Social connection and healthy foods are key ingredients of Blue Zone Communities.

It’s a cold winter morning in Davos, but the pictures on the screen are aglow with warmth  – a 100-year-old man cuddling an infant; ancient women with faces wrinkled in laughter; aged men sharing a flask of local red wine;  and an extended family gathered around a Mediterranean meal of chickpeas, cheeses, salads and seafood. 

These are everyday scenes from the world’s best known “Blue Zone” communities – far-flung regions of the world with huge cultural, economic and geographic differences that share something deeply in common. 

In these Blue Zone communities, longevity is common and chronic disease is less prevalent, explained Dan Buettner Jr, executive vice president of the Blue Zones Initiative, at a session of the Davos Alzheimer’s Collaborative during the 2026 World Economic Forum (WEF). 

What are blue zones?

Centenarian women in Okinawa, Japan which has the longest healthy life expectancy in the world.

The term Blue Zones refers to “geographically demographically defined places of longevity,” explained Buettner, at the session in the DAC “Brain House”, which hosted a series of WEF side events  that zeroed in on the growing relevance of brain health to global health and economic policy. 

“These are longevity hotspots, places even at 10 times the rating we get in the United States.”

People in Blue Zone communities maintain the “longest disability free life expectancy in the world, seven good years longer than most Americans,” alongside “one-fifth the rate of dementia and a sixth the rate of cardiovascular disease,” he said.

Perhaps most striking is that wealth is not the driver: “Four out of five of these places are places that are at or below the poverty line, so they don’t have big pharmacies, billion-dollar health systems, big health plans, and yet they’re getting what we’re talking about right here.”

Dan Buettner maps out some of the world’s outstanding Blue Zones.

Flipping through scenes as diverse as Okinawa, Japan; Sardinia, Italy; Ikaria, Greece; Costa Rica and Loma Linda, a community of Seventh Day Adventists in Southern California, Buettner talked about their differences – but also what they still have in common. 

Sardinia, noted for its high number of centenarians, largely relies on a plant-based diet and strong social fabric.  Loma Linda, a tightly-woven community of Seventh-Day Adventists, emphasises a diet straight from the Bible, leading to a longer, healthier life. People in the Nicoya Peninsula in Costa Rica and Ikaria in Greece, a relatively poor Aegean Sea island, also have a high likelihood of reaching age 100, with a focus on natural movement, community connection, and celebrating life.

“Take Nicoya Peninsula, Costa Rica,” said Buettner.  There is abject poverty, and yet, according to the World Health Organization, if you can reach age 50 here, you have the highest likelihood of making it to 100 anywhere else on planet Earth. 

“And again, we see communities that are well connected, families that are nearby, people who are engaged in a purpose and a mostly vegetarian diet with lots of beans, beans, beans. So this idea that you have to be elite in order to afford good, whole food that’s healthy for you, is a myth.”

Even more revealing is the mindset of the people who live in the Blue Zones. Of the hundreds of centenarians in diverse communities surveyed, “not a single one pursued health, not a single one pursued fellowship or purpose or love for all of them, ensued as a byproduct of where they lived, that’s environment, and who they lived with, the culture, the rituals, the lifestyle,” Buettner observed. 

Those insights flip conventional wellness culture on its head. Longevity is less about individual discipline and more about the visible architecture of communities – the spaces where people move, as well as the foods most available for people to consume – and the invisible architecture of social connectivity.

Lessons from longevity hotspots

People in Blue zones consume healthy homemade foods, generally mostly vegetarian.

Across diverse regions of the world, patterns repeat with surprising consistency. Their lifestyles are not extreme; they are embedded.

“They all lived in environments and had hobbies, were they able to move a little bit every day, as opposed to the sedentary life that we have,” Buettner said. Social rituals matter just as much: “It is about the ritual of a glass of red wine over a healthy meal with friends… and of course, it all sits on a bedrock of connection.”

Purpose also plays a measurable role. “Purpose is good for four to six years of added life expectancy.”

The takeaway is clear: health is not pursued. It emerges from what Buettner calls the “Power Nine” best practices of Blue Zones, including: moving naturally, managing stress, eating a plant-heavy diet, living in a well-networked community with social rituals, and having a sense of purpose.

“None of these people was pursuing health or longevity or long life,” Buettner observed. “Ït ensued as a byproduct of where they lived, the culture that they belong to.”

Asked what people truly need in life, one 98-year-old grandmother offered a simple formula, Buettner recalled: “We all need four things: someone to love, something to do, some way to give back, and something to look forward to.”

He believes communities that deliver those essentials can transform public health. “If we can give that to people… they will do the transformation for us.”

Designing communities for brain health

Left to right: Jochem Reiser, UTMB, Dan Buettner, Blue Zones Project; Amy Dittmar, Rice University

“For decades, Blue Zones have shown real-world evidence that everyday environments supporting movement, connection, purpose and lifelong learning can prevent cognitive decline, dementia and preserve independence,” said Rice University’s Provost, Amy Dittmar, who moderated the discussion at the DAC Brain House in Davos. 

But after years of studying natural Blue Zones, researchers have begun asking a harder question: can such conditions be recreated in places where they haven’t emerged organically?

If Blue Zone communities could also be engineered, then the implications for healthier minds and dementia prevention could be enormous.

“Healthy neighborhoods lead to healthy neurons,” added Buettner, summing it all up.

Buettner believes they can, but only by shifting the focus away from the individuals and to the community settings. 

“Individual discipline is a muscle, and muscles always fatigue,” he said. “It’s hard to always make the right choice.”

Instead, success depends on structural change. “You don’t rely solely on individual discipline. You have to set people up for success. You empower them… with the invisible hand that nudges all of us all day long around food systems, tobacco and the built environment.”

When these elements align, Buettner argues, “you can literally engineer the effect of living in a Blue Zone anywhere in the world.”

To test out his theories, Buettner’s initiative has already linked up some 90 communities around the United States in a network of Blue Zone project communities. 

Communities in the network engage to promote healthier foods, more physical activity and ‘natural’ mobility via walking paths and bicycle lanes, as well as fora for social connectivity. 

Taken together the strategies mean that “when you step out of your door for your life mindlessly, you’re being inundated with a few more choices that are the healthy choices and they’re the easy choice,” as Buettner describes it.

Landmark collaboration 

New UTMB- Galveston partnership with the nationwide netework of Blue Zone projects.

But if Blue Zone communities can be engineered, can their health benefits also be measured more conclusively by researchers?  That question is now driving a landmark collaboration between Buettner and the University of Texas Medical Branch (UTMB) at Galveston, Texas.

UTMB is now partnering with the City of Galveston as well as Buettner’s Blue Zone network of some 90 US cities, to study the physical and human ecology of Blue Zones, and how they can improve help, said Jochem Reiser, President of UTMB at the session.  

“One of the biggest pushbacks we have got… is, where is the scientific evidence?” said Reiser. “Everybody believes it, but what’s the evidence?”

“We are going to create a research institute that studies the biological and the genetic underpinnings of Blue Zone,” Reiser explained. The effort aims to “define biomarkers and spark innovation as well as extending research beyond laboratories to “have impact in the communities.”   

Rice is also a part of the action, Dittmar observed, noting that the two universities are also collaborating in the context of the Rice Brain Institute – an interdisciplinary hub uniting experts in engineering, natural sciences and social sciences to advance brain health.   

Mapping longevity in Galveston

The new UMTB partnership is focusing first on the city of Galveston, Texas, a diverse coastal community seen as an ideal testing ground.

Buettner described the project’s ambition: “What we’re looking to do is to take a deeper clinical  dive into how environment and lifestyle can be expressed in the human body, whether it’s biometrics, whether it’s epigenetics.”

The approach breaks new ground. “What if we baseline people not with a program, a lifestyle program, but with an environment, and then had them just live their lives in that environment and then show that their lifestyle shifted?” Buettner asked.

Reiser sees Galveston as a microcosm. “We have a mix of people from all kinds of backgrounds… We also have centenarians, and we have people who die early. So we will study all of that.”

The UMTB collaboration also includes what Buettner called a “brain trust” compact with UTMB that will link their research and science powerhouse… with the Blue Zone Project’s international network of longevity experts and community experts to further advance the science of implementing lessons of the Blue Zones.”

Ultimately, the work aims to scale the insights “for everyone, whether they live in a Blue Zone project city or not.”

The added value of prevention

While the innate appeal of the Blue Zones is longer, healthier and happier lives, a stark financial reality is also a driver. 

“We spend seven times more on health care than any other nation, arguably not getting a very good return on investment,” Buettner warned. 

“Of that $4 trillion a year, which represents 20% of the American GDP, the predominance of it is spent on chronic disease, preventable chronic disease, and a fraction is spent on prevention. 

“And that [prevention part] is typically spent on diets, supplements, exercise, medication – short term wins, long term failures. Why is that? It’s because individual discipline is a muscle, and muscles always fatigue.

“The puck is moving,” Buettner said. With rising labor costs, inflation, and growing disease burden, the current system is “utterly unsustainable.”

“You’re a single mother, you’re a firefighter, you’re a nurse. Crap happens. It’s hard to always make the right choice. 

“But if you can get to a tipping point of people, places and policy, you can make the healthy choice, the easy choice, you can literally engineer the effect of living in a Blue Zone anywhere in the world.” 

Image Credits: Health Policy Watch .

African Union leaders sign an agreement with Rwanda’s Ministry of Health to establish the African Medicines Agency’s first headquarters in the capital, Kigali, in June 2023.

The African Medicines Agency (AMA) called on the 24 African member states that are yet to ratify the AMA Treaty to “act without delay” at a meeting on the sidelines of last week’s African Union assembly in Addis Ababa.

AMA aims to improve African countries’ capacity to regulate medical products, which will improve access to quality, safe and efficacious medical products on the continent. It will do so by harmonising regulatory requirements and practices across the national medicines authorities (NMRAs) of the AU member states. 

However, since the AMA Treaty was signed in 2019, it has only been ratified by 31 of the 55 AU member states, which is “leaving gaps in protection against substandard and falsified medical products and limiting the benefits of a unified African regulatory system”, according to a media release from the agency on Monday.

Ratification by 15 states enabled AMA to be established, with headquarters in Kigali, and in June last year, Ghana’s Dr Delese Mimi Darko was appointed AMA Director General.

Darko briefed the meeting last week, stressing that AMA wants to be universally ratified,  achieve WHO Listed Authority status and be financially self-reliant by 2030. 

“Over the past five years, we have moved from a treaty on paper to a living institution,” said Darko, who stressed that AMA is “already working hand‑in‑hand with member states that have ratified to strengthen regulatory systems, streamline joint assessments and increase reliance on shared expertise.”

Boost from Seychelles

At the meeting, Sebastien Pillay, Vice President of Seychelles, reaffirmed his country’s political support and committed $200,000 to AMA, doubling the seed fund contribution of $100,000 required of state parties. 

Tunisian Health Minister Dr Mustapha Ferjani reinforced the foundational importance of regulation, highlighting that “today, a single truth imposes itself: Africa’s health sovereignty depends on regulatory sovereignty. 

“Let us all ratify, and equip AMA with the capacity to act—with resources, skills, clear procedures, and effective governance. Our people deserve it, our health security demands it, and our sovereignty depends on it.” 

Ambassador Amma Twum‑Amoah, AU Commissioner for Health, Humanitarian Affairs and Social Development, described AMA as “a shared continental asset integral to delivering on the African Health Strategy 2030 and Agenda 2063, and the commitments our Member States have made to protect the health and wellbeing of their people.”

She affirmed that the Commission “firmly believes that universal ratification, full implementation and sustainable financing of the African Medicines Agency are achievable within this political cycle.”

 

Image Credits: Rwanda Ministry of Health.

Adapting to a much hotter world will include changing the design of buildings, moving away from glass high-rises.

Extreme heat will rise rapidly as the 1.5°C threshold is crossed, potentially causing half the world’s population to live in extreme heat by 2050, 

Shiny, glass-facade buildings are a symbol of modernisation and growth, but such buildings are dangerously vulnerable in a rapidly warming world, as they trap solar heat and will face much greater heat stress over their lifetime than expected, according to a new study from Oxford University. 

This disconnect between modern aesthetics and thermal reality is emblematic of a wider adaptation gap. While glass towers lock in high energy demand, the report’s findings focus on the more urgent scale of human exposure, tracking how billions in the most vulnerable communities will be forced to navigate a world of unprecedented heat.

Almost half the world’s population, almost four billion people, will be living with extreme heat by 2050 if the world reaches 2°C of global warming above pre-industrial times, according to the report, a global gridded dataset published in Nature Sustainability.

By population exposure, six countries – India, Nigeria, Indonesia, Bangladesh, Pakistan and the Philippines – will have the largest populations affected by the extremes. 

As absolute heat intensity surges, 20 countries, primarily in Africa, South America, and Southeast Asia, are estimated to see the greatest absolute change in heat intensity. The hottest countries are predicted to be Central African Republic, Nigeria, South Sudan, Laos, and Brazil.

Paradoxically, colder climates will see the largest relative change. Compared to the 2006–2016 period, a 2.0°C rise would more than double “uncomfortably hot days” in Canada and Austria, with Ireland seeing a staggering 230% increase.

The hottest 20 countries.

What are CDDs and HDDs?

The study’s results are measured in ‘cooling degree days’ and ‘heating degree days’ metrics commonly used in climate research and weather forecasting to estimate whether cooling or heating is needed to keep people within safe temperatures. 

Cooling Degree Days (CDDs) and Heating Degree Days (HDDs) are simple measures of how much heating or cooling buildings need. They compare outdoor temperatures to a reference temperature (often around 18°C). For example, a day with a mean outdoor temperature of 30 °C has 12 CDDs. Adding up all such days over a year gives the annual CDD value. A value of 3,000 CDD means that, over the year, temperatures are persistently high enough to create very large heat exposure. 

“In practical terms, 3,000 CDD signals that cooling is no longer optional or occasional — it becomes a central issue for building design, energy use, and health,” Jesus Lizana, one of the report’s authors, told Health Policy Watch. 

While the 18°C reference point helps policymakers and engineers to improve standards, ‘safety’ for the average citizen in the Global South is a far more complex equation. For a street vendor in Kolkata or the construction worker in Lagos, extreme heat isn’t just a matter of energy demand, but it’s a biological limit. 

Crossing the 1.5°C threshold means setting new public safety standards, for instance, based on wet-bulb temperatures, where humidity and heat combine to make outdoor labour life-threatening. These new standards need to ensure that adaptation strategies protect those without the luxury of living in glass buildings and air conditioning. 

The danger is 2030 not 2050 

The report’s most urgent finding is that the threat is not decades away. The most significant shifts in adaptation requirements occur in the early stages of warming, as we cross the 1.5° warming threshold.

“If we pass 1.5° around 2030 – which is likely – India will have an average CDD of 3,078. By 2050, it will have an (annual) average CDD of 3,248,” Radhika Khosla, of the Smith School of Enterprise and the Environment and an author of the report, told HPW. 

In comparison, a decade ago, between 2006 and 2016, when the world had warmed by 1 degree, India already had 2,864 CDDs annually. 

“Our study shows that India will continue to have the largest affected population globally, and that the number of extremely hot days it faces will rise exponentially as we pass 1.5°,” Khosla says. 

Global South: Hot, hotter 

The Central African Republic is predicted to see the greatest increase in heat intensity.

Countries in South Asia and Africa are more used to extreme heat, and 18°C days are usually a rarity in the countries mentioned in South and Southeast Asia, Africa and South America. But Khosla says that doesn’t mean its impacts will be any less acute, particularly when we are talking about a significant increase in the number of “dangerously hot days”.

In the authors’ assessment, while some Indian cities already have heat action plans to improve responses when temperatures rise, implementation needs accountability as the impacts of heat intersect across development priorities, such as healthcare, energy access, productivity, and education. 

In Africa, the Central African Republic and Nigeria face an even steeper challenge, the authors point out. They will need to adapt to ever more extreme heat while building reliable energy grids, all while dealing with life-threatening heat. 

“It is worth remembering that these countries are responsible for only a fraction of the emissions that have caused climate change, raising important questions of climate justice and adaptation finance,” Khosla adds.

What should policymakers do?

The warning is clear that the adaptation to higher temperatures needs to be sped up. Most increases in CDDs occur before reaching the 1.5° threshold across the top 20 countries, indicating that the most significant shifts in adaptation requirements occur in the early stages of warming – before 2030, rather than in a steady progression. 

This dataset provides a basis for incorporating new climate data into sustainability planning and development policy. For buildings, CDD is a useful metric to estimate and design the increased demand for cooling while ensuring it is sustainable – for instance, how to deliver more air conditioning but with lower emissions and power consumption. 

“This research adds to the body of evidence that heat exposure in vulnerable communities is accelerating, in some cases faster than many have predicted,” says Luke Parsons of The Nature Conservancy. 

Low-income nations with relatively higher social vulnerability are usually the least equipped to face some of the largest increases in extreme heat. 

“Unless we move to rapidly limit global warming, we are on track to see major impacts in the short and long term,” he says.

Rethink glass high-rises

Policy-makers need to rethink architecture, such as these glass buildings that characterise Dubai, to prepare for heat.

More visibly, this means that the glass high-rise buildings designed today will face much greater heat stress than expected. Building standards need to be updated to avoid locking in high energy use, overheating risks and costly retrofits later. 

“This is especially relevant for glass-facade high-rises, which have become symbols of growth but often perform poorly in hot conditions. Large glass areas trap solar heat, increasing cooling demand and vulnerability during heatwaves,” Jesus Lizana told HPW. 

Inclusive adaptation requires looking past the shiny skyscrapers to the neighbourhoods where most people actually live. In dense, low-income urban areas, the ‘Urban Heat Island’ effect can make local temperatures several degrees hotter than official weather station readings. 

Real adaptation, for the majority, looks like ‘cool roofs’ for informal housing, greater urban tree canopies to provide natural shade, and improving the energy grid to prevent the power outages that turn modest homes into ovens. The Oxford data shows that the most vulnerable communities are already on the clock.

The glass high-rise is emblematic of a larger disconnect: a modernisation strategy that prioritises aesthetics over global warming reality. For the billions living in informal housing or working outdoors, adaptation cannot be a luxury. 

The message for the Global South is clear. Policy choices made today must be built for the 1.5°C reality of 2030, not the cooler world of the past.

Image Credits: Erika Plepyte/ Unsplash, Shashi Yadav/ Unsplash.

Climate change EPA

Hailed as the “single largest deregulatory action in US history,” the Environmental Protection Agency repealed a 2009 scientific decision that gave the agency the authority to regulate climate change pollutants, also known as the Endangerment Finding.

The US Environmental Protection Agency (EPA) has eliminated the scientific finding that determined planet warming gases also harm human health. 

For the last 15 years, that finding has served as the legal basis for EPA’s regulation of greenhouse gas emissions by power plants, vehicles, and other sources. 

Reversal of the finding effectively pulls the legs out from the framework that underpins virtually all of the climate rules enacted since by the EPA – whose mandate is to regulate pollutants once it’s found that they damage public health and the environment. 

In a White House announcement, EPA administrator Lee Zeldin derided the Endangerment Finding as the “‘Holy Grail’ of the ‘climate change religion.’

Critics in the US and worldwide slammed the US reversal as a politically-charged policy decision that would lead to more ill health as well as putting “millions” of lives at risk in the US and worldwide, if the new finding survives the court challenges that are expected to follow, in the words of former EPA administrator Gina McCarthy. 

EPA following ‘letter of the law’

EPA trump Zeldin Climate change
EPA Administrator Lee Zeldin at a White House press conference, announcing the repeal of the Endangerment Finding, alongside President Trump.

“The Trump EPA is strictly following the letter of the law, returning common sense to policy, delivering consumer choice to Americans and advancing the American Dream,” Zeldin countered at a press conference at the White House on Thursday. He was joined by President Trump, who called the rule the legal foundation for the “Green New Scam.”

The 2009 finding issued after a technical assessment by EPA staff scientists determined that current and projected concentrations of six key greenhouse gases, including methane, carbon dioxide, and hydrofluorocarbons, threaten public health in current and future generations. 

The ruling, which directly connected greenhouse gases to human health impacts for the first time, followed a 2007 Supreme Court decision that greenhouse gases are also air pollutants covered by the 1970 Clean Air Act. But the Court also ordered the EPA to determine “whether or not emissions of greenhouse gases from new motor vehicles cause or contribute to air pollution that may reasonably be anticipated to endanger public health or welfare, or whether the science is too uncertain to make a reasoned decision.”

The White House announcement marked the culmination of years of backstage work by climate skeptics and conservatives aligned with President Donald Trump to undo the finding following his election to a second term. 

Speaking at a press conference alongside Zeldin yesterday at the White House, the President blamed the rule for costing “trillions of dollars in regulation” and for “driving up the cost of vehicles for American families and small businesses.” 

No longer a matter of debate 

The Administration statements also attacked the scientists who issued the findings for taking “novel mental leaps” and being part of an “ideological crusade” to connect greenhouse gases to human health harms, also describing the  2009 ruling as “legal fiction.”

Yet the evidence linking climate change and health is “no longer a matter of debate,” said Maria Neira, former World Health Organization Director of the Department of Climate, Environment and Health, told Health Policy Watch. 

“Evidence has grown exponentially since 2009. Today, it is no longer a matter of debate; it is a matter of record,” Neira said. “Research shows that heat extremes, air pollution, the spread of infectious diseases, and food insecurity driven by climate change are intensifying — and already costing millions of lives each year worldwide.”  

Furthermore, the Finding has led to changes in vehicle design that have reduced other harmful tailpipe pollution emissions, as well as making them more fuel efficient. So while the Administration claims that the repeal will save Americans $2400 per vehicle, critics pointed to the millions of dollars in long-term climate and pollution-related health costs that the reversal will entail – if tailpipe and power plant emissions indeed rise once more. And that’s regardless of new tariff policies that have also raised vehicle costs by thousands of dollars.

Tentative evidence is now resolved 

“Much of the understanding of climate change that was uncertain or tentative in 2009 is now resolved – and new threats have been identified,” said the National Academy of Sciences, Engineering, and Medicine in a 2025 report.

The EPA’s repeal of the endangerment finding “disregards decades of unequivocal scientific evidence on the severe health threats posed by climate change and fossil fuel–related emissions, and on the associated harms to the broader economy,” said Dr Marina Romanello, executive director of the Lancet Countdown on Climate and Health, in a statement to Health Policy Watch. “It is a direct attack on the health and survival of people in the US and beyond,” she said. 

Her group recently published the first estimates of heat-related deaths – over half a million in the past decade – or one heat-related death per minute.

“Together with the promotion of coal burning, it shows the US administration is prioritizing the economic interests of a wealthy few to the detriment of people’s health and wellbeing. 

“As the US loses its scientific leadership, other countries have the opportunity to lead the way forward, ensuring a safe environment, and reaping the major benefits that the transition away from dirty fuels can deliver.”

Win for industry, deregulatory champions

In this latest finding, the Administration argued that the 1970 Clean Air Act applies only to localized pollutants like smog and particulate matter – and not to the greenhouse gases, which disperse across the globe. 

That ignores, however, the fact that other polluting gases and particles also travel tens or hundreds of miles – and across borders, wreaking health damage on neighboring cities, rural areas, and countries. 

Other conservatives have argued that Congress should pass a new law to regulate greenhouse gases if it wishes to do so, instead of relying on the Clean Air Act. 

The debate over the economic cost of cleaner air regulations played a central part in the repeal, despite evidence that such regulations save millions in healthcare and disaster-related costs. 

“The final rule will save Americans over $1.3 trillion by removing the regulatory requirements to measure, report, certify, and comply with federal GHG emission standards for motor vehicles, and repeals associated compliance programs, credit provisions, and reporting obligations that exist solely to support the vehicle GHG regulatory regime,” said the EPA statement. “Americans will have certainty, flexibility and regulatory relief, allowing companies to plan appropriately, and empowering American families.”

Yet many emissions savings that followed the Endangerment Finding, such as start-stop ignitions in idling cars, also saved drivers some 7-26% in fuel economy savings. 

Wildfires and extreme weather 

Drought, wildfire, and other extreme weather events have and are expected to increase in frequency and intensity.

While Administration officials touted the immediate economic benefits around the ruling, they were silent about the costs of extreme weather – even though there is increasing recognition in American communities that climate is one of the drivers. 

“Repealing the Endangerment Finding will shape our clinical reality for years to come,” argued Lisa Patel, a pediatric hospitalist and executive director of the Medical Society Consortium on Climate and Health, in an opinion piece.

“Clinically, the implications are straightforward. Increased greenhouse gas emissions mean more days of unhealthy air, higher concentrations of ground-level ozone, and more frequent and intense wildfires,” Patel explained. “For pediatricians, this translates into more asthma exacerbations, more emergency department visits, and more hospitalizations. 

“For obstetricians and neonatologists, it means higher risks of preterm birth, low birthweight, and hypertensive disorders of pregnancy. For internists and cardiologists, it means higher rates of myocardial infarction, stroke, and heart failure exacerbations during heat waves and pollution events,” she said.

Heatwaves and natural disasters costing more 

EPA climate change cost
Cost of extreme weather-related events over the past several decades.

Already, the intensity of heatwaves and natural disasters is costing mounting damage, according to the University of Chicago’s Energy Policy Institute, which stated in a recent policy brief: 

“The average American experiences 20 percent more extremely hot days than they did two decades ago, and the last decade was the warmest on record. 

“Hurricanes of all intensity categories have become more frequent, and the most extreme, Category 5, have doubled in frequency. 

“If planet-warming emissions continue to rise at the same rate they have over the last few decades, by the end of this century there may be seven times more extremely hot days compared to today. 

“In that scenario, nearly half of U.S. states could experience summer temperatures hotter than today’s summers in India or Egypt,” the Institute stated. “Going forward, the combined effects on labor productivity, health, and energy systems “could cost roughly 0.7 percent of GDP for every 1°F increase in temperature on average.” 

Environmental groups gear up for court fights

“The repeal will likely face strong legal challenges,” said Arthur Wyns, Assistant Director of the Australia’s Center for Disease Control, in a social media post. 

Several US environmental groups have already vowed to challenge the Administration’s decision.

These groups still do have the 2007 Supreme Court ruling, determining that climate pollutants  can potentially harm health, although a more conservative bench may be sympathetic to the Administration’s arguments that short of new Congressional Legislation, the 2009 Endangerment Finding represented overreach of the EPA’s authority under the Clean Air Act.  

“This move is part of a growing pattern of hostility toward the American public: stripping protections and making people less safe, all while billionaires profit,” said Natural Resource Defense Council CEO Manish Bapna.

“NRDC will not let this stand. We will see them in court — and we will win.”

The Environmental Defense Fund echoed this sentiment. “This decision is now endangering all of it — and all of us.

“We need to know the truth about the challenges we face, not fake science. We need investment in our communities to promote health, support families, lower costs and power the economy. EDF will challenge this decision in court, where evidence matters, and keep working with everyone who wants to build a better, safer and more prosperous future.”

Looking at the opportunity – rather than costs 

Adds Neira: “This is not abstract science. It reflects Americans’ lived reality. Anyone who has fallen ill during a heatwave, struggled to breathe through wildfire smoke, or faced the aftermath of a devastating hurricane understands that climate change is not a distant environmental issue — it is an immediate and escalating threat to human health.

“But that is only half the story,” she added.

“When governments act to reduce the drivers of climate change, they also address some of the most pressing health challenges of our time. Cleaner vehicles and cleaner sources of electricity mean cleaner air — and fewer deaths from heart and lung disease. Designing cities around safe sidewalks and protected bike lanes encourages walking and cycling, increasing physical activity and lowering the risk of chronic illness.

“The benefits multiply across sectors. Climate action is not a sacrifice; it is a public health opportunity. By confronting climate change, we do not just protect the planet — we advance healthier, longer, and more equitable lives.”

Image Credits: White House, Matt Howard/ Unslash, WMO, Enel North America.

The US flag being removed from outside the WHO headquarters in Geneva last month, signalling the country’s exit from the global body. Since then, three US states and one city have opted to join the WHO’s outbreaks network.

The World Health Organization (WHO) has welcomed the decision of the US states of California, Illinois, New York and New York City to join its Global Outbreak Alert and Response Network (GOARN).

GOARN is a global network of public health institutions, governments, academic bodies and laboratories that helps to detect and control infectious disease outbreaks and public health emergencies throughout the world.

Dr Maria van Kerkhove, WHO Director of Epidemic and Pandemic Threat Management, said that GOARN is an “asset to the world” that currently has over 360 members.

Established 20 years ago, members include national and sub-national institutions with public health and field experience in outbreak response and preparedness, she explained.

“We welcome anyone who wants to be part of GOARN to see our website and fill in the application. It’s an incredible network of national and sub-national institutes, student and academic organisations that meet regularly and share information. They are sometimes deployed to outbreaks around the world,” Van Kerkhove told a media briefing on Wednesday.

Trump’s ‘reckless decision’

California Governor Gavin Newsom at the World Economic Summit in Davos recently, where he met WHO officials.

On 23 January, the day after the Trump administration completed its withdrawal from the WHO, California Governor Gavin Newsom announced that his state would join GOARN.

“The Trump administration’s withdrawal from WHO is a reckless decision that will hurt all Californians and Americans,” said Newsom in a statement. 

“California will not bear witness to the chaos this decision will bring. We will continue to foster partnerships across the globe and remain at the forefront of public health preparedness, including through our membership as the only state in WHO’s Global Outbreak Alert and Response Network.”

Illinois Governor JB Pritzker followed suit on 2 February, stating that US President Donald Trump’s withdrawal of the country from the WHO “has undermined science and weakened our nation’s ability to detect and respond to global health threats”.

By joining GOARN, “we are ensuring that our public health leaders – and the public – have the information, expertise, and partnerships they need to protect the people of our state”, Pritzker added. 

Safety during FIFA World Cup

Last week (5 February), the New York City Health Department also announced that it was joining GOARN, and on 10 February, New York State also reported that it would be joining GOARN.

“To best prevent disease outbreaks and public health emergencies and to protect New Yorkers and visitors from them, the NYC Health Department is joining hundreds of public health institutions worldwide that share critical public health information to support life-saving prevention and response efforts,” said Dr Michelle Morse, NYC’s Acting Health Commissioner.

“Infectious diseases know no boundaries, and nor should the information and resources that help us protect New Yorkers,” she said, adding that GOARN membership would give the city direct access to information and partners during “major events with high levels of international travel, such as the 2026 FIFA World Cup”.

Kathy Hochul, Governor of New York State, also announced her state’s membership: “By joining GOARN, we’re sharing our expertise, laboratories and highly skilled workforce to detect and respond to outbreaks worldwide while helping prevent global health threats from reaching New York State and the United States.”

GOARN members hold weekly meetings, exchange reports on international global health issues, provide support, technical assistance and even send people to assist during outbreaks, if requested to do so.

MOUs in place of multilateralism?

WHO Director General Dr Tedros Adhanom Ghebreyesus is “not worried” that US bilateral health deals with various countries will replace multilateral bodies.

The Trump administration has tried to ameliorate its withdrawal from the WHO by signing health Memorandums of Understanding (MOUs) with former health aid recipients, trading ongoing health support for immediate access to all information about pathogen outbreaks.

This is in keeping with its America First Global Health Strategy, published last September by the US State Department, which aims to “make America safer” by “continuing to support a global surveillance system that can detect an outbreak within seven days”.

“We will accomplish this through bilateral relationships with countries,” according to the strategy.

But the US has only signed health MOUs with 16 countries, and it has not yet translated any of these into bilateral agreements. In addition, the 16 countries are all based in Africa and do not appear to have been targeted because of their disease outbreak profiles.

SARS-CoV2, the virus that caused the COVID-19 pandemic, originated in China – an unlikely candidate for an MOU. Meanwhile, a recent European Commission Joint Research Centre report identifies Latin America as the region at highest risk of outbreaks of the diseases identified by the WHO as the most likely to cause epidemics and pandemics. Oceania is the second most likely area. The most risky countries are Papua New Guinea and the Republic of the Congo.

In contrast to the bilaterals that will be time-consuming to manage, the WHO’s 193 member states are bound by the International Health Regulations (IHR), a legal framework that defines their rights and obligations in managing public health risks, events and emergencies that have the potential to cross borders.

In addition, negotiations between WHO member states are at an advanced level about a global pathogen access and benefit-sharing (PABS) system, the final piece of the Pandemic Agreement adopted by the WHO last May.

WHO Director-General Dr Tedros Adhanom Ghebreyesus reiterated this week that bilateral agreements between countries are “not a new phenomenon”, and he did not think that the US-driven MOUs can replace the multilateral system.

“Any member state can have any MOU with any country it wants. This is between sovereign countries, and they know best for their respective countries,” said Tedros.

Tedros also shrugged off concerns that these MOUs will undermine the PABS system being negotiated as part of the WHO’s Pandemic Agreement.

“I don’t see that there will be any impact on the PABS negotiations. We’re not really worried… There can be bilateral agreements, and there can also be multilateral agreements. It’s not one or the other. Both can exist without any problem.”

A child in a camp in Tawila, North Darfur, for people displaced from Al Fasher.

Famine indicators are worsening in the most vulnerable areas of Sudan, where “a situation that is already awful continues to deteriorate”, World Health Organization (WHO) Director-General Dr Tedros Adhanon Ghebreyesus told a media briefing on Wednesday.

Last week, acute malnutrition surpassing famine thresholds was identified in two areas of North Darfur, by the Integrated Food Security Phase Classification (IPC).

Thousands of people fled to these areas, Um Baru and Kernoi, last last year to avoid violent attacks on civilians in the town of El Fasher.

“Famine conditions were confirmed in two other cities in November last year, and we know that where hunger goes, disease follows,” said Tedros, adding that an estimated 4.2 million cases of acute malnutrition are expected across Sudan this year – a 14% increase from 2025.

Violence is ongoing, including attacks on healthcare facilities. In the past three years of the war, the WHO has verified 205 attacks on health facilities, which have led to 1,924 deaths and 529 injuries.

WHO’s Sudan Country Representative, Dr Shible Sahbani,

WHO’s Sudan Country Representative, Dr Shible Sahbani, told the media briefing that, aside from famine and violence, Sudan is battling major outbreaks of cholera, malaria, dengue and measles.

Over 2.9 million malaria cases have been recorded, 124,000 cholera cases and more than 3,500 deaths, and over 63,000 dengue cases.

“Water, hygiene, sanitation and health conditions are very bad in many, many states,” said Sahbani, adding that continued fighting made it impossible for humanitarian efforts to reach those who need help.

No support for rape survivors

Widespread rape and gender-based violence have been hallmarks of the conflict, and Sakhani said that there was little access to services such as emergency obstetric care, and clinical management of rape.

Meanwhile, Dr Teresa Zakaria, WHO head of Humanitarian and Disaster Action, told the briefing that “70% of women in crisis are subjected to gender based violence”. 

However, “over 60% of organisations that in the past have provided clinical care, social protection, and social assistance to survivors of sexual violence have had to scale back or stop services because of funding cuts”, added Zakaria.

“Humanitarian aid cuts to the gender based violence sector amount to over $110 million. In 2025, what this represented is that three million people, mostly women and girls, but also boys and men in humanitarian crisis are deprived of access to services,” she said, adding that the situation this year “is only going to become much worse”.

Guinea-Bissau trial is ‘unethical’

When asked about a controversial trial to examine various impacts of the hepatitis B vaccine on newborn babies in Guinea-Bissau, Tedros declared bluntly that it is not ethical.

“Guinea-Bissau is one of the countries with a high prevalence of hepatitis B, and withholding a birth dose could actually expose infants to a high chance of infection,” said Tedros.

“This violates basic protocol. When you have an effective medicine, denying half of the population of children access to a vaccine that has been there for more than 40 years, which is safe and effective, is not ethical.”

A day after the press conference, the WHO issued a statement outlining in more detail why the study is “inconsistent with established ethical and scientific principles”.

It listed five reasons, namely:

  • withholding the vaccine from some study participants exposes newborns to serious and potentially irreversible harm, including chronic infection, cirrhosis, and liver cancer.
  • A placebo or no‑treatment vaccine trial is only acceptable when no proven intervention exists or when such a design is indispensable to answer a critical question of efficacy or safety. Neither condition appears to be met based on publicly available descriptions of the study.
  • The protocol does not question the established efficacy and impact of the birth dose; instead, it posits hypothetical safety outcomes without sufficient credible evidence of a safety signal that would warrant exposing participants to risk.
  • The single‑blind, no‑treatment‑controlled design raises a significant likelihood of substantial risk of bias, limiting interpretability of the study results and their policy relevance.
  • Exploiting scarcity is not ethical: Resource constraints cannot be used to justify withholding proven care in a research study involving people. Ethical obligations require minimizing risk and ensuring a prospect of benefit for participants.

There has been global outrage over the ethics of the trial, which would only give half the 14,000 babies it aims to enroll a hepatitis B vaccination shortly after birth – despite clinical evidence that early vaccination is highly effective at preventing mother-to-child transmission of the virus, which is the leading global cause of liver disease. 

A Danish research group, Bandim Health Project, headed by Dr Christine Stabell Benn, an ally of US Health Secretary Robert F Kennedy Jr, has been given a $1,6 million, five-year grant by the US Centers for Disease Control and Prevention (CDC) to “assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”.

Stabell Benn is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns. 

“Of course, a sovereign country can decide whatever it wants. But as far as WHO is concerned, it’s unethical to proceed with this study,” Tedros stressed.

In a statement, WHO listed glaring ethical violations for witholding the vaccine: the proven benefit of the vaccine, foreseeable harm of the disease, no scientific necessity for the no-treatment arm, insufficient scientific justification, biased and low-utility design, and that exploiting scarcity is not ethical.

WHO’s head of immunisation and vaccines, Dr Kate O’Brien, questioned purpose of the trial, adding that WHO’s representative in Guinea-Bissau had been in regular contact with the country’s Health Ministry about the trial.

“It’s a safe and extremely effective vaccine,” she said, adding that over 150 countries currently use the hepatitis B vaccine.

WHO’s head of immunisation and vaccines, Dr Kate O’Brien, questioned the reason for the trial.

“Whenever research is proposed, there has to be some foundation for proposing it, especially when it is asking a question about an authorised vaccine that has a very long-standing safety profile,” said O’Brien.

“There has to be some basis for expecting that there is an issue or a question that needs to be asked. And, to our knowledge, there is no underpinning evidence that would suggest that there is any concern with respect to hepatitis B vaccine.”

She added that, aside from policy relevance, the research needed to “protect the interests of the participants”.

“There are some very concerning aspects of the study that have been proposed, and these are some of the questions that we were asking of the investigators when we had a very good opportunity to discuss it with them.”

Two weeks ago, Guinea-Bissau Health Minister, Quinhim Nanthote, told a media briefing that the trial had been “suspended or cancelled”.

This is despite recent assertions by the US Health and Human Services (HHS) Department that it was going ahead.

‘Non-specific effects’ of vaccines

Nanthote initially told the briefing that his country’s ethics committee had not yet held a meeting about the trial, but later said that it “did not have the required technical resources” to approve the trial.

Nanthote, who addressed the briefing in military fatigues, was only appointed health minister on 29 November 2025, following a military coup three days earlier, and was not part of the discussions about the trial.

For years, Stabell Benn, co-principal investigator of the trial, has researched the “non-specific effects” (NSE) of vaccines. She and colleagues have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

One of the research aims of their Guinea-Bissau trial is to investigate the effect of the vaccination “on neuro-development by five years of age”. This dovetails with Kennedy’s belief that the rise of autism is linked to childhood vaccinations.

“RFK Jr. has manipulated the [Guinea-Bissau] study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine,” observed US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, on his Substack platform.

Story updated to include the WHO statement on the Guinea-Bissau trial.

Image Credits: UNICEF.

The US and Burundi signed a health MOU on 6 February.

Burundi has become the 16th African country to sign a five-year bilateral health Memorandum of Understanding (MOU) with the United States.

The US “intends to provide more than $129 million of health assistance in Burundi for HIV/AIDS, malaria, and infectious disease surveillance, response, and preparation”, according to a statement from the US State Department.  

In return, Burundi has pledged to increase domestic health expenditures by $26 million, to assume greater financial responsibility for its citizens’ healthcare.

US support will include support for “surveillance and outbreak responses, laboratory commodities, frontline health care workers, and data systems”. 

It will also “continue to improve access to malaria prevention, diagnostic tests and treatments, as well as HIV rapid diagnostic tests and antiretroviral HIV treatment regimens”.

As with the other 15 MOUs, Burundi has agreed to share “information and data” about infectious disease outbreaks with epidemic or pandemic potential, according to the US State Department.

The pace of signings has slowed after a flurry of MOUs the US signed late last year under its “America First Global Health Strategy”.

However, the health MOUs have given way to a flurry of US trade agreements, focusing on critical and rare earth minerals – with at least 21 MOUs related to minerals being signed in the past five months, including 11 signed last week alone alongside a Ministerial meeting on critical minerals, according to the US State Department.

The US has also chosen Hungary as its partner in advancing religious freedom in sub-Saharan Africa and the Middle East.

An MOU between the two countries was signed last week between US Deputy Secretary for Management and Resources Michael Rigas and Hungary’s Tristan Azbej, State Secretary for the Aid of Persecuted Christians and the Hungary Helps Program. It aims to “facilitate cooperation in supporting Christians and people of faith facing persecution, particularly in the Middle East and sub-Saharan Africa.”

A child getting a measles vaccination. 

Measles cases in Europe and Central Asia dropped by three-quarters in 2025 compared to the previous year – but the decline is partly due to the virus running out of people to infect after spreading rapidly through under-vaccinated communities.

Preliminary data from 53 countries in the World Health Organization (WHO) European Region reported 33,998 measles cases in 2025 and 127,412 in 2024, according to the WHO and UNICEF.

“While cases have reduced, the conditions that led to the resurgence of this deadly disease in recent years remain and must be addressed,” warned Regina De Dominicis, UNICEF Regional Director for Europe and Central Asia.

“Until all children are reached with vaccination, and hesitancy fuelled by the spread of misinformation is addressed, children will remain at risk of death or serious illness from measles and other vaccine-preventable diseases.”

In 2024, 19 countries had ongoing measles cases – up from 12 the previous year, according to the European Regional Verification Commission for Measles and Rubella Elimination.

“This represents the most significant setback in measles elimination in the region in recent years,” according to the two UN bodies.

WHO Regional Director for Europe, Dr Hans Henri Kluge, warned that over 200,000 people in our region have contracted measles in the past three years. 

“Unless every community reaches 95% vaccination coverage, closes immunity gaps across all ages, strengthens disease surveillance and ensures timely outbreak response, this highly contagious virus will keep spreading,” Kluge warned.

“In today’s environment of rampant fake news, it’s also crucial that people rely on verified health information from reliable sources such as WHO, UNICEF and national health agencies. Eliminating measles is essential for national and regional health security.”

Two doses of the measles vaccine provide up to 97% life-long protection against the virus and a vaccination rate of 95% with both doses in every community each year is needed to prevent measles outbreaks and achieve herd immunity. 

This protects infants too young for measles vaccination and other people for whom it is not recommended due to medical conditions, like those who are immunocompromised.

Measles is one of the most contagious viruses with every infected person able to infect up to 18 unvaccinated people.

It can cause serious illness, death and damage to the immune system, including by “erasing” its memory of how to fight infections, leaving measles survivors vulnerable to other diseases and death.

Image Credits: WHO.

Indonesia delivering a statement at IGWG5 on behalf of the Group of Equity.

Powerful member state blocs at the World Health Organization (WHO) stressed on Monday that they will not compromise on the final outstanding piece of the Pandemic Agreement simply to meet the May deadline.

The Group of Equity and the WHO’s Africa, Eastern Mediterranean and South-East Asia regions stated that they wanted a Pathogen Access and Benefit-Sharing (PABS) system with legal certainty at the second-to-last meeting of the Intergovernmental Working Group (IGWG).

“PABS is the heart of the Pandemic Agreement. If the heart is weak, the body cannot function, and the agreement will not deliver equity,” said Indonesia on behalf of the Group of Equity, and the three regions – collectively representing over 80% of the world’s population.

The PABS system aims to set out how countries can share information about pathogens and their genetic sequence data and ensure that those sharing this information get access to the benefits developed as a result, such as vaccines, diagnostics and therapeutics.

But the current PABS draft contains “major loopholes” that will prevent the system – an annex to the Pandemic Agreement – from functioning effectively, Indonesia added.

“The annex must articulate the operational details of the PABS System, and provide legal clarity on the rights and obligations of the providers of PABS material and sequence information, as well as various users of the system. We also question how any terms and conditions can be enforced when users are permitted to remain anonymous,” stressed Indonesia.

“We understand the pressure of timelines. But we should be clear about the choices and decisions in front of us: We are aiming for an annex by [the World Health Assembly in] May, that can actually deliver a functioning PABS System in totality. But if we cut too many corners now, we will pay for it later in credibility and implementation.”

Zimbabwe – speaking for the Africa Group – stated that “a system that safeguards some while leaving others exposed is not only unjust, it is ineffective”.

“For the Africa Group, equity and benefit-sharing must be operational, enforceable and central to Pandemic Agreement, including the PABS annex. These elements cannot be aspirational, deferred or left to voluntary implementation. Past experiences has shown the consequences of such approaches.”

Pragmatism and speed

The EU representative and France’s Anne-Claire Amprou.

However, the European Union, backed by G7 leader France, called for pragmatism and speed.

“We remain deeply committed to work towards an effective, workable and implementable PABS system in the remaining 12 Days of negotiations that we have at our disposal,” said the EU representative.

“We hope that a sense of pragmatism and common sense will help to guide us towards convergence on the key remaining outstanding areas for the purpose of bringing this process to a successful conclusion within the timeframe.”

Speaking for France, Anne-Claire Amprou, a former co-chair of the Pandemic Agreement negotiations, urged “quick progress” to adopt the annex by the World Health Assembly in May. 

“Given the time remaining, we need to be reasonable in terms of the amendments we make to the text,” said Amprou. “We invite member states not to reopen subjects or provisions which were already adopted as part of the Pandemic Agreement.”

The Pandemic Agreement cannot be endorsed or operationalised without the PABS annex, which means there is no global agreement on how to approach the next pandemic – which can strike at any time.

Benefit-sharing demands

India warned against adopting an ambiguous annex.

But for many low- and middle-income countries (LMICs), the bitter memory of being unable to get access to vaccines during the COVID-19 pandemic – even for health workers and their most vulnerable citizens – was a sobering lesson.

Some indicated that they would be prepared to miss the May deadline rather than budge on their demand for a legally binding PABS system that balances access and benefit-sharing.

India, speaking for the South-East Asia region, stated that “it is essential that quality is not compromised by the pressure of timelines”. 

“Our priority must be an annex that provides clear legal certainty with minimum room for interpretive ambiguity. Such clarity is critical for effective implementation and long-term trust in multilateralism, “ said India.

“Benefit-sharing obligation must be proportionate to access and cannot be voluntary, aspirational or based on ‘best endeavours’. 

Non-monetary benefits

Some LMICs also stressed – as India did – that benefit-sharing must extend “beyond monetary contributions and donations of vaccines, diagnostics and therapeutics”. 

“Non-monetary benefits, including timely capacity development, technical assistance and non-exclusive manufacturing licences for developing countries, must be clearly specified and applied both during pandemics and during the inter-pandemic period,” said India, for the South-East Asia region.

Indonesia said that, while equitable access to vaccines, therapeutics and diagnostics (VTDs) is essential, “we should also be serious about benefits that support timely diversified regional and local production, including non-exclusive licensing to manufacturers in developing countries, transfer of technology, and meaningful collaboration in R&D.”

“Benefit sharing cannot depend on purchasing power, ad hoc arrangements or discretionary decisions taken during emergencies,” said Namibia.

“It must be triggered by access, governed by multilateral rules and delivered when it matters most. Namibia also places strong emphasis on technology transfer and regional manufacturing capacity. Strengthening local and regional production is essential to reducing dependency and building real resilience.”

Way forward

The IGWG meeting – the fifth of six – ends on Saturday, and while it plans four evening sessions, co-chair Tovar da Silva Nunes reminded delegates that the meeting’s access to interpreters is limited, a casualty of WHO budget cuts.

There are 100 days to the deadline, and by the end of this week’s talks, it should be clear whether the annex is on track for adoption in May.

Mexico, meanwhile, indicated that it is available to facilitate “dialogue between blocs of countries”.

“We are convinced that, with political will and pragmatism, we can reach the necessary consensus so that we can allow this process to conclude successfully and strengthen our multilateral stance for future pandemics.” said Mexico.

Egypt leads the charge Friday against renewing WHO relations with NGOs working in the sexual and reproductive health rights space.

After fits, starts, hours of back room negotiations and hesitations, the closing day of WHO’s Executive Board session Friday saw agreement on a number of small – but potentially meaningful – efficiency measures aimed at saving booth member states and the financially-strapped agency a time and money in preparing for and responding to member state mandates.  

The changes come amidst mounting geopolitical and social tensions amongst member states, with an increasing share of discussion time consumed by a handful of highly politicized items, including the wars in Ukraine and Gaza, as well as sexual and reproductive health rights. 

At the same time, the Executive Board and the annual World Health Assembly (WHA) have become overloaded with a growing volume of draft decisions and resolutions – many costly to implement and not always aligned with established strategic plans.

Among the key reforms is an initiative to streamline timelines and criteria for the submission of proposed draft resolutions and decisions by member states. This could curb the proliferation of proposals seen over the past several years.

Streamlining discussion on Palestine and de-escalating flashpoints

WHO Director General Dr Tedros Adhanom Ghebreyesus Friday evening in emotional appeals for streamlining debates around divisive issues such as reproductive health rights and Palestine.

Another small efficiency steps for the upcoming WHA include a compromise on language, which enabled the approval of  WHO’s continued engagement with five NGOs working on sexual and reproductive health rights.

In addition, a plan to consolidate discussion around two overlapping reports on the thorny question of health conditions in the “Occupied Palestine Territory (OPT)’’ into a single WHA agenda item avoids duplications that have consumed hours of WHA time since 2024. That is when the Israel-Hamas war led to the development of a second WHO report on health conditions in the OPT, in addition to the annual report that has been a perennial feature on the WHA every year since Israel occupied the territories in 1967. 

Addressing the Executive Board on Friday, WHO Director-General Dr Tedros Adhanom Ghebreyesus framed the latter consolidation as both an efficiency gain and a confidence-building measure.

“As you know, the UN Security Council welcomed the comprehensive plan to end the Gaza conflict last November through Resolution 2803. This holds the real promise for advancing peace and …in a region with such urgent needs, peace is built one brave step at a time. It’s a commitment we renew every day. Peace endures only when we carry it forward together. Each of us can contribute through our decisions in the EB and the WHA,” Tedros said.

“Today, I propose one concrete step combining the two WHA agenda items… into a single discussion. …By taking this step together, we not only foster a more constructive environment for our governance deliberations, but also contribute, in a small way, to the success of the peace initiative.” 

More efficient process for advancing WHA resolutions  

Administratively, the Board also backed proposals to enforce stricter timelines for submitting draft resolutions and decisions, along with closer WHO Secretariat supervision to ensure their alignment with agency priorities and budgets, and manageable meeting agendas.

While current rules hold that zero drafts should be submitted several months before a session – and final drafts no later than 15 days ahead – in practice, many proposals have arrived late, leaving little time for review by the WHO Secretariat or member states.

In a draft decision Friday, Board members also agreed to advance a proposed rule change whereby three WHO member states from at least two regions must agree to co-sponsor any new decision or resolution. The innovation aims to curb member states’ debate on measures with little real backing. 

But the provision remains bracketed  in the draft text, which also refers to the  “piloting” of the reform measures, signalling the long road that remains to actual approval.  

Opposition to WHO’s engagement with reproductive health NGOs 

Norway’s EB representative, Cathrine Lofthus, Ministry of Health Director General, led negotiations with the Egyptian-led bloc on WHO collaborations with reproductive health NGOs.

The Executive Board also reached a time-saving agreement on another topic of frequent WHA conflict – WHO engagements with non-state actors that work on sexual and reproductive health rights (SRHR). 

Egypt, where abortion is illegal unless a woman’s life is at risk and is even subject to a jail sentence,  has long been a leader in opposing WHO’s engagements with NGOs working in this space. 

This year, that included opposition to WHO collaborations with five groups whose terms of engagement with WHO are due to be renewed this year, as part of a routine, triennial review process.

The groups are the International Planned Parenthood Federation, American Society for Reproductive Medicine, Family Health International, the Population Council and the World Association for Sexual Health. 

Speaking for the Organization of Islamic Cooperation (OIC), which includes states from WHO’s Eastern Mediterranean Region as well as countries in North Africa and Asia, Egypt’s delegate declared that continued engagement with the five NGOs is “contrary” to WHO’s Framework of Engagement with Non-State Actors (FENSA), which aims to ensure the agency’s “integrity, independence and credibility is not compromised” and that non-state actors do not wield undue “influence” in setting “policies, norms and standards.”

Norway, leading the EU and other supportive member states, spent several hours negotiating an addendum that effectively renews collaboration while taking “note” of reservations and affirms that “member states have full sovereign rights over which non-state actors operate within their national territories,” in line with their “national context and legislation.”

Addendum to EB decision renewing WHO’s collaboration’s with reproductive health NGOs de-escalated potential controversy at the upcoming World Health Assembly.

Here too, Tedros added his own support, recalling how parliamentary reforms liberalizing Ethiopia’s abortion laws during his tenure as health minister helped cut maternal mortality fivefold, as many deaths were linked to unsafe abortions.

“I myself invited not only WHO, but other international organizations for help, and it’s during that time, our Parliament passed a bill on how to handle unsafe abortion, because nobody wanted for our mothers to die, our sisters to die,” Tedros said.  

“We don’t allow our norms and standards to be influenced by anyone. We take sides with science,” Tedros affirmed. “Any country has sovereignty, either to invite us or not invite us [to support them]. But whatever relationship we have, it will not be forced on any country.” 

The EB negotiations and word-smithing, while tortuous and time-consuming, may help avert an even larger debate at the WHA.

Temporary fixes? 

Palestinian EB representative Ryad Awaja: consolidated discussion on health conditions in the Occupied Palestinian Territory is an “exceptional” move.

Despite the budget pressure that helped push member states toward incremental reforms, most changes remain tentative—preliminary or applicable only to the upcoming WHA.

Agreeing to combine discussions on the two overlapping WHO reports on “health conditions in the Occupied Palestine Territory (OPT)” into one dedicated discussion on the WHA agenda, Palestine’s EB representative Ryad Awaja stressed that the arrangement was temporary. 

He attributed it to logistical constraints facing this year’s WHA, with some meetings shifting to WHO headquarters during renovations at Geneva’s UN Offices in the Palais des Nations.

“To know this is exceptional,” Awaja said of the consolidated discussion. “It’s not …forever. It’s just an exception from Palestine to help for this time.”