Sealed windows and an aging HVAC system in a Stockholm apartment building – a combination that experts now say can lead to health risks from indoor air pollution.

Nearly seven million people die prematurely each year because of ambient and household air pollution, according to the World Health Organization (WHO). Moreover, studies have shown a direct correlation between classroom air quality and children’s performance in school. Finally, according to WHO, household air pollution exposure contributes to non-communicable diseases, including increased risk of illness and death from stroke, ischaemic heart disease, chronic obstructive pulmonary disease and lung cancer.

However, most of WHO’s work on indoor air pollution has been focused on dirty wood, coal and biomass stove use in developing countries. Less studied are the health risks associated with poor ventilation in modern buildings – ranging from virus transmission to high CO2 levels and the outgassing of chemicals like formaldehyde from building materials and furnishings.

With these challenges in mind, the WHO’s European Region, the Swiss government and the Geneva Health Forum are partnering on a first-ever Indoor Air Conference on September 20 in Bern, Switzerland. The day-long event will bring together diverse experts to discuss indoor air pollution, why it needs monitoring, and how to improve indoor air in older buildings.

COVID triggered a re-evaluation of indoor air pollution risks

Ventilation tips for reducing virus transmission risks, issued by the US Centers for Disease Control during the COVID pandemic.

“We spend around 80% or 90% of our time indoors, so what we are exposed to there has an impact,” said Catherine Noakes, of lifestyle patterns in urban settings of developed countries.  A professor of Environmental Engineering for Buildings at the University of Leeds, she will moderate the event.

The COVID-19 pandemic underscored the significance of proper ventilation in reducing the spread of viruses that cause respiratory illnesses; higher exchange rates reduced indoor virus transmission, WHO documented in a milestone set of guidelines for schools, homes and offices, issued  during the pandemic.

Chemical pollutants indoors getting more attention

Particleboard often contains formaldehyde, a known carcinogen.

But the risks are not limited to infectious diseases. In the absence of proper ventilation, even cooking on a modern gas stove can lead to excessive exposures of fine particulates and oxides of nitrogen (NOx), which have been linked to childhood asthma. Indoor dampness and mold also are associated with increased risks of asthma, chronic respiratory illnesses and allergic reactions, according to WHO.

Chronic exposure to toxic cleaning products and carcinogenic chemicals such as formaldehyde used in particleboard, glues and resins of many modern furniture and building materials can lead to increased risks of chronic health conditions over time.

CO2 and cognitive performance

A number of recent studies, including one published by a team of Harvard researchers, has documented how higher levels of CO2 indoors are associated with reduced cognitive performance. The team compared the performance of student volunteers engaged in a game simulation, in settings with indoor CO2 levels of 600 1000 and 2,500 parts per million (ppm). Outdoor levels typically range from 300-400 ppm although they can rise as high as 900 ppm in cities.  The researchers found a slight drop in mental performance at CO2 concentrations of 1,000 ppm, and a significantly larger decline at 2500 ppm.

Finally, in heavily polluted cities, outdoor air pollution can seep into buildings and cause harm – from allergies to respiratory conditions or, as WHO documented, even death.

CO2 monitor measures indoor levels of carbon dioxide; high levels have recently been associated with reduced cognitive performance.

‘No magic bullet’

Unfortunately, there “is no single magic bullet” that can solve the indoor air pollution crisis, Noakes said. However, there are several recommendations – many of them inexpensive and applicable in the Global North and South.

“There are lots of different strategies,” Noakes said. “You don’t need an expensive ventilation system in every building.”

First, the best way to remove pollutants is to provide fresh air. Ventilation needs to be integrated into the design of a building – whether that includes windows that open or a sophisticated system of mechanical ventilation and air purification. In highly polluted cities, indoor air purification systems are increasingly a part of the equation, removing harmful particulates from, breaking down volatile organic compounds and neutralizing bad smells inside homes and office facilities.

According to Noakes, part of the solution is also building awareness so that people can catch pollution before it causes lasting harm.

A study by the Royal Academy of Engineering showed that improving ventilation could reduce long-range aerosol transmission of diseases by about 50%. Improving ventilation and ensuring good air quality could also enhance productivity by around 1-4%.

Climate change vs. indoor air pollution

Modern offices may be airtight and thus energy efficient – but also lack adequate indoor air exchanges and healthy ventilation.

There is, however, a tension today between trying to save energy and reduce the impact on climate change and the environment by improving insulation and air tightness of a home or office and ensuring its proper ventilation, explained Noakes. While very well insulated homes and office buildings reduce greenhouse gas emissions, it also means the spaces cannot “breathe.”  Without advanced mechanical ventilation systems and proper air filtration, harmful chemicals, viruses and CO2 may all build up.

“On the one hand, the more we move to reduce fossil fuels, take gas, oil and solid fuels for heating and cooking out of the home, that is a good thing,” Noakes said. “On the other hand, some actions around net zero are potentially making indoor environments worse by sealing pollutants in buildings.”

‘We should be breathing good quality air’

Noakes said she hoped this event would spark discussion around the topic and bring about new solutions.

“If you go back 100 or 150 years, we had the same discussions around clean water, and now it is just accepted that everyone should have clean water. It should be the same thing with air,” Noakes said.

She acknowledged that there are costs associated with improving air quality, and those need to be considered in the equation. But ultimately there is no downside to having clean air.

“We all breathe continuously,” she concluded. “We should be breathing good quality air.”

For more information or to register for the First WHO/Europe Indoor Air​ Conference, click here.

Image Credits: Pelle Sten/Flickr, US Centers for Disease Control, DMW/Flickr, Geneva Health Forum , Rachel Lovinger/Flickr.

The European Parliament’s ambitious air quality targets set the stage for the European battle on air pollution.

European air quality activists have won a key victory in the European Parliament, which approved tough new air pollution rules that would require countries to meet stricter WHO air quality guidelines by 2035, and allow EU citizens to sue for financial compensation for air pollution-related health damage.  But the draft legislation still faces an uphill battle for approval in the European Commission and European Council for it to become law.  

An air of uncertainty loomed over the European Parliament in Strasbourg on Wednesday as lawmakers prepared to vote on new air pollution rules that would set the bar for the European Union’s ambitions to tackle the unsafe air that 98% of its citizens breathe. 

The vote was seen by many as the latest test of the European Parliament’s commitment to the Green Deal, the EU’s flagship package of policies to fight climate change. 

Echoes of the highly politicized vote on biodiversity restoration in July, which passed by a razor-thin margin after an all-out push by right-wing parties to shoot it down, hung over Commission President Ursula von der Leyen’s State of the Union address before voting began.

“We are facing, with air pollution, a slow-motion pandemic,” Javi López, the centre-left Spanish MEP in charge of negotiating the Parliament’s position, said ahead of the vote. “The administration should fight against air pollution like we were fighting against the pandemic.” 

But the parliamentary vote, advertised as a down-to-the-wire affair, wasn’t even close. The final tally – 363 votes in favour, 226 against and 46 abstentions – was a welcome relief for environmental groups, who had feared that a campaign by the same right-wing coalition that joined forces to take down the biodiversity law would succeed the second time around. 

Key victories in voting marathon

A 40-minute voting marathon on over 130 pages of amendments notched up several key victories for air quality advocates, who had sought to strengthen the Parliament’s position on Europe’s largest environmental health threat. 

Significantly, an amendment by political conservatives that would have stripped EU citizens of their right to seek financial compensation from companies and governments for health damages caused by unlawful levels of air pollution was defeated.

“It should be a relic of the past that polluting industries continue their delay game to reap profit while tax-payers pay the health costs,” Dr Ebba Malmqvist, professor of environmental health at the University of Lund, said after the vote. 

New provisions were added to address the training and education of healthcare professionals, health inequalities caused by healthcare costs associated with air pollution, and stricter rules for air quality monitoring systems.

Alignment with WHO guideline levels pushed to 2035

Most fundamentally, a provision aligning member states to World Health Organization’s (WHO) air quality guidelines, which are much stricter than EU standards currently in force, passed comfortably, albeit with a five-year delay to 2035 to appease some centrist members of parliament.

Current EU rules, for instance, permit annual average concentrations of PM2.5 to be as high as 25 micrograms/cubic meters of air.  Adherence to WHO guidelines would reduce these concentrations fivefold, to just 5 micrograms per cubic meter of air.

Although Europe can boast some of the best air quality in the world, air pollution still causes nearly 300,000 premature deaths each year.

Despite improvements in air quality across the European Union since 2005, air pollution remains the largest single environmental health risk for its citizens, causing an estimated 287,000 premature deaths annually.

Almost the entire global population breathes polluted air which can cause premature death, heart disease, stroke, lung cancer, and respiratory diseases, according to the WHO. Air pollution is a silent killer, cutting short nearly 7 million lives globally every year.

“Anything less than alignment with the WHO would not have been acceptable from a health point of view,” said Dr Cale Lawlor, senior policy manager for global public health at the European Public Health Alliance. “To know the science and not act to protect health is not acceptable.” 

Another blow to the crusade against the Green Deal 

Air pollution
Air pollution is the 10th leading cause of death in the European Union.

This vote over the air pollution legislation effectively meant another battle lost by the European People’s Party (EPP), the largest party in the European Parliament and political home of Commission President Ursula von der Leyen, which has sought to derail the 2020 European Green Deal, the centrepiece of her legislative legacy.

A campaign by the EPP and far-right allies such as Spain’s populist Vox party to  portray the air pollution law as a car ban – which it is not – failed to gain traction. Provisions in the draft law compelling municipal authorities to consider proven air quality measures such as low-emission zones, speed limits, and low-traffic neighbourhoods passed easily. 

“There’s clearly a strategy to demonise these measures and the way the directive works,” said Zachary Azdad, a policy officer at the advocacy NGO Transport & Environment, who followed the Parliament negotiations. “It’s reassuring to see that this didn’t take and that decisions were made from a more rational point of view.” 

Long and difficult battle through the EU legislative labyrinth

The ambitious targets established in the Parliament’s vote on new air pollution rules set the stage for what will be a long and difficult battle through the EU’s legislative labyrinth. To get over the line and become law, the new legislation must also win the approval of the European Commission and the European Council. 

Environmental groups were not happy with the Parliament’s compromise agreement Wednesday to postpone the deadline for meeting WHO’s air quality guidelines from 2030 to 2035, calling it a “lifeline for dirty cars”. But that target date is nearly certain to be the most ambitious to come out of the EU’s three legislative institutions. 

The European Commission, the EU governing body, had earlier proposed that WHO air quality guidelines only come into force in 2050. The EU Council, comprising the governments of all 27 member states, is widely expected to water down the ambitions set by the Parliament, as it has done with nearly all environmental legislation. The Council is expected to publish its position on the revised air quality rules in December. 

The publication of the EU Council’s position will mark the beginning of inter-institutional negotiations to finalise the law. Negotiations between the three branches of the European Union’s legislature take place behind closed doors, making the process more difficult for civil society to follow and influence. 

“That’s why the Parliament vote was so important,” said Azdad. “We really wanted Parliament to send the signal to the other institutions that the people elected by European citizens want clean air.” 

In April 2024, the Spanish presidency of the European Council ends, and the position rotates to another EU government, setting a tight timeline for lawmakers to finalise the first update to Europe’s air quality directives since 2008. A rightward shift in the balance of power in the Parliament could derail negotiations altogether if the deadline is not met. 

“There’s a risk of the whole file being forgotten after the European elections,” said Azdad. “That’s why we absolutely want it to be adopted before.” 

Image Credits: CC, IQ Air , Mariordo.

WHA76
The World Health Organization has set a May 2024 deadline for negotiations on the Pandemic Accord, which are set to conclude at the 77th World Health Assembly n Geneva .

Lawrence O. Gostin is “confident” that countries will adopt a pandemic accord at the 2024 World Health Assembly. 

The question is whether it will include the kind of “robust norms” necessary to ensure that the new accord is “transformative” with respect to correcting disparities and injustices uncovered in the last pandemic, and effective in its enforcement of new norms. 

As the head of Georgetown’s WHO Collaborating Center in national and global health law, Gostin is playing a key behind-the-scenes role in negotiations.

Here is his take on what is at stake and what choices need to be made.

Health Policy Watch: What is a pandemic treaty? What does it entail?

Lawrence Gostin: The Pandemic Accord, currently in development, has the potential to be a landmark in global governance, akin to the Paris Agreement. Its impact will depend on its final content, mainly if it includes strong norms.

These norms should ensure equitable sharing of lifesaving resources, promote a “One Health” approach to prevent zoonotic diseases and establish robust compliance mechanisms. The Accord could transform global health law by emphasizing equity, a holistic health strategy, and effective enforcement.

HP-Watch: Based on your observations of the draft versions of the treaty, where are the opportunities for an “accord”?

Gostin: I’m confident governments will adopt a Pandemic Accord at the May 2024 World Health Assembly. However, I’m concerned it might lack the robust norms I mentioned. This could weaken its impact. Bold norms and strong accountability mechanisms could make it powerful, but high-income countries might hesitate to ratify it.

It could be diluted during negotiations, potentially failing to ensure equitable access to lifesaving resources or overlooking the “One Health” strategy. I urge all nations to seize this once-in-a-lifetime opportunity. Let’s make the world safer, more secure, and fairer. Failing to do so would be our own responsibility.

HP-Watch: There has also been a lot of “discord” during the pandemic accord negotiations. Which countries are contributing to these disagreements, and why?

Gostin: Failing now could postpone meaningful global health reforms for decades. The main hurdles lie in disagreements between high-income and low-income countries, particularly African nations and the US/Europe. Rich countries prioritize full access to scientific data for governments and scientists, like pathogen samples and genomic sequencing.

This data is crucial for understanding and responding to pathogens. However, lower-income countries view these samples and data as their only bargaining power for equitable resource sharing. They’re concerned about sharing scientific information used to develop vaccines and drugs but not getting access to these lifesaving resources in return.

The 76th World Health Assembly 76 in progress in May 2023.

HP-Watch:  What are the main stumbling blocks to a robust treaty?

Gostin: Key obstacles revolve around equity, funding, compliance, and accountability. Like climate change discussions, a significant factor in these debates is the principle of “common but differentiated responsibilities” (CBDR). CBDR, established as Principle 7 in the 1992 Rio Declaration, means that countries have distinct obligations based on their socioeconomic status and historical contributions to the issue, such as preventing pandemics.

While all nations must protect the environment, wealthier countries have greater responsibilities in compliance and funding. However, disagreement persists regarding the application of this principle to pandemic governance. Currently, the CBDR principle is only an “option” for varying implementation of the Accord.

HP-Watch: What are the gaps in the draft treaty? What are their origins, and what are some suggested solutions?

Gostin: Various drafts of the Pandemic Accord are extensive, but the final version might have significant omissions. Throughout the drafts, “options” range from robust action to inaction. For instance, one draft offered two choices: establish strong obligations for the One Health approach or take no action. This dichotomy leaves little room for compromise.

The Accord’s direction depends on whether governments advocate for strong or weak norms. Those favoring weak norms may do so to safeguard their sovereignty, dilute obligations, emphasize sovereignty as a principle, distrust the WHO, or resist international obligations. Populist nationalist governments often oppose UN treaties.

If governments opt for weak norms, critical areas like equity and One health will suffer from significant gaps. Equally important are deficiencies in what I call “good governance,” with inadequate mechanisms for ensuring transparency, compliance, enforcement, or accountability of state obligations.

HP-Watch: What are your thoughts on the treaty’s negotiation mechanisms for promoting timely information sharing in the context of national interest conflicts?

Gostin: During the COVID-19 pandemic, and even well before, the world suffered from two failures of cooperation. First, nations failed to promptly report novel and dangerous outbreaks or share pathogen and genomic sequence data. The second is that countries failed to equitably share those lifesaving resources once vaccines and therapeutics were developed.

As a result, there is currently considerable distrust in the negotiations. The tensions often exist between higher and lower-income countries. The only real tool WHO currently has to encourage countries to prioritize global solidarity over their own national interests in the negotiations is diplomacy; reminding countries of the immense toll of the pandemic, both in terms of lives lost and economically, and that preventing history from repeating itself can only be achieved through strong norms and global cooperation.

The World Health Organization defines One Health as “an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes”.

HP-Watch: Could you comment on mechanisms the United States, Africa, and the European Union suggested?

Gostin: African nations advocate waiving intellectual property rights for easier vaccine and drug development during health crises. Lower-income countries endorse “technology transfer” to enable local manufacturing. The WHO backs mRNA manufacturing hubs in countries like South Africa.

The focus should shift from charitable donations to empowering nations for self-reliance, necessitating global cooperation. Meanwhile, the US and the EU emphasize timely, transparent reporting and access to pathogen data, with the EU favoring One Health provisions.

HP-Watch: Why prioritize incentives over sanctions, especially when some experts argue for stronger enforcement measures?

Gostin: The WHO has long been adverse to compulsory measures, including sanctions. Member states often can accept the idea of incentives but are resistant to enforcement measures. In my judgment, we need both carrots and sticks.

Carrots could include financing for health systems in lower-income countries. Sticks might include public disclosure of countries that fail to abide by their international obligations. There could also be some form of adjudication system, such as occurs with the World Trade Organization. Compliance-enhancing measures are vital. These can include incentives but they also need to include other more formal means of encouraging compliance with norms.

One idea that has been floated is that parties would establish a universal health and preparedness review or some other peer review mechanism, enhancing compliance with countries’ preparedness obligations under the Accord.

HP-Watch: How confident are you in incentivizing compliance, given the IHR enforcement issues during the COVID-19 pandemic?

Gostin: I am not at all confident. History with the IHR teaches us that without effective compliance mechanisms, countries often won’t abide by their international obligations. Good governance requires better forms of accountability, such as an independent oversight mechanism empowered to investigate outbreaks or treaty violations and enforce commitments, fair resource allocation, and regular reporting on progress, with some scope for civil society participation.

The International Health Regulations Working Group concluded its fourth meeting on revisions to IHR in Geneva in July.

HP-Watch: How will negotiators balance accountability and sovereignty when implementing compliance measures?

Gostin: Right now negotiators are at a loss. One very interesting compromise might be found in proposals by the US and by the African bloc on compliance and implementation. There are good faith negotiations on those proposals in the IHR reform processes, which include a compliance committee comprised of key member states.

This committee would be tasked with finding means to better ensure state compliance. We need that kind of buy-in for compliance in the Pandemic Accord, which currently includes draft language establishing an Implementation and Compliance Committee comprised of expert members elected by the Accord’s Governing Body.

HP-Watch: Will equity discussions lead to concrete actions for fair access during health crises?

Gostin: This is perhaps the most important topic in the negotiations. Right now we don’t have agreement on reliable and sustainable funding, technical support, technology transfer, and equitable allocation of life-saving resources. There are several innovative methods to seek greater equity. One promising model is the Pandemic Influenza Preparedness (PIP) Framework.

Under the PIP Framework, pharmaceutical companies, laboratories, and academic centers pledge to give doses of vaccines or drugs, or to provide funding to WHO. In return, these actors gain access to pathogen samples.

The WHO then distributes the benefits to countries on an equitable basis. I also mentioned the idea of diversified manufacturing or technology transfer. Ultimately, it is important for low- and middle-income countries to gain the capacity to manufacture emergency products themselves and not rely on philanthropy.

HP-Watch: What are the potential consequences of the draft Accord’s narrow focus on health-centric solutions?

Gostin: The issue of One health is essential. Everyone knows that there are vast connections between human health, animal health and the environment. Yet, this requires intersectoral cooperation and governance.

The Pandemic Accord is a WHO instrument and we must find ways to link to the law and governance of animals and the environment. Relevant bodies include the World Organisation for Animal Health, the Food and Agriculture Organization, the UN Environment Programme and the World Trade Organization. This kind on intersectoral coordination is largely absent in the current draft.

On 24 February 2021, a plane carrying the first shipment of 600,000 COVID-19 vaccines distributed by the COVAX Facility landed at Kotoka International Airport in Accra.

HP-Watch: What’s the debate on equitable access to medical countermeasures, intellectual property, and trade language, and how will it influence the negotiations?

Gostin: There are huge gaps between high and low-income nations. High-income countries are reluctant to sign onto binding obligations to share lifesaving resources. But low-income countries demand that they have a right to fair and affordable access to vaccines and drugs.

The truth is we need both and we shouldn’t trade one important value for the other. It is clear that rapid reporting, sharing pathogen samples and genomic sequence data, and sharing scientific and epidemiologic information are vital for global health. It is equally clear that we cannot tolerate a system where all the benefits go to high-income countries and lower-income countries are left behind.

HP-Watch: How does the ongoing United Nations high-level meeting discussion relate to the concurrent negotiations for a pandemic accord and amendments to the IHR?

Gostin: The UN High Level Meeting (UNHLM) on Pandemic Prevention, Preparedness and Response this September is our best chance to gain support and deep engagement of heads of state and government. The UNHLM is expected to adopt a Political Declaration on Pandemic Prevention, Preparedness and Response. Thus far, many civil society organizations have expressed disappointment in the draft Political Declaration.

While the draft Political Declaration is high on lofty principles, it is wholly inadequate on concrete action, such as pledges for funding health systems. And while processes in Geneva and in New York must be synergistic, there has been too little cooperation between the UN and WHO. This is disappointing especially as WHO was the UN’s first specialized agency formed in 1948. 

HP-Watch: What’s behind the resistance to the UN High-Level Meeting, and how might it affect the Geneva discussions?

Gostin: There are longstanding but subtle tensions between Geneva and New York. In my view action by both the UN and WHO is needed. WHO is undoubtedly the health leader. But we also need high-level political support and an all of government approach to pandemic preparedness and response, as the causes and impacts of pandemics go well beyond the health sector. The WHO is a UN agency and we need more cooperation at every level. This shouldn’t be a competition, but sometimes it seems to be. 

The Declaration on Pandemic Preparedness and Response passed by the United Nations General Assembly in September offers “little hope” of strengthening global readiness for the next pandemic, according to global health experts.

HP-Watch: Why is the draft UN Political Declaration not ambitious, and how can it be strengthened, especially regarding the ‘Global Health Threats Council’?

Gostin: The Global Health Threats Council aims to elevate pandemic preparedness discussions to the highest political level. Whether it’s based in New York or Geneva matters less than securing active engagement from heads of state or government. Adequate, sustainable funding is another crucial aspect.

Pandemic preparedness involves various government ministries, and it should encompass an all-of-society approach, including public and private entities and robust civil society involvement.

HP-Watch: What role does the pharma industry play in shaping the treaty, and how do we differentiate responsible advocacy from profit-focused lobbying?

Gostin: Pharmaceutical companies are vital in vaccine development but must act cooperatively. They often prioritize profits, which can hinder global access. It’s crucial they don’t influence treaty negotiations. High-income countries have sometimes prioritized industry interests. Involving pharmaceutical companies in negotiations could risk such influence.

HP-Watch: How can WHO and the UN tackle misinformation while preserving citizen privacy and free speech on social media through collaboration with governments?

Gostin: Misinformation poses a serious health threat, especially in vaccine distribution. Balancing free speech with combating misinformation is challenging. An all-of-society approach is needed, involving medical societies, tech companies, and fact-checking organizations. WHO can lead partnerships between scientific experts and information disseminators to ensure credible information reaches the public.

HP-Watch: What’s your take on the pandemic treaty timeline, balancing speed and thoroughness, and a realistic estimate for an ideal agreement’s timing?

Gostin: Ideally, I would like to see WHO meet its deadline of presenting a draft treaty for adoption to the World Health Assembly in May 2024. I know that is pushing it, and member states are nowhere near to making enough progress. But the reason for speed is compelling. It is clear that the COVID-19 pandemic injected a sense of urgency.

As memories of the pandemic fade, political will declines. If we wait too long, we may lose this historic opportunity. Now is the time to forge [an] agreement. With every passing week and month, the world’s attention shifts to other priorities, such as climate change, the war in Ukraine, and food insecurity.

At the opening of the 73rd WHO Africa regional meeting in August, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that the slow pace of negotiations has put the pandemic accord at risk of missing the May 2024 deadline.

HP-Watch: How do we address the draft treaty’s health-centric focus criticized by some, considering the need for a broader approach to pandemic response during negotiations?

Gostin. In Geneva, most negotiators come from health backgrounds, lacking a comprehensive perspective. To improve this, we can draw inspiration from the WHO Framework Convention on Tobacco Control (FCTC) negotiations, where civil society played a crucial role.

While the WHO allows civil society input, it often remains formal. Unlike the FCTC negotiations, there’s a lack of robust advocacy in the Pandemic Accord negotiations, which is regrettable. The lessons from tobacco control and the AIDS pandemic highlight that real transformational reforms require strong bottom-up social mobilization. 

HP-Watch: What’s the current status of discussions on the Pandemic Fund, and how might it impact the treaty?

Gostin: I don’t know of a single global health advocate who is optimistic about progress on a Pandemic Fund. The World Bank has an initiative, but the Fund is still significantly below its funding goal, and we have seen the Bank sputter in the past on pandemic funding. And while the G7 and G20 have made promising noises, I don’t see any concrete plans for ample and sustainable funding taking shape.

That is a great missed opportunity because the only way to truly make the world more prepared is through funding, and especially funding of robust health systems. In the Pandemic Accord negotiations, there has been much discussion of funding. Still, there doesn’t seem to be agreement on a mechanism and long-term funding sources. Ultimately, rich countries will have to step up. But that hasn’t happened thus far despite the urgency.

HP-Watch: How do initiatives like medical countermeasures and mRNA tech-transfer hubs fit into treaty discussions, and what’s your perspective on their impact, given the crisis faced by initiatives like ProMED?

Gostin: In addition to all the other suggestions, we must remember that WHO is also working on a new multi-disease platform to coordinate equitable access to health information, tools, and countermeasures right from the onset of the next pandemic to replace fragmented initiatives and better ensure that all populations can be served. This new platform builds on lessons learned from the ACT-Accelerator.

This ambitious platform was developed to share COVID-19 tools and resources but fell short of its goals. The new platform is facing challenges related to how it will function and how it will be governed. But getting such a platform in place before the next major epidemic or pandemic arises, one that reaches and incorporates the voice of all populations will be critical for health equity.

WHO’s mRNA hub in South Africa began operating at full capacity in 2022.

HP-Watch:  What do you think about the Global Preparedness Monitoring Board‘s key asks for the UN HLM declaration on the treaty negotiations, like changing the language from ‘acknowledge’ to ‘commit’?

Gostin: As I have stated above, there is a delicate balance between incorporating actual mechanisms for accountability into the Accord against national interests in sovereignty. We all need to step back and remember that if we fail to meet the moment, it could be many decades before we have the chance for significant reforms in global health.

We need to be bold and an Accord that both high- and low-income countries will ratify. As I discussed above, there are ways to meet these interests through carrots and sticks. I want to reiterate that we genuinely have a historic opportunity to make the world safer, more secure, and fairer. If we don’t grasp this moment, we have no one to blame but ourselves.

HP-Watch: What do you think about the social media backlash WHO has been experiencing, regarding social media listening/surveillance, which seemed to be included in the treaty draft and poses privacy threats to citizens in countries where social media expressions are turned against them?

Gostin: I don’t accept this criticism because it is untrue. The Accord will not require disclosure of personally identifiable or sensitive health data. Privacy laws such as the EU Health Privacy Directive will remain in effect. The Accord would not interfere with a country’s protection of the health and privacy of its citizens. I should add that the public also has the right to accurate, evidence-based information.

Social media often disseminates false or misleading information that can harm the health of individuals and populations, mainly misinformation about vaccinations. Surveillance in the context of the Pandemic Accord means public health surveillance, that is, early detection of infectious diseases in humans and potentially also in animals and the environment. It does not mean intrusive surveillance of citizens or privacy violations; nowhere in the Accord is this even considered.

HP-Watch:  How did the misconception that WHO agreements, like a pandemic accord, would erode national sovereignty start, and what can be done to combat this misinformation going forward?

Gostin: In many nations and throughout social media, there is distrust of international institutions and a fundamental misunderstanding about international law built on state consent to be bound. Nationalism and populism have created a groundswell for “my nation first.” The problem is that the world would be less safe if all nations put themselves first. We need mutual solidarity and shared obligations. No one is safe unless everyone is safe. 

Lawrence Gostin, is the director of Georgetown University´s WHO Collaborating Center on National and Global Health Law.  He holds a JD from Duke University Law School and a BA in psychology from SUNY Brockport. Prior to taking on his current position at Georgetown in public health law/Washington DC, he also taught at Harvard and Johns Hopkins Universities. Gostin also led the development of the Model State Emergency Health Powers Act (a proposed law to give states more authority to handle bioterrorism or disease outbreaks, recommended by organizations like the CDC) and advises on various WHO expert committees. His expertise has been instrumental during global health crises, such as AIDS, Zika, and COVID-19, earning him accolades from organizations like the National Academy of Medicine.

Image Credits: WHO, WHO , UNICEF/Kokoroko, UN Photo/Manuel Elias, WHO .

Leading global health experts and activists have expressed frustration and disappointment at the draft political declarations on pandemics, universal health coverage (UHC) and tuberculosis that world leaders are expected to adopt at the United Nations General Assembly (UNGA) next week.

Key criticisms of the three declarations are that they offer no advancement on previous international agreements, are devoid of human rights safeguards and do not chart a clear path to improved access to healthcare and medicines, particularly in low-middle income countries and among vulnerable groups.

Next week there is an unprecedented focus on health at the UN. The Sustainable Development Goals (SDGs) Summit, which aims to  take stock of goals to end poverty by 2030, is on Monday and Tuesday. Wednesday brings a High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) and a climate ambition summit. On Thursday, there is a HLM on universal health coverage (UHC) and Friday brings a HLM on TB. (See links to the lineup here).

The political declarations for the three HLMs have been negotiated over the past few months, with much focus on the rushed talks on the draft pandemic declaration, which is notable only for being lacklustre and aspirational – rather than engaging in firm commitments.

Pandemic declaration: A missed opportunity

Rajat Khosla, director of the International Institute on Global Health at the UN University

Rajat Khosla, director of the International Institute on Global Health at the UN University, described the draft pandemic declaration as a “big disappointment and missed opportunity.” 

The declaration “can be best described as half-hearted half-measures” with “some perfunctory references to rights,” Khosla told a webinar on Wednesday hosted by the O’Neill Institute’s Global Health Policy and Politics Initiative, Aidsfonds, and Love Alliance.

“The declaration does very little in terms of advancing the discussion on pandemic preparedness and response,” added Khosla.

Issues such as “addressing inequalities, vulnerable populations, accountability, international cooperation and funding” have “been all glossed over and with some very vague or weak language,” he added.

Instead of addressing some of the COVID-19 pandemic’s more distressing aspects – including criticisms of state ‘overreach’ in pandemic response, the collapse of international co-operation and lack of accountability of pharmaceutical companies – the declaration “spends more time re-emphasising national sovereignty as the key issue that needs to be safeguarded,” he added.

Language related to protecting vulnerable groups and addressing inequalities is “very weak”, offering “very little tangibility” or legal obligations in terms of transfer of technologies, or addressing countries stockpiling pharmaceutical products”.

Meanwhile, a detailed analysis of how the PPPR declaration squares up to key asks that have been made by over 100 community and civil society has been developed by the Coalition of Advocates for Global Health and Pandemic Preparedness. This shows that the declaration is particularly devoid of financial commitments to PPPR, the coalition concluded.

On a more upbeat note, however, Helen Clark is the eminent speaker due to address the pandemics HLM. As former co-chair of the Independent Panel for Pandemic Preparedness, she is unlikely to sugarcoat any pandemic shortcomings or shirk from what needs to be said about protecting the world against future pandemics, participants in the webinar predicted.

UHC: Virtually nothing new since 2019

Luis Gil Abinader, a Fellow at the O’Neill Institute’s Global Health Policy and Politics Initiative

The draft political declaration on UHC was similarly described as being a “missed opportunity” to expand on UHC commitments, as virtually all the measures in the 2023 declaration were also covered in the prior declaration adopted at the last UN HLM in 2019.

This is according to Luis Gil Abinader, a Fellow at the O’Neill Institute’s Global Health Policy and Politics Initiative.

Using digital health as an example, Abinader said that the 2019 declaration recognises the need to protect privacy in the digital environment, and a very similar recognition is made in the 2023 draft declaration – despite the possibilities of violations of human rights in the digital sphere becoming more evident in the past four years with the rise of artificial intelligence.

Erosion of gender and human rights

Lucica Ditiu, Executive Director of the Stop TB Partnership (STBP), confessed to being “a bit sour and grumpy and frustrated” by what she described as the erosion of long-established language on gender rights and human rights in all three declarations.

“My experience with the negotiations in the UN that I have attended this year was disastrous,” said Ditiu.

“I was in the room and I could hear with my own ears and see with my own eyes Member States literally saying ‘we don’t want to see any language around gender’; ‘can you remove everything that is about the rights of the key and vulnerable populations’. Bodily autonomy and integrity is like up there in the sky.”

“Even as weak, as watered down as these declarations are, as far as I understand, none of them is actually fully endorsed.” 

Lucica Ditiu, Executive Director of the Stop TB Partnership

Tuberculosis: Some wins

The TB draft declaration, does, however, contain some wins, Ditiu and others agreed. But there remains uncertainty around  consensus support around the final draft, which “will go directly to the UN HLM without having clarity if the consensus was reached” as the silence procedure that the agreed-on declaration had been placed under was broken twice “for political terminology”. 

Notably, the latest draft offers “specific, measurable and time-bound targets to find, diagnose, and treat people with TB with the latest WHO recommended tools (para. 48 a and b), as well as time-bound and specific targets for funding the TB response and R&D (para. 62 & 68),” in the words of a civil society analysis of the TB declaration,

Another big win for the TB community is stronger language around a commitment “to strengthen financial and social protections for people affected by TB and alleviate the health and non-health related financial burden of TB experienced by affected people and their families” (para. 81) and to ensure that by 2027 “100% of people with tuberculosis have access to a health and social benefits package so they do not have to endure financial hardship because of their illness” (para. 48 c).

Other positive notes include the explicit recognition that it is a human right to enjoy the benefits of scientific progress.

But some key targets have also been watered down. And as per the general erosion of language around gender and human rights in HLM texts, none of the key asks related to ensuring that all national TB responses are “equitable, inclusive, gender-sensitive, rights-based and people-centred” were secured.

Ditiu also expressed frustration around some of the vague language used such as the need to “intensify national efforts to address TB”.

“Trying to translate this into something measurable for governments to be able to held accountable will be a hell of a job because everybody understands whatever from this.

Meanwhile, a general reference to “equitable, inclusive, people-centered” TB response that “promotes gender equality and respects human rights” is part of a long run-on text in paragraph 77 that dilutes the impact of the terms, she said.

“Actually, paragraphs 77 and 78 looks like a soup in which everybody throws everything in from vegetables to potatoes to shoes.”

A pharmacy in Kenya: Inconsistent regulation across Africa impedes access to new medicines and formulations.

Strengthening Africa’s medicines regulatory framework is key to achieving the “bold goal” of having 60% of the continent’s vaccines produced locally by 2040, said Margareth Ndomondo-Sigonda, head of health at the African Union’s development agency, AUDA-NEPAD.

But only 7% of African country’s national medicines regulatory agencies (NMRA) have “moderately developed capacity”, and more than 90% of the agencies have “either minimal or no capacity at all”, Ndomondo-Sigonda told the opening of a conference on regulation strengthening hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA on Tuesday.

However, she mentioned a number of hopeful signs: five NMRAs have attained World Health Organization (WHO)  Maturity Level Three, which “essentially is a sign of having a robust regulatory system.

In addition, stronger NMRAs such as in South Africa and Egypt have started to work together. 

Regional regulatory bodies have also been set up in west, east and southern Africa 

But real change will happen once a sizeable number of the continent’s 55 countries have signed and ratified the African Medicines Agency (AMA), which aims to harmonise the regulation of medicines on the continent. So far, while some 37 countries have formally supported the treaty, only 26 countries have actually ratified the treaty. While big swingers like Kenya have recently ratified, other leading countries like South Africa and Nigeria have not yet moved to approve the treaty. 

 

Catching up after COVID

“We are all aware of the fact that the continent was sidelined in the global rush for vaccines in 2021 and 2022 and currently we have fewer than half of the African population that has been fully vaccinated [against COVID-19],” said Ndomondo-Sigonda.

Stung by its exclusion, AU Heads of State and the Africa Centres for Disease Control and Prevention adopted a New Public Health Order in September 2022, with institutional strengthening and local medicine manufacturing making up two of its five pillars.

The Partnership for African Vaccine Manufacturing (PAVM), also established during the pandemic, is overseeing the local production of vaccines with the assistance of Nepad-AUDA’s African Medicines Regulatory Harmonisation Initiative.

Once the AMA is operational – it is in the process of being set up in Rwanda – it will take on the responsibility of ensuring coordinating regulatory systems strengthening, explained Ndomondo-Sigonda.

She expressed concern that countries such as Nigeria, Tanzania and South Africa have yet to ratify the AMA and depose their instrument of ratification –  formal notification that their governance structures have ratified the treaty.

“What is very, very important is for all the stakeholders to see that they have a responsibility to advocate for the ratification of AMA and I think it’s also very important to note the fact that as strong AMA will be based on strong NMRAs,” she added.

She also challenged the pharmaceutical sector, which “has access to politicians”, to advocate for all African countries to fully ratified the AMA.

Currently, 37 countries have taken some action to recognise the AMA – but only 21 of these have fully ratified it.

Image Credits: Luigi Guarino .

Thousands of people and hundreds of civil society organisations are expected to march in New York City this weekend to call on US President Joe Biden to use his executive powers to stop the expansion of fossil fuel projects in the country.

The march is one of over 400 marches, rallies and protests worldwide coordinated by the Global Fight to End Fossil Fuels ahead of the Climate Ambition Summit at United Nations (UN) headquarters in New York next week.

More than 600 civil society organisations and some 10,000 people from across the country are expected to attend the march in front of the UN in New York City, according to the organisers.

The Climate Ambition Summit, convened by UN Secretary-General Antonio Guterres, hopes to extract commitments from world leaders to shorten national timelines to phase out fossil fuels.

The summit follows the release of the UN global stocktake report on progress towards the 2015 Paris Agreement targets last week.

The technical report, which will be a key reference document at the UN climate summit in Dubai in November, found that the world is drastically off track in limiting global warming to the 1.5C degrees target set in Paris eight years ago.

The report warned that the rapid scale-up of renewable energy and phase-out of fossil fuels are “indispensable” to correcting course towards the Paris Agreement targets.

Profits bolster the resilience of fossil fuel extraction

World leaders who received invitations to the UN climate summit last month were told that only countries that have demonstrated significant commitment to climate action will be allowed to participate.

The invitation, which was sent by the UN Secretary-General, António Guterres, said that net-zero commitments not backed by action would not be sufficient to participate, according to reporting by the Guardian. Countries that did not meet the standards of climate policy ambition set by the UN can still observe the summit.

British Prime Minister Rishi Sunak reportedly will not attend the UN climate summit out of fear of being excluded from the meeting due to the expansion of his government’s oil drilling in the North Sea.

However, the US is the world’s largest fossil fuel producer, but Biden is expected to attend the summit. However, the Inflation Reduction Act passed by the Biden administration has made nearly $400 billion in incentives and funding available for green projects in the country, creating a windfall of green investment.

“The more oil, gas and coal we burn, the more toxic air we breathe; the more heatwaves, fires, and floods we face, all while wealthy fossil fuels CEOs rake in record profits,” march organizers said in a press release.

“President Biden has the power to stop them by putting an end to the expansion of fossil fuels – ensuring that we all have clean air and water, and better health and safety for our communities,” said the march organizers.

The Biden administration has been under fire from environmental groups for not taking action on seven oil and gas leases in Alaska’s Arctic National Wildlife Refuge issued in the waning days of the Trump administration. However, the US Interior Department this week cancelled the leases, saying they were legally flawed.

US oil giants Exxon Mobil and Chevron, meanwhile, have rebuffed calls to scale down fossil fuel production, electing to go in the opposite direction.

The Russian invasion of Ukraine caused a surge in profits for the world’s largest oil companies. Exxon Mobil announced in February that it made $56 billion in profits in 2022. The $6.3 million in profits made each hour is the most a Western oil company has ever earned in one year.

“July 2023 was the hottest month in recorded climate history. The unparalleled, deadly climate disasters sweeping the world seem to leave polluters unfazed,” said Tesneem Essop, Executive Director of the Climate Action Network. “Historical emitters like Norway, the UK and the USA are announcing new fossil fuel projects even as floods, fires and heatwaves take over our lives.”

The global movement against fossil fuels grows

The march at UN headquarters is part of a growing global movement to demand an end to fossil fuels. In recent months, there have been large-scale protests in countries around the world, including the United Kingdom, the Netherlands and Australia.

More than 2,400 climate protestors were arrested this week during a three-day blockade of a major highway outside of the Hague in the Netherlands.

The protest was organized by the Scientist’s Rebellion, a group led by academics urging an end to the estimated $37 billion in fossil fuel subsidies provided by the Dutch government each year.

In the United States, climate scientist Rose Abramoff and five other women were arrested this week for chaining themselves to a fracked gas pipeline in West Virginia. The arrest makes Abramoff the first climate scientist to face criminal civil disobedience charges for a climate protest in the United States.

“My greatest fear is the world we’re creating for future generations,” Abramoff told the climate newsletter HEATED. “That outweighs the fear I have of the personal consequences that I might suffer.”

Image Credits: The Lancet Countdown.

A mother and her newborn baby at a health centre in the Patna district of Bihar, India.

Ahead of next week’s United Nations Summit on the Social Development Goals, a new report asserts that a few simple measures could slash the deaths of mothers and babies

A series of relatively simple interventions could save the lives of millions of mothers and babies and put the world on course to achieve the Sustainable Development Goals (SDG) related to child deaths and maternal mortality.

This is according to the Bill & Melinda Gates Foundation’s (BMGF) Goalkeepers 2023 report, which was released on Tuesday.

The COVID-19 pandemic seriously disrupted the SDGs’ progress, including the goals of ending all preventable child deaths, cutting child deaths to 12 per 1000 live births, and cutting the maternal mortality rate to less than 70 deaths per 100,000 births by 2030. 

The United Nations has convened a special SDG summit in New York on Monday and Tuesday next week to review progress and accelerate the implementation of the 2030 Agenda for Sustainable Development.

The draft political declaration for the summit concedes that the achievement of the 17 SDGs “is in peril”, declaring that progress is “either moving much too slowly or has regressed below the 2015 baseline”. 

Every year, five million children die before they turn five – three-quarters of these deaths in the child’s first year – while almost two million babies are stillborn. 

The SDG for cutting newborn deaths to 12 per 1000 births is far from being achieved.

“For new mothers, progress has hit a brick wall. Globally, maternal mortality rates have remained stubbornly static over the past eight years, and in some countries, from the United States to Venezuela, they have risen,” according to the Goalkeepers report.

This is not just a problem for low and middle-income countries. In the United Kingdom and the United States, the death rates for Black mothers have doubled since 1999.

“For nearly all of human history, we simply didn’t know enough about preventing or treating the common childbirth complications that lead to death, such as postpartum haemorrhage or infection,” according to Melinda French Gates, BMGF co-chair.

“Today, we know a great deal. Yet, as is so often the case in global health, new breakthroughs aren’t making their way to the people who need them most: women in low-income countries like Malawi, as well as Black and Indigenous women in high-income countries like the United States, who are dying at three times the rate of white women, even when holding for economic and education levels.”

According to the report, in the 2010s doctors “uncovered revolutionary information about maternal and child health—everything from the exact diseases that are killing children; to the role anaemia can play in increasing blood loss during childbirth; to previously unknown ways in which a baby’s health is linked to their mother’s”. 

By applying this information, the BMGF estimates that nearly 1,000 mothers and babies could be saved every day to the end of the decade – a total of two million lives. 

SDGs maternal mortality

Postpartum haemorrhaging

The first intervention involves addressing postpartum haemorrhage, the number-one cause of maternal death. 

The World Health Organization (WHO) defines postpartum haemorrhage as losing more than half a litre of blood within 24 hours of childbirth, something that kills 70,000 women annually, primarily in low-income countries, and leaves many others with disabling heart or kidney failure. 

Research conducted in four African countries by Dr Hadiza Galadanci, a Nigerian obstetrician, found that many healthcare workers struggled to recognise how much blood loss is too much – and over half the women who experienced it were never diagnosed.

“There is a simple, low-cost way to identify when blood loss is dangerously excessive: a drape that looks like a V-shaped plastic bag. When this calibrated obstetric drape is hung at the edge of the bed collected blood rises like mercury in a thermometer. And in a busy hospital ward, that visual gauge tells providers which patients are in danger in just a single glance,” according to French Gates.

Five treatments are conventionally used to stop the bleeding – uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and genital tract examination. 

“But those interventions were being delivered sequentially—and far too slowly,” according to the report.

So Galadanci’s researchers asked healthcare providers to administer all five at once and this, combined with the use of the V-shaped blood bags, decreased severe bleeding by 60%. 

Anaemia affecting pregnancies

A common cause of haemorrhaging is anaemia, or severe iron deficiency, which affects 37% of pregnant women around the world – and in some places in South Asia, is as high as 80%. “Every pregnant woman should have access to maternal micronutrient supplements – high-quality prenatal vitamins that include iron—which can prevent most mild maternal anaemia cases,” according to the report.

Screening for anaemia during antenatal care is important – but some women dislike the unpleasant side effects of taking iron.

Nigerian obstetrician Dr Bosede Afolabi is working on a one-off, 15-minute intravenous infusion of iron to replenish women’s iron reserves during pregnancy.

Preventing infections, boosting nutrients

Another leading cause of maternal death and disability is an infection that leads to sepsis, something that can easily be treated by a common antibiotic, azithromycin.

When given during labour, azithromycin reduces maternal infections, and during a trial across sub-Saharan Africa, it reduced sepsis cases by a third, according to the report.

“It could also be a game-changer in the US, where 23% of maternal deaths are from sepsis,” according to French Gates. “The United States has some of the most abysmal—and most inequitable—maternal mortality rates among high-income countries.”

“American women are more than three times more likely to die from childbirth than women in almost every other wealthy country,” she added, and the “biggest crisis is among Black and Indigenous women”. 

Recalling tennis star Serena Williams’s account of how close she came to dying after giving birth and the death in April of Olympic track and field star Tori Bowie from treatable childbirth complications in her home, French Gates said that “azithromycin has the potential to address the cause of nearly a quarter of American maternal deaths”.

The report also advocates for giving Bifidobacteria (B. Infantis), a new probiotic supplement to infants at risk of malnutrition alongside breastmilk and multiple micronutrient supplements for breastfeeding mothers to replenish their nutrient stores in pregnant women and ensuring those vital nutrients are transferred to the baby 

In addition, the report proposes giving antenatal corticosteroids (ACS)  to women who will give birth prematurely to accelerate foetal lung growth, and AI-enabled portable ultrasounds to enable nurses to monitor high-risk pregnancies in low-resource settings.

“Of course, these interventions aren’t silver bullets on their own—they require countries to keep recruiting, training, and fairly compensating health care workers, especially midwives, and building more resilient health care systems. But together, they can save the lives of thousands of women every year,” asserted French Gates.

Innovations to prevent maternal mortality.

Causes of babies’ death

Meanwhile, BMGF co-chair Bill Gates spoke of the importance of data about the causes of babies’ deaths, recalling how the BMGF supported the Child Health and Mortality Prevention Surveillance (CHAMPS) initiative since 2015. 

“Even 10 years ago, public health officials had only the vaguest information about why babies were dying,” said Gates.”Back then, any record of a child’s death would generally list one of the four most common causes: diarrhoea, malnutrition, pneumonia, or premature birth. But each was a vast ocean of different illnesses, each with scores of different causes and cures. Pneumonia, for example, is linked to more than 200 types of pathogens.”

The Foundation funded three studies to fill in the gaps – CHAMPs to uncover the most inscrutable causes of death, PERCH, which examined the causes of childhood pneumonia, and GEMS which looked at diarrhoeal diseases. 

Innovations to save babies

“As doctors compiled and compared case after case, a clearer, and often surprising, picture of child death emerged. For instance, some pathogens were less likely than was expected, like pertussis which causes whooping cough, but others were more likely than we expected, like Klebsiella which can be harder to treat,” said Gates.

“Over the past eight years, the field of child health has moved faster and farther than I thought I’d see in my lifetime. And if our delivery can keep pace with our learning – if researchers can keep developing new innovations and health workers can get them to every mother and child that needs them – then doctors could all but guarantee a baby would survive their crucial first days,” he added.

However, the report asserts that lives will only be saved “if all mothers and babies have access to both quality healthcare services and [these] innovations”.

“We need policy changes, political will, more investment into women’s health, and health care workers – including midwives.”

Image Credits: BMGF.

Hong Kong experienced its worst flooding since 1884 last week (8 September 2023)

Much more action, ambition and trillions of dollars are needed to limit global heating to 1.5ºC above pre-industrial levels as agreed by the Paris Agreement, according to a global stocktake report released on Friday by the United Nations Framework Convention on Climate Change (UNFCCC).

While the 46-page report with 17 key findings is delivered in technical language, its key message is unambiguous and chilling: There is “a rapidly narrowing window” to confine global warming to 1.5 °C. 

The stocktake was released during a week that saw unprecedented floods in places as diverse as Hong Kong, Brazil, Spain, Venezuela, Pakistan, Greece and Nigeria.

It calls for “much more ambition in action and support” and “more ambitious targets” by countries – called nationally determined contributions (NDC).

The challenge is dauntingly huge: global greenhouse gas (GHG) emissions need to be cut by 43% by 2030 and further by 60% by 2035 (compared with 2019 levels) and reach net zero CO2 emissions by 2050.

The key to achieving this is phasing out all unabated fossil fuels – which in turn rests on massively scaling up renewable energy. Doing so needs “systems transformations” in industry, transport, buildings and other sectors.

Reversing deforestation by 2030 and restoring natural ecosystems will “result in large-scale CO2 absorption and co-benefits” – but achieving this rests on intensifying sustainable agriculture without further land expansion.

‘Redeploy trillions of dollars’

Some of the paths to achieving this include economic diversification and “strategically deploying international public finance” to support climate action in developing countries.

“It is essential to unlock and redeploy trillions of dollars to meet global investment needs, including by rapidly shifting finance flows globally to support a pathway towards low GHG emissions and climate-resilient development,” asserts the stocktake.

“More than 137 non-Party stakeholders submitted input on their actions and support for the Paris Agreement goals, in total over 170,000 pages of written submissions were received, and we had over 252 hours of meetings and discussions over the three meetings of the technical dialogue – in plenaries, roundtables and world café formats,” said co-facilitator Harald Winkler, a professor from the University of Cape Town in South Africa.

“Much more is needed now, on all fronts and by all actors to meet the long-term goals of the Paris Agreement.”

The stocktake will be discussed at the 28th UN climate negotiations, the Conference of the Parties (COP28), hosted in the United Arab Emirates from 30 November.

Simon Stiell, Executive Secretary of UN Climate Change, urged all governments to “carefully study the findings of the report and ultimately understand what it means for them and the ambitious action they must take next”. 

“While the catalytic role of the Paris Agreement and the multilateral process will remain vital in the coming years, the global stocktake is a critical moment for greater ambition and accelerating action,” Stiell added.

Accra, Ghana: Traffic, waste burning and desert dust all combine to make air pollution a burgeoning problem in this fast-growing city.

The World Health Organization (WHO) will host a summit on air pollution in Accra, Ghana in 2024, the organization announced on Thursday. The summit will be the second ever to address air pollution, which is responsible for millions of premature deaths each year, and the first to be held in Africa.

The announcement was made on Thursday by Dr Maria Neira, Director of the Public Health, Environment and Social Determinants of Health Department at WHO. The UN health agency considers air pollution “one of the biggest public health emergencies” facing the world, said Neira. 

“Every single day we have news, scientific evidence and papers published demonstrating even more damage caused by exposure to air pollution,” said Neira. “In addition to the death, which is already horribly dramatic, we need to keep in mind that we are talking about chronic diseases… [that] take away quality of life and bring costs for health systems.” 

The announcement of the summit was made on the International Day of Clean Air and Blue Skies, established by the UN General Assembly in 2019 to raise awareness of the health risks of air pollution. 

Air pollution is responsible for nearly 7 million premature deaths each year.

The high-level meeting planned for Accra reflects the growing global recognition that air pollution, once seen as an environmental issue, is now a serious health concern. The summit is expected to be attended by government representatives, businesses, civil society organizations and other stakeholders from around the world.

“Every year, air pollution is killing more people than COVID killed,” Dr Ardvind Kumar, a lung specialist based in New Delhi and founder of the Lung Care Foundation, told a World Bank Panel on Thursday. “COVID caused death immediately, directly. Air pollution causes slow, indirect death, and hence does not get the attention.” 

“The world needs to respond to air pollution in the same that that we responded to COVID,” said Kumar. 

Air pollution will be high on the agenda at the upcoming UN climate summit in Dubai, which will kick off in November. The summit will be the first UN climate negotiation to directly consider health as a factor in the climate crisis. 

G20 to tackle air pollution

A thick layer of smog hangs over the Indian capital, New Delhi, which will be the site of the G20 summit that begins on Saturday.

Air pollution is also expected to be a topic of discussion at the G20 summit in New Dehli which will take place this weekend.

Ten Indian cities are in the world’s top 15 cities with the highest levels of air pollution, according to IQ Air, an air quality platform based on official and crowdsourced data. The health effects on Indian citizens have become a critical political issue in the host country as it grapples with reducing pollution in its cities. 

“Thirty years back when I started as a lung cancer surgeon, I would see 95% smokers,” said Kumar. “But today, 50% of my patients are ‘so-called’ non-smokers. I use the words ‘so-called’ because I believe that in a polluted country, there is no true non-smoker.”

The WHO estimates that 99% of people globally breathe unsafe air. South Asia faces the world’s heaviest health toll from air pollution. This cuts the life expectancy of the average South Asian by about five years, leading to annual costs estimated at more than 10% of regional GDP.

“Everyone has a right to live in a clean and healthy environment, and air pollution violates this right for 99% of the world’s population,” said UN Environment Programme Director Inger Andersen. 

The air shared by countries in the Indo-Gangetic Plain and Himalayan foothills – including India, Pakistan, Nepal and Bangladesh – is the most harmful worldwide, according to the World Bank. In some of the region’s most populated cities, air pollution is up to 20 times the WHO guideline.

“In Delhi, a nebulizer has become ubiquitous in every household,” Kumar told the World Bank panel. “I never heard this term when I was a child. But today, when they start getting breathless, every child says to themselves, ‘Oh, I’m going to get the nebulizer’.”

PM2.5, the primary harmful form of air pollution, is generated from a variety of sources, including car emissions, forest fires, and industrial activity. It can enter the lungs and bloodstream, causing a range of health problems, including respiratory infections, heart disease, and cancer.

Global air pollution heat map published by Swiss air quality technology company IQAir.

Black carbon, another major type of air pollution made up of soot and other particles that can enter the lungs and bloodstream, is produced by the incomplete combustion of fossil fuels such as coal, oil and wood.

“We’ve tended to express health impacts through the number of premature deaths. But our day-to-day quality of life is affected, too,” said Martina Otto, who leads the Climate and Clean Air Coalition convened by the UN Environment Programme. “Exposure at any level can have health implications that impair quality of life and come with costs for the individual, our societies and our economies.”  

Air pollution disproportionately impacts women, children and the elderly. Low- and middle-income countries also suffer the highest exposures. 

The air pollution crisis affects everyone – even children who have not yet entered the world, said Kumar. 

“The bad effects of air pollution do not wait for us to be born, it actually starts even before we are born,” said Kumar. “Pregnant mothers who are in polluted cities, when they breathe polluted air, the pollutants go through to the foetus through the placenta.

“Newborns start smoking, figuratively, from the very first breath of their life,” he said. 

Nairobi kicks off World Clean Air Day with a new wall mural by local artist @bankslaveone highlighting the importance of clean transport and improved air quality for children’s health.

Image Credits: WHO/Blink Media, Nana Kofi Acquah, Jean-Etienne Minh-Duy, Clean Air Fund/@bankslaveone.

The WHO has fired Maurizio Barbeschi (left) for sexual misconduct.

The World Health Organization (WHO) has dismissed Dr Maurizio Barbeschi, former head of its Health Security Unit, for sexual misconduct after a three-year investigation that started in January 2020, according to The Telegraph.

Barbeschi had been on administrative leave since late 2021 as the global body investigated complaints against him, including that he removed his trousers during a meeting with a female colleague in a hotel room.

The Italian national and biosecurity expert has worked for WHO for the past 20 years and is also an adjunct professor in the Faculty of Medicine of Flinders University in Adelaide, Australia, according to his LinkedIn profile, which still reflects that he works for the WHO.

Earlier in the year, The Telegraph broke the story about the complaints against Maurizio after speaking to some of the women involved as well as some of his colleagues.

Allegations include that Maurizio “rested his hand on women’s thighs if they sat next to him in meetings”, tried to kiss a WHO consultant and urged women to “go and put their bikinis on” during a meeting.

WHO spokesperson Marcia Poole confirmed Maurizio’s dismissal “following findings of sexual misconduct against him and corresponding disciplinary process”.

“He was informed of the decision yesterday (6 September),” Poole told Health Policy Watch via email.

She added that perpetrators of sexual misconduct are entered into the UN “ClearCheck” screening database “as a matter of standard process to avoid their hiring or re-hiring by UN agencies”.

“Sexual misconduct of any kind by anyone working for WHO – be it as staff, consultant, partner – is unacceptable. Over the past two years WHO has been implementing a comprehensive programme of reform across the entire organisation to prevent sexual misconduct and ensure that there is no impunity if it happens,” said Poole, and encouraged anyone who may have been affected by sexual misconduct to “come forward through our confidential reporting mechanisms”.

Dr Gaya Gamhewage, Director of the WHO’s Prevention & Response to Sexual Exploitation, Abuse and Harassment.

More decisive action

The WHO has been trying to deal more decisively with sexual misconduct allegations within its staff following a huge sexual abuse scandal in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola outbreak.

A WHO independent commission concluded that 83 emergency responders, including 21 WHO employees and consultants, had likely abused dozens of Congolese women, obtaining sex in exchange for promises of jobs – also raping nine women outright. 

In the wake of that scandal, the WHO appointed Dr Gaya Gamhewage as its director of Prevention and Response to Sexual Misconduct and it has since hired more investigators for its Internal Oversight Services (IOS) department.

Earlier this year, Gamhewage told Health Policy Watch that her unit had terminated the contracts of four staff or consultants as a result of sexual misconduct allegations in the last quarter of 2022 – the most of any year so far. The contracts of a further three people were terminated between January and March.

New sexual misconduct policy

WHO’s new policy on Preventing and Addressing Sexual Misconduct (PASM) came into effect on 8 March this year, with the aim of enhancing WHO’s legal and accountability frameworks “for achieving zero tolerance for sexual misconduct and inaction against it”.

In April, the WHO dismissed a senior manager at its Geneva Headquarters, Temo Waqanivalu, on charges of sexual misconduct. This followed a six-month investigation into allegations that Waqanivalu, who was in the running to be the Western Pacific’s regional director, had harassed a British doctor at the World Health Summit in Berlin last October. 

“In the last year, our investigation team acted on not just the cases that were highlighted in the media, but have completed 120 investigations into sexual misconduct, and 72 other investigations are ongoing,” Gamhewage told a media briefing in April.

In May, the global body dismissed scientist Peter Ben Embarek, one of the leaders of the independent team of scientists sent to Wuhan to investigate the origins of COVID-19.

He was dismissed “following findings of sexual misconduct against him and corresponding disciplinary process,” said WHO spokeswoman Marcia Poole told Associated Press.“The findings concern allegations relating to 2015 and 2017 that were first received by the WHO investigations team in 2018.”

Image Credits: United Nations, Israel in Geneva/ Nathan Chicheportiche.