WGIHR starts its sixth meeting on 7 December.

A single oversight and compliance body may be set up to oversee both the new pandemic agreement and the amended International Health Regulations (IHR), according to  Dr Ashley Bloomfield, the co-chair of the Working Group on Amendments to the International Health Regulations (WGIHR).

Bloomfield was responding to a question about whether his group had discussed independent monitoring from Dame Barbara Stocking, chair of the Panel for a Global Public Health Convention, at the start of the WGIHR’s sixth meeting on Thursday.

Several civil society groups have called for independent oversight of the implementation of the pandemic agreement currently being negotiated by the intergovernmental negotiating body (INB) and the amended IHR.

Stocking reiterated the need for “independent assessment in both the IHR and any new treaty” because of a lack of trust between countries, as well as between citizens and governments.

“Having independent assessment is a really important way of actually making sure that there is trust in what is being done, and what is being said to be done,” said Stocking.

“We’re very aware of the importance of this issue of compliance, oversight and monitoring, including what independent monitoring might look like,” responded Bloomfield, who said that the WGIHR and the INB were first considering existing monitoring arrangements such as the independent oversight and advisory committee set up by the WHO Director-General.

Bloomfield added that the issue was featured in a new article in the IHR (Article 53) and well as in Article 54.

“Likewise, there are relevant provisions in the draft INB agreement that were discussed over the last few days,” said Bloomfield, who attended this week’s INB meeting as an observer.

“All these matters are ones that we will be considering within our individual processes, but I can say that there are already informal discussions happening about how a future oversight and compliance arrangement would be constructed that takes into account both processes.” 

He later added that there was considerable overlap between the two groups on financing and there could be a joint process on that too.

Civil society concerns

Meanwhile, other civil society organisations also raised their concerns at the open plenary of the WGIHR. 

The World Trade Organization (WTO) offered its technical expertise and experience to the WGIHR on proposed amendments that “address topics with trade-related elements” such as open supply chains, trade restrictions, unnecessary interference with international traffic and trade, the transfer of technology and know-how and to develop and diversify manufacturing capacity. 

“We have a shared interest in promoting synergies and coherence across our organisations and our legal instruments. To this end, we would welcome the opportunity to collaborate with the WHO on the development and implementation of an international pandemic response as mandated by our ministers last year,” said the WTO.

Jamie Love of Knowledge Ecology International (KEI).

Jamie Love of Knowledge Ecology International reminded the group that the WHO had adopted a resolution at the World Health Assembly in 2019 (WHA78) “on improving the transparency of markets for medicines, vaccines and other health products”. 

“Among the measures we hope can be reflected in future revisions of the IHR are measures to implement the transparency obligations in WHA78, including but not limited to those relating to the transparency of prices and units sold for countermeasures, and the transparency and collection of data on R&D subsidies, patent landscapes, and the outcomes and costs and subsidies relating to relevant clinical trials on countermeasures,” said Love.

Noting that cancer treatment was disrupted during pandemics, the European Society of Medical Oncology urged member states to “support amendments to the IHR which would build, develop and maintain health systems capacities at secondary and tertiary care levels to avoid leaving millions of patients with cancer behind in times of health emergencies”. 

Mohga Kamal-Yanni for Oxfam and the People’s Vaccine Alliance

Mohga Kamal-Yanni for Oxfam and the People’s Vaccine Alliance appealed for  “practical measures to operationalize equity of access to pandemic-related products”.

Grega Kumer of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  called for three measures to “modernise” the IHR: “One, raising the alarm early by ensuring the rapid sharing of outbreak information and immediate access to pathogens and genetic data. 

“Two, enabling the innovative ecosystem including protection incentives on IP to reinforce the pipeline for needed medical countermeasures, and third, fostering multi-stakeholder partnerships and dialogue, including with private sector, to ensure balanced and implementable approaches.”

WGIHR progress

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah Assiri.

Meanwhile, WGIHR Co-Chair Dr Abdullah Assiri reported that two inter-sessional activities have been held since the group’s last meeting in mid-November. 

“The first was an informal consultation on Article 44 and 44 A, Annex One and 10,” said Assiri. 

“The second was the joint INB-WGIHR briefing on the public health alert system [known as the public health emergency of international concern], the pandemic continuum, including definitions, criteria and the process for determining each.”

The Bureaus of the INB and the WGIHR have also held two joint meetings. The first (25 October), discussed financing mechanisms and preparations for the joint INB-WGIHR briefing. The second (6 December) continued discussions on “key areas of overlap between the two processes, particularly financing, surveillance and prevention, including One Health, capacity building and know-how”, said Assiri.

Bloomfield described Wednesday’s joint meeting with the INB Bureau as “very helpful” in enabling the two bodies to “really think further about how we progress with the work, and where there are overlaps between our two processes”. 

“I’ve certainly found it useful to be in the room during the INB meeting over the last three days and other members of our Bureau were also able to listen into those discussions as well.”

INB update

The INB ended later than anticipated on Wednesday night so its public report-back was perfunctory. 

However, INB co-chair Roland Driece reported on Wednesday that the body had established four drafting subgroups: one on prevention, surveillance, preparedness, readiness, and One Health (Articles 4, 5 and 6 of the negotiation text);  the second on sustainable production and technology transfer (Articles 10 and 11 and possibly 13); the third on access and benefit sharing (Article 12) and the fourth subgroup on financing and capacity building (Articles 19 and 20). 

These drafting subgroups held inter-sessional meetings in November and early December, and the drafting group completed a review of the proposal for negotiation text. The next INB meeting is scheduled for 19 February to 1 March 2024. 

Meanwhile, Bloomfield noted that financing is “an area where there is clearly a lot of overlap and common interest between our two processes”.

“So we will be canvassing [member states’] views on how we might progress that area of financing in a joined-up way to make sure that we coordinate and are coherent across the two processes,” said Bloomfield.

The first-ever Latin American Self-Care Regional Congress took place in São Paulo, Brazil, breaking new ground for self-care initiatives on the continent.

A monumental step for self-care was taken this month at the first Latin American Self-Care Regional Congress. Taking place in November in Sao Paulo, Brazil, the two-day congress brought together stakeholders from across the Latin America region to discuss critical topics, such as public policy and regulation, innovation and sustainability, and empowerment and health literacy, among others.

Together with the Global Self-Care Federation (GSCF), the Brazilian Association of Self-Care Products (ACESSA) and the Latin American Association for Responsible Self-Care (ILAR) brought together government officials, healthcare professionals, industry representatives and experts for an excellent first edition of this event.

The theme of the congress was “making self-care a health movement” and was accompanied by an overall objective to amplify and advance discussions on a future World Health Organization’s Resolution on Self-Care. And we were able to do just that.

The crux of this is the Sao Paulo Declaration on Self-Care for Universal Health Coverage (UHC). The Declaration is a huge step towards advancing global health equity and access to healthcare services.

Discourse and action around self-care have continued to advance this year, with the HRP, WHO, UNDP, UNFPA and the World Bank publishing a joint statement on the importance of self-care at the World Health Summit a few weeks ago.

Using the momentum gained through those advancements, we must continue to grow awareness of the importance of self-care until the adoption of a Resolution on Self-Care for Health at the World Health Assembly (WHA), an initiative driven by the United for Self-Care Coalition partners.

If we are to see sustainable and reliable healthcare systems develop for the future, self-care must be included as a foundational aspect. UHC is a key element to achieving the United Nations Sustainable Development Goals (SDGs). SDG 3 aims to ensure healthy lives and promote well-being for all.

Furthermore, the right to health is fundamentally enshrined in international human rights law. The Declaration endorsed at this congress makes a clear commitment to advocate for policies that advance healthcare and expand access to it.

Self-care: A need for Latin America

Yearly savings through self-care globally, according to the Global Self-Care Federation.

As we look towards a future where health systems are constantly in flux, the need for self-care has never been so apparent. 

The Global Self-Care Federation’s Economic and Social Value of Self-Care report notes that “Latin America has the highest percentage of amenable mortality due to receipt of poor-quality health service.” Amenable mortality is defined as deaths from diseases that are potentially preventable with appropriate treatment.

But this treatment for patients doesn’t only need to come from primary healthcare providers. Pharmacists and overall health literacy can make huge strides for health in low-access regions.

Historically in Latin America, self-care is not simply represented by treatment with over-the-counter medications. Treatment with traditional medicines remains prevalent to this day, and it forms a key pillar of self-care and health literacy for the region.

Individuals need to continue to be empowered in order to seek out optimal healthcare solutions according to their situation, and initiatives such as the São Paulo Declaration will enable health systems to continue to grow holistically.

Speaking at the first Latin American Self-Care Regional Congress, Eva Maria Ruiz de Castilla, Executive Director of the Latin America Patients Academy (LAPA), said: “Individuals should be empowered to be able to manage their own health, and health systems should enable them to do so through making healthcare more accessible.

Self-care is a central component of truly integrated health systems and restores the balance between health professionals and individuals. Additionally, integrating self-care into the health continuum supports the achievement of UHC, preventing overburdening of healthcare systems, and should be further expanded to more systems globally”.

Primary health care: A continuum

The São Paolo Declaration was launched on November 9 at the inaugural Latin American Self-Care Regional Congress in Brazil.

The current barriers to healthcare that populations currently face within our healthcare systems clearly demonstrate that we need to consider Primary Health Care (PHC) as a continuum.

This starts with self-care practices at home, seeking out available resources within a community or online, continues with seeking input from various health professionals such as pharmacists, nutritionists and health promoters, and finishes with taking steps to seek out treatment with a specific healthcare provider. Establishing resources for those seeking care to be able to reach out to in order to practice effective self-care is a needed and critical step.

Dr Alejandra Acuña Navarro, Executive Secretary of COMISCA, (Council of Health Ministers of Central America and the Dominican Republic) was one of the speakers at the congress this week.

In her talk titled “Self-Care in the Health Integration System of Central America,” Acuña highlighted the need for a balanced policy effort to establish the sustainable health systems of the future, noting that we cannot simply focus on expanding primary healthcare providers or hospitals as a sole solution.

“We must continue to work towards international recognition of self-care with a World Health Organization’s Global Self-Care Resolution,” said Acuña “In order to drive real change and ultimately achieve UHC, we need all stakeholders to actively support the Resolution.”

The time is now 

If we are to continue with our goal of creating sustainable health systems for the future, self-care needs to be intentionally recognized and adopted within our systems. We know that self-care can be introduced, scaled up, and established as complementary to existing systems. We saw it worldwide during the COVID-19 pandemic as extraordinary circumstances forced drastic action from Ministries of Health around the world. 

We know that it’s possible – but we shouldn’t wait until the next time circumstances force our hand. Self-care must be integrated into national and international healthcare systems, and we are seeing the first steps with actions such as the Sao Paulo Declaration.

With momentum on our side, and the international healthcare community growing in awareness and knowledge about the importance of self-care this is an opportunity we cannot miss. We must continue our push for a Global Self-Care Resolution at the World Health Assembly.

Being able to participate in an international congress such as this is a true pleasure, and I leave inspired and committed. I look forward to seeing the next steps that my peers from across the world will take as we continue this journey together. 

About the author

Juan Thompson is the Director General of Latin-American Association of Responsible Self-Care (ILAR), a non-governmental organization that leads the promotion of responsible self-care as the best way to be and stay healthy, as well as ensuring proper access and use of self-care products in Latin America. ILAR is an NGO with consultative status with the UN Economic and Social Council (ECOSOC) and members of the GSCF.

Image Credits: GSCF, GSCF.

South Africa’s Economic Freedom Fighters’ party protests against Uganda’s Anti-Homosexuality Act in Pretoria, South Africa.

As violence against LGBTQ people in Uganda continues to rise following the country’s adoption of its harsh Anti-Homosexuality Act (AHA), four legal challenges to the law have been consolidated into a single case.

However, Uganda’s Attorney General has ignored human rights groups’ application for an injunction against the implementation of the law until the appeals have been heard, LGBTQ activist Pepe Onziema told Health Policy Watch.

After a series of meetings between the four groups petitioning against the law and Ugandan Constitutional Court Judge Geoffrey Kiryabwire last week, the petitioners agreed to combine their cases.

Five groups have applied to be amicus (friends of the court) to support the court challenge, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), a group of pharmaceutical companies (VIIV Healthcare, Glaxosmithkline, Gilead and Merck), academics and the two human rights law organisations (the Southern African Litigation Centre and Centre for Applied Legal Studies).

But Uganda’s Attorney General has objected to the amici and their applications will be heard by a panel of five judges.

The hearing date will be set after a final meeting between the parties and Judge Kiryabwire on 11 December.

“These hearings are usually heard by a panel of five judges,” said Onziema, adding that the application for an injunction “has been ignored by the Attorney General” as “they have never given us an opportunity to present it.”

Ugandan LGBTQ activist Pepe Onziema.

Rape, beatings and evictions

The Human Rights Awareness and Promotion Forum (HRAPF), which has a countrywide network of community paralegals and legal aid centres, handled 83 cases in October involving people targeted for their sexual orientation or gender identity. This is up from 68 cases in September.

One of the attacks involved the rape of a transgender woman in Kampala by two men who followed her home one night, then called her neighbours to “wake up and see a homosexual”.

A woman in the Isingiro district, who provided counselling services to HIV-positive lesbian women, was attacked after being accused of “recruiting women into lesbianism”, and her leg was broken. She was also attacked at her home by the same group and was forced to flee.

HRAPF says 28 of the cases involved violence while 37 people were evicted. The law makes it illegal for landlords to rent property to LGBTQ people.

Meanwhile, this week US Secretary of State Antony Blinken announced visa restrictions on “current or former Ugandan officials or others” who are believed to be responsible for, or complicit in, undermining the democratic process in Uganda or for policies or actions aimed at repressing members of marginalised or vulnerable populations” including “environmental activists, human rights defenders, journalists, LGBTQI+ persons, and civil society organisers”. 

Previously, the US excluded Uganda from its African Growth and Opportunity Act (AGOA) trade programme, which gives preferential treatment to certain trading partners.

However, Ugandan Parliamentary Speaker Anitah Among, a staunch promoter of the AHA, told Parliament this week that she did not regret backing the law despite having her visa application rejected. Meanwhile, MP Jonathan Ebwalu (Soroti West) told Ugandans opposed to the Act to relocate to nations like US and UK , saying he is ready to shed blood “to fight against homosexuality “.

Solidarity as activists ‘walk through fire’

Onziema says that both international, regional and local solidarity have helped the LGBTQ community after the enactment of one of the world’s harshest laws against sexual orientation.

Within Uganda, LGBTQ activists and allies in academia, the medical sector and the hospitality industry have come together to form the Convening for Equality to oppose the law and offer support and often shelter to people.

“Some landlords and hotels have told us that we deserve shelter and have offered us safe places,” said Onziema.

He added that lobbying of politicians, the World Bank and other stakeholders at an international level had opened the door to dialogue between the Ugandan government and the LGBTQ leaders. 

“Much as they say we are Western agents, it seems that they are only interested in engaging with us when Western governments engage them,” said Onziema.

In August, the World Bank suspended new public loans to Uganda after the country passed the Act. The US President’s Emergency Plan for AIDS Relife (Pepfar) has also paused new funding to Uganda.

Onziema appealed to donors to provide unrestricted funds to assist LGBTQ activists “as we are literally walking through fire. There are attacks, kidnappings, and extortion. We have to change tactics all the time as something that works today might not work tomorrow.”

Helping vulnerable populations get access to energy options that reduce air pollution during cooking is an easy way to cut carbon emissions while also improving health and gender equity

Improving access to clean cooking will not only help the world get closer to net-zero carbon emissions by 2050, but it will not be possible to reach the 2030 Sustainable Development Goals (SDGs) without doing so, said experts speaking on the sidelines of COP28. 

“We don’t want people to be breathing polluted air as a result of the fact that they are preparing food,” said Maria Neira, the World Health Organization’s (WHO) Director of Environment, Climate Change and Health.

Globally around 2.3 billion people rely on polluting traditional fuels like wood and biomass for cooking, according to the latest report by WHO. It estimates that the cooking sector contributes 3% to the annual global carbon emissions.

It also causes tremendous indoor air pollution. In 2022 alone, indoor air pollution was estimated to be responsible for 3.2 million deaths, according to WHO. 

Women and children are particularly vulnerable as in many cultures they are responsible for cooking and related chores like gathering firewood. Air pollution is also linked to a rise in miscarriages and worsens pregnancy outcomes. 

The lack of clean cooking is a human rights issue, especially for women and children, said Bhushan Tuladhar, Chief of Party of USAID Clean Air in Nepal.

 “There are so many co-benefits associated with it that it’s almost a no-brainer. And it’s a low-hanging fruit,” he told a COP28 side event on a just and inclusive cooking transition.

The impact of indoor air pollution on women’s health has only in recent years garnered some attention, despite clear evidence of it.

 

Bhushan Tuladhar, an air pollution expert from Nepal.

In addition, cooking with biomass leads to the release of a sooty black material called black carbon. In fragile ecosystems like the Himalayan country of Nepal, this black carbon settles on the glacier ice and increases the rate of melting.

“It’s not just about climate benefit, but when you are reducing black carbon emissions, you’re also not altering your monsoon seasons. There’s energy and agricultural security, and food security is being impacted by this emission,” Michael Johnson, Technical Director of Berkeley Air Monitoring Group, told the event.

The $2.3 trillion cost of inaction

WHO estimates that 1.9 billion people will not have access to clean cooking by 2030 if the pace of improving access is not accelerated. 

In its report titled, “Achieving universal access and net-zero emissions by 2050,” WHO estimates that the annual cost of the impacts of lack of clean cooking on health, gender, and the global climate is US$2.4 trillion.

“Lifting the world’s 2.3 billion people still living in cooking poverty, as we call it, is an urgent issue. And it has enormous potential for societal benefits, particularly for public health, women’s productivity, empowerment, climate and environment. The important thing is the cost of inaction is a staggering US$2.4 trillion given all the damages this can cause,” said Chandrasekhar Govindarajalu, an energy specialist at the World Bank. 

 

Chandrasekhar Govindarajalu of the World Bank said the bank is working to improve access to clean cooking in 33 countries, and its support has reached 43 million people.

Need for clean cooking in sub-Saharan Africa

Access to clean cooking fuels has improved around the world. In Asia, governments have been pushing policies to improve access to LPG cylinders and electric stoves. 

In Nepal for instance, now 54% of the households rely on biomass compared to 75% 10 years back, due to the government initiative to improve LPG access, Tuladhar said. In India, the world’s most populous country, government push improved LPG access from 43.8% in 2016 to 58.6% in 2021. While the numbers are higher for urban households, rural areas continue to lag. 

But in sub-Saharan Africa, the number of people without access to clean cooking has increased. “Population growth has outpaced these improvements, particularly in Sub-Saharan Africa where the number of people without access reached 0.9 billion in 2021,” according to WHO’s report. 

 

The number of people without access to clean cooking is the highest in sub-Saharan Africa, as the growth of population has outpaced rate of the growth of access.


Govindarajalu added that to meet the climate and energy access targets, the rate at which access to clean cooking is currently improving has to be double or triple.

Alternate options: LPG and electric stoves

The two options for clean cooking to replace traditional fuel are electric stoves and LPG cylinders. Both have their challenges, especially in rural areas. While for electric stoves one needs steady and reliable electricity, it is hard to lug LPG cylinders across rural and mountainous terrain. 

Tuladhar said electric stoves are proving to be cheaper in Nepal’s rural areas but electricity access is not yet 100% and the intensity of electricity is not adequate in all areas. 

WHO too estimates that while LPG access will improve in the near term, in the long term it will be the electric stoves that will have to be employed to reduce emissions.  

WHO’s roadmap to help the cooking sector get to net-zero carbon emissions.

Tuladhar told Health Policy Watch that while soon the focus will have to be to increase LPG access, in the long-term it is electric stoves that will bring the maximum reduction in air pollution and carbon emissions. They can only be pushed once electricity access improves.  

Countries are also including clean cooking as a part of their national climate targets, said Johnson which is a good move but its impact is hard to measure, and each country is currently using their own frameworks to do so.

Experts reiterated that the issue of clean cooking is closely linked to the development of the country. “When it comes to energy transition there is no silver bullet, and clean cooking has to be part of the solution, especially as an issue that is so anchored to the development of the country,” said Duccio Tenti, UNDP’s energy team leader

Image Credits: Aalok Atreya/ Unsplash.

Despite strong evidence that taxing alcohol is one of the “most effective measures to reduce consumption and address alcohol-related harms”, countries are not using this effectively, according to Ruediger Krech, the World Health Organization’s (WHO) director of health promotion.

Krech was speaking on Tuesday at the launch of a WHO manual on alcohol tax policy and administration and a report on sugar-sweetened beverage (SSB) taxes. 

“Alcohol is one of the few toxic and psychoactive substances that many governments permit to be sold widely in the market. However, with this permission comes responsibility and governments have a duty to regulate the market to minimise harm,” said Krech.

“Alcohol is one of the leading risk factors for non-communicable diseases, including cancers and cardiovascular diseases. It is also associated with communicable diseases, prenatal conditions, injuries, drowning, mental health conditions and violence. Given the extensive list of harmful effects, addressing the harmful use of alcohol is a priority for the World Health Organization.”

At least 148 countries have applied excise taxes to alcoholic drinks, but wine is exempted in at least 22 countries, mostly in Europe. 

Meanwhile, around 108 countries are taxing some sort of sugar-sweetened beverages but the global average is a low 6.6%. In addition, half of all countries taxing SSBs are also taxing water, which is not recommended by WHO. 

The alcohol manual provides data from the tax systems of different countries as well as advice on the different tax options and their administration. It is the third in a series of WHO manuals on harmful products, with previous manuals addressing tobacco and SSB taxes.

Underwhelming

Devora Kestel, WHO’s director of Mental Health and Substance Abuse, said that while alcohol was linked to over 200 health conditions and had “far-reaching and often devastating effects”, progress to curb consumption at a country level has been “underwhelming”. 

“The global average of alcohol consumed per person has only seen a marginal decline, highlighting the need for more impactful action,” said Kestel.

Furthermore, the World Bank’s Ceren Ozer pointed out, “in high and low and middle-income countries, alcohol has become more affordable over the last three decades”. 

Moreover, the industry is expecting serious growth in the consumption of alcoholic beverages across the board, she added.

Yet alcohol taxes contributed only about 0.3% of GDP in tax revenue globally, which is about half that of tobacco taxes. However, a few countries have shown progress, said Ozer. 

“For instance, in the Philippines between 2012 and 2020, alcohol excise revenue has increased by 140% in real inflation-adjusted terms following significant increases in beer and spirits excise taxes,” said Ozer.

“South Africa is another country where we have detailed data-driven research that shows improvement not only to revenue but also the health impact due to improvements to after alcohol tax design and increasing in rates leading to significant gains from the late 1990s to recent years,” said Ozer.

South African Treasury official Mpho Legote told the launch that as his country taxed the alcohol content of beverages (as opposed to the size as in some countries), this had “incentivized the industry to introduce lower alcohol beers”, for example.

South African Treasury official Mpho Legote.

Improvements in Kosovo and Lithuania

Kosovo has had a “dramatic increase in revenue” almost entirely due to improvements in tax administration, and tax compliance, with an increase of almost a 25% in alcohol tax revenue between 2019 and 2022, Ozer said.

Meanwhile, Lithuania increased alcohol tax revenue from €234 million in 2016 to €323 million in 2018 and saw alcohol-related deaths drop from 23.4 per 100 000 people in 2016 to 18.1 per 100 000 people in 2018, according to WHO.

“About 0.5% to almost 2% of the country’s GDP is lost every year due to alcohol consumption or alcohol use,” pointed out Odd Hanssen, a health economist with the United Nations Development Program (UNDEP,

“This comes from a couple of ways, mainly in what health systems have to spend in order to treat people who have alcohol-caused diseases, but more significantly, the indirect costs of people with these diseases who are unable to work as productively,” said Hanssen.

No ‘one size fits all’

Explaining the manual’s key messages, the WHO’s Jeremias Paul said that “there is really no one size fits all given the heterogeneity of alcohol beverages and tax structures.

Each country’s context was different, and governments had to “consider several factors, such as the patterns of consumption, the administrative capacity, the different kinds of alcohol, beverages available, the policy goals of a country and the political economy and industry structure”, said Paul.

The bottom line, however, was that “the taxes should be high enough to impact affordability”, said Paul.

“One thing for sure is that you can expect industry pushback to reform and in the manual you can essentially find tips. What are the typical industry arguments against tax increases, and how to counter them.”

Image Credits: Taylor Brandon/ Unsplash.

pandemic
Health workers donning personal protective equipment during the COVID-19 pandemic.

This is a bumper week for pandemic negotiations – the last formal set for the year – with meetings of both the World Health Organization’s (WHO) intergovernmental negotiating body (INB) and the Working Group on Amendments to the International Health Regulations (WGIHR).

The INB, which is negotiating a pandemic agreement, meets until Wednesday, while the WGIHR meets on Thursday and Friday.

The proximity of the meetings is intentional, as it enables negotiating teams to attend one another’s meetings to ensure synergy between the two processes.

The International Health Regulations (IHR) define the processes leading to the declaration by the WHO Director General of a public health emergency of international concern and member states’ responsibilities. They are the only global internally binding obligations related to health emergencies.

The pandemic agreement is due to map out pandemic prevention, preparedness and response based on equity, and establish the institutional requirements to achieve this.

INB focus

INB co-chairs Roland Driece and Precious Matsoso

Unlike previous INB meetings, this week’s session did not start with an open plenary as the meeting is considered to be a continuation of the seventh meeting, which started a month ago. In the intervening period, member states have been meeting to discuss various issues related to the negotiating text for the pandemic agreement.

This week’s INB started with several sub-groups looking at key issues on Monday, including pandemic prevention and surveillance, One Health and preparedness, readiness and resilience (Articles 4-6); sustainable production and tech transfer (10-11),  access and benefit sharing (12), global supply chains (13)  Implementation capacity and financing (19-20).

Plenary sessions on Tuesday and Wednesday will consider member states’ text submissions on several of the articles that have been discussed since the previously discussed, including the contentious research and development article, as well as terminology and institutional arrangements needed to implement the agreement.

The INB will conclude with an open plenary to report back to stakeholders who are not part of the INB on Wednesday afternoon.

Meanwhile, Geneva Health Files reported recently that Namibia’s representative at the INB – an articulate champion of equity – had been sent home at short notice and that sources had speculated that wealthier countries may have applied pressure on the small African country to do so.

However, the US and the European Union denied this. Interestingly, Namibia’s response to GHF did not deny that they had come under pressure to recall their diplomat but simply indicated that his term had ended and that Namibia was a sovereign country.

The INB has to conclude its work in time to present the draft pandemic agreement to the next World Health Assembly in May 2024.

WGIHR agenda

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah M Assiri.

According to the WGIHR draft programme of work, the closed-door meeting will begin on Thursday with the co-chairs proposing a way forward to address the amendments received. It will then proceed to discuss text proposals received for several articles, including the proposal by Bangladesh and the Africa Goup for Article 13A on “equitable access to health products, technologies and know-how for public health response” the establishment pf an implementation committee (also proposed by the Africa Group) and the compliance committee (US proposal).

The co-chairs will also introduce the Bureau’s text proposals for a number of articles  and annexes and facilitate discussion on these proposals. This includes the heart of the IHR – the “assessment and notification of events that may constitute a public health emergency of international concern”.

The WGIHR is due to report to the WHO’s executive board on 22 January 2024.

Image Credits: Tehran Heart Centre .

Bhavreen Kandhari of Warrior Moms at a meeting during the UN General Assembly in New York, September, 2023.

Two mothers battled air pollution in Delhi and its suburbs well before it became a thing. Motivated by how their children have suffered,  Ruchika Sethi Takkar and Bhavreen Kandhari speak with Health Policy Watch about why they don’t give up and what other parents can learn from their work. 

DELHI, India – On a gently rolling field of garbage next to swanky high-rises, Ruchika Sethi Takkar bends to look closely at a piece of wrapping. “Sometimes you can trace where a load of garbage came from,” the 51-year-old says, sounding like a veteran detective. She’s standing by the side of a major road in the Delhi suburb of Gurugram. 

Takkar’s no detective nor did she ever imagine that she would often stand ankle-deep in rubbish. She’s the driving force behind Citizens For Clean Air Bharat, a small loose grouping of Gurugram residents.   

Ruchika Sethi Takkar standing on a garbage dump, where she looks for addresses to trace the source. For several years she’s been pushing authorities to prevent open dumping and burning of rubbish in Gurugram.

Bhavreen Kandhari is a more familiar face in India, often seen on national television and quoted in reports about air pollution. Based in Delhi, Kandhari, also 51 years old, began Warrior Moms with a few others. 

Both women aim to improve the quality of air in India, something that more and more people across the country are increasingly concerned about. In the most recent global rankings, 39 out of 50 of India’s major 50 cities were listed as the most polluted in the world.

But Takkar and Kandhari’s journeys began over 20 years ago, at least a decade before the air pollution crisis hit the headlines in 2014 when the World Health Organization (WHO) ranked Delhi as the most polluted city in the world – worse than Beijing, which until then had held the top pollution spot. 

There are striking commonalities in their paths, and Takkar and Kandhari’s learnings may be seen as useful case studies at a time when citizen activism is rising. Be it their organisational approach, their strategies, their negotiations with authorities or even the harsh pushback they’ve faced at times because of their, self-admittedly, privileged background.  

‘My world collapsed months after my daughter was born’

In 2001, Takkar was pregnant and heading an export team doing over $10 million in business annually. Her daughter was born on her 30th birthday. Within a couple of weeks, the new parents realised there were “issues” with their baby. Their doctor advised tests and, when she turned three months, he broke the news to Takkar. She recounts, “He said: ‘Your daughter has mental retardation’. And at that point, my world just collapsed.” =

Apart from the many things Takkar had to deal with, including giving up her job to care full-time for her infant, she wanted to understand what happened. Her doctor said it could be a neurodevelopmental disorder and the foetus had microcephaly, described as a birth defect where the baby has a small head.

Genetic profiling tests gave no indication of what caused it. During her pregnancy, Takkar had been diagnosed with intrauterine growth retardation (IUGR), and doctors noted that the foetus wasn’t growing that well. But the ultrasound didn’t flag anything, she recalls.

Looking back, she wonders whether the fumes from a diesel generator she was exposed to in the early months of her pregnancy could have been the cause. There were power outages at her office and fumes used to “flood in” though she accepts it’s hard to pin blame on this alone. Studies have linked IUGR, developmental disorders and other conditions to air pollution.

Soon, Takkar’s baby developed frequent respiratory ailments and had to use a nebuliser. It made Takkar aware of their surroundings. At the time they lived a short drive from a massive landfill in east Delhi. 

“I was aware that there is something in the environment also which is not helping. It was known that Noida [a suburb in east Delhi] has much more industrial pollution even next to the residential area. But still, I had no idea about municipal laws and environmental laws. All I knew was that the children were now being diagnosed a lot with asthmatic conditions.”

November 2023 saw average PM 2.5 levels in four cities including Delhi hit a five-year high.

By 2011, Takkar’s family had shifted to Gurugram, bordering south Delhi, to an up-market residential complex. But she frequently noticed a burning smell and was in for a rude surprise. It was waste being burnt next to their complex from their complex that had been dumped there by the builders. The rude surprise wasn’t just this but the apathy of some of her neighbours. One of them told her: ‘Why bother, you can just pop a medicine’. 

The following year Takkar started a group called Malba Hatao Movement (‘Remove Garbage Movement’.) It drew her into a maze of red tape and direct contact with three major government departments – the district administration, city municipality and building regulator. 

Three long years later, she had her first success when two departments banned the burning of waste, Takkar proudly recollects. All she had done was read the rules. “There came this realisation that the law is there, but for it to work you need more voices.”

Takkar’s biggest breakthrough came when she managed to get the top bureaucrats of the three departments into the same meeting in November 2015. They had one agenda: to stop waste burning in Gurugram, and they agreed to start pilot projects. 

Before setting up this meeting, Takkar made progress with two other stakeholders. First, more residents began to see waste burning as a health risk not as a solution to waste. She conducted over a dozen roadshows which meant taking residents to garbage dumps to drive home both the problem and solution. 

Her second success was using the simpler and more sidely understood word, pollution:  “The press kept focusing on the seasonal factors but not the persistent local factors which I had started coining as pollution because nobody else was picking up the word ‘civic deficiencies’.” 

However, eight years later, waste burning remains rampant in Gurugram. Takkar and other citizens frequently complain either directly to officers or on social media, tagging top ministers and the press. If there are any gains from those years of activism then it is that the administration is more responsive – although whether their responses are sufficient is another matter. 

In 2016, Takkar started a new group, Citizens for Clean Air Bharat. A loosely organised collective with no funding or organisation structure, the group frequently reports open burning to officials and politicians in charge. 

‘Something not right’

Bhavreen Kandhari in front of Delhi’s iconic Jawharlal Nehru Stadium.

Bhavreen Kandhari’s advocacy for air quality began earlier, after 1995 when frequent trips between Delhi and New York, enabled her to compare the air quality.

“I started kind of feeling that there is something not right in the air. And when I go from here to there [New York], you feel more energetic, and (it’s better for) your skin, and your hair,” said Kandhari, who had begun reading up on the Great Smog of London and California’s battle with air pollution, but could not get data about Delhi’s air. 

After 2002, things changed for Kandhari. Her twin girls were born prematurely at just six months and weighed 600 grams each and spent several weeks in hospital. From their first year, they began getting coughs and colds. 

“After three to four years, I realised that their colds and coughs don’t go away easily. They start around the same time year after year,” she said.

But when the children were taken to New York, from “the moment you land there, (their coughs and colds) would go away magically. The elders would always blame allergies. But now I was sure. This is something really about the air.” 

Around 2007-08, she participated in small protests outside India’s Ministry of the Environment demanding policy action for clean air – but there was little resonance amongst the public or the press, which she blamed on the absence of data. 

That information gap began to be addressed around 2011 when a Delhi-based think-tank started advising Kandhari. The tipping point for her clean air advocacy came after the WHO’s 2014 shock listing of Delhi as the world’s most polluted city.

‘Elite’ protest

Kandhari and a few other organisers decided to protest in the heart of Delhi, at a designated protest spot near Parliament in November 2016. While a couple of hundred people showed up, some of them arrived in diesel SUVs which are notorious for spewing pollution. “Many of our cars were photographed, and the media said that they are the elite mothers coming for this thing.”

The elite tag is something both Takkar and Kandhari have faced from several stakeholders. Both are self-funded, and both their fathers were in government service – one in the top bureaucracy and the other in the air force. Both belong to the ‘cream’ of civil society, and are urbane and well-off. And both could see that their approach needed to change. 

Kandhari admits the protest with SUVs “was my game changer. I thought that yes, this movement cannot be elite, it has to have masses with us. The biggest mistake I think I was making those days was not writing much in Hindi.”

Takkar says she was already working a lot with Hindi newspapers. She positioned the air problem and her campaign simply, as a “dhool aur dhooyen ki kahaani” – a story of dust and smoke – something that’s tangible. 

Providing a template for complaints

Widening the social net took their work to a new level. “What I could sense is that if government officials think that only a few people are bothered about it, then they don’t think it’s a problem. Then they think it’s your fetish, it’s your pastime,” says Takkar.

The outreach led her to adopt a new approach for those approaching her with pollution complaints. “That’s where my time goes, just talking to people and then telling them how to go about it. What bothered me was they would expect me to solve their problems. I said: ‘It can’t be done this way. I will give you a template. This is the number, this is the email’.” 

Kandhari says that, as she has been campaigning for clean air for a long time, she can help others. “Air pollution is a problem in different cities. But I can’t manage that. I have no resources. I can just connect people.” 

It led her and a few others to set up Warrior Moms in 2020, ironically because of blue skies instead of haze. The COVID-19 lockdowns showed how removing cars and several other sources of pollution could lead to blue skies. 

“It was the world’s biggest experiment, you know, a natural experiment showing us that it’s the emissions and it was so easy for us to prove. But we couldn’t go out.” 

Warrior Moms was born out of this need. It grew from a core of about five groups to almost 20 today with a membership of over 1,700, especially when pollution is high. ‘

But it is all voluntary work. There’s no structured membership and people can join or leave depending on their requirements. It’s essentially now a knowledge and support network as more people, including top personalities, voice their concerns about air pollution. 

Cricket stars troubled by air pollution

During the recent Cricket World Cup hosted by India, air pollution levels started to peak. India’s cricker captain, Rohit Sharma, expressed concern about air pollution in Mumbai when he landed for a match: “Looking at our future generations, your kids, my kid, obviously it is important that they get to live without any fear. Every time I get to speak outside of cricket, or not discussing cricket, I always talk about this. We have to look after our future generations.” 

England’s Joe Root, said following his team’s defeat to South Africa in Mumbai. “I’ve not played in anything like that before,” Root had said. “It just felt like you couldn’t get your breath. It was like you were eating the air. It was unique.” 

The teams playing in Delhi were worse off. The comments forced the organisers to acknowledge the poor air quality in Delhi and Mumbai. 

After 20 years with little progress, why not give up? 

Since Takkar and Kandhari began their advocacy work,  air quality has barely improved especially between October to March. The waste burning continues, and they have little or no financial or logistical support. Why don’t they just give up? 

For the first time in an hour-long interview, Takkar pauses. Her eyes well up. “You know, you just need to live with my daughter for a day. She’s getting nothing back from this society. Nothing. Yet, I think you have to make do with what you have.” 

After another pause, she continues: “There is always somebody out there who is weaker, who is getting affected. So we need to recognize, I think just by virtue of the fact that we are alive and we have some abilities, we have to do better for our lot.”

The Gurugram mom wants fellow residents to ask questions about their welfare. “We have data which is coming in about the non-communicable diseases (NCDs) growing, your own loved ones… you don’t have answers, where did (that) cancer come from?

“I don’t think anybody should give up. But yes, I do feel exhausted now, especially with the courts and all that,” Bhavreen Kandhari says, referring to her work petitioning courts to protect trees in the Capital. 

Kandhari speaks of tense times at home when her husband’s business hit a rough patch. They came through that but she’s determined to continue accepting that she’s not indispensable. 

“Everyone’s looking towards each other. I’ve always looked up to so many people. That’s how people are looking up to me. And how can we do this? How can we allow… I mean, if I’m angry, I am angry that, yeah, what you said, 20 years. And my girls are turning 20 and I have not been able to give them clean air and only damaged lungs.” 

Image Credits: Chetan Bhattacharji, Respirer Reports.

Drought in Burkina Faso

Drought data shows “an unprecedented emergency on a planetary scale”, according to a report released as the world leaders meet in Dubai at the annual climate summit, COP28, to discuss response to climate change.

The report warns that the “massive” impacts of human-induced droughts are only beginning to unfold, with data showing that droughts are worsening across the world.  Asia, particularly China, and the Horn of Africa, are the worst-hit. Up to 85% people affected by droughts live in low- and middle-income countries (LMIC).

The report was launched by the UN Convention to Combat Desertification (UNCCD) in collaboration with International Drought Resilience Alliance (IDRA).

Africa’s drought-related economic losses in the past 50 years are estimated to amount to $70 billion. Meanwhile, Argentina’s soybean harvest this year is expected to drop by 44% compared to the average of the past five years thanks to drought. It would make this the lowest yield since 1989 for the country and is set to cause a 3% drop in the country’s GDP this year.

“Unlike other disasters that attract media attention, droughts happen silently, often going unnoticed and failing to provoke an immediate public and political response. This silent devastation perpetuates a cycle of neglect, leaving affected populations to bear the burden in isolation,” said Ibrahim Thiaw, Executive Secretary of UNCCD.

UNCCD is one of three conventions that originated at the 1992 Earth Summit in Rio de Janeiro. The other two address climate change, the UN Framework Convention on Climate Change (UNFCCC) and biodiversity, the UN Convention on Biodiversity (UN CBD). 

IDRA is a global coalition of 34 countries that aims to create political momentum, mobilize finance and technical resources for a drought-resilience.

Worsening droughts are causing the loss of grazing land and forests, according to the latest UN data.

China, Horn of Africa – most vulnerable regions

In China around 15-20% of the population is likely to face frequent moderate to severe droughts by the turn of this century and the intensity of these is expected to rise by 80%. In the Horn of Africa, drought had already made 23 million people food insecure by the end of December 2022.

In North America, countries like the US are also facing worse drought periods, while the 2022 drought in Europe was the worst in 500 years. 

A key impact of droughts has been the reduction of food production, which has consequently affected the health and nutrition of dependent communities. Between 2016 and 2018, 70% of cereal crops were damaged by drought in the Mediterranean region. 

“With the frequency and severity of drought events increasing, as reservoir levels dwindle and crop yields decline, as we continue to lose biological diversity and famines spread, transformational change is needed,” Thiaw said, calling this report a wake-up call. The report draws on existing research and evidence from a range of agencies around the world.

Even if the average global temperature rise is restricted to 1.5 degrees Celsius compared to the pre-industrial period, 120 million people will experience extreme drought. If the temperature rise continues on the current trajectory, this number would swell to 170 million, according to the report.

Global carbon emissions are continuing to rise in 2023, according to the latest data from the World Meteorological Organization WMO). At this point, research places the future global temperature rise at anywhere between two to three degrees Celsius. 

“Several countries are already experiencing climate-change-induced famine,” the report said. “Forced migration surges globally; violent water conflicts are on the rise; the ecological base that enables all life on earth is eroding more quickly than at any time in known human history.”

Nearly a third of grazing land in South Africa has been lost to drought and the expected forest loss in the Mediterranean region in the high emission scenario is twice to thrice the current rate of forest loss, the report said.  

Apart from causing a rise in water stress for local communities, animals and forests, droughts are also affecting the shipping industry.  

During 2022, ships’ arrivals and departures were delayed in Europe due to low water levels on the Rhine River and this led to a 75% reduction in cargo capacity of some vessels. Low water levels in the Mississippi River in the US caused an economic loss of $20 billion as it led to supply chain disruptions.

What response could look like

The report also clearly spells out what the response to worsening droughts could look like, underlining that land restoration, sustainable land management and nature-positive agricultural practices are critical to building drought resilience.

“Urban intensification, active family planning, and curbing rapid population growth are prerequisites for societal development that respects planetary boundaries,” the report said.

The reduction or further conversion of global forests and natural land for agriculture could be halted if consumers cut their consumption of animal products such as pork, chicken, beef and milk.

Early warning systems are an important response to building drought resilience, according to the report. Efficient water management is another key component of global drought resilience. This includes investing in sustainable water supply systems, conservation measures and the promotion of water-efficient technologies.

The adoption of early warning systems is another key response to prepare for drought. Investing in meteorological monitoring, data collection and risk assessment tools can help respond quickly to drought emergencies and minimize impacts. Building global drought resilience requires international cooperation, knowledge sharing and environmental and social justice.

Global cooperation will be the key, the report added. “We need to reach binding global agreements for proactive measures that are to be taken by nations to curtail the spells of drought,” the report said. 

Image Credits: Yoda Adaman/ Unsplash.

Delegates convened for the first-ever Health Day at a UN climate summit in Dubai.

DUBAI, UAE – The inaugural Health Day at COP28 on Sunday saw a strong push by some global leaders, led by US Climate Envoy John Kerry, for a swift transition away from the world’s dependence on fossil fuels. While some ministers of health among the 50 countries gathered for the day also echoed Kerry’s call for a fossil fuel-free future, others were more hesitant.

The high-level Health Day, the first in 27 years of climate conferences, unfolded amidst an uproar over the revelation of remarks by COP President Sultan Al Jaber, who also serves as CEO of the United Arab Emirates national oil company Adnoc.

Al Jaber, whose dual role as COP28 President and oil barron is viewed by many observers as a serious conflict of interest, was quoted on Sunday saying that there is “no science” behind the claim that phasing out fossil fuels is required to slow global warming, suggesting it could send society “back into caves.”  He made the remarks in an online event 21 November with former UN Special Climate Envoy Mary Robinson, reported Sunday by The Guardian.

At the morning opening of the Health Day plenary, United Arab Emirates Assistant Minister of Health Dr Maha Barakat delivered the opposite message, affirming the Gulf state’s commitment to combatting climate change.

“On this first-ever Health Day, we must call upon the world to rapidly transition away from fossil fuels and keep 1.5°C within reach,” declared Barakat.

In a lineup that included the heads of the World Health Organization, the International Energy Agency, billionaire philanthropist Bill Gates, and Brazil’s Minister of Health, it was US Special Climate Envoy John Kerry who issued the most powerful call for change at Health Day. 

“If you poison our land, then you poison our water and you poison our air,” said Kerry. “The fact is that our bodies are ecosystems, the world is an ecosystem, and everything has an impact on everything.”

“It’s astonishing to me that it has taken as long as it has to have health as the centrepiece of the climate discussion because the reality is that it is killing people around the planet,” he added. “We should not measure progress on the climate crisis just by the degrees averted but by the lives saved.”

“I do not understand how adults who are in a position of responsibility can be avoiding responsibility for taking away those things that are killing people on a daily basis,” said Kerry. “The reality is that a climate crisis and health crisis are one and the same, totally connected, totally converging at this moment in time.”

Tackle coal first of all says Kerry

US Climate Envoy John Kerry (center) speaks at the inaugural COP Health Day in Dubai.

Kerry criticized, in particular, the world’s continued reliance on coal, citing its disproportionate impact on air pollution, climate and health, even in comparison to other fossil fuels.

“Coal, in fact, doubles the number of deaths over the other sources of air-carrying pollution … we ought to be transitioning out of coal,” said Kerry. “There shouldn’t be any more coal-fired plants permitted anywhere in the world. That’s how you can do something for your health.  And the reality here is that we are not doing it.”

Coal has always been a high priority target for climate mitigation, emitting 75% more CO2 per unit of energy than natural gas, for instance, and more than half of health-harmful PM2.5 emissions from fossil fuels globally.

But the US Climate Envoy’s impassioned appeal on coal carried sharp geopolitical undertones as well. While the United States remains the world’s largest producer and consumer of oil and gas, it has been winding down coal production, which is no longer a vital part of its energy mix, setting a 2040 target date for phasing it out altogether. 

Comparison of US and China fossil fuel production and use indicators for 2022.

China, a leading geopolitical rival, remains heavily reliant and coal, accounting for 52.7% of global consumption. China also continues to expand coal production planning and building new coal plants both domestically and abroad, despite pledges to reduce its use starting in 2026.

Health must remain a ‘permanent feature’ of the climate agenda

The first Health Day must not be the last, WHO chief Dr Tedros Adhanom Ghebreyesus said.

Despite the controversy surrounding the COP28 President, the Health Day plenary session saw a consensus among speakers on the urgent need to address the health impacts of climate change.

World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus described the recognition of the climate crisis as a health crisis as “long overdue”, highlighting that 27 COPs (Climate Conferences) have come and gone without a serious discussion of the topic.

“Undoubtedly health stands as the most compelling reason for taking climate action. The threats to health from climate change are immediate and present,” the UN health chief said. “For too long, health has been a footnote in climate discussions.”

That’s despite the fact that the evidence of health impacts are unequivocable, he said, noting that heat-related deaths among people over 65 have climbed by 75 percent over the past two decades.

“Every year, 7 million people die from air pollution. Changing weather patterns, driven by human activity and the burning of fossil fuels, is contributing to record numbers of cholera outbreaks,” he added. “And our warming planet is expanding the range of mosquitoes, which carry dangerous pathogens like dengue, chikungunya, Zika and yellow fever into places that have never dealt with them before.

“This is the first COP Health Day, but it must not be the last,” he concluded. “Health must be a permanent feature of the climate change agenda from now on.” 

Non proliferation treaty support

In his Health Day remarks Tedros’ did not refer to the thorny issue of fossil fuel phase out  – although the WHO leader has spoken vigorously on the issue in the weeks leading up to the climate conference.  At a high level COP28 event Saturday championing a “Fossil Fuel Non-Proliferation Treaty” he compared the impacts of fossil fuel use on climate change to the impacts of tobacco use on cancer incidence, saying:

“Much like we cannot discuss lung cancer without acknowledging the impact of tobacco, it’s undeniable that over 75% … of greenhouse gas emissions stem from oil, gas and coal combined… which not only harm our planet but also pose a great threat to human health.

“Addressing climate change, necessitates addressing the role of fossil fuels,” he said at the event hosted by the small island Pacific nations of Tuvalu and Vanuatu, which face potential extinction from rising sea levels.

“When …oil, natural gas and coal combined contribute more than 75%, why can’t we name that major contributor?  Without addressing this… achieving the 1.5°C limit is baloney. It will not happen.

“The objectives outlined in the proposed treaty are clear, evidenced-based and equitable,” he said. “A rapid phase-out of fossil fuels is imperative to save island nations, preserve the integrity of our planet and protect the health and well-being of all.”

Gates dodges fossil fuel debate, urges adaptation to climate impacts

Also speaking at the Health Day event, Bill Gates, the billionaire philanthropist and one of the WHO’s largest donors steered entirely clear of the contentious issue of fossil fuel divestment, emphasizing instead the need for adaptation strategies to mitigate the health impacts of climate change.

Gates focused his address on the development and deployment of innovative technologies to counteract the detrimental effects of climate change, particularly in the agricultural sector. He advocated for enhancing food systems’ resilience against rising temperatures and drought to combat malnutrition, a major risk factor for childhood diseases.

Gates urged the global community to maintain its commitment to investing in combating poverty-related diseases like malaria alongside the ongoing climate crisis.

“Nobody would be better off in a world with fewer carbon emissions, where we are reducing our interventions to reduce illness, starvation and death,” he declared.  “Even in the face of climate, investing in these health interventions, are not to be pushed to the side.”

COP presidency defends record at the climate conference 

COP28 has seen a surge in attendance from every corner of the globe. Some 97,372 delegates registered to attend the summit, while COP officials reported  over 35,000 entries on Friday, 1 December, the second day of the conference.

At a a press briefing Monday, Al Jaber pushed back at the outrage over his comments on fossil fuels saying that as an economist, “I respect the science in everything I do. And I respect and trust numbers and figures.

“The science says that we must get to net zero emissions by 2050, and we must reduce emissions by 43% by 2030 in order for us to be able to keep 1.5 within reach. I have been very clear that my job and this mission, is to ensure that my North Star continues to be, and we stay laser focused on, keeping 1.5 within reach.

“I know that there are strong views among some parties about the phase down or phase out of fossil fuels. And allow me to say this again, this is the first presidency ever to actively call on parties to come forward with language on all fossil fuels for the negotiated task text.

“I respect facts, I respect numbers, and these are the facts on the ground. I have called on parties many times to find common ground, build consensus, and come to me with language that will work with all parties. This presidency is committed to delivering the highest ambition possible….Judge us on what we will deliver at the end of this COP.”

UAE Presidency recaps list of accomplishments at ongoing COP

Speaking at a press briefing Saturday evening, COP Director General Ambassador Majid Al Suwaidi recited a list of accomplishes made so far, including a new pledge signed by some 50 major fossil fuel companies to slash methane emissions from oil and gas operations by 90% by 2030.

Methane, climate pollutant more potent than CO2, remains in the atmosphere for about a decade, significantly shorter than CO2’s lifespan of a century or more. Therefore, swift action on methane can provide a crucial window for the implementation of CO2 mitigation strategies to kick in.

Additionally, this COP has witnessed a pledge to triple investments in renewable energy infrastructure and double energy efficiencies by 2030, backed by $2.5 billion in commitments, Al Suwaidi said. And the first two days of the conference saw the operationalization and capitalization of a historic new loss and damage fund, along with over $3 billion in new commitments to the Green Climate Fund and a UAE-led $2.7 billion commitment to a new health and climate fund.

“We took early and decisive action to fulfill our commitment to address loss and damage,” declared Suwaidi. “We have taken a significant step towards enhancing the availability, accessibility, and affordability of climate finance.”

The COP also played host to the Business and Philanthropy Climate Forum, where the the mobilization of $5 billion through blended finance structures aimed at accelerating the climate transition was announced Saturday. And the World Bank has pledged $9 billion.

“On negotiations, there is a sense of optimism and progress,” Suwaidi added, acknowledging that civil society groups and leading countries are still awaiting the final outcome documents to determine if and how commitments to fossil fuel phaseout will be incorporated.

5.1 million lives lost from air pollution generated by fossil fuel sources

Joy Phumaphi, co-chair of the Global Preparedness Monitoring Board, outlines the health gains that would be obtained from rapid energy transition at a COP28 Health Day Event.

In a side event following the Health Day plenary, Joy Phumaphi, former Botswana Minister of Health presented the findings of a recent Lancet Pathfinder Commission report, which concluded that rapid decarbonization of electricity systems could yield the most significant reduction in the health impacts of climate change, saving an estimated 5 million lives annually from related air pollution effects. She spoke at a side event on “How Ambitious Emission Reductions Can Prevent Illness, Improve Human Health and Save Lives.”

According to a major new BMJ assessment, some 8.3 million lives were lost to air pollution in 2019, including 5.1 million lives from pollution generated by fossil fuel burning.

Financing remains a major barrier

Pakistani Health Minister Dr Nadeem Jan.

However, financial constraints continue to pose a major obstacle for heavily indebted low-income countries seeking to transition to renewable energy sources, emphasized Pakistan’s Minister of Health, Dr Nadeem Jan, at the same event.

“We are solarizing health facilities and planning to convert from fossil fuels to renewable energy, but we are in this debt trap,” lamented Jan, saying that Pakistan’s already high level of indebtedness limits its ability to finance capital investments in clean energy.  

“We contribute only 1% to the climate problem, but are bearing 78% of the burden, disproportionately suffering from climate impacts,” he added, referring to events like the recent catastrophic flooding seen in 2022. “We need debt relaxation in order to take this vision to concrete action…. We aren’t asking for compassion, we are asking for justice.”

Helen Clark to co-lead new commission on air quality policy and finance unveiled

The Clean Air Fund announced the establishment of a high-level Commission on international air quality policy and finance, to be led by former New Zealand Prime Minister Helen Clark and former WHO Chief Scientist Soumya Swaminathan.  Clark has been extremely active on global health issues since co-chairing the Independent Panel on Pandemic Prevention Preparedness and Response, which in 2021 issued a scathing report on the world’s response to COVID.

The Commission, co-founded with the Council on Energy, Environment and Water, aims to “address the political barriers to implementing actions on air quality… and strengthen the economic case to secure additional financing conditions and track progress,” Jane Burston, CAF’s Executive Director, stated at the Health Day Plenary.

She also welcomed the introduction of a new set of UNFCCC “Climate and Health Finance” principles, designed to facilitate increased financing for renewable energy projects that simultaneously mitigate air pollution.

–Updated 4 December with details of press conference by COP President Sultan Al Jaber and WHO DG Tedros’ remarks at COP on fossil fuels phaseout.

Image Credits: WHO , Stockholm Environment Institute / UNEP, WHO, E. Fletcher .

On the eve of the first-ever COP Health Day, 124 countries endorsed a milestone declaration on climate and health. The political declaration marks the first time that the health impacts of climate change have taken centre stage in 28 years of UN climate talks.

At the 2016 UN Climate Conference in Marrakesh, a small group of public health professionals from around the world laid out the shocking connections between the more than half a million childhood pneumonia deaths annually and children’s routine exposures to air pollution from both household and outdoor sources.

While this was a first, our health-focused message was glaringly absent from the mainstream COP agenda at that time. Fast forward to 2023, and thankfully, the healthcare community is no longer sitting on the sidelines of the climate conversation. 

In fact, this year’s COP28 UN Climate Conference features a health and climate ministerial as well as a dedicated WHO Health Pavilion, which aims to incorporate health concerns into climate negotiations. 

The speakers are armed with a growing array of data about the 7 million lives lost yearly from air pollution — much of it generated by the same sources that drive climate change.  Additionally, the latest IPCC report has projected some 9 million deaths annually by the end of the century from climate change-driven extreme heat, infectious diseases, and malnutrition in a business-as-usual scenario.

Public health professionals also are joining the larger discussion. Even so, health professionals may struggle with the contribution that they can make to the debate. 

While the health sector is looking at new ways to clean up its own carbon emissions, estimated to be about 5% of the global total, it cannot dictate policies on energy, transport, agriculture and building sectors that contribute the lion’s share to climate change today. 

So how can the health care community continue to expand its role in accelerating climate and clean air action? Here are some concrete examples of actions that healthcare professionals can undertake.

They are drawn from settings as diverse as Kampala, Uganda;  Accra, Ghana and Indore, India among others, and offer a kind of ‘proof of concept‘ about the role the health sector can play. 

These stories illustrate three main arenas in which the health sector can make significant contributions on the front lines, in policy circles and in more linked-up health and environment data collection and analysis.

Raising awareness and reducing risks on the front lines of care

Air pollution looms over New Delhi, November 2023.

Visits between patients and their primary healthcare providers are the most crucial touch point in the chain of outreach for healthcare services generally. In terms of the intersection of health and climate, these contacts are being mobilized to build awareness as well as minimize peoples’ exposure to both climate and air pollution risks.  

In Indore, ranked as India’s cleanest city, ASHAs are now being trained to provide guidance to their patients on minimizing their exposure to leading pollution sources, such as traffic, the open burning of waste, and cooking over open wood fires. These contacts can most frequently happen when patients seek medical attention for conditions such as asthma and pneumonia, which have clear air pollution triggers.

A continent away, community health officers across East Africa have learnt how to use messages on clean air as a strategy to promote health. In the Ugandan capitol of Kampala, they have been instrumental in a campaign to discourage open waste burning. 

Linked up health and climate policymaking 

A man from Ghana burns electronic waste to reveal the metals at the Agbogbloshie electronic waste site in Accra, Ghana (2018).

At the policy level, even more potential exists to build a united front between the health and climate sectors, which emphasizes the health gains and avoided health costs of action. . Demonstrating the lifesaving capacity and cost-saving potential of climate and environment action through the lens of health can turn the tide on empty pledges and quicken measurable improvements.  

In Ghana’s capital,  Accra, an Urban Health Initiative launched in 2016 by the Ministry of Health, Ministry of Environment, and metropolitan authorities, with the support of the UN agencies, had the explicit goal of increasing awareness of the benefits of health-driven clean air policies. 

The work included mapping the policies and stakeholders concerned with Accra’s air quality and then, sector by sector, developing plans for alternative means of powering homes and businesses, managing waste, and making transport more eco-friendly. 

Multiple policy recommendations made by the Urban Health Initiative were ultimately implemented as part of Accra’s ongoing urban planning strategies. Even more profoundly, the credible evidence provided by the health sector on both the health impacts of the status quo and the health benefits of greener development alternatives helped cement a shared understanding of linked problems and solutions.

More data, more awareness and better solutions  

Uganda
Kampala, the bustling capital city of Uganda, is home to 1.5 million people. Air pollution claims 28,000 in the city lives every year.

What binds this all together is the availability of data. Good data informs strategy and provides convincing evidence for politicians to act.

This has been evident not only in Ghana but also in the experiences in Uganda, a nation where an estimated 28,000 people die annually as a result of air pollution. 

In 2021, Kampala’s city authority released details of a three-year Clean Air Action Plan that was anchored by investments in low-cost air-quality monitoring stations to deliver real-time data. 

That data then activates health experts in the region, who know exactly where and how to disseminate messaging around local blights like waste burning as well as the importance of clean air, generating a groundswell of public support for more action. 

As a result of the monitoring programme,  Uganda’s National Environment Management Authority has now developed standards for ambient air quality across the country. 

The Kampala Capital City Authority can, in turn, cross-reference the data from monitoring stations against the Environment Management Authority’s regulations and use that to guide enforcement and accountability.

Crucially, the Capital City Authority has begun hosting events such as the 2023 Car-Free Day alongside partners from Kampala’s  Environment Management Authority and the national Ministry of Health to emphasize the symbiosis between cleaner air and longer, healthier lives.  

The good news is that even if they are not attending COP, the world’s health workers can still contribute to addressing the inextricable link between our health and that of our planet. 

This includes lobbying for effective legislation to reduce carbon emissions and protect our ecosystems from pollution; training frontline workers and clinicians to raise awareness and reduce environmental health risks among their patients; and supporting linked-up health and environment data collection and analysis.  Progress necessitates all three. 

About the authors

Sumi Mehta is the vice president of environmental and climate health at Vital Strategies. 

Daniel Okello Ayen is the Director of Public Health and Environment at Kampala Capital City Authority.

Image Credits: Jean-Etienne Minh-Duy, EPA/CHRISTIAN, Angella Birungi.