs are already available where they are needed. If recommended, this high-quality evidence could quickly translate into better treatment options suitable for all people with drug-resistant tuberculosis.” 

Image Credits: The Global Fund / John Rae.