Al Shifa Hospital in northern Gaaza at time of WHO delivery of medical supplies on 16 December, 2023

From earthquakes in Afghanistan to floods in Libya and the conflicts in Gaza and Sudan, WHO’s Eastern Mediterranean region, is beset with one of the world’s largest concentrations of people trapped in humanitarian crises and in desperate need of emergency health services, food aid, as well as peace,  said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, Tuesday. 

“Our region is home to 38% of the global population in need of humanitarian aid, which means over 140 million persons,” said Al-Mandhari, speaking from the WHO Regional Office in Cairo at an end-year WHO briefing.  “This number represents the everyday tragedies experienced by the people of Syria, Afghanistan and Iraq after earthquakes. The lived horrors of the people of Libya after catastrophic flooding, drought in the Horn of Africa, the rapidly worsening conflict in Sudan, and of course, the humanitarian crisis that continues to unfold in Gaza with unprecedented brutality.”

The Palestinian death toll in Gaza from the conflict between Israel and Hamas is now approaching 20,000 people, with high levels of hunger, crippled health services and growing prospects of disease outbreak, Mandhari warned.  At the same time, the  brutal war raging in Sudan between the Sudanese Armed Forces and the paramilitary Rapid Support Forces (RSF), has led to the displacement of some 7 million people, leaving some 4.9 million people on the brink of famine, he said.

Dr Ahmed Al-Mandhari, WHO Director for the Eastern Mediterranean Region

Unlike Gaza, the Sudanese civil war has been happening pretty much “off the radar screen”, added Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean, at the briefing. 

“We’re not seeing much on the news media, in the international media,” observed Brennan.  However, there has been a marked escalation in hostilities over the past several days as RSF forces advance on the city of Wad Madani, south east of Khartoum, where hundreds of thousands of poeple from the capital had taken refuge and many are now forced to flee.

“Over 24 million people are in need of aid. It’s the largest displacement crisis in the world today,” said Brennan of the Sudan war. “There are high levels of fighting and violence, high levels of displacement, a major food and security crisis. People are going hungry.  There is a rapidly progressing cholera outbreak, as well as rapidly spreading outbreaks of malaria, dengue and measles.”

Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean

Meanwhile, the western Sudanese region of Darfur, there has also been a fresh escalation of war-related violence against civilians, including “terrible stories of sexual violence against women and atrocities against the husbands and partners,” said Brennan. But despite the crisis there are large areas of the encircled region to which WHO and other humanitarian relief groups have no access at all. “We can only reach Darfour from cross border operations via Chad,” he said.

Sudan war: pink indicates areas controlled by Sudanese Armed Forces and allies as of 10 December 2023; green indicates control by Rapid Support Forces; yellow indicates control by Sudan People’s Liberation Movement-North.

WHO immediate aims for Gaza relief in ‘shrinking humanitarian space’

On Sunday, 11 December the WHO Executive Board approved a draft resolution to the World Health Assembly calling for the “immediate, sustained and unimpeded passage” of humanitarian relief to Gaza, including healthworkers, vehicles and supplies.

The most immediate needs include restoring the functionality of at least four hospitals in northern Gaza, with the support of emergency medical teams; expanding bed capacity and operations in southern Gaza hospitals, now in the line of fire as well; and a “better organized” medivac for wounded and ill Palestinians to Egypt or elsewhere abroad, said Dr Richard Peeperkorn, representative to WHO’s Jerusalem-based office in the Occupied Palestinian Territories (OPT).

Dr Richard Peeperkorn, WHO Representative, occupied Palestinian territory

But such aims faced huge challenges in light of the “shrinking humanitarian space.. and military activities making it very difficult for the One UN, including WHO, to move supplies, staff and patients.”

Coordination for safe passage of patients, health workers and supplies is “incredibly cumbersome,” he added, noting that a WHO mission to two northern Gaza hospitals had to be cancelled on Tuesday, due problems in coordinating safe passage.

On a visit to Al Ahli Hospital, in Gaza’s north last week, Peeperkorn said that he was “shocked” both by the scenes of urban devastation around the hospital and the needs inside, which were “unlike anything I had seen in my life.”

He described wounded people being brought in for emergency treatment on horse and donkey carts with over 200 patients “everywhere”, including the chapel of the hospital, operated by the Anglican Church.

Yesterday, Peeperkorn said he had received reports that “the fence surrounding the hospital had been demolished and there were tanks stationed outside.” A dozen people on the hospital grounds were reportedly arrested and remain in detention, including five staff.  That follows on a pattern of previous Israeli detentions and arrests of health workers at Al Ahli and elsewhere, he said.

“They’ve asked who to support with medical supplies, water and fuel. So we are planning a mission there tomorrow. But we hope on the current circumstances that this is possible,” Peeperkorn concluded.

More calls for Gaza cease-fire but prospects remain dim

WHO Executive Board meeting on the health and humanitarian situation in Gaza, Sunday. 10 December saw a fragile consensus reached.

“Stop this war, with no delay,” said Al Mandhari of the Gaza conflict.

In Sudan, “we absolutely need a ceasefire but unfortunately the military offensive is continuing, and more and more people are going to get caught up in the crisis because of the onward march of the military offensive,” added Brennan.

Yet another UN Security Council vote on the Gaza situation was scheduled for later Tuesday. Under US pressure, a fresh UN Security Council call for a “an urgent and lasting cessation in hostilities” had reportedly been watered down to call for an “urgent suspension of hostilities”.

Real prospects for a cease-fire in the near term seemed dim as Israel’s military advanced deeper into Gaza, including areas of the south where over 1.9 million displaced Palestinians are now living, after fleeing the north. Hamas has meanwhile said it will not negotiate over the release of more hostages under Israeli fire, demonstrating its resolve by lobbing missiles at Tel Aviv again on Tuesday, after releasing a new video Monday of three elderly Israeli hostages pleading for the Israeli government to prioritize their release along with the other 112 people still in captivity.

Israel initially launched air strikes on Gaza, followed by a ground invasion, in response to the 7 October Hamas incursion into Israeli communities near the Gaza enclave, in which gunmen killed over 1000 men, women and children in their homes along with young people at an outdoor festival.  Another 240 Israelis and foreign workers were carried back to Gaza, including about 30 children.

Some 114 hostages, mostly women and children, were released in a series of exchanges with Palestinian prisoners held by Israel during a week-long humanitarian pause in late November, before hostilities resumed. Israel has now seized large parts of northern Gaza, flattening most of the urban landscape, and carrying the battle to the tiny enclaves southern strongholds where most of Gaza’s population is now living in schools, around hospitals and makeshift shelters.

Israel, supported by the United States, Canada and other allies, has maintained that Hamas forces sytematically built tunnels, stored weapons and even hid hostages in and around health infrastructure, and any permanent cease-fire that leaves the organization’s military prowess intact would pave the way for more bloody attacks like that of  7 October, which Hamas leaders have already pledged to repeat.

Palestinians, supported by a large majority of other UN member states, have charged that the Palestinian civilian toll, including deaths of more than 7,000 children, has been disproportionately high, and the targeting of health facilities remains in contravention of international law regardless of claims about Hamas military deployment.

Regarding attacks on healthcare facilities, Mandhari issued an appeal to all sides, saying: “WHO and UN is always saying that attacks on healthcare is a breach of international humanitarian law, ..and any attack on these institutions or mobile teams on the ground is considered that way.  And we always call those conflicting parties to respect that law.  And if there is any breach, WHO encourages the relevant units, departments or organizations …to take it seriously and start doing whatever investigations are needed and then act against those who breach that sort of law.” 

Image Credits: @WHO, Eliajah Pepe/Wikipedia .

Vials of Pfizer´s COVID-19 vaccine.

Days after government officials took a break from frenetic pandemic accord negotiations, news broke that European countries had destroyed at least 215 million unwanted COVID-19 vaccine doses valued at over €4 billion.

The 19 countries surveyed dumped 0.7 doses per resident – with Estonia and Germany being the most wasteful, according to Politico, which broke the story this week.

In 2021, the European Union (EU) bought the equivalent of three doses per resident in secret deals with drug companies – hoarding these when African countries did not have access to any vaccines, not even for health workers.

Ending this cycle of waste and want is at the heart of the current pandemic agreement negotiations hosted by the World Health Organization (WHO). The talks are due to conclude in May 2024 with an agreement to govern countries’ conduct during pandemics – but parties seem to have entrenched disagreement about how best to ensure equitable access to vaccines and other medical products in future pandemics.


The People’s Vaccine Alliance’s Piotr Kolczyński said that the EU appears not to have learnt from its COVID mistakes, based on the positions it has taken during the pandemic agreement negotiations.

“The EU pumped unprecedented public funding into COVID-19 vaccines with no strings attached to ensure universal access. Yet, instead of learning from its mistakes, public funding conditionalities have been deleted from the draft Pandemic Agreement, and the EU is now trying to remove the remaining transparency and equity measures too,” said Kolczyński, who is the EU Health Policy Advisor at Alliance and Oxfam.

Several countries and non-state actors involved in the pandemic agreement negotiations advocate for governments that have invested public money in the development of pandemic products to retain a stake in these – via measures such as shares or joint intellectual property (IP) – so that private companies do not call the shots during pandemics.

However, the EU and the US have been lukewarm about this proposal.

COVAX lessons: Mitigating vaccine nationalism

Vaccine deliveries by the global COVAX facility.

Meanwhile, the four global co-convenors of the COVID-19 vaccine access platform, COVAX, urged in a joint statement on Tuesday that “future global pandemic preparedness and response architecture” be informed by COVAX learnings.

Noting that COVAX would close at the end of December, the Coalition for Epidemic Preparedness Innovations (CEPI), vaccine alliance Gavi, UNICEF and the WHO, highlighted three key learnings.

The first is the need to design, invest in and implement “an end-to-end solution to equitable access ahead of time” that “centres on the needs of the most vulnerable”.

While “vaccine nationalism will persist in future pandemics”, they urge “mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply”.

The third lesson is “the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures”. 

Money left over from COVAX will be redirected to implement some of these lessons, including investing $1 billion in the establishment of an African Vaccine Manufacturing Accelerator (AVMA) to support African vaccine manufacturing, a measure announced recently by the Gavi board.

“In addition, a First Response Fund will be established to ensure financing for a vaccine response is immediately available in the event of a future pandemic,” they note.

New Africa-Caribbean solidarity

Meanwhile, Tuesday also saw the launch of a new South-South partnership, the Health Development Partnership for Africa and the Caribbean (HeDPAC) to strengthen health cooperation between Africa and the Caribbean.

“Promoting technology transfer for pharmaceutical manufacturing, building regulatory capacity, and enhancing universal health coverage will be core HeDPAC strategies,” according to a statement released via the WHO.

“COVID-19 left an indelible scar on our global solidarity and the right of all people to good health”, said Prime Minister Mia Mottley of Barbados. “It is our shared responsibility to ensure that the inequity of the global response to COVID-19 is not repeated. This is the kind of action that will allow us to help people where they need it most.”

HeDPAC will also focus on strengthening the health workforce in the two regions, and sharing innovative solutions in primary health care, with a special emphasis on climate resilience, and maternal and child health.

Pandemic negotiations 2024 deadline

The seventh meeting of the Intergovernmental Negotiating Body (INB) negotiating the pandemic agreement ended late on 7 December with a rapid and vapid report back – likely indicating that the negotiations remain difficult.

While informal inter-sessional meetings are set to continue in early January, the INB meets for the eighth time from 19 February to 1 March 2024. 

A ninth meeting is also planned before the World Health Assembly at the end of May at which the pandemic agreement is due to be presented.

Image Credits: Photo by Mat Napo on Unsplash, @CEPI .

Some of those petitioning against Uganda’s Anti-Homosexuality Act in court on Monday, including Pepe Onziema (left) and Frank Mugisha (centre).

The court challenge to Uganda’s Anti-Homosexuality Act, one of the harshest anti-LGBTQ laws in the world, began in Kampala on Monday before five Constitutional Court judges.

The Act, which was passed by an overwhelming majority of Members of Parliament in May, includes penalties such as a life sentence for same-sex acts between consenting adults, 10 years in prison for “attempted homosexuality;” the death penalty for “aggravated homosexuality” and 20 years in prison for  “promotion of homosexuality”.

However, there is unlikely to be much more live court action after Deputy Chief Justice Richard Buteera, chair of the hearing, agreed to entertain written submissions rather than live hearings.

This followed a request by the lawyers representing the eight petitioners, including MP Fox Odoi-Oywelowo, and LGBTQ leaders Frank Mugisha and Pepe Onziema,  that they wished to proceed by way of written submissions.

Respondents, the Attorney General, supported by evangelical Pastor Martin Ssempa and Watoto Church elder Stephen Langa, served the petitioners with their written submissions at the hearing, and the court directed the respondents to reply by 5pm on 20 December.

Thereafter, the court will deliver its judgment “on notice”, either in court or electronically.

Commenting on the decision, Nicholas Opiyo, the attorney for the petitioners, said that the intention was “to avoid the theatrical intention of some of the people admitted into the process whose only objective appeared to be using the court as a platform to raise money and profile”. 

“In the end, a decorous process to preserve the integrity of the court and the hearing was chosen over and above oral presentation,” added Opiyo on X inan apparent reference to Ssempa’s attempts to use the court challenge to fundraise for his anti-LGBTQ crusade.

Researchers threaten to withdraw after directive 

Meanwhile, Uganda’s National Council for Science and Technology faced international condemnation for directing all researchers to report anyone who violated, or was suspected to be violating, the Act in their research programmes to the police.

In an open letter sent to Dr Martin Ongol, acting secretary of the council, some 260 researchers worldwide call on him to immediately withdraw a directive he issued on 27 October.

 

The directive informed researchers that “the duty of confidentiality in research may be waived for the purposes of reporting to the relevant authorities the commission of an offence” in terms of the Anti-Homosexuality Act.

The Act itself obliges citizens to report anyone who has committed or intends to commit any offence under the Act or face “a criminal penalty or a fine”.

“This Directive means we cannot uphold our moral commitment to the rights of our study participants to life, health, dignity, integrity, self-determination, privacy, and confidentiality,” notes the letter.

“We are asking you to immediately withdraw this Directive, if not, we will be forced to reassess our current research in Uganda and our future research plans.”

Uganda has already paid heavily for its homophobia, with the county’s new World Bank loans currently on hold along with new grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the country’s exclusion from the US African Growth and Opportunity Act (AGOA) that gives preferential trading terms to select African governments and US visa sanctions on key supporters of the Act, including all the MPs who voted for it.

Global spending on health increased during 2021 at the height of the COVID-19 pandemic, reaching a record $9.8 trillion or 10.3% of global gross domestic product (GDP) – mostly as a result of governments devoting more domestic resources to health,

Country spending was highest on hospitals, accounting for 40% of expenditure, followed by ambulatory care (outpatients) providers (19%–24%) and pharmacies (16%–23%). 

The fastest growth in spending was on preventive care providers, such as public health institutions and disease control agencies. 

This is according to the World Health Organization’s (WHO) Global Health Expenditure Report 2023, based on data from 50 countries.

However, the per capita spending was “unequal”, the report notes, with high-income countries spending an average of $4001 per person in comparison to a mere $45 in low-income countries. Upper-middle-income countries spent $531, which was substantially more than the $146 per person in lower-middle-income countries.

“The distribution of global spending on health remained highly skewed in 2021: 79% was in high-income countries, which are home to less than 16% of the world population,” according to the report. 

“Low-income countries accounted for only 0.24% of the global health expenditure, despite having an 8% share of the world’s population.”

Spending on COVID-19 rose in real terms in 39 of 48 countries with data, accounting for 11% of government and compulsory insurance health spending in 2021, up from 7% in 2020. 

There was “no evidence” that the additional COVID-19 spending meant countries spent less on other diseases, or that spending on COVID-19 vaccines meant less money for testing and treatment, the report finds, stating: 

“The analysis suggests that the increased spending for COVID-19 did not crowd out spending for other health needs, although it might have affected the rate of growth of spending for these other purposes.” 

In addition, out-of-pocket spending on health in low-income countries fell in 2020 and 2021 but rose to pre-pandemic levels in high, upper-middle and lower-middle-income countries in 2021 after a decline in 2020.

Lack of data on spending patterns

The WHO said that action is still needed at the domestic and international levels to improve data collection on spending patterns. 

“While most countries regularly report aggregated health spending data, few consistently report the critical details that underpin these high-level results. Accordingly, only a partial view of the spending dynamics during the COVID-19 pandemic – by provider, function, and disease and condition – is possible in this report.”

The report also notes the lack of information on health capital investment “which limits the insights into this critical area of health policy”. 

“More effort is needed, therefore, to improve data collection and increase the number of countries developing and reporting disaggregated health account data. Key to this is institutionalising health account practices at the country level.”

Hard to sustain higher spending levels

External aid was “crucial” in supporting government spending in 2021 in low and lower-middle-income countries. However, sustaining government health spending and external aid at 2021 levels may be challenging given “the deterioration in global economic conditions and the rise in debt-servicing obligations”.

“Amid this more difficult financing environment, a key challenge for countries will be to resist the urge to de-prioritize government spending on health. Doing so risks rolling back progress towards universal health coverage,” according to the report.

Image Credits: WHO African Region , WHO PAHO.

Dr Anshu Banerjee, WHO director for maternal, newborn, child, adolescent health and ageing, described the new guidelines as “a tool to support a holistic approach to chronic low back pain care”.

The World Health Organization (WHO) has released its first guidelines for addressing low back pain, a condition affecting an estimated 619 million people, or one in 13 worldwide.

The new guidelines are designed to enhance care quality for millions suffering from the condition, offering healthcare professionals a range of non-surgical treatments applicable in primary and community care settings. The guidelines also list treatments to avoid, including lumbar braces, traction-based physical therapies, and opioid painkillers.

The prevalence of low back pain is expected to surge as the global population ages, with estimates predicting a rise to 843 million affected individuals by 2050. Low back pain currently accounts for 8.1% of years lived with disability globally, according to the WHO.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO assistant director-general for universal health coverage and life course, in a press release accompanying the guideline launch.

Nine out of ten cases of low back pain are chronic, deeply affecting patients’ ability to work and stay active in family and social life, often leading to broader economic and mental health consequences. The guidelines emphasise mental health care as crucial in treating these conditions.

Chronic low back pain also has significant economic repercussions at the national level, pushing individuals out of the workforce and straining health systems.

The annual global costs associated with low back pain exceed $50 billion and potentially reach up to $100 billion at the upper end of estimates, according to the British Medical Journal. This financial impact is especially pronounced in low- and middle-income countries (LMICs), where 80-90% of employment involves heavy labour, significantly increasing the prevalence of LBP compared to high-income nations.

The WHO guidelines provide a multifaceted approach to treatment, emphasising patient education in self-care techniques, structured exercise programs, spinal manipulative therapy, and massage, while cautioning against certain treatments like traction and therapeutic ultrasound.

WHO officials emphasised that while the guidelines provide a general framework, adapting them to local clinical practices is essential for effective implementation.

“Addressing chronic low back pain requires an integrated, person-centred approach,” said Banerjee. “This means considering each person’s unique situation and the factors that might influence their pain experience.”

Recognising low back pain as a national health priority is crucial for optimising healthcare management in this area, WHO stressed – a step many countries have yet to take.

Image Credits: Adam McGuffie.

Vidya Kishnan and Garry Aslanyan on "Dialogues," a new series from the Global Health Matters podcast.
Vidya Kishnan and Garry Aslanyan on “Dialogues,” a new series from the Global Health Matters podcast.

The elimination of tuberculosis cannot be achieved if medicines are locked in a “patent panoply,” according to Indian author and journalist Vidya Kishnan.

Speaking to Garry Aslanyan on the most recent episode of Dialogues, a new series from the Global Health Matters podcast, the author of “Phantom Plague: How Tuberculosis Shaped History” said that “everything that happened in COVID has been happening for decades with TB.

“In India, the entire TB program got ‘Covidized,’ down to the helpline of the Ministry [of Health], and infections and respiratory diseases don’t simply go away,” Kishnan said. “So, the first thing we need to do is look at how technology is transferred because vaccines and drugs first and foremost, it’s technology. It’s somebody’s intellectual property. And I feel like TB elimination cannot, will not be achieved if the medicines, the latest most humane therapy, is locked in a patent panoply.”

The most exasperating aspect, according to Kishnan, is that the advancements in tuberculosis therapies resulted from a sincere collaboration within the public domain. Universities, student funds, and philanthropic contributions collectively supported these efforts. Notably, several late-stage clinical trials for bedaquiline took place in India and South Africa, with patients actively contributing to the process.

“It’s really unfair that you use patients for research, but then when … all of these drugs came out of industrial scale subsidies to pharmaceutical companies, and others in patent panoplies.”

Throughout her writing career, Kishnan has dedicated considerable effort to investigating and documenting the profound impact of tuberculosis on individuals from various backgrounds in India. In her book, she delves into critical questions concerning the intersection of race and caste within policies that shape the dynamics of tuberculosis spread and control in the contemporary context of her home country.

Kishnan tells Aslanyan that in India, people live in congested cities and are still segregated by race, caste, and class. Pathogens do not respect these boundaries. However, the rich generally access medicines, whereas the poor are left behind.

In India, tuberculosis has reemerged as the foremost infectious disease killer. She said the lessons from previous pandemics underscore a fundamental truth: No one can be considered safe until everyone is protected from the threat.

“I feel like a stuck record saying this over and over again everywhere I speak. But it was quite surreal to see the science denialism and the racism and casteism in my country, all of the things I had read about, the xenophobia, all of it just came to life in the past three years,” Kishnan said. “If we are greedy and if we think in these myopic ways, I don’t see any way we will prevail over these pathogens despite all the fruits of modern medicine.”

Aslanyan concluded: “This conversation reminds us, as global health professionals, of many challenges on the long road ahead toward the ultimate goal of tuberculosis elimination and the importance of community engagement.”

Listen to previous episodes of Dialogues on Health Policy Watch.

Image Credits: Global Health Matters (TDR), Global Health Matters Podcast (TDR).

Dr Tedros Adhanom Ghebreyesus at end 2023 press briefing

In the wake of COP28, WHO will press ahead with calls for fossil fuel phase out, stepped up commitments for health sector decarbonization, and a new resolution on Climate and Health, set to go before the World Health Assembly in May 2024.

Those were key takeaways from an end-year WHO global press briefing by WHO Director General Dr Tedros Adhanom and other senior officials in an end-year press briefing Friday before the Geneva press corps.

Health and humanitarian crises associated with raging conflicts in Gaza, Sudan, Myanmar, Haiti, DR Congo and other conflict hotspots were also top on the agenda of WHO, as well as other UN agencies in as second press briefing Friday morning, looking back on 2023.

In addition, WHO warned that a more dangerous clade of mpox, the virus that swept the world in 2022 and 2023, is now being transmitted by sexual contact in the central and western Africa, including female sex workers as well as men who have sex with men – and its spread also represents a potential global threat. Even so, “not a single dollar” of donor funds has been raised to support the scale up of diagnosis, treatment, vaccination or monitoring and surveillance in DR Congo and other African states where the virus is most active and spreading, said Maria Van Kerkhove, a WHO Health Emergencies specialist.

Fossil fuels the main driver of climate change

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

“We single out fossil fuels because it’s not just one of the contributors, it is the major contributor to climate change,” said Dr Tedros, at the Friday afternoon press briefing. “Fossil fuels are three components – oil, coal and natural gas.  And these three combined contribute more than 75% of carbon emissions.  So if you don’t focus on the fossil fuels that contribute more than 75% to the carbon emissions, then where do you focus?

“When you focus on the major contributor, you can make progress and that is why the global community is asking for more consensus on phasing out fossil fuels.”

A landmark agreement Wednesday, at the close of the UN Climate Conference in Dubai, COP28, took the first tentative steps towards that goal. The final agreement calls, endorsed by 198 nations, for a “just, orderly, and equitable” transition away from fossil fuels in energy systems to achieve “net zero by 2050 in keeping with the science”.    A call for a complete phase out of fossil fuels, supported by 127 nations at COP28, was removed from the text after intense lobbying by oil-producing nations, led by Saudi Arabia. The reference to “energy systems” also creates a giant loophole in the calls for transition, effectively overlooking fossil fuel use in heavy industries like cement and steel industries, as inputs to fertilizers and plastics, and possibly transport.

Following a first-ever “health day” at COP28, a WHA resolution on climate and health is now being negotiated by member states, said Dr Maria Neira, head of WHO’s Department of Climate, Environment and Health.

There are also initial efforts underway to explore how health indicators could be better integrated into global measures of progress on climate change – to better underline the health connection and inspire progress, she said.

“Why not put up a health-related indicator as the ultimate demonstration of success,” she told Health Policy Watch, adding that air pollution exposures could be one relevant measure, insofar as most air pollution is created by the same sources of fossil fuel or biomass burning that contribute to climate change.  “Or how about the number of countries implementing air quality guidelines for instance, or having health incorporated into national determined contributions (NDCs)?”

Unprecedented number of health and humanitarian crises

Emergency shelters at the Awar camp site in Mahagi, Ituri province in the eastern Democratic Republic of the Congo.

As the climate crisis continues to exact an increasingly severe human toll, 2023 has seen an almost unprecedented number of health and humanitarian crises raging across the world, Tedros and other WHO officials at the briefing noted.

Those range from the approximately 1.9 million Palestinians displaced in Gaza amidst the ongoing Israel-Hamas war; to the war in the Sudan which has displaced over 7 million people, also causing acute, widespread hunger; a new civil war in Ethiopia, this time with rebels in the country’s Amhara region; gang violence in Haiti, and rebel violence in eastern DR Congo that has displaced a record 6.9 million people. And that list doesn’t even include Russia’s war in Ukraine, as well as protracted conflicts in Myanmar, northwestern Syria and elsewhere.

“All of these crises come at a heavy price, in term of lives lost and communities destroyed, but also in terms of the cost of delivering humanitarian aid,” said Tedros.  He called again for an immediate cease-fire and unfettered access by health workers transporting patients and bringing supplies to hospitals in all parts of the beseiged enclave, and particularly to three still-functioning hospitals in northern Gaza, an epicenter of combat.

While a recent Israeli announcement that it would open up a new crossing into Gaza from its Kerem Shalom crossing point is “very good news”, Dr Richard Peeperkorn, WHO representative to the Occupied Palestinian Territories, stressed that “we are not only talking about getting supplies into Gaza, ware talking about getting supplies to people all over Gaza.”

Sexual transmission of Clade 1 mpox raises renewed concerns

Mpox lesions

Meanwhile, WHO officials expressed growing concerns over the increasing signs of sexual transmisson of the deadly Clade 1 of mpox in DR Congo, Nigeria and neighboring countries.  While last year’s global outbreak of Clade 2 of the virus was primarily seen among men who have sex with men, Clade 1 is now being transmitted sexually to women, including sex workers in major Nigerian and Congolese cities, such as Goma, said WHO’s Rosamund Lewis, speaking at a Friday morning press briefing convened by the UN press office in Geneva.

Whereas the Clade 2 virus that trigggered a WHO declaration of a global public health emergency in 2022, has a case fatality rate of about .18%, death rates of Clade 1 are 5-8% in the DRC, which has recorded its highest-ever levels of confirmed and suspected cases this year, Lewis said.

“This is a much more serious disease,” said Mike Ryan, at the WHO Friday evening briefing. “The virus is growing in geographic dimensions, and in numbers. Anytime you see a virus breaking those geographic barriers, breaking the susceptible group barriers. You have to be very careful. 

“From a global level, we have not been able to raise any funding to deal with an ancient threat that is killing right now, spreading right now, evolving, right now,” Ryan stressed, also noting the genetic links between mpox, an orthopoxvirus, and smallpox, which was finally eradicated in the 1970s.  

“We talk about all of the casualties of war, but smallpox probably killed more people than all of the wars in  history,” Ryan added. 

Image Credits: E. Fletcher , Yoda Adaman/ Unsplash, IOM 2023, Tessa Davis/Twitter .

Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia.

A spike in COVID-19 cases in Southeast Asia has prompted Indonesia, Singapore and Malaysia to reintroduce screening for travellers at airports.

In the past week, Indonesia has installed thermal body scanners at Jakarta International Airport and the main ferry line.

The Bali Port Health Office has also implemented thermal checks at three border entry points: Benoa Port, Celuk Bawang, and I Gusti Ngurah Rai International Airport, and appealed to travellers to wear masks – particularly if they are feeling unwell.

Should a tourist or foreign national test positive for COVID-19 upon arrival, they will be immediately quarantined in a designated health facility or referral hospital in Bali, according to a circular issued this week by the Ministry of Health.

The Indonesian health authorities have also urged citizens to wear masks, ensure they are fully vaccinated and postpone travel to areas that are reporting a spike in COVID-19 cases.

https://twitter.com/BloombergAU/status/1735242493136920598

Jump in cases in Singapore

In Singapore, COVID cases increased by 10,000 in a single week, jumping from 22,000 to 32,035 in the week ended 2 December, according to the health ministry.

“The increase in cases could be due to a number of factors, including waning population immunity and increased travel and community interactions during the year-end travel and festive season,” said the Ministry of Health. 

“We urge the public to exercise precaution, personal and social responsibility,” said the Singaporean Health Ministry.

“When travelling overseas, stay vigilant and adopt relevant travel precautions, such as wearing a mask at the airport, purchasing travel insurance, and avoiding crowded areas with poor ventilation.”

“Everyone is advised to keep up to date with their COVID-19 vaccinations. This includes an additional dose around one year after their last vaccine dose for those aged 60 years and above, medically vulnerable persons, and residents of aged care facilities,” it added.

Malaysia COVID cases: 14 December 2023

Meanwhile, cases in Malaysia doubled in a week, jumping from 6,796 cases at the end of November to nearly 13,000 by 9 December, according to the New Strait Times.

Malaysian Health Minister Dzulkefly Ahmad recommended on Thursday that people wear masks and get a COVID-19 booster if they were elderly or had co-morbidities, according to the Strait Times.

Image Credits: WHO Indonesia.

The COP28 climate summit, the largest in history, concluded with a landmark but contentious agreement to transition away from fossil fuels, endorsed by 198 nations. This historic agreement, known as the UAE Consensus, represents the first time in the 28-year history of UN climate summits that nations have collectively resolved to move away from the fossil fuels that are at the heart of the climate crisis.

The final agreement calls for a “just, orderly, and equitable” transition away from fossil fuels in energy systems to achieve “net zero by 2050 in keeping with the science”. A call for a complete “phase-out” of fossil fuels was left out of the final agreement after intense lobbying from oil-producing countries led by Saudi Arabia, despite strong support for the phase-out wording from 127 nations, representing over 72% of the nations attending the climate summit.

“To those who opposed a clear reference to phase out of fossil fuels during the COP28: Whether you like it or not, fossil fuel phase-out is inevitable,” United Nations (UN) Secretary-General Antonio Guterres said on Wednesday. “Let’s hope it doesn’t come too late.” 

The final agreement notably restricts the call for a fossil fuel transition to “energy systems”, raising questions over the agreement’s applicability to fossil fuels used in heavy industry, as feedstocks for chemicals and plastics, and in transportation — all major contributors to annual greenhouse gas emissions.

Dr. Sultan Al Jaber, the summit’s president, lauded the agreement as a “historic” triumph of “unity, solidarity, and collaboration.”

“Together, we have confronted realities and we have set the world in the right direction,” said Al Jaber. “We have given it a robust action plan to keep 1.5 within reach. It is a plan that is led by the science.”

Reactions from scientists, activists, and policymakers were mixed, with many highlighting both the deal’s historic nature and its shortcomings.

“The deal is historic, no doubt. The final text signals the beginning of the end of the fossil fuel era,” Dr Maria Neira, head of the Department of Climate, Environment and Health at the World Health Organization (WHO) told Health Policy Watch.

“However, as fossil fuels are the leading driver of climate change and its health impacts, responsible for seven million premature deaths every year, and many other additional health hazards, a rapid and ambitious phase-out will be critical for health,” Neira added.  

Language in the UAE Consensus limiting the transition away from fossil fuels to “energy systems” has raised concerns about the scope of global commitments to reduce dependence on fossil fuels in other sectors. / Data: IEA

Dr Friederike Otto, a prominent climate scientist from Imperial College London and a founding member of the World Weather Attribution group, expressed profound disappointment with the outcomes of the COP28 agreement.

 “The lukewarm agreement reached at COP28 will cost every country, no matter how rich, no matter how poor. Everyone loses. With every vague verb, every empty promise in the final text, millions more people will enter the frontline of climate change and many will die,” said Otto.  

“It’s hailed as a compromise, but we need to be very clear what has been compromised. The short-term financial interest of a few has again won over the health, lives and livelihoods of most people living on this planet,” she added. 

Small island states, already grappling with the existential threats of rising sea levels and intensifying storms, epitomize this sense of sacrifice and imminent danger on the frontlines of climate change. Delegates from these imperilled island nations characterized the absence of a complete fossil fuel phase-out in the final agreement as a “death sentence” for their homelands.

“We have built a canoe with a weak and leaky hull. Yet we have to put it into the water because we have no other option,” a representative from the Marshall Islands told the closing plenary of the summit. “We need to phase out fossil fuels. It’s a small step in the right direction. In the context of the real world, it is not enough.”

‘A historic COP’

The agreement, nonetheless, is groundbreaking. It recommits the world to the 1.5°C warming target of the 2015 Paris Agreement, a goal reiterated 13 times in the text, and clearly states that the science dictates countries must cut emissions by 43% by 2030, and 60% by 2035 relative to 2019 levels.

It also commits to reaching net zero carbon dioxide emissions by 2050, calls for a tripling of global renewable energy capacity, and slashing methane emissions. 

The agreement also candidly addresses the immense scale of the financial challenges ahead. It estimates that developing countries will require between $215-billion and $387 billion in adaptation finance by 2030, with a global annual investment of $4.3 trillion in green energy required until 2030, escalating to $5 trillion thereafter. 

The agreement also includes a call for reforming the global financial architecture, notably the World Bank and the International Monetary Fund, to enable developing countries to access vital finance to adapt to climate change. 

“We got a loss and damage fund. We got the recapitalisation of the Green Climate Fund for adaptation. We got an affirmation of a climate finance system, which runs from public finance to private finance. We got a commitment to the tripling of renewables and we got an affirmation of transitioning away from fossil fuels,” Avinash Persaud, Special Envoy to Barbados Prime Minister Mia Mottley, said in a media briefing on Wednesday. 

“Those are five difficult things,” he added. “It’s a historic COP, the best we’ve had in eight years (since Paris).” 

Further accomplishments of the UAE Consensus include pledges to halt deforestation by 2030 and to incorporate health as a distinct sector in adaptation funding, a key ask of the World Health Organization and global health experts. 

“Health is firmly embedded in the newly adopted Global Goal on Adaptation,” Arthur Wyns, COP28 advisor at the WHO, told Health Policy Watch. “A dedicated health adaptation target helps to ensure the health sector itself will receive a stronger focus on adaptation going forward.”

‘A litany of loopholes’

Global greenhouse gas emissions has steadily increased year-on-year since the first UN Climate Summit in 1995.

Despite these advancements, the agreement’s non-binding nature and “litany of loopholes” elucidated by the Alliance of Small Island States have raised significant concerns about its implementation and whether it will mark a true turning point in the climate crisis.

The final agreement contains a series of concessions to fossil fuel interests, including references to “transition fuels” — code for natural gas — and carbon capture and storage technologies, which remain unproven on a large scale. An estimated 79% of operating carbon capture capacity globally is used to reinject captured carbon into the ground to produce more oil. These technologies also incur significant costs and frequently result in net increases in emissions. 

A timeline for the complete phase-out of methane emissions – a potent but short-lived greenhouse gas – and language calling for a peak in global greenhouse gas emissions by 2025, were removed from the final agreement.

Global standards for regulating carbon markets, a key issue given the prevailing skepticism about the legitimacy of carbon markets as a means to offset emissions, remained unestablished due to opposition spearheaded by Saudi Arabia, China, and India.

These loopholes leave considerable room for interpretation and potential exploitation by vested interests, Simon Stiell, President of the UN Framework Convention on Climate Change (UNFCCC) said in his closing remarks on Wednesday. 

“Loopholes leave us vulnerable to fossil fuel vested interests, which could crash our ability to protect people everywhere against rising climate impacts,” Stiell remarked in his closing comments. “Transparency and people holding their governments to account will be vital to closing these loopholes.”

“Whilst we didn’t turn the page on the fossil fuel era in Dubai, this outcome is the beginning of the end,” said Stiell. “Now all governments and businesses need to turn these pledges into real-economy outcomes, without delay.”

Climate finance question remains unanswered

Climate finance from rich countries fell to $21 billion in 2021, hundreds of billions short of the estimated financial needs of developing countries every year for adaptation alone.

While the agreement recognizes the need for trillions, not billions, of dollars to tackle climate change,  it stops short of outlining specific funding sources. The more than $85 billion mobilized in new climate finance at COP28 is significant but falls far short of what is required for developing countries to transition equitably to green energy. The United States, the world’s largest economy, committed a mere $20 million in new climate funds at the summit.

Madeline Diouff Sarr, chair of the Least Developed Countries Group representing nearly 50 of the world’s poorest nations, expressed disappointment in the agreement, describing it as “the very lowest possible ambition we could accept.”

“There is recognition in this text of the trillions of dollars needed to address climate change in our countries. Yet it fails to deliver a credible response to this challenge. Next year will be critical in deciding the new climate finance goal,” said Sarr. “Today’s outcome is full of eloquent language but regrettably devoid of actionable commitments.”

While COP28 marked a day-one victory for climate finance by operationalizing the Loss and Damage Fund, which aims to provide financial assistance to vulnerable countries in the path of the most devastating effects of climate change, the fund is effectively empty so will do little to bridge the climate finance gap in the short-term.

“Limiting warming to 1.5°C is a matter of survival,” said Sarr. “[It] not only requires countries to urgently reduce domestic emissions but also the delivery of significant climate finance.”

Fossil fuel production paradox

Governments’ fossil fuel expansion plans show they intend to produce, in total, 110% more fossil fuels in 2030 than are compatible with the 1.5°C limit set out in the Paris Agreement, and 69% more than is consistent with 2°C of warming, according to UNEP.

The agreement also fails to address the paradox of ongoing global fossil fuel production expansion. Despite a clear mandate for drastic emission reductions by the decade’s end, there remains a significant gap between current efforts and those required to maintain the 1.5°C target.

Saudi Arabia and other oil and gas-producing states made headlines for their efforts to exclude fossil fuel language from the final agreement, but governments and industries worldwide continue to ramp up fossil fuel production, casting a shadow over the commitments made in Dubai.

Ursula von Der Leyen, President of the European Commission,  praised the Dubai agreement as “historic” and marking “the beginning of the post-fossil era,” yet European countries continue to spend billions on new liquified natural gas terminals as the continent diversifies away from Russian oil and gas and increase imports from the very African countries it is asking to limit use of these energy sources. 

The United States, which backed stronger language on eliminating fossil fuels, continues to lead the world in oil and gas production, which is at historic highs, and expand production. 

Adnoc is opening up new oil and gas fields in the United Arab Emirates and expanding its drilling sites off the coast of the Arabian Peninsula. 

Adnoc, the Abu Dhabi National Oil Company run by COP President Al Jaber, plans to invest over $150 billion over the next five years to expand production – the largest such plan by any company in the world. More than 92% of Adnoc’s oil and gas expansion plans are not compatible with the 1.5°C pathways, according to data from German environmental NGO Urgewalt. 

Despite the escalating climate crisis, 96% of oil and gas companies involved in exploration for new deposits continue to develop new oil and gas fields, according to the Global Oil and Gas Exit list, a database which tracks the activity of companies responsible for 95% of global oil and gas output.

“COP is meant to be the vehicle for solutions, but all it seems to do is recognise problems that the rest of the world identified years ago,” said Mike O’Sullivan, a leading climate expert from the University of Exeter. “It’s obvious to most people that limiting global warming meant reduced fossil fuel use, but only now do our leaders say this.

“But so what? Where are the real global plans for the energy transition, without relying on fanciful tech solutions, with adequate support for poorer nations? Where is the global leadership to take the right action, not the selfish action? Across the globe, there are plans to expand fossil production – how does this fit with the text that’s just been agreed?” said O’Sullivan. 

The market’s reaction to the COP28 pledge did not indicate concern for its potential impact on the fossil fuel sector. In fact, premarket trading saw a modest increase in the shares of oil giants Chevron and Exxon Mobil on Wednesday. 

In another sign of confidence in the sector, Aramco, the leading global oil producer, finalized an agreement on Tuesday to secure a 40% stake in Gas & Oil Pakistan, marking its inaugural venture into the Pakistani market and the latest chapter of the company’s global expansion. 

Mike Berners-Lee, a carbon footprinting specialist at Lancaster University, cautioned that the fossil fuel sector achieved its goals at the summit.

“Cop28 is the fossil fuel industry’s dream outcome,” he observed. “Because it looks like progress, but it isn’t.”

Image Credits: UNEP.

Rush hour traffic in Ho Chi Minh City in Vietnam.

Ten countries have slashed their road traffic deaths in half between 2010 and 2021, while  35 others have reduced deaths by between 30% and 50%, according to the World Health Organization’s (WHO) Global Status Report on Road Safety 2023 released this week.

The big achievers are Belarus, Brunei, Denmark, Japan, Lithuania, Norway, Russia, Trinidad and Tobago, United Arab Emirates and Venezuela.

Meanwhile, there was an overall global reduction in deaths of 5% over the period, with 1.19 million people dying per year.

“Yet with more than two deaths occurring per minute and over 3,200 per day, road traffic crashes remain the leading killer of children and youth aged 5–29 years,” according to the WHO.

“The tragic tally of road crash deaths is heading in the right direction, downwards, but nowhere near fast enough,” says WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “The carnage on our roads is preventable. We call on all countries to put people rather than cars at the centre of their transport systems, ensuring the safety of pedestrians, cyclists and other vulnerable road users.”

The majority of road traffic deaths occurred in the WHO’s South-East Asia Region (28%), followed by the Western Pacific (25%), African Region (19%), the Americas (12%), and the Eastern Mediterranean Region (11%). The least occurred in the European Region (5%).

Some 90% of deaths occur in low- and middle-income countries (LMICs), and the risk of death is three times higher in low-income than high-income countries despite low-income countries only having 1% of the world’s motor vehicles.

More than half of fatalities occur among pedestrians, cyclists and motorcyclists, in particular those living in LMICs. Pedestrian deaths rose 3% to 274,000 over the decade, accounting for 23% of global fatalities. Deaths among cyclists rose by nearly 20% to 71,000, accounting for 6% of global deaths. 

“Research indicates that 80% of the world’s roads fail to meet pedestrian safety standards and just 0.2% have cycle lanes, leaving these road users dangerously exposed. And while nine in 10 people surveyed identify as pedestrians, just a quarter of countries have policies to promote walking, cycling and public transport,” according to WHO.

The report also reveals an alarming lack of progress in advancing laws and safety standards. Only six countries have laws that meet WHO best practice for all risk factors, namely speeding, drunk driving, compulsory motorcycle helmets, seatbelts and child restraints.

The global motor vehicle fleet is set to double by 2030, but only 35 countries – less than a fifth of UN Member States – legislate on all key vehicle safety features, while only a quarter require vehicle safety inspections that cover all road users.

“Our mission at Bloomberg Philanthropies is to save and improve as many lives as possible, and one of the best ways to do that is to make more of the world’s roads safe for all,” said Michael R. Bloomberg, founder of  Bloomberg Philanthropies, which supports a substantial global road safety programme.

“For more than a decade now, we’ve made encouraging progress together with the WHO and our partners. Still, as this new report makes clear, road safety demands stronger commitments from governments worldwide – and we’ll continue to urge more leaders to take lifesaving action,” added Bloomberg, who is the WHO’s Global Ambassador for Noncommunicable Diseases and Injuries.

Image Credits: tph567/Flickr, Flickr/ M M.